Yogendra Shakya

Family Relationships of Afghan, Karen and Sudanese Refugee Youth

Research with immigrant and refugee families consistently documents acculturation gaps and role reversals between migrant youth and their parents. However, debate exists over whether these necessarily lead to family conflict and distress. This question was explored in this community-based qualitative study through focus groups and interviews with 70 newcomer refugee youth aged 16 to 24 from the Afghan, Karen and Sudanese communities in Toronto. Thematic analysis revealed that youths’ responsibilities increased following migration, often involving service navigation, language interpretation, and providing financial and emotional support, in addition to household chores and pursuing education and employment. Several youth explicitly took on parental roles in the absence of a parent. These changes did not necessarily lead to conflict, and where family conflict and distancing occurred, other factors such as lack of time together or low levels of family support seemed to be the contributing factors. Youth were clearly “resettlement champions” for their families, which increased family-level well-being, often at the cost of individual-level well-being. Policy implications are discussed. Une recherche documentée sur les familles d’immigrés et de réfugiés montre de manière consistante des écarts dus à l’acculturation ainsi que des renversements de rôle entre les jeunes immigrés et leurs parents. Il y a cependant un débat sur la question de savoir si ceci doit forcément mener à des conflits familiaux et à une certaine détresse. Cette question a fait l’objet d’une étude qualitative réalisée dans les communautés afghanes, karènes et soudanaises de Toronto à partir de groupes cibles et d’entrevues menées avec 70 jeunes réfugiés nouvellement arrivés et âgés de 16 à 24 ans. Une analyse thématique a révélé que les responsabilités de ces jeunes augmentaient suite à l’immigration, souvent afin d’aider les leurs à s’orienter dans les services, à leur servir d’interprète et à leur apporter un soutien financier et émotionnel, et ce en plus de tenir la maison, de continuer des études et de gagner leur vie. Plusieurs d’entre eux ont pris explicitement le rôle de parents en l’absence de l’un d’entre eux. Ces changements n’ont pas automatiquement provoqué de conflits sauf que, là où il y en a eu dans la famille ou qu’elle a souffert de distanciation, d’autres facteurs tels que le manque de temps en commun ou un bas niveau de support familial semblent y avoir contribué. Les jeunes sont clairement les «champions du réétablissement» pour les leurs, améliorant le bien-être familial, souvent au prix d’un mieux-vivre individuel. Il s’agit donc de voir ce que cette situation implique au niveau des politiques à leur égard.

Reflexivity A Methodological Tool in the Knowledge Translation Process

Knowledge translation is a dynamic and iterative process that includes the synthesis, dissemination, exchange, and application of knowledge. It is considered the bridge that closes the gap between research and practice. Yet it appears that in all areas of practice, a significant gap remains in translating research knowledge into practical application. Recently, researchers and practitioners in the field of health care have begun to recognize reflection and reflexive exercises as a fundamental component to the knowledge translation process. As a practical tool, reflexivity can go beyond simply looking at what practitioners are doing; when approached in a systematic manner, it has the potential to enable practitioners from a wide variety of backgrounds to identify, understand, and act in relation to the personal, professional, and political challenges they face in practice. This article focuses on how reflexive practice as a methodological tool can provide researchers and practitioners with new insights and increased self-awareness, as they are able to critically examine the nature of their work and acknowledge biases, which may affect the knowledge translation process. Through the use of structured journal entries, the nature of the relationship between reflexivity and knowledge translation was examined, specifically exploring if reflexivity can improve the knowledge translation process, leading to increased utilization and application of research findings into everyday practice.

Self-Management, Health Service Use and Information Seeking for Diabetes Care among Black Caribbean Immigrants in Toronto

OBJECTIVE The objective of this research was to explore self-management practices and the use of diabetes information and care among Black-Caribbean immigrants with type 2 diabetes. METHOD The study population included Black-Caribbean immigrants and Canadian-born participants between the ages of 35 to 64 years with type 2 diabetes. Study participants were recruited from community health centres (CHCs), diabetes education centres, hospital-based diabetes clinics, the Canadian Diabetes Association and immigrant-serving organizations. A structured questionnaire was used to collect demographics and information related to diabetes status, self-management practices and the use of diabetes information and care. RESULTS Interviews were conducted with 48 Black-Caribbean immigrants and 54 Canadian-born participants with type 2 diabetes. Black-Caribbean immigrants were significantly more likely than the Canadian-born group to engage in recommended diabetes self-management practices (i.e. reduced fat diet, reduced carbohydrate diet, non-smoking and regular physical activity) and receive regular A1C and eye screening by a health professional. Black-Caribbean immigrant participants were significantly more likely to report receiving diabetes information and care through a community health centre (CHC) and nurses and dieticians than their Canadian-born counterparts. CONCLUSIONS CHCs and allied health professionals play an important role in the management of diabetes in the Black-Caribbean immigrant community and may contribute to this groups favourable diabetes self-management profile and access to information and care. Additional research is necessary to confirm whether these findings are generalizable to the Black-Caribbean community in general (i.e. immigrant and non-immigrant) and to determine whether the use of CHCs and/or allied health professionals is associated with favourable outcomes in the Black-Caribbean immigrant community as well as others.

A pilot with computer-assisted psychosocial risk –assessment for refugees

BackgroundRefugees experience multiple health and social needs. This requires an integrated approach to care in the countries of resettlement, including Canada. Perhaps, interactive eHealth tools could build bridges between medical and social care in a timely manner. The authors developed and piloted a multi-risk Computer-assisted Psychosocial Risk Assessment (CaPRA) tool for Afghan refugees visiting a community health center. The iPad based CaPRA survey was completed by the patients in their own language before seeing the medical practitioner. The computer then generated individualized feedback for the patient and provider with suggestions about available services.MethodsA pilot randomized trial was conducted with adult Afghan refugees who could read Dari/Farsi or English language. Consenting patients were randomly assigned to the CaPRA (intervention) or usual care (control) group. All patients completed a paper-pencil exit survey. The primary outcome was patient intention to see a psychosocial counselor. The secondary outcomes were patient acceptance of the tool and visit satisfaction.ResultsOut of 199 approached patients, 64 were eligible and 50 consented and one withdrew (CaPRA = 25; usual care = 24). On average, participants were 37.6 years of age and had lived 3.4 years in Canada. Seventy-two percent of participants in CaPRA group had intention to visit a psychosocial counselor, compared to 46 % in usual care group [X2 (1)=3.47, p = 0.06]. On a 5-point scale, CaPRA group participants agreed with the benefits of the tool (mean = 4) and were ‘unsure’ about possible barriers to interact with the clinicians (mean = 2.8) or to privacy of information (mean = 2.8) in CaPRA mediated visits. On a 5-point scale, the two groups were alike in patient satisfaction (mean = 4.3).ConclusionThe studied eHealth tool offers a promising model to integrate medical and social care to address the health and settlement needs of refugees. The tool’s potential is discussed in relation to implications for healthcare practice. The study should be replicated with a larger sample to generalize the results while controlling for potential confounders.

Pathways between under/unemployment and health among racialized immigrant women in Toronto

ABSTRACT Objective. We sought to document pathways between under/unemployment and health among racialized immigrant women in Toronto while exploring the ways in which gender, class, migration and racialization, as interlocking systems of social relations, structure these relationships. Design. We conducted 30 interviews with racialized immigrant women who were struggling to get stable employment that matched their education and/or experience. Participants were recruited through flyers, partner agencies and peer researcher networks. Most interviews (21) were conducted in a language other than English. Interviews were transcribed, translated as appropriate and analyzed using NVivo software. The project followed a community-based participatory action research model. Results. Under/unemployment negatively impacted the physical and mental health of participants and their families. It did so directly, for example through social isolation, as well as indirectly through representation in poor quality jobs. Under/unemployment additionally led to the intensification of job search strategies and of the household/caregiving workload which also negatively impacted health. Health problems, in turn, contributed to pushing participants into long-term substandard employment trajectories. Participants’ experiences were heavily structured by their social location as low income racialized immigrant women. Conclusions. Our study provides needed qualitative evidence on the gendered and racialized dimensions of under/unemployment, and adverse health impacts resulting from this. Drawing on intersectional analysis, we unpack the role that social location plays in creating highly uneven patterns of under/unemployment and negative health pathways for racialized immigrant women. We discuss equity informed strategies to help racialized immigrant women overcome barriers to stable work that match their education and/or experience.

Refugee maternal and perinatal health in Ontario, Canada: a retrospective population-based study

Objectives Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes. Design This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data. Setting and participants Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014. Primary outcomes Numerous adverse maternal and perinatal health outcomes. Results Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers. Conclusions Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration experiences.

Newcomer Youth Self-Esteem: A Community-Based Mixed Methods Study of Afghan, Columbian, Sudanese and Tamil Youth in Toronto, Canada

Self-esteem is recognized as an important correlate of youth mental wellbeing and, by extension, supportive of individual resilience. While an extensive body of literature exists on self-esteem of mainstream youth, less is known about self-esteem experiences of immigrant youth, and in particular newcomer and refugee youth. Applying a community-based participatory research approach, and using mixed methods, the aim of the study presented was to understand social determinants of newcomer youth’s mental wellbeing, and recognize both their challenges and resilience. The chapter focuses on the self-esteem of newcomer youth from four ethnic backgrounds (Afghan, Colombian, Sudanese, and Tamil).The study findings can contribute to mental health promotion strategies in multicultural and immigrant-receiving community settings.

Newcomer Refugee Youth as ‘Resettlement Champions’ for their Families: Vulnerability, Resilience and Empowerment

Due to experiences of forced migration, a large proportion of resettled refugee families arrive in resettlement countries with low levels of education, limited official language fluency, fractured family relationships, and less than optimal physical and mental health. These pre-migration determinants intersect with systemic barriers in ways that make it extremely difficult for refugees to secure employment/income security, access health and settlement services, and pursue their educational and other goals. This chapter discusses the role that newcomer refugee youth play in helping their families resettle in response to systemic post-migration barriers.

Patients’ Mental Health Journeys: A Qualitative Case Study with Interactive Computer-Assisted Client Assessment Survey (iCASS)

Despite growing concerns about common mental disorders (CMDs), challenges persist in accessing timely and appropriate care, especially for immigrant, refugee, racialized and low-income groups. Partnering with a community health centre serving these populations in Toronto, we examined the Interactive Computer-assisted Client Assessment Survey (iCCAS) that screens for CMDs (depression, generalized anxiety, post-traumatic stress, and alcohol overuse) and related social factors. In this case study design with embedded units, we explored the mental health care journeys of patients who screened positive for a CMD. The analysis identified three major pathways of care: (1) early detection of previously unidentified CMDs; (2) detection of comorbid mental health conditions; and (3) prevention of possible relapse and/or management of existing previously recognized mental health condition. These cases indicate iCCAS holds potential to facilitate more open, tailored, and informed collaborations between patients and clinicians regarding mental health care plans.

Mental health of South Asian youth in Peel Region, Toronto, Canada: a qualitative study of determinants, coping strategies and service access.

Objectives This qualitative study set out to understand the mental health challenges and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada. Setting In-depth semistructured interviews were carried out with South Asian youth living in Peel Region (Mississauga, Brampton and Caledon), a suburb of Toronto, Canada, home to over 50% of Ontario’s South Asian population. Participants South Asian youth (n=10) engaged in thoughtful, candid dialogue about their mental health and service access barriers. Primary and secondary outcome measures Qualitative interview themes related to mental health stressors and mental health service access barriers experienced by youth living in Peel Region were assessed using thematic analysis. Results South Asian youth face many mental health stressors, from intergenerational and cultural conflict, academic pressure, relationship stress, financial stress and family difficulties. These stressors can contribute to mental health challenges, such as depression and anxiety and drug use, with marijuana, alcohol and cigarettes cited as the most popular substances. South Asian youth were only able to identify about a third (36%) of the mental health resources presented to them and did not feel well informed about mental health resources available in their neighbourhood. Conclusions They offered recommendations for improved youth support directed at parents, education system, South Asian community and mental health system. Institutions and bodies at all levels of the society have a role to play in ensuring the mental health of South Asian youth.