Unmet Health Care Needs for Syrian Refugees in Canada: A Follow-up Study.

Unmet health care needs are under explored among refugees. Previously we found unmet health care needs in Syrian refugees may be higher than in the general Canadian population (Oda et al. CMAJ Open 5(2):E354-E358, 2017; Oda et al. J Immigr Minor Health, 2018. https://doi.org/10.1007/s10903-018-0780-z). This follow-up study with Syrian refugees who entered Canada between July 2015 and July 2016 aimed to understand if there are changes in unmet health care needs 6 months to a year after baseline collection. The number reporting unmet needs was high (42.6%). Although some refugees had their needs met, unmet health needs persist, and it seems that they are linked with sponsorship pathway and post-migration socio-economic position. While caution should be used generalizing these results, they do suggest that greater coordination between services may be needed as many of the refugees report unmet needs within months of arriving and continue to report needs after being here for a period up to 2 years.

Differences in Self-Reported Health and Unmet Health Needs Between Government Assisted and Privately Sponsored Syrian Refugees: A Cross-Sectional Survey.

Between November 2015 and January 2017, the Government of Canada resettled over 40,000 Syrian refugees through different sponsorship programs (GAR and PSR). Timely access to healthcare is essential for good health and successful integration. However, refugee support differs depending on sponsorship program, which may lead to differences in healthcare service access and needs. A cross-sectional study with a sample of Syrian refugees was conducted to assess healthcare access, and perceived physical and mental health status. Results indicate demographic and healthcare access differences between GARs and PSRs. GARs reported significantly lower perceived physical and mental health, as well as, higher unmet healthcare needs than PSRs. GARs are among the most vulnerable refugees; they report higher needs, more complex medical conditions and tend to have more difficulty re-settling. These factors likely combine to help explain lower self-reported health and higher health needs in our sample compared to PSRs.

Novas vidas, novos desafios: acesso a serviços de violência por parceiro íntimo para mulheres imigrantes de língua portuguesa / New lives, new challenges: access to intimate partner violence services for portuguese-speaking immigrant women

A violência por parceiro íntimo é um problema global e mais comum sofrida pelas mulheres. Este estudo explorou barreiras aos serviços de saúde relacionadas à violência por parceiro íntimo entre mulheres imigrantes de língua portuguesa em Toronto, Canadá. Estudo exploratório de discussões em grupo com 12 mulheres imigrantes de língua portuguesa. Os resultados esclarecem lutas enfrentadas pelas mulheres imigrantes e seus caminhos para cuidar e buscar ajuda. O medo de serem deportadas, a obtenção de evidências de abuso e a falta de serviços no idioma específico foram as barreiras relatadas. Fé e religião foram apontadas como fatores-chave no apoio a resiliência das mulheres, quando disponíveis os serviços comunitários no idioma específico. Enfermeiros que prestam assistência às mulheres que lidam com a violência por parceiro íntimo devem repensar o escopo de suas ações de defesa para abordar essas barreiras estruturais, construindo alianças com organizações para melhor servir e proteger as mulheres em situações vulneráveis.

Intimate partner violence is a global health issue and the most common form of violence experienced by women. This study explored barriers to accessing help to Intimate partner violence related health services among Portuguese-speaking immigrant women in Toronto, Canada. Exploratory study conducted by a survey and focus group discussions with 12 Portuguese-speaking immigrant women. Results clarify the struggles faced by Portuguese-speaking immigrant women and their pathways to care and help-seeking. Participants reported that the fear of being deported, obtaining evidence of abuse, and lack of language-specific services were the key barriers to seeking help. When available, language-specific community-based services, along with faith and religion, were noted as key factors that supported women's resilience. Nurses who provide care and services to women who are dealing with Intimate partner violence should rethink the scope of their advocacy actions toward addressing these structural barriers by building alliances with organizations to better serve and protect women in such vulnerable situations.

Health care needs and use of health care services among newly arrived Syrian refugees: a cross-sectional study.

BACKGROUND: Canada welcomed 33 723 Syrian refugees between November 2015 and November 2016. This paper reports the results of a rapid assessment of health care needs and use of health care services among newly arrived Syrian refugees in Toronto. METHODS: A cross-sectional study was conducted in Toronto among Syrian refugees aged 18 years or more who had been in Canada for 12 months or less. Participants were recruited initially through distribution of flyers in hotels and through direct referrals and communication with community and settlement agency partners, and then through snowball sampling. We collected sociodemographic information and data on self-perceived physical health and mental health, unmet health care needs and use of health care services. RESULTS: A total of 400 Syrian refugees (221 women [55.2%] and 179 men [44.8%]) were enrolled. Of the 400, 209 (52.2%) were privately sponsored refugees, 177 (44.2%) were government-assisted refugees, and 12 (3.0%) were refugees under the Blended Visa Office-Referred Program. They reported high levels of self-perceived physical and mental health. Over 90% of the sample saw a doctor in their first year in Canada, and 79.8% had a family doctor they saw regularly. However, almost half (49.0%) of the respondents reported unmet health care needs, with the 3 most common reasons reported being long wait times, costs associated with services and lack of time to seek health care services. INTERPRETATION: Many factors may explain our respondents' high levels of self-perceived physical and mental health during the first year of resettlement, including initial resettlement support and eligibility for health care under the Interim Federal Health Program. However, newly arrived Syrian refugees report unmet health care needs, which necessitates more comprehensive care and management beyond the initial resettlement support.

Governing through community allegiance: a qualitative examination of peer research in community-based participatory research.

The disappointing results of many public health interventions have been attributed in part to the lack of meaningful community engagement in the planning, implementation, and evaluation of these initiatives. Community-based participatory research (CBPR) has emerged as an alternative research paradigm that directly involves community members in all aspects of the research process. Their involvement is often said to be an empowering experience that builds capacity. In this paper, we interrogate these assumptions, drawing on interview data from a qualitative study investigating the experiences of 18 peer researchers (PRs) recruited from nine CBPR studies in Toronto, Canada. These individuals brought to their respective projects experience of homelessness, living with HIV, being an immigrant or refugee, identifying as transgender, and of having a mental illness. The reflections of PRs are compared to those of other research team members collected in separate focus groups. Findings from these interviews are discussed with an attention to Foucault's concept of 'governmentality', and compared against popular community-based research principles developed by Israel and colleagues. While PRs spoke about participating in CBPR initiatives to share their experience and improve conditions for their communities, these emancipatory goals were often subsumed within corporatist research environments that limited participation. Overall, this study offers a much-needed theoretical engagement with this popular research approach and raises critical questions about the limits of community engagement in collaborative public health research.

Modelling the social determinants of health and simulating short-term and long-term intervention impacts for the city of Toronto, Canada.

There is a substantial body of evidence highlighting the importance of the social determinants of health in shaping the health of urban populations in Canada. The low socio-economic status of marginalized, disadvantaged, and precarious populations in urban settings has been linked to adverse health outcomes including chronic and infectious disease, negative health behaviours, barriers to accessing health care services, and overall mortality. Given the dynamic complexities and inter-relationships surrounding the underlying drivers of population health outcomes and inequities, it is difficult to assess program and policy intervention tradeoffs, particularly when such interventions are studied with static models. To address this challenge, we have adopted a systems science approach and developed a simulation model for the City of Toronto, Canada, utilizing system dynamics modelling methodology. The model simulates changes in health, social determinants, and disparities from 2006 and projects forward to 2046 under different assumptions. Most of the variables in the model are stratified by ethnicity, immigration status, and gender, and capture the characteristics of adults aged 25-64. Intervention areas include health care access, behaviour, income, housing, and social cohesion. The model simulates alternative scenarios to help demonstrate the relative impact of different interventions on poor health outcomes such as chronic disease rates, disability rates, and mortality rate. It gives insight into how much, and how quickly, interventions can reduce mortality and morbidity. We believe this will serve as a useful learning tool to allow diverse stakeholders and policy makers to ask "what if" questions and map effective policy directions for complex population health problems, and will enable communities to think about their health futures.

Development and use of an evaluation tool for taste-testing activities by school-aged children.

We describe the development and application of a teacher-administered tool for routine program evaluation of food-tasting activities among low-income children and adolescents in a classroom or afterschool setting. This six-item evaluation tool is intended to capture student willingness to try new foods and ask for them at home. Phase 1 involved one-on-one interviews to determine the feasibility of the taste test tool among nine elementary school teachers in 2009 (168 students) and a validation pilot study in 2010 among 114 school-aged students participating in a University of California Supplemental Nutrition Assistance Program Nutrition Education (UC SNAP-Ed) summer program. Phase 2 determined instrument reliability and compared student response by grade level and food category in a convenience sample of 514 UC SNAP-Ed classrooms in 2010-2011. The mean proportion of the classroom ever having tried the foods before was 0.62 ± 0.33, and 0.77 ± 0.27 were willing to ask for the foods at home (P<0.0001). Compared with younger students (preschool through sixth grade), older students (seventh through 12th grade) were less likely to try the foods in class and less willing to try them again or ask for them at home (P<0.05). Students reported significantly greater previous exposure and willingness to try the food again for fruits than for vegetables (P<0.0001). A teacher-administered taste test tool is feasible to use in a group setting and capable of yielding valid, reliable information to evaluate student response and to guide SNAP-Ed program delivery.

Violence against Women: An Exploration of the Physical and Mental Health Trends among Immigrant and Refugee Women in Canada.

Violence against women is a serious health and social problem for women worldwide. Researchers have investigated the broad physical and mental health consequences of violence against women but few have focused on immigrant and refugee women. We assessed the history of violence and the impairment of physical and mental health among 60 women participants from the Iranian and Sri Lankan Tamil communities in Toronto, Canada. Our survey findings revealed that the participants had experienced various types of violence throughout their lifespan, with psychological abuse by a spouse/partner occurring most frequently in the past 12 months. Commonly reported types of abuse included insulting, criticizing, and intimidation by partner (psychological abuse); slapping, hitting, and shoving (physical abuse); and forced sexual intercourse and sexually degrading acts (sexual abuse) by a partner/spouse. We found that a substantial proportion of the participants also had experienced physical and mental health impairment, which could be a result of the various types of violence they had experienced throughout their lifespan. Research and practice implications are provided.

Building an international collaboration on participatory health research.

THE PROBLEM: Participatory health research (PHR) is receiving increased international attention as an approach for addressing various health issues. However, PHR has not yet achieved the status of other forms of research in terms of having an impact on health policy decisions. PURPOSE OF ARTICLE: This article reports on the current status of the new International Collaboration on Participatory Health Research (ICPHR). KEY POINTS: By formulating common definitions and standards for PHR and synthesizing the results and methods of participatory research, the collaboration will seek to strengthen the role of PHR in academic and political institutions. CONCLUSION: The collaboration is an important structure for advancing the practice, theory, and impact of PHR internationally.

A call for an international collaboration on participatory research for health.

Participatory health research (PHR) has emerged as an important approach for addressing local health issues, including building capacity for health promotion. Increasingly, PHR is drawing the attention of communities, funders, decision-makers and researchers worldwide. It is time to consolidate what we know about PHR in order to secure its place as a source of knowledge and action for public health. This can be achieved through an International Collaboration on Participatory Research for Health to addresses the following issues:Set a framework in which information can be exchanged, decisions can be reached and information can be disseminated on central issues in PHR. Provide an international forum to discuss standards and quality. Produce guidelines for researchers, practitioners and community members. Synthesize the findings of PHR internationally. Formulate recommendations regarding generalizable findings. Similar to the Cochrane Collaboration on clinical trials research, the PHR Collaboration will be dependent on a host of experts from various countries to bring together what we know about PHR and to make that knowledge accessible to an international audience. Unlike the Cochrane Collaboration, the PHR Collaboration will include both quantitative and qualitative research approaches. The goal of the PHR Collaboration will not be able to achieve a standardization of research protocols, but rather to find meaningful ways to judge the quality of PHR and to report on its findings while respecting the variety of locally based approaches to research design, data collection and interpretation.

The health of trafficked women: a survey of women entering posttrafficking services in Europe.

Trained counselors interviewed 192 women who had been trafficked and sexually exploited about abuse and evaluated their physical and mental health status within 14 days of entry into posttrafficking services. Most reported physical or sexual violence while trafficked (95%), pre-trafficking abuse (59%), and multiple posttrafficking physical and psychological problems. Newly identified trafficked women require immediate attention to address posttrauma symptoms and adequate recovery time before making decisions about participating in prosecutorial or immigration proceedings or returning home.

Street smarts and urban myths: women, sex work, and the role of storytelling in risk reduction and rationalization.

Storytelling has a strong tradition in inner-city American communities. In this article, we examine patterns of storytelling among a sample of drug-using women from New York City who engage in street-based sex work. We consider two particular formats of storytelling for analysis: "street smarts" and "urban myths." Street smarts are stories of survival, and urban myths are compilations of street legends spread by word of mouth. The narratives are filled with tales of extreme risk across situations. The women used the stories to delineate the boundaries of risk as well as to rationalize risks they deemed to be inevitable but temporary in their lives. Few of the women capitalized on the greater instructive quality of the stories toward increased risk reduction, which may relate to the women's distance from an identity of "sex worker." If properly harnessed, the strength of storytelling suggests new avenues for risk-reduction interventions.

Reassurance or judgement? Parents' views on the delivery of child health surveillance programmes.

BACKGROUND: The first year of a child's life is a crucial time for child development. Current guidance about child health surveillance and health promotion programmes emphasises a partnership approach between health professionals and parents when it comes to child health care. Parents' voices have been largely absent from discussions about local child health programmes. For partnership working to be effective and for local services to be able to evolve effectively parents' views are vital. OBJECTIVES: This study aimed to explore parents' views on the child health surveillance and health promotion programmes offered during the first year of their child's life. The study aimed to be consumer-led through the involvement of lead parents in all stages of the research process. METHODS: This study employed a qualitative methodology of focus groups and individual interviews. 35 participants were drawn from three general practices using a snowball sampling technique. Eligibility was determined as parents with a child under the age of one year or expecting a baby within the study timescale and registered at one of the 3 general practices. Focus groups were led by three 'parent-researchers' and individual interviews were conducted by a researcher. All focus groups and interviews were tape-recorded, transcribed and analysed using Atlas.Ti. RESULTS: Several main themes were identified in this study. Firstly, when discussing scheduled health checks for children under one year of age parents expressed more positive feelings for the eight-week check which was seen to be comprehensive and informative rather than the eight-month check which was viewed as bureaucratic and less reassuring. Secondly, parents clearly articulated a need for reassurance and support from health professionals involved in child health surveillance and health promotion programmes. Thirdly, a crucial professional in the delivery of these programmes was the health visitor. Whilst parents expressed support for the concept of health visitors some health visitors were seen as bureaucratic and as making judgements of need based on socio-economic factors. Finally, some parents spoke of feeling excluded from accessing support as they were deemed not to be 'in need'. CONCLUSIONS: Wider concepts of partnership working between health professionals and parents, and, needs assessment are important to this study. Crucial elements of the partnership appear to be missing and this coupled with needs assessments that leave parents feeling excluded mean that there are discrepancies between expectations and experiences of parents. These issues require consideration in order to improve services and experiences.