Research Library

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.
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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.
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Administrative data was used to study COVID-19 vaccine coverage in immigrants and refugees compared to the Canadian-born population. Broadly, immigrants and refugees (78.2%) had comparable vaccine coverage to Canadian-born individuals (76%). However, initiatives to improve vaccine coverage is needed for older immigrants, immigrants in rural areas, and immigrants from certain ethnicities. Administrative data was used to study COVID-19 vaccine coverage in immigrants and refugees compared to the Canadian-born population. Broadly, immigrants and refugees (78.2%) had comparable vaccine coverage to Canadian-born individuals (76%). However, initiatives to improve vaccine coverage is needed for older immigrants, immigrants in rural areas, and immigrants from certain ethnicities.
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This community-based research study provides new data collected from 25 in-depth individual interviews with immigrant women HCAs who were working in LTC in Calgary, Alberta between January 1 and March 30, 2021. The data, analysed through the lens of intersectional exclusion, highlight how the pandemic has impacted the working lives of immigrant women employed in LTC facilities on a daily basis, as well as their suggestions for enhancing their safety and employment conditions. Two key themes emerged during the process of data analysis: (a) HCA experiences of economic exclusion and workplace precarity—many of which pre-dated the pandemic but have been exacerbated by current policies and practices that prioritize profits over quality of community care, and (b) experiences of broader social exclusion, many of which are tied to being considered “just HCAs” who are doing “immigrant’s work”, rather than including HCAs in broader conversations about how to reform and improve the LTC sector for future. Concluding thoughts discuss how to improve policy to support low wage workers within LTC in order to address intersectional inequalities and to better support front-line care workers during current and future health pandemic recovery efforts. This community-based research study provides new data collected from 25 in-depth individual interviews with immigrant women HCAs who were working in LTC in Calgary, Alberta between January 1 and March 30, 2021. The data, analysed through the lens of intersectional exclusion, highlight how the pandemic has impacted the working lives of immigrant women employed in LTC facilities on a daily basis, as well as their suggestions for enhancing their safety and employment conditions. Two key themes emerged during the process of data analysis: (a) HCA experiences of economic exclusion and workplace precarity—many of which pre-dated the pandemic but have been exacerbated by current policies and practices that prioritize profits over quality of community care, and (b) experiences of broader social exclusion, many of which are tied to being considered “just HCAs” who are doing “immigrant’s work”, rather than including HCAs in broader conversations about how to reform and improve the LTC sector for future. Concluding thoughts discuss how to improve policy to support low wage workers within LTC in order to address intersectional inequalities and to better support front-line care workers during current and future health pandemic recovery efforts.
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In this qualitative study, researchers conducted interviews with 11 participants who had entered Canada through the Temporary Foreign Worker Program and who had since loss status. Findings show policy changes, abuse and exploitation by employers, language barriers, and misinformation and language gaps drive workers out of status. Once without status, people often remain in Canada because they are motivated by issues related to family. These can include the continued desire to bring family members to Canada, financial responsibilities for family members in countries of origin, the desire to stay with Canadian partners or children, or the breakdown of family ties which dissuades the desire to return. Challenges of living without status include mental health struggles, financial strain, and barriers to service access. Interplays between factors driving status loss and experiences of those who live without status in Canada show that the state plays an important role in creating precarity through restrictive immigration and residency policies. Understandings the state’s role in the production of precarity may inform effective policy changes moving forward. In this qualitative study, researchers conducted interviews with 11 participants who had entered Canada through the Temporary Foreign Worker Program and who had since loss status. Findings show policy changes, abuse and exploitation by employers, language barriers, and misinformation and language gaps drive workers out of status. Once without status, people often remain in Canada because they are motivated by issues related to family. These can include the continued desire to bring family members to Canada, financial responsibilities for family members in countries of origin, the desire to stay with Canadian partners or children, or the breakdown of family ties which dissuades the desire to return. Challenges of living without status include mental health struggles, financial strain, and barriers to service access. Interplays between factors driving status loss and experiences of those who live without status in Canada show that the state plays an important role in creating precarity through restrictive immigration and residency policies. Understandings the state’s role in the production of precarity may inform effective policy changes moving forward.
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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.
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Children with disabilities are among the most at-risk groups for marginalization due to compounded disadvantages from the intersection of risk factors such as refugee status and disability status. Despite this high risk, there is no systematic data collected on this group and scant literature on the topic contributing to a feeling of invisibility. We conducted a narrative inquiry on the experiences of two Syrian refugee families with children living with disabilities. Narrative inquiry is a way to understand experience as a storied phenomenon. In order to understand the complexities of the experience as a refugee with a child living with disabilities, attending to the lived and told stories is essential. In hearing the narration of these experiences across time, place, and social contexts various narrative threads emerged. The narrative threads that resonated across the experiences of two families included waiting and a struggle for agency, as well as disruption and continuity. Children with disabilities are among the most at-risk groups for marginalization due to compounded disadvantages from the intersection of risk factors such as refugee status and disability status. Despite this high risk, there is no systematic data collected on this group and scant literature on the topic contributing to a feeling of invisibility. We conducted a narrative inquiry on the experiences of two Syrian refugee families with children living with disabilities. Narrative inquiry is a way to understand experience as a storied phenomenon. In order to understand the complexities of the experience as a refugee with a child living with disabilities, attending to the lived and told stories is essential. In hearing the narration of these experiences across time, place, and social contexts various narrative threads emerged. The narrative threads that resonated across the experiences of two families included waiting and a struggle for agency, as well as disruption and continuity.
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This cross-sectional study examines the healthcare experiences of Albertans during the COVID-19 pandemic, with a focus on comparing experiences between those born in and outside Canada. The study collected 10,175 surveys in October 2020, with nearly 10% of respondents reporting their status as born outside Canada. The study found that foreign-born Albertans experienced more delays in care and had less access to healthcare services than Canadian-born Albertans. The study highlights the need for policy and practice changes to address the healthcare disparities faced by immigrant populations during the pandemic. This cross-sectional study examines the healthcare experiences of Albertans during the COVID-19 pandemic, with a focus on comparing experiences between those born in and outside Canada. The study collected 10,175 surveys in October 2020, with nearly 10% of respondents reporting their status as born outside Canada. The study found that foreign-born Albertans experienced more delays in care and had less access to healthcare services than Canadian-born Albertans. The study highlights the need for policy and practice changes to address the healthcare disparities faced by immigrant populations during the pandemic.
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There remains an ongoing need to address not only the post-migration experiences of newcomers settling in Calgary but also to understand how systems that serve them perceive, make sense of, and contribute to these experiences. By hearing from those who work with newcomers within the institutional settings that support newcomers, we can begin to understand some complexities of newcomer integration. The purpose of this qualitative pilot study was to explore the perceptions that front-line workers hold regarding needs and experiences of newcomers. This study involved a series of eleven semi-structured interviews with workers at an immigrant-serving language-learning agency which were analyzed using thematic coding. The findings highlighted: front-line workers perception of their newcomer cli-ents’ identity in connection to language; the clients’ emotional burden and sense of belonging; and the challenges clients faced balancing everyday commitments. Moreover, this study explored the front-line worker’s role in cultural brokerage and promoting wellness. This study provided reason to value the practices and interpretations that front-line workers have of the newcomer experience due to the role they play in creating a sense of integration for newcom-ers. The interpretations that surfaced in this study sheds light on the complexity that both front-line workers and newcomers face and implies that further research and interventions are needed to ensure successful integration There remains an ongoing need to address not only the post-migration experiences of newcomers settling in Calgary but also to understand how systems that serve them perceive, make sense of, and contribute to these experiences. By hearing from those who work with newcomers within the institutional settings that support newcomers, we can begin to understand some complexities of newcomer integration. The purpose of this qualitative pilot study was to explore the perceptions that front-line workers hold regarding needs and experiences of newcomers. This study involved a series of eleven semi-structured interviews with workers at an immigrant-serving language-learning agency which were analyzed using thematic coding. The findings highlighted: front-line workers perception of their newcomer cli-ents’ identity in connection to language; the clients’ emotional burden and sense of belonging; and the challenges clients faced balancing everyday commitments. Moreover, this study explored the front-line worker’s role in cultural brokerage and promoting wellness. This study provided reason to value the practices and interpretations that front-line workers have of the newcomer experience due to the role they play in creating a sense of integration for newcom-ers. The interpretations that surfaced in this study sheds light on the complexity that both front-line workers and newcomers face and implies that further research and interventions are needed to ensure successful integration
This publication has no Abstract to dispaly