(WPO7a) Cultural Sensitivity and Equity in Healthcare Delivery I

Presenters in this session will share their research on the barriers, challenges and complexities of the healthcare system in a wider global context and why it is critical to integrate medical humanism in medical education to foster culturally-sensitive and patient-centered care equity in a growing diverse world. Studies show that cultural sensitivity and equity in healthcare is a foundational pillar for reducing health disparities among ethnic minority and lower socio-economic groups of people. Recognizing patients as individuals, regardless of their cultural or linguistic backgrounds shows respect for the patient and contributes to more empathetic and compassionate care with better health outcomes. Tags: Health and Care, Migration and Immigration, Work And Professions

Organizer: Cindy Sinclair, University of Toronto; Chair: Cindy Sinclair, University of Toronto

Presentations

Krithika Subbiah, University of Waterloo; Ruah Alsaghier, University of Waterloo

"Even if we want help, there is no help": Exploring Perceptions and Barriers in Home Care Services within the South Asian Communities

In Canada, the demand for home care services continues to increase due to the ongoing growth of the aging population. This aging population is marked not only by the increase in the number of older adults but also by its significant diversity (National Advisory Council on Aging, 2005). There is a growing need to address disparities in the utilization of home care services among immigrant older adults (Wellesley Institute, 2016). Despite the importance of home care services, little is known about how ethnic minorities perceive home care services in Ontario, specifically South Asian communities – who are the largest minority in Canada. Therefore, recognizing this overarching context, my research aimed to explore South Asian communities’ nuanced perceptions about home care services in Ontario, barriers they face when accessing these services and recommendations on how home care services in Ontario can be structured to address their unique needs. The study aimed to explore South Asian communities nuanced perceptions about home care services in Ontario and the barriers they experience when they access home care services. Additionally, it sought recommendations from these communities on how to enhance home care services for older adults, aiming to improve the provision of culturally aligned home care services for South Asian communities in Ontario. Methods: This study employed an exploratory qualitative research design to investigate the nuanced perceptions about home care services in Ontario, barriers they face when accessing these services and recommendations on how home care services in Ontario can be structured to address their unique needs. Thirteen participants, including seven care partners, three South Asian older adults, and three social workers who engaged with South Asian older adults, contributed to the study. A Reflexive Thematic Analysis (RTA) was utilized to engage with the data and generate themes for the study. iv This method facilitated a rigorous and reflexive examination of participants narratives, enhancing the depth and richness of the study findings. The participants emphasized a significant demand for home care services within South Asian communities. In shedding light on the barriers faced by these communities in accessing home care services, various challenges experienced by care partners and older adults in Ontario were revealed. The findings also revealed the impact of duration of residency in Canada on openness to formal home care, the presence of stigma hindering care-seeking, and a lack of awareness about available home care services. Evolving gender roles and care partner burdens were discussed, emphasizing the necessity of culturally tailored support services. Preferences for culturally competent and humble care, language concordance, and alignment with care providers gender and ethnicity emerged as significant themes. Additionally, the study participants offered valuable recommendations to improve home care services for South Asian communities. These suggestions, ranging from enhancing accessibility to customizing services, aim to align with the cultural needs of the South Asian communities. The study reinforced the notion that the South Asian communities are a diverse and heterogeneous group. Perceptions of home care services differed based on the extent of Western cultural adaptation and lived experiences. The research also underscored that while the general population faces obstacles in accessing home care, these challenges are more pronounced within the South Asian communities due to factors like cultural expectations, language barriers, and financial constraints. Additionally, it highlighted the need for culturally tailored home care services to meet the specific needs of an increasingly diverse aging population.This study significantly contributed to ethnogerontological knowledge by examining South Asian communities nuanced perceptions about home care services in Ontario, barriers they v faced when accessing these services and recommendations on how home care services in Ontario can be structured to address their unique needs. Recommendations included targeted awareness strategies and culturally sensitive services for South Asian communities. The study advocated for a holistic home care model, patient-centered care, and cautioning against reliance on cultural stereotypes. Future research suggestions included exploring perceptions among recent immigrants, those with dementia, and an intersectional analysis. Additionally, investigating cultural factors like filial piety and their impact on long-term care decisions within the South Asian communities is recommended.

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Non-presenting authors: Elena Neiterman, University of Waterloo

Anila Zainub, HE Solutions, Inc.

Immigrants' Health and Socio-Economic Integration in Canada

Muslim high skilled immigrant population in Canada has been steadily increasing in the past few decades. They continue to join the previous high skilled cohorts in facing the tribulations of economic and social settlement. Research shows that high skilled Muslim immigrants are a young, likely to be underemployed/unemployed, and a visibly racialized minority in Canada. Upon arrival they face many obstacles in their integration process. The obstacles to successful socio-economic integration include but are not limited to non-recognition of credentials, occupational downgrading, demands for Canadian experience, and discrimination in hiring and retention (Banerjee et. al., 2021; Ellis, 2019; Guo, 2013; Lightman and Gingrich, 2018), all of which can have a significant impact on immigrants health (Zainub, 2023). Previous research (Dean and Wilson, 2009; Premji and Shakya, 2017) shows a link between under/unemployment and health as well as fields which are highly feminized and racialized can expose immigrants to precarity and poor working conditions. The existing literature review shows that there is a dearth of qualitative research examining the lived experiences of high skilled Muslim immigrants and their health as it pertains to their socio-economic integration. The data for this work is extracted from my doctoral study which explored the social and economic integration outcomes and lived experiences of highly skilled Muslim immigrants in Canada. My doctoral study investigated the effect of race and religion on their experiences of socio-economic integration and examines their strategies of resistance in response to the challenges. I conducted twenty-one qualitative, semi-structured interviews and applied the theoretical perspectives of Muhammad Iqbals concept of Khudi (Self) and Anti-colonial Discursive framework. My study found that Muslim immigrants experience acute disadvantages socially and economically and face Islamophobia and racism in the labour market. This leads to low socio-economic integration, poor physical and mental health which is rooted in not only the tribulations of the migration process but more significantly to credential/skill mismatch, occupational downgrading, and Islamophobia in the labour market. I present these findings along with recommendations for addressing these health concerns, among them are the role of health care practitioners and policymakers. This presentation argues that connections between the integration process and its influence on Muslim immigrants health must be better understood by medical practitiioners. Furthermore, policy makers must also address the non-recognition of foreign credentials/ skills as well as the rise in discrimination and Islamophobia in the Canadian labour market.  

Zahid Zulfiqar, National College of Business Administration & Economics Multan Sub Campus; Kamran Ishfaq, Bahauddin Zakariya University Multan, Pakistan

Mothers Experiences Having a Thalassemia Major Child: An Evidence From District Multan, Pakistan

Thalassemia is an inherited blood disorder that is passesfrom parents to their children. It is a major health problem in Pakistan and South Asian countries. About 6-8 % population of Pakistanis are thalassemia carriers traits, thus more than 10 million thalassemia carriers are in Pakistan and every year 5000 children are born with the disease of thalassemia major. Thalassemia major patients require regular blood transfusions and medicines throughout their whole life that impact patients and their families, particularly mothers. The objective of the present study was to know the lived experiences of mothers having thalassemia major children and to dig out the effects of Thalassemia major on the mothers of the patients. This qualitative study explored the lived experience of 20 mothers of children with thalassemia major by conducting semi-structured interviews. The present study was conducted at the Thalassemia Centre of the Children’s Hospital and the Institute of Child Health Multan, Pakistan and data were analyzed by using content analysis. Ethical approval was obtained for the interviews from the ethics committee of the Hospital. The study reported that thalassemia major child disease that affects the mother’s life socially, psychologically, and economically. Mothers were stressed because of their childrens sickness. The study reported that the majority of the mothers had inadequate knowledge about the genetic disorders. Mothers were worried about their children’s frequent transfusions of blood and their behavioral changes. They were concerned about their child’s present status and their future. Most mothers had no sufficient knowledge about thalassemia disease, prevention, and management. They were worried about the childs appearance, education and difficulties, repeated blood transfusions, and costly medicines. Most mothers identified the effects of illness on their children’s school attendance. The study recommended that healthcare professionals including social workers should educate and inform the mothers clearly about the thalassemia disease, its management, and prevention. Community support programs must be started for the thalassemia patients’ parents. Thalassemia support groups should be established officially to provide social, psychological, emotional, and economic support to thalassemia patients and their mothers in addition to their basic knowledge of thalassemia.

Kawalpreet Kaur, Newcomer Women's Services Toronto; Neethu Varghese, University of Toronto; Cindy Sinclair, University of Toronto

Why Engage Medical Residents in Humanism Conversations?

Sir William Osler, considered the Father of Modern Medicine, was a renowned Canadian physician and a dedicated humanist. His enduring words, “the good physician treats the disease; the great physician treats the patient who has the disease”, carry the same profound significance a century later in contemporary medical practice. Recent concerns regarding the disconnect between patients and doctors, particularly due to a growing shortage of doctors in Canada, have been disturbing. Presently, over six million people in Canada do not have access to a family doctor, whose role is paramount to the comprehensive health and well-being of an individual. The increasing influx of newcomer immigrants and refugees from vastly diverse ethnic and social backgrounds, has created a unique demand for a more culturally sensitive patient-care services. The Canadian patient population has become increasingly diverse in terms of multicultural and ethnic backgrounds over the past few decades, particularly in larger cities like Toronto. In Toronto, more than 50% of the population consists of patients from visible minorities and cultural backgrounds. Evidence indicates that marginalized ethnic minority individuals bear the most significant consequences in the face of a shortage of doctors. For instance, the province of Ontario, which attracts a higher number of newcomer immigrants and refugees, is experiencing a critical shortage of doctors, and this scarcity disproportionately affects visible minority patient population. Currently, 1.4 million Ontarians lack access to a family doctor, and this is exacerbated by the challenges faced by practicing family doctors, including burnout, retirement, or pursuing alternative career paths, contributing to increased healthcare risks for visible minority and marginalized communities. As the medical profession grapples with the overwhelming number of patient inflow and strives to meet the healthcare needs of the population, there is a risk of overlooking the individuality of each patient. This shift contributes to reducing patients from being unique individuals with personal concerns and stories to mere medical cases or statistics. In order to counteract this shift, it is essential to promote a patient-centered approach by considering individuals as human beings, emphasizing on the person who has the disease rather than solely being disease-oriented. This approach aligns with Sir William Osler’s humanistic philosophy of the patient-doctor relationship. The objectives of this presentation are to address the critical need for human-centered medical teaching in residency education and to explore the utilization of the medical skills and expertise of Immigrant Medical Graduates (IMGs) to support interactive learning and preparation of doctors for the future of medicine in a multicultural Canada. This presentation also discusses how humanistic medicine can bridge the gap between visible minority patients and physicians, by fostering a culturally sensitive patient-centered care. The theoretical framework that underpins the objectives of this presentation is Sir William Osler’s humanistic philosophy which emphasizes focusing on the patient as an individual human being, thus contributing toward a patient-centered care. The humanistic interaction between the patient and the physician plays a critical role in patient care and the patient-doctor relationship. Several countries have integrated medical humanities into their medical curricula. Different approaches and modalities such as interdisciplinary teaching teams, recording student reflections, publishing student narratives, role modeling, lectures, dialogical teaching, humanism roundtables, mortality and morbidity meetings, training in interpersonal skills, reviewing video recordings of patient encounters, and small group teaching using standardized patients, are utilized to foster humanism in medical residency education. With increasingly diverse patient population in Canada, there is a call for culturally sensitive patient-centered care, underpinned by Sir William Osler’s humanistic philosophy. This presentation discusses the need for the integration of medical humanism in medical residency education, and the utilization of the medical expertise of immigrant medical graduates, to foster a culturally sensitive patient-centered care in multicultural Canada.