From struggle to strength in African and Middle Eastern newcomers' integration stories to Canada: A participatory health equity research study.

BACKGROUND AND OBJECTIVES: Newcomers (immigrants, refugees, and international students) face many personal, gender, cultural, environmental and health system barriers when integrating into a new society. These struggles can affect their health and social care, reducing access to mental health care. This study explores the lived experiences of African and Middle Eastern newcomers to Ontario, Canada. An understanding of newcomer integration challenges, successes and social justice issues is needed to improve health equity and social services. METHODS: In this qualitative study, we used a participatory research approach to collect stories reflecting participants' integration perspectives and experiences. Beginning with our immigrant community network, we used snowball sampling to recruit newcomers, ages 18 to 30, originating from Africa or the Middle East. We used qualitative narrative analysis to interpret stories, identifying context themes, integrating related barriers and facilitators, and resolutions and learnings. We shared our findings and sought final feedback from our participants. FINDINGS: A total of 18 newcomers, 78% female and approximately half post-secondary students, participated in the study. Participants described an unknown and intimidating migration context, with periods of loneliness and isolation aggravated by cold winter conditions and unfamiliar language and culture. Amidst the struggles, the support of friends and family, along with engaging in schoolwork, exploring new learning opportunities, and participating in community services, all facilitated integration and forged new resilience. CONCLUSIONS: Community building, friendships, and local services emerged as key elements for future immigrant service research. Utilizing a participatory health research approach allowed us to respond to the call for social justice-oriented research that helps to generate scientific knowledge for promoting culturally adaptive health care and access for marginalized populations.

Examining the disparities: A cross-sectional study of socio-economic factors and food insecurity in Togo.

BACKGROUND: Despite many interventions, Togo continues to have one of the highest rates of poverty and food insecurity in the sub-Saharan African region. Currently there is no systematic analysis of the factors associated with household food-insecurity in this country. This study aimed at exploring the factors associated with food insecurity in Togo. METHODS: This was a cross-sectional study that used data from five waves (2014 to 2018) of the Gallup World Poll (GWP) for Togo. Sample size included 4754 participants, aged 15 and above. Food insecurity was measured using the Food Insecurity Experience Scale (FIES) questionnaire as per the Food and Agricultural Organization (FAO) guidelines. Our outcome variable was food insecurity, categorized as: 1) food secure (FIES score = 0-3), moderately food insecure (FIES score = 4-6), and severely food insecure (FIES score = 7-8). We did descriptive and multinomial regressions to analyze data using Stata version 16. RESULTS: Between 2014 and 2018, the percentage of severe food insecurity fluctuated-42.81% in 2014, 37.79% in 2015, 38.98% in 2016, 45.41% in 2017, and 33.84% in 2018. Whereas that of moderate food insecurity increased from 23.55% to 27.33% except for 2016 and 2017 where the percentage increased to 32.33% and 27.46% respectively. In the logistic regression analysis, we found that respondents with lower than elementary education had a higher relative risk ratio of moderate (RRR = 1.45,95%CI = 1.22-1.72) and severe (RRR = 1.72, 95%CI = 1.46-2.02) food insecurity compared to those with secondary and higher education. Rural respondents had higher RRR of severe food insecurity (RRR = 1.37, 95%CI = 1.16-1.62) compared to those who lived in the urban areas. Compared with those in the richest wealth quintile, respondents in the poorest wealth quintile had 2.21 times higher RRR of moderate (RRR = 2.21, 95%CI = 1.69-2.87) and 3.58 times higher RRR of severe (RRR = 3.58, 95%CI = 2.81-4.55) food insecurity. CONCLUSION: About two-thirds of participants experienced some level of food insecurity in 2018. Lower levels of education, rural residency and poorer household wealth index areas were associated with a higher risk of food insecurity. National food security programs should focus on promoting education and improving socioeconomic condition of people especially in rural areas.

Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study.

BACKGROUND: Proper utilization of maternal healthcare services plays a major role on pregnancy and birth outcomes. In sub-Saharan Africa, maternal and child mortality remains a major public health concern, especially in least developed countries such as Togo. In this study, we aimed to analyze factors associated with use of maternal health services among Togolese women aged 15-49 years. METHODS: This study used data from third round of nationally representative Demographic and Health Survey conducted in Togo in 2013. Analysis included 4,631 women aged 15-49 years. Outcome variables were timely first antenatal care (ANC) visits, adequate ANC4 + visits, and health facility delivery. Data were analyzed using Stata version 16. RESULTS: Overall, proportion of maternal healthcare utilization was 27.53% for timely first ANC visits, 59.99% for adequate ANC visits, and 75.66% for health facility delivery. Our multivariable analysis showed significant differences among women in highest wealth quintile, especially in rural areas with increasing odds of timely first ANC visits (Odds ratio (OR) = 3.46, 95% CI = 2.32,5.16), attending adequate ANC visits (OR = 2.19, 95% CI = 1.48,3.24), and delivering in health facilities (OR = 8.53, 95% CI = 4.06, 17.92) compared to those in the poorest quintile. Also, women with higher education had increased odds of timely first ANC visits (OR = 1.37, 95% CI = 1.11,1.69), and attending adequate ANC visits (OR = 1.73, 95% CI = 1.42,2.12) compared to those with no formal education. However, having higher parity and indigenous beliefs especially in rural areas decreased odds of using healthcare services. CONCLUSIONS: Findings from this study showed that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. There is therefore a need to improve accessibility and the utilization of maternal healthcare services through women's economic empowerment and education to reduce the barriers.

Utilization of healthcare services by women of childbearing age has been shown to reduce maternal and child mortality. However, in sub-Saharan Africa, maternal and child mortality remains a major public health issue. This is especially the case in Togo, one of the smallest countries in West Africa. The objective of this study was to assess the factors associated with utilization of maternal healthcare services among Togolese women aged 15­49 years. This was a cross-sectional study that used data from the Togo 2013 Demographic and Health Survey, a nationally representative household survey of women of childbearing age in Togo. Findings from the current study showed that the overall proportion of maternal healthcare utilization was 27.53% for timely first antenatal care visits, 59.99% for adequate antenatal care visits, and 75.66% for health facility delivery. Also, this study found that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. For instance, women in the highest wealth quintile, those with higher education, and those who were covered by health insurance had higher odds of utilizing maternal healthcare service. Whereas, women who had indigenous beliefs, those from other ethnicities, who lived in the Savanes and Plateaux regions, as well as those with higher parity had lower odds of using maternal healthcare services. The results indicate that there is an urgent need to promote women's economic empowerment and education to improve accessibility and the utilization of maternal healthcare services.

A Systematic Review on Vaccine Hesitancy in Black Communities in Canada: Critical Issues and Research Failures.

Black communities have been disproportionately impacted by Coronavirus Disease 2019 (COVID-19) in Canada, in terms of both number of infections and mortality rates. Yet, according to early studies, vaccine hesitancy appears to be higher in Black communities. The purpose of this systematic review is to examine the prevalence and factors associated with vaccine hesitancy in Black communities in Canada. Peer-reviewed studies published from 11 March 2020 to 26 July 2022, were searched through eleven databases: APA PsycInfo (Ovid), Cairn.info, Canadian Business & Current Affairs (ProQuest), CPI.Q (Gale OneFile), Cochrane CENTRAL (Ovid), Embase (Ovid), Érudit, Global Health (EBSCOhost), MEDLINE (Ovid), and Web of Science (Clarivate). Eligible studies were published in French or English and had empirical data on the prevalence or factors associated with vaccine hesitancy in samples or subsamples of Black people. Only five studies contained empirical data on vaccine hesitancy in Black individuals and were eligible for inclusion in this systematic review. Black individuals represented 1.18% (n = 247) of all included study samples (n = 20,919). Two of the five studies found that Black individuals were more hesitant to be vaccinated against COVID-19 compared to White individuals, whereas the other three found no significant differences. The studies failed to provide any evidence of factors associated with vaccine hesitancy in Black communities. Despite national concerns about vaccine hesitancy in Black communities, a color-blind approach is still predominant in Canadian health research. Of about 40 studies containing empirical data on vaccine hesitancy in Canada, only five contained data on Black communities. None analyzed factors associated with vaccine hesitancy in Black communities. Policies and strategies to strengthen health research in Black communities and eliminate the color-blind approach are discussed.

[Immigrant health in Canada: current state of knowledge, interventions and issues]. / La sante des immigrants au Canada: etat des connaissances, interventions et enjeux.

This article presents a synthesis of current research, presented during a symposium entitled, 'Immigrant health in Canada: Current state of knowledge, interventions and issues,' organized by the Public Health Agency of Canada. We begin with a general overview of the health of immigrants in Canada. We then analyze the role of community health workers in tackling health inequalities in this population, and certain ways of adapting health services to respond to the growing linguistic and cultural diversity present in Canadian society. We conclude with a discussion of one initiative developed by elderly-friendly local authorities. Throughout the symposium, the speakers emphasized an approach based on the determinants of health, which aims to improve health outcomes of the targeted populations, provide appropriate services and reduce health inequalities.

Physical inactivity among Francophones and Anglophones in Canada.

OBJECTIVE: Leisure-time physical activity participation is influenced by various socio-demographic factors. Recent evidence suggests that being part of a minority negatively impacts an individual's health status. The objective of this study was to compare inactive leisure-time physical activity between the Francophone minority and the Anglophone majority in Canada. METHODS: Data from the fusion of cycles 2.1, 3.1, 4.1, 2008 and 2009 of the Canadian Community Health Survey (CCHS) were used. The linguistic variable was determined by languages spoken at home, first language learned and still understood, language of interview, and language of preference. Leisure-time physical activity was based on a questionnaire provided during the interview. Factors associated with inactive leisure time were examined using logistic regression models. RESULTS: Francophones were more likely than Anglophones to be physically inactive in their leisure time (49.1% vs. 47.2%). A greater percentage of Francophones had poor self-perceived health, were older, were single, had lower education, had higher rate of unemployment and lived in rural areas compared to Anglophones. When these socio-demographic factors were taken into account, there were no further differences in the likelihood of being inactive between Francophones and Anglophones. CONCLUSION: The Francophone minority in Canada is characterized by socio-demographic factors that have a negative impact on leisure-time physical activity participation.

Comparison of dietary intake between Francophones and Anglophones in Canada: data from CCHS 2.2.

OBJECTIVE: To compare the dietary intake and food choices between Francophone Canadians in a state of linguistic minority (outside of Quebec) and the English-speaking majority. METHODS: We used the 2004 Canadian Community Health Survey (CCHS) cycle 2.2 (general health and 24-hour dietary recalls) to describe dietary intake of Francophone Canadians (excluding Quebec) and compare them to the English-speaking majority. The linguistic variable was determined by languages spoken at home, first language learned and still understood, language of interview, and language of preference. The mean differences in daily nutrient and food intake were assessed by t and chi-square tests. RESULTS: Differences in total energy and daily food intakes by language groups were not observed in the sample; however, significant differences in weekly consumption were found in different age and sex categories: lower fruits and vegetables consumption, and vitamins and macronutrients intakes for older Francophone men and higher intakes of energy and saturated fat from "unhealthy" foods for Francophone men 19-30 years of age. Based on the Acceptable Macronutrients Distribution Range (AMDR), approximately 50% of the sample exceeded their acceptable energy intake from saturated fats, and 80% were below their required intake of linoleic fatty acid. CONCLUSION: We confirmed that belonging to Francophone minorities in Canada affects food choices and nutritional well-being of this population. The most vulnerable groups identified by our study were Francophone men in the youngest (19-30) and older (50 and over) age categories. The extent to which the cultural setting influences the diet and, in turn, the health of the minority population needs further examination.

[The priorities for research on the health of Francophones in Ontario]. / Les priorités de recherche sur la santé des francophones en Ontario.

OBJECTIVES: Several studies have demonstrated the health inequity between Francophones in minority-language communities (FMLC) and their English counterparts. While Ontario has the largest number of FMLC in Canada, health research priorities for FMLC have not yet been determined in this province. This article aims to fill this gap. METHODS: An online 2-round Delphi consultation was conducted electronically with Francophone researchers, policy-makers, community members and health professionals working or living in Ontario. Themes and subthemes were identified based on the literature. In order to assess the differences in opinion between participants, a Kruskal-Wallis test was performed in the second round. RESULTS: There were 34 participants in the first round and 31 in the second round. The top three priorities that emerged were: health services in French, health human resources, and health services policy in French. Among the subthemes listed within these three priorities, education in French and planning services were ranked among the top three priorities in the four groups. CONCLUSION: The participatory approach used in this study relied on the opinion of all stakeholders. The results obtained can inform future research agenda and inform the development of health policies for the provision of health services in French with a higher probability of responding adequately to the needs of Francophone users.

Pilot testing of a questionnaire for the evaluation of mental health services in family health team clinics in Ontario.

Family health teams (FHTs), regarded today as a premier model of provision of primary care services in North America, were introduced in 2004 to improve traditionally fragmented primary healthcare in Ontario. Physicians and healthcare providers from various disciplines team up under the same roof in FHTs to provide and coordinate care and to ensure adequate access to and continuity of care. Because many Canadians with mental health problems consult family physicians in primary care, routine evaluation of the delivery of primary mental health care services in FHTs is becoming important. The authors' goal was to develop and test an evaluation tool (containing a questionnaire for patients and a questionnaire for providers) for mental health services provided in FHTs with a focus on accessibility, availability, quality, continuity of care and coordination of services. They developed and pilot tested an English-French tailored evaluation instrument in several FHTs in South East, Champlain and North East Local Health Integration Networks across Ontario. A convenience sample of English- and French-speaking healthcare providers and patients using mental health services was recruited. Provider and patient questionnaires were developed and pilot-tested with 12 providers and 10 clients. Patient reviewers rated the patient questionnaire consistently as "good" or "very good." Provider reviewers found the provider questionnaire to be important and timely and the questions to be adequate and interesting. This instrument evaluates, from both the patient and provider perspectives, whether mental health services are structured to meet expectations set for FHTs, and enables healthcare providers, administrators and policy makers to learn about the benefits and the deficiencies of mental health care delivered through these clinics. This instrument can also be used to enhance future research and evaluation of FHTs. Further validation effort will be required to establish its validity and reliability.

Integrating psychologists into the Canadian health care system: the example of Australia.

Canada and Australia share many similarities in terms of demographics and the structure of their health systems; however, there has been a divergence in policy approaches to public funding of psychological care. Recent policy reforms in Australia have substantially increased community access to psychologists for evidence-based treatment for high prevalence disorders. In Canada, access remains limited with the vast majority of consultations occurring in the private sector, which is beyond the reach of many individuals due to cost considerations. With the recent launch of the Mental Health Commission of Canada, it is timely to reflect on the context of the current Canadian and Australian systems of psychological care. We argue that integrating psychologists into the publicly-funded primary care system in Canada would be feasible, beneficial for consumers, and cost-effective.