Diana L. Gustafson

''They Can't Understand It'': Maternity Health and Care Needs of Immigrant Muslim Women in St. John's, Newfoundland

ObjectivesThe purpose of this qualitative study was to document and explore the maternity health care needs and the barriers to accessing maternity health services from the perspective of immigrant Muslim women living in St. John’s, Canada.MethodsA purposive approach was used in recruiting six individuals to participate in in-depth semi-structured interviews. Data were analyzed using a two-step process of content analysis. Three metathemes were identified and compared to previous research on maternity health and the care needs of immigrant women.ResultsWomen experienced discrimination, insensitivity and lack of knowledge about their religious and cultural practices. Health information was limited or lacked the cultural and religious specificity to meet their needs during pregnancy, labor and delivery, and postpartum phases. There were also significant gaps between existing maternity health services and women’s needs for emotional support, and culturally and linguistically appropriate information. This gap was further complicated by the functional and cultural adjustments associated with immigration.ConclusionsMaternity health care information and practices designed to meet the needs of mainstream Canadian-born women lacked the flexibility to meet the needs of immigrant Muslim women. Recommendations for change directed at decision makers include improving access to culturally and linguistically appropriate maternity and health related information, developing the diversity responsiveness of health care providers and the organizations where they work and establishing social support networks and partnerships with immigrant communities. Changes that address the needs of immigrant Muslim women have the potential to create more inclusive and responsive maternity health services for all Canadian women.

Transcultural nursing theory from a critical cultural perspective.

This critical cultural discourse analysis explores the internal logic of Transcultural Nursing Theory and interrogates the underlying assumptions, goals, and strategies of this approach to race and other human and social differences. Drawing on examples from nursing textbooks and policy documents, I assert that Transcultural Nursing Theory operates from a liberal standpoint that focuses attention on a broadly defined, but narrowly applied, concept of culture. The goal of providing culturally competent care and the processes used to achieve that outcome reinforce, rather than transform, the social practices and relations that institutionalize the dominant approach to social and human differences.

Mental Health Needs of Visible Minority Immigrants in a Small Urban Center: Recommendations for Policy Makers and Service Providers

This qualitative pilot study explored the mental health needs of visible minority immigrants in St. John’s—a small urban center in Atlantic Canada with limited ethnoracial diversity and ethnospecific infrastructure. The study examined the facilitators and barriers to maintaining immigrants’ mental health and their perspectives on availability and access to support services and programs that support mental health. Our findings revealed several determinants of the mental health of visible minority immigrants: social support, income, employment, culture, physical environment, coping skills, gender, and availability, accessibility and cultural appropriateness of mental health services. We offer 18 recommendations framed by Health Canada determinants of health that may be of interest to decision-makers in government, health agencies and social services in similar small urban centers.

Primary mental health care information and services for St. John's visible minority immigrants: gaps and opportunities.

This article draws on an environmental scan and interviews with visible minority immigrants in a small urban Atlantic community to report on gaps and opportunities for improving access to information about primary mental health care services and barriers to utilization of these services. Information about services was limited and did not specifically address the complex health-related concerns of immigrants with diverse religious and cultural backgrounds. Accessing information about mental health care services was challenging for some visible minority immigrants because of physical and financial constraints and limited computer and language literacy. The major barriers to the utilization of primary mental health care services were lack of information, language and literacy issues, a mistrust of primary mental health care services, the stigma associated with mental illness, long wait times, lack of finances, and religious and cultural differences and insensitivity. A list of nine recommendations, which may be of interest to mental health decision-makers and service providers in small urban centers with limited ethno-cultural diversity, is provided.

How are we 'doing' cultural diversity? A look across English Canadian undergraduate medical school programmes

Background: Cultural diversity education is a required curriculum component at all accredited North American medical schools. Each medical school determines its own content and pedagogical approaches. Aim: This preliminary study maps the approaches to cultural diversity education in English Canadian medical schools. Methods: A review of 14 English Canadian medical school websites was undertaken to identify the theoretical approaches to cultural diversity education. A PubMed search was also completed to identify the recent literature on cultural diversity medical education in Canada. Data were analysed using 10 criteria that distinguish pedagogical approaches, curricular structure, course content and theoretical understandings of cultural diversity. Results: Based on the information posted on English Canadian medical school websites, all schools offer cultural diversity education although how each ‘does’ cultural diversity differs widely. Two medical schools have adopted the cultural competency model; five have adopted a critical cultural approach to diversity; and the remaining seven have incorporated some aspects of both approaches. Conclusions: More comprehensive research is needed to map the theoretical approaches to cultural diversity at Canadian medical schools and to evaluate the long-term effectiveness of these approaches on improving physician–patient relationships, reducing health disparities, improving health outcomes and producing positive learning outcomes in physicians.

Methodological and ethical issues in research using social media: a metamethod of Human Papillomavirus vaccine studies

BackgroundOnline content is a primary source of healthcare information for internet-using adults and a rich resource for health researchers. This paper explores the methodological and ethical issues of engaging in health research using social media.MethodsA metamethod was performed on systematically selected studies that used social media as a data source for exploring public awareness and beliefs about Human Papillomaviruses (HPV) and HPV vaccination. Seven electronic databases were searched using a variety of search terms identified for each of three concepts: social media, HPV vaccine, and research method. Abstracts were assessed for eligibility of inclusion; six studies met the eligibility criteria and were subjected to content analysis. A 10-item coding scheme was developed to assess the clarity, congruence and transparency of research design, epistemological and methodological underpinnings and ethical considerations.ResultsThe designs of the six selected studies were sound, although most studies could have been more transparent about how they built in rigor to ensure the trustworthiness and credibility of findings. Statistical analysis that intended to measure trends and patterns did so without the benefit of randomized sampling and other design elements for ensuring generalizability or reproducibility of findings beyond the specified virtual community. Most researchers did not sufficiently engage virtual users in the research process or consider the risk of privacy incursion. Most studies did not seek ethical approval from an institutional research board or permission from host websites or web service providers.ConclusionsThe metamethod exposed missed opportunities for using the dialogical character of social media as well as a lack of attention to the unique ethical issues inherent in operating in a virtual community where social boundaries and issues of public and private are ambiguous. This suggests the need for more self-conscious and ethical research practices when using social media as a data source. Given the relative newness of virtual communities, researchers and ethics review boards must work together to develop expertise in evaluating the design of studies undertaken with virtual communities. We recommend that the principles of concern for welfare, respect for person, and justice to be applied in research using social media.

Best Laid Plans: Examining Contradictions between Intent and Outcome in a Feminist, Collaborative Research Project

This article critically examines a feminist, collaborative research method that was intended to be political in standpoint, gendered in focus, reflexive in process, and transformative in outcome. By incorporating collaborative elements into a qualitative, three-step research design, the author hoped to challenge both what was known about nurses’ job displacement and how that knowledge was produced. This article explores the contradictions between the author’s best laid plans and the actual process of discovery. Recommendations for future research include considerations about the social and political context in which the research takes place, cautions about gender inclusivity in the research population and analytic frame-works, strategies for encouraging participants’ critical thinking, and a caveat with regard to transformative outcomes.

Ethics, “Vulnerability,” and Feminist Participatory Action Research With a Disability Community

We consider the work of research ethics boards and funding models for research that at times are incompatible with the relationship building required for feminist participatory action research with a disability community. We explore the barriers that emerged for university- and community-based partners as they asserted individual and collective identities, and negotiated boundaries, access, and power relations in the process of designing and conducting research. This critical reflection contributes to our understanding of the structures of academic research funding, ethics approval, and how problematic conceptualizations of vulnerability embedded in the Tri-Council Policy Statement and research ethics board practices impact on relationship building and the research process. Recommendations for change will be helpful to researchers studying disability, those using participatory action research, and individuals serving on ethics review boards.

Rethinking immigrant tuberculosis control in Canada: from medical surveillance to tackling social determinants of health.

Current tuberculosis control strategies in Canada rely exclusively on screening and surveillance of immigrants. This is consistent with current public health discourse that attributes the high burden of immigrant tuberculosis to the exposure of immigrants to infection in their country of origin. The effectiveness of control strategies is questionable given the evidence that many immigrants are at higher risk of tuberculosis reactivation because of risk factors such as poverty, malnutrition and overcrowded housing. This paper argues that the absence of policies that address poverty-related disadvantages among immigrants makes these populations more vulnerable to the reactivation of their tuberculosis long after they have been exposed in their countries of birth. Policies for tuberculosis prevention in the Aboriginal population attend to their poverty and other social determinants of health. Effective health prevention policy for tuberculosis within the immigrant population must take similar direction.

Coloring the white plague: a syndemic approach to immigrant tuberculosis in Canada.

Objective. In this article, we adopt a syndemic approach to immigrant tuberculosis (TB) in Canada as a way of challenging contemporary epidemiological models of infectious diseases that tend to racialize and medicalize the risk of infections in socio-economically disadvantage populations and obscure the role of social conditions in sustaining the unequal distribution of diseases in these populations. Design. A syndemic approach unravels social and biological connections which shape the distribution of infections over space and time and is useful in de-racializing and de-medicalizing these epidemiologic models. The socio-historic framework allows us to examine social factors which, refracted through medical science, were central to the development of TB control in Canada at the beginning of twentieth century. Results. We expose the ideological assumptions about race, immigration, and social status which underpin current policies designed to control TB within the immigrant population. We argue that TB control policies which divert the attention from structural health determinants perpetuate health and social inequities of racialized populations in Canada. Medical screening and surveillance is an ineffective control policy because the proportion of TB cases attributed to immigrants increased from 18 to 66% between 1970 and 2007. Conclusion. More effective TB control policies require shifting the focus from the individual disease carriers toward social inequities which underlie the problem of immigrant TB in Canada. In addition, de-racialization and de-medicalization of the contemporary epidemiological models of infectious diseases entail an in-depth exploration of how the categories of ethnicity, culture, and immigration status are played out in everyday health-related experiences of racialized groups.