Sophie Yohani

Immigrant women's experience of maternity services in Canada: A meta-ethnography

OBJECTIVE to synthesise data on immigrant womens experiences of maternity services in Canada. DESIGN a qualitative systematic literature review using a meta-ethnographic approach METHODS a comprehensive search strategy of multiple databases was employed in consultation with an information librarian, to identify qualitative research studies published in English or French between 1990 and December 2011 on maternity care experiences of immigrant women in Canada. A modified version of Noblit and Hares meta-ethnographic theoretical approach was undertaken to develop an inductive and interpretive form of knowledge synthesis. The seven-phase process involved comparative textual analysis of published qualitative studies, including the translation of key concepts and meanings from one study to another to derive second and third-order concepts encompassing more than that offered by any individual study. ATLAS.ti qualitative data analysis software was used to store and manage the studies and synthesise their findings. FINDINGS the literature search identified 393 papers, of which 22 met the inclusion criteria and were synthesised. The literature contained seven key concepts related to maternity service experiences including social (professional and informal) support, communication, socio-economic barriers, organisational environment, knowledge about maternity services and health care, cultural beliefs and practices, and different expectations between health care staff and immigrant women. Three second-order interpretations served as the foundation for two third-order interpretations. Societal positioning of immigrant women resulted in difficulties receiving high quality maternity health care. Maternity services were an experience in which cultural knowledge and beliefs, and religious and traditional preferences were highly relevant as well but often overlooked in Canadian maternity settings. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE in order to implement woman-centered care, to enhance access to maternity services, and to promote immigrant womens health, it is important to consider these womens social position, cultural knowledge and beliefs, and traditional customs in the health care.

An ethnographic study of communication challenges in maternity care for immigrant women in rural Alberta

BACKGROUND many immigrant and ethno-cultural groups in Canada face substantial barriers to accessing health care including language barriers. The negative consequences of miscommunication in health care settings are well documented although there has been little research on communication barriers facing immigrant women seeking maternity care in Canada. This study identified the nature of communication difficulties in maternity services from the perspectives of immigrant women, health care providers and social service providers in a small city in southern Alberta, Canada. METHODS a focused ethnography was undertaken incorporating interviews with 31 participants recruited using purposive and snowball sampling. A community liaison and several gatekeepers within the community assisted with recruitment and interpretation where needed (n=1). All interviews were recorded and audio files were transcribed verbatim by a professional transcriptionist. The data was analysed drawing upon principles expounded by Roper and Shapira (2000) for the analysis of ethnographic data, because of (1) the relevance to ethnographic data, (2) the clarity and transparency of the approach, (3) the systematic approach to analysis, and (4) the compatibility of the approach with computer-assisted qualitative analysis software programs such as Atlas.ti (ATLAS.ti Scientific Software Development GmbH, Germany). This process included (1) coding for descriptive labels, (2) sorting for patterns, (3) identification of outliers, (4) generation of themes, (5) generalising to generate constructs and theories, and (6) memoing including researcher reflections. FINDINGS four main themes were identified including verbal communication, unshared meaning, non-verbal communication to build relationships, and trauma, culture and open communication. Communication difficulties extended beyond matters of language competency to those encompassing non-verbal communication and its relation to shared meaning as well as the interplay of underlying pre-migration history and cultural factors which affect open communication, accessible health care and perhaps also maternal outcomes. CONCLUSION this study provided insights regarding maternity health care communication. Communication challenges may be experienced by all parties, yet the onus remains for health care providers and for those within health care management and professional bodies to ensure that providers are equipped with the skills necessary to facilitate culturally appropriate care.

Applying the ADAPT Psychosocial Model to War-Affected Children and Adolescents:

Multiple individual, social, and environmental factors have long been recognized as influencing a child’s response to traumatic experiences. However, there remain few socio-ecological frameworks to guide researchers and practitioners working with war-affected children. This article examines Silove’s psychosocial model of adaptation and development after trauma and persecution (ADAPT model) in relation to war-affected children. The utility of the model is explored by examining whether the systems of safety, attachment, identity, justice, and existential meaning described in the ADAPT model are represented in a narrative review of research from the last 20 years on the experiences of war-affected children and adolescents. Results suggest that research with war-affected children has covered all five psychosocial pillars in the model, but with overemphasis on the safety, followed by the attachment, domains. This review highlights that need for research and psychosocial interventions that focus on adaptation of war-affected children’s identity development, sense of justice, and meaning systems.

Intersections Between Hope and Vulnerability in Couples’ Experiences of the Reflecting Team Process

Couple therapists have asserted that hope and vulnerability are active forces in the therapeutic process. However, no research has been published that examines clients’ experiences of hope and vulnerability when participating in couple therapy. To address this gap in the literature, the authors conducted in-depth interpersonal process recall interviews with six clients (three couples). Interviews focused on their underlying experiences of hope and vulnerability during the reflecting team process. The authors present clients’ descriptions of where these experiences overlap. Using the information provided by clients, they make suggestions regarding attending to hope and vulnerably during the reflecting team process.

Pathways to Help-Seeking and Mental Health Service Provision for African Female Survivors of Conflict-Related Sexualized Gender-Based Violence

ABSTRACT African migration to Canada is a relatively new development. There is a dearth of literature on the mental health of this newer immigrant population, especially those from the conflict zones of Sub-Saharan Africa. Our exploratory study examined the experiences of African female survivors of conflict-related sexualized violence based on the insights of six community mental health professionals. Guided by interpretive inquiry, semi-structured interviews were analyzed thematically and interpreted in light of multicultural feminist and transnational perspectives. Findings highlight refugee women’s resilience in the face of threats of social isolation and stigma. Their prioritization of assistance with practical needs, parenting, community/social supports, and education attainment in the context of counseling raises questions about agency and identity in understanding the relationships between female survivors, what they identify as important to their recovery, and their pathways to accessing mental health services.

A Scoping Review on Intimate Partner Violence in Canada’s Immigrant Communities

Canada relies on newcomers for population growth, labor supply, and cultural diversity. Newcomers, in turn, see Canada as a haven of economic opportunities. However, the extent to which these mutual benefits can be realized depends on how well newcomers fare in Canada. Intimate partner violence (IPV) significantly undermines immigrants’ capacity to rebuild their lives in host societies. As in other Western democracies, recent immigrants and refugees to Canada are highly vulnerable to IPV; they arrive with limited support systems, wrestle with changing family dynamics, and may have to adapt to new gender roles. IPV often occurs in the private domain of the family and poses serious risks to women, children, families, and the broader society. Our scoping review of 30 articles on IPV within Canadian immigrant groups identifies crucial differences in perceptions and experiences of, responses to, and coping mechanisms among female survivors, and a tendency to place the blame for IPV on the cultural values and practices that immigrants bring to Canada. The majority of existing services and policies, our review shows, are not well suited to immigrant women’s needs and may undermine women’s capacity to find satisfying solutions. Our review is limited by a dearth of literature; it is based mainly on the experiences of South East Asian immigrant women in the Greater Toronto Area. Our findings suggest that future research should address women’s and men’s experiences of IPV, include nonheterosexual couples, extend to the broader immigrant population, and incorporate the voices of stakeholders other than survivors.

Support Programs for Women Survivors of Sexualized Gender-Based Violence From African Conflict Zones: A Contextual Review

The increasing attention paid to sexualized gender-based violence (GBV) against women in African conflict zones by the international community is a welcome development to many stakeholders, including scholars, policy makers, human rights advocates, international organizations, and nongovernmental organizations. Little is known, however, about the experiences of survivors who end up in Western host countries, such as Canada, as newcomers. Much less is known about their interactions with Western-based mental health care intervention models and the assumptions and understandings they hold about survivors’ histories and life circumstances before, during, and after migration. We argue, therefore, for studies that place the experiences of survivors in a broader social and political context—as one crucial facet of culturally effective interventions. This review of the state of knowledge reveals the gaps in literature, identifies areas for future research, and contributes to the search for effective intervention measures that could enhance survivors’ transition and integration into Western societies.

Transnationalism, parenting, and child disciplinary practices of African immigrants in Alberta, Canada

Child discipline remains a topic of public health interest across the globe. Despite this enduring interest, very little is known about the child disciplinary practices of African immigrants in Canada. This paper explores the disciplinary practices of African immigrant parents in Alberta, a Canadian province with a recent surge in the population of African immigrants. Employing a critical ethnographic methodology, informed by transnational theory, we collected data through in-depth qualitative interviews with a purposive sample of African community leaders (n = 14), African immigrant parents (n = 32), policymakers (n = 2), and health and immigrant settlement workers (n = 10). As members of the African immigrant community, we were deeply immersed in the research settings, which afforded us the opportunity to collect pertinent observational data in the form of reflexive notes. Thematic analysis of the data revealed child disciplinary approaches that incorporate Canadian and African parenting practices, as well as practices that appear somewhat unique to this demographic. We found that African immigrant parents used corporal discipline, persuasive discipline, and a hybrid of the two, as well as emerging practices involving transnational fostering and emotional isolation of children who persistently misbehaved. These practices, in their totality, appeared to be influenced by the transnational experiences of parents and precepts that are traceable to Canadas legal and educational systems. We present theoretical, policy, and service implications of our findings, including a recommendation to incorporate sociocultural dimensions of child discipline into Canadian child welfare policies and practices.

Cultural brokers’ role in facilitating informal and formal mental health supports for refugee youth in school and community context: a Canadian case study

ABSTRACT Refugee youth, who experience developmental, settlement and/or premigration related challenges, rarely utilise mental health services due to systemic and cultural barriers. Cultural brokering, the act of linking different cultural groups to enhance practice and communication, is one approach to addressing barriers to mental health service provision experienced by refugees. Results from a qualitative case study in Canada identified informal and formal activities of four cultural brokers that facilitate the mental health and adaptation of refugee youth in schools: facilitating cultural integration and sense of belonging, bridging to settlement services, supportive counselling, facilitating referrals to mental health practitioners, educating about mental health, providing contextual information and cultural interpretation. Results provide initial insights into a holistic approach that could be used by mental health service providers to enhance service provision and the wellbeing of refugee youth in schools and community settings.