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)

This qualitative research used the Long Interview method to study cultural and gender influences on mental health, health beliefs, health behaviour, help-seeking and treatment expectations for mental health problems in newcomers to Canada who are members of an ethnocultural, visible minority population - the Sri Lankan Tamils. The study employed a comparative design and analyzed data from interviews with Tamil men (N=8) and Tamil women (N=8) who self-identified as having been diagnosed with depression, and service providers (N=8) who provide frontline mental health and related services to the Sri Lankan Tamil community. The objectives were to a) understand cultural and gender factors inherent in the Sri Lankan Tamil community; b) investigate how these cultural and gender factors impact mental health and influence the trajectory of help-seeking and treatment for depression in the Sri Lankan Tamil community; c) explore the intersection of culture and gender as it relates to health behaviour; and d) explore service providers’ perceptions of the influence of culture and gender in relation to help-seeking for mental health problems and the application of this understanding to service delivery. The study found that the respondents equated social function with health and that this concept informed help-seeking and treatment expectations. Socially appropriate functioning was seen as an indicator of health, and this differed by gender. Gender-differentiated social stressors contributed to depression. Women played a role as enablers of care, both for family members and acquaintances. Men were more resistant to help-seeking and tended to disengage from care. There was a distinct preference for service providers who understood the culture and spoke Tamil. Religious groups served a social support function. Family physicians and Tamil service providers in the social service sectors were identified as key players in the pathways to care. Service providers did not appear to understand the community’s holistic view of health; however, they did use their knowledge of the community to make adaptations to practice. Recommendations that result from these findings include health promotion and prevention strategies beyond the traditional health care system, targeted culture and gender-informed interventions, and the need for multisectoral collaborations.

This qualitative research used the Long Interview method to study cultural and gender influences on mental health, health beliefs, health behaviour, help-seeking and treatment expectations for mental health problems in newcomers to Canada who are members of an ethnocultural, visible minority population - the Sri Lankan Tamils. The study employed a comparative design and analyzed data from interviews with Tamil men (N=8) and Tamil women (N=8) who self-identified as having been diagnosed with depression, and service providers (N=8) who provide frontline mental health and related services to the Sri Lankan Tamil community. The objectives were to a) understand cultural and gender factors inherent in the Sri Lankan Tamil community; b) investigate how these cultural and gender factors impact mental health and influence the trajectory of help-seeking and treatment for depression in the Sri Lankan Tamil community; c) explore the intersection of culture and gender as it relates to health behaviour; and d) explore service providers’ perceptions of the influence of culture and gender in relation to help-seeking for mental health problems and the application of this understanding to service delivery. The study found that the respondents equated social function with health and that this concept informed help-seeking and treatment expectations. Socially appropriate functioning was seen as an indicator of health, and this differed by gender. Gender-differentiated social stressors contributed to depression. Women played a role as enablers of care, both for family members and acquaintances. Men were more resistant to help-seeking and tended to disengage from care. There was a distinct preference for service providers who understood the culture and spoke Tamil. Religious groups served a social support function. Family physicians and Tamil service providers in the social service sectors were identified as key players in the pathways to care. Service providers did not appear to understand the community’s holistic view of health; however, they did use their knowledge of the community to make adaptations to practice. Recommendations that result from these findings include health promotion and prevention strategies beyond the traditional health care system, targeted culture and gender-informed interventions, and the need for multisectoral collaborations.