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Van Dam L, Diab E, Johnson J. Canadian immigrants' oral health and oral health care providers' cultural competence capacity. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2024; 58:34-47. [PMID: 38505317 PMCID: PMC10946319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/23/2023] [Accepted: 11/22/2023] [Indexed: 03/21/2024]
Abstract
Background Immigrants to Canada count among the socially disadvantaged groups experiencing higher rates of oral disease. Culturally competent oral health care providers (OHCPs) stand to be allies for immigrant oral health. The literature reveals limited knowledge of practising OHCPs' cultural competency, and little synthesis of the topic has been completed. A scoping review is warranted to identify and map current knowledge of OHCPs' understanding of culturally competent care along with barriers and facilitators to developing capacity. Methods This study was conducted between December 2022 and April 2023 using Arksey and O'Malley's 5-step framework and PRISMA-ScR checklist. Four databases were searched using keywords related to 4 themes: population, provider, oral health, and cultural competence. Peer-reviewed articles published in English in the last 10 years were included. Results Search results yielded 74 articles. Title and abstract review was completed and an author-developed critical appraisal tool was applied. Forty-six (46) articles were subject to full-text review and 14 met eligibility criteria: 7 qualitative and 7 quantitative. Six barriers and six facilitators at individual and systemic levels were identified, affecting oral care for immigrants and providers' ability to work cross-culturally. Discussion Lack of cultural or linguistically appropriate resources, guidance, and structural supports were identified as contributing to low utilization of services and to lack of familiarity between providers and immigrants. Conclusion OHCPs' cultural competency development is required to improve oral health care access and outcomes for diverse populations. Further research is warranted to identify factors impeding OHCPs' capacity to provide culturally sensitive care. Intentional policy development and knowledge mobilization are needed.
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Affiliation(s)
- Lindsay Van Dam
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Elizabet Diab
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | - Jennifer Johnson
- School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
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Naous J. The Mental Health Crisis in Refugee Populations. Fam Med 2023; 55:140-142. [PMID: 36888667 PMCID: PMC10622010 DOI: 10.22454/fammed.2023.223919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jihane Naous
- Department of Community Health and Family Medicine, University of FloridaGainesville, FL
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3
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Goldenberg SM, Schafers S, Grassby MHS, Machado S, Lavergne R, Wiedmeyer ML. 'We don't have the right to get sick': A qualitative study of gaps in public health insurance among Im/migrant women in British Columbia, Canada. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001131. [PMID: 36962991 PMCID: PMC10022316 DOI: 10.1371/journal.pgph.0001131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023]
Abstract
Globally, the exclusion of im/migrants from public health care systems remains a significant health and human rights issue, calling into question claims of 'universality' of public health systems where eligibility for coverage is determined by immigration status. We aimed to describe lived experiences of health insurance coverage and the health and social impacts of gaps in health insurance amongst im/migrant women in British Columbia (BC), Canada. This analysis draws on qualitative in-depth interviews (n = 78) with im/migrant women and im/migrant-focused service providers (n = 10) conducted between July 2018-March 2021 in Metro Vancouver, BC, as part of a larger community-based, mixed-methods study of im/migrants' health access (IRIS). In contrast to common perceptions of Canada's health system as 'universal', participants faced multifaceted barriers to health insurance and necessary healthcare for themselves and their families following arrival in BC. Narratives highlighted the ways in which ineligibility for public health insurance coverage resulted in unmet needs for essential sexual and reproductive health and preventive care among im/migrant women, children, and families. Participants also described ineligibility for public health insurance as resulting in a high economic burden, and that exclusion from public health insurance perpetuated experiences of discrimination, invisibility, and exclusion from systems of care amongst im/migrant participants. Despite these structural challenges, participant narratives highlighted the crucial role of community-based supports for minimizing harm and navigating oppressive immigration and health systems. Changes to immigration and health policies are required to remove barriers to public health care for im/migrant women and ensure that Canada's health system is accessible to all. Expanding health insurance options to cover all residents and decoupling health insurance eligibility from immigration status are recommended, alongside implementation of 'Sanctuary' policies at the local level.
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Affiliation(s)
- Shira M Goldenberg
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, CA, United States of America
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Shaina Schafers
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Maggie Hamel-Smith Grassby
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Stefanie Machado
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Ruth Lavergne
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mei-Ling Wiedmeyer
- Centre for Gender and Sexual Health Equity, St. Paul's Hospital, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, University Boulevard, Vancouver, BC, Canada
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Cabieses B, Obach A, Blukacz A, Carreño A, Pérez C, Vicuña JT, Stefoni C, Avaria A. Recursos y vulnerabilidades de comunidades migrantes en Chile para enfrentar la pandemia SARS-CoV-2. Rev Salud Publica (Bogota) 2022. [DOI: 10.15446/rsap.v24n4.99551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objetivo Conocer, en contexto de la pandemia por SARS-CoV-2, las vulnerabilidades psicosociales y socioeconómicas de la población migrante internacional en Chile y los recursos y capitales sociales reportados desde la propia comunidad.
Métodos Estudio cualitativo descriptivo. Se realizaron 40 entrevistas semiestructuradas a migrantes (N=30) e informantes claves (N=10), ejecutadas virtualmente durante el 2020. El material fue analizado mediante análisis temático. El proyecto fue aprobado por el Comitè de Ètica Científico de la Facultad de Medicina de la Universidad del Desarrollo.
Resultados Como principales vulnerabilidades enfrentadas por parte de personas migrantes en pandemia se identifican: hacinamiento, precariedad laboral y necesidades económicas, uso del transporte público, desinformación y creencias en torno al COVID-19, discriminación, falta de redes de apoyo, y estatus migratorio. Como recursos se reconocen: contar con redes de apoyo, posibilidad de teletrabajo o salir a trabajar, acceso a información y a la red asistencial y municipal, apoyo gubernamental y de la sociedad civil. Adicionalmente, se reportan experiencias de diagnóstico de COVID-19, identificando dificultades en acceso a PCR y adaptaciones familiares y laborales como cambios en los hábitos de vida dentro y fuera del hogar.
Discusión El estudio entrega información relevante e inédita para la construcción de políticas en salud para migrantes internacionales con foco en crisis sanitarias. Se destaca la necesidad de fortalecer adecuaciones interculturales en las estrategias de prevención del contagio y de promoción de la salud y aumentar la disponibilidad de respuesta en el acceso a salud en el marco de la pandemia, mitigando así la vulnerabilidad social en migrantes y potenciando sus recursos de afrontamiento.
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Cervical Cancer Screening by Refugee Category in a Refugee Health Primary Care Clinic in Calgary, Canada, 2011-2016. J Immigr Minor Health 2022; 24:1534-1542. [PMID: 35233682 DOI: 10.1007/s10903-022-01345-5] [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: 02/07/2022] [Indexed: 10/19/2022]
Abstract
Newly arrived refugees and refugee claimants experience low cervical cancer screening (CCS) rates in Canada. We investigated CCS at a dedicated refugee clinic. We completed a retrospective cohort study among patients at the Mosaic Refugee Health Clinic in Calgary, Canada, between 2011 and 2016. We investigated CCS offers and completion by refugee category. We then used multivariable logistic regression to estimate the association of CCS screening and refugee category, accounting for sociodemographic and clinical factors. We included 812 refugees. Most were married (71%) and had limited English proficiency (57%). Overall, 88% and 77% of patients were offered and completed screening, respectively. Compared to government assisted refugees, privately sponsored refugees completed CCS more often (OR 1.60, 95% CI [1.02-2.49]). A dedicated refugee clinic may provide effective CCS to newly arrived refugees irrespective of refugee category, insurance status or other barriers.
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6
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Odhiambo AJ, Forman L, Nelson LE, O'Campo P, Grace D. Unmasking legislative constraints: An institutional ethnography of linkage and engagement in HIV healthcare for African, Caribbean, and Black people in Ontario, Canada. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000714. [PMID: 36962554 PMCID: PMC10021522 DOI: 10.1371/journal.pgph.0000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/26/2022] [Indexed: 11/19/2022]
Abstract
The Human Immunodeficiency Virus (HIV) epidemic significantly impacts African, Caribbean, and Black (ACB) immigrants in Canada. Health scholarship has revealed striking injustices within Canada's public healthcare system that restrict access to healthcare and violate the human rights of ACB immigrants living with HIV who are marginalized. We conducted an institutional ethnography to comprehensively understand how HIV healthcare in Ontario is organized and experienced by ACB immigrants, focusing on unjust and discriminatory legislative frameworks and institutional practices regulating access to publicly funded healthcare resources and services. We interviewed 20 ACB immigrants and 15 healthcare workers, including specialists, primary care providers, immigration physicians, and social workers. We found a disjuncture between the organization of HIV healthcare in Ontario and how ACB immigrants experienced access to care. We uncovered how immigration, public health and healthcare laws and related institutional practices intersect to produce structural violence which create barriers and missed opportunities to timely linkage and engagement in HIV healthcare. Black immigrants' accounts revealed that they underwent mandatory HIV under the Immigration Medical Examination policy (IME) without providing informed consent and receiving pre and post-test counselling. Furthermore, Black immigrants did not receive referrals and were not adequately linked to care following HIV diagnosis. Troubling encounters with immigration and public health state agents and healthcare legislative barriers including difficulty finding a physician, the 3-month waiting period under the Ontario Health Insurance Plan (OHIP), long wait times, lack of drug coverage, and stigma, discrimination, and anti-Black racism shaped and affected Black people's linkage and engagement in HIV care. We elucidate how the legislative and structural organization of healthcare regulated and constrained health service access for ACB immigrants living with HIV, including their ability to "achieve" HIV undetectability.
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Affiliation(s)
- Apondi J Odhiambo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Forman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - LaRon E Nelson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Yale School of Nursing, New Haven, Connecticut, United States of America
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- St, Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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7
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Factors Associated with Condom Knowledge, Attitude, and Use among Black Heterosexual Men in Ontario, Canada. ScientificWorldJournal 2021; 2021:8862534. [PMID: 34566521 PMCID: PMC8463252 DOI: 10.1155/2021/8862534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 04/03/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Abstract
African, Caribbean, and Black (ACB) men living in Canada share a heightened risk of HIV infection and the associated risk factors such as suboptimal use of family planning services such as condom use. In this study, we assessed the factors associated with knowledge, attitude, and condom use among ACB men in Ontario. Methods. This was a cross-sectional study that surveyed heterosexual ACB men regardless of their residency status living in Ontario (n = 430). This is a part of a larger mixed methods study informed by critical race theory, intersectionality, and community-based participatory research (CBPR). Outcome variables were knowledge of condom use, attitude towards condom use, and actual use of condom during the last 12 months. Results. Of 430 participants, 77.70% has good knowledge of condom use as a protection against HIV transmission, 31.77% had positive attitude towards condom use, and 62.43% reported using condom regularly with casual partners during the last 12 months. Men who were currently married had more positive attitude towards condom use compared with their unmarried counterparts (odds ratio = 1.46, 95% CI = 1.20, 1.78). Canadian residents were found to have higher odds of having correct knowledge of condom (odds ratio = 1.31, 95% CI = 1.11, 1.55), and positive attitude towards condom use (odds ratio = 1.44, 95%CI = 1.09, 1.92). Men who visited sexual health clinics showed a positive association with having correct knowledge of condom (odds ratio = 1.78, 95% CI = 1.30, 2.44) and reported experiences of difficulty in accessing sexual health. This showed a negative association towards condom use (odds ratio = 0.45, 95% CI = 0.21, 0.97]. Conclusion. A considerable percentage of heterosexual ACB men did not have correct knowledge regarding the protective effect of condom use against HIV and positive attitude towards the use of condom. Several sociodemographic and healthcare-related factors were significantly associated with knowledge, attitude, and use of condom.
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Rousseau C, Rummens JA, Frounfelker RL, Yebenes MRC, Cleveland J. Canadian Health Personnel Attitudes Toward Refugee Claimants' Entitlement to Health Care. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2021; 23:1341-1356. [PMID: 34522190 PMCID: PMC8429477 DOI: 10.1007/s12134-021-00892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/03/2022]
Abstract
Health care personnel attitudes toward refugee claimant entitlement to health care are influenced by multilevel factors including institutional and societal culture. Although individual attitudes may be modified through training, macro- and meso-issues require system-level interventions. This paper analyzes the role of individual-, institutional-, and city-level factors in shaping attitudes toward refugee claimants' access to health care among Canadian health care personnel. A total of 4207 health care personnel in 16 institutions located in Montreal and Toronto completed an online survey on attitudes regarding health care access for refugee claimants. We used multilevel logistic regression analysis to identify individual-, institutional-, and city-level predictors of endorsing access to care. Participants who had prior contact with refugee claimants had greater odds of endorsing access to care than those who did not (OR 1.13; 95% CI 1.05, 1.21). Attitudes varied with occupation: social workers had the highest probability of endorsing equal access to health care (.83; 95% CI .77, .89) followed by physicians (.77; 95% CI .71, .82). An estimated 7.97% of the individual variation in endorsement of equal access to health care was attributable to differences between institutions, but this association was no longer statistically significant after adjusting for city residence. Results indicate that the contexts in which health care professionals live and work are important when understanding opinions on access to health care for vulnerable populations. They suggest that institutional interventions promoting a collective mission to care for vulnerable populations may improve access to health care for precarious status migrants.
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Affiliation(s)
- Cécile Rousseau
- Department of Psychiatry, McGill University, CIUSSS Centre-Ouest de L'Ile-de-Montréal, QC H3N 1Y9 Montreal, Canada
| | | | - Rochelle L Frounfelker
- Department of Psychiatry, McGill University, CIUSSS Centre-Ouest de L'Ile-de-Montréal, QC H3N 1Y9 Montreal, Canada
| | - Monica Ruiz Casares Yebenes
- Department of Psychiatry, McGill University, CIUSSS Centre-Ouest de L'Ile-de-Montréal, QC H3N 1Y9 Montreal, Canada
| | - Janet Cleveland
- Sherpa Research Centre, CIUSSS Centre-Ouest de L'Ile-de-Montréal, Montreal, QC Canada
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9
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Maillet L, Champagne G, Déry J, Goudet A, Charest S, Abou-Malham S, Desjardins F, Touati N, Duhoux A, Jouego Fotso AC, Doré C, Roy B, Gagnon S, Lane J. Implementation of an intersectoral outreach and community nursing care intervention with refugees in Quebec: A protocol study. J Adv Nurs 2021; 77:4586-4597. [PMID: 34423471 DOI: 10.1111/jan.15022] [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: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Abstract
AIM To establish and assess an intersectoral local network focused on the roles of registered nurses and primary healthcare nurse practitioners to ensure the continuity of care and service pathways for refugees in Quebec. DESIGN Developmental evaluation with a mixed methodology. METHODS The qualitative component will include: (1) a document review; (2) observations of participants during meetings of different governance structures; (3) semi-structured interviews with key actors (n = 40; 20/neighbourhood interventions); and (4) focus groups with end users of the services (refugees) (n = 4; 6 to 8 participants per group). The quantitative component will be based on: (1) a data sheet on health and social interventions for refugees users filled in by registered nurses, primary healthcare nurse practitioners and physicians and (2) data analysis of the clinical-administrative database since 2012. This study received funding in June 2019 and Research Ethics Committee approval was granted in July 2020. DISCUSSION In Quebec, refugee vulnerability is exacerbated by the lack of integration of existing resources and the lack of access to care and continuity of services. To address these issues, an integrated local network for refugees must be developed. Additionally, we will explore the role of registered nurses and their collaboration with primary healthcare nurse practitioners. IMPACT This study will provide recommendations on how to optimize the scopes of practice of registered nurses and primary healthcare nurse practitioners, adapt care and services and develop a local intersectoral network to better meet the complex needs of refugees. It will evaluate the use and the appreciation of new services for targeted populations (neighbourhoods and refugees) and aim to improve the accessibility, continuity and user experience of all health services for those populations.
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Affiliation(s)
- Lara Maillet
- National School of Public Administration, Montreal, Canada.,Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada
| | | | | | - Anna Goudet
- National School of Public Administration, Montreal, Canada.,Institut national de la recherche scientifique, Montreal, Canada
| | - Stéphanie Charest
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Centre intégré universitaire de santé et des services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Sabina Abou-Malham
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Université de Sherbrooke, Longueuil, Canada
| | - France Desjardins
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Centre intégré universitaire de santé et des services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Canada
| | - Nassera Touati
- National School of Public Administration, Montreal, Canada
| | | | | | - Chantal Doré
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Université de Sherbrooke, Sherbrooke, Canada
| | | | - Suzanne Gagnon
- Université Laval, Quebec, Canada.,Centre intégré universitaire de santé et des services sociaux de la Capitale-Nationale, Université Laval, Quebec, Canada
| | - Julie Lane
- Institut Universitaire de première ligne en santé et services sociaux, Sherbrooke, Canada.,Université de Sherbrooke, Sherbrooke, Canada
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10
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Rivera JMB, Puyat JH, Wiedmeyer ML, Lavergne MR. Primary Care and Access to Mental Health Consultations among Immigrants and Nonimmigrants with Mood or Anxiety Disorders: Soins de première ligne et accès aux consultations en santé mentale chez les immigrants et les non-immigrants souffrant de troubles de l'humeur ou anxieux. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:540-550. [PMID: 32878459 PMCID: PMC8138741 DOI: 10.1177/0706743720952234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the association between usual place of primary care and mental health consultation among those with self-reported mood or anxiety disorders. We also describe access to mental health services among people who are recent immigrants, longer-term immigrants, and nonimmigrants and determine whether the association with place of primary care differs by immigration group. METHODS We used data from the Canadian Community Health Survey (2015 to 2016) to identify a representative sample of individuals with self-reported mood or anxiety disorders. We used logistic regression, with models stratified by immigration group (recent, longer-term, nonimmigrant), to examine the association between usual place of primary care and receiving a mental health consultation in the previous 12 months. RESULTS Higher percentages of recent and longer-term immigrants see a doctor in solo practice, and a higher percentage of recent immigrants use walk-in clinics as a usual place of care. Compared with people whose usual place of care was a community health center or interdisciplinary team, adjusted odds of a mental health consultation were significantly lower for people whose usual place of care was a solo practice doctor's office (AOR = 0.71; 95% CI, 0.62 to 0.82), a walk-in clinic (AOR = 0.75; 95% CI, 0.66 to 0.85), outpatient clinic/other place (AOR = 0.72 95% CI, 0.59 to 0.88), and lowest among people reporting no usual place other than the emergency room (AOR = 0.59; 95% CI, 0.51 to 0.67). Differences in access to mental health consultations by usual place of primary care were greatest among immigrants, especially recent immigrants. CONCLUSIONS People with mood or anxiety disorders who have access to team-based primary care are more likely to report mental health consultations, and this is especially true for immigrants. Expanded access to team-based primary health care may help reduce barriers to mental health services, especially among immigrants.
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Affiliation(s)
- Joanna Marie B Rivera
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada
| | - Joseph H Puyat
- Faculty of Medicine, Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mei-Ling Wiedmeyer
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada.,Faculty of Medicine, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Gender & Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
| | - M Ruth Lavergne
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada.,Centre for Gender & Sexual Health Equity (CGSHE), Vancouver, British Columbia, Canada
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11
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Frounfelker RL, Rahman S, Cleveland J, Rousseau C. A Latent Class Analysis of Attitudes Towards Asylum Seeker Access to Health Care. J Immigr Minor Health 2021; 24:412-419. [PMID: 33893935 DOI: 10.1007/s10903-021-01204-9] [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] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
In the past decade there has been an increase in focus on the concept of deservingness and how it plays out in debates around health care for migrant populations with precarious legal status. This study uses latent class analysis to identify subtypes of attitudes regarding asylum seeker access to health care and endorsement of support for asylum seeker access to care among 4066 employees of health care institutions in Montreal and Toronto, Canada. Authors identified four classes of attitudes towards asylum seeker access to care named 'Favorable,' 'Opposed,' 'Ambivalent/Reactive,' and 'Unconcerned/Status quo'. The odds of endorsing access to health care depended on the individual's class membership of asylum seeker attitude. Although there are segments of the population that overwhelmingly endorse, or reject, asylum seeker access to care, there are important variants in opinions and beliefs. Interventions are needed to engage professionals more ambivalent or opposed to asylum seeker access to care.
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Affiliation(s)
- Rochelle L Frounfelker
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
| | - Samiha Rahman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Janet Cleveland
- SHERPA Research Centre, CIUSSS Centre-Ouest de l'Ile de Montréal, McGill University, Montreal, QC, Canada
| | - Cecile Rousseau
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
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12
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Abdelaal M, Blake C, Lau J. Challenges of Providing Palliative and End-of-Life Care to Refugee Claimants in Canada: A Case Report. J Palliat Med 2020; 24:635-638. [PMID: 33196336 DOI: 10.1089/jpm.2020.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Refugees are a highly vulnerable marginalized population with unique medical and psychosocial needs. Unfortunately, the Interim Federal Health Program (IFHP) in Canada partially covers the medical needs of refugee claimants but does not include hospice or home-based palliative care. This report describes the case of a refugee claimant cancer patient who was admitted to an inpatient tertiary cancer center medical oncology ward in Ontario, Canada, for ∼11 months due to insufficient community-based palliative care resources available for patients covered by the IFHP. This case report highlights the differences in palliative care coverage between the provincial health care coverage, Ontario Health Insurance Plan, and federal health care coverage for refugees, IFHP, from a practical point of view, how this can affect the palliative care available for patients and their families, and the impact on the Canadian health care system.
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Affiliation(s)
- Mohamed Abdelaal
- Department of Palliative Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Palliative Care, Department of Supportive Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Christopher Blake
- Division of Palliative Care, Department of Supportive Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Lau
- Division of Palliative Care, Department of Supportive Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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13
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The Challenges of the Health Care Providers in Refugee Settings: A Systematic Review. Prehosp Disaster Med 2019; 34:188-196. [DOI: 10.1017/s1049023x19000190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background:All over the world, migration is affecting millions of people who either choose or are forced to leave their countries of origin. Health is considered to be one of the important aspects of migration that is highly influenced by the circumstances created by mobility within or across countries. In the context of forced migration, it is well-established that refugees are susceptible to various diseases and other health conditions which might occur or deteriorate based on the health systems and health care provision in receiving countries. There is a considerable amount of research on the challenges encountered by refugees in receiving countries, in terms of health care systems and services. However, there seems to be little focus on the health care providers’ perspectives of the challenges in health care provision in refugee settings. This review aims to explore some of the articles discussing the challenging issues surrounding refugee health from a provider’s perspective.Methods:A systematic review was conducted through five main online databases: Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA); Science Direct (Elsevier; Amsterdam, Netherlands); Scopus (Elsevier; Amsterdam, Netherlands); Sage (Sage Publications; Thousand Oaks, California USA); and Google Scholar (Google Inc.; Mountain View, California USA), including only the articles published in English. In addition, grey literature resources available online were used.Results:Forty-eight articles were included in this review, mainly based on the amount of emphasis they placed on providers’ viewpoints in refugee health settings. Most of the articles were retrieved based on their availability in the databases which Hacettepe University (Ankara, Turkey) is subscribed to. Almost all of the articles mentioned the challenges caused by linguistic and cultural barriers, and some focused on providers’ limited knowledge and skills, as well as inefficient health care systems. There was little emphasis on ethical discussions, and the physical and emotional impact of caring for refugees on health care professionals. In the few articles discussing ethical and personal dimensions, issues concerning stress, burnout, and safety risks were found to be the recurring themes.Conclusions:Evidence gathered suggests that the challenges faced by health care providers involve a variety of factors that are specific to health care settings involving refugees, such as linguistic and cultural barriers, and a lack of proper support and training. It seems that the challenges that health care providers face in refugee settings could be further investigated both from professional and personal aspects for a better understanding of refugee health care.Kavukcu N, Altıntaş KH. The challenges of the health care providers in refugee settings: a systematic review. Prehosp Disaster Med. 2019;34(2):188–196
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Robert E, David PM. “Healthcare as a refuge”: building a culture of care in Montreal for refugees and asylum-seekers living with HIV. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2019. [DOI: 10.1108/ijhrh-01-2018-0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Between 2012 and 2016, the Government of Canada modified health insurance for refugees and asylum seekers. In Quebec, this resulted in refusals of care and uncertainties about publicly reimbursed services, despite guaranteed coverage for people with this status under the provincial plan. The Chronic Viral Illness Service (CVIS) at the McGill University Health Centre in Montreal continued to provide care to refugees and asylum seekers living with HIV. The purpose of this paper is to explain how and why challenges brought by this policy change could be overcome.
Design/methodology/approach
A qualitative case study was conducted using interviews with patients and staff members, observation sessions and a review of media, documents and articles. A discussion group validated the interpretation of preliminary results.
Findings
The CVIS provides patient-centered care through a multidisciplinary team. It collectively responds to medical, social and legal issues specific to refugees. Its organizational culture and expertise explain the sustained provision of care. The team’s empathetic view of patients, anchored in the service’s history, care for men who have sex with men and commitment to human rights, is key. A culture of care developed over time thanks to the commitment of exemplary figures. Because they countered the team’s values, changes in refugee healthcare coverage strengthened the service’s culture of care. However, the healthcare system reform launched in 2014 in Quebec is perceived as jeopardizing the culture of care, as it makes, refugee and asylum-seeker patients a non-lucrative venture for providers.
Originality/value
This research analyzes the origin of sustained provision of care to refugees and asylum seekers living with HIV through the lens of culture of care. It considers the historical and political contexts in which this culture developed.
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Keboa MT, Hovey R, Nicolau B, Esfandiari S, Carnevale F, Macdonald ME. Oral healthcare experiences of humanitarian migrants in Montreal, Canada. Canadian Journal of Public Health 2019; 110:453-461. [PMID: 30850954 DOI: 10.17269/s41997-019-00193-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/06/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand the oral healthcare experiences of humanitarian migrants in Montreal and their perceptions of ways to improve access to oral healthcare. METHODS We used focused ethnography informed by a public health model of the dental care process. The adapted McGill Illness Narrative Interview (MINI) guided interviews of a purposeful sample of humanitarian migrants who received or needed dental care in Montreal. Each interview (50-60 min) was audio-recorded for verbatim transcription. Observation of dental care episodes occurred during mobile dental clinics in underserved communities over the same period (2015-2016). Data analysis combined deductive codes from the theoretical frameworks and inductive codes from interview transcripts and field notes to inform themes. RESULTS We interviewed 25 participants (13 refugees and 12 asylum seekers) from 10 countries, who had been in Canada for a range of 1 month to 5 years. The dental care experiences of participants included delayed consultation, proximity to dental clinics, quality care, limited treatment choices, high cost, and long waiting times. A more inclusive healthcare policy, lower fees, integration of dental care into public insurance, and creation of community dental clinics were proposed strategies to improve access to dental care. CONCLUSION Humanitarian migrants in this study experienced inadequate oral healthcare. Their lived experiences help us to identify gaps in the provision of oral healthcare services, and suggestions of participants have great potential to improve access to oral healthcare.
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Affiliation(s)
- Mark Tambe Keboa
- Faculty of Dentistry, McGill University, #500-2001 McGill College, Montréal, QC, H3A 1G1, Canada.
| | - Richard Hovey
- Faculty of Dentistry, McGill University, #500-2001 McGill College, Montréal, QC, H3A 1G1, Canada
| | - Belinda Nicolau
- Faculty of Dentistry, McGill University, #500-2001 McGill College, Montréal, QC, H3A 1G1, Canada
| | - Shahrokh Esfandiari
- Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Franco Carnevale
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Mary Ellen Macdonald
- Faculty of Dentistry, McGill University, #500-2001 McGill College, Montréal, QC, H3A 1G1, Canada
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Subedi A, Edge DS, Goldie CL, Sawhney M. Resettled Bhutanese Refugees in Ottawa: What Coping Strategies Promote Psychological Well-Being? Can J Nurs Res 2019; 51:168-178. [DOI: 10.1177/0844562119828905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Since 2008, Bhutanese refugees have been resettled in Canada, including Ottawa. This relocation and resettling process is associated with significant physical and psychological stress, as individuals acclimatize to a new country. Purpose To assess the relationship between coping strategies and psychological well-being of Bhutanese refugees resettled in Ottawa. Methods A cross-sectional survey utilizing a convenience sample of adults (n = 110) was conducted in the fall of 2015 in Ottawa. Two tools, Brief COPE and general well-being schedule were used. Results Bhutanese refugees were in moderate distress. Using multiple linear regression, age, education, and three coping strategies (positive reframing, self-blame, and venting) were identified as predictors of general well-being ( F (11, 96) = 3.61, p < .001, R2 = 21.2%). Higher levels of education and positive reframing were associated with greater general well-being scores, while self-blame and well-being between ages 41 and 50 years were inversely associated with general well-being. Conclusions Findings suggest that a broad intersectorial approach between nurses and partner agencies is needed to enhance the mental health of this population for better adjustment in the host country. Nurses could provide support and counseling to minimize the use of self-blame and venting and promote positive coping strategies.
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Affiliation(s)
- Anita Subedi
- School of Nursing, Queen’s University, Kingston, ON, Canada
| | - Dana S. Edge
- School of Nursing, Queen’s University, Kingston, ON, Canada
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Moreau AM, Hennous F, Dabbagh B, Ferraz Dos Santos B. Oral Health Status of Refugee Children in Montreal. J Immigr Minor Health 2018; 21:693-698. [PMID: 30406328 DOI: 10.1007/s10903-018-0835-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study aimed to assess the oral health status of refugee children in comparison with that of Canadian children. In addition, we investigated the extent to which demographic factors are associated with caries experience in this population. Children with a confirmed refugee status and Canadian children (control group) matched for age and sex composed the study population. A comprehensive review of dental charts was completed to assess children's demographic data, caries experience, oral hygiene and gingival health status. The majority of refugee children had never seen a dentist before their arrival to Canada. Refugee children had significant higher dmft/DMFT scores than Canadian children (7.29 ± 5.1 and 4.47 ± 5, respectively; p < 0.0001). Furthermore, individual factors, such as refugee status (OR = 5.08; 95% CI = 2.31-11.1) and child age (OR = 2.17; 95% CI = 1.04-4.51) were significantly associated with caries experience. Access to appropriate dental care to refugee children should be a key priority for health care providers and policy makers.
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Affiliation(s)
- Anne-Marie Moreau
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada
| | - Fatima Hennous
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada
| | - Basma Dabbagh
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada
| | - Beatriz Ferraz Dos Santos
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, 1040 Atwater Avenue, Montreal, QC, H3Z 1X3, Canada.
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Kahn S, Alessi EJ, Kim H, Woolner L, Olivieri CJ. Facilitating Mental Health Support for LGBT Forced Migrants: A Qualitative Inquiry. JOURNAL OF COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jcad.12205] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sarilee Kahn
- School of Social Work; McGill University; Montreal Quebec Canada
| | | | - Hanna Kim
- School of Social Work; McGill University; Montreal Quebec Canada
| | - Leah Woolner
- School of Social Work; McGill University; Montreal Quebec Canada
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Rink N, Muttalib F, Morantz G, Chase L, Cleveland J, Rousseau C, Li P. The gap between coverage and care-what can Canadian paediatricians do about access to health services for refugee claimant children? Paediatr Child Health 2017; 22:430-437. [PMID: 29479260 DOI: 10.1093/pch/pxx115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction In June 2012, the government of Canada severely restricted the scope of the Interim Federal Health Program that had hitherto provided coverage for the health care needs of refugee claimants. The Quebec government decided to supplement coverage via the provincial health program. Despite this, we hypothesized that refugee claimant children in Montreal would continue to experience significant difficulties in accessing basic health care. Objectives (1) Report the narrative experiences of refugee claimant families who were denied health care services in Montreal following June 2012, (2) describe the predominant barriers to accessing health care services and understanding their impact using thematic analysis and (3) derive concrete recommendations for child health care providers to improve access to care for refugee claimant children. Methods Eleven parents recruited from two sites in Montreal participated in semi-structured interviews designed to elicit a narrative account of their experiences seeking health care. Interviews were recorded, transcribed, coded using NVivo software and subjected to thematic analysis. Results Thematic analysis of the data revealed five themes concerning barriers to health care access: lack of continuous health coverage, health care administrators/providers' lack of understanding of Interim Federal Health Program coverage, refusal of services or fees charged, refugee claimants' lack of understanding about health care rights and services and language barriers, and four themes concerning the impact of denial of care episodes: potential for adverse health outcomes, psychological distress, financial burden and social stigma. Conclusion We propose eight action points for advocacy by Canadian paediatricians to improve access to health care for refugee claimant children in their communities and institutions.
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Affiliation(s)
- N Rink
- Department of Paediatrics, The Montreal Children's Hospital, McGill University, Montreal, Quebec
| | - F Muttalib
- Department of Paediatrics, The Montreal Children's Hospital, McGill University, Montreal, Quebec
| | - G Morantz
- Department of Paediatrics, The Montreal Children's Hospital, McGill University, Montreal, Quebec
| | - L Chase
- School of Oriental and African Studies, University of London, London, UK
| | - J Cleveland
- CSSS de la Montagne - Centre de recherche et de formation, Montreal, Quebec
| | - C Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montreal, Quebec
| | - P Li
- Department of Paediatrics, The Montreal Children's Hospital, McGill University, Montreal, Quebec
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Newbold B, McKeary M. Investigating the diversity of Canada’s refugee population and its health implications: does one size fit all? INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2017. [DOI: 10.1108/ijmhsc-02-2015-0007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Based on a case study in Hamilton, Ontario, Canada, the purpose of this paper is to explore the difficulties faced by local health care providers in the face of constantly evolving refugee policies, programs, and arrivals. In doing so, it illustrates the complications faced by service providers in providing care to refugee arrivals and how the diversity of arrivals challenges health care provision and ultimately the health and well-being of refugees.
Design/methodology/approach
A series of semi-structured, in-depth interviews with key service professionals in both the social service and health fields in Hamilton, Ontario, Canada, examined both health and health care issues.
Findings
Beyond challenges for service providers that have been previously flagged in the literature, including language barriers and the limited time that they have with their clients, analysis revealed that health care providers faced other challenges in providing care, with one challenge reflecting the difficulty of providing care and services to a diverse refugee population. A second challenge reflected the lack of knowledge associated with constantly evolving policies and programs. Both challenges potentially limit the abilities of care providers.
Research limitations/implications
On-going changes to refugee and health care policy, along with the diversity of refugee arrivals, will continue to challenge providers. The challenge, therefore, for health care providers and policy makers alike is how to ensure adequate service provision for new arrivals.
Practical implications
The Federal government should do a better job in disseminating the impact of policy changes and should streamline programs. This is particularly relevant given limited budgets and resources, tri-partite government funding, short time-frames to prepare for new arrivals, inadequate background information, barriers/challenges or inequitable criteria for access to health and social services, while addressing an increasingly diverse and complex population.
Social implications
The research reinforces the complexity of the needs and challenges faced by refugees when health is considered, and the difficulty in providing care to this group.
Originality/value
While there is a large refugee health literature, there is relatively little attention to the challenges and difficulties faced by service providers in addressing the health needs of the diverse refugee population, a topic that is particularly important given limited funding envelopes, shifting policies and programs, and a focus on clients (refugees). It is this latter piece – the challenges faced by providers in providing care to refugees – which this paper explores.
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Chase LE, Cleveland J, Beatson J, Rousseau C. The gap between entitlement and access to healthcare: An analysis of “candidacy” in the help-seeking trajectories of asylum seekers in Montreal. Soc Sci Med 2017; 182:52-59. [DOI: 10.1016/j.socscimed.2017.03.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 03/16/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
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