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Olanlesi-Aliu A, Tulli M, Kemei J, Bonifacio G, Reif LC, Cardo V, Roche H, Hurley N, Salami B. A scoping review on the operationalization of intersectional health research methods in studies related to the COVID-19 pandemic. Int J Qual Stud Health Well-being 2024; 19:2302305. [PMID: 38207090 PMCID: PMC10786425 DOI: 10.1080/17482631.2024.2302305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024] Open
Abstract
PURPOSE The COVID-19 pandemic began in early 2020 and became a global health crisis with devastating impacts. This scoping review maps the key findings of research about the pandemic that has operationalized intersectional research methods around the world. It also tracks how these studies have engaged with methodological tenets of oppression, comparison, relationality, complexity, and deconstruction. METHODS Our search resulted in 14,487 articles, 5164 of which were duplicates, and 9297 studies that did not meet the inclusion criteria were excluded. In total, 14 articles were included in this review. We used thematic analysis to analyse themes within this work and Misra et al. (2021) intersectional research framework to analyse the uptake of intersectional methods within such studies. RESULTS The research related to the COVID-19 pandemic globally is paying attention to issues around the financial impacts of the pandemic, discrimination, gendered impacts, impacts of and on social ties, and implications for mental health. We also found strong uptake of centring research in the context of oppression, but less attention is being paid to comparison, relationality, complexity, and deconstruction. CONCLUSIONS Our findings show the importance of intersectional research within public health policy formation, as well as room for greater rigour in the use of intersectional methods.
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Affiliation(s)
| | - Mia Tulli
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Janet Kemei
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Glenda Bonifacio
- Women and Gender Studies, Arts and Science, University of Lethbridge, Lethbridge, Canada
| | - Linda C. Reif
- CN Professor of International Trade, Law, University of Alberta, Edmonton, Canada
| | - Valentina Cardo
- Politics and Identity, University of Southampton, Southampton, United Kingdom
| | - Hannah Roche
- Department of English and Related Literature, University of York, Heslington, United Kingdom
| | - Natasha Hurley
- Dean of Humanities and Social Sciences, Memorial University¸Newfoundland and Labrador’s University, St. John’s Newfoundland, Canada
| | - Bukola Salami
- Intersections of Gender Signature Area, Intersections of Gender, Nursing, Fellow, Canadian Academy of Nursing, Health and Immigration Policies and Practices Research Program (HIPP), University of Alberta, Edmonton, Canada
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Sierra-Heredia C, Tayyar E, Bozorgi Y, Thakore P, Hagos S, Carrillo R, Machado S, Peterson S, Goldenberg S, Wiedmeyer ML, Lavergne MR. Growing inequities by immigration group among older adults: population-based analysis of access to primary care and return to in-person visits during the COVID-19 pandemic in British Columbia, Canada. BMC PRIMARY CARE 2024; 25:332. [PMID: 39243016 PMCID: PMC11378608 DOI: 10.1186/s12875-024-02530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 07/18/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, followed by a gradual return to in-person visits. Virtual visits may offer more convenient access to care for some, but others may experience challenges accessing care virtually, and some medical needs must be met in-person. Experiences of the shift to virtual care and benefits of in-person care may vary by immigration experience (immigration status and duration), official language level, and age. We examined use of virtual care and return to in-person visits in the Canadian province of British Columbia (BC), comparing patterns by age and across immigration groups, including length of time in Canada and language level (official languages English and French) at time of arrival. METHODS We used linked administrative health and immigration data to examine total primary care visits (virtual or in-person) and return to in-person visits during the COVID-19 pandemic (2019/20-2021/2) in BC. We examined the proportion of people with any primary care visits and with any in-person visits within each year as measures of access to primary care. We estimated the odds of any primary care visits and any in-person visits by immigration group and official language level assessed prior to arrival: non-immigrants, long-term immigrants, recent immigrants (< 5 years) with high assessed official language level and recent immigrants (< 5 years) with low assessed official language level (assessed prior to arrival), stratified by age. RESULTS In general, changes in access to primary care (odds of any visits and odds of any in-person visits) were similar across immigration groups over the study period. However, we observed substantial disparities in access to primary care by immigration group among people aged 60 + , particularly in recent immigrants with low official language level (0.42, 0.40-0.45). These disparities grew wider over the course of the pandemic. CONCLUSION Though among younger adults changes in access to primary care between 2019-2021 were similar across immigration groups, we observed significant and growing inequities among older adults, with particularly limited access among adults who immigrated recently and with low assessed official language level. Targeted interventions to ensure acceptable, accessible care for older immigrants are needed.
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Affiliation(s)
| | - Elmira Tayyar
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Yasmin Bozorgi
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Padmini Thakore
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Selamawit Hagos
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Ruth Carrillo
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Stefanie Machado
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Shira Goldenberg
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Mei-Ling Wiedmeyer
- Centre for Gender &, Sexual Health Equity, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Santhakumaran S, Baiad A, Ranjbari D, Correa JA, Chaudhry Z, Toffoli D. Impact of 5 waves of COVID-19 on pediatric ophthalmology. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00187-X. [PMID: 39106963 DOI: 10.1016/j.jcjo.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/05/2024] [Accepted: 06/16/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE To characterize the impact of multiple waves of COVID-19 on pediatric ophthalmology at a tertiary care hospital. METHODS Medical records were reviewed from pediatric patients seen for ophthalmic emergencies at the Montreal Children's Hospital (Montreal, Canada) from 5 COVID-19 periods: March 13 to May 31, 2020; September 20, 2020, to February 21, 2021; March 21 to May 31, 2021; August 17 to November 5, 2021; and December 19, 2021, to January 25, 2022, as well as 2 pre-COVID time periods: March 13 to May 31, in 2018 and 2019). RESULTS There was a significant reduction in ophthalmic consultations when comparing pre-COVID to all 5 COVID waves (p < 0.0001). There was an increase in the average number of daily urgent (p = 0.01) ophthalmic consultations from waves 1 to 4. Mean household income of patients was not significantly different pre-COVID compared to during the 5 COVID waves (p = 0.96). The most common referral reason was ocular trauma (38.0% of cases). There was a non-significant trend demonstrating more infectious disease presentations during waves 3 to 5 (p = 0.07). There was no difference in symptom duration prior to presentation (p = 0.54); however, there was a difference in the time between emergency room and ophthalmology assessment in waves 3 and 4 compared with wave 5 (p = 0.003). CONCLUSION The number of pediatric ophthalmology consultations was less during the 5 COVID waves than pre-COVID. An increase in urgent pediatric ophthalmology consultations occurred as COVID-19 infection rates in Quebec decreased. Access to health care and time to care were preserved across waves compared with pre-pandemic.
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Affiliation(s)
| | - Abed Baiad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Dorsai Ranjbari
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - José A Correa
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | - Zoya Chaudhry
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, Canada
| | - Daniela Toffoli
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, Canada
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Lin SL. Immigrant and Racialized Populations' Cumulative Exposure to Discrimination and Associations with Long-Term Conditions During COVID-19: A Nationwide Large-Scale Study in Canada. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02074-1. [PMID: 39017775 DOI: 10.1007/s40615-024-02074-1] [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: 04/01/2024] [Revised: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND This cross-sectional study examines associations between the race-migration nexus, cumulative exposure to intersectional discrimination (2 years before and during the COVID-19 pandemic), and long-term conditions. METHODS A nationwide self-selected sample (n = 32,605) was obtained from a Statistics Canada's Crowdsourcing online survey from August 4 to 24, 2020. Binary and multinomial logistic regression models were used to examine disparities by the race-migration nexus in accumulative experiences of multiple situations- and identity-based discrimination and their relations with long-term conditions, after controlling for sociodemographic covariates. RESULTS During the pandemic, discrimination stemming from racialization - such as race/skin color (24.4% vs 20.1%) and ethnicity/culture (18.5% vs 16.5%) - and cyberspace (34.1% vs 29.8%) exaggerated relative to pre-pandemic period; compared to Canadian-born (CB) whites, the likelihood of experiencing multiple discrimination increased alongside the domains of discrimination being additively intersected (e.g., identity-based, all p's < 0.001) among CB racialized minorities (ORs 2.08 to 11.78), foreign-born (FB) racialized minorities (ORs 1.99 to 12.72), and Indigenous populations (ORs 1.62 to 8.17), except for FB whites (p > 0.01); dose-response relationships were found between cumulative exposure to multiple discrimination and odds of reporting long-term conditions (p's < 0.001), including seeing (ORs 1.63 to 2.99), hearing (ORs 1.83 to 4.45), physical (ORs 1.66 to 3.87), cognitive (ORs 1.81 to 3.79), and mental health-related impairments (ORs 1.82 to 3.41). CONCLUSIONS Despite a universal health system, Canadians who are CB/FB racialized and Indigenous populations, have a higher prevalence of cumulative exposure to different aspects of discrimination that are associated with multiple long-term conditions during the COVID-19 pandemic. Equity-driven solutions are needed to tackle upstream determinants of health inequalities through uprooting intersectional discrimination faced by racialized and immigrant communities.
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Affiliation(s)
- Shen Lamson Lin
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong SAR, China.
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
- Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom.
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Hetherington E, Darling E, Harper S, Nguyen F, Schummers L, Norman WV. Inequalities in access to prenatal care during the COVID-19 pandemic: Analysis of a population-based cohort. Paediatr Perinat Epidemiol 2024; 38:291-301. [PMID: 38339962 DOI: 10.1111/ppe.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Before the COVID-19 pandemic, access to prenatal care was lower among some socio-demographic groups. This pandemic caused disruptions to routine preventative care, which could have increased inequalities. OBJECTIVES To investigate if the COVID-19 pandemic increased inequalities in access to prenatal care among those who are younger, live in rural areas, have a lower socio-economic situation (SES) and are recent immigrants. METHODS We used linked administrative datasets from ICES to identify a population-based cohort of 455,245 deliveries in Ontario from January 2018 to December 2021. Our outcomes were first-trimester prenatal visits, first-trimester ultrasound and adequacy of prenatal care. We used joinpoint analysis to examine outcome time trends and identify trend change points. We stratified analyses by age, rural residence, SES and recent immigration, and examined risk differences (RD) with 95% confidence intervals (CI) between groups at the beginning and end of the study period. RESULTS For all outcomes, we noted disruptions to care beginning in March or April 2020 and returning to previous trends by November 2020. Inequalities were stable across groups, except recent immigrants. In July 2017, 65.0% and 69.8% of recent immigrants and non-immigrants, respectively, received ultrasounds in the first trimester (RD -4.8%, 95% CI -8.0, -1.5). By October 2020, this had increased to 75.4%, with no difference with non-immigrants (RD 0.4%, 95% CI -2.4, 3.2). Adequacy of prenatal care showed more intensive care as of November 2020, reflecting a higher number of visits. CONCLUSIONS We found no evidence that inequalities between socio-economic groups that existed prior to the pandemic worsened after March 2020. The pandemic may be associated with increased access to care for recent immigrants. The introduction of virtual visits may have resulted in a higher number of prenatal care visits.
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Affiliation(s)
- Erin Hetherington
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- ICES McMaster, Hamilton, Ontario, Canada
| | - Elizabeth Darling
- ICES McMaster, Hamilton, Ontario, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Sam Harper
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Laura Schummers
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Acquadro-Pacera G, Valente M, Facci G, Molla Kiros B, Della Corte F, Barone-Adesi F, Ragazzoni L, Trentin M. Exploring differences in the utilization of the emergency department between migrant and non-migrant populations: a systematic review. BMC Public Health 2024; 24:963. [PMID: 38580984 PMCID: PMC10996100 DOI: 10.1186/s12889-024-18472-3] [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: 11/16/2023] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Migrants face several barriers when accessing care and tend to rely on emergency services to a greater extent than primary care. Comparing emergency department (ED) utilization by migrants and non-migrants can unveil inequalities affecting the migrant population and pave the way for public health strategies aimed at improving health outcomes. This systematic review aims to investigate differences in ED utilization between migrant and non-migrant populations to ultimately advance research on migrants' access to care and inform health policies addressing health inequalities. METHODS A systematic literature search was conducted in March 2023 on the Pubmed, Scopus, and Web of Science databases. The included studies were limited to those relying on data collected from 2012 and written in English or Italian. Data extracted included information on the migrant population and the ED visit, the differences in ED utilization between migrants and non-migrants, and the challenges faced by migrants prior to, during, and after the ED visit. The findings of this systematic review are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. RESULTS After full-text review, 23 articles met the inclusion criteria. All but one adopted a quantitative methodology. Some studies reported a higher frequency of ED visits among migrants, while others a higher frequency among non-migrants. Migrants tend to leave the hospital against medical advice more frequently than the native population and present at the ED without consulting a general practitioner (GP). They are also less likely to access the ED via ambulance. Admissions for ambulatory care-sensitive conditions, namely health conditions for which adequate, timely, and effective outpatient care can prevent hospitalization, were higher for migrants, while still being significant for the non-migrant population. CONCLUSIONS The comparison between migrants' and non-migrants' utilization of the ED did not suggest a clear pattern. There is no consensus on whether migrants access EDs more or less than non-migrants and on whether migrants are hospitalized at a higher or lower extent. However, migrants tend to access EDs for less urgent conditions, lack a referral from a GP and access the ED as walk-ins more frequently. Migrants are also discharged against medical advice more often compared to non-migrants. Findings of this systematic review suggest that migrants' access to care is hindered by language barriers, poor insurance coverage, lack of entitlement to a GP, and lack of knowledge of the local healthcare system.
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Affiliation(s)
- Giulia Acquadro-Pacera
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, 13100, Italy
| | - Giulia Facci
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
| | | | - Francesco Della Corte
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
| | - Francesco Barone-Adesi
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, 13100, Italy
| | - Monica Trentin
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Universià del Piemonte Orientale, Novara, 28100, Italy.
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy.
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He JW, Terry AL, Lizotte D, Bauer G, Ryan BL. Understanding intersectional inequality in access to primary care providers using multilevel analysis of individual heterogeneity and discriminatory accuracy. PLoS One 2024; 19:e0296657. [PMID: 38241267 PMCID: PMC10798491 DOI: 10.1371/journal.pone.0296657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Despite the Canadian healthcare system's commitment to equity, evidence for disparate access to primary care (PC) providers exists across individual social identities/positions. Intersectionality allows us to reflect the realities of how social power shapes healthcare experiences at an individual's interdependent and intersecting social identities/positions. The objectives of this study were to determine: (1) the extent to which intersections can be used classify those who had/did not have a PC provider; (2) the degree to which each social identity/position contributes to the ability to classify individuals as having a PC provider; and (3) predicted probabilities of having a PC provider for each intersection. METHODS AND FINDINGS Using national cross-sectional data from 241,445 individuals in Canada aged ≥18, we constructed 320 intersections along the dimensions of gender, age, immigration status, race, and income to examine the outcome of whether one had a PC provider. Multilevel analysis of individual heterogeneity and discriminatory accuracy, a multi-level model using individual-level data, was employed to address intersectional objectives. An intra-class correlation coefficient (ICC) of 23% (95%CI: 21-26%) suggests that these intersections could, to a very good extent, explain individual variation in the outcome, with age playing the largest role. Not all between-intersection variance in this outcome could be explained by additive effects of dimensions (remaining ICC: 6%; 95%CI: 2-16%). The highest intersectional predicted probability existed for established immigrant, older South Asian women with high income. The lowest intersectional predicted probability existed for recently immigrated, young, Black men with low income. CONCLUSIONS Despite a "universal" healthcare system, our analysis demonstrated a substantial amount of inequity in primary care across intersections of gender, age, immigration status, race, and income.
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Affiliation(s)
- Jennifer W. He
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Amanda L. Terry
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Dan Lizotte
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Computer Science, Western University, London, Ontario, Canada
| | - Greta Bauer
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Bridget L. Ryan
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Department of Family Medicine, Western University, London, Ontario, Canada
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Vincent R, Coulibaly KS, Ahmed A, Ahmed Y, Hanna TA, Ravi S, Hawkes MT, Gnidehou S. Access to healthcare services and confidence in healthcare professionals' management of malaria: the views of Francophone sub-Saharan African Immigrants living in western Canada. BMC Public Health 2023; 23:2456. [PMID: 38066503 PMCID: PMC10704657 DOI: 10.1186/s12889-023-17266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There is a paucity of knowledge about the healthcare attitudes and practices of French-speaking immigrants originating from Sub-Saharan Africa (FISSA) living in minority settings. The purpose of this study was to characterize FISSA healthcare experiences and confidence in the malaria-related knowledge of health professionals in Edmonton. METHODS A structured survey was used to examine a cohort of 382 FISSA (48% female; 52% male) living in Edmonton. FISSA general healthcare attitudes, experiences and satisfaction with the Canadian healthcare system were studied. Healthcare Competency Perception (HCP) was characterized by using an index score. Statistical analyses were performed to evaluate the impact of healthcare experiences and other outcomes. RESULTS Intriguingly, while only 42% of FISSA had a French-speaking family physician, 83% (197/238) of those who had received health care services in Alberta found that access to medical treatment was easy, and 77% (188/243) were satisfied with received care. Although 70% (171/243) of FISSA did not receive services in French, 82% (199/243) surprisingly reported having good levels of comprehension during their visits. Satisfaction with care was associated with having a family physician (p = 0.018) and having health insurance (p = 0.041). Nevertheless, confidence in the healthcare system's ability to treat malaria effectively was significantly lower, with only 39% (148/382) receiving a positive score on the HCP index. CONCLUSION This study provides an important insight into FISSA experience with and perception of the Alberta's healthcare system.
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Affiliation(s)
- Rémi Vincent
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | | | - Ali Ahmed
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Youssef Ahmed
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Taylor A Hanna
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Srilata Ravi
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada
| | - Michael T Hawkes
- Department of Pediatrics, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sedami Gnidehou
- Faculté Saint-Jean, University of Alberta, Edmonton, AB, Canada.
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada.
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Fakhari N, McIsaac JLD, Feicht R, Reddington S, Brigham S, Mandrona A, McLean C, Harkins MJ, Stirling Cameron E. Looking through the lens: a photovoice study examining access to services for newcomer children. Int J Qual Stud Health Well-being 2023; 18:2255176. [PMID: 37683119 PMCID: PMC10494737 DOI: 10.1080/17482631.2023.2255176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Canadian new immigrant families (also known as newcomers) encounter challenges navigating systems when trying to access programmes critical for their children's healthy development. The purpose of this study is to understand how newcomer families find and use early childhood programmes and services from the perspective of families and early childhood educators (ECEs) working within a settlement organization. METHODS Using photovoice methodology, newcomer family members (n = 8) with young children and ECEs (n = 6) participated in a series of virtual workshops to share photos and reflect on their experiences. RESULTS Participants discussed the systemic barriers that obstructed newcomer families' access to services for young newcomer children. Financial challenges due to unemployment/underemployment, language and cultural differences were emphasized. Despite these barriers and challenges, participants shared how culturally responsive programmes enhanced their connections to programmes and services. Both groups of participants discussed the critical role of social networks in supporting newcomers to use programmes by helping families become aware of available services and assistance with various processes such as registration. CONCLUSIONS This research illustrates the lived experiences of newcomer families and identifies opportunities to address inequities, improve early childhood programmes, and enhance families' access to programmes and services.
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Affiliation(s)
- Nahal Fakhari
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Jessie-Lee D. McIsaac
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Canada
- Faculty of Education, Mount Saint Vincent University, Halifax, Canada
- Department of Child and Youth Study, Mount Saint Vincent University, Halifax, Canada
| | - Rebecca Feicht
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Sarah Reddington
- Department of Child and Youth Study, Mount Saint Vincent University, Halifax, Canada
| | - Susan Brigham
- Faculty of Education, Mount Saint Vincent University, Halifax, Canada
| | - April Mandrona
- Division of Art History and Contemporary Culture, NSCAD University, Halifax, Canada
| | - Christine McLean
- Department of Child and Youth Study, Mount Saint Vincent University, Halifax, Canada
| | - Mary Jane Harkins
- Faculty of Education, Mount Saint Vincent University, Halifax, Canada
| | - Emma Stirling Cameron
- Early Childhood Collaborative Research Centre, Mount Saint Vincent University, Halifax, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Kangmennaang J, Siiba A, Bisung E. Does Trust Mediate the Relationship Between Experiences of Discrimination and Health Care Access and Utilization Among Minoritized Canadians During COVID-19 Pandemic? J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01809-w. [PMID: 37787945 DOI: 10.1007/s40615-023-01809-w] [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: 07/11/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES We sought to determine if trust in government institutions mediate the relationship between experiences of discrimination and health care utilization during the COVID-19 pandemic. METHODS We used data from Statistics Canada's Crowdsourcing Data: Impacts of COVID-19 on Canadians-Experiences of Discrimination. We used generalized linear latent and mixed models (Gllamm) with a binomial and logit link function as well as generalized structural equation modeling (GSEM) to determine if reported discrimination and trust were associated with difficulties in accessing health services, health care, and the likelihood of experiencing negative health impacts. We also examined if trust mediated the relationship between experiences of discrimination and these health outcomes. Our analytical sample consisted of 2568 individuals who self-identified as belonging to a visible minority group. RESULTS The multivariate results indicate that experiences of discrimination during COVID-19 were associated with higher odds of reporting difficulties in accessing general health services (OR = 1.99, p ≤ 0.01), receiving care (OR = 1.65, p ≤ 0.01), and higher likelihood of reporting negative health impacts (OR = 1.68, p ≤ 0.01). Our mediation analysis indicated that trust in public institutions explained a substantial portion of the association between reported discrimination and all the health outcomes, although the effects of experiencing discrimination remain significant and robust. CONCLUSION The findings show that building and maintaining trust is important and critical in a pandemic recovery world to build back better.
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Mothupi M, Dasgupta J, Hosseini Jebeli SS, Stevenson J, Berdichevsky K, Vong S, Barasa E, George A. Using an intersectionality approach to transform health services for overlooked healthcare users and workers after covid-19. BMJ 2023; 381:e072243. [PMID: 37286226 DOI: 10.1136/bmj-2022-072243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Mamothena Mothupi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | | | - Jacqui Stevenson
- United Nations University International Institute of Global Health, Kuala Lumpur, Malaysia
| | - Karla Berdichevsky
- National Center for Gender Equity and Reproductive Health, Ministry of Health, Mexico City, Mexico
| | | | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Asha George
- Complexity and Social Change, School of Public Health, University of the Western Cape, Cape Town, South Africa
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Li Q, Wang Y, Knight JC, Yi Y, Ozbek S, Shariati M, Wang PP, Zhu Y. Dental health status, dentist visiting, and dental insurance of Asian immigrants in Canada. Int J Equity Health 2023; 22:73. [PMID: 37098603 PMCID: PMC10131415 DOI: 10.1186/s12939-023-01863-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/16/2023] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVE This study examined the dental care utilization and self-preserved dental health of Asian immigrants relative to non-immigrants in Canada. Factors associated with oral health-related disparities between Asian immigrants and other Canadians were further examined. METHODS We analyzed 37,935 Canadian residents aged 12 years and older in the Canadian Community Health Survey 2012-2014 microdata file. Factors (e.g., demographics, socioeconomic status, lifestyles, dental insurance coverage, and year of immigration) associated with disparities in dental health (e.g., self-perceived teeth health, dental symptoms during past one month, and teeth removed due to decay in past one year) and service utilization (e.g., visiting dentist within the last three years, visiting dentist more than once per year) between Asian immigrants and other Canadians were examined using multi-variable logistic regression models. RESULTS The frequency of dental care utilization was significantly lower in Asian immigrants than their non-immigrant counterparts. Asian immigrants had lower self-perceived dental health, were less likely to be aware of recent dental symptoms, and more likely to report tooth extractions due to tooth decay. Low education (OR = 0.42), male gender(OR = 1.51), low household income(OR = 1.60), non-diabetes(OR = 1.87), no dental insurance(OR = 0.24), short immigration length (OR = 1.75) may discourage Asian immigrants from dental care utilization. Additionally, a perceived lack of necessity to dentist-visiting was a crucial factor accounting for the disparities in dental care uptake between Asian immigrants and non-immigrants. CONCLUSION Asian immigrants showed lower dental care utilization and oral health than native-born Canadians.
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Affiliation(s)
- Qianqian Li
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Yu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - John C Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Sara Ozbek
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Matin Shariati
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Peizhong Peter Wang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 534, Toronto, ON, M5T 3M7, Canada.
- Centre for New Immigrant Wellbeing, 200-80 Acadia Ave, Markham, ON, L3R 9V1, Canada.
| | - Yun Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
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Assefa N, Abdullahi YY, Hemler EC, Lankoande B, Madzorera I, Wang D, Ismail A, Chukwu A, Workneh F, Mapendo F, Millogo O, Abubakari SW, Febir LG, Lyatuu I, Dianou K, Baernighausen T, Soura A, Asante KP, Smith E, Vuai S, Worku A, Killewo J, Mwanyika-Sando M, Berhane Y, Sie A, Tajudeen R, Oduola A, Fawzi WW. COVID-19 Preventive Practices, Psychological Distress, and Reported Barriers to Healthcare Access during the Pandemic among Adult Community Members in Sub-Saharan Africa: A Phone Survey. Am J Trop Med Hyg 2023; 108:124-136. [PMID: 36509058 PMCID: PMC9833061 DOI: 10.4269/ajtmh.22-0349] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/24/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has had serious negative health and economic impacts in sub-Saharan Africa. Continuous monitoring of these impacts is crucial to formulate interventions to minimize the consequences of COVID-19. This study surveyed 2,829 adults in urban and rural sites among five sub-Saharan African countries: Burkina Faso, Ethiopia, Nigeria, Tanzania, and Ghana. Participants completed a mobile phone survey that assessed self-reported sociodemographics, COVID-19 preventive practices, psychological distress, and barriers to healthcare access. A modified Poisson regression model was used to estimate adjusted prevalence ratios (aPRs) and 95% CIs to investigate potential factors related to psychological distress and barriers to reduced healthcare access. At least 15.6% of adults reported experiencing any psychological distress in the previous 2 weeks, and 10.5% reported that at least one essential healthcare service was difficult to access 2 years into the pandemic. The majority of participants reported using several COVID-19 preventive methods, with varying proportions across the sites. Participants in the urban site of Ouagadougou, Burkina Faso (aPR: 2.29; 95% CI: 1.74-3.03) and in the rural site of Kintampo, Ghana (aPR: 1.68; 95% CI: 1.21-2.34) had a higher likelihood of experiencing any psychological distress compared with those in the rural area of Nouna, Burkina Faso. Loss of employment due to COVID-19 (aPR: 1.77; 95% CI: 1.47-2.11) was also associated with an increased prevalence of psychological distress. The number of children under 5 years in the household (aPR: 1.23; 95% CI: 1.14-1.33) and participant self-reported psychological distress (aPR: 1.83; 95% CI: 1.48-2.27) were associated with an increased prevalence of reporting barriers to accessing health services, whereas wage employment (aPR: 0.67; 95% CI: 0.49-0.90) was associated with decreased prevalence of reporting barriers to accessing health services. Overall, we found a high prevalence of psychological distress and interruptions in access to healthcare services 2 years into the pandemic across five sub-Saharan African countries. Increased effort and attention should be given to addressing the negative impacts of COVID-19 on psychological distress. An equitable and collaborative approach to new and existing preventive measures for COVID-19 is crucial to limit the consequences of COVID-19 on the health of adults in sub-Saharan Africa.
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Affiliation(s)
- Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yasir Y Abdullahi
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Elena C Hemler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Bruno Lankoande
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Isabel Madzorera
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Dongqing Wang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Abbas Ismail
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | | | - Frank Mapendo
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | | | - Sulemana Watara Abubakari
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Lawrence Gyabaa Febir
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Isaac Lyatuu
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Kassoum Dianou
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Till Baernighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Emily Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.,Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Raji Tajudeen
- Division of Public Health Institutes and Research, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ayo Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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