The increasing frequency of disasters in recent years has made clear the importance of preparing for their devastating impacts. The intersection of immigrant status and older age in immigrant older adults subjects them to a high risk for harm in disasters. Thus, ensuring that this population can effectively prepare for disasters is crucial. However, research that focuses on disaster preparedness among immigrant older adults in a Canadian context is limited. We interviewed informal caregivers of immigrant older adults to explore their experiences regarding the disaster preparedness of their care recipients. We aimed to describe caregivers’ knowledge of disaster risk among immigrant older adults, as well as their experiences and perceptions of barriers and facilitators of preparedness among older immigrants. We conducted semi-structured individual interviews with a sample of 10 informal caregivers of older immigrants who reside in Ottawa and Toronto. All interviews were audio-recorded, and interview content was analyzed using inductive thematic analysis. Participants were able to identify the additional risks their older immigrant family members experience, and they took on the responsibility for disaster preparedness and response for the care recipients. However, the following barriers to preparedness efforts were identified: The financial costs of preparing, lack of confidence to prepare due to inadequate information about preparedness measures, communication difficulties among family members, and time constraints. Participants’ contingency plans for caregiving for the older immigrants were largely unspoken, and influenced by cultural norms. Lastly, faith-based organizations were seen by participants as potentially having a significant role in their family members’ disaster preparedness and response; participants were largely unaware of any other relevant community-based supports. We anticipate that our results will provide insight into the barriers and protective factors that older immigrants and their caregivers experience in safeguarding against harm in disasters, and we anticipate the recommendations will inform policies and interventions to support them.

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Background: Currently, there is limited research on the importance and need for access to healthcare amongst refugee and immigrant populations in Canada. Amongst such populations are the Sri Lankan Tamils in Canada, who arrived in Canada as either refugees or immigrants due to the ongoing war in Sri Lanka in the late 1980s. Although Canada is home to the majority of Sri Lankan Tamils, there is minimal research showcasing the need and access to better healthcare for such individuals who have fled from a crisis, the civil war in Sri Lanka. As such, this study aims to assess and understand the experiences of the Canadian Sri Lankan Tamils in accessing healthcare upon their initial arrival to Canada and how these experiences have changed overtime. Methods: An Interpretative Phenomenological Analysis approach was used to conduct semi-structured interviews in English and Tamil with 8 Sri Lankan Tamil Canadians who arrived in Canada during the late 1980s and are currently between the ages of 55-75 years, residing in the Greater Toronto Areas. Interviews were transcribed and analyzed using the IPA to elicit themes. Results: The interviews revealed facilitators and challenges to access care within the past and present experiences of Sri Lankan Tamil Canadians. Past experiences revealed facilitators to access care, such as the influences of personal factors, the significance of social support systems and structural facilitators. The impacts of immigration status and acculturation in Canada were identified as barriers to access to care in the past. As for present experiences in accessing care, the degradation of the Canadian healthcare system revealed itself as a barrier to care, whereas settling down as a gradual process came up as a facilitator to accessing healthcare services. Conclusion: While Sri Lankan Tamil Canadian’s perspectives suggested facilitators in accessing care, their experiences still reveal many areas for improvement in the healthcare system for future newcomer populations in Canada. As such, these findings may have implications for policymakers who focus on refugee and immigrant health and service providers working with these populations. / Thesis / Master of Science (MSc)

Contexte: De récentes études ont explicitement démontré que les communautés d’immigrants doivent affronter des difficultés particulières afin d'accéder aux services de santé et font face à des disparités sanitaires significatives, subissant l'effet de déterminants sociaux sous-jacents de la santé (DSS). Les immigrants représentant un pourcentage grandissant de la population dans de nombreux pays développés, mieux comprendre et supprimer ces barrières est une des grandes priorités. En se fondant sur l'utilisation d'une structure DSS, cette thèse contribue aux recherches actuelles concernant l'accès aux services de santé parmi les populations d'immigrants bangladais dans trois villes internationales : Lisbonne (Portugal), Bruxelles (Belgique) et Boston (Massachusetts, U.S.A.). À cet effet, elle apporte des précisions sur les données qualitatives limitées disponibles concernant les communautés immigrantes bangladaises qui vivent sur les sites de recherche mentionnés ci-dessus.Résultats: Les résultats obtenus ont montré que les immigrants bangladais vivant sur ces trois sites de recherche possèdent une vision généralement holistique de la santé et du bien-être. Les pressions de l'acculturation et l'isolement social constituent deux des DSS pertinents ayant une influence sur la santé et l'accès aux services sanitaires. Parmi les principaux enjeux de santé et besoins en soins de cette communauté, les problèmes de santé mentale et l'isolement social, l'alimentation et les habitudes alimentaires, le manque d'activité physique, des niveaux élevés de diabète et de maladies cardiovasculaires ont été identifiés comme facteurs influençant. Certaines valeurs culturelles associées à des motivations d'ordre économique peuvent conditionner l'importance que les individus accordent à leur santé. A titre d'exemple, l'obligation envers la famille, profondément ancrée dans la culture bangladaise, se traduit souvent chez les immigrants travaillant à l'étranger par un sentiment de pression économique et se manifeste par un stress chronique et un déséquilibre entre vie professionnelle et vie personnelle. La communication et les barrières linguistiques apparaissent comme étant les principaux freins à l'engagement des immigrants bangladais avec les prestataires de soins. Enfin, le type ainsi que le contexte de l'immigration joue un rôle important dans l'utilisation des services de santé par les immigrants bangladais: le sentiment d’être dans une situation transitoire sur le lieu où ils se trouvent tel qu'à Lisbonne et Bruxelles, en opposition à une perspective d'établissement plus permanent tel qu'à Boston, semble influencer l'utilisation active de soins de santé continus.Conclusion: Les problèmes de santé de chaque individu, la situation de leur statut d'immigrant et les circonstances familiales ont joué un rôle sur la manière dont les membres de la communauté bangladaise ont accédé et utilisé les services de santé sur chaque site de recherche. Bien que les liens sociaux au sein des communautés bangladaises vivant à l'étranger soient forts, tous les individus ne se trouvaient pas nécessairement en contact avec les membres de leur communauté. Ceci met en exergue le besoin d'un engagement et d'une sensibilisation auprès des immigrants susceptibles de ne pas bénéficier de la protection du capital social de leur communauté. Cette dissertation a permis de dresser le profil des déterminants sociaux influençant l'accès aux services de santé de la communauté immigrante bangladaise, avec pour objectif d'informer les professionnels travaillant avec cette population. A cet effet, les conclusions de cette recherche seront partagées avec les participants et intervenants de chaque site d'études afin de renforcer la compréhension des communautés immigrantes bangladaises et accroître les ressources mises à leur disposition. / Background: Recent studies clearly identify that immigrant communities experience specific challenges in accessing health care services, and face significant health disparities, that are impacted by underlying social determinants of health (SDH). As immigrants comprise an increasing percentage of the population in many developed nations, a better understanding and eliminating of these barriers is a major priority. Using an SDH framework, this dissertation contributes to the current research regarding access to health services among Bangladeshi immigrant populations in three international cities: Lisbon (Portugal), Brussels (Belgium), and Boston (MA-USA). In doing so, it expands upon the limited qualitative data available that concerns Bangladeshi immigrant communities living in these aforementioned research sites.Methods: This dissertation utilized a qualitative descriptive research design to comprehend issues from the perspective of both immigrant community members and service providers. The findings presented in this study, therefore, focus on data analyzed from 45 original in-depth interviews with Bangladeshi immigrant community members (n=32) and service providers (n=13) across Lisbon, Brussels, and Boston. Data was collected primarily using a semi-structured interview guide.Results: Bangladeshi immigrants living across the three research sites possess an overall holistic view of health and well-being according to results. Relevant SDH affecting health and accessing health services included pressures of acculturation and social isolation. The following were identified as some of the key community health issues and care needs: mental health and social isolation, food and dietary habits, lack of exercise, high levels of diabetes and cardiovascular disease. Certain cultural values coupled with economic motivators may influence the way individuals prioritize their health. For example, the obligation towards family that is deeply embedded in Bangladeshi culture often translated to feelings of economic pressure by immigrants working abroad and manifested as chronic stress and a work-life imbalance. Communication and language barriers emerged as the most prominent issue of engagement between Bangladeshi immigrants and service providers. Finally, the type and context of immigration played in important role in health service utilization by Bangladeshi immigrants: a transitory outlook on their current location such as in Lisbon and Brussels, as opposed to a more permanent outlook in Boston, appeared to influence the active uptake of continuous health care.Conclusion: Individual health priorities, immigration status, and family circumstances affected how Bangladeshi community members accessed and utilized health services at each research site. Although social networks in Bangladeshi communities abroad were strong, not all individuals were necessarily connected with their fellow community members. This underlines the need to initiate engagement and outreach to immigrant individuals who may fall outside of the protection of social capital in their community. This dissertation has established a profile of social determinants impacting access to health services for Bangladeshi immigrant communities, with the purposes of informing professionals working within this population. As such, results will be shared with participants and stakeholders at each of the study sites in order to strengthen the understanding of and resources available to Bangladeshi immigrant communities.

Immigrants to Canada report better health status than the Canadian-born population when they first arrive in Canada, a phenomenon called the Healthy Immigrant Effect. However, by the fourth year after immigration, immigrants report a health status that is worse than that of the Canadian-born population. Visible minority immigrant women report the largest deterioration in health. The purpose of this qualitative study was to explore the lived experiences of visible minority immigrant women with encounters with the Canadian healthcare system to examine the multiplicative impact of gender, ethnicity, and immigration on their health. This phenomenological study, guided by Crenshaw's feminist intersectionality framework, explored the perspectives of a purposive sample of 8 immigrant women in Ottawa, Canada, about their encounters with the healthcare system. Data were collected through individual interviews. These data were inductively coded and subjected to thematic analysis following the process outlined by Smith et al. for interpretative phenomenological analysis. Key findings of the study revealed that immigrant women define health more holistically and have expectations of the encounters with healthcare that are not met due to barriers that impact them accessing healthcare services, experiencing healthcare services, and following the recommended options. The positive social change implications of this study include recommendations for public health to consider immigration and racism as determinants of health; and for Health Canada to undertake system-level lines of inquiry to shed light on the ways structural discrimination and racism have had an impact on immigrant women's social and health trajectory.

Latino immigrants encounter an entanglement of rights and policies after occupational injury or illness. In collaboration with an immigrant worker center, ethnographic research and a survey are used to analyze injured workers’ experiences. The center uses survey results to identify common threads and systematic problems, and to explore potential direct action. Through interviews with workers and medical and legal professionals, I investigate the barriers Latino immigrants face following occupational injury or illness, how their lived experiences relate to the greater medicolegal frameworks that demarcate most formal processes of compensation and treatment, and the experiences of professionals who mediate these structures. Research results confirm that immigrant workers lack information about their labor rights and the workers’ compensation system, which prevents them from filing claims, and contributes to the underreporting of workplace injuries. However, this research project also documents how workers who do file claims and report injuries are systematically barred access to redress due to a confluence of factors including unresponsive and fraudulent employers, biases in the medical system, discourses of deservingness, insufficient protections from retaliation, and the effects of a market-based medical system. I argue that future work-related injury prevention efforts should go beyond rights education, and include reforms to the compensation system.

Past studies often find that, upon arrival U.S. immigrants generally have favorable health profiles than native-born persons, but their health deteriorates with prolonged stay. The classical explanations of this phenomenon are healthy immigrant selection and negative acculturation. With the number of foreign-born people living in the United States reaching an all-time high, the health and financial costs of this “negative acculturation” is substantial. Meanwhile, the negative duration effect on health is contradictory to expectations from classic assimilation theory and what has been observed by labor economists. This study aims to empirically study the effect of duration on immigrant health, with particular attention given to how socioeconomic status differentiates the duration-health relationship. Results based on two national datasets confirmed that immigrants, especially recent arrivals, have a considerably lower risk of worse health relative to native-born adults. I also found that socioeconomic status plays an essential role in the varying level of initial health selectivity among immigrants. The analysis of the interaction effect between duration and SES reveals that duration effects on health vary significantly by socioeconomic status. High SES immigrants tend to experience a non-negative duration effect regardless of their length of U.S. residence, while immigrants with lower socioeconomic standing are more likely to experience a negative duration effect on health with longer duration. Moreover, this study also shows that the initial foreign-born advantages in health are typically larger for persons with low SES than for persons with high SES. However, little evidence suggests there is a health convergence between long-term immigrants and their native-born counterparts with similar socioeconomic status. Potential explanations and implications of these findings are also discussed. / text

Health care disparities are U.S. national public health concerns that disproportionately affect minority populations. The focus of published studies on the health of larger immigrant populations from Europe, Asia, South America, and the Caribbean has revealed a knowledge gap on the health of African and other minority immigrants. The purpose of this phenomenological study was to explore disparities in access to maternal and child health (MCH) care as well as the causes and effects of such disparities to care-seeking experiences of recent African immigrants. Andersen's behavioral model of health services use provided the theoretical lenses to interpret study findings. Eleven recent African immigrant mothers living in metropolitan Boston, Massachusetts, participated in semistructured questions that generated data used in this study. NVivo 11 was used to manage data, which enabled convenient use of Colaizzi's data analysis technique to identify themes and subthemes that were synthesized into final findings. Study results indicated that although participants used MCH care services, factors such as racial/ethnic discrimination, insurance differences, immigration, and socioeconomic status marred the process of seeking care, with notable access disparities that negatively affect MCH care experiences. The field of health for African immigrants is ripe for research. Other researchers could replicate this study elsewhere in the United States and other traditional immigrant-destination countries. Study findings could benefit health care providers, public health professionals, researchers, and immigrant populations. Actions for sustainable positive social change may result in the form of improved health care access and health outcomes for minority immigrants in the United States and beyond.

Social supports are linked in public health research to improved birth outcomes. This study explored the relationship of social supports, stress and birth outcomes among pregnant Latinas in Pinellas County, Florida. A sample of 411 Healthy Start women at risk of poor birth outcomes participated in this study (99 Latinas, 142 Black, and 158 White). Study methods included ANOVA, Principal Component Analysis, multivariable regression, logistic regression, and structural equation modeling to identify significant associations between social support scores, stress scores, demographics and health risk factors with infant birth weight, preterm and small for gestational age by ethnic group. Study findings indicated there was a direct association between social support and stress across all ethnic groups. However, many confounding variables did not have an effect in the study sample. Latina study participants exhibited significantly lower mean social support scores compared to White and Black participants (p=0.000). Latinas also presented higher stress scores that were significantly different from White and Black participants (p=0.000). The study also found ethnic differences in stress level perceptions using the Perceived Stress Scale. Recommendations for public health included conducting additional studies to assess if the study variables have an impact on a different population, exploring different ethnic interpretations of stress, using repeated measures to assess stress in high risk populations and considering using alternate stress measures such as biological markers and stress life event scales to assess social support, stress and birth outcomes.

While the healthy immigrant effect (HIE) has been seen throughout the western world in the adult population; research on the older population shows an inverse relationship between self-reported health and immigration status – i.e., in many instances, a health disadvantage for older immigrants. Explanations for this vary from a lack of selection into population, among older immigrants, to a duration effect; such that perceived health advantages seen in early life dissipate upon reaching older age. While these are the widely accepted reasons for the disappearance of the HIE among older people, not all mitigating factors have been examined in detail. This study aims to identify if there is an association between retirement and the healthy immigrant effect seen in Europe. It uses SHARE data for 27 European countries to examine self reported health (SRH) outcomes & presence of longterm illness’ (LTI) for population groups aged 55-74. The findings indicate the presence of a greater health disadvantage for retired immigrants (versus native-born retirees) as compared with those who are not retired. Additionally, better health outcomes (compared to native-born individuals) were seen for immigrants who retired late (after the age of 65) versus those who retired early. Retirement due to poor health was examined as an explanation for these findings, but it did not appear to affect the results, suggesting the observed patterns are most likely caused by an alternative factor relating to retirement. Further research is recommended to identify these factors.