Belonging and Mental Wellbeing Among a Rural Indian-Canadian Diaspora: Navigating Tensions in "Finding a Space of Our Own"

A Scoping Review on Older Adults from Africa Social Connectedness Experiences in North America

The percentage of older adult immigrants in Canada and the United States is increasing with older adult immigrants from Africa forming a small proportion of the population, but one of the fastest growing groups in the area. Depending on the circumstances leading to the move, migration can be very stressful, especially for older adults. The purpose of this scoping review is to summarize the evidence on the social connectedness of older African immigrants in Canada and the United States. The researchers searched databases including Cochrane Library, BMJ Online, CINAHL, Medline (Ovid), PsycInfo (Ovid), PsycArticles (Ovid), Web of Science, SpringerLINK, CBCA Canadian Business and Current Affairs Database, Academic Search Complete, Sage Journals Online, ABI/Inform, Emerald Fulltext, Expanded Academic ASAP, General OneFile, Joanna Briggs Institute EBP Database, Journals@Ovid, JSTOR, Oxford Journals Online, Taylor & Francis Journals, Wiley Online Library, ProQuest Dissertations and Thesis Global, and Google Scholar from 2000-2020. Four manuscripts met the search inclusion criteria of published peer-reviewed and unpublished research studies in the English language on aging, older adult, social connectedness, African immigrants, Canada, and the United States. The authors found limited studies on African older adult immigrants' social connectedness in Canada and the United States with dearth of research on the older adults' access to health care, use of smart technology and social media to promote their health and social connectedness which are gaps in the literature that should be researched in the future.

Living with cystic fibrosis during the COVID-19 pandemic: a social connectedness perspective

Purpose

This study explores the concept of social connectedness for adults with Cystic Fibrosis (CF), generally and during the onset of the COVID-19 pandemic, to help inform contemporary CF healthcare. Social connectedness is an essential component of belonging and refers to an individual’s sense of closeness with the social world. Unique disease factors make exploration of social connectedness pertinent, added to by COVID-19, with the CF population potentially facing increased risk for severe illness.

Methods

Seventeen adults with CF in Western Australia undertook interviews, with findings categorized as overarching themes.

Results

In a general sense, participants described social connectedness challenges caused by CF, despite which they reported meaningful connections that benefits their mental and physical health. Within a COVID-19 specific context, participants demonstrated resilience in the face of adversity, highlighted the importance of empathy in relation to the pandemic, and described how social support is both an outcome and enhancer of social connectedness.

Conclusions

This study contributes to limited social connectedness literature within CF and chronic illness in general, highlighting the importance of social connectedness awareness raising, assessments and interventions in CF healthcare inside and outside the COVID-19 pandemic.

"This Group is Like a Home to Me:" understandings of health of LGBTQ refugees in a Swedish health-related integration intervention: a qualitative study

BACKGROUND

When large numbers of asylum seekers immigrate to a country, civil society is encouraged to contribute to their integration. A subgroup of asylum seekers comprising lesbian, gay, bisexual, transgender, or queer (LGBTQ) refugees are specifically deemed vulnerable to developing health and integration problems due to the double stigma of being a sexual/gender minority and a refugee. The Swedish Federation for LGBTQ Rights (RFSL) is a civil societal organization that has established the support group "RFSL Newcomers," a health-related integration intervention that targets such refugees. The aim of the present study is reconstructing the subjective understanding of health of LGBTQ refugees.

METHODS

Eleven participants in Newcomers and eight organizers were interviewed about LGBTQ refugees' experiences of migrating and participating in RFSL Newcomers. Qualitative content analysis was used to reconstruct subjective understandings of health that were constructed in these narratives. As the data did not originally concentrate on exploring understandings of health, a broad theoretical approach was used as a heuristic for the analysis, which focused on the common everyday approach of conceptualizing health as wellbeing.

RESULTS

The narratives revealed three interconnected, interdependent categories of understanding health in which tensions occur between wellbeing and ill-being: belonging versus alienation, security and safety versus insecurity, and recognition versus denial. The categories contribute to an overarching theme of health as framed freedom - i.e., freedom framed by conditions of society.

CONCLUSIONS

For our participants, belonging, recognition, and security/safety are conceptual elements of understanding health, not its social determinants. Thus, these understandings emphasize relational and existential meanings of health (theoretical implication). As for practical implications, the understandings of health were connected to being either inside or outside the Newcomers group and a new society, depending on whether LGBTQ refugees comply with social requirements. As a significant actor that is representative of the cultural majority and a facilitator of LGBTQ refugees' resettlement process, RFSL provides LGBTQ refugees with crucial orientations for becoming a "good migrant" and a "good LGBTQ person," yet a "bad bio-citizen." Generally, organizers of interventions may enhance the effectiveness of their interventions when relational, existential, and biomedical understandings of health are all incorporated.

Emerging best practices for supporting temporary migrant farmworkers in Western Canada

The aim of this study was to examine the role of support people in determining migrant agricultural workers' access to, or ability to navigate, public spaces and services. While the role of support networks for this population is still in its infancy, much can be gained from understanding the emerging best practices for helping this group. Using a situational analysis research approach, we carried out 4 focus groups and 25 one-on-one interviews, recruiting a total of 30 informal and formal support people as study participants between 2018 and 2019. Data analysis occurred over a 2-year period largely simultaneously with data collection. Developing analytic maps as outlined by Clarke's approach to situational analysis, we reviewed texts and preliminary codes by organising them in terms of situations, social worlds, and discursive positions. Ultimately, we identified four best practices: (a) Anticipating and addressing barriers; (b) building trust and community; (c) acknowledging rights and system accountability and (d) bearing witness and looking to the future. Underlying these best practices was the need for support people to display 'support readiness', or specialised skills, motivation and a personal connection to migrant farmworkers. While these practices have the potential to improve migrant workers' ability to fully participate in public spaces and access public services, until systemic constraints are addressed, support people will be unable to fill the gaps in support for this population.

Availability, Accessibility, Acceptability, and Quality of Interpreting Services to Refugee Women in New Zealand

A significant number of people have been displaced from their country of origin and become refugees. Good health is essential for refugees to actively engage and take up opportunities within the society in their host countries. However, negotiating a new and unfamiliar health system hinders refugees' ability to access and make use of the available health services. Communication difficulties due to language barriers are the most commonly cited challenges faced by refugees in accessing and utilizing health services post-resettlement. In this study, we aimed to examine effectiveness of interpreting services for refugee women in New Zealand. Data were collected through three sources: focus groups with Bhutanese women, focus group with Bhutanese men, and individual interviews with health professionals. The findings of this study reveal inadequacies and constraints in the provision of a socioculturally and linguistically effective interpreting service to Bhutanese women and provide evidence for recommendations to address these inadequacies.

Pursuing Well-Being Among Rural-Dwelling Adults With Disabilities

Through this constructivist grounded theory study, it was our purpose to create a substantive theory to explain how rural-dwelling, working-age adults with disabilities define and pursue well-being. Twelve rural-dwelling participants were interviewed up to 3 times to understand the processes involved in defining and pursuing well-being. From this exploration, we suggest that well-being is not a set state to be achieved and then enjoyed, rather well-being results from establishing and maintaining membership in the rural community. Membership facilitated access to the array of material and psychological supports needed for a sense of well-being. Findings support the assumption that urban models of care are insufficient for rural areas. This study also provides an understanding of how individuals in this population mobilize resources to overcome functional limitations and environmental barriers to establish group membership and create a sense of well-being. Implications for health care practice and policy are discussed.

Spaces of Exclusion: Safety, Stigma, and Surveillance of Mothers Experiencing Homelessness

Lack of affordable housing, poverty, and intimate partner violence are among the most common reasons for homelessness among mothers and their children in Canada. Mothers experience social exclusion in compounding and debilitating ways. In the literature on social exclusion and health, rarely is safety recognized as a prominent component of social exclusion. The purpose of this critical narrative study was to better understand the unique narratives of social exclusion for mothers experiencing homelessness in Ontario. A critical narrative methodology with an intersectional lens was used. Twenty-six ( N = 26) mothers participated in the study. The overarching finding of unsafe spaces represents the unique forms of exclusion from safety participants experienced in public and private spaces. Emerging out of this overarching category are two intertwined subcategories of (a) exclusion from safety and (b) stigma: public surveillance and discrimination. Participants’ narratives of exclusion from safety signify an ecosystem of unsafe spaces. The findings illuminate and reiterate the imperative for nurses to recognize that safety is a human right and is foundational for health. Nurses can use critical self-reflection and challenge the inherent “nursing gaze” to promote spaces of support rather than surveillance and engage in political advocacy to address structural inequalities, such as gender-based violence.

Spatially exploring the intersection of socioeconomic status and Canadian cancer-related medical crowdfunding campaigns

OBJECTIVES

Medical crowdfunding is a rapidly growing practice where individuals leverage social networks to raise money for health-related needs. This practice has allowed many to access healthcare and avoid medical debt but has also raised a number of ethical concerns. A dominant criticism of this practice is that it is likely to increase inequities in access to healthcare if persons from relatively wealthy backgrounds, media connections, tech-savvy and educational attainments are best positioned to use and succeed with crowdfunding. However, limited data has been published to support this claim. Our objective in this paper is to assess this concern using socioeconomic data and information from crowdfunding campaigns.

SETTING

To assess this concern, we present an exploratory spatial analysis of a new dataset of crowdfunding campaigns for cancer-related care by Canadian residents.

PARTICIPANTS

Four datasets were used: (1) a medical crowdfunding dataset that included cancer-related campaigns posted by Canadians, (2) 2016 Census Profile for aggregate dissemination areas, (3) aggregate dissemination area boundaries and (4) forward sortation area boundaries.

RESULTS

Our exploratory spatial analysis demonstrates that use of crowdfunding for cancer-related needs in Canada corresponds with high income, home ownership and high educational attainment. Campaigns were also commonly located near city centres.

CONCLUSIONS

These findings support concerns that those in positions of relative socioeconomic privilege disproportionately use crowdfunding to address health-related needs. This study was not able to determine whether other socioeconomic dimensions such as race, gender, ethnicity, nationality and linguistic fluency are also correlated with use of medical crowdfunding. Thus, we call for further research to explore the relationship between socioeconomic variables and medical crowdfunding campaigning to explore these other socioeconomic variables and campaigns for needs unrelated to cancer.

"Until You Hit Rock Bottom There's No Support": Contradictory Sources and Systems of Support for Mothers Experiencing Homelessness in Southwestern Ontario

Nurses are vital community advocates and uniquely situated to support mothers experiencing homelessness. The purpose of this study was to examine the multidimensional nature of social exclusion in the lives of mothers experiencing homelessness in Southwestern Ontario. This article reports findings from one segment of a larger study that critically examined the sociopolitical context, health needs, exclusionary and inclusionary forces, and strategies of resistance demonstrated by mothers experiencing homelessness. Central to the women’s experiences of mothering while homeless were their interactions with “the system.” The contradictory nature of these systems was categorized into four subthemes: (1) “Until you hit rock bottom there’s no support,” (2) “It’s just not enough”: Insufficient support, (3) “Help comes with a price”: Support with surveillance, and (4) “Every shelter is so different”: Organizational philosophies impacting support. The contradictory nature of the system created an illusion of support, but in mothers’ lived realities, it perpetuated experiences of exclusion in spaces ironically designed to enhance inclusion. Implications for nursing practice include action the macro-, meso-, and microlevels. Nurses can advocate for Housing-First initiatives and evidence-informed approaches to poverty reduction while recognizing the system-level barriers to health and providing respective, compassionate care.

Double Burden of Rural Migration in Canada? Considering the Social Determinants of Health Related to Immigrant Settlement Outside the Cosmopolis

There is a large and growing body of research acknowledging the existence of health disparities between foreign-born and native-born populations in many high immigrant-receiving countries. Significant attention has been paid to the role of physical and social environments in the changing health status of immigrants over time. However, very limited attention has been given to these issues within the context of rural geographies, despite global evidence that immigrants are increasingly settling outside of traditional gateway cities and into rural communities. This paper presents the results of a scoping review aimed at assessing the state of knowledge on the health impacts of immigrant migration into rural communities in Canada. Guided by Arksey and O’Malley’s scoping protocol, we conduct a review of academic literature in Canada related to rural migration. A total of 25 articles met inclusion criteria which included access to the social determinants of health. Findings identified a paucity of research directly connecting rural settlement to health but the literature did emphasize five distinct social determinants of health for rural residing immigrants: social inclusion, culturally-appropriate services, gender, employment, and housing. This paper concludes with an identification of research gaps and opportunities for future research into whether rural-residing immigrants face a double burden with respect to health inequity.

The Weight of Things: Understanding African American Women's Perceptions of Health, Body Image, and Attractiveness

Negative attitudes toward being overweight or obese are widespread, and these notions perpetuate into conceptions about one's health. Clinically, being overweight is associated with health problems such as diabetes, hypertension, heart disease, and many other illnesses. African American women, who are generally larger in body size, are a particular target for health interventions. However, these women have resisted the "obesity" label, arguing that dominant measures of health are White norms and oppressive. Through the use of in-depth interviews, this study investigates how African American women understand and experience healthfulness, body image, and barriers to each. Findings show that African American women are ambivalent in their acceptance of dominant markers of health and expressed an almost universal disdain for the thin ideal as a marker of "good" health and a positive body image. Moreover, participants articulated a suspicion of formal medical measurements of obesity.