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.
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What can be learned about the healthcare access of undocumented workers? How can health equity be advanced through sensitivity to the process of precaritization and the precarities informing their lives? Thailand and Spain are the only countries in the world that offer the same healthcare access to undocumented migrants as citizens. Most European countries only offer emergency services: France, the Netherlands, Portugal, Spain, and Switzerland allow undocumented migrants to access similar services to citizens if they meet conditions (proof of identity; length of residence in the country). European cities such as Ghent, Frankfurt, and Dusseldorf, offer barrier-free healthcare. Throughout the USA, Federally Qualified Health Centers support care to the uninsured regardless of immigration status. In Canada, Ontario and Quebec, provide a base level of healthcare access to undocumented migrants, and a small number of stand-alone community-based clinics offer additional care and specialized services. To promote healthcare for undocumented migrants in Alberta, barrier-free access to vaccination, COVID-19 treatment, and proof of vaccinations are essential, but an equity lens to healthcare service— informed by analytic understanding and robust approach to precaritization as a social determinant, is most needed. What can be learned about the healthcare access of undocumented workers? How can health equity be advanced through sensitivity to the process of precaritization and the precarities informing their lives? Thailand and Spain are the only countries in the world that offer the same healthcare access to undocumented migrants as citizens. Most European countries only offer emergency services: France, the Netherlands, Portugal, Spain, and Switzerland allow undocumented migrants to access similar services to citizens if they meet conditions (proof of identity; length of residence in the country). European cities such as Ghent, Frankfurt, and Dusseldorf, offer barrier-free healthcare. Throughout the USA, Federally Qualified Health Centers support care to the uninsured regardless of immigration status. In Canada, Ontario and Quebec, provide a base level of healthcare access to undocumented migrants, and a small number of stand-alone community-based clinics offer additional care and specialized services. To promote healthcare for undocumented migrants in Alberta, barrier-free access to vaccination, COVID-19 treatment, and proof of vaccinations are essential, but an equity lens to healthcare service— informed by analytic understanding and robust approach to precaritization as a social determinant, is most needed.
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The entire healthcare system, including primary healthcare (PHC) services, has been disrupted since the onset of the COVID-19 pandemic. As the crisis threatens all citizens significantly, further barriers to accessing care exist for those who are most vulnerable, experience marginalization, and have pre-existing challenges. We aimed to explore immigrants’ lived experiences in accessing and receiving PHC services during the pandemic. A multiphase mixed-methods study using a sequential explanatory design was employed. The first study includes a systematic review that synthesizes the evidence on the experiences that immigrant patients have receiving PHC. Study two provides insights from a recently employed “COVID-19 Experiences and Impacts Survey” data and compares the experiences of Albertans that were born in and outside Canada. Descriptive statistics and multivariable logistic regression were performed, using STATA. The third study is a qualitative inquiry that aims to gain a deeper understanding of the newcomers’ (living in Canada ≤5 years) and providers’ experiences in PHC during the pandemic. A thematic analysis was applied, using NVivo software. Immigrants reported many challenges in accessing and receiving PHC, and these challenges have been increased since the COVID-19 pandemic. The results of this thesis yielded six recommendations that can inform PHC quality improvement initiatives and PHC policy. The entire healthcare system, including primary healthcare (PHC) services, has been disrupted since the onset of the COVID-19 pandemic. As the crisis threatens all citizens significantly, further barriers to accessing care exist for those who are most vulnerable, experience marginalization, and have pre-existing challenges. We aimed to explore immigrants’ lived experiences in accessing and receiving PHC services during the pandemic. A multiphase mixed-methods study using a sequential explanatory design was employed. The first study includes a systematic review that synthesizes the evidence on the experiences that immigrant patients have receiving PHC. Study two provides insights from a recently employed “COVID-19 Experiences and Impacts Survey” data and compares the experiences of Albertans that were born in and outside Canada. Descriptive statistics and multivariable logistic regression were performed, using STATA. The third study is a qualitative inquiry that aims to gain a deeper understanding of the newcomers’ (living in Canada ≤5 years) and providers’ experiences in PHC during the pandemic. A thematic analysis was applied, using NVivo software. Immigrants reported many challenges in accessing and receiving PHC, and these challenges have been increased since the COVID-19 pandemic. The results of this thesis yielded six recommendations that can inform PHC quality improvement initiatives and PHC policy.
This publication has no Abstract to dispaly
