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Cao T, Rishworth A, Wilson K, Ali F, Gallaway T. Lived Experiences of the COVID-19 Pandemic Among the Vietnamese Population in the Region of Peel. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01804-1. [PMID: 37821791 DOI: 10.1007/s40615-023-01804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
Racial discrimination towards Southeast Asian populations is a longstanding issue in Canada which has intensified during the COVID-19 pandemic. Although extensive work demonstrates inequities among Southeast Asian communities during the pandemic, much work categorizes Asians as one homogenous population neglecting the unique experiences of different Asian subgroups along with the ways COVID-19 differentially affects Southeast Asians. To attend to population variations, this paper explores the lived experiences among Vietnamese individuals during the pandemic in the Peel Region of Ontario Canada. Specifically, this paper examines social and economic impacts of COVID-19, access to healthcare services and vaccines, sources of vaccine information, and impacts of COVID-19 related discrimination among young and older adults. Drawing on in-depth interviews with young and older adults (n=6:8) the results reveal important social and economic impacts created by COVID-19 that vary across generations and impact health and wellbeing. These impacts are challenged further by barriers to healthcare access which were compounded by intersecting inequities experienced among Vietnamese immigrants in the Peel Region. While vaccine hesitancy was not a main concern, the findings demonstrate important generational differences with respect to commonly used and trusted information related to historical events and social media use. Although racial discrimination was a dominant concern, younger participants did not feel unsafe but expressed concern for the safety of their older family members and friends. The study underscores the need to consider historical dynamics and the ways they shape government opinions and trust, experiences of racial discrimination and socio-economic realities among racialized, immigrant populations.
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Affiliation(s)
- Tiffany Cao
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, Mississauga, Ontario, Canada
| | - Andrea Rishworth
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, Mississauga, Ontario, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics and Environment, University of Toronto, Mississauga, Mississauga, Ontario, Canada
| | - Fatema Ali
- Department of Anthropology, University of Toronto, Mississauga, Mississauga, Ontario, Canada
| | - Tracey Gallaway
- Department of Anthropology, University of Toronto, Mississauga, Mississauga, Ontario, Canada
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Zhao Y, Sazlina SG, Rokhani FZ, Su J, Chew BH. The Expectations and Acceptability of a Smart Nursing Home Model Among Chinese Older Adults and Family Members: A Qualitative Study. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:208-218. [PMID: 37661084 DOI: 10.1016/j.anr.2023.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/14/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023] Open
Abstract
PURPOSE This study aims to explore the expectations and acceptability of a smart nursing home model among Chinese older adults and their family members based on a scoping review that defines the concept of smart nursing homes. METHODS A qualitative case study was employed for this research. Semi-structured, in-depth interviews and focus group discussions were conducted on WeChat. Participants were purposively sampled through snowball sampling in Hainan and Dalian, China. A total of 28 older adults aged 60-75 and six adult children were interviewed until data saturation was achieved, followed by a thematic analysis. RESULTS The expectations of smart nursing homes include: 1) quality of care supported by governments and societies; 2) smart technology applications; 3) the presence of a skilled healthcare professional team; 4) access to and scope of basic medical services; and 5) integration of medical services. The acceptability of smart nursing homes included factors such as stakeholders' perceived efficaciousness, usability, and collateral damages of using smart technologies, and the coping process of adoption was influenced by factors such as age, economic status, health status, education, and openness to smart technologies among older adults. CONCLUSIONS Chinese older adults and their family members have a positive perception of the smart nursing home model. The qualitative evidence regarding their expectations and acceptability of smart nursing homes contributes valuable insights for a wide range of stakeholders involved in the planning and implementation of smart nursing homes.
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Affiliation(s)
- Yuanyuan Zhao
- The School of Smart Health and Wellness (Health Medical College), Zhejiang Dongfang Polytechnic, China
| | - Shariff-Ghazali Sazlina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia; Malaysian Research Institute on Ageing (MyAgeing (TM)), Universiti Putra Malaysia, Malaysia
| | - Fakhrul Z Rokhani
- Faculty of Engineering, Universiti Putra Malaysia, Malaysia; Malaysian Research Institute on Ageing (MyAgeing (TM)), Universiti Putra Malaysia, Malaysia
| | - Jing Su
- International School of Public Health and One Health, Hainan Medical University, China
| | - Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia; Clinical Research Unit, Hospital Pengajar Universiti Putra Malaysia (UPM Teaching Hospital), Serdang, Malaysia.
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Choe H, Pak TY. Food insecurity and unmet healthcare needs in South Korea. Int J Equity Health 2023; 22:148. [PMID: 37542235 PMCID: PMC10403829 DOI: 10.1186/s12939-023-01937-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Food insecurity is a significant risk factor for chronic and infectious diseases. It is also a barrier to accessing healthcare because food insecurity tends to co-occur with other socioeconomic disadvantages. The objective of this study is to examine whether food insecure individuals in South Korea can access desired level of healthcare when needed. METHODS This repeated cross-sectional study used data from the 2013-2015 and 2019-2021 waves of the Korean National Health and Nutrition Examination Survey. Multivariable logistic regression models were used to examine the association between household food insecurity and two indicators of unmet healthcare needs - any experience of forgoing medical service and the reasons for unmet needs (problems with availability, acceptability, and accessibility). Covariates indicating predisposing, enabling, and need factors were included in the regression analyses. RESULTS Of the 19,394 participants aged 19-64 years, 4.5% were moderately food insecure, 0.9% were severely food insecure, and 9.3% reported unmet healthcare needs. In the adjusted model, moderate food insecurity (OR, 1.47; 95% CI, 1.19-1.82) and severe food insecurity (OR, 3.32; 95% CI, 2.27-4.85) were associated with higher odds of unmet healthcare needs in a dose-graded manner. These associations were largely due to the increased odds of accessibility-related unmet needs among participants with moderate (OR, 2.31; 95% CI, 1.68-3.19) and severe food insecurity (OR, 6.15; 95% CI, 3.91-9.68). CONCLUSIONS Food insecurity was associated with higher odds of unmet healthcare needs among Korean adults. Competing life demands may have a cumulative impact on health over the short and long term. Efforts to address trade-offs between healthcare needs and food insecurity may improve the health and well-being of marginalized populations.
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Affiliation(s)
- Hwi Choe
- Department of Consumer Science and Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, South Korea
| | - Tae-Young Pak
- Department of Consumer Science and Convergence Program for Social Innovation, Sungkyunkwan University, Seoul, South Korea.
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Bajgain BB, Chowdhury MZI, Dahal R, Bajgain KT, Adhikari K, Chowdhury N, Turin TC. Unmet Primary Health Care Needs among Nepalese Immigrant Population in Canada. Healthcare (Basel) 2023; 11:2120. [PMID: 37570361 PMCID: PMC10419120 DOI: 10.3390/healthcare11152120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Immigrants represent over one-fifth (21.9%) of the Canadian population, which is an increasing trend. Primary care is a gateway to accessing the healthcare system for the majority of Canadians seeking medical services; however, Canada reported a growing shortage of healthcare providers, mainly primary care practitioners. Canadians, including immigrants, encounter many unmet healthcare needs due to various reasons. This study aimed to assess unmet healthcare (UHC) needs and associated factors among Nepalese immigrants residing in Calgary. METHODS A cross-sectional study using a self-administered questionnaire was conducted in 2019. UHC needs were measured based on a single-item question: "During the past 12 months, was there ever a time that you felt you needed medical help, but you did not receive it". A follow-up question was asked to learn about associated unmet needs factors, and the responses were categorized into availability, accessibility, and acceptability. Descriptive and multivariable logistic regression was employed to assess the association between UHC needs and its predictors by using STATA version 14.2. RESULTS Of 401 study participants, nearly half of the participants (n = 187; 46.63%) reported UHC needs, which was not significantly different among male and female participants (p = 0.718). UHC needs were nearly two times higher among those aged 26-45 (AOR 1.93) and those ≥56 years (AOR 2.17) compared to those under 25 years of age. The top reasons reported for unmet needs were long waits to access care (67.91%), healthcare costs (57.22%), and lack of knowing where to get help (31.55%). Overall, "services availability when required" was a leading obstacle that accounted for UHC needs (n = 137, 73.26%). Nearly two-thirds (n = 121, 64.71%) of participants reported that "accessibility of services" was a barrier, followed by "acceptability (n = 107, 57.22%). Those who reported UHC needs also reported an impact on their lives personally and economically. The most commonly reported personal impact was mental health impact, including worry, anxiety, and stress (67.38%). The most common economic impact reported due to UHC needs was increased use of over-the-counter drugs (33.16%) and increased healthcare costs (17.20%). CONCLUSIONS UHC needs are presented in the Nepalese immigrant population. Accessibility to healthcare is limited for several reasons: waiting time, cost, distance, and unavailability of services. UHC needs impact individuals' personal health, daily life activities, and financial capacity. Strategies to improve access to PHC for disadvantaged populations are crucial and need to be tackled effectively.
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Affiliation(s)
- Bishnu Bahadur Bajgain
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Community Scholar and Citizen Researcher, Nepalese-Canadian Community, Calgary, AB T2N 1N4, Canada
| | - Mohammad Z. I. Chowdhury
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Rudra Dahal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 1M4, Canada
| | - Kalpana Thapa Bajgain
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Community Scholar and Citizen Researcher, Nepalese-Canadian Community, Calgary, AB T2N 1N4, Canada
| | - Kamala Adhikari
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Population and Public Health, Alberta Health Services, Calgary, AB T2W 1S7, Canada
| | - Nashit Chowdhury
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tanvir C. Turin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Ranjan A, Thiagarajan S, Garg S. Measurement of unmet healthcare needs to assess progress on universal health coverage - exploring a novel approach based on household surveys. BMC Health Serv Res 2023; 23:525. [PMID: 37221549 DOI: 10.1186/s12913-023-09542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) aims to ensure universal access to quality healthcare according to health needs. The extent to which population health needs are met should be a key measure for progress on UHC. The indicators in use for measuring access mostly relate to physical accessibility or insurance coverage. Or, utilization of services is taken as indirect measure for access but it is assessed against only the perceived healthcare needs. The unperceived needs do not get taken into account. The present study was aimed at demonstrating an approach for measuring the unmet healthcare needs using household survey data as an additional measure of UHC. METHODS A household survey was conducted in Chhattisgarh state of India, covering a multi-stage sample of 3153 individuals. Healthcare need was measured in terms of perceived needs which would be self-reported and unperceived needs where clinical measurement supplemented the interview response. Estimation of unperceived healthcare needs was limited to three tracer conditions- hypertension, diabetes and depression. Multivariate analysis was conducted to find the determinants of the various measures of the perceived and unperceived needs. RESULTS Of the surveyed individuals, 10.47% reported perceived healthcare needs for acute ailments in the last 15 days. 10.62% individuals self-reported suffering from chronic conditions. 12.75% of those with acute ailment and 18.40% with chronic ailments received no treatment, while 27.83% and 9.07% respectively received treatment from unqualified providers. On an average, patients with chronic ailments received only half the medication doses required annually. The latent need was very high for chronic ailments. 47.42% of individuals above 30 years age never had blood pressure measured. 95% of those identified with likelihood of depression had not sought any healthcare and they did not know they could be suffering from depression. CONCLUSION To assess progress on UHC more meaningfully, better methods are needed to measure unmet healthcare needs, taking into account both the perceived and unperceived needs, as well as incomplete care and inappropriate care. Appropriately designed household surveys offer a significant potential to allow its periodic measurement. Their limitations in measuring the 'inappropriate care' may necessitate supplementation with qualitative methods.
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Affiliation(s)
- Alok Ranjan
- Department of Humanities and Social Sciences, Indian Institute of Technology, Jodhpur, India
- State Health Resource Center, Chhattisgarh, India
| | | | - Samir Garg
- State Health Resource Center, Chhattisgarh, India.
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Zhuoga C, Cuomu Z, Li S, Dou L, Li C, Dawa Z. Income-related equity in inpatient care utilization and unmet needs between 2013 and 2018 in Tibet, China. Int J Equity Health 2023; 22:85. [PMID: 37165400 PMCID: PMC10173530 DOI: 10.1186/s12939-023-01889-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/08/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Providing equitable access to health care for all populations is an important sustainable development goal. China has made significant progress in achieving equity in healthcare utilization. However, research on equity in healthcare utilization in Tibet is sparse. This study aims to evaluate changes in income-related inequity in inpatient care utilization and unmet needs between 2013 and 2018 among the Tibetan population and identify the inequity source. METHODS Data for this cross-sectional study were obtained from the fifth and sixth waves of the National Health Services Survey in 2013 and 2018. After excluding observations with missing values for key variables, 11,092 and 10,397 respondents were included in this study, respectively. The outcome variables of interest were inpatient service utilization and unmet hospitalization needs. The concentration index and horizontal inequity index (HI) were used to assess income-related inequity. Non-linear decompositions were performed to identify the main contributors to inequity. In the decomposition method, need variables included sex, age, chronic diseases, and the EuroQol-Visual Analog Scale; non-need variables consisted of income, education, employment status, marital status, and health insurance schemes. RESULTS The probability of inpatient care utilization increased from 6.40% in 2013 to 8.50% in 2018. The HI for inpatient care utilization was 0.19 (P < 0.001) in 2013, whereas it decreased to 0.07 (P < 0.001) in 2018. The contribution of income to inequity in inpatient care utilization decreased from 87.09% in 2013 to 59.79% in 2018. As for unmet inpatient care needs, although its probability increased from 0.76 to 1.48%, the percentage of reasons for financial hardship decreased from 47.62 to 28.57%. The HI for unmet hospitalization need was - 0.07 in 2013 and - 0.05 in 2018, and neither was statistically significant. The New Rural Cooperative Medical Scheme made majority contributions to promote equity in unmet hospitalization need. Moreover, the female respondents reporting low EuroQol-Visual Analog Scale scores and patients with chronic disease were not only more likely to seek for inpatient care, but also have more unmet need than the reference groups. CONCLUSIONS The inequity in inpatient care utilization in Tibet narrowed from 2013 to 2018, and there was no inequity in unmet hospitalization needs in 2013 and 2018. Income and the New Rural Cooperative Medical Scheme are the main drivers of equity promotion. To promote access to inpatient care utilization and decrease the probability of unmet hospitalization need in future, policymakers should target high-need residents in Tibet to improve accessibility, availability, and acceptability.
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Affiliation(s)
- Cidan Zhuoga
- Medical College of Tibet University, Lhasa, 850000, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China
| | - Zhaxi Cuomu
- Medical College of Tibet University, Lhasa, 850000, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Chaofan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, Jinan, 250012, China.
| | - Zhaxi Dawa
- Medical College of Tibet University, Lhasa, 850000, China.
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China.
- High Altitude Health Science Research Center, Tibet University, Lhasa, 850000, China.
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Ssendikaddiwa JM, Goldenberg S, Berry NS, Lavergne MR. Sex, Immigration, and Patterns of Access to Primary Care in Canada. J Immigr Minor Health 2023; 25:548-559. [PMID: 36870007 DOI: 10.1007/s10903-023-01459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/05/2023]
Abstract
Access to primary care is crucial to immigrant health and may be shaped by sex and gender, but research is limited and inconclusive. We identified measures that reflect access to primary care using 2015-2018 Canadian Community Health Survey data. We used multivariable logistic regression models to estimate adjusted odds of primary care access and to explore interaction effects between sex and immigration group (recent immigrant: < 10 years in Canada, long-term immigrant: 10 + years, non-immigrant). Recency of immigration and being male were negatively associated with access to primary care, with significantly lower odds of having a usual place for immediate care among male recent immigrants (AOR: 0.36, 95% CI 032-0.42). Interaction effects between immigration and sex were pronounced, especially for having a regular provider or place of care. Results underscore the need to examine approachability and acceptability of primary care services, especially for male recent immigrants.
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Affiliation(s)
- Joseph M Ssendikaddiwa
- Faculty of Health Sciences, Simon Fraser University, 8888, University Dr, Burnaby, BC, V5C 1S6, Canada
| | - Shira Goldenberg
- Division of Epidemiology and Biostatistics, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA.,Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, BC, Canada
| | - Nicole S Berry
- Faculty of Health Sciences, Simon Fraser University, 8888, University Dr, Burnaby, BC, V5C 1S6, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Halifax, NS, B3J3TA, Canada.
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Lambert S, Loban E, Li J, Nghiem T, Schaffler J, Maheu C, Dubois S, Folch N, Gélinas-Phaneuf E, Laizner AM. Chronic Illness Management in Culturally and Linguistically Diverse Patients: Exploring the Needs, Access, and Understanding of Information. QUALITATIVE HEALTH RESEARCH 2021; 31:2426-2439. [PMID: 34636279 PMCID: PMC9207989 DOI: 10.1177/10497323211040769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In Canada, people from culturally and linguistically diverse (CALD) backgrounds are at a greater risk of developing a chronic illness, and are more likely to experience adverse health effects and challenges in accessing high-quality care compared with Canadian-born individuals. This, in part, has been attributed to having inadequate access to information and resources needed to manage their illness(es). A qualitative descriptive design and inductive content analysis were used to explore the information needs of 24 CALD patients with chronic illnesses. Participants identified medical, lifestyle, and psychosocial information needs. How much information was needed depended on such antecedents as illness trajectory, severity, and perception. Most information needs remained unmet. A number of communication strategies were identified to bridge language barriers that go beyond translation and are based on effective health education strategies. Findings can help health care professionals better identify CALD patients' information needs and provide strategies that go beyond translation.
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Affiliation(s)
- Sylvie Lambert
- McGill University, Montreal, Quebec, Canada
- St. Mary’s Research Centre, Montreal, Quebec, Canada
| | - Ekaterina Loban
- McGill University, Montreal, Quebec, Canada
- St. Mary’s Research Centre, Montreal, Quebec, Canada
| | - Jane Li
- McGill University, Montreal, Quebec, Canada
| | | | | | | | - Sylvie Dubois
- Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie Folch
- Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | | | - Andréa Maria Laizner
- McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
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Pandey M, Maina RG, Amoyaw J, Li Y, Kamrul R, Michaels CR, Maroof R. Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study. BMC Health Serv Res 2021; 21:741. [PMID: 34311712 PMCID: PMC8314461 DOI: 10.1186/s12913-021-06750-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immigrants from culturally, ethnically, and linguistically diverse countries face many challenges during the resettlement phase, which influence their access to healthcare services and health outcomes. The "Healthy Immigrant Effect" or the health advantage that immigrants arrive with is observed to deteriorate with increased length of stay in the host country. METHODS An exploratory qualitative design, following a community-based research approach, was employed. The research team consisted of health researchers, clinicians, and community members. The objective was to explore the barriers to healthcare access among immigrants with limited English language proficiency. Three focus groups were carried out with 29 women and nine men attending English language classes at a settlement agency in a mid-sized city. Additionally, 17 individual interviews were carried out with healthcare providers and administrative staff caring for immigrants and refugees. RESULTS A thematic analysis was carried out with transcribed focus groups and healthcare provider interview data. Both the healthcare providers and immigrants indicated that limited language proficiency often delayed access to available healthcare services and interfered with the development of a therapeutic relationship between the client and the healthcare provider. Language barriers also impeded effective communication between healthcare providers and clients, leading to suboptimal care and dissatisfaction with the care received. Language barriers interfered with treatment adherence and the use of preventative and screening services, further delaying access to timely care, causing poor chronic disease management, and ultimately resulting in poor health outcomes. Involving untrained interpreters, family members, or others from the ethnic community was problematic due to misinterpretation and confidentiality issues. CONCLUSIONS The study emphasises the need to provide language assistance during medical consultations to address language barriers among immigrants. The development of guidelines for recruitment, training, and effective engagement of language interpreters during medical consultation is recommended to ensure high quality, equitable and client-centered care.
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Affiliation(s)
- Mamata Pandey
- Research Department, Wascana Rehabilitation Centre, Saskatchewan Health Authority, 2180-23rd Ave, Regina, SK, S4S 0A5, Canada.
| | - R Geoffrey Maina
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Jonathan Amoyaw
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, NS, Canada
| | - Yiyan Li
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Rejina Kamrul
- Department of Academic Family Medicine, University of Saskatchewan, Regina, SK, Canada
| | - C Rocha Michaels
- Department of Academic Family Medicine, University of Saskatchewan, Regina, SK, Canada
| | - Razawa Maroof
- Department of Academic Family Medicine, University of Saskatchewan, Regina, SK, Canada
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Kaur N, Kandelman D, Potvin L. Development and pilot testing of an oral hygiene self-care photonovel for Punjabi immigrants: a qualitative study. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2021; 55:30-38. [PMID: 33643415 PMCID: PMC7906123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 06/26/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The purpose of this research study was to develop and pilot test a culturally and linguistically appropriate oral hygiene self-care photonovel for Punjabi immigrants. METHODS Purposeful sampling technique was used to recruit 5 members of a Punjabi community organization (the Sikh Women's Association of Montreal) for participation in 3 focus group sessions in August 2015. A thematic content analysis approach was used to sort the data, enabling identification of the storyline and photonovel contents from the themes that emerged. Comic Life 3 version 3.1.1 software was used to create a "Safeguard Your Smile" (SYS) photonovel, which was printed for pilot testing. Ten additional participants were recruited for this pilot testing, enabling further revision of the photonovel based on their suggestions. RESULTS Four major themes emerged from the focus group discussions: 1) lack of understanding of oral hygiene self-care and risk factors; 2) lack of oral hygiene self-care-related awareness and routine; 3) lack of emphasis on prevention by oral health care providers; and 4) perceived barriers to accessing dental health care. Thematic content analysis revealed a lack of knowledge of oral hygiene self-care skills and routine. Guided by these overarching themes, a final version of the photonovel script was created including photographs of key characters. The photonovel was subsequently printed for pilot testing. Pilot test results revealed close to 80% of participants agreed that the SYS photonovel was culturally and linguistically appropriate and easy to understand. CONCLUSIONS A culturally and linguistically appropriate photonovel may be a useful tool for enhancing oral hygiene self-care knowledge among ethnic communities. Further studies are required to test the effectiveness of such a tool.
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Affiliation(s)
- Navdeep Kaur
- Research associate, Unité de recherche en psychiatrie des toxicomanies, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal,
QC, Canada
| | - Daniel Kandelman
- Associate professor, Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Louise Potvin
- Canada Research Chair, Community Approaches and Health Inequalities; Scientific director, Centre de recherche en santé publique, Université de Montréal; Centre
intégré universitaire de santé et services sociaux du Centre-sud-de-l’île-de-Montréal, Montreal, QC, Canada
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Zhang L, Ding D, Fethney J, Gallagher R. A psychometric evaluation of the Health Literacy Questionnaire for Chinese immigrants: Linguistic and cultural considerations. Int J Nurs Pract 2021; 27:e12909. [PMID: 33501737 DOI: 10.1111/ijn.12909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 10/28/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Health literacy is an important predictor of health outcomes. The Health Literacy Questionnaire has been widely adopted to measure health literacy and has been translated into multiple languages including Chinese. This study aims to evaluate the psychometric properties of the simplified Chinese Health Literacy Questionnaire. METHODS Data were obtained from a sample of 362 Chinese immigrants from Chinese community organizations in New South Wales, Australia. Statistical analyses include descriptive and exploratory factor analyses. RESULTS A seven-factor solution was derived from 39 of the original 44 items, all with acceptable to excellent internal consistency but differing from the original construction. The health literacy subscale scores were negatively associated with age and with age at immigration, but positively associated with duration of stay (years) in Australia, better English proficiency and current employment. Differing interpretations of the questions based on Chinese culture could possibly explain the variations between the two versions. CONCLUSION The simplified Chinese Health Literacy Questionnaire measures some central concepts of health literacy well. However, the questionnaire may require further development, especially in linguistic and cultural aspects.
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Affiliation(s)
- Ling Zhang
- Susan Wakil School of Nursing and Midwifery/Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,The Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Ding Ding
- The Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Judith Fethney
- Susan Wakil School of Nursing and Midwifery/Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery/Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,The Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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12
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Bajgain BB, Bajgain KT, Badal S, Aghajafari F, Jackson J, Santana MJ. Patient-Reported Experiences in Accessing Primary Healthcare among Immigrant Population in Canada: A Rapid Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238724. [PMID: 33255379 PMCID: PMC7727859 DOI: 10.3390/ijerph17238724] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/21/2022]
Abstract
(1) Background: Immigrants represent around 21.9% of the total population in Canada and encounter multifaceted obstacles in accessing and receiving primary healthcare. This literature review explores patient experiences in primary care from the perspective of immigrants and identifies areas for further research and improvement. (2) Methods: A comprehensive search was performed on PubMed, MEDLINE, Embase, SCOPUS, and Google scholar to identify studies published from 2010 to July 2020. Relevant articles were peer-reviewed, in English language, and reported patient experiences in primary healthcare in Canada. (3) Results: Of the 1566 searched articles, 19 articles were included in this review. Overall, the finding from articles were summarized into four major themes: cultural and linguistic differences; socioeconomic challenges; health system factors; patient–provider relationship. (4) Conclusion: Understanding the gaps to accessing and receiving appropriate healthcare is important to shape policies, enhance the quality of services, and deliver more equitable healthcare services. It is therefore pertinent that primary healthcare providers play an active role in bridging these gaps with strong support from policymakers. Understanding and respecting diversity in culture, language, experiences, and systems is crucial in reducing health inequalities and improving access to quality care in a respectful and responsive manner.
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Affiliation(s)
- Bishnu Bahadur Bajgain
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; (B.B.B.); (F.A.)
| | | | - Sujan Badal
- School of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA;
| | - Fariba Aghajafari
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; (B.B.B.); (F.A.)
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | | | - Maria-Jose Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada; (B.B.B.); (F.A.)
- Correspondence:
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Chowdhury N, Naeem I, Ferdous M, Chowdhury M, Goopy S, Rumana N, Turin TC. Unmet Healthcare Needs Among Migrant Populations in Canada: Exploring the Research Landscape Through a Systematic Integrative Review. J Immigr Minor Health 2020; 23:353-372. [DOI: 10.1007/s10903-020-01086-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
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Russell G, Kunin M, Harris M, Levesque JF, Descôteaux S, Scott C, Lewis V, Dionne É, Advocat J, Dahrouge S, Stocks N, Spooner C, Haggerty J. Improving access to primary healthcare for vulnerable populations in Australia and Canada: protocol for a mixed-method evaluation of six complex interventions. BMJ Open 2019; 9:e027869. [PMID: 31352414 PMCID: PMC6661687 DOI: 10.1136/bmjopen-2018-027869] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/03/2019] [Accepted: 06/12/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Access to primary healthcare (PHC) has a fundamental influence on health outcomes, particularly for members of vulnerable populations. Innovative Models Promoting Access-to-Care Transformation (IMPACT) is a 5-year research programme built on community-academic partnerships. IMPACT aims to design, implement and evaluate organisational innovations to improve access to appropriate PHC for vulnerable populations. Six Local Innovation Partnerships (LIPs) in three Australian states (New South Wales, Victoria and South Australia) and three Canadian provinces (Ontario, Quebec and Alberta) used a common approach to implement six different interventions. This paper describes the protocol to evaluate the processes, outcomes and scalability of these organisational innovations. METHODS AND ANALYSIS The evaluation will use a convergent mixed-methods design involving longitudinal (pre and post) analysis of the six interventions. Study participants include vulnerable populations, PHC practices, their clinicians and administrative staff, service providers in other health or social service organisations, intervention staff and members of the LIP teams. Data were collected prior to and 3-6 months after the interventions and included interviews with members of the LIPs, organisational process data, document analysis and tools collecting the cost of components of the intervention. Assessment of impacts on individuals and organisations will rely on surveys and semistructured interviews (and, in some settings, direct observation) of participating patients, providers and PHC practices. ETHICS AND DISSEMINATION The IMPACT research programme received initial ethics approval from St Mary's Hospital (Montreal) SMHC #13-30. The interventions received a range of other ethics approvals across the six jurisdictions. Dissemination of the findings should generate a deeper understanding of the ways in which system-level organisational innovations can improve access to PHC for vulnerable populations and new knowledge concerning improvements in PHC delivery in health service utilisation.
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Affiliation(s)
- Grant Russell
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Marina Kunin
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Jean-Frédéric Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- Bureau of Health Information, Sydney, New South Wales, Australia
| | - Sarah Descôteaux
- St. Mary’s Research Centre, McGill University, Montreal, Quebec, Canada
| | - Catherine Scott
- PolicyWise for Children & Families, Calgary, Alberta, Canada
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Victoria, Australia
| | - Émilie Dionne
- St. Mary’s Research Centre, McGill University, Montreal, Quebec, Canada
| | - Jenny Advocat
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Nigel Stocks
- Department of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine Spooner
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Kaur N, Kandelman D, Potvin L. Effectiveness of "Safeguard Your Smile," an oral health literacy intervention, on oral hygiene self-care behaviour among Punjabi immigrants:A randomized controlled trial. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2019; 53:23-32. [PMID: 33240339 PMCID: PMC7533823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 12/14/2018] [Accepted: 01/14/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Research shows that immigrants have higher rates of oral diseases, poorer access to dental care services, and lower levels of health literacy than their Canadian-born peers. Oral health literacy has emerged as a potential pathway to reduce oral health disparities. The scarcity of studies on oral health literacy interventions, particularly among immigrants, lent urgency to this study, the purpose of which was to evaluate the effectiveness of an oral health literacy intervention promoting oral hygiene self-care behaviour among Punjabi immigrants. METHODS The study used a parallel group, non-blinded, randomized controlled trial design. One hundred and forty (140) Punjabi immigrants between 18 and 60 years of age were enrolled. Participants were randomly allocated to receive either the Safeguard Your Smile (SYS) intervention or a conventional pamphlet. The following outcome measures were assessed at baseline and 3 months post-intervention: self-reported oral hygiene self-care behaviour and knowledge, plaque and gingival indices, and oral health literacy. A linear mixed model for repeated measures was used to compare the intervention and control groups (between) at pre- and post-intervention (within). RESULTS Participants who received the SYS intervention showed improvements ( p <0.0001) for the following dependent variables: oral hygiene self-care knowledge and behaviour, oral health literacy, and plaque and gingival indices. CONCLUSIONS SYS intervention enhanced positive oral hygiene self-care behaviour among Punjabi immigrants with low oral health literacy. SYS intervention can be employed among other vulnerable groups with low levels of oral health literacy to improve oral hygiene self-care behaviour.
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Affiliation(s)
- Navdeep Kaur
- Postdoctoral researcher, Method development platform, Quebec SPOR-SUPPORT Unit, Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Daniel Kandelman
- Associate professor, Faculty of Dental Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Louise Potvin
- Tier 1 Canada Research Chair, Institut de recherche en santé publique, School of Public Health, Université de Montréal; Centre de recherche Léa-Roback, Montreal, Quebec, Canada
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Ha R, Jung-Choi K, Kim CY. Employment Status and Self-Reported Unmet Healthcare Needs among South Korean Employees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010009. [PMID: 30577551 PMCID: PMC6339133 DOI: 10.3390/ijerph16010009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 11/16/2022]
Abstract
We aimed to examine the association between employment status and self-reported unmet healthcare needs and to identify factors influencing self-reported unmet healthcare needs by employment status. Nationally representative data from the 2012 Korea National Health and Nutrition Examination Survey were used. Participants were classified by employment status as either permanent or precarious workers. Explanatory variables included sociodemographic, labor-related, and health-related factors. Multivariate logistic regression ascertained the association between employment status and self-reported unmet healthcare needs and explanatory factors associated with self-reporting of unmet healthcare needs. Precarious workers had a higher prevalence of self-reported unmet healthcare needs than permanent workers, with a statistically significant odds ratio (OR) (1.74; 95% confidence interval (CI), 1.19–2.54). Male precarious workers working >40 h per week were more likely to self-report unmet needs than male precarious workers working <40 h (OR, 3.90; 95% CI, 1.40–10.87). Female precarious workers with a lower household income were about twice as likely to self-report unmet needs. Working hours and household income were significantly influential factors determining self-reporting of unmet healthcare needs, especially among precarious workers. Policy interventions to improve access to healthcare for precarious workers are needed.
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Affiliation(s)
- Rangkyoung Ha
- Department of Occupational and Environmental Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea.
| | - Kyunghee Jung-Choi
- Department of Occupational and Environmental Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea.
| | - Chang-Yup Kim
- Department of Health Policy and Management, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea.
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17
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Read JG, Smith PB. Gender and national origin differences in healthcare utilization among U.S. Immigrants from Mexico, China, and India. ETHNICITY & HEALTH 2018; 23:867-883. [PMID: 28277018 PMCID: PMC6563819 DOI: 10.1080/13557858.2017.1297776] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/15/2017] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To examine gender and national origin differences in the healthcare utilization of immigrants from the three largest populations in the U.S. today (Mexico, China, and India) and to determine if barriers to utilization operate similarly across groups. METHODS The analysis uses nationally-representative data from the 2003 New Immigrant Survey (NIS) to compare utilization behaviors among legal permanent residents from Mexico, China, and India (n = 2244). Conceptually, the study draws on Andersen's Behavioral Model to hypothesize gender and national origin differences in utilization based on factors that might predispose, enable, or necessitate healthcare. Multivariate logistic regression models are used to predict the odds of having seen a doctor in the past year and to test whether obstacles to utilization differ across immigrant groups. RESULTS Chinese immigrants are less likely than Mexican and Indian immigrants to have seen a doctor in the past year, a finding that is largely driven by a lack of health insurance. Female immigrants are more likely than males to have done so, despite having fewer resources that enable access to care (e.g. income, English proficiency). Moreover, the relationship between gender and utilization is moderated by English language proficiency: among immigrants with low levels of proficiency, women are significantly more likely than men to have seen a doctor in the past year, while no difference exists between men and women who are proficient in English. This pattern is most evident among Mexican, and to a lesser extent, Indian immigrants. CONCLUSIONS Barriers to immigrant healthcare utilization vary by gender and national origin. Research will need to continue documenting such variation in order to better inform policy makers and health practitioners of potential solutions for improving health outcomes in increasingly diverse immigrant communities.
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Affiliation(s)
- Jen'nan Ghazal Read
- a Department of Sociology and Global Health , Duke University , Durham , USA
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18
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McGeoch G, Holland K, Kerdemelidis M, Elliot N, Shand B, Fink C, Dixon A, Gullery C. Unmet need for referred services as measured by general practice. J Prim Health Care 2018. [PMID: 29530138 DOI: 10.1071/hc17044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P ≤ 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data.
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Affiliation(s)
- Graham McGeoch
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Kieran Holland
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Melissa Kerdemelidis
- Planning and Funding and Decision Support, Canterbury District Health Board, Christchurch, New Zealand
| | - Nikki Elliot
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Brett Shand
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Catherine Fink
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Anne Dixon
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Carolyn Gullery
- Planning and Funding and Decision Support, Canterbury District Health Board, Christchurch, New Zealand
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Self-management Following a Cardiac Event in People of Chinese Ethnicity Living in Western Countries: A Scoping Review. J Immigr Minor Health 2017; 20:744-754. [DOI: 10.1007/s10903-017-0584-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ou CHK, Wong ST, Levesque JF, Saewyc E. Healthcare needs and access in a sample of Chinese young adults in Vancouver, British Columbia: A qualitative analysis. Int J Nurs Sci 2017; 4:173-178. [PMID: 31406739 PMCID: PMC6626120 DOI: 10.1016/j.ijnss.2017.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 03/06/2017] [Indexed: 11/28/2022] Open
Abstract
Objectives Immigrants of Chinese ethnicity and young people (between 18 and 30 years of age) are known to access health services less frequently and may be at greater risk for experiencing unmet health needs. The purpose of this study was to examine the health beliefs, health behaviors, primary care access, and perceived unmet healthcare needs of Chinese young adults. Methods Semi-structured in-depth interviews were carried out with eight Chinese young adults in Vancouver, Canada. Results A content analysis revealed that these Chinese young adults experienced unmet healthcare needs, did not have a primary care provider, and did not access preventive services. Cultural factors such as strong family ties, filial piety, and the practice of Traditional Chinese Medicine influenced their health behaviors and healthcare access patterns. Conclusion Chinese young adults share similar issues with other young adults in relation to not having a primary care provider and accessing preventive care but their health beliefs and practices make their needs for care unique from other young adults.
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Affiliation(s)
- Christine H K Ou
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Sabrina T Wong
- School of Nursing & Centre for Health Services and Policy Research, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Jean-Fréderic Levesque
- Bureau of Health Information of New South Wales, 67 Albert Avenue, New South Wales, Australia
| | - Elizabeth Saewyc
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, British Columbia, Canada
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Barriers to Access of Primary Healthcare by Immigrant Populations in Canada: A Literature Review. J Immigr Minor Health 2015; 18:1522-1540. [DOI: 10.1007/s10903-015-0276-z] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lombardo AP, Angus JE, Lowndes R, Cechetto N, Khattak S, Ahmad F, Bierman AS. Women's strategies to achieve access to healthcare in Ontario, Canada: a meta-synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:575-587. [PMID: 24405076 DOI: 10.1111/hsc.12093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2013] [Indexed: 06/03/2023]
Abstract
As part of a mixed methods study on women's access to the healthcare system in Ontario, Canada, we undertook a qualitative meta-synthesis to better understand the contextual conditions under which women access healthcare. An earlier phase of the synthesis demonstrated a series of factors that complicate women's access to healthcare in Ontario. Here, we consider women's agency in responding to these factors. We used meta-study methods to synthesise findings from qualitative studies published between January 2002 and December 2010. Studies were identified by searches of numerous databases, including CINAHL, MEDLINE, Scopus, Gender Studies Database and LGBT Life. Inclusion criteria included use of a qualitative research design; published in a peer-reviewed journal during the specified time period; included a sample at least partially recruited in Ontario; included distinct findings for women participants; and in English language. Studies were included in the final sample after appraisals using a qualitative research appraisal tool. We found that women utilised a spectrum of responses to forces limiting access to healthcare: mobilising financial, social and interpersonal resources; living out shortfalls by making do, doing without, and emotional self-management; and avoiding illness and maintaining health. Across the studies, women described their efforts to overcome challenges to accessing healthcare. However, there were evident limits to women's agency and many of their strategies represented temporary measures rather than viable long-term solutions. While women can be resourceful and resilient in overcoming access disparities, systemic problems still need to be addressed. Women need to be involved in designing and implementing interventions to improve access to healthcare, and to address the root problems of these issues.
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Ghuman SJ, Brackbill RM, Stellman SD, Farfel MR, Cone JE. Unmet mental health care need 10-11 years after the 9/11 terrorist attacks: 2011-2012 results from the World Trade Center Health Registry. BMC Public Health 2014; 14:491. [PMID: 24885506 PMCID: PMC4053282 DOI: 10.1186/1471-2458-14-491] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/29/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is little current information about the unmet mental health care need (UMHCN) and reasons for it among those exposed to the World Trade Center (WTC) terrorist attacks. The purpose of this study was to assess the level of UMHCN among symptomatic individuals enrolled in the WTC Health Registry (WTCHR) in 2011-2012, and to analyze the relationship between UMHCN due to attitudinal, cost, and access factors and mental health symptom severity, mental health care utilization, health insurance availability, and social support. METHODS The WTCHR is a prospective cohort study of individuals with reported exposure to the 2001 WTC attacks. This study used data from 9,803 adults who completed the 2003-2004 (Wave 1) and 2011-2012 (Wave 3) surveys and had posttraumatic stress disorder (PTSD) or depression in 2011-2012. We estimated logistic regression models relating perceived attitudinal, cost and access barriers to symptom severity, health care utilization, a lack of health insurance, and social support after adjusting for sociodemographic characteristics. RESULTS Slightly more than one-third (34.2%) of study participants reported an UMHCN. Symptom severity was a strong predictor of UMHCN due to attitudinal and perceived cost and access reasons. Attitudinal UMHCN was common among those not using mental health services, particularly those with relatively severe mental health symptoms. Cost-related UMHCN was significantly associated with a lack of health insurance but not service usage. Access-related barriers were significantly more common among those who did not use any mental health services. A higher level of social support served as an important buffer against cost and access UMHCN. CONCLUSIONS A significant proportion of individuals exposed to the WTC attacks with depression or PTSD 10 years later reported an UMHCN, and individuals with more severe and disabling conditions, those who lacked health insurance, and those with low levels of social support were particularly vulnerable.
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Affiliation(s)
- Sharon J Ghuman
- New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA.
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Abstract
RÉSUMÉCette étude a exploré comment les immigrants âgés d’origine sud-asiatique, parlant le pendjabi (quatre groupes de discussion; 33 participants) de Surrey en Colombie-Britannique, perçoivent leur santé buccale et les problèmes connexes. L’analyse a relevé deux thèmes généraux: les interprétations de la condition bucco-dentaire et les défis de santé bucco-dentaire. Le thème des interprétations avait quatre sous-thèmes: les dommages causés par lewai, les perturbations causé par la carie, l’adaptation aux prothèses dentaires, et qualité de vie; alors que le thème des défis considérés: remèdes à domicile, dentisterie occidentale; et difficultés d’accès aux dentistes. Les participants ont expliqué les maladies bucco-dentaires en termes d’une infection systémique (resha) et ont dit préféré les remèdes faits maison pour diminuer les écarts de chaleur (wai) dans la bouche. Nous concluons que les immigrants âgés d’origine sud-asiatique parlant le pendjabi interprète la santé et les maladies bucco-dentaires dans un contexte mixte de traditions occidentales et Ayurvédique, et gèrent leur santé buccale au moyen de remèdes traditionnels faits maison, complémentés au besoin par des soins d’urgence dispensés au Canada.
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Palepu A, Gadermann A, Hubley AM, Farrell S, Gogosis E, Aubry T, Hwang SW. Substance use and access to health care and addiction treatment among homeless and vulnerably housed persons in three Canadian cities. PLoS One 2013; 8:e75133. [PMID: 24124470 PMCID: PMC3790780 DOI: 10.1371/journal.pone.0075133] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 08/07/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction We examined the prevalence of substance use disorders among homeless and vulnerably housed persons in three Canadian cities and its association with unmet health care needs and access to addiction treatment using baseline data from the Health and Housing in Transition Study. Methods In 2009, 1191 homeless and vulnerably housed persons were recruited in Vancouver, Toronto, and Ottawa, Canada. Interviewer administered questionnaires collected data on socio-demographics, housing history, chronic health conditions, mental health diagnoses, problematic drug use (DAST-10≥6), problematic alcohol use (AUDIT≥20), unmet physical and mental health care needs, addiction treatment in the past 12 months. Three multiple logistic regression models were fit to examine the independent association of substance use with unmet physical health care need, unmet mental health care need, and addiction treatment. Results Substance use was highly prevalent, with over half (53%) screening positive for the DAST-10 and 38% screening positive for the AUDIT. Problematic drug use was 29%, problematic alcohol use was lower at 16% and 7% had both problematic drug and alcohol use. In multiple regression models for unmet need, we found that problematic drug use was independently associated with unmet physical (adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI] 1.43–2.64) and unmet mental (AOR 3.06; 95% CI 2.17–4.30) health care needs. Problematic alcohol use was not associated with unmet health care needs. Among those with problematic substance use, problematic drug use was associated with a greater likelihood of accessing addiction treatment compared to those with problematic alcohol use alone (AOR 2.32; 95% CI 1.18–4.54). Conclusions Problematic drug use among homeless and vulnerably housed individuals was associated with having unmet health care needs and accessing addiction treatment. Strategies to provide comprehensive health services including addiction treatment should be developed and integrated within community supported models of care.
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Affiliation(s)
- Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anita M. Hubley
- Department of Education and Counseling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada
| | - Susan Farrell
- Department of Psychiatry, Royal Ottawa Health Care Group, University of Ottawa, Ottawa, ON, Canada
| | - Evie Gogosis
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | - Tim Aubry
- Centre for Research on Educational and Community Services, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Stephen W. Hwang
- Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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Pappa E, Kontodimopoulos N, Papadopoulos A, Tountas Y, Niakas D. Investigating unmet health needs in primary health care services in a representative sample of the Greek population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2017-27. [PMID: 23685827 PMCID: PMC3709361 DOI: 10.3390/ijerph10052017] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 11/16/2022]
Abstract
Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (>18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access.
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Affiliation(s)
- Evelina Pappa
- Faculty of Social Sciences, Hellenic Open University, Riga Fereou 169 & Tsamadou, Patras 26222, Greece; E-Mails: (N.K.); (A.P.); (D.N.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +30-2610-367-441; Fax: +30-2610-367-442
| | - Nick Kontodimopoulos
- Faculty of Social Sciences, Hellenic Open University, Riga Fereou 169 & Tsamadou, Patras 26222, Greece; E-Mails: (N.K.); (A.P.); (D.N.)
| | - Angelos Papadopoulos
- Faculty of Social Sciences, Hellenic Open University, Riga Fereou 169 & Tsamadou, Patras 26222, Greece; E-Mails: (N.K.); (A.P.); (D.N.)
- “ATTIKON” University Hospital, 1 Rimini Street, Athens 12462, Greece
| | - Yannis Tountas
- Centre for Health Services Research, Department of Hygiene and Epidemiology, Medical School, Athens University, 25 Alexandroupoleos Street, Athens 11527, Greece; E-Mail:
| | - Dimitris Niakas
- Faculty of Social Sciences, Hellenic Open University, Riga Fereou 169 & Tsamadou, Patras 26222, Greece; E-Mails: (N.K.); (A.P.); (D.N.)
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Mayberry JF, Farrukh A. Gastroenterology and the provision of care to Panjabi patients in the UK. Frontline Gastroenterol 2012; 3:191-198. [PMID: 28839663 PMCID: PMC5517281 DOI: 10.1136/flgastro-2012-100119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2012] [Indexed: 02/04/2023] Open
Abstract
Panjabi is spoken by 1.3 million people in the UK. It is the second most common language used in the country and is the first choice of 75% of Panjabis. It is becoming more common. For many patients it forms part of the barrier which limits access to gastrointestinal services. The provision of appropriate support services is woeful and yet seldom leads to formal complaints. This review considers the impact of gastrointestinal disorders on the Panjabi community and assesses some of the interventions that could be developed to ensure equity of care.
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Affiliation(s)
- John Francis Mayberry
- Department of Digestive Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Affifa Farrukh
- Department of Digestive Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
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Morgan S, Hanley G, Cunningham C, Quan H. Ethnic differences in the use of prescription drugs: a cross-sectional analysis of linked survey and administrative data. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2011; 5:e87-93. [PMID: 21915239 PMCID: PMC3148005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 09/07/2010] [Accepted: 09/07/2010] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evidence from the United States and Europe suggests that the use of prescription drugs may vary by ethnicity. In Canada, ethnic disparities in prescription drug use have not been as well documented as disparities in the use of medical and hospital care. We conducted a cross-sectional analysis of survey and administrative data to examine needs-adjusted rates of prescription drug use by people of different ethnic groups. METHODS For 19 370 non-Aboriginal people living in urban areas of British Columbia, we linked data on self-identified ethnicity from the Canadian Community Health Survey with administrative data describing all filled prescriptions and use of medical services in 2005. We used sex-stratified multivariable logistic regression analysis to measure differences in the likelihood of filling prescriptions by drug class (antihypertensives, oral antibiotics, antidepressants, statins, respiratory drugs and nonsteroidal anti-inflammatory drugs [NSAIDs]). Models were adjusted for age, general health status, treatment-specific health status, socio-economic factors and recent immigration (within 10 years). RESULTS We found evidence of significant needs-adjusted variation in prescription drug use by ethnicity. Compared with women and men who identified themselves as white, those who were South Asian or of mixed ethnicity were almost as likely to fill prescriptions for most types of medicines studied; moreover, South Asian men were more likely than white men to fill prescriptions for antibiotics and NSAIDs. The clearest pattern of use emerged among Chinese participants: Chinese women were significantly less likely to fill prescriptions for antihypertensives, antibiotics, antidepressants and respiratory drugs, and Chinese men for antidepressant drugs and statins. INTERPRETATION We found some disparities in prescription drug use in the study population according to ethnic group. The nature of some of these variations suggest that ethnic differences in beliefs about pharmaceuticals may generate differences in prescription drug use; other variations suggest that there may be clinically important disparities in treatment use.
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