Dissertations / Theses on the topic 'Refugees – Medical care – Canada'

This study examines the importance of age, education, and the health system reforms in the mid 1990's on the utilization of five health services: specialists' visits, family doctor visits, non-physician health professional visits, hospital use, and home care services. The analysis focuses on the Canadians 45 and over, and uses data from the National Population Health Survey.
Results. Age per se has only a minor effect on utilization; the relative high utilization rates observed among the aged relate to the use of services by people with chronic conditions, whose prevalence is higher among the aged. Education has little impact on use of services among the aged. The reforms had only significant effect for four services. They increased utilization of non-medical health professional consults, and increased probability of consulting a specialist. They reduced length of stay, and decreased the number of visits made to family doctors.

Population aging in Canada is expected to result in a sharp increase in the use of health services by the aged. The purpose of this thesis, is to enhance the knowledge of the utilization of the health system by the elderly. For this, an analysis of the utilization of three health services was pursued, using data from two health surveys, and two general social surveys in a statistical examination; to describe age-use; identify the major determinants of utilization; and to discover the sources of change in use. The results show that the aged were the highest users of health services among all age groups. Use increased for some services, and decreased for others. Changes in how people were managed by the health system, and to a lesser extent a rise in disease prevalence, were the primary sources of variations in utilization. There was no conclusive evidence of the presence of supplier induced demand. Population aging was not a significant determinant of changes in health service use, but rather factors associated with the management of the elderly by the health system; this includes technological changes in medicine, and changes in treatment patterns.

Telehealth is defined by Jocelyne Picot as "the use of communications and information technology to deliver health and health care services and information over large and small distances" (Telehealth Industry 1). Current research in telehealth focuses on the evaluation of applications and projects, on the competitiveness of the telehealth industry, and on its role in international development. In contrast, this dissertation contextualizes telehealth in social history and theory. In so doing, it adopts an analytical, cultural studies approach rather than an empirical one. It also studies the extent of citizen involvement in current telehealth initiatives in Canada. More specifically, the dissertation examines whether the forms of involvement promoted by telehealth initiatives empower Canadian citizens. The examination is conducted through a five-step process. The first four steps involve an overview of the following: (1) histories of medical technology; (2) critiques of medical technology; (3) history and critique of the Canadian health care system; (4) critiques of information and communications technology and policy. The fifth step consists in mapping out the current state of telehealth development in Canada, including policy, applications and projects, as well as distinguishing the main roles of citizens in such initiatives. In closing, ways of achieving citizen empowerment through telehealth are suggested, whether it is found to be achieved in recent initiatives or not. Theoretical frameworks with the aim of positioning new technology in order that it may accomplish social change and citizen empowerment are put forward as an innovative means of evaluating current telehealth applications and projects in Canada.

This multi-sited ethnography focuses on beliefs and practices associated with death, dying, and palliative care among the Low German-Speaking (LGS) Mennonites. The qualitative data, collected through participant-observation fieldwork and interviews conducted in three LGS Mennonite communities in Mexico and Canada, show a gap between official definitions of palliative care and its practice in real life. The LGS Mennonites’ care for their dying members, in reality, is integrated into their community lives that emphasize or reinforce discipleship by promoting the practices of mutual aid, social networks, and brotherhood/sisterhood among community members. This study also offers ethnographic insights into some difficulties that healthcare providers face while delivering the “holistic” palliative care services to their patients in general, and to the LGS Mennonites in particular. Finally, it provides some suggestions that may aid healthcare providers in developing culturally safe and competent health care services for the LGS Mennonite people living in Canada.
xi, 231 leaves ; 29 cm

This thesis considers the rationalization of health care in Canada. It focuses on the conflicting roles modern physicians play in our system, acting as both patient advocate and social agent. It begins by tracing the origin of both of these duties. It then examines the ethical, professional, and legal issues which arise in the limited circumstances where front-line physicians must participate in the rationing of health care. It offers a framework for resolving the double agent dilemma and states five interlocking recommendations which are the building blocks of the resolution.

A number of theoretical explanations seek to describe the factors that have led to the position of the United States as the last industrialized Western nation without a universal health care program. Theories focus on institutional arrangement, historic precedent, and the influence of the private sector and market forces. This study explores another factor: the role of underlying social values. The research examines differences in values among ten European countries, the United States and Canada, and analyzes the associations between the values that have been seen to contribute the individualism-collectivism dynamic in the United States. The hypothesis that equality and generalized trust are positively associated with universalism is only partially true. Equality is positively associated (B = .301, p < .001), while generalized trust is negatively associated with universalism (B = -.052, p < .001). Not only do Americans show lower levels of support for income equality and universalism than Europeans, but the effect of being American holds even after controlling for socio-demographic and religious variables (B = .044, p < .01). When the model tests the association of equality and trust on universalism in each region, it explains approximately 17 percent of the variance of universalism for the United States, and approximately 13 percent in Europe and Canada.

Les services reproductifs transfrontaliers (SRT) réfèrent au déplacement d'une juridiction à une autre, de personnes ou de matériel reproductif dans le cadre d'un projet de procréation assistée (PA). Ce phénomène a été observé dans de nombreux pays, mais le système de PA mondialisé canadien, ou reproscape, demeure sous-étudié. Ce manque de connaissances nuit au développement normatif en matière de PA. En adoptant un cadre conceptuel issu de l'anthropologie médicale, l'objectif général de cette thèse était de décrire et comprendre le reproscape canadien. Pour alimenter la réflexion éthique et juridique et la prestation des services de PA, nous avons réalisé une enquête ethnographique clinique multisite combinant : (1) une revue de la littérature, (2) l'observation participante et non participante de deux cliniques de fertilité (Québec et Ontario), d'une agence d'importation de gamètes et d'une dizaine de congrès scientifiques, ainsi que (3) des entrevues semi-dirigées avec 45 actrices et acteurs des SRT : personnes utilisatrices, personnel médical et intermédiaires. Les données ont fait l'objet d'une analyse qualitative inductive, assistée du logiciel NVivo 11. Trois dimensions émergent de nos résultats. (1) Le Canada se caractérise par une mosaïque de lois et de règlements locaux, fédéraux et provinciaux qui influencent de façon paradoxale les SRT. L'obligation de don altruiste, établie par la Loi sur la procréation assistée (LPA), joue un rôle prédominant sur le reproscape canadien. (2) Au niveau de l'expérience des SRT, la simplicité de certains SRT intégrés à la pratique clinique, comme l'importation de sperme ou d'ovocytes, contraste avec la complexité des voyages vers l'étranger auxquels les personnes utilisatrices se sentent souvent contraintes. (3) Interrogées sur leurs perspectives éthiques, quatre positions principales ressortent des entrevues: (a) le respect de leur autonomie reproductive, (b) les risques individuels et (c) sociaux des SRT, dont celui d'exploitation des gestatrices et des donneuses d'ovules, ainsi que (d) les incohérences de la LPA quant à sa capacité d'atténuer ces risques. En conclusion, le reproscape canadien se caractérise, entre autres, par une situation de " sous-traitance reproductive " : une reconnaissance institutionnelle des SRT, combinée à une délocalisation des risques moraux et médicaux hors des frontières nationales. Les conclusions de notre étude mettent en évidence le caractère inextricable du local et du global en PA et comment le reproscape mondial fonctionne par vases communicants.
Abstract : Cross-border reproductive care (CBRC) refers to the movement from one jurisdiction to another of persons or reproductive material as part of assisted reproductive technology (ART) treatment. This phenomenon has been observed in many countries, but the Canadian globalized ART system (or "reproscape") remains understudied empirically. This lack of data undermines the normative development in terms of ART. The aim of this dissertation is to describe and understand the Canadian reproscape in order to support ethical and legal reflection. To achieve this goal, we conducted a multi-site clinical ethnography combining (1) literature reviews, (2) participant and non-participant observation in two fertility clinics (Quebec and Ontario), a gamete importation and distribution agency and a dozen scientific congresses, (3) as well as semi-directed interviews with 45 actors of CBRC: users, medical professionals and intermediaries. The data were analyzed by inductive qualitative analysis assisted by NVivo 11 software. Three dimensions emerge from our results. (1) Regarding the legal and clinical contexts of ART, Canada is characterized by a local mosaic of laws and regulations that paradoxically influence CBRC. The altruistic obligation established by the Assisted Human Reproduction Act (AHRA) plays a predominant role on the reproscape. (2) In terms of the experience of the main actors, the simplicity of CBRC integrated to the clinic, such as the import of semen or oocytes, contrasts with the complexity of journeys abroad for which users often feel constrained. (3) When asked about their ethical perspectives, the actors mentioned four main positions: (a) the respect for their reproductive autonomy, (b) the individual and (c) social risks of CBRC, including the exploitation of egg donors as well as gestational surrogates, and (d) AHRA inconsistencies in its ability to mitigate these risks. Our conclusion is that the Canadian reproscape is characterized, inter alia, by a situation of "reproductive outsourcing." This concept is characterized by an institutional recognition of CBRC combined with a relocation of moral and medical risks outside national borders. The results of our study underline the inextricable local and global nature of ART and how CBRC works as communicating vessels.

Syfte: Det övergripande syftet med denna licentiatavhandling är att beskriva resultat från en kartläggning av hälsosituationen hos nyanlända flyktingar som genomgår SFI studier samt att belysa den självskattade hälsorelaterade livskvalitet som arabisktalande deltagare i en specifik hälsofrämjande gruppaktivitet (Hälsoskola) beskriver före, efter samt vid en sexmånaders uppföljning av aktiviteten. Design, metod, urval: Urvalet deltagare i delstudie I var nyanlända arabisktalande flyktingar bosatta i Fosie stadsdel i Malmö och som deltog i SFI utbildning. Undersökningsgruppen bestod av sammanlagt 67 personer, 52 procent män och 48 procent kvinnor. Datainsamlingen genomfördes med hjälp av frågeformulär innehållande frågor om familj och anhöriga, nätverk och service, svenskundervisning och delaktighet, introduktion och hjälpbehov samt om sömn och återhämtning. I delstudie II bestod urvalet av arabisktalande nyanlända flyktingar som genomgick en sju veckors Hälsoskola som en del i sin introduktionsplanering. Dataunderlag bestod av kvalitativa data inhämtat vid deltagande observationer och muntliga grupputvärderingar med 65 kursdeltagare. Därutöver besvarades ett frågeformulär för självskattning av hälsorelaterad livskvalitet samt om sömn och återhämtning. Frågeformuläret besvarades vid kursstart, kursavslutning samt sex månader efter kursens slut. Respondenter i denna del var 39 kursdeltagare som besvarat samtliga tre frågeformulärsomgångar. Därutöver innehåller avhandlingen en artikel vars syfte är att beskriva kursen/metoden Hälsoskola, dess bakgrund och teoretiska kopplingar samt den samverkansprocess som utvecklats mellan professionella aktörer och brukare. Resultat: I delstudie I rapporterade respondenterna hög förekomst av sömn- och trötthetsbesvär. Sextioåtta procent av respondenterna hade sömnproblem motsvarande hälften av veckans dagar. Något färre 43 % rapporterade regelbundna besvär med sömnighet, till exempel att man nickade till under dagen. Fyrtioen procent (män 36 %, kvinnor 50 %) uppfyllde kraven för klinisk insomni baserat på att respondenterna hade både sömnbesvär och trötthetsbesvär under minst hälften av veckans dagar. Därutöver upplevde drygt 80 % av samtliga stor oro över sin familj eller andra anhöriga i hemlandet. Många kände sig isolerade och ensamma, hade svårt att få kontakter med föreningsliv, få tillgång till platser för kulturella aktiviteter, för religionsutövning och för sportaktivitet. Många upplevde också svårighet att få tillgång till hälso- och sjukvård samt tandvård. I utbildningssituationen upplevde drygt hälften stora svårigheter att förstå vad läraren sade och 68 % hade svårt att hinna med i tempot på lektioner. Drygt 64 % rapporterade koncentrationssvårigheter, de hade problem att förstå hemuppgifter liksom att kunna göra hemuppgifter i lugn miljö. För många respondenter rådde oklarhet om introduktionsplanen och cirka hälften av dem hade velat få mera hjälp av sin introduktionshandläggare med läkar- och sjukvårdskontakter samt med sin bostadssituation. I den kvalitativa delen av delstudie II vars syfte var att belysa de viktigaste frågorna från deltagarnas synvinkel, utkristalliserade sig fyra kategorier: 1) Fördjupningsfrågor beträffande innehåll i kursen/Hälsoskolan. 2) Kommentarer angående form och struktur på kursen/Hälsoskolan. 3) Vilka av kursdeltagarnas ”behovsområden” som kursen/Hälsoskolan täcker in och vilka områden som saknas? 4) Vad kursdeltagarna önskar få framfört till administratörer, beslutsfattare och politiker. I den kvantitativa uppföljningsstudien framkom att deltagarna upplevde en hög grad av sömn och koncentrationsproblematik vid kursstart. Denna problematik var betydligt mindre vid kursens avslutning och förändringen kvarstod vid uppföljning sex månader senare. Det framkom även att sömnproblematik var relaterad till de fem variablerna av hälsorelaterad livskvalitet;( rörlighet, aktivitet, egenvård, smärta och oro/depression) och till upplevelsen av det allmänna hälsotillståndet. Angående variablerna smärta och oro/depression kvarstod en signifikant förändring både vid uppföljning ett och vid uppföljning två sex månader efter kursavslut. Både män och kvinnor bedömde sitt allmänna hälsotillstånd som signifikant bättre vid båda uppföljningarna jämfört med vid kursstart, men förändringen var störst beträffande kvinnorna. Konklusion: De sammantagna resultaten visar att det finns en hög fysisk och psykisk ohälsoproblematik i den undersökta populationen med avseende på deras självskattade hälsa. Denna problematik har ett nära samband med sömn och koncentrationsproblem och får även konsekvenser för de nyanländas dagliga aktiviteter och etablering i det nya samhället. Det framkommer ett stort behov av hjälp från hälso- och sjukvården men också en brist på tillit till detsamma, bland annat beroende på svårtillgänglighet och brist på professionella tolkar. Å andra sidan visar resultaten i denna licentiatavhandling att mottagningssystemet med noga överlagda insatser kan åstadkomma betydande positiva förändringar för gruppen nyanlända flyktingar. Den självupplevda hälsorelaterade livskvaliteten för deltagare i kursen Hälsoskola visade på signifikanta förändringar inom de undersökta aspekterna för gruppen som helhet vid kursslut och vid senare uppföljning. De reella faktiska kunskaperna inom egenvård och om det svenska hälso- och sjukvårdssystemet hade ökat betydligt vid kursavslut. Nämnda effekter kan även få positiva följdverkningar för nästa generation och andra personer i kursdeltagarnas nära omgivning.
Aim: The overall aim of this thesis is to describe the results of a survey of the health situation of newly-arrived refugees attending a course in Swedish for Immigrants (SFI) (study I) and elucidate the self-rated health-related quality of life that Arabic-speaking participants in a spe-cific health-promoting group activity (Health School) report before, immediately after and at a six-month follow-up of that activity (study II). Design, method, sample: The sample in study I comprised newly-arrived Arabic-speaking refugees living in the Malmö district of Fosie who were attending a SFI course. A total of 67 persons participated, 52 per cent men, 48 per cent women. Data were collected with the aid of a questionnaire with both open-ended and closed alternative responses about family and relatives, networks and services, Swedish language lessons and participation, introduction and needs, sleep and recovery. In study II the sample comprised newly-arrived Arabic-speaking refu-gees who attended a seven-week Health School as a part of their intro-ductory planning. The study was based on qualitative data obtained by participatory observation and oral group evaluations with 65 course participants. In addition, we used a questionnaire with closed response alternatives for self-rating health-related quality of life, including sleep and recovery. The questionnaire was administered at the beginning and end of the group activity as well as six months after the end. This sam-ple comprised 39 participants in the group activity who responded to the questionnaire on all three occasions. Furthermore, the thesis contains an article describing the Health School group activity/method, its background and theoretical links, as well as the collaborative process that developed between professionals and re-cipients. Results: The respondents in study I reported a high frequency of sleep- and fatigue-related complaints. Sleep disturbances on the equivalent of every other day were reported by 68 per cent and somewhat fewer, 43 per cent, reported regular problems with drowsiness, for instance drop-ping off during the day. Criteria for clinical insomnia were met by 41 per cent (36 per cent of the men, 50 per cent of the women), based on the combination of sleep disturbance and complaints of fatigue at least every other day. In addition, over 80 per cent of the sample experienced great anxiety about their family or other relatives in their home country. Many felt isolated and lonely, found it hard to get in touch with associations, have access to places for cultural activities, practicing religion and participating in sports. Many also experienced difficulties in gaining access to health care and dental care. In the educational situation (SFI), more than half had great difficulty in understanding what the teacher said and 68 per cent found it hard to keep up with the pace of the lessons. More than 64 per cent reported difficulties with concentration, problems with understanding homework and being able to do homework in a calm environment. Many respondents were uncertain about the introductory plan and roughly half had wanted their introductory officer to be more helpful in contacts with health care, including doctors, and housing matters. The qualitative part of study II, which aimed to elucidate the most im-portant issues according to the participants, gave rise to four categories: 1) More in-depth issues concerning the content of the group activi-ty/Health School, 2) Comments on the form and structure of the group activity/Health School, 3) Which of the participants’ “needs” were cov-ered by and which were missing, and 4) What the participants wanted to convey to administrators, decision-makers and politicians. The quantitative follow-up study showed that when the group activity started, the participants experienced a high degree of problems with sleep and concentration. Such problems were considerably less frequent at the end of the activity and this change persisted six months later. Moreover, the sleep disturbances were related both to the five variables of the health-related quality of life (mobility, activity, self-care, pain and anxiety/depression) and to the perception of general health. The variables pain and anxiety/depression showed significant improvements at the end of the activity as well as six months later. Men as well as women rated their general health as significantly improved at both follow-ups compared with baseline; the change was greatest for women. Conclusions: Taken together, the results show that in terms of self-rated health, the studied population has a high degree of problems with physical and mental ill-health. These problems are closely related to problems with sleep and concentration, besides having consequences for the newly-arrived persons’ daily activities and for settling in the host country. A great need of assistance from health care emerges, as well as a lack of trust in this, partly due to difficulty of access and a lack of professional interpreters. At the same time, the findings in this thesis show that the reception sys-tem with evidence-based inputs can achieve considerable positive changes for newly-arrived refugees. The self-rated health-related quality of life for participants in the group activity/Health School showed that for the group as a whole, the studied aspects had improved significantly both by the end of the activity and at the six-month follow-up. Proper actual knowledge about self-care and the Swedish health care system had increased significantly by the end of the activity. These effects can also have positive consequences for the next generation and others close to the participant. The group activity needs to be tested with other language groups of newly-arrived in order to warrant general conclusions.

Sedan flera hundra år tillbaka har människor immigrerat till Sverige. Efterhand har denna invandring mer och mer reglerats genom olika lagar och samarbeten. I Sverige har det så uppstått en grupp av personer som inte är asylsökande och som av olika skäl lever i landet utan uppehållstillstånd. En del av dessa har tidigare sökt asyl men fått avslag, medan andra aldrig sökt asyl. Dessa personer kan inte åtnjuta hälso- och sjukvård på samma villkor som den svenska befolkningen eller ens på de villkor som staten beslutat att asylsökande ska ha rätt till. Den vård gömda flyktingar har rätt till är den vård som klassas som omedelbar. Många gömda flyktingar är dessutom rädda för att söka vård och deras vårdbehov täcks till stor del av ideella organisationers insatser. Som sjuksköterska kan man komma att möta denna patientgrupp i stort sett var man än arbetar och det är då av största vikt att man funderat över sina etiska ställningstaganden och satt sig in i de lagar som är aktuella. I denna uppsats granskas och sammanställes den litteratur som finns att tillgå kring gömda flyktingar och sjukvård. Det sammanställda materialet diskuteras sedan ur en vårdvetenskaplig synvinkel och med hjälp av begreppen livsvärld, hälsa och lidande. Man kan i det valda materialet konstatera att det saknas litteratur skriven med vårdvetenskaplig ansats. I de åtta texterna som granskats har tre fokus hittats; Barns situation, Att leva som gömd flykting samt Hinder och möjligheter för tillgång till vård. Slutligen diskuteras vikten av vårdvetenskaplig forskning på området med mål att underlätta för kliniskt verksamma sjuksköterskor i mötet med denna patientgrupp.

Program: Sjuksköterskeutbildning

Uppsatsnivå: C

Mångkulturell hälso- och sjukvård har ökat i Sverige på senare år på grund av krig i Syrien, och oro i andra länder i bland annat Mellanöstern och Afghanistan. Det har medfört mänskliga tragedier och stora flyktingströmmar. Sverige har tagit emot en stor andel av flyktingströmmen. Detta ställer nya krav på distriktssköterskan som i ett tidigt skede möter flyktingarna. Syftet med studien var att beskriva distriktssköterskans erfarenheter av hälsofrämjande och förebyggande arbete med nyanlända flyktingar ur ett vårdcentralsperspektiv. Metod: En kvalitativ intervjustudie med sju distriktssköterskor från olika vårdcentraler inom en västsvensk region. Materialet analyserades med en kvalitativ innehållsanalys. Resultat: Det framkom åtta subteman och fyra teman i analysen. Huvudteman var: Egenvårdens betydelse för att främja hälsan, Förebyggande arbete ur ett vårdcentralsperspektiv, Att kommunicera via tredje part samt Samordning mellan parter. Slutsats: Distriktssköterskornas hälsofrämjande och förebyggande arbete var betydelsefullt för de nyanlända flyktingarna eftersom distriktssköterskan var en av de yrkesprofessioner som de träffade i ett tidigt skede. Egenvårdsråd utmärkte det hälsofrämjande arbetet med nyanlända flyktingar men kunde vara svårt då många nyanlända flyktingar var vana från sina hemländer att alltid möta en läkare. Det utmärkande för det förebyggande arbetet var framförallt arbetet med vaccinationsuppföljning, som innebar en stor och krävande arbetsinsats för distriktssköterskorna.
Multicultural health and medical care has increased in Sweden during the last few years due to war in Syria and unrest in other countries among others in the Middle East and in Afghanistan. This has led to human tragedies and big streams of refugees. Sweden has received a large number of these refugees. This poses new demands on district nurses who at an early stage meet the refugees. The purpose of the study was to describe district nurses experience of health promoting and preventive care of newly arrived refugees from a perspective of the care centre. Method: A qualitative interview study with seven district nurses from different care centres within a region in West Sweden. The material was analysed with a qualitative analysis of content. Result: The analysis resulted in eight subthemes and four themes. Main themes were: The importance of self-care in order to promote health, Preventive work from a perspective of the care centre, To communicate through a third party and Co-ordination between parties. Conclusion: District nurses health promoting and preventive care was important for newly arrived refugees as the district nurse was one of the professionals they met at an early stage. Advice on self-care characterized the health promoting work with newly arrived refugees but could be difficult, as many refugees were used always to meet a doctor in their home countries. Characteristic for the preventive work was above all the follow-up of vaccinations, which required big and demanding efforts for district nurses.

“Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship.

Background: Sudden Infant Death Syndrome (SIDS) is a problem worldwide. In North Jordan, SIDS rate was high as 1.32 per 1,000 live births and contributed 6% to the infant mortality rate (Bataineh, Shawagfeh, & Twalbeh, 2008). However, SIDS risk factors are preventable and can be reduced by improving knowledge and changing relevant behaviours of parents and healthcare providers (American Academy of Pediatrics, 2013; American SIDS Institute, 2011; Bataineh, Hussein Shawagfeh, & Twalbeh, 2008; Bredemeyer, 2004; Grazel, Phalen, & Polomano, 2010b; Moon, Oden, & Grady, 2004; NICHD, 2010). Still educating Jordanians about SIDS has not been a national health policy priority. Currently, Jordanians demonstrate infant care practices that increase the risk of SIDS, such as side sleep position and excessive bedding and clothing being the most common practices. Commonly, home environments also are not SIDS safe because of smoking and poor ventilation. Healthcare providers can assume the role of information provider and change agent by working with mothers, families and the community to change practices. Aims: This study aimed to determine whether a hospital-based SIDS education intervention program, relevant to Jordanian settings, would encourage Jordanian neonatal healthcare providers to revise parent education and training practices regarding SIDS prevention. The long-term goal was to reduce the incidence of SIDS by influencing Jordanian lifestyles and infant care practices. Methods: This mixed method intervention study included both quantitative and qualitative data collection methods and was conducted at a major education hospital in Jordan, King Abdullah University Hospital (KAUH), over three phases. Phase-1 used two main surveys, an observation-survey explored baseline data on SIDS-safe sleeping positioning practices using an audit of sleeping positions of healthy and medically stable infants in open cots in the neonatal units. The questionnaire-survey explored baseline data on available SIDS teaching resources and staff knowledge and their parental/family instruction regarding SIDS and relevant prevention practices. Phase-2 investigated the development, implementation, and impact of a Jordanian SIDS Infant Education Package (JSEP) among a sample of neonatal healthcare providers at the hospital using the same tools as in the pre intervention phase. This phase examined the impact the JSEP on neonatal healthcare provider SIDS-knowledge, access to appropriate SIDS resources, SIDS-safe sleeping positioning practices in the neonatal units at KAUH. Phase-3 used focus groups of the JSEP participants to explore participants’ experience in undertaking the JSEP. Results: Phase-1 revealed that high proportion (47%) of a total of 403 infant positioning observations; infants were placed in a high SIDS risk sleeping position. In addition, 33% of a total 231 neonatal healthcare providers who completed the questionnaire-survey had never accessed information or resources for SIDS at baseline. Moreover, 40% of the 231 neonatal healthcare providers who completed the questionnaire-survey did not have any knowledge about national SIDS prevention guidelines released by the American Academy of Paediatrics. In addition, the neonatal healthcare providers had not played an active role in the education of parents and families in Jordan regarding SIDS prevention practices. Only 21% of neonatal healthcare providers sometimes provided SIDS information to parents and families and another 33% rarely advised them. The questionnaire-survey discovered that most advice provided for parents and families regarding infant sleep care practices were inappropriate and, in fact, could heighten the risk of SIDS. The JSEP in phase-2 resulted in significant improvement in infant positioning practices at KAUH. The proportion of infants who were placed in a high SIDS risk sleeping position decreased to only 21% of the total post-intervention infant positioning observations (N=400), and this change was statistically significant (Chi-square= 40.777; df= 1; p Conclusions: The SIDS education program targeted at neonatal healthcare providers within the Jordanian context was effective in improving staff knowledge, practices and preparedness to instigate parental/family education. Healthcare providers were identified as an effective education and training group for community health promotion. However, challenges were identified in achieving this goal, including overwork, time limitations, staff shortages, and hospitalisation policies, as well as resistance from Jordanian families to adopting SIDS-safe infant sleep care or having a SIDS-safe home environment. Recommendations: SIDS education programs for health care providers need to be extended, with continued research and evaluation on the effectiveness of specific initiatives in Middle Eastern countries. Further research is needed to explore the incidence of SIDS, SIDS risk factors and associated cultural issues. Furthermore, research need to targeted potentially high risk groups such as refugees, rural and remote residents, and Bedouin families living in isolated regions of Jordan.

L'imagerie médicale est une activité de soins à la croisée de toutes les spécialités médicales. Elle est devenue une activité de soins primordiale au coeur du diagnostic et du traitement de nombreuses pathologies en oncologie, neurologie et cardiologie, par exemple. Son rôle essentiel dans le parcours de soins du patient est le résultat du développement important des technologies, mais également des indications cliniques. L'encadrement de l'imagerie médicale dans le système de santé français reste néanmoins flou et bordé de contraintes juridiques et économiques. Ce flou juridique et économique est un frein à l'accès effectif aux techniques d'imagerie médicale pour les patients à travers notamment un contrôle exacerbé des installations des équipements et une tarification des actes désorganisée. Par ailleurs, l'absence d'évaluations médico-économiques retarde l'implémentation des innovations et crée même des risques d'atteinte à la sécurité et à la qualité des examens d'imagerie réalisés
Medical imaging is a care activity at the crossroads of all medical specialties. It has become a primary care activity at the heart of the diagnosis and treatment of many pathologies in oncology, neurology and cardiology, for instance. Its essential role in the care path of the patient is the result of the important development of the technologies, but also of the clinical indications. The framing of medical imaging in the French healthcare system remains nevertheless unclear and bordered by legal and economic constraints. This legal and economic uncertainty is an obstacle to the effective access to medical imaging technology for patients through, in particular, an exacerbated control of equipment installations and a disorganized acts pricing procedure. Furthermore, the lack of medico-economic evaluations delays the implementation of innovations and even creates risks to the safety and quality of the imaging tests performed

This thesis focuses on the experiences of Vietnamese immigrants and refugees in accessing health care services in Saskatoon. Within Canada, terms such as immigrant and refugee are assigned to reflect the differing circumstances that “newcomers,” i.e. foreign-born residents, arrive under, who are typically classified as either temporary or permanent residents (Gushulak et al. 2011). Research has suggested that newcomers to Canada from non-European countries tend to under-utilize health services (Curtis and MacMinn 2008; Luu, Leung and Nash 2009; O’Mahony and Donnelly 2007; Whitley, Kirmayer and Groleau 2006), while language and cultural differences are cited as barriers to health care (Asanin and Wilson 2008; Gushulak et al. 2011; Kirmayer et al. 1996). Qualitative health research regarding Vietnamese immigrants and refugees in Saskatchewan is currently lacking. The purpose of this study was to elicit a deeper understanding of experiences in accessing health care services through open-ended interviews. A total of 14 interviews were conducted regarding the health care experiences of members of the Vietnamese community in Saskatoon. The aim was to examine the possible socio-cultural determinants affecting the experiences of this study’s participants, to explore whether or not these determinants resulted in health care under-utilization, and to determine areas for future research, particularly, in working to resolve barriers to care for immigrant and refugee groups. Participants iterated the challenges that newcomers face in accessing health care, such as language, cultural, geographical, and socio-economic differences, as identified within the literature. However, the most elaborate responses given by the Vietnamese-born participants in this study were built around references to Vietnam (their country of origin). In particular, they described their experiences in Saskatoon through comparisons of health care and larger socio-economic circumstances in Vietnam. While participants described both positive and negative experiences, the consensus was that health care is generally better in Canada than in Vietnam. This thesis illustrates the value of examining the participants’ descriptions of Vietnam in understanding their experiences with health care in Saskatoon. These findings contribute to a contextual understanding of the socio-cultural determinants affecting the experiences of immigrants and refugees. I follow previous research studies to suggest that the cross-cultural contexts of health and illness need to be continually explored in health research regarding immigrants and refugees.

Problems experienced by individuals in institutions tend to be hidden from the public gaze. This is so for inmates of prisons where regulations and bureaucratic structure conceal the daily life situation of prisoners from public view. Anonymity and concealment are enhanced by the widespread misperception of prisoners as an homogenous group. As a result, problems of vulnerable groups, such as people with disabilities, can be ignored. One such group is prisoners with impaired hearing. This descriptive study utilized a multidisciplinary approach to investigate the problems experienced by prisoners within the context of social control. Drawing from selected literature in health, sociology and criminology, the theoretical framework merges the labelling perspective [interactionism] with macro-level theories of social control. The study provides, for the first time, an examination of the percentage, degree and social import of hearing loss in federal prisoners in the Pacific Region of the Correctional Service of Canada. Through the use of survey, audiometric measurement, and interview techniques, an examination was undertaken of the presence and implications of partial hearing loss in inmates of federal penitentiaries in British Columbia. Interview subjects were identified through hearing testing of volunteers in eight federal penitentiaries. Data were gathered through interviews with prisoners with impaired hearing, a comparison group of prisoners with normal hearing, and a selection of custodians. Of 114 prisoners screened, 69% had some degree of impaired hearing, often previously unidentified. Custodians, 86% of the time, labelled behaviours characteristic of the hard of hearing as deviant, and often aggressive, behaviours. Prisoner accounts revealed that failure to test hearing at time of incarceration has harmful effects on performance in programmes and encounters with the justice system. A social activist approach is recommended, to address structural inequalities among prisoners and barriers for prisoners in general. This work indicates that lower-class, lower-status persons may be more susceptible to negative labelling. Prisoners with partial hearing loss, due to the often invisible nature of their condition, are particularly vulnerable to negative labelling. Study recommendations include: 1] Routine hearing screening of all prisoners at time of incarceration. 2] Education of custodians to understand behaviours and communication needs of persons with impaired hearing. 3] A partnership effort between correctional services, the disabled consumer group, and professionals, to improve the situation of prisoners who are hard of hearing.

A Research Report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements of the Degree of Master of Arts, Applied Ethics for Professionals. Johannesburg, 2017
Many asylum seekers and refugees in South Africa reportedly find it difficult to access basic health care services. The issue about foreign nationals in relation to health care can be considered from different angles. The concept of access, though, points to gate-keeping. Gate-keeping is the practice that guides decision making about who has access to what and to what extent they might enjoy benefits. In this essay, the question of whether gate-keeping is a morally justifiable practice in South Africa in relation to asylum seekers and refugees’ right to basic health care services is explored. It is concluded that carefully considered and consistently implemented gate-keeping might be a morally justifiable practice that could contribute to ensuring that resources are distributed fairly. It is also argued that the kind of gate-keeping often observed is inconsistent with human rights and Ubuntu precepts. These moral frameworks seem to be the main ones shaping the view of most South Africans as well as our institutional arrangements. Considering the current South African context in which asylum seekers and refugees have difficulty in accessing basic health care services, patriotic bias claims are considered. However, it is concluded that partiality towards compatriots ought not to hold sway when any human being’s basic needs are at stake.
MT2018

As the public sector and specifically the health sector, undergo reform throughout the Western world in order to find systems that work better and cost less, the phenomenon of accountability is of increasing concern to policy-makers. Although the public administration concept of accountability is ancient, and has been debated and described in the languages of many diverse disciplines, little academic work is available on its meaning or application to the Canadian Health System. Without a clearer understanding of the concept, the basis for improving accountability in the Canadian Health System will remain unknown. This dissertation seeks to clarify the concept of health system accountability and elucidate the issues related to improving accountability in the system. This is accomplished through a concept analysis methodology using two qualitative data collection strategies: a structured review of Canadian literature on accountability from the domains of health policy/administration, professional and popular literature sources; and an interview process whereby 24 health system leaders from five Canadian provinces were interviewed. The findings reveal that the concept of accountability, in its current explicit, performance-based form, is relatively new to Canadian health system policy discussions, its use only beginning in the 1980’s. Prior to this, accountability was implicit in the delegation of health matters to self-regulating professions. The concept evolved from public administration theory and continues to evolve as a health concept. An attempt is made to disentangle the concept of health system accountability from its many related concepts and references. The defining attributes of accountability are: a performance assessment according to standards/goals; an obligation to render an account; and an answerability to the community served. Antecedents or pre-requisites to accountability include a renewed culture, strategic direction, citizen engagement, information management, performance measurement and reporting. Consequences of accountability are: a sustainable health system, increased public confidence, improved health outcomes and quality services, added bureaucracy and uncertainty. Although there is a majority view on the defining attributes, there are several conceptions of accountability: as a theoretical or ethical construct; as gesture; as a formal system or set of practices; as an on-going political process; and as desired outcomes or results. Likewise several normative modes or models exist: the historical professional model, the emerging managerial model and the potential citizen participation model. These are all encompassed within the broader political framework. Also, accountability is a multi-level construct: personal, organizational and political. There are several policy issues related to accountability and democratic governments in today’s modem societies. Within the health sector, the key issues identified, by health system leader research participants, as problematic to improving accountability included: a lack of direction and role definition, cultural issues, a lack of citizen engagement, and a lack of appropriate measurement and information with which to evaluate organization and system performance. Although the purpose of this dissertation is not to answer or provide prescriptions to policy issues, several health policy questions are generated. I trust that the conceptual analysis presented here will assist to clarify our language and understanding of accountability as it continues to evolve in health care, provide a helpful reference point from which to discuss health system policy issues, and prompt further research in an area that has largely been ignored by Canadian academics. We need to get clear about our language, (so that), our intelligence is not bewitched by our language. (Hodgkinson, 1996, p.144)
Graduate

Advance care planning (ACP) is defined as a process of open communication and information sharing between the health care team, the patient, and his/her family to enable patient’s wishes for future care and medical treatment to be explored and supported. The purpose of this study was to investigate the knowledge, attitudes, and experiences of medical-surgical nurses working in Winnipeg, Manitoba in relation to ACP. This cross-sectional descriptive study involved the use of a questionnaire developed and used in Singapore and assessed for face validity by local experts. A sample of 218 registered nurses responded to the web-based survey. Nurses were found to have: a sound understanding of foundational ACP concepts; communal and also varied attitudes toward ACP; and reported variable levels of involvement in ACP with patients and families. The results of this study can be used to inform change within both the educational and clinical care settings.
October 2015

Text in English
South Africa is currently in the process health care reform as the Government has undertaken the task of providing universal health care to all South Africans through the implementation of the National Health Insurance Scheme (NHI). This study took an in-depth look at the history and progression of the post-1994 South African health care policy, and applied the Power Resources Theory to the political economy of the current health care reform process in South Africa. Through a comparative study of the pivotal elements in the phases of health reform in Canada and Sweden this study drew lessons for the design and implementation of universal public health care provision in South Africa. This study found that a strong culture of care, strong political will, active civil society participation and a focus on equality as opposed to poverty in the creation of policy is essential to a successful implementation of universal health care.
Sociology
M.A. (Sociology)

Text in English
South Africa is currently in the process health care reform as the Government has undertaken the task of providing universal health care to all South Africans through the implementation of the National Health Insurance Scheme (NHI). This study took an in-depth look at the history and progression of the post-1994 South African health care policy, and applied the Power Resources Theory to the political economy of the current health care reform process in South Africa. Through a comparative study of the pivotal elements in the phases of health reform in Canada and Sweden this study drew lessons for the design and implementation of universal public health care provision in South Africa. This study found that a strong culture of care, strong political will, active civil society participation and a focus on equality as opposed to poverty in the creation of policy is essential to a successful implementation of universal health care.
Sociology
M.A. (Sociology)

Canadian doctors have historically been an extremely powerful interest group. While there are many variables that account for their political influence, it is widely accepted that much of their power is due to their control over specialized knowledge. To determine whether or not physicians’ control over knowledge is changing, I examine doctors’ position relative to the state, the public and other health professionals. This research finds that, in all three relationships, physicians’ control over knowledge is weakening. Moreover, organized medicine’s response to these developments has largely been a strategy of co-optation, demonstrating that doctors are aware that these changes often cannot be openly fought. This strategy signals that the medical profession recognizes that some changes in its control over knowledge are bound to occur. This study concludes that these changes could contribute to a ‘critical juncture’ signalling the potential for significant change in the physician-state relationship.

Immunisations are one of the most important interventions to decrease mortality and provide a foundation for a successful health system. Eliminating disparities in immunisation access is needed to meet immunisation coverage goals. Although migrants have been identified as influencing recent measles outbreaks in South Africa, research on access to immunisations is lacking for migrants in the country. Numerous barriers to accessing health care have been reported for international migrants in South Africa despite official policies of equal access. Children of Mozambican refugees may be a vulnerable group and not being immunised because of their migration status or other socio-economic and demographic factors. This study aims to determine immunisation rates in rural South Africa and identify socioeconomic and demographic factors influencing immunisation access including being a child of a refugee. All children under 5 years during 2003 and 2006 censuses in the Agincourt subdistrict, Mpumalanga, South Africa (N=17,532) are included in this retrospective, nested cross-sectional multivariate analysis of immunisation access community level data. Immunisation rates are approximately 85% for the first immunisation but rates for subsequent dosing decreased and only 5% of children of appropriate age obtained all immunisations on the South African immunisation schedule. Children of former Mozambican refugees were significantly more likely to be immunised than South African children (OR=1.59, p=0.018) controlling for other socio-economic and demographic characteristics. Children who lived in a village with a clinic (OR=1.43, p=0.015), children with older mothers (OR=1.02, p=0.028), and children in households with higher wealth (OR=1.13, p=0.033) were also more likely to be immunised. Strategies for increasing immunisation access should focus on delivery of services to villages without health care facilities, providing support and outreach to poorer and younger mothers, and ensuring continuing engagement with the immunisation programme. This study adds to the sparse existing research on predictors of immunisation access in South Africa as well as health care access for refugees in South Africa. This research shows that health care access can be higher for international migrants than the host population. Policymakers can use this research to target vulnerable groups to decrease disparities.
Thesis (M.Dev.Studies)-University of KwaZulu-Natal, Durban, 2011.

Different people can have different cultural interpretations of the person—atomic versus embedded—and these may affect health care decision-making. This study examines both the ethics of variations in personhood as well as their implications for the doctrine of informed consent and the duty to warn of genetic disease risk. It argues that variations in personhood are consistent with the ethics of the Principle of Autonomy and the Canadian stand on informed consent, though autonomy and consent play out differently in practice on the two models. Also as a result of different interpretations of the person, the duty to warn of hereditary risk is found to be relevant to the atomic conception but unnecessary among embedded individuals.
Graduate
0422
0566
0326
pkdheri@uvic.ca

An advance directive is an instruction made by a competent person about his or her preferred health care choices, should the person become incapable to make treatment decisions. Legal recognition of advance directives has developed over the last half century in response to medical advances that can prolong the life of a patient who is no longer sentient, and who has decided to forego some or all treatment under such circumstances. Two types of directive have emerged in the law: an instructional directive, in which a person sets out treatment choices, and a proxy directive, which enables the person to appoint a proxy to make treatment decisions. Development of the law has been impeded by fear that advance directives diminish regard for the sanctity of life and potentially authorize euthanasia or assisted suicide. In Canada, this fear explains the continued existence of outdated criminal law prohibitions and contributes to provincial advance directive legislation that is disharmonized and restrictive, in some provinces limiting personal choice about the type of advance directive that can be made. The British Columbia Representation Agreement Act (RAA)1 is an example of such restrictive legislation. The RAA imposes onerous execution requirements, is unduly complex and restricts choice of planning instrument. Respect for patient autonomy requires that health care providers honour patients' prospective treatment preferences. Capable persons must have ready access to a choice of health care planning instruments which can be easily executed. B.C. should implement advance directive legislation that meets the needs and respects the autonomy of B.C. citizens. The Criminal Code must be amended to eliminate physicians' concern about potential criminal liability for following an advance directive. Advance directive legislation across Canada should be harmonized. Finally, health care providers should receive training on effective ways to communicate with patients about end-of-life treatment decisions to ensure that patients' health care choices are known and respected.
Law, Peter A. Allard School of
Graduate

The last decade has been defined by the forced displacement of an unprecedented number of people, on a scale not seen since World War II. As of 2018, more than 71 million people across the globe have been forced to migrate as a result of conflict, natural disasters, drought and famine. More than 19 million crossed international borders seeking safety, and were formally registered as refugees. Forced migration has placed stress and pressure on surrounding low-and middle-income countries. This has been most notable in the Middle East and North Africa as a result of the crisis in Syria. Host countries in the Middle East and North Africa are overwhelmed by this rapid influx, particularly by the healthcare needs of this population. Stakeholders face difficulties providing health services to refugees, owing to the increased number of refugees in urban settings, the large demands on host country health systems and the epidemiologic transition towards non-communicable diseases (NCDs). Health challenges have been exacerbated by weaknesses in the global humanitarian architecture, that result in a fragmented and competitive sector that is unprepared for the current context. Few comparative analyses have examined the diversity of policies and practices aimed at improving services for urban-based refugees with NCDs in the MENA region. Furthermore, a variety of quantitative studies examined NCD incidence, prevalence and service utilization. However, these studies have quickly become outdated and do not explore, in adequate depth, the refugee experience and perspective on accessing NCD services in urban settings. Lastly, numerous NCD interventions have been recommended for LMICs. However, very little guidance exists to support actors addressing these health concerns in crisis-affected contexts. As a result, this dissertation is presented in three papers and responds to these gaps in the literature. Each paper focuses on a specific aim and research question and together they identify and provide recommendations for improvement to service delivery and policy formulation. Paper 1 identifies policies and practices, implemented by host countries and humanitarian actors, aimed at improving access to NCD services for urban refugees in the Middle East and North Africa. Paper 2 examines, using qualitative methods, the healthcare access experience of urban-based Syrian refugees who have been diagnosed with NCDs in Jordan. The third portion of this dissertation (Paper 3) is a policy series that provides recommendations for the government of Jordan and humanitarian actors to improve healthcare access for urban-based refugees with NCDs. It is anticipated that this series of publications will be relevant to traditional and non-traditional actors that respond to the health needs of refugees in urban settings in the MENA region.

The purpose of the study is to investigate lived experiences of refugees when accessing healthcare services in Pretoria, South Africa. A qualitative phenomenological research approach was followed which assisted in exploring and describing the day-to-day lives of refugees living in Pretoria regarding their health outcomes. Face-to-face interviews were conducted on purposively selected participants, representing refugees from different African countries ranging from age 27 to 58 years. Collected data were transcribed, coded, and relevant themes were extracted and analysed by employing Colaizzi's seven-step analysis framework. Main findings demonstrated that the public healthcare services accessed by refugees, compared to private healthcare services, can be described as mostly dysfunctional. Also, healthcare providers from public healthcare services are often hostile towards refugees of African descent. Failure to speak a local language, unofficial documentation as viewed by a healthcare provider on duty, being a foreigner, and failure to pay undue consultation fees led to refugees being denied access to healthcare or receiving negative treatment in the public healthcare sector. Recommendations for programmes to promote human rights and refugee awareness in healthcare facilities could subsequently contribute to alleviating complications around access to healthcare services, which would denote improved health outcomes for the refugees.
Health Studies
M. P. H. (Health Studies)

In Alberta, decision-making in the health system has been devolved to seventeen Regional Health Authorities (RHAs). This thesis undertakes a broad analysis of the values that underlie this regionalization. Divided into two parts, the first half of the thesis develops a liberal egalitarian theory for the distribution of resources in society that turns on the importance of providing all people with the basic resources required to plan for, develop and achieve their life goals. Four requirements for any health system that seeks to uphold the values inherent in this theory are then articulated. These requirements include the need for the health system to be sensitive to the broader determinants of health, and the need for understanding the concepts of health and disease within the context of the social and cultural communities that the system is meant to serve. Part One concludes with an argument suggesting that expressions of Canadian values cohere with the normative theory developed. In Part Two the evolution of Alberta's regionalized healthcare system is traced. The values implicit in the regionalization of the health system in this province are then examined for their congruence with the four requirements developed in Part One. Following this, the ethical difficulties faced by RHAs are considered. The thesis culminates with thoughts on the ethical challenges Alberta's regionalized healthcare system must confront, offering recommendations for how some of these challenges may be addressed. It is concluded in the thesis that while a regionalized health system is not necessary for meeting the requirements elucidated, these standards can be met with a regionalized approach. However, at least in the case of the Alberta experience, a number of important changes would have to take place for this to occur. Among these changes is a paradigm shift in the way health and disease are understood towards a more evaluative approach; the recentralization of public health initiatives to the provincial level; and an overall change in governmental health policy recognizing that many areas of society, and consequently the policies of government agencies beyond a disease-based healthcare system, impact health and well-being.

Children and youth in state or statutory care (children-in-care) are at a higher risk of not having their health needs met than the general pediatric population. A literature review found a paucity of evidence on the health information needed for initial assessments of children-in-care in health record information systems in Canada, particularly when compared with information collected in the comparator countries the United States, United Kingdom, and Australia. This qualitative research reviewed six forms currently used in British Columbia (BC) for assessing the health needs of children-in-care, and for planning future health care delivery for these children. The forms were reviewed with social workers, foster parents, and medical care providers to understand how the forms met their needs for health information for initial assessments when a child first enters care. One researcher conducted 31 interviews with 37 participants —a mixture of social workers, foster parents, and medical care providers allowed for source triangulation— in urban and rural communities using a 19-question, nonvalidated interview tool. NVivo-10 was used to inductively encode participant interviews relying on Pava’s 9-step, nonlinear sociotechnical systems approach to identify themes and concepts raised by the interviews. The researcher conducted an informal review of relevant Ministry of Children and Family Development (MCFD) organization documents and method triangulated the results to the interview findings to identify similarities, differences, and gaps. Findings from these two analyses were compared with the literature review findings. The six forms were found to document most of the required information for typical children-in-care provided the forms were available to the care team and completed in full prior to the initial assessment. Additional forms were used for children-in-care with complex health needs. Key health information included parents’ relevant health and social information, prenatal and birth records, medical and social history of the child, immunization record, whether the child had experienced adverse childhood events, and anything that might remind the child of a stressful situation and cause the child an adverse mental or physical outcome. Complexity in acquiring the needed health information comes from a variety of circumstances. For example, the child may transition in and out of care, parents may be unavailable, and social workers, foster parents, and medical care providers may each change while the child is in care. To overcome information-sharing challenges and barriers, research participants recommended several improvements including funding changes to support medical care provider participation, an information-sharing framework, and electronic options such as a centralized child-in-care record with secure email capability. Introducing some practices from other jurisdictions, notably a senior medical advisor role and a medical assessment model, might help address process challenges when health information is missing during the initial medical assessment. These resources would help round out MCFD’s existing conceptual child-in-care health-care framework. Together these changes may support social workers, foster parents, and medical care providers to provide care to and plan for children-in-care.
Graduate
0723 (Information Science), 0769 (Health Care Management), 0452 (Social Work)
cdthomps@uvic.ca

Ongoing research in the fields of genetics and biotechnology hold the promise of improved diagnosis and treatment of genetic diseases, and potentially the development of individually tailored pharmaceuticals and gene therapies. Difficulty, however, arises in determining how these services are to be evaluated and integrated equitably into public health care systems such as Canada's. The current context is one of increasing fiscal restraint on the part of governments, limited financial resources being dedicated to health care, and rising costs for new health care services and technologies. This has led to increasing public debate in the last few years about how to reform public health care, and whether we should prohibit, permit or perhaps even encourage private purchase of health care services. In Canada, some of these concerns have crystallized around the issue of gene patents and commercial genetic testing, in particular as illustrated by the case of Myriad Genetics' patented BRACAnalysis test for hereditary breast and ovarian cancer. While most Canadians who currently access genetic services do so through the public health care system, for those with the means, private purchase is becoming an option. This situation raises serious concerns - about justice in access to health care; about continued access to safe and reliable genetic testing supported by unbiased patient information; and about the broader effects of commercialization for ongoing research and the Canadian public health care system. Commercial genetic testing presents a challenge to health care professionals, policy analysts, and academics concerned with the social, ethical and policy implications of new genetic technologies. Using the Myriad case as an exemplar, tools from moral philosophy, the social sciences, and health policy and law will be brought to bear on the larger issues of how as a society we should regulate commercial research and product development, and more coherently decide which services to cover under public health insurance and which to leave to private purchase. Generally, the thesis is concerned with the question of "how best to bring capital, morality, and knowledge into a productive and ethical relationship" (Rabinow 1999, 20).

This research implements a mixed method design to examine complementary and alternative medicine (CAM) use among Chinese Canadians. Using logistic regression to analyze data from the Canadian Community Health Survey, this study explores the relationship between Chinese ethnicity and CAM use. This study also uses narrative accounts from case study interviews with Chinese Canadian CAM users to understand why they use CAM. The quantitative results indicate that Chinese ethnicity and other cultural variables significantly affect respondents' likelihood of using CAM. The qualitative results reveal four main reasons for CAM use: (1) adherence to traditional understandings of health and illness, (2) views about the effectiveness of Chinese medicine, (3) acceptance of use by family and friends, and (4) access to Chinese medicine practitioners. The findings are integrated and discussed in the context of the study's theoretical and methodological contributions for the sociological study of CAM use among visible minority groups.

Refugee children often experience social exclusion upon arrival in their new host countries. The United Nations Convention on the Rights of the Child (CRC) obligates States to ensure the social inclusion of all children, including refuges. While all but two countries have ratified the CRC, few have fully implemented it. In this thesis, I tested the hypothesis that the social inclusion of refugee children will be greater in a country that has more fully implemented the CRC (Sweden) than in a country where implementation is weaker (Canada). The results of a policy analysis supported the hypothesis. The findings of this study will contribute to the development of methods to measure the implementation of the CRC, as well as to our understanding of the relationships among human rights, domestic policy and children’s well-being.

The Delivery of Medicine to the North West Region of British Columbia examines the relationship between medical culture and imperialism, religion and social progress from the arrival of the Hudson's Bay Company to the mid twentieth century. The evolutionary stages examined in this study move through imperialism to colonialism and the arrival of the medical missionaries, to the contract medicine of resourced based industries, to the ascendancy of nurses and the outpost hospitals and finally the emergence of modern state supported medicine. It contends that medicine should not be examined alone but within the context of its cultural and social influences.

Diabetes is a chronic disease which affects approximately 5% of all Canadians and contributes to considerable health care costs. At present diabetes can be controlled but not cured. Increased recognition that the provision of diabetes education is essential in diabetes management has led to the development of education programs in many Canadian hospitals. However, participation surveys done in the United States indicate that only 12 to 35% of individuals with diabetes receive education through formal programs. This study seeks to identify factors deterring participation of elderly Sikh Indo-Canadians with NIDDM in education programs. In depth interviews were conducted with the research participants. The Adapted Chain of Response Model was used as the framework to develop questions for the interview guide and to collect, organize and analyze the data. Deterrents identified in previous studies and supported by this study include: older age, low self-confidence, questioning the worth of the program, being on oral medications versus insulin, having one's own ways of self-care, having a family doctor for treating diabetes, financial concerns, time constraints and transportation problems, and an underestimation of the seriousness of NIDDM by doctors. Deterrents unique to the study include: viewing self as healthy, desiring anonymity, reliance on religion, not valuing non-doctors, lacking familial support, perceiving health professionals as lacking cultural sensitivity, lacking awareness of program purpose and existence, and not being referred at time of diagnosis. Family doctors not valuing diabetes education and/or services of health professionals and not encouraging individuals to attend were also identified as deterrents. This study makes recommendations for practice and research which may be useful to diabetes educators, health care organizations and researchers in assisting them to fully understand and address challenges involved in making diabetes education a reality for a greater number of individuals with diabetes.

For many years Canada has quietly rationalized importing temporary “low-skilled” migrant labour through managed migration programs to appease industries desiring cheap and flexible labour while avoiding extending citizenship rights to the workers. In an era of international human rights and global competitive markets, the Canadian Seasonal Agricultural Workers Program (SAWP) is often hailed as a “model” and “win-win” solution to migration and labour dilemmas, providing employers with a healthy, just-in-time labour force and workers with various protections such as local labour standards, health care, and compensation. Tracing migrant workers’ lives between Jamaica, Mexico and Canada (with a focus on Ontario’s Niagara Region), this thesis assesses how their structural vulnerability as non-citizens effectively excludes them from many of the rights and norms otherwise expected in Canada. It analyzes how these exclusions are rationalized as permanent “exceptions” to the normal legal, social and political order, and how these infringements affect workers’ lives, rights, and health. Employing critical medical anthropology, workers’ health concerns are used as a lens through which to understand and explore the deeper “pathologies of power” and moral contradictions which underlie this system. Particular areas of focus include workers’ occupational, sexual and reproductive, and mental and emotional health, as well as an assessment of their access to health care and compensation in Canada, Mexico and Jamaica. Working amidst perilous and demanding conditions, in communities where they remain socially and politically excluded, migrant workers in practice remain largely unprotected and their entitlements hard to secure, an enduring indictment of their exclusion from Canada’s “imagined community.” Yet the dynamics of this equation may be changing in light of the recent rise in social and political movements, in which citizenship and related rights have become subject to contestation and redefinition. In analyzing the various dynamics which underlie transnational migration, limit or extend migrants’ rights, and influence the health of migrants across borders, this thesis explores crucial relationships between these themes. Further work is needed to measure these ongoing changes, and to address the myriad health concerns of migrants as they live and work across national borders.

Indiana University-Purdue University Indianapolis (IUPUI)
The PeerSpirit Circle is a non-hierarchical, intentional, and relationship-centered practice of collaboration. There is a lack of scientific knowledge about the phenomenon of the PeerSpirit Circle in nursing or its potential impact on nursing practice, education, research, and the evolution of the profession and health care. The health care milieu is often entrenched in ways of being that do not support sustained change. For vitality to prosper and creativity to abound, paradigmatic shifts and new models of practice that emphasize collaboration are being called for. The purpose and aims of this phenomenological research study are to explore and give voice to the experiences of nurses who have participated in the PeerSpirit Circle model of practice with other nurses. The study includes interviews from five registered nurses from Canada and the United States conducted from 2009–2010 and interpreted from a Gadamerian philosophical hermeneutic perspective. The research findings reveal three themes: (1) experiencing the Circle container” where participants begin to understand the value of intentional preparation of the interpersonal space for safe human interaction and stronger collaboration—there are experiences of gathering, protecting, appreciating ritual, and sharing stories; (2) Experiencing space where protected space seems to be the essential element to inspire the presencing of participants with self and other, which in turn engenders genuine dialogue, a sense of sacred space, and freedom to be authentic; and (3) Experiencing our humanity, an unfolding theme, where participants experience reconnection with and understanding of their deeper humanity, stronger congruence with their core values, deeper experiences of caring and courage, personal and professional growth, and a profound appreciation for belonging to a lineage of nurses. The findings inspire a deeper understanding of barriers to congruence between values and action in nursing and nurses’ need to acknowledge, honor, support, and protect each other’s vulnerability. The implications for nursing practice, education, and research show that the PeerSpirit Circle model is a beneficial for use in all settings.