Facilitators of and barriers to accessing clinical prevention services for the South Asian population in Surrey, British Columbia: a qualitative study

Navigating Living Kidney Donation and Transplantation Among South Asian Canadians: The ACTION Project

RATIONALE & OBJECTIVE

South Asian (SA) Canadians with kidney failure have a 50%-77% lower likelihood of kidney transplant and are less likely to identify potential living donors (LDs). This study aimed to identify health system-, patient-, and community-level barriers and facilitators for accessing LD kidney transplantation in the SA community to inform the development of health system- and community-level interventions to address barriers.

STUDY DESIGN

Qualitative study.

SETTING & PARTICIPANTS

20 SA recipients of an LD or deceased-donor kidney transplant, 10 SA LDs, and 41 general SA community members.

ANALYTICAL APPROACH

In-depth multilingual interviews were conducted with recipients and LDs. Gender-, language-, and age-stratified focus groups were conducted with general SA community members. Summative content analysis was used to analyze the data.

RESULTS

Hesitancy in approaching potential donors, fear about the health of potential LDs, information gaps, language barriers, and challenges evaluating out-of-country donors were highlighted as significant barriers by recipients, and financial concerns and information gaps were identified by donors. Cultural barriers in the SA community were highlighted by donors, recipients, and community members as critical factors when considering donation and transplant; women and elderly SA Canadians highlighted nuanced challenges. Participants reported generally a favorable perception of their health care teams, citing SA representation in the teams as important to providing culturally and linguistically sensitive care.

LIMITATIONS

Limited geographic, race, and cultural representation and reliance on virtual data collection.

CONCLUSIONS

This study highlights several culturally relevant barriers to donation and transplant that are potentially modifiable through patient-, health system-, and community-focused engagement and education.

The colon cancer screening behaviours survey for South Asians: a pilot study of feasibility and psychometric evaluation

PURPOSE

The purpose of the study was to pilot test the English and Urdu version of the Colon Cancer Screening Behaviours Survey among South Asians in Canada. The first objective was to evaluate feasibility of administration, data collection using computer assisted personal interviewing software on a tablet, and response burden. The second objective was to examine the prevalence of colorectal cancer screening among South Asians and evaluate the psychometric properties of sub-scales in the survey.

METHODS

Purposive, network and snowball sampling were used to recruit participants for this cross-sectional study. Interviewer-led administration of the Colon Cancer Screening Behaviours Survey was conducted across two cities in Ontario, Canada. Qualitative data analysis assessed feasibility; and sub-scales were evaluated through principal component analysis, item-scale correlations, and construct validity using multiple linear and logistic regression.

RESULTS

A total of 328 South Asians participated, 47% Urdu speaking, and 53% English speaking. There was a 23% refusal rate to participate. Feasibility identified: (1) successful recruitment despite reasons for refusal; (2) problematic items and response categories; and (3) computer/tablet limitations. Principal component analysis identified 14 components that explained 68.7% of total variance; 34 items were retained after factor analysis. Internal consistency of 4 scales ranged from 0.79-0.91. There were significant differences in perceived barriers scale scores (- 12.21; 95% CI, - 17.13 to - 7.28; p <  0.0001) between those who participated and those who did not participate in screening. No association was found with years of residence and uptake of screening after adjustment (OR 0.91 (0.46-1.79), p = 0.783).

CONCLUSIONS

Recruitment and data collection methods are feasible among South Asians if functionality of the tablet selected is improved. The Colon Cancer Screening Behaviours Survey was finalized and retained items in sub-scales demonstrated good psychometric properties to assess behaviours for colon cancer screening among South Asians in Canada. The interviewer-led survey may be used by public health, cancer care or other health practitioners to describe or predict colorectal cancer screening behaviours among South Asians in similar settings or adapted and tested in other contexts.

Utilisation of Healthcare Services and Medicines by Pakistani Migrants Residing in High Income Countries: A Systematic Review and Thematic Synthesis

Migration, as a global phenomenon, gives rise to many challenges for healthcare professionals providing care to migrant populations. Migrants originating from diverse cultural backgrounds have unique beliefs and healthcare needs, and their utilisation of healthcare services and medicines is influenced by a number of factors. This review aims to assess the factors influencing the utilisation of healthcare services and medicines among Pakistani migrants residing in high income countries. The databases searched included PubMed/Medline, Scopus, EMBASE, Web of Science, CINAHL, and IPA. Of the 2566 publications initially obtained, 37 met the inclusion criteria. They included eight countries-the United Kingdom, United States of America, Canada, Denmark, Norway, Australia, United Arab Emirates and Cyprus. Eight descriptive themes emerged and two analytical constructs were established, as a result of thematic synthesis of included publications. The profile of utilisation of healthcare services and medicines among Pakistani migrants was multifaceted and influenced by their individual circumstances (socioeconomic characteristics; personal beliefs, preferences, and experiences; individual culture and religion; family and friends; and language and communication), and host country characteristics (work environment; healthcare organisation, access and affordability; and health professionals' education, practices, and preferences). Awareness of population-specific characteristics of migrant communities is important to promote and implement culturally appropriate healthcare practices and service provision.