Research Library

Despite rising forced displacement globally, refugees’ health and research priorities are largely unknown. We investigated whether a diverse refugee committee could utilize participatory methods to identify health priorities and a research agenda to address them. We conducted a qualitative study with focus groups of current and former refugees, asylum claimants and evacuees from a specialized refugee clinic over a year. We collected sociodemographic data using standardized instruments, then utilized a four-step nominal group technique process (idea generation, recording, discussion, and voting) to identify and rank participants’ health and research priorities. Participants ranked their top five priorities across three time periods: Pre-migration/early arrival (0–3 months), post-migration (3 months–2 years), and long-term health (>2 years). Participants created overarching priorities and corroborated findings via a member checking step. Twenty-three participants (median age 35 years) attended one or more of five focus groups. Twenty-one completed sociodemographic surveys: 16/21 (76%) were women, representing 8 countries of origin. Twelve participants completed the member checking process, affirming the results with minor clarifications. This proof-of-concept study illustrates how refugees can use a rigorous consensus process without external influence to prioritize their healthcare needs, direct a health research agenda to address those needs, and co-produce research. These low-cost participatory methods should be replicated elsewhere. Despite rising forced displacement globally, refugees’ health and research priorities are largely unknown. We investigated whether a diverse refugee committee could utilize participatory methods to identify health priorities and a research agenda to address them. We conducted a qualitative study with focus groups of current and former refugees, asylum claimants and evacuees from a specialized refugee clinic over a year. We collected sociodemographic data using standardized instruments, then utilized a four-step nominal group technique process (idea generation, recording, discussion, and voting) to identify and rank participants’ health and research priorities. Participants ranked their top five priorities across three time periods: Pre-migration/early arrival (0–3 months), post-migration (3 months–2 years), and long-term health (>2 years). Participants created overarching priorities and corroborated findings via a member checking step. Twenty-three participants (median age 35 years) attended one or more of five focus groups. Twenty-one completed sociodemographic surveys: 16/21 (76%) were women, representing 8 countries of origin. Twelve participants completed the member checking process, affirming the results with minor clarifications. This proof-of-concept study illustrates how refugees can use a rigorous consensus process without external influence to prioritize their healthcare needs, direct a health research agenda to address those needs, and co-produce research. These low-cost participatory methods should be replicated elsewhere.
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As the newcomer population in Canada continues to grow, we aimed to collaborate with newcomer families arriving in an urban center in Alberta, Canada to identify strategies to overcome identified barriers newcomers face in obtaining routine childhood vaccines (RCVs). Methods: We recruited newcomers living in Calgary, Alberta to participate in a workshop utilizing the Nominal Group Technique (NGT) to develop solutions addressing barriers to obtaining RCVs. Ranking exercises helped identify the top-proposed interventions based on perceived impact and feasibility for implementation. Based on the identified need for translated vaccine resources, infographics on school-based vaccines were developed. The infographics were pilot-tested in a first-language focus group before the final product was translated into 10 different languages. Results: Consensus from 15 NGT workshop participants identified five key solutions to facilitate obtaining routine childhood immunizations: (1) Increasing access to reliable vaccine information; (2) Ensuring vaccine information and healthcare services are available in different languages; (3) Increasing vaccine appointment availability and optimizing the booking system for ease of navigation; (4) Increasing the role of family doctors in vaccine counseling and administration; (5) Streamlining vaccine record tracking. We developed infographics on the vaccines children in Alberta can receive through school-based vaccine programs and these were pilot-tested with 16 participants in a first-language (Arabic) focus group. Conclusions: The collaborative and iterative process of solution development with newcomers provided a platform for knowledge translation through the development of educational resources on school-based vaccines, addressing the information barrier that newcomers identified when accessing RCVs. As the newcomer population in Canada continues to grow, we aimed to collaborate with newcomer families arriving in an urban center in Alberta, Canada to identify strategies to overcome identified barriers newcomers face in obtaining routine childhood vaccines (RCVs). Methods: We recruited newcomers living in Calgary, Alberta to participate in a workshop utilizing the Nominal Group Technique (NGT) to develop solutions addressing barriers to obtaining RCVs. Ranking exercises helped identify the top-proposed interventions based on perceived impact and feasibility for implementation. Based on the identified need for translated vaccine resources, infographics on school-based vaccines were developed. The infographics were pilot-tested in a first-language focus group before the final product was translated into 10 different languages. Results: Consensus from 15 NGT workshop participants identified five key solutions to facilitate obtaining routine childhood immunizations: (1) Increasing access to reliable vaccine information; (2) Ensuring vaccine information and healthcare services are available in different languages; (3) Increasing vaccine appointment availability and optimizing the booking system for ease of navigation; (4) Increasing the role of family doctors in vaccine counseling and administration; (5) Streamlining vaccine record tracking. We developed infographics on the vaccines children in Alberta can receive through school-based vaccine programs and these were pilot-tested with 16 participants in a first-language (Arabic) focus group. Conclusions: The collaborative and iterative process of solution development with newcomers provided a platform for knowledge translation through the development of educational resources on school-based vaccines, addressing the information barrier that newcomers identified when accessing RCVs.
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The United States and Canada have resettled over 120,000 Afghan refugees since August 2021, but sociodemographic and health status data remains sparse with investigations often limited to refugee entrance exams, standardized health screenings, or acute health settings. This retrospective community-engaged cohort study investigated Afghan patients who received care between January 1, 2011 and December 31, 2020 at an interdisciplinary specialized refugee clinic in Calgary, AB, Canada that provides care to newly arrived refugees. 2 reviewers independently extracted and manually verified sociodemographic factors, medical diagnoses, and clinic utilization variables from patients’ electronic medical records, then coded patient diagnoses into ICD-10 codes and chapter groups. Diagnosis frequencies were calculated and stratified by age group and sex. We corroborated these findings with Afghan refugee co-investigators. Among 402 Afghan refugee patients, they were relatively young, experienced diverse health characteristics, and had multi-specialty care engagement in their first two years after arrival. These findings may guide specialized healthcare provision to this inadequately characterized but growing population of refugee arrivals in North America and elsewhere. The United States and Canada have resettled over 120,000 Afghan refugees since August 2021, but sociodemographic and health status data remains sparse with investigations often limited to refugee entrance exams, standardized health screenings, or acute health settings. This retrospective community-engaged cohort study investigated Afghan patients who received care between January 1, 2011 and December 31, 2020 at an interdisciplinary specialized refugee clinic in Calgary, AB, Canada that provides care to newly arrived refugees. 2 reviewers independently extracted and manually verified sociodemographic factors, medical diagnoses, and clinic utilization variables from patients’ electronic medical records, then coded patient diagnoses into ICD-10 codes and chapter groups. Diagnosis frequencies were calculated and stratified by age group and sex. We corroborated these findings with Afghan refugee co-investigators. Among 402 Afghan refugee patients, they were relatively young, experienced diverse health characteristics, and had multi-specialty care engagement in their first two years after arrival. These findings may guide specialized healthcare provision to this inadequately characterized but growing population of refugee arrivals in North America and elsewhere.
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Recent events, such as the COVID-19 pandemic, have drawn nationwide attention to systemic racism as a serious threat to public health in Canada. One promising approach to address such racism is through developing and implementing standardized procedures for collecting and using disaggregated, race-based data. In this commentary, we summarize why this approach is necessary to address systemic racism in Canada, and highlight municipal actions being taken in Edmonton, Alberta, to move this approach forward. This article describes Edmonton’s Race-based Data Table created in 2021. In documenting the beginning stages of the Table, and in evaluating its ongoing progress, we contribute to national conversations regarding the need for government institutions and other organizations to consistently collect and use race-based data as a means of increasing transparency and accountability in their actions. Recent events, such as the COVID-19 pandemic, have drawn nationwide attention to systemic racism as a serious threat to public health in Canada. One promising approach to address such racism is through developing and implementing standardized procedures for collecting and using disaggregated, race-based data. In this commentary, we summarize why this approach is necessary to address systemic racism in Canada, and highlight municipal actions being taken in Edmonton, Alberta, to move this approach forward. This article describes Edmonton’s Race-based Data Table created in 2021. In documenting the beginning stages of the Table, and in evaluating its ongoing progress, we contribute to national conversations regarding the need for government institutions and other organizations to consistently collect and use race-based data as a means of increasing transparency and accountability in their actions.
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Little is known about human papillomavirus (HPV) vaccination among immigrant children in Canada. We conducted a study in Alberta, Canada to assess HPV vaccine coverage among school-aged immigrant children compared with non-immigrant children. This cohort study analyzed population-based linked administrative health data to measure HPV vaccine coverage for 346749 school-aged children, including 31656 immigrants. Coverage was examined at 12 years of age from 2008 to 2018 for females, and from 2014 to 2018 for males and both sexes combined. Vaccine series completion was considered receipt of three doses, with initiation (one or more dose) as a supplementary analysis. Multivariable logistic regression examined the association of vaccine coverage with migration status, adjusting for sociodemographic variables. Overall, immigrant children had significantly higher rates of HPV vaccination than nonimmigrant children. When controlled for location, income, biological sex and year, immigrant children still had greater odds of vaccine series completion than nonimmigrant children. Little is known about human papillomavirus (HPV) vaccination among immigrant children in Canada. We conducted a study in Alberta, Canada to assess HPV vaccine coverage among school-aged immigrant children compared with non-immigrant children. This cohort study analyzed population-based linked administrative health data to measure HPV vaccine coverage for 346749 school-aged children, including 31656 immigrants. Coverage was examined at 12 years of age from 2008 to 2018 for females, and from 2014 to 2018 for males and both sexes combined. Vaccine series completion was considered receipt of three doses, with initiation (one or more dose) as a supplementary analysis. Multivariable logistic regression examined the association of vaccine coverage with migration status, adjusting for sociodemographic variables. Overall, immigrant children had significantly higher rates of HPV vaccination than nonimmigrant children. When controlled for location, income, biological sex and year, immigrant children still had greater odds of vaccine series completion than nonimmigrant children.
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Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada. Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities. Given our participants’ different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada. Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities. Given our participants’ different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations.
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This qualitative inquiry delved into the healthcare needs and experiences of Afghan refugee women resettled in Edmonton, AB, Canada, addressing three primary research questions. Employing a community-based participatory research approach alongside qualitative narrative inquiry, the study explored the lived experiences of Afghan women refugees accessing healthcare services, at the New Canadians Health Centre (NCHC). Through focus groups with six NCHC staff and semi-structured interviews with three Afghan women clients, a nuanced understanding of their healthcare journeys emerged. Their insights offered valuable recommendations for culturally sensitive service provision. Ultimately, this study highlighted the imperative of culturally safe healthcare practices and underscored the transformative role of community and empowerment in shaping the healthcare experiences of Afghan refugee women in Canada. This qualitative inquiry delved into the healthcare needs and experiences of Afghan refugee women resettled in Edmonton, AB, Canada, addressing three primary research questions. Employing a community-based participatory research approach alongside qualitative narrative inquiry, the study explored the lived experiences of Afghan women refugees accessing healthcare services, at the New Canadians Health Centre (NCHC). Through focus groups with six NCHC staff and semi-structured interviews with three Afghan women clients, a nuanced understanding of their healthcare journeys emerged. Their insights offered valuable recommendations for culturally sensitive service provision. Ultimately, this study highlighted the imperative of culturally safe healthcare practices and underscored the transformative role of community and empowerment in shaping the healthcare experiences of Afghan refugee women in Canada.
This publication has no Abstract to dispaly

The World Health Organization stresses the need for tailored COVID-19 models of vaccination to meet the needs of diverse populations and ultimately reach high rates of vaccination. However, little evidence exists on how COVID-19 models of vaccination operated in the novel context of the pandemic, how vulnerable populations, such as refugees, experience COVID-19 vaccination systems in high-income countries, and what lessons may be learned from vaccination efforts with vulnerable populations. To address this gap, this study explored COVID-19 vaccine delivery models available to newcomer refugees and immigrants, and refugee experiences across diferent COVID-19 vaccine delivery models in Calgary, Canada, and surrounding area in 2021 and 2022, to understand the barriers, strengths, and strategies of models to support access to COVID-19 vaccination for newcomer refugees and immigrants. Structured interviews with Government Assisted Refugees (n=39), and semistructured interviews with Privately Sponsored Refugees (n=6), private refugee sponsors (n=3), and stakeholders involved in vaccination systems (n=13) were conducted in 2022. Thematic analysis was conducted to draw out themes related to barriers, strengths, and strategies of vaccine delivery models and the intersections with patient experiences. Newcomer refugee and immigrant focused vaccination models and strategies were explored. They demonstrated how partnerships between organizations, multi-pronged approaches, and culturally responsive services were crucial to navigate ongoing and emergent factors, such as vaccine hesitancy, mandates, and other determinants of under-vaccination. Many vaccination models presented through interviews were not specific to refugees and included immigrants, temporary residents, ethnocultural community members, and other vulnerable populations in their design. Increasing COVID-19 vaccine uptake for newcomer refugees and immigrants, is complex and requires trust, ongoing information provision, and local partnerships to address ongoing and emerging factors. Three key policy implications were drawn. The World Health Organization stresses the need for tailored COVID-19 models of vaccination to meet the needs of diverse populations and ultimately reach high rates of vaccination. However, little evidence exists on how COVID-19 models of vaccination operated in the novel context of the pandemic, how vulnerable populations, such as refugees, experience COVID-19 vaccination systems in high-income countries, and what lessons may be learned from vaccination efforts with vulnerable populations. To address this gap, this study explored COVID-19 vaccine delivery models available to newcomer refugees and immigrants, and refugee experiences across diferent COVID-19 vaccine delivery models in Calgary, Canada, and surrounding area in 2021 and 2022, to understand the barriers, strengths, and strategies of models to support access to COVID-19 vaccination for newcomer refugees and immigrants. Structured interviews with Government Assisted Refugees (n=39), and semistructured interviews with Privately Sponsored Refugees (n=6), private refugee sponsors (n=3), and stakeholders involved in vaccination systems (n=13) were conducted in 2022. Thematic analysis was conducted to draw out themes related to barriers, strengths, and strategies of vaccine delivery models and the intersections with patient experiences. Newcomer refugee and immigrant focused vaccination models and strategies were explored. They demonstrated how partnerships between organizations, multi-pronged approaches, and culturally responsive services were crucial to navigate ongoing and emergent factors, such as vaccine hesitancy, mandates, and other determinants of under-vaccination. Many vaccination models presented through interviews were not specific to refugees and included immigrants, temporary residents, ethnocultural community members, and other vulnerable populations in their design. Increasing COVID-19 vaccine uptake for newcomer refugees and immigrants, is complex and requires trust, ongoing information provision, and local partnerships to address ongoing and emerging factors. Three key policy implications were drawn.
This publication has no Abstract to dispaly

Despite the Canadian universal healthcare system, new immigrants face a number of challenges in accessing primary healthcare (PHC) services. As immigration to Canada consistently increases, understanding various types of barriers to PHC and how they differ across different sub-groups is critical. We conducted a qualitative study among Nepalese immigrant men to learn from their experience with PHC access to inform healthcare providers, stakeholders, and policymakers to devise feasible approaches to enhancing access to care. We undertook a qualitative research approach employing focus groups among a sample of first-generation Nepalese immigrant men who had prior experience with accessing PHC in Canada. We conducted six focus groups in total with 34 participants in their preferred language, Nepalese, or English. Participants reported experiencing multiple barriers at two stages: before accessing PHC services and after accessing PHC services. To our knowledge, this is the first study in Canada which explored barriers faced by Nepalese immigrant men in accessing PHC. This study identifies barriers to accessing PHC in Canada from a group of immigrant men’s perspective. It is important to account for these while making any reforms and adding new care services to the existing healthcare system so that they are equitable for these groups of individuals as well. Despite the Canadian universal healthcare system, new immigrants face a number of challenges in accessing primary healthcare (PHC) services. As immigration to Canada consistently increases, understanding various types of barriers to PHC and how they differ across different sub-groups is critical. We conducted a qualitative study among Nepalese immigrant men to learn from their experience with PHC access to inform healthcare providers, stakeholders, and policymakers to devise feasible approaches to enhancing access to care. We undertook a qualitative research approach employing focus groups among a sample of first-generation Nepalese immigrant men who had prior experience with accessing PHC in Canada. We conducted six focus groups in total with 34 participants in their preferred language, Nepalese, or English. Participants reported experiencing multiple barriers at two stages: before accessing PHC services and after accessing PHC services. To our knowledge, this is the first study in Canada which explored barriers faced by Nepalese immigrant men in accessing PHC. This study identifies barriers to accessing PHC in Canada from a group of immigrant men’s perspective. It is important to account for these while making any reforms and adding new care services to the existing healthcare system so that they are equitable for these groups of individuals as well.
This publication has no Abstract to dispaly

Refugee decisions to vaccinate for COVID-19 are a complex interplay of factors which include individual perceptions, access barriers, trust, and COVID-19 specific factors, which contribute to lower vaccine uptake. To address this, the WHO calls for localized solutions to increase COVID-19 vaccine uptake for refugees and evidence to inform future vaccination efforts. However, limited evidence engages directly with refugees about their experiences with COVID-19 vaccinations. To address this gap, researchers conducted qualitative interviews (N = 61) with refugees (n = 45), sponsors of refugees (n = 3), and key informants (n = 13) connected to local COVID-19 vaccination efforts for refugees in Calgary. Thematic analysis was conducted to synthesize themes related to vaccine perspectives, vaccination experiences, and patient intersections with policies and systems. Findings reveal that refugees benefit from ample services that are delivered at various stages, that are not solely related to vaccinations, and which create multiple positive touch points with health and immigration systems. This builds trust and vaccine confidence and promotes COVID-19 vaccine uptake. Despite multiple factors affecting vaccination decisions, a key reason for vaccination was timely and credible information delivered through trusted intermediaries and in an environment that addressed refugee needs and concerns. As refugees placed trust and relationships at the core of decision-making and vaccination, it is recommended that healthcare systems work through trust and relationships to reach refugees. This can be targeted through culturally responsive healthcare delivery that meets patients where they are, including barrier reduction measures such as translation and on-site vaccinations, and educational and outreach partnerships with private groups, community organizations and leaders. Refugee decisions to vaccinate for COVID-19 are a complex interplay of factors which include individual perceptions, access barriers, trust, and COVID-19 specific factors, which contribute to lower vaccine uptake. To address this, the WHO calls for localized solutions to increase COVID-19 vaccine uptake for refugees and evidence to inform future vaccination efforts. However, limited evidence engages directly with refugees about their experiences with COVID-19 vaccinations. To address this gap, researchers conducted qualitative interviews (N = 61) with refugees (n = 45), sponsors of refugees (n = 3), and key informants (n = 13) connected to local COVID-19 vaccination efforts for refugees in Calgary. Thematic analysis was conducted to synthesize themes related to vaccine perspectives, vaccination experiences, and patient intersections with policies and systems. Findings reveal that refugees benefit from ample services that are delivered at various stages, that are not solely related to vaccinations, and which create multiple positive touch points with health and immigration systems. This builds trust and vaccine confidence and promotes COVID-19 vaccine uptake. Despite multiple factors affecting vaccination decisions, a key reason for vaccination was timely and credible information delivered through trusted intermediaries and in an environment that addressed refugee needs and concerns. As refugees placed trust and relationships at the core of decision-making and vaccination, it is recommended that healthcare systems work through trust and relationships to reach refugees. This can be targeted through culturally responsive healthcare delivery that meets patients where they are, including barrier reduction measures such as translation and on-site vaccinations, and educational and outreach partnerships with private groups, community organizations and leaders.
This publication has no Abstract to dispaly