International Journal for Equity in Health | |
A study of Iranian immigrants’ experiences of accessing Canadian health care services: a grounded theory | |
Linda Ogilvie2  Karin Olson2  Mahdieh Dastjerdi1  | |
[1] York University, Faculty of health, School of Nursing, 4700 Keele Street, Toronto, M3J 1P, Canada;University of Alberta, Faculty of Nursing, 11405 87 Avenue, Edmonton, T6G 1C9, Canada | |
关键词: Constructivist grounded theory; Canada; Iranians; Access; Health care; Refugees; Immigrants; | |
Others : 826217 DOI : 10.1186/1475-9276-11-55 |
|
received in 2012-05-01, accepted in 2012-09-13, 发布年份 2012 | |
【 摘 要 】
Background
Immigration is not a new phenomenon but, rather, has deep roots in human history. Documents from every era detail individuals who left their homelands and struggled to reestablish their lives in other countries. The aim of this study was to explore and understand the experience of Iranian immigrants who accessed Canadian health care services. Research with immigrants is useful for learning about strategies that newcomers develop to access health care services.
Methods
The research question guiding this study was, “What are the processes by which Iranian immigrants learn to access health care services in Canada?” To answer the question, a constructivist grounded theory approach was applied. Initially, unstructured interviews were conducted with 17 participants (11 women and six men) who were adults (at least 18 years old) and had immigrated to Canada within the past 15 years. Eight participants took part in a second interview, and four participants took part in a third interview.
Results
Using a constructivist grounded theory approach, “tackling the stumbling blocks of access” emerged as the core category. The basic social process (BSP), becoming self-sufficient, was a transitional process and had five stages: becoming a stranger; feeling helpless; navigating/seeking information; employing strategies; and becoming integrated and self-sufficient. We found that “tackling the stumbling blocks of access” was the main struggle throughout this journey. Some of the immigrants were able to overcome these challenges and became proficient in accessing health care services, but others were unable to make the necessary changes and thus stayed in earlier stages/phases of transition, and sometimes returned to their country of origin.
Conclusion
During the course of this journey a substantive grounded theory was developed that revealed the challenges and issues confronted by this particular group of immigrants. This process explains why some Iranian immigrants are able to access Canadian health care effectively while others cannot. Many elements, including language proficiency, cultural differences, education, previous experiences, financial status, age, knowledge of the host country’s health care services, and insider and outsider resources work synergistically in helping immigrants to access health care services effectively and appropriately.
【 授权许可】
2012 Dastjerdi et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20140713090724312.pdf | 441KB | download | |
Figure 1. | 77KB | Image | download |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]Ng E: The healthy immigrant effect and mortality rate. Ottawa: Statistic Canada; 2011. http://www.statcan.gc.ca/pub/82-003-x/2011004/article/11588-eng.pdf webcite
- [2]Dossa P: On social suffering: Fatima’s story. In Multiculturalism an immigration in Canada: An introductory reader. Edited by Cameron E. Toronto: Canadian Scholars’ Press; 2004:369-393.
- [3]Dossa P: Politics and poetics of migration: Narratives of Iranian women from the Diaspora. Toronto: Canadian Scholars’ Press; 2004.
- [4]Jafari S, Baharlou S, Mathias M: Knowledge of determinants of mental health among iranianimmigrants of BC, Canada: a qualitative study. J Immigr Minor Health 2010, 12:100-106.
- [5]Khanlou N: Migrant mental health in Canada. 2010, 9-16. [Canadian Issues/ Thèmes Canadians]
- [6]Shakya Y, Khanlou N, Gonsalves T: Determinants of mental health for newcomer youth: Policy and service implications. 2010, 98-102. [Canadian Issues/ Thèmes Canadians]
- [7]Wong R, Tsang A: When Asian immigrant women speak: from mental health to strategies of being. Am J Orthopsychiatry 2004, 17(4):456-466.
- [8]Padilla Y, Villaobos G: Cultural response to health among Mexican American women and their families. Fam Community Health 2007, 30(15):S24-S33.
- [9]Wang L: Immigration, ethnicity, and accessibility to culturally diverse family physicians. Health Place 2007, 13:656-671.
- [10]Wu Z, Penning M, Schimmele C: Immigrant status and unmet health care needs. Can J Public Health 2005, 96(5):369-373.
- [11]Behjati-Sabet A, Chambers N: People of Iranian descent. In Cross-cultural caring. Edited by Waxler-Morrison N, Anderson J, Richardson E, Chambers N. Vancouver: University of British Columbia Press; 2005:127-162.
- [12]Emami A, Benner P, Ekman S: A sociocultural health model for late-in-life immigrants. J Transcult Nurs 2001, 12(1):15-24.
- [13]Emami A, Ekman S: Living in a foreign country in old age: senior Iranian immigrants’ experiences of their social situation in Sweden. Health Care in Later Life 1998, 3:183-199.
- [14]Emami A, Torres S, Lipson J, Ekman S: An ethnographic study of a day care center for Iranian immigrant seniors. West J Nurs Res 2000, 2:169-188.
- [15]Charmaz K: Constructing grounded theory: A practical guide through qualitative analysis. London: Sage; 2006.
- [16]Richard L, Morse J: Readme first for a user’s guide to qualitative methods. London: Sage; 2012.
- [17]Denzin N, Lincoln Y: The sage handbook of qualitative research. Sage: London; 2011.
- [18]Morse J, Barrett M, Mayan M, Olson K, Spiers J: Verification strategies for establishing reliability and validity in qualitative research. IJQM 2002, 1(2):1-10. http://ejournals.library.ualberta.ca/index.php/IJQM/article/view/4603/3756 webcite
- [19]Ricoeur P: Oneself as another. Chicago: University of Chicago Press; 1992.
- [20]Shahideh L: The power of Iranian narratives: A thousand years of healing. Dallas: University Press of America; 2004.
- [21]De Maio F, Kemp E: The deterioration of health status among immigrants to Canada.Global public health. An International Journal for Research, Policy and Practice 2010, 5(5):462-478.
- [22]Meadows L, Thurston W, Melton C: Immigrant women’s health. Soc Sci Med 2001, 52(9):1451-1458.
- [23]Pinderhughes E: Understanding race, ethnicity, and power: The key to efficacy in clinical practice. New York: Free Press; 1989.
- [24]Sirvastava R: Health care professionals guide to clinical cultural competence. Toronto: Mosby/Elsevier; 2007.
- [25]Kale E, Syed H: Language barriers and the use of interpreters in the public health services. A questionnaire-based survey. Patient Educ Couns 2010, 81(2):187-191.
- [26]Leduc N, Proulx M: Patterns of health services utilization. Public Health Nurs 2004, 21(5):412-418.
- [27]Lavizzo-Mourey R: Unequal treatment: Confronting racial and ethical disparities in health care. National Academies Press, Institute of Medicine; 2002. Retrieved June 20, 2002, from http://www.iom.edu/topic.asp?id=18007 webcite
- [28]National Institute of Health: Addressing health disparities, the NIH program of action. 2002. http://www.healthdisparities.nih.gov/whatare.html webcite
- [29]Ivanov L, Buck K: Health care utilization patterns of Russian-speaking immigrant women across age groups. J Immigr Health 2002, 4(1):17-27.
- [30]Boulware E, Cooper L, Ratner L, LaVeist T, Powe N: Race and trust in the health-care system. Public Health Rep 2003, 118:358-365.
- [31]Barron F, Hunter A, Mayo R, Willoughby D: Acculturation and adherence: issues for health care providers working with clients of Mexican origin. J Transcult Nurs 2004, 15(4):331-337.
- [32]Newbold K: Self-rated health within the Canadian immigrant population: risk and the healthy immigrant effect. Soc Sci Med 2004, 60:1359-1370.
- [33]Goldlust J, Richmond A: A multivariate model of immigrant adaptation. International Migration Review 1974, 8:193-216.
- [34]Sedighdeilami F: Psychological adjustment of Iranian immigrants and refugees in Toronto. New York University: Doctoral Dissertation; 2003.
- [35]Freire P: Pedagogy of the oppressed. 30 anniversary edition. New York: The Continuum International Publishing Group; 2000. ISBN: 0826412769
- [36]Geiger J: Racial stereotyping and medicine: the need for cultural competence. Can Med Assoc J 2001, 164:1699-1700.
- [37]Glouberman S: Policies and programs: The evolution of health for all in Canada. Paper presented at the “Health for All”, Conference Calgary, Merck Frosst Co; 1999.
- [38]Institute of Medicine: Access to health care in America. Washington, DC: National Academy; 1993.
- [39]DesMeules M, Gold J, Kazanjian A, Manuel D, Payne J, Bissandjee B, et al.: New approaches to immigrant health assessment. Can J Public Health 2004, 95(3):122-126.
- [40]Freedman LP: Human rights and women’s health. In Women and health. Edited by Goldman MB, Hatch MC. San Diego: Academic; 2000:428-438.
- [41]Castles S, Miller MJ: The age of migration: International population movements in the modern world. New York: Guilford Press; 2008.
- [42]Strohschein FJ, Merry L, Thomas J, Gagnon A: Strengthening data quality in studies of migrants not fluent in host languages: a Canadian example with reproductive health questionnaires. Res Nurs Health 2010, 33:369-379.
- [43]Urquia ML, Glazier RH, Blondel B, Zeitlin J, Gissler M, Macfarlane A, Ng E, Heaman M, Stray-Pedersen B, Gagnon AJ: International migration and adverse birth outcomes: role of ethnicity, region of origin and destination. J Epidemiol Community Health 2010, 64:243-245.
- [44]Vissandjee B, Hyman I, Spitzer DL, Apale A, Kamrun N: Integration, clarification, substantiation: sex, gender, ethnicity and migration as social determinants of women’s health. Journal of International Women’s Studies 2007, 8(4):1-17. May