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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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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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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

In this study, we applied an intersectional framework to explore service providers’ perspectives on the mental health needs of newcomer young men. We conducted focus groups and interviews with 26 service providers in Edmonton, Calgary, and Vancouver, Canada. Findings show that service providers made sense of young men’s mental health needs and service access in the context of systems. We identified three interconnected themes: newcomer young men’s senses of self in relation to macrosystems, including racism and economic marginalization; settling well as a determinant of mental health; and systems capacities and interdependent resilience. While service providers are engaged in cross-sectoral work in support of newcomer young men’s mental health, this work is not being sufficiently supported. Further work is needed around cross-sector capacity bridging and advocacy, as well as the tailoring of services to young men without the assumption and reinforcement of gender stereotypes. In this study, we applied an intersectional framework to explore service providers’ perspectives on the mental health needs of newcomer young men. We conducted focus groups and interviews with 26 service providers in Edmonton, Calgary, and Vancouver, Canada. Findings show that service providers made sense of young men’s mental health needs and service access in the context of systems. We identified three interconnected themes: newcomer young men’s senses of self in relation to macrosystems, including racism and economic marginalization; settling well as a determinant of mental health; and systems capacities and interdependent resilience. While service providers are engaged in cross-sectoral work in support of newcomer young men’s mental health, this work is not being sufficiently supported. Further work is needed around cross-sector capacity bridging and advocacy, as well as the tailoring of services to young men without the assumption and reinforcement of gender stereotypes.
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Due to the ongoing conflict in Syria, approximately 50,000 Syrian refugees arrived in Canada between 2015 and 2020. Upon arrival, Syrians needed to find housing, employment, healthcare, and language training. They also had to address psychosocial needs, such as cultivating social supports and establishing a sense of safety, which are critical for mitigating trauma and stress related to resettlement. In March 2020, the global COVID-19 pandemic was declared, and disproportionately impacted refugees by compounding pre-existing and systemic health, social, and economic inequities. Refugees are identified as particularly vulnerable during the pandemic due to the precarious working, living, economic, and health conditions they often face. Only three Canadian studies to date have explored Syrian refugee experiences during COVID-19: one used quantitative methods, the other focused on postnatal women, and one explored housing stability. Therefore, there is a dearth of qualitative information regarding how Syrian refugees in Canada have been impacted by the pandemic, especially regarding their psychosocial adaptation during this period. This study explored the impact of the COVID-19 pandemic for Syrian refugees in Canada and identified supports needed, from the perspectives of Syrian refugees themselves. This study is embedded within a broader community-based participatory research project investigating psychosocial adaptation with the Syrian refugee community and used qualitative description and thematic analysis to examine semi-structured interviews conducted with 10 Syrian refugees. Due to the ongoing conflict in Syria, approximately 50,000 Syrian refugees arrived in Canada between 2015 and 2020. Upon arrival, Syrians needed to find housing, employment, healthcare, and language training. They also had to address psychosocial needs, such as cultivating social supports and establishing a sense of safety, which are critical for mitigating trauma and stress related to resettlement. In March 2020, the global COVID-19 pandemic was declared, and disproportionately impacted refugees by compounding pre-existing and systemic health, social, and economic inequities. Refugees are identified as particularly vulnerable during the pandemic due to the precarious working, living, economic, and health conditions they often face. Only three Canadian studies to date have explored Syrian refugee experiences during COVID-19: one used quantitative methods, the other focused on postnatal women, and one explored housing stability. Therefore, there is a dearth of qualitative information regarding how Syrian refugees in Canada have been impacted by the pandemic, especially regarding their psychosocial adaptation during this period. This study explored the impact of the COVID-19 pandemic for Syrian refugees in Canada and identified supports needed, from the perspectives of Syrian refugees themselves. This study is embedded within a broader community-based participatory research project investigating psychosocial adaptation with the Syrian refugee community and used qualitative description and thematic analysis to examine semi-structured interviews conducted with 10 Syrian refugees.
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As Canada and other high-income countries continue to welcome newcomers, this study aimed to 1) understand newcomer parents’ attitudes towards routine-childhood vaccinations (RCVs), and 2) identify barriers newcomer parents face when accessing RCVs in Alberta (Calgary, Edmonton and High River). Overall, parents in the focus groups were motivated and willing to vaccinate their children but experienced several barriers related to their capability and opportunity to access RCVs. Five main themes emerged: 1) lack of reputable information about RCVs, 2) language barriers when looking for information and asking questions about RCVs, 3) lack of access to a primary care provider (PCP), 4) lack of affordable and convenient transportation options, and 5) due to the COVID-19 pandemic, lack of available vaccine appointments. The findings highlight that several barriers faced by newcomer families ultimately stem from issues related to accessing information about RCVs and the challenges families face once at vaccination clinics, highlighting opportunities for health systems to better support newcomers in accessing RCVs. As Canada and other high-income countries continue to welcome newcomers, this study aimed to 1) understand newcomer parents’ attitudes towards routine-childhood vaccinations (RCVs), and 2) identify barriers newcomer parents face when accessing RCVs in Alberta (Calgary, Edmonton and High River). Overall, parents in the focus groups were motivated and willing to vaccinate their children but experienced several barriers related to their capability and opportunity to access RCVs. Five main themes emerged: 1) lack of reputable information about RCVs, 2) language barriers when looking for information and asking questions about RCVs, 3) lack of access to a primary care provider (PCP), 4) lack of affordable and convenient transportation options, and 5) due to the COVID-19 pandemic, lack of available vaccine appointments. The findings highlight that several barriers faced by newcomer families ultimately stem from issues related to accessing information about RCVs and the challenges families face once at vaccination clinics, highlighting opportunities for health systems to better support newcomers in accessing RCVs.
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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.
This publication has no Abstract to dispaly

Canadian refugee healthcare has been impacted by periodic upheavals including federal funding cuts, Syrian and Yazidi resettlement programs, and COVID-19. These upheavals will have undoubtedly led to changes in clinic use, shifts in clinic demographics, or clinic policy. Refugees are a vulnerable population with specific physical health, mental health, and social needs. One model of care that can address these needs is a specialized refugee health clinic. Understanding the impacts of recent upheavals on a specialized refugee health clinic’s utilization, its staff and clinicians is critical for future planning. We studied a specialized refugee health clinic in Calgary, AB from 2011 to 2020, across five time periods: Pre-Interim Federal Health Program (IFHP) Cuts (January 2011 – June 2012), IFHP Cuts (July 2012 – October 2015), Syrian Surge (November 2015- January 2017), Yazidi Period (February 2017 – February 2020), and COVID-19 (March 2020 – December 2020). We analyzed quantitative changes as well as conducted semi-structured interviews with clinic leadership. Utilization increased greatly over different policy changes and a pandemic, at a specialized refugee clinic over ten years. These upheavals challenged clinic leadership and providers to adapt. The stress of these upheavals negatively impacted staff wellness and patient care. Understanding how health and immigration policy changes affect care, especially at specialized refugee clinics, is critical for being able to anticipate and thrive through future upheavals as turmoil globally seems to continue. Canadian refugee healthcare has been impacted by periodic upheavals including federal funding cuts, Syrian and Yazidi resettlement programs, and COVID-19. These upheavals will have undoubtedly led to changes in clinic use, shifts in clinic demographics, or clinic policy. Refugees are a vulnerable population with specific physical health, mental health, and social needs. One model of care that can address these needs is a specialized refugee health clinic. Understanding the impacts of recent upheavals on a specialized refugee health clinic’s utilization, its staff and clinicians is critical for future planning. We studied a specialized refugee health clinic in Calgary, AB from 2011 to 2020, across five time periods: Pre-Interim Federal Health Program (IFHP) Cuts (January 2011 – June 2012), IFHP Cuts (July 2012 – October 2015), Syrian Surge (November 2015- January 2017), Yazidi Period (February 2017 – February 2020), and COVID-19 (March 2020 – December 2020). We analyzed quantitative changes as well as conducted semi-structured interviews with clinic leadership. Utilization increased greatly over different policy changes and a pandemic, at a specialized refugee clinic over ten years. These upheavals challenged clinic leadership and providers to adapt. The stress of these upheavals negatively impacted staff wellness and patient care. Understanding how health and immigration policy changes affect care, especially at specialized refugee clinics, is critical for being able to anticipate and thrive through future upheavals as turmoil globally seems to continue.
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Two studies were completed as a part of this Master’s thesis. Study 1: Human papillomavirus vaccine coverage among immigrant children in Alberta: a population-based cohort study concluded that overall, immigrant children in Alberta had higher HPV vaccination coverage in comparison to non-immigrants, which is encouraging given some previous literature has suggested the opposite. This implies that efforts to increase vaccination rates among immigrant children may be having a positive impact. Among immigrants, routine immunization promotion strategies should be targeted to those living in rural residences and from North America, Oceania, and South America, in order to improve HPV vaccination coverage in this group even further. Study 2: Study 2: COVID-19 vaccine coverage among immigrants and refugees in Alberta: A population-based cross-sectional study concluded that high COVID-19 vaccination coverage among immigrant populations in Alberta is an encouraging outcome. However, continued efforts are needed to target public health interventions towards older immigrants, immigrants living in rural areas, and immigrants from specific continental backgrounds in order to improve COVID-19 vaccination coverage. Two studies were completed as a part of this Master’s thesis. Study 1: Human papillomavirus vaccine coverage among immigrant children in Alberta: a population-based cohort study concluded that overall, immigrant children in Alberta had higher HPV vaccination coverage in comparison to non-immigrants, which is encouraging given some previous literature has suggested the opposite. This implies that efforts to increase vaccination rates among immigrant children may be having a positive impact. Among immigrants, routine immunization promotion strategies should be targeted to those living in rural residences and from North America, Oceania, and South America, in order to improve HPV vaccination coverage in this group even further. Study 2: Study 2: COVID-19 vaccine coverage among immigrants and refugees in Alberta: A population-based cross-sectional study concluded that high COVID-19 vaccination coverage among immigrant populations in Alberta is an encouraging outcome. However, continued efforts are needed to target public health interventions towards older immigrants, immigrants living in rural areas, and immigrants from specific continental backgrounds in order to improve COVID-19 vaccination coverage.
This publication has no Abstract to dispaly

Racialized, low-income, and migrant communities in East and Northeast Calgary were disproportionately impacted by COVID-19, yet faced vaccine access barriers. This article is a formative evaluation of a low-barrier, community-engaged vaccine outreach clinic in Calgary, Alberta, Canada, on June 5–6, 2021. Stakeholder respondents felt the clinic was effective (99.2%), efficient (96.9%), patient-centered (92.3%), and safe (90.8%), and that the outreach model was scalable 94.6% (123/130). Suggested improvements include increased time for clinic planning and promotion, more multilingual staff, and further efforts to reduce accessibility barriers, such as priority check-in for people with disabilities. These findings support the value of community-engaged outreach to improve vaccine equity among other marginalized newcomer communities. Racialized, low-income, and migrant communities in East and Northeast Calgary were disproportionately impacted by COVID-19, yet faced vaccine access barriers. This article is a formative evaluation of a low-barrier, community-engaged vaccine outreach clinic in Calgary, Alberta, Canada, on June 5–6, 2021. Stakeholder respondents felt the clinic was effective (99.2%), efficient (96.9%), patient-centered (92.3%), and safe (90.8%), and that the outreach model was scalable 94.6% (123/130). Suggested improvements include increased time for clinic planning and promotion, more multilingual staff, and further efforts to reduce accessibility barriers, such as priority check-in for people with disabilities. These findings support the value of community-engaged outreach to improve vaccine equity among other marginalized newcomer communities.
This publication has no Abstract to dispaly