Research Library

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.
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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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Available evidence in Canada suggests children born to immigrants face a greater risk of poor mental health outcomes. However, these comparisons often mask important ethno-racial differences in mental health risks and outcomes among immigrant populations. Recent evidence suggests African immigrant children have some of the poorest social and mental health outcomes in Canada. Despite this awareness, research has yet to identify community-based strategies for addressing the stressors underpinning such outcomes. This study used data obtained from focus groups with African immigrant parents in Edmonton, AB and surrounding towns to identify child mental health stressors and child mental health promotion strategies in the African immigrant community. Available evidence in Canada suggests children born to immigrants face a greater risk of poor mental health outcomes. However, these comparisons often mask important ethno-racial differences in mental health risks and outcomes among immigrant populations. Recent evidence suggests African immigrant children have some of the poorest social and mental health outcomes in Canada. Despite this awareness, research has yet to identify community-based strategies for addressing the stressors underpinning such outcomes. This study used data obtained from focus groups with African immigrant parents in Edmonton, AB and surrounding towns to identify child mental health stressors and child mental health promotion strategies in the African immigrant community.
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This study sought to examine the challenges encountered by immigrant-serving agencies in meeting the health needs of temporary foreign workers and their families in one Canadian province. Some of the challenges that agencies face in delivering programs and services for temporary foreign workers and their families include the time required to build trust with this population, temporary foreign workers’ reluctance to use services due to fear that it will affect their immigration status, and the emotional labor associated with working with temporary foreign workers. This study sought to examine the challenges encountered by immigrant-serving agencies in meeting the health needs of temporary foreign workers and their families in one Canadian province. Some of the challenges that agencies face in delivering programs and services for temporary foreign workers and their families include the time required to build trust with this population, temporary foreign workers’ reluctance to use services due to fear that it will affect their immigration status, and the emotional labor associated with working with temporary foreign workers.
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This paper explores how government members of the Alberta Legislative Assembly (MLAs) “constructed” migrant work and migrant workers in legislature and media statements between 2000 and 2011. Government MLAs asserted that migrant work (1) was economically necessary and (2) posed no threat to Canadian workers. Government MLAs also asserted that international migrant workers (3) had questionable occupational, linguistic or cultural skills and (4) caused negative social and economic impacts in Canada. Taken individually, these narratives appear contradictory, casting migrant work as good but migrant workers as bad. Viewed together, these narratives comprise an effort to dehumanize temporary and permanent international migrant workers. This (sometimes racialized) “othering” of migrant workers justifies migrant workers’ partial citizenship and suppresses criticism of their poor treatment. This paper explores how government members of the Alberta Legislative Assembly (MLAs) “constructed” migrant work and migrant workers in legislature and media statements between 2000 and 2011. Government MLAs asserted that migrant work (1) was economically necessary and (2) posed no threat to Canadian workers. Government MLAs also asserted that international migrant workers (3) had questionable occupational, linguistic or cultural skills and (4) caused negative social and economic impacts in Canada. Taken individually, these narratives appear contradictory, casting migrant work as good but migrant workers as bad. Viewed together, these narratives comprise an effort to dehumanize temporary and permanent international migrant workers. This (sometimes racialized) “othering” of migrant workers justifies migrant workers’ partial citizenship and suppresses criticism of their poor treatment.
This publication has no Abstract to dispaly

Data on immigrant and refugees’ access to services in Canada does not typically focus on children. To fill this gap, this study explored immigrant and refugee mothers’ perceptions of barriers and facilitators (things that help) for mental health care for their children in Edmonton, Alberta, Canada. Barriers included financial strain, lack of information, racism/discrimination, language barriers, stigma, feeling isolated, and feeling unheard by service providers. Facilitators included schools offering services, personal levels of higher education, and free services. Nurses can improve access to mental health services by addressing issues related to racism within the health system, by creating awareness related to mental health, and by providing trained interpreters to help bridge barriers in communications. Data on immigrant and refugees’ access to services in Canada does not typically focus on children. To fill this gap, this study explored immigrant and refugee mothers’ perceptions of barriers and facilitators (things that help) for mental health care for their children in Edmonton, Alberta, Canada. Barriers included financial strain, lack of information, racism/discrimination, language barriers, stigma, feeling isolated, and feeling unheard by service providers. Facilitators included schools offering services, personal levels of higher education, and free services. Nurses can improve access to mental health services by addressing issues related to racism within the health system, by creating awareness related to mental health, and by providing trained interpreters to help bridge barriers in communications.
This publication has no Abstract to dispaly

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

We investigate discrimination experiences of (1) immigrants and racialized individuals, (2) Indigenous peoples, and (3) comparison White non-immigrants in nine regions of Southwestern Ontario containing small- and mid-sized communities. For each region, representative samples of the three groups were recruited to complete online surveys. In most regions, over 80 percent of Indigenous peoples reported experiencing discrimination in the past 3 years, and in more than half of the regions, over 60 percent of immigrants and racialized individuals did so. Indigenous peoples, immigrants and racialized individuals were most likely to experience discrimination in employment settings and in a variety of public settings, and were most likely to attribute this discrimination to racial and ethnocultural factors, and for Indigenous peoples also their Indigenous identity. Immigrants and racialized individuals who had experienced discrimination generally reported a lower sense of belonging and welcome in their communities. This association was weaker for Indigenous peoples. The findings provide new insight into discrimination experienced by Indigenous peoples, immigrants and racialized individuals in small and mid-sized Canadian communities, and are critical to creating and implementing effective anti-racism and anti-discrimination strategies. We investigate discrimination experiences of (1) immigrants and racialized individuals, (2) Indigenous peoples, and (3) comparison White non-immigrants in nine regions of Southwestern Ontario containing small- and mid-sized communities. For each region, representative samples of the three groups were recruited to complete online surveys. In most regions, over 80 percent of Indigenous peoples reported experiencing discrimination in the past 3 years, and in more than half of the regions, over 60 percent of immigrants and racialized individuals did so. Indigenous peoples, immigrants and racialized individuals were most likely to experience discrimination in employment settings and in a variety of public settings, and were most likely to attribute this discrimination to racial and ethnocultural factors, and for Indigenous peoples also their Indigenous identity. Immigrants and racialized individuals who had experienced discrimination generally reported a lower sense of belonging and welcome in their communities. This association was weaker for Indigenous peoples. The findings provide new insight into discrimination experienced by Indigenous peoples, immigrants and racialized individuals in small and mid-sized Canadian communities, and are critical to creating and implementing effective anti-racism and anti-discrimination strategies.
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International Medical Graduates (IMGs), who completed their medical degree and training outside Canada area notable portion of skilled migrants to Canada. However, due to a long and uncertain licensure process and limited opportunities many IMGs look for alternative career pathways where they can utilize their learned skills. Alternative careers in the health and wellness sector may offer such opportunities; however, IMGs’ success in these pathways were also less evident despite their high potential. Barriers that IMGs face when attempting alternative jobs in Canada was studied through focus groups in Calgary, AB and Toronto, ON. Focus groups found that IMGs encounter many barriers in different stages of their resettlement journey in Canada, including both the pre-migration and post-migration phases. Collaborations between organizations, policy makers and researchers are needed to target these barriers. International Medical Graduates (IMGs), who completed their medical degree and training outside Canada area notable portion of skilled migrants to Canada. However, due to a long and uncertain licensure process and limited opportunities many IMGs look for alternative career pathways where they can utilize their learned skills. Alternative careers in the health and wellness sector may offer such opportunities; however, IMGs’ success in these pathways were also less evident despite their high potential. Barriers that IMGs face when attempting alternative jobs in Canada was studied through focus groups in Calgary, AB and Toronto, ON. Focus groups found that IMGs encounter many barriers in different stages of their resettlement journey in Canada, including both the pre-migration and post-migration phases. Collaborations between organizations, policy makers and researchers are needed to target these barriers.
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