Medical Interpreting Services for Refugees in Canada: Current State of Practice and Considerations in Promoting this Essential Human Right for All

Language barriers, specifically among refugees, pose significant challenges to delivering quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development of innovative alternatives such as telephone-based and video-conferencing medical interpreting services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights the absence of a cohesive national strategy, reflected in diverse funding models employed across provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating for medical interpreting, both as a moral imperative and a prudent investment, this article draws from human rights principles and ethical considerations, justified in national and international guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally, this article illuminates decision-making processes for utilizing interpreting services; recognizing the pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating intersectional considerations such as gender, culture and age, underscoring the importance of a collaborative approach. Finally, it provides recommendations at provider, organizational and system levels to ensure equitable access to this right and to promote the health and well-being of refugees and other individuals facing language barriers within Canada's healthcare system.

"You Can Do So Much Better Than What They Expect": An Arts-Based Engagement Ethnography on School Integration With Newcomer Youth

Newcomer adolescents make up a large minority of Canada's population and their positive integration experiences with education systems across the country are critical for both their development and the country's long-term success. The current study examined newcomer adolescents' (n = 4, between 16 and 18 years old) integration experiences using an arts-based engagement ethnography to understand what influences their positive integration into the school system. Artifacts, interview, and focus group data were analyzed systematically using ethnographic research guidelines. Five structures were identified: (1) barriers to advancement at individual, school, and macro levels, (2) fluctuating relationship with cultural identity, (3) limited trust in systems, (4) resilience through independent learning, and (5) facilitating factors to positive integration experiences at the family and school level. In keeping with a relational developmental systems theory framework, each structure accounts for multiple inter- and intra-individual factors at multiple environmental levels. These findings outline considerations for systemic issues in academic institutions and offer suggestions for how institutions can better support newcomer adolescents.

Canadian Guideline on the Management of a Positive Human Papillomavirus Test and Guidance for Specific Populations

The purpose of this paper is to provide evidence-based guidance on the management of a positive human papilloma virus (HPV) test and to provide guidance around screening and HPV testing for specific patient populations. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC), and the Canadian Partnership Against Cancer. The literature informing these guidelines was obtained through a systematic review of relevant literature by a multi-step search process led by an information specialist. The literature was reviewed up to July 2021 with manual searches of relevant national guidelines and more recent publications. The quality of the evidence and strength of recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include primary care providers, gynecologists, colposcopists, screening programs, and healthcare facilities. The implementation of the recommendations will ensure an optimum implementation of HPV testing with a focus on the management of positive results. Recommendations for appropriate care for underserved and marginalized groups are made.

The affective commitment of newcomers in hybrid work contexts: A study on enhancing and inhibiting factors and the mediating role of newcomer adjustment

This study focuses on one of the most impacted human aspects of digital transformation in contemporary organizations: the development of the affective commitment of newcomers in hybrid work contexts. Specifically, this study addresses a research gap related to the factors that influence the affective commitment of newcomers in hybrid work contexts. First, it investigates the role of two drawbacks of the remote component of hybrid work contexts inhibiting affective commitment: workplace social isolation and technostress. Second, it explores the role of two factors that were previously investigated in in-presence contexts and proved to enhance affective commitment: perceived organizational support and perceived supervisor support. Moreover, this study considers the possible mediating role of newcomer adjustment, intended as a proximal outcome of successful onboarding and an antecedent of newcomer affective commitment. In order to examine enhancing and inhibiting factors and the mediating role of newcomer adjustment, a quantitative study was carried out involving newcomers who began to work in their current organization after January 2021 and who still do remote work at least 1 day a week. Results confirm the inhibiting role of workplace social isolation and the enhancing role of perceived organizational support and perceived supervisor support on affective commitment in hybrid work contexts. Furthermore, they support the mediating role of newcomer adjustment in the relationship between workplace social isolation and affective commitment. While contributing to theory advancement in understanding newcomer affective commitment in current hybrid work contexts, these results also suggest important managerial implications in the field of human resources management, specifically the need to pay greater attention to strategies devoted to increasing newcomers' perception of organizational and supervisor support.

Does inclusive leadership affect the organizational socialization of newcomers from diverse backgrounds? The mediating role of psychological capital

Introduction

This paper aims to explore the influence of inclusive leadership on the organizational socialization of newcomers from diverse backgrounds, as mediated by psychological capital.

Methods

Structural equation model was used by Mplus 8.3 to analyze the effect of inclusive leadership and psychological capital on organizational socialization. This study used the 1,000 bootstrap replications method and the mediating path effect test to find out the mediating effect of psychological capital between the relationship of inclusive leadership and organizational socialization.

Results

The result found that (1) inclusive leadership positively affects newcomers' organizational culture, interpersonal relationships,socialization into organizational politics and can improve employees' job competence. (2) Psychological capital plays an intermediary role between inclusive leadership and the organizational culture, interpersonal relationships and socialization into organizational politics and job competence. Inclusive leaders improve newcomers' psychological capital by encouraging and recognizing their diversity, tolerating their mistakes. It can increase new generation of newcomers' resilience, self-efficacy and optimism. Individuals with high psychological capital are more likely to integrate into the organizational culture and increase their interaction with colleagues and then are more likely to integrate into the organization.

Discussion

Organizations should encourage leaders to develop inclusive leadership behaviors to foster newcomer socialization. In an inclusive leadership context, newcomers have high levels of psychological capital that promote their organizational socialization. Inclusive leadership is crucial for helping newcomers from diverse backgrounds to integrate into organizations.

Do not ask, but you shall still receive: Newcomer reactions to receiving negative gossip

As research regarding the targets and initiators of workplace gossip is gaining traction, one perspective that remains overlooked is the gossip receiver. Organizational newcomers are a particularly relevant population to study the impact of receiving negative gossip on because they use social information to navigate an unfamiliar organizational terrain. We propose a parallel moderated mediation model in which receiving negative gossip has contradicting effects on newcomer job anxiety through perceived social inclusion and negative rumination, and agreeableness as a boundary condition of the effects of receiving negative gossip. We collected data from 202 newcomers using a four-wave time-lagged design and found that receiving negative gossip increased newcomer job anxiety via negative rumination but did not decrease job anxiety via perceived social inclusion. Further, agreeableness moderated the effect of receiving negative gossip on negative rumination (but not perceived social inclusion) such that the effect of receiving negative gossip on negative rumination was stronger for less agreeable newcomers. Lastly, the indirect effect of receiving negative gossip on job anxiety via negative rumination was stronger for less agreeable newcomers. Theoretical and practical implications specific to gossip and newcomers are discussed.

Experiences of discrimination and its impacts on well-being among racialised LGBTQ+ newcomers living in Waterloo region, Ontario, Canada

Discrimination (i.e. racism, homo/bi/transphobia) at both the individual and systemic levels may negatively impact the well-being of racialised LGBTQ+ newcomers living in Waterloo Region, Ontario, Canada. Current research about the experiences of LGBTQ+ newcomers focuses predominantly on homogeneous samples of gay men living in large metropolitan city centres. The present study aims to extend the current literature by exploring the experiences of discrimination and its impacts on well-being among racialised LGBTQ+ newcomers living in a small urban area and representing a variety of intersecting identities (i.e. ethno-racial background, LGBTQ+ identity, newcomer status). Using a qualitative method, 10 individuals were invited to complete a semistructured interview between fall 2019 and summer 2020 about their experiences of discrimination in Waterloo Region, and how such experiences impact their well-being. Using an intersectional lens, a thematic analysis revealed that racialised LGBTQ+ newcomers experienced discrimination before and after settlement in Waterloo Region. Prior to settlement, participants spoke predominantly about experiences of homo/biphobia and the associated feelings of internalised oppression. Alternatively, upon settling in Waterloo Region, experiences of discrimination were predominantly racism, and, in particular, systemic racism, which manifested as an inability to access adequate services and a lack of representation in various spaces throughout Waterloo Region. These results extend previous research by identifying the service barriers experienced by racialised LGBTQ+ newcomers living in a small urban area and can be used to inform best practices for addressing these barriers in Waterloo Region and other small urban areas with similar demographics. Implications and limitations are discussed.

HIV treatment outcomes among newcomers living with HIV in Manitoba, Canada

BACKGROUND

Despite the overrepresentation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, research on their HIV treatment outcomes is limited. This study addressed this knowledge gap by describing treatment outcomes of newcomers in comparison with Canadian-born persons living with HIV in Manitoba.

METHODS

Clinical data from 1986 to 2017 were obtained from a cohort of people living with HIV and receiving care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed using univariate and multivariate statistics to compare differences in socio-demographic and clinical characteristics and treatment outcomes among newcomers, Canadian-born Indigenous persons, and Canadian-born non-Indigenous persons on entry into HIV care.

RESULTS

By end of 2017, 86 newcomers, 259 Canadian-born Indigenous persons, and 356 Canadian-born non-Indigenous persons were enrolled in the cohort. Newcomers were more likely than Canadian-born Indigenous and non- Indigenous cohort participants to be younger and female and have self-reported HIV risk exposure as heterosexual contact. Average CD4 counts at entry into care did not differ significantly between groups. A higher proportion of newcomers was also diagnosed with tuberculosis within 6 months of entry into care (21%), compared with 6% and 0.6% of Canadian-born Indigenous non-Indigenous persons, respectively. Newcomers and Canadian-born non-Indigenous persons had achieved viral load suppression (< 200 copies/mL) at a similar proportion (93%), compared with 82% of Canadian-born Indigenous participants (p < 0.05).

CONCLUSIONS

The distinct demographic and clinical characteristics of newcomers living with HIV requires a focused approach to facilitate earlier diagnosis, engagement, and support in care.

Health of Asylees Compared to Refugees in the United States Using Domestic Medical Examination Data, 2014-2016: A Cross-Sectional Analysis

BACKGROUND

Between 2008 and 2018, persons granted asylum (asylees) increased by 168% in the United States. Asylees are eligible for many of the same domestic benefits as refugees under the US Refugee Admissions Program (USRAP), including health-related benefits such as the domestic medical examination. However, little is known about the health of asylees to guide clinical practice.

METHODS

We conducted a retrospective cross-sectional analysis of domestic medical examination data from nine US sites from 2014 to 2016. We describe and compare demographics and prevalence of several infectious diseases such as latent tuberculosis infection (LTBI), hepatitis B and C, and select sexually transmitted infections and parasites by refugee or asylee visa status.

RESULTS

The leading nationalities for all asylees were China (24%) and Iraq (10%), while the leading nationalities for refugees were Burma (24%) and Iraq (19 %). Approximately 15% of asylees were diagnosed with LTBI, and 52% of asylee adults were susceptible to HBV infection. Prevalence of LTBI (Prevalence Ratio [PR]=0.8), hepatitis B (0.7), hepatitis C (0.5) and Strongyloides (0.5) infections were significantly lower among asylees than refugees. Prevalence of other reported conditions did not differ by visa status.

CONCLUSIONS

Compared to refugees, asylees included in our dataset were less likely to be infected with some infectious diseases but had similar prevalence of other reported conditions. The Centers for Disease Control and Prevention's Guidance for the US Domestic Medical Examination for Newly Arrived Refugees can also assist clinicians in the care of asylees during the routine domestic medical examination.

Cross-Cultural and Cross-Organizational Evidence for an Evolved Hazing Motivation

We report the first cross-cultural and cross-organizational evidence for an evolved hazing motivation. Using experiments performed in the United States, Japan, and among members of a hazing and a nonhazing organization, we demonstrate an invariant set of core hazing predictors. In particular, we show that the perception of near-term group benefits, which would have been ancestrally exploitable by new group members, substantially increases desired hazing severity in all samples. Results are discussed in light of human organizational psychology and the difficulty of reliably suppressing hazing behavior.

Canadian newcomer children's bone health and vitamin D status

Adequate calcium intake and supply of vitamin D during childhood play important roles in ensuring adequate bone mass gain to achieve optimal peak bone mass. The Healthy Immigrant Children study employed a mixed-method cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. This paper presents bone mineral content and vitamin D status data along with qualitative data that deepen the understanding of newcomer bone health status. A significantly higher percentage of refugee children (72.3%) had insufficient (<50 nmol/L) or deficient (<30 nmol/L) serum vitamin D compared with immigrants (53.2%). Vitamin D deficiency was most common among ethnic minority girls. Newcomer children with higher intakes of vitamin D, younger newcomer children, and those from western Europe or the United States had higher serum vitamin D levels. Immigrants had significantly higher mean total body bone mineral content compared with refugees. Total body fat, serum vitamin D, calcium intake, height, height by calcium intake, total body fat by calcium intake, and total body fat by height predicted total body bone mineral content levels. Vitamin D deficiency among newcomer children may be related to lack of knowledge regarding children's vitamin D requirements in the Canadian environment, dietary habits established in country of origin, low income that limits healthy dietary choices, and lifestyle habits that limit exposure to sunlight. Results suggest a need to screen newcomer children and pregnant women for vitamin D deficiency and support early intervention.

Healthcare provider perspectives on the uptake of the human papillomavirus vaccine among newcomers to Canada: a qualitative study

Human papillomavirus is among the most common sexually transmitted infections in the world. Newcomers, defined in Canada as foreign-born individuals who are either immigrants or refugees, but may also include students and undocumented migrants, face numerous barriers to HPV vaccination. This study sought to understand, from the perspective of healthcare providers, barriers and facilitators to HPV vaccination, and recommendations to improve HPV vaccine uptake among newcomers. Semi-structured interviews were conducted with 10 healthcare providers between March and April 2018. Data were analyzed at the manifest level using a Qualitative Content Analysis approach. Categories of barriers to vaccination included: access, communication, knowledge, culture, and provider-related factors. Facilitators included targeted health promotion; understanding the relevance of HPV vaccination; trusting the healthcare system; and cultural sensitivity. Two overarching recommendations were to publicly fund the HPV vaccine, and enhance language- and culturally-appropriate health promotion activities. Further research should explore informational desires and needs from the perspective of newcomers to inform strategies to promote equitable HPV vaccine coverage.

Don't abandon hope all ye who enter here: The protective role of formal mentoring and learning processes on burnout in correctional officers

BACKGROUND

Within a Job Demands-Resources Model framework, formal mentoring can be conceived as a job resource expressing the organization's support for new members, which may prevent their being at risk for burnout.

OBJECTIVE

This research aims at understanding the protective role of formal mentoring on burnout, through the effect of increasing learning personal resources. Specifically, we hypothesized that formal mentoring enhances newcomers' learning about job and social domains related to the new work context, thus leading to lower burnout.

METHODS

In order to test the hypotheses, a multiple regression analysis using the bootstrapping method was used.

RESULTS

Based on a questionnaire administered to 117 correctional officer newcomers who had a formal mentor assigned, our results confirm that formal mentoring exerts a positive influence on newcomers' adjustment, and that this in turn exerts a protective influence against burnout onset by reducing cynicism and interpersonal stress and also enhancing the sense of personal accomplishment.

CONCLUSIONS

Confirming previous literature's suggestions, supportive mentoring and effective socialization seem to represent job and personal resources that are protective against burnout. This study provides empirical support for this relation in the prison context.

A cross-sectional study of retrospectively reported seasonality in native and non-native residents of Chukotka and Turkmenistan

Seasonality represents a response of human mood, physiology, and behavior to annual variations in natural and social environment. A strong seasonal response is expected in non-native than native residents of such regions as Turkmenistan that is characterized by high air temperature in summer and Chukotka that is characterized by high-amplitude annual variation in both air temperature and day length. Seasonality was retrospectively reported by 732 residents of these regions. Self-reports on sleep-wake traits and mental and physical health were analyzed as possible confounding variables. The expectation of stronger seasonality in non-native residents was confirmed only for Chukotka samples. However, the native-non-native seasonality differences in this region paralleled the differences in several health scores, while native-non-native health difference in Turkmenistan was found to be non-significant. Given the possible role of such confounding factor as poor health in producing higher self-reported seasonality scores, caution must be taken when the conclusion is drawn from the results suggesting a reduced degree and severity of seasonality in native residents of Chukotka as compared to other native and non-native residents of the two regions.

Immunization and technology among newcomers: A needs assessment survey for a vaccine-tracking app

Objectives: Newcomers experience unique challenges with respect to vaccination. These challenges are compounded by the need to navigate complex vaccination catch-up schedules upon arrival in their new home countries. Our group has pioneered the development of CANImmunize, a free, bilingual, pan-Canadian digital application designed to empower individuals to manage their vaccination records. To inform how a vaccine tracking app such as CANImmunize might be tailored to meet the unique needs of newcomers, this study sought to determine commonly spoken languages, technology use, and current methods of vaccine tracking among recent newcomers to Canada.

Methods: Government-assisted refugees attending a health clinic in Ottawa, Canada were invited to complete a 17-question needs assessment survey. The survey captured data on household demographics, spoken languages, country of origin, technology use and methods used to track vaccination history.

Results: 50 newcomers completed the needs assessment survey. Arabic was the predominant language spoken by surveyed individuals. Although 92% of participants owned a smartphone, the majority did not actively use digital health applications. 18 (36%) participants reported being vaccinated before arriving in Canada. 27 (54%) participants were parents, 23 of whom reported that their children were vaccinated prior to arrival in Canada. 38 (76%) participants indicated that they would use a vaccine tracking app such as CANImmunize if it were translated into their primary language of communication.

Conclusions: The results of our study indicate that mobile technology may be a useful tool to help newcomer families stay on track with provincial and territorial immunization schedules.

"You Can See How Things Will End by the Way They Begin": The Contribution of Early Mutual Obligations for the Development of the Psychological Contract

This study explores dynamic processes in the development of the psychological contract, focusing on the interaction of obligations related to the two parties (i.e., employees' perceptions of both their own and the organization's obligations fulfillment) on attitudinal outcomes (organizational commitment and turnover intention) during the initial stage of the employment relationship. In a twofold cross-sectional and two-wave study on newly hired correctional police officers, we examined: (a) whether perception of organizational obligations fulfillment moderates the relationship between employee obligations and their attitudes (Study 1, n.500); (b) the direct and moderated influence of perceived obligations at the entrance stage on those in the following months (Study 2, n.223). Results confirmed that, in the eyes of the newcomer, the obligations fulfillment of each of the two parties interact, having an additional effect beyond the main direct effects, in influencing both subsequent obligations perceptions and, through this, the outcome variables. Theoretical and practical implications of the findings are discussed.

Exploring the evolved concept of NEWCOMER: experimental tests of a cognitive model

Enduring human coalitions face the adaptive problem of integrating new members. Although newcomers can provide benefits (e.g., additional labor), newcomers can also create costs (e.g., by free riding). Due to the unique adaptive problems they pose, we hypothesize that the mind contains an evolved concept of NEWCOMER. We test the design of this concept experimentally and show that the activation of the NEWCOMER concept elicits a variety of anti-free rider responses (e.g., a decrease in trust) with adaptively-targeted exceptions (e.g., a minimal increase in exclusion sentiment). These results support the hypothesis that the mind contains specialized concepts for understanding, creating, and sustaining intergenerational coalitions.

Characteristics of participants visiting the Canada on the move website

BACKGROUND

The Internet is a potential medium to attain large groups of Canadians for physical activity monitoring and interventions, however, little is known about the characteristics of participants who could be recruited on a national level. Our objectives were to determine: 1) the extent to which our sample was representative of the Canadian population; 2) the demographic, social-cognitive and physical activity behaviour, and environmental characteristics of one-time and multi-time users of the Canada on the Move website; and 3) whether certain recruitment strategies were more likely to reach specific demographic subgroups.

METHODS

Web-based self-report measures were collected on demographic, social-cognitive, physical activity behaviour, and environmental factors. Descriptive statistics were employed to address the study's research objectives.

RESULTS

Significant differences (p<0.001) were found between our total sample and 2001 Canadian census/Canadian Community Health Survey (CCHS) data on all demographic and physical activity behaviour measures. One-time and multi-time users significantly differed on age (p<0.005) and being responsible for children under age 13 (p=0.01). No differences existed between the groups on any of the social-cognitive, behavioural or environmental variables. Source of knowledge about the Canada on the Move website between one-time and multi-time users was not significantly different.

CONCLUSION

The Canada on the Move website presents a viable approach to reaching diverse demographic groups. Further work needs to be undertaken to: 1) develop engaging websites; 2) detail the monitoring of the web-based access information; 3) integrate the website with other organizations promoting physical activity; and 4) expand the number of recruitment sources.