The case of Iranian immigrants in the greater Toronto area: a qualitative study

International Journal for Equity in Health

Mahdieh Dastjerdi¹ 

[1] Faculty of Health, School of Nursing, York University, Toronto, ON, Canada

关键词: Social workers;    Health care professionals;    Health care providers;    Toronto;    GTA;    Canada;    Iranian immigrants and refugees;    Access to health care;   

Others  :  829284
DOI  :  10.1186/1475-9276-11-9

 received in 2011-11-02, accepted in 2012-02-27,  发布年份 2012

【 摘 要 】

Introduction

Iranians comprise an immigrant group that has a very different cultural background from that of the mainstream Canadian population and speaks a language other than English or French; in this case mainly Farsi (Persian). Although Iranian immigrants in Toronto receive a high proportion of care from Farsi-speaking family physicians and health care providers than physicians who cannot speak Farsi, they are still not satisfied with the provided services. The purpose of this study was to identify the obstacles and issues Iranian immigrants faced in accessing health care services as seen through the eyes of Iranian health care professionals/providers and social workers working in Greater Toronto Area, Canada.

Methods

Narrative inquiry was used to capture and understand the obstacles this immigrant population faces when accessing health care services, through the lens of fifty Iranian health care professionals/providers and social workers. Thirty three health care professionals and five social workers were interviewed. To capture the essence of issues, individual interviews were followed by three focus groups consisting of three health care professionals and one social worker in each group.

Results

Three major themes emerged from the study: language barrier and the lack of knowledge of Canadian health care services/systems; lack of trust in Canadian health care services due to financial limitations and fear of disclosure; and somatization and needs for psychological supports.

Conclusion

Iranians may not be satisfied with the Canadian health care services due to a lack of knowledge of the system, as well as cultural differences when seeking care, such as fear of disclosure, discrimination, and mistrust of primary care. To attain equitable, adequate, and effective access to health care services, immigrants need to be educated and informed about the Canadian health care system and services it provides. It would be of great benefit to this population to hold workshops on health topics, and mental health issues, build strong ties with the community by increasing their involvement, use plain language, design informative and health related websites in both Farsi and English, and provide a Farsi speaking telephone help line to answer their health related issues.

【 授权许可】

   
2012 Dastjerdi; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Citizenship and immigration Canada: [http://www.cic.gc.ca/english/pdf/research-stats/facts2008.pdf] webciteFacts and Figures: Immigration overview permanent and temporary residents. Ottawa: ON: Statistics Canada; 2008.
• [2]Statistics Canada In Annual demographic statistics. Ottawa, ON: Statistics Canada; 2006.
• [3]Ali J: Mental health of Canada's immigrants. Supplement to Health Reports, Statistics Canada 2002. Catalogue 82-003-SIE:1-11
• [4]Blanton M, Rushing O, Ruiz S: Key Facts: Race, Ethnicity and medical care. Prepared for the Kaiser Family Foundation 2003.
• [5]Gee E, Kobayashi K, Prus S: Examining the "Healthy Immigrant Effect" in Later Life: Finding from the Canadian Community Health Survey. [http://www.socserv2.mcmaster.ca/sedap] webciteSEDAP Research Paper 98 Hamilton: McMaster University; 2003.
• [6]Muenning P, Fah M: Health status and hospital; utilization of recent immigrants to New York City. Prev Med 2002, 35:225-231.
• [7]Newbold KB: Health Status and health care utilization of the foreign-born in canada: a longitudinal analysis. 1994/95-2000/01. J Health Res Services Policy 2005, 2(10):77-83.
• [8]Newbold KB: Self-rated health within the Canadian immigrant population: risk and the healthy immigrant effect. Social Sci Med 2005, 60:1359-1370.
• [9]Gafner G, Benson S: Indirect ego-strengthening in treating PTSD in immigrants from Central America. Contemp Hypn 2006, 18(3):135-144.
• [10]Steel Z, Silove D, Brooks R, Momartin S, Alzuhairi B: Impact of immigration detention and temporary protection on the mental health of refugees. British J Psychiatry 2006, 188:58-64.
• [11]Silove D, Steel B, McGorry P, Miles V, Drobny J: The Impact of torture on post-traumatic stress symptoms in war-affected tamil refugees and immigrants. Compr Psychiatry 2009, 43(1):49-55.
• [12]Carter-Pokras O, Bethune L: Defining and measuring acculturation: a systematic review of public health studies with Hispanic populations in the United States. A commentary on Thomson and Hoffman-Goetz. Social Sci Med 2009, 69(7):992-995.
• [13]Eke P, Jaramillo F, Thornton-Evans G, Griffin S: Acculturation and dental visits among Hispanic Adults. Atlanta: Centers for Disease Control and Prevention; 2009.
• [14]Lasser KE, Himmelstein DU, Woolhandler S: Access to Care, Health Status, and Health Disparities in the United States and Canada. Result of a Cross-national Population-Based Survey 2006.
• [15]Emami A, Benner P, Ekman S: A sociocultural health model for late-in-life immigrants. J Transcult Nurs 2001, 12(1):15-24.
• [16]Emami A, Torres S, Lipson J, Ekman S: An ethnographic study of a day care center for Iranian immigrant seniors. Western J Nurs Res 2000, 2:169-188.
• [17]Karimi Moghari F: Elderly wellbeing: A comparative study between aged ethnic Iranians and native Swedes [abstract]. [http://semj.sums.ac.ir] webciteShiraz E-Medical Journal 2003, 4(4):3.
• [18]Dossa P: On social suffering: Fatima's story. In Multiculturalism an Immigration in Canada: An introductory reader. Edited by Cameron E. Toronto, Canada: Canadian Scholars' Press; 2004:369-393.
• [19]Dossa P: Politics and Poetics of Migration: Narratives of Iranian Women from the Diaspora. Toronto, Canada: Canadian Scholars' Press 2004.
• [20]Dastjerdi M: Becoming self-sufficient: The experience of Iranian immigrants who Access Canadian health care services. PhD thesis, University of Alberta, Faculty of Nursing; 2007.
• [21]Hassett A, George K, Harrigan S: Admissions of elderly patients from Englishspeaking and non-English-speaking-background to an inpatient psychogeriatric unit. Aust New Zealand J Psychiat 1999, 33:576-582.
• [22]Snowden L: African American service use for mental health problems. J Community Psychol 1999, 27:303-313.
• [23]Klimidis S, McKenzie D, Lewis J, Minas IH: Continuity of contact with psychiatric services: immigrant and Australian-born patients. Soc Psych Psych Epid 2000, 35:554-563.
• [24]Ziguras S, Klimidis S, Lewis J, Stuart G: Ethnic Matching of Clients and Clinicians and Use of Mental Health Services by Ethnic Minority Clients. Psychiatric Services 2003, 54(4):535-541.
• [25]Clandinin JD, Connelly FM: Narrative inquiry: Experience and story in qualitative research. San Francisco: Jossey-Bass; 2000.
• [26]Connelly MF, Clandinin JD: Stories of Experience and Narrative Inquiry. Educ Res 1990, 19:2-14.
• [27]Morse J: Strategies of intraproject sampling. In Nursing Research: A Qualitative perspective, Edited by Munhall PI. Sudbury: Jones and Barrlett; 2007:529-539.
• [28]Lavizzo-Mourey R: Unequal treatment: Confronting racial and ethical disparities in health care. [http://www.iom.edu/topic.asp?id=18007] webciteWashington, DC: National Academies Press, Institute of Medicine; 2002.
• [29]Bender D, Clawson M, Harlan C, Lopez R: Improving access for Latino immigrants: Evaluation of language training adapted to the needs of health professionals. J Immigr Health 2004, 6(4):197-209.
• [30]Safdar S, Lay C, Struthers W: The process of acculturation and basic goals: Testing a multidimensional individual difference acculturation model with Iranian immigrants in Canada. Appl Psychol 2003, 52(4):555-579.
• [31]National Institute of Health [http://www.healthdisparities.nih.gov/whatare.html] webciteAddressing health disparities: The NIH program of action 2002
• [32]Ito K: Health culture and the clinical encounter: Vietnamese refugees' responses to preventive drug treatment of inactive tuberculosis. Med Anthropol Q 1999, 13:338-364.
• [33]Sin DD, Svenson LW, Cowie RL: Paul Man SF: Can universal access to health care eliminate health inequalities between children of poor and nonpoor families? Am College Chest Physicians 2003, 124(1):51-56.
• [34]Documet P, Sharma R: Latinos' health care access: Financial and cultural barriers. J Immigr Health 2004, 6(1):5-13.
• [35]Pinderhughes E: Understanding race, ethnicity, and power: the key to efficacy in clinical practice. New York: Free Press; 1989.
• [36]Freire P: Pedagogy of the oppressed: 3th Anniversary editio. New York: Continuum; 2000. [Original work published 1921]
• [37]Glouberman S: Policies and programs: The evolution of health for all in Canada. In Paper presented at the "Health for All" Conference. Calgary, Merck Frosst Co; 1999.