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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Comprehensive sexual education (CSE) is defined by the United Nations Educational, Scientific, and Cultural Organization as “a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality” (2018, p. 16). Given the social and cultural aspects of sexual education, my research posits that newcomer access to comprehensive sexual education could be crucial to settlement and inclusion processes in Canada. Thus, my research asks: where does immigration and settlement policy intersect with sexual education policy in Canada? How does newcomer and immigrant community access to sexual education impact immigration and settlement processes? To investigate the ways in which the policy areas of immigration and settlement and sexual education overlap, I examine how sexual education is delivered in Edmonton, Alberta, a city that has one of the most robust and multifaceted settlement frameworks in Canada. A key data source for this research includes interviews with settlement workers and others who administer social integration programming, to assess whether or not they think sexual education is integral to settlement and integration, what barriers might exist in providing these services, and relationships between organizations who work in these fields. Before engaging with interview findings, however, this thesis will first provide several contextual chapters. This includes discussion of how access to sexual education and sexual health for newcomers and immigrant communities are part of the landscapes of biopolitics and sexual citizenship in Canada, the multijurisdictional nature of immigration and settlement policy, the terrain of sexual education policy in Canada, and the capacity of comprehensive sexual education to engage in anti-racist approaches. This thesis establishes that sexual education does in fact overlap with immigration and settlement policy, as norms around sex and gender are woven into the immigration process. Although issues related to sexual education do arise in a settlement context, there are both structural and cultural barriers that hinder a more fulsome engagement with sexual education in the services and programs provided by settlement agencies. However, these barriers have been challenged by service providers with strategies that emphasize integrative and relational approaches to sexual education with clients, as well as framing sexual educational content around individual and family wellness. These strategies relate to approaches outlined by UNESCO for effective implementation of CSE, suggesting that settlement work can be conducive to CSE. This thesis also identifies key service gaps in the provision of settlement services at large, and thus sexual education in this context. The research also highlights service gaps from organizations invested in the implementation of CSE in serving newcomer and immigrant communities. The research culminates in recommendations to address these gaps and further areas of research to be pursued. Comprehensive sexual education (CSE) is defined by the United Nations Educational, Scientific, and Cultural Organization as “a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality” (2018, p. 16). Given the social and cultural aspects of sexual education, my research posits that newcomer access to comprehensive sexual education could be crucial to settlement and inclusion processes in Canada. Thus, my research asks: where does immigration and settlement policy intersect with sexual education policy in Canada? How does newcomer and immigrant community access to sexual education impact immigration and settlement processes? To investigate the ways in which the policy areas of immigration and settlement and sexual education overlap, I examine how sexual education is delivered in Edmonton, Alberta, a city that has one of the most robust and multifaceted settlement frameworks in Canada. A key data source for this research includes interviews with settlement workers and others who administer social integration programming, to assess whether or not they think sexual education is integral to settlement and integration, what barriers might exist in providing these services, and relationships between organizations who work in these fields. Before engaging with interview findings, however, this thesis will first provide several contextual chapters. This includes discussion of how access to sexual education and sexual health for newcomers and immigrant communities are part of the landscapes of biopolitics and sexual citizenship in Canada, the multijurisdictional nature of immigration and settlement policy, the terrain of sexual education policy in Canada, and the capacity of comprehensive sexual education to engage in anti-racist approaches. This thesis establishes that sexual education does in fact overlap with immigration and settlement policy, as norms around sex and gender are woven into the immigration process. Although issues related to sexual education do arise in a settlement context, there are both structural and cultural barriers that hinder a more fulsome engagement with sexual education in the services and programs provided by settlement agencies. However, these barriers have been challenged by service providers with strategies that emphasize integrative and relational approaches to sexual education with clients, as well as framing sexual educational content around individual and family wellness. These strategies relate to approaches outlined by UNESCO for effective implementation of CSE, suggesting that settlement work can be conducive to CSE. This thesis also identifies key service gaps in the provision of settlement services at large, and thus sexual education in this context. The research also highlights service gaps from organizations invested in the implementation of CSE in serving newcomer and immigrant communities. The research culminates in recommendations to address these gaps and further areas of research to be pursued.
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