Community Ecosystem Mapping: A Foundational Step for Effective Community Engagement in Research and Knowledge Mobilization.

Community engagement is a key strategy for achieving various goals, such as social and environmental change, sustainable development, health promotion, and community building. It involves collaborations and partnerships with the community that help mobilize resources, impact systems, rectify partner dynamics, and function as catalysts for modifying policies, programs, and practices. It also ensures mutual trust among all parties involved, giving community members greater personal agency and involvement potential. We have learned a range of practical aspects of community engagement with communities, particularly with immigrant/racialized communities, by running a community-engaged program of research on the health and wellness issues of immigrant/racialized communities in Calgary, Canada. In this article, we focus on a crucial early step of community engagement-understanding the community ecosystem. The community ecosystem refers to its human, social, and cultural makeups. Understanding this ecosystem requires conscious efforts to comprehend the demography, participate in socio-cultural events, identify community spots, reach out to hard-to-access groups, find the community champions and communication channels/organizations, and reaching out to them to establish relationships. Understanding the community ecosystem allows us to identify the pivotal factors, key actors, and pulse of the community that we are engaging with. This enables us to build mutual trust and goals for research and knowledge mobilization. Subsequently, an empowered, continual, and collaborative partnership becomes possible, resulting in sustained and desirable outcomes.

Employing diffusion of innovation theory for 'not missing the mass' in community-engaged research.

INTRODUCTION: Engaging with minority communities, such as immigrants and ethnic minorities, often involves adopting top-down approaches, wherein researchers and policymakers provide solutions based on their perspective. However, these approaches may not adequately address the needs and preferences of the community members, who have valuable insights and experiences to share. Therefore, community-engaged approaches, which involve collaborative partnerships between community members and researchers to identify issues, co-create solutions, and recommend policy changes, are becoming more recognized for their effectiveness and relevance. Yet, prevailing community engagement efforts often focus on easily reachable and already engaged segments of the community, sometimes overlooking the broader population. METHODS: When working with immigrant and racialized communities, we encountered difficulties in engaging the wider community through traditional researcher-led approaches. We realized that overcoming these challenges required innovative strategies rooted in community-based participatory research principles and the diffusion of innovation theory. We recognized that a nuanced understanding of the community's dynamics and preferences was crucial in shaping our approach and building trust and rapport with the community members. RESULTS: The need to bridge the gap between researcher-led initiatives and community-driven involvement has never been more pronounced. Our experience, chronicled in this article, highlights the journey of our research program with an immigrant/racialized community. This reflection enhances our comprehension of community engagement that deliberately strives to reach a larger cross-section of the community. By providing practical methods for reaching the broader community and navigating the intricacies of engagement, we aim to assist fellow researchers in conducting effective community-engaged research across various minority communities. CONCLUSION: In sharing our insights and successful strategies for community engagement, we hope to contribute to the field's knowledge. Our commitment to fostering meaningful collaboration underscores the importance of co-creating solutions that resonate with the diverse voices within these communities. Through these efforts, we envision a more inclusive and impactful approach to addressing the complex challenges faced by minority populations.

Conceptualising community engagement as an infinite game implemented through finite games of 'research', 'community organising' and 'knowledge mobilisation'.

Meaningful community engagement process involves focusing on the community needs, building community capacity and employing culturally tailored and community-specific strategies. In the current practices of community-engaged health and wellness research, generally, community engagement activities commence with the beginning of a particular research project on a specific topic and end with the completion of the project. The outcomes of the community engagement, including the trust, partnership and contribution of the community to research, thus remain limited to that specific project and are not generally transferred and fostered further to the following project on a different topic. In this viewpoint article, we discussed a philosophical approach to community engagement that proposes to juxtapose community engagement for the specific short-term research project and the overarching long-term programme of research with the finite game and infinite game concepts, respectively. A finite game is a concept of a game where the players are known, rules are fixed and when the agreed-upon goal is achieved, the game ends. On the other hand, in infinite games, the players may be both known and unknown, have no externally fixed rules and have the objective of continuing the game beyond a particular research project. We believe community engagement needs to be conducted as an infinite game that is, at the programme of research level, where the goal of the respective activities is not to complete a research project but to successfully engage the community itself is the goal. While conducting various research projects, that is, finite games, the researchers need to keep an infinite game mindset throughout, which includes working with the community for a just cause, building trust and community capacity to maximise their contribution to research, prioritising community needs and having the courage to lead the community if need be. Patient or Public Contribution: While preparing this manuscript, we have partnered actively with community champions, activists, community scholars and citizen researchers at the community level from the very beginning. We had regular interactions with them to get their valuable and insightful inputs in shaping our reflections. Their involvement as coauthors in this paper also provided a learning opportunity for them and facilitated them to gain insight on knowledge engagement. All authors support greater community/citizen/public involvement in research in an equitable manner.

Partnering with organisations beyond academia through strategic collaboration for research and mobilisation in immigrant/ethnic-minority communities.

Community-engaged research needs involving community organisations as partners in research. Often, however, considerations regarding developing a meaningful partnership with community organisations are not highlighted. Researchers need to identify the most appropriate organisation with which to engage and their capacity to be involved. Researchers tend to involve organisations based on their connection to potential participants, which relationship often ends after achieving this objective. Further, the partner organisation may not have the capacity to contribute meaningfully to the research process. As such, it is the researchers' responsibility to build capacity within their partner organisations to encourage more sustainable and meaningful community-engaged research. Organisations pertinent to immigrant/ethnic-minority communities fall into three sectors: public, private and non-profit. While public and private sectors play an important role in addressing issues among immigrant/ethnic-minority communities, their contribution as research partners may be limited. Involving the non-profit sector, which tends to be more accessible and utilitarian and includes both grassroots associations (GAs) and immigrant service providing organisations (ISPOs), is more likely to result in mutually beneficial research partnerships and enhanced community engagement. GAs tend to be deeply rooted within, and thus are often truly representative of, the community. As they may not fully understand their importance from a researcher's perspective, nor have time for research, capacity-building activities are required to address these limitations. Additionally, ISPOs may have a different understanding of research and research priorities. Understanding the difference in perspectives and needs of these organisations, building trust and creating capacity building opportunities are important steps for researchers to consider towards building durable partnerships.

Involving im/migrant community members for knowledge co-creation: the greater the desired involvement, the greater the need for capacity building.

Researchers need to observe complex problems from various angles and contexts to create workable, effective and sustainable solutions. For complex societal problems, including health and socioeconomic disparities, cross-sectoral collaborative research is crucial. It allows for meaningful interaction between various actors around a particular real-world problem through a process of mutual learning. This collaboration builds a sustainable, trust-based partnership among the stakeholders and allows for a thorough understanding of the problem through a solution-oriented lens. While the created knowledge benefits the community, the community is generally less involved in the research process. Often, community members are engaged to collect data or for consultancy and knowledge dissemination; however, they are not involved in the actual research process, for example, developing a research question and using research tools such as conducting focus groups, analysis and interpretation. To be involved on these levels, there is a need for building community capacity for research. However, due to a lack of funds, resources and interest in building capacity on the part of both researchers and the community, deeper and meaningful involvement of community members in research becomes less viable. In this article, we reflect on how we have designed our programme of research-from involving community members at different levels of the research process to building capacity with them. We describe the activities community members participated in based on their needs and capacity. Capacity-building strategies for each level of involvement with the community members are also outlined.

Knowledge translation in health and wellness research focusing on immigrants in Canada.

INTRODUCTION Knowledge translation (KT) is a relatively new concept referring to transfers of knowledge into practice in collaboration with multiple sectors that work for the health and wellness of society. Knowledge translation is crucial to identifying and addressing the health needs of immigrants. AIM To scope the evidence on KT research engaging immigrants in the host country regarding the health and wellness of immigrants. METHODS This study followed a scoping review approach suggested by Arksey O'Malley. We identified relevant studies from both academic and grey literature using structured criteria, charted the data from the selected studies, collated, summarised and report the results. RESULTS Analysis of the eligible studies found two types of KT research: integrated KT and end-of-grant KT. Meeting or discussion with community-level knowledge-users were common KT activities among immigrants, but they were involved in the entire research process only if they were hired as members of research teams. Most KT research among immigrants explored cancer screening and used a community-based participatory action research approach. Barriers and enablers usually came from researchers rather than from the community. There was little practice of evaluation and defined frameworks to conduct KT research among immigrants in Canada. CONCLUSION This study can help the researchers and other stakeholders of health and wellness of the immigrant population to identify appropriate KT research activities for immigrants and where KT research is required to facilitate the transfer of research knowledge into action.

Meaningful and deep community engagement efforts for pragmatic research and beyond: engaging with an immigrant/racialised community on equitable access to care.

Primary healthcare access is one of the crucial factors that ensures the health and well-being of a population. Immigrant/racialised communities encounter a myriad of barriers to accessing primary healthcare. As global migration continues to grow, the development and practice of effective strategies for research and policy regarding primary care access are warranted. Many studies have attempted to identify the barriers to primary care access and recommend solutions. However, top-down approaches where the researchers and policy-makers 'prescribe' solutions are more common than community-engaged approaches where community members and researchers work hand-in-hand in community-engaged research to identify the problems, codevelop solutions and recommend policy changes. In this article, we reflect on a comprehensive community-engaged research approach that we undertook to identify the barriers to equitable primary care access among a South Asian (Bangladeshi) immigrant community in Canada. This article summarised the experience of our programme of research and describes our understanding of community-engaged research among an immigrant/racialised community that meaningfully interacts with the community. In employing the principles of community-based participatory research, integrated knowledge translation and human centred design, we reflect on the comprehensive community-engaged research approach we undertook. We believe that our reflections can be useful to academics while conducting community-engaged research on relevant issues across other immigrant/racialised communities.

Community-Driven Prioritization of Primary Health Care Access Issues by Bangladeshi-Canadians to Guide Program of Research and Practice.

Research around probable solutions to immigrants accessing health care in Canada is not extensive, and the perspective of immigrant communities on priorities and potential solutions has not been captured effectively. The purpose of this article is to describe a research initiative that involved grassroots community members as producers of research priorities on primary care access issues. This study aimed to seek input from an immigrant community in Calgary, Canada. Members of the Bangladeshi community of Calgary were asked through a survey to rank 10 predefined primary care access topics as to what they felt constituted priorities for solution-oriented research (1, highest; 10, lowest). We used frequencies and percentages to describe the participant demographics. Ratings of preferred research themes were analyzed on the basis of relative weighted priority rank. We received 432 responses: 51.2% female; 58.9% aged 36 to 55 years; 90.5% had university-level education; 46.2% immigrated to Canada between 10 and 19 years ago; 82.5% employed full/part-time or self-employed. Lack of resources, lack of knowledge, health care cost, and workplace-related barriers were among the top-ranked topics identified as solution-oriented research priorities. Through partnerships and reciprocal learning, public input can increase insider perspectives to help develop interventions that align with the needs of community members.

Overcoming the Challenges Faced by Immigrant Populations While Accessing Primary Care: Potential Solution-oriented Actions Advocated by the Bangladeshi-Canadian Community.

INTRODUCTION: Immigrants continue to face significant challenges in accessing primary healthcare (PHC) that often negatively impact their health. The present research aims to capture the perspectives of immigrants to identify potential approaches to enhance PHC access for this group. METHODS: Focus group discussions (FGDs) were conducted among a sample of first-generation Bangladeshi immigrants who had experience with PHC in Canada. A total of 13 FGDs (7 among women, 6 among men) were conducted with 80 participants (women = 42, men = 38) in their preferred language, Bangla. We collected demographic information prior to each focus group and used descriptive statistics to identify the socio-demographic characteristics of participants. We applied thematic analysis to examine qualitative data to generate a list of themes of possible approaches to improve PHC access. RESULTS: The focus group findings identified different levels of approaches to improve PHC access: individual-, community-, service provider-, and policy-level. Individual-level approaches included increased self-awareness of health and wellness and personal knowledge of cultural differences in healthcare services and improved communication skills. At the community level, supports for community members to access care included health education workshops, information sessions, and different support programs (eg, carpool services for senior members). Suggested service-level approaches included providers taking necessary steps to ensure an effective doctor-patient relationship with immigrants (eg, strategies to promote cultural competencies, hiring multicultural staff). FGD participants also raised the importance of government- or policy-level solutions to ensure high quality of care (eg, increased after-hour clinics and lab/diagnostic services). CONCLUSIONS: Although barriers to immigrants accessing healthcare are well documented in the literature, solutions to address them are under-researched. To improve healthcare access, physicians, community health centers, local health agencies, and public health units should collaborate with members of immigrant communities to identify appropriate interventions.

Unmet Healthcare Needs Among Migrant Populations in Canada: Exploring the Research Landscape Through a Systematic Integrative Review.

OBJECTIVES: Migrants are a growing part of the Canadian population, yet they encounter many unmet healthcare needs. These needs arise from the difference between the services deemed necessary, often based on their unique socio-cultural background, and the services actually received. Therefore, a systematic integrative review was conducted to (1) identify the literature on unmet healthcare needs among different migrant populations in Canada, and (2) compile the reported factors associated with these unmet needs in various migrant groups. DESIGN: We systematically searched all major databases and grey literature sources. We included original articles that studied unmet healthcare needs among immigrants, refugees, and/or temporary migrants in Canada. RESULTS: Thirty-one studies reported unmet healthcare needs among migrants in Canada. We found five categories of unmet needs across different groups of migrants including immigrants, refugees, and temporary migrants. Immigrants and refugees face unique factors that influence the development of unmet needs, such as socio-cultural differences, communication difficulties, and lack of information. Alternatively, temporary migrants have unmet needs due to factors associated with their immigration clauses, such as healthcare coverage being conditional to work permit renewal or precarious living conditions associated with work-related housing. CONCLUSION: Further research is required on unmet needs of migrants that considers the variation of unmet needs and their causal factors within different groups of migrants, in particular, refugee claimants, foreign workers, international students, and elderly migrants.

Perceived barriers and primary care access experiences among immigrant Bangladeshi men in Canada.

OBJECTIVE: The study aimed to explore the experience of male members of a rapidly grown community of Bangladeshi immigrants while accessing primary healthcare (PHC) services in Canada. DESIGN: A qualitative research was conducted among a sample of Bangladeshi immigrant men through a community-based participatory research approach. Focus group discussions were conducted to collect the qualitative data where thematic analysis was applied. SETTING: The focus group discussions were held in various community centres such as individual meeting rooms at public libraries, community halls and so on arranged in collaboration with community organisations while ensuring complete privacy. PARTICIPANT: Thirty-eight adults, Bangladeshi immigrant men, living in Calgary were selected for this study and participated in six different focus groups. The sample represents mostly married, educated, Muslim, Bangla speaking, aged over 25 years, full-time or self-employed and living in an urban centre in Canada >5 years. RESULT: The focus groups have highlighted long wait time as an important barrier. Long wait at the emergency room, difficulties to get access to general physicians when feeling sick, slow referral process and long wait at the clinic even after making an appointment impact their daily chores, work and access to care. Language is another important barrier that impedes effective communication between physicians and immigrant patients, thus the quality of care. Unfamiliarity with the healthcare system and lack of resources were also voiced that hinder access to healthcare for immigrant Bangladeshi men in Canada. However, no gender-specific barriers unique to men have been identified in this study. CONCLUSION: The barriers to accessing PHC services for Bangladeshi immigrant men are similar to that of other visible minority immigrants. It is important to recognise the extent of barriers across various immigrant groups to effectively shape public policy and improve access to PHC.

Perceived Challenges and Unmet Primary Care Access Needs among Bangladeshi Immigrant Women in Canada.

INTRODUCTION: Understanding barriers in primary health care access faced by Canadian immigrants, especially among women, is important for developing mitigation strategies. The aim of this study was to gain an in-depth understanding of perceived challenges and unmet primary health care access needs of Bangladeshi immigrant women in Canada. METHODS: In this qualitative study, we conducted 7 focus groups among a sample of 42 first-generation immigrant women on their experiences in primary health care access in their preferred language, Bangla. Descriptive analysis was used for their socio-demographic characteristics and inductive thematic analysis was applied to the qualitative data. RESULTS: The hurdles reported included long wait time at emergency service points, frustration from slow treatment process, economic losses resulting from absence at work, communication gap between physicians and immigrant patients, and transportation problem to go to the health care centers. No access to medical records for walk-in doctors, lack of urgent care, and lack of knowledge about Canadian health care systems are a few of other barriers emerged from the focus group discussions. CONCLUSIONS: The community perception about lack of primary health care resources is quite prevalent and is considered as one of the most important barriers by the grassroots community members.

Primary care access barriers faced by immigrant populations in their host countries: a systematic review protocol aiming to construct a conceptual framework using root cause analysis to capture 'what leads to what'.

INTRODUCTION Understanding primary care access or health service utilisation challenges among immigrant communities is important for tailoring services to community needs, which is the core of precision population health. AIM We aim to inventory the primary care access barriers faced by immigrant communities through a comprehensive systematic review and develop a conceptual framework to explain the barriers, using a root cause analysis approach. METHODS Academic databases of primary research articles and grey literature will be searched using appropriate keywords. Relevant information will be extracted into tabular format from finally selected literature. Our proposed approach of framing the barriers to identify the root causes is adapted from the root cause analysis method, which is the process of identifying and understanding the underlying causes to discover the root causes of problems. RESULTS The study will produce a systematic, quantified and documented list of the barriers faced by immigrants in a solution-oriented approach. DISCUSSION The proposed research, as a first step towards determining possible mitigation strategies for health-care access by immigrants, will provide the background needed to devise and test tailored interventions to improve future access to health care for immigrants. We will follow the integrated knowledge translation or community engagement knowledge mobilization approach, where we are engaged with community-based citizen researchers from the inception of our programme. We plan to disseminate the results of our review through meetings with key stakeholders and social media outreach, followed by journal publications and presentations on relevant platforms.

Health and well-being literacy initiatives focusing on immigrant communities: an environmental scan protocol to identify "what works and what does not".

INTRODUCTION: Most of the major cities in the developed western countries are characterized by an increasing multiculturalism brought by the immigrant population. The immigrant communities face challenges in the new environment with their health and wellness related unmet needs. It is imperative to find sustainable ways to empower these diverse communities to champion their health and wellness. Community-based health and wellness literacy initiatives (CBHWLI) focusing on immigrant communities can be an important step towards citizen empowerment in this regard. The aim of the present environmental scan is to identify the key factors that might impact a CBHWLI in immigrant communities in Canada in order to facilitate the process in practice and identify the competencies and training required for its implementation. METHODS: This study will gather information from existing literature and online sources as well as will capture expert and lay perspectives on the factors that can impact the effectiveness and sustainability of CBHWLIs through conducting a comprehensive environmental scan: (i) a systematic scoping review of published literature and grey literature, (ii) a comprehensive Internet search, (iii) key informant interviews, and (iv) community consultation. Specific methodological and analytical frameworks will guide each step. ETHICS AND DISSEMINATION: This study is the first step in establishing a practical base for developing CBHWLI implementation research. Once the initial findings have been generated, the second step will involve inviting experts to provide their input. We first plan to disseminate the results of our scoping review and Internet scan through meetings with key stakeholders, to be followed by journal publications and conference or workshop presentations. Ethical approval is not required for the scoping review or Internet scan; however, approval to conduct interviews with key informants and community consultations in the second stage of the study will be sought from the Conjoint Health Research Ethics Board.

Knowledge mobilisation in bridging community-practice-academia-policy through meaningful engagement: systematic integrative review protocol focusing on studies conducted on health and wellness among immigrant communities.

INTRODUCTION: Though the importance of knowledge mobilisation has been established globally in health and wellness research, a certain degree of ambiguity remains regarding the meaning and extent of knowledge mobilisation activities and how they have been implemented. In this study, we aim to explore the different descriptions of knowledge mobilisation and the diverse ways mobilisation activities have been realised by different researchers working for the betterment of health and wellness of immigrant communities in their host countries. METHODS AND ANALYSIS: We aimed to conduct an integrative review to organise the available literature describing knowledge mobilisation pertaining to health and wellness in immigrant communities. We will employ a comprehensive search, using appropriate search-terms, to identify relevant literature and will qualitatively synthesise the information toward fulfilling our objectives. Specific methodological and analytical frameworks related to the integrative review process will guide each step of the process. A librarian designed the systematic search of the academic and grey literature from database inception to December 2019. The databases include MEDLINE (Ovid), Embase, PsycINFO, PubMed, CINAHL and SocINDEX. For grey literature, we will conduct searches in AHS Insite, Google, Google Scholar, OAISter and government websites. A two-stage (title-abstract and full-text) screening will be conducted, including single-citation tracking and hand search of reference lists. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. We first plan to disseminate the results of our systematic review protocol through meetings with key stakeholders, followed by appropriate publications and presentations at applicable platforms. We also have opted for an integrated knowledge translation or community-engaged knowledge mobilisation approach where we have engaged with community-based citizen researchers from the inception of our research.

Community engagement with immigrant communities involving health and wellness research: a systematic review protocol towards developing a taxonomy of community engagement definitions, frameworks, and methods.

INTRODUCTION: The importance of community engagement has been established globally in health and wellness research. A certain degree of ambiguity remains, however, regarding the meaning of community engagement, which term has been used for various purposes and implemented in various forms. In this study, we aimed to explore the different definitions of community engagement, discuss the various objectives that have been proposed and uncover the diverse ways this concept has been implemented among researchers working for the betterment of the health and wellness of immigrant communities in host countries. METHODS AND ANALYSIS: Taxonomy is a process for classifying complex and multifaceted matters using logical conceptual domains and dimensions for clearer way of contextualising. We will develop a taxonomy to organise the available literature on community engagement in immigrant health and wellness research in a way that captures user knowledge and understanding of its various meanings and processes. Specific methodological and analytical frameworks for systematic review and taxonomy development will guide each step. We will conduct a comprehensive systematic search in relevant databases, from inception to December 2019, using appropriate keywords followed by snowball search (single-citation tracking, reference lists). Papers will be included if they fall within predefined inclusion criteria (seen as most likely informative on elements pertaining to community engagement) and are written in English, regardless of design (conceptual, qualitative and quantitative). Two reviewers will independently employ two-stage screening (title-abstract screening followed by screening of the full text to determine inclusion). Finally, information that helps to develop taxonomy of the concept and practice of community engagement will be abstracted and used towards taxonomy development, where different levels of stakeholder research team members will be involved. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review. We have opted for an integrated knowledge translation or a community-engaged knowledge mobilisation approach where we are engaged with community-based citizen researchers from the inception of our programme. We plan to disseminate the results of our review through meetings with key stakeholders, followed by journal publications and presentations at applicable platforms.

Hypercholesterolemia and Lifetime Risk of Coronary Heart Disease in the General Japanese Population: Results from the Suita Cohort Study.

AIM: Lifetime risk (LTR) is a measure of disease burden, which presents the probability of occurrence of a specific disease in the remaining lifetime of a group of people for a given index age. This measure is useful for presenting the risk dynamics of a disease at the population level, which constitutes important public health information toward prevention. To date, there have been no studies investigating the LTR for coronary heart diseases (CHDs) in relation to hypercholesterolemia in Asian populations. Therefore, we estimated the LTR of CHDs according to serum low-density lipoprotein cholesterol (LDL-C). METHODS: The participants included in this study were 2,559 men and 2,848 women, enrolled in the Suita Cohort Study of urban residents followed up from 1989 to 2007 for a total of 69,823 person-years. We estimated the sex- and index-age-specific LTR for the first CHD event among participants with or without hypercholesterolemia (LDL-C ≥ 160 mg/dL), accounting for the competing risk for mortality. RESULTS: For men with hypercholesterolemia, the LTR was 47.2% (95% confidence interval [CI]: 29.3-65.1%) and 44.5% (95% CI: 21.4-68.5%) for those aged 45 and 75, respectively. The LTRs of women with hypercholesterolemia were also higher than of those without hypercholesterolemia. However, their LTRs were lower for all index ages compared to men. These results did not differ for hypercholesterolemia defined by non-high-density lipoprotein cholesterol. CONCLUSIONS: The presence of hypercholesterolemia increases the LTR for CHDs in the Japanese population, especially in men. This estimate can be used in preventive knowledge translation efforts at the population level.

Barriers to Breast Cancer Screening Among Immigrant Populations in Canada.

The objective of this study is to summarize the current knowledge about barriers to breast cancer screening among immigrant and ethnic women and to determine future research opportunities in this area. A scoping review of the literature was conducted following a five-stage framework. Electronic databases of peer-reviewed articles and grey literature were searched based on comprehensive sets of key words, without restricting the time period or language. Barriers were classified into six themes: socioeconomic, cultural, communication, healthcare-system-related, knowledge-related, and personal barriers. Lack of education, lack of physicians' recommendation, a preference for female physicians, the inability to speak one of the official languages, and embarrassment were some of the common barriers identified. The reported barriers can be used as a source of information for policymakers, healthcare providers, and researchers to decide the future direction of research in this field.