Health Literacy of Healthcare Providers and Mental Health Needs of Immigrant Perinatal Women in British Columbia: A Critical Ethnography.

AIMS: This research explores how health care providers determine the mental health needs of immigrant women in the perinatal phase of childbirth. The contextual factors that affect the mental health of these women and influence their engagement with the British Columbian communities in which they reside are investigated. METHOD: Using a critical ethnographic approach, eight health care providers were interviewed to gain insight into health care provider's health literacy and immigrant perinatal women's mental health. Each participant was interviewed for 45-60 min in the period from January to February 2021 to obtain relevant data. RESULTS: Three themes emerged from the data analysis: the health care provider's role and his/her health literacy, the health literacy of the participant, and the impact of the ongoing COVID-19 pandemic on the participant's situation. CONCLUSIONS: The findings indicate that a healthy working relationship between the health care provider and an immigrant woman in the perinatal phase of childbirth is essential to facilitate an effective interchange of health information.

Use of participatory action research to support Syrian refugee mothers in the resettlement period in Canada: A longitudinal study.

Research has shown that refugees in a foreign country often experience physical and mental health challenges upon resettlement (Ahmad et al., 2021; Salam et al., 2022). In Canada, refugee women experience a range of physical and mental barriers, including poor access to interpreter services and transportation, and a lack of accessible childcare, all of which can negatively affect their successful integration (Stirling Cameron et al., 2022). Social factors that support Syrian refugees to settle successfully in Canada have been unexplored systematically. This study examines these factors from the perspectives of Syrian refugee mothers living in the province of British Columbia (BC). Framed by principles of intersectionality and community-based participatory action research (PAR), the study draws on Syrian mothers' perspectives of social support in early, middle, and later phases of resettlement. A qualitative longitudinal design consisting of a sociodemographic survey, personal diaries, and in-depth interviews was used to gather information. Descriptive data were coded, and theme categories were assigned. Six themes emerged from data analysis: (1) Steps in the Migration Journey; (2) Pathways to Integrated Care; (3) Social Determinants of Refugee Health; (4) COVID-19 Pandemic Impacts and Ongoing Resettlement; (5) Strength-Based Capabilities of Syrian mothers; (6) Peer Research Assistant's Research (PRAs) Experience. Results from themes 5 and 6 are published separately. Data obtained in this study contribute to the development of support services that are culturally appropriate and accessible to refugee women living in BC. Our objectives are to promote the mental health and improve the quality of life of this female population, and to enable it to access healthcare services and resources in a timely manner.

Exploring Foot Care Conditions for People Experiencing Homelessness: A Community Participatory Approach.

INTRODUCTION: People experiencing homelessness are faced with complex challenges and are at high risk of illness due to inequities and disparities in access to health care services. OBJECTIVE: To explore the health and foot care problems related to people experiencing homelessness in British Columbia. METHODS: A community participatory research approach was used with a sample of 65 people experiencing homelessness. Data were collected using a survey questionnaire and face-to-face semistructured interviews. RESULTS: Thematic findings shows risk of foot injuries, lack of foot care resources, and absence of family support. Barriers to equitable access to services for most participants experiencing homelessness were lack of housing (76.92%), inability to work (72.31%), and inability to afford the cost of living on their own (63.08%). CONCLUSIONS: There is a pressing need for early screening and detection by health care professionals and enhanced foot care services to reduce foot problems and improve foot care wellness of homeless people. Addressing foot-related care are necessary steps in promoting health, preventing illness, and improving access to health services among people experiencing homelessness.

Facilitators and barriers to accessing mental health care services and social supports among perinatal refugee women: a qualitative systematic review protocol.

OBJECTIVE: The objective of this qualitative review is to identify, critically appraise, and synthesize evidence describing facilitators and barriers to perinatal refugee women's access to mental health care services and social supports. INTRODUCTION: Perinatal refugee women are a vulnerable population and at risk of mental health illness. Understanding facilitators and barriers will provide a better understanding of their experiences to inform health care practices, programs, and policies. INCLUSION CRITERIA: This qualitative review will consider all peer-reviewed qualitative studies and gray literature on perinatal refugee women's experiences of accessing mental health care services and social supports. Non-English articles and studies that do not explicitly state participants' migration status as refugees will be excluded. METHODS: This review will adhere to the JBI methodology for conducting qualitative systematic reviews. Key information sources searched will be CINAHL, PsycINFO, PubMed, Web of Science, and the Social Sciences Citation Index. Search terms will be modified for each information source. Sources of evidence published in English between January 2011 and the present will be assessed for inclusion. Two independent reviewers will screen titles and abstracts using the inclusion criteria for study selection. The reviewers will critically appraise methodological quality and rigor. Data will be extracted on facilitators and barriers among perinatal refugee women accessing mental health care services and social supports. Synthesis will involve aggregation of these findings to generate a set of statements based on their meaning similarity. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021245240.

Opening the doors for school health-An exploration of public health nurses' capacities to engage in comprehensive school health programs.

OBJECTIVES: Public health nurses (PHNs) have a significant role in engaging the voice and actions of school communities in promoting the health of children and youth. School nursing was one of the early 20th century public health nursing foci and specialties in Canada, however over several decades, there has been a gap in actualizing PHNs' full potential in schools. At the same time, intersectoral and interdisciplinary comprehensive school health (CSH) models have emerged as exemplars of partnerships between schools and communities to advance health promotion and ultimately chronic disease prevention with school populations (Pan-Canadian Joint Consortium for School Health, ; World Health Organization, ). DESIGN AND MEASUREMENT: Using a participatory action research methodology we explored the role of PHNs in CSH, drawing on the concept of engagement in intersectoral healthy school teams. RESULTS AND CONCLUSIONS: The three themes that emerged from the data analysis were: facilitators of public health nursing engagement, barriers to public health nursing engagement, and the influences of community context on engagement. Overall, findings indicate that the PHN role in CSH must be developed and supported so that PHNs remain a vital link between school health communities, programs, and policies in the promotion of health.

Immigrant Women and Mental Health Care: Findings from an Environmental Scan.

Immigrant women's mental health is a growing public health policy issue. New immigrant mothers may be particularly vulnerable to less than optimal mental health following childbirth given the cultural and geographic isolation, socioeconomic factors, gender roles, and language difficulties that influence their postpartum experiences. The purpose of this environmental scan was to increase understanding of immigrant women's perinatal mental health care services within the interior of a western Canadian province. Four interrelated themes emerged to impact postpartum health of immigrant women: (i) community capacity building, (ii) facilitators of mental health support and care, (iii) barriers of mental health promotion and support, and (iv) public policy and postpartum depression. Knowledge gained from this study contributes to healthy public policy and practices that promote mental health and support among immigrant women.

Immigrant women's experiences of postpartum depression in Canada: a protocol for systematic review using a narrative synthesis.

BACKGROUND: Literature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women. There exists a need to synthesize information on the contextual factors and social determinants of health that influence immigrant women's reception of and behavior in accessing existing mental health services. Our research question is: what are the ethnoculturally defined patterns of help-seeking behaviors and decision-making and other predictive factors for therapeutic mental health care access and outcomes with respect to postpartum depression for immigrant women in Canada? METHODS/DESIGN: Our synthesis incorporates a systematic review using narrative synthesis of reports (peer- and non-peer reviewed) of empirical research and aims to provide stakeholders with perspectives on postpartum mental health care services as experienced by immigrant women. To reach this goal we are using integrated knowledge translation, thus partnering with key stakeholders throughout the planning, implementation and dissemination stages to ensure topic relevancy and impact on future practice and policy. The search and selection strategies draw upon established systematic review methodologies as outlined by the Centre for Reviews and Dissemination and also incorporate guidelines for selection and appraisal of gray literature. Two search phases (a database and a gray literature phase) will identify literature for screening and final selection based on an inclusion/exclusion checklist. Quality appraisal will be performed using the tools produced by the Centre for Evidence Based Management. The narrative synthesis will be informed by Popay et al. (2006) framework using identified tools for each of its four elements. The integrated knowledge translation plan will ensure key messages are delivered in an audience-specific manner to optimize their impact on policy and practice change throughout health service, public health, immigration and community sectors. DISCUSSION: The narrative synthesis methodology will facilitate understandings and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socio-economic status, pre-migration history and geographical location. Our review aims to have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the context of postpartum mental health of immigrant women. PROSPERO registration number CRD42012003020.

Cultural background and socioeconomic influence of immigrant and refugee women coping with postpartum depression.

Postpartum depression is a serious condition that can have long lasting traumatic effects on women and their families. Until recently postpartum depression research has focused more on the population as a whole rather than refugee and immigrant women. Informed by Kleinman's explanatory model and the postcolonial feminist perspective, 30 immigrant and refugee women were interviewed to find out what factors influenced them in seeking postpartum care and what strategies would be helpful in prevention and treatment of postpartum depression. We found that the immigrant and refugee women in our sample: (a) were influenced by both cultural background and socioeconomic factors in seeking support and treatment; (b) were influenced by cultural differences and social stigma when making decisions about health care practices; and (c) employed numerous coping strategies to deal with postpartum depression. Recommendations are provided for more culturally appropriate and equitable mental health care services for immigrant and refugee women living in Canada.

Using critical ethnography to explore issues among immigrant and refugee women seeking help for postpartum depression.

Critical ethnography was used as a pragmatic research methodology to explore the postpartum depression (PPD) experiences of immigrant and refugee women. We examined the social, political, economic, and historical factors that affected the help-seeking behavior of these women during PPD episodes. The critical ethnography method allowed participants to share their experiences with each other and afforded opportunities to the researchers to acknowledge and validate, rather than simply observe and record, their testimony. This study of PPD thus increased our awareness and understanding of the health issues of immigrant and refugee women.

Barriers and facilitators of social supports for immigrant and refugee women coping with postpartum depression.

An emerging concern for health care providers is how to assist immigrant and refugee women adapt to a new milieu and to cope with postpartum depression (PPD). Thirty women were interviewed to find out their perspective on what factors influence their help-seeking behavior and decision making about postpartum care and what strategies would be helpful in PPD prevention and treatment. Findings reveal that (a) social support networks can be supportive or nonsupportive with widespread effects on physical and psychological health and well-being; (b) cultural background and socioeconomic factors influence seeking support; (c) health care relationship was viewed a critical determinant to seek and accept help for PPD.

A postcolonial feminist perspective inquiry into immigrant women's mental health care experiences.

The number of immigrants coming to Canada has increased in the last three decades. As a result, there is greater emphasis on health care providers and the health care system to provide culturally appropriate and equitable care. It is well documented that many immigrant women suffer from serious mental health problems and experience difficulties in accessing and using mental health services. In this paper we advocate for new ways of research inquiry in exploring immigrant women's mental health care experiences, ones that move beyond the individual experiences of health and illness toward recognition that the health of immigrant women must be addressed within the social, cultural, economic, historical, and political context of their lives. Drawing on past research we demonstrate how the postcolonial feminist perspective can be used to illuminate the ways in which race, gender, and class relations influence social, cultural, political, and economic factors, which, in turn, shape the lives of immigrant women. We suggest that postcolonial feminism provides an analytic lens to (a) generate transformative knowledge about immigrant women's mental health care experiences; (b) improve equitable health care; and (c) increase understanding of what would be helpful in meeting the immigrant women's health care needs.

Health care providers' perspective of the gender influences on immigrant women's mental health care experiences.

The number of immigrants coming to Canada has increased in the last three decades. It is well documented that many immigrant women suffer from serious mental health problems such as depression, schizophrenia, and post migration stress disorders. Evidence has shown that immigrant women experience difficulties in accessing and using mental health services. Informed by the post-colonial feminist perspective, this qualitative exploratory study was conducted with seven health care providers who provide mental health services to immigrant women. In-depth interviews were used to obtain information about immigrant women's mental health care experiences. The primary goal was to explore how contextual factors intersect with race, gender, and class to influence the ways in which immigrant women seek help and to increase awareness and understanding of what would be helpful in meeting the mental health care needs of the immigrant women. The study's results reveal that (a) immigrant women face many difficulties accessing mental health care due to insufficient language skills, unfamiliarity/unawareness of services, and low socioeconomic status; (b) participants identified structural barriers and gender roles as barriers to accessing the available mental health services; (c) the health care relationship between health care providers and women had profound effects on whether or not immigrant women seek help for mental health problems.

The influence of culture on immigrant women's mental health care experiences from the perspectives of health care providers.

It is well documented that serious mental health problems such as depression, schizophrenia, and post migration stress disorders exist among immigrant women. Informed by Kleinman's explanatory model, this qualitative exploratory study was conducted with seven health care providers who provided mental health services to immigrant women. Analysis of the data revealed that (a) immigrant women face many difficulties when accessing mental health care services due to cultural differences, social stigma, and unfamiliarity with Western biomedicine, (b) spiritual beliefs and practices that influence immigrant women's mental health care practices, and (c) the health care provider-client relationship, which exerts great influence on how immigrant women seek mental health care. The study also revealed that cultural background exerts both positive and negative influences on how immigrant women seek mental health care. We suggest that although cultural knowledge and practices influence immigrant women's coping choices and strategies, awareness of social and economic differences among diverse groups of immigrant women is necessary to improve the accessibility of mental health care for immigrant women.