Experiences of recently-arrived, non-literate, non-English-speaking African refugee women accessing healthcare in Greater Vancouver A. Floyd, MScPH, BSN, D. Sakellariou, PhD, MSc, S. Barry, BSN, K. Grant, PhD & M. Mayhew, MD
Introduction • Inability to communicate in the local language and lack of literacy have been shown to be barriers to accessing healthcare for new immigrants to Canada. • African refugee women may face additional challenges as they simultaneously belong to several marginalized groups: immigrants, women, racialized minority, lowincome. • Non-English or French speakers are underrepresented in sampling frames for research on immigrants access to healthcare in Canada.
The study’s purpose was: • To explore the experience of accessing healthcare for recently-arrived refugee women who were nonliterate and non-English-speaking. • To identify barriers to accessing and utilizing healthcare for this population. • To identify strategies that the population use to gain access to healthcare.
• Eight women interviewed: 3 Somali, 2 Liberian, 2 Eritrean, 1 Ethiopian • Ages likely between 20 and 38 years old • 2 living with husbands, 1 separated from husband by war, 5 single • 0-8 children living with them • In Canada 6 months to 3 years
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Qualitative design using descriptive phenomenology Third-party recruitment Interpreters used for six of eight participants Two in-depth, semi-structured interviews each Analyzed using Moustakas’ modification of Van Kaam’s method
Special thanks to: Interpreters- Jamila Ali, Nima Bolow and Gamachu Taha The VCH Research Challenge Team
Findings Dependence "A boy who's 10 years old took me there" Results in lack of choice and lack of autonomy. Isolation manifesting as: Rejection "So the first visit, she went by herself, there was no way that they can communicate with the doctor and the specialist called the clinic, said, "We can't communicate," so there was nothing done at that visit. And she has to wait seven months to get a new appointment." Confusion
Methods
Funding provided by the VCH Research Challenge- Paetzold Family Fund for Nurses in the community.
Sample
"Sometimes I didn't get to the place because my reading is not good. And everything you have to read to look, and it was difficult, yeah." Fear "It was frightening not knowing the language…I had no idea what they [healthcare workers] were talking about or what they were going to do to me."
Discussion and Implications for Practice • This study raises issues of whether we truly have equality of access to healthcare in Canada. • Social injustice and structural violence continue to be aspects of these women’s lives, despite their resettlement in Canada. • Understanding of the experiences of accessing healthcare from the perspective of these women can guide healthcare workers and policy makers in improving services for populations who lack literacy or English skills. • In particular, interpreter access should be a priority in all healthcare encounters
Shame "I'm just like someone they take from the bush because my problem, my mom had no money, we never have chance to go to school.”
Resourcefulness "So when you ask people all the time, "Help," they will hate you ... I don't want to wait until I reach that point. I have to know, by myself, where to go and direction. I have to figure out by myself."
Feeling cared for Any healthcare that we need, it was there for us.
Knowledge Translation • Manuscript being prepared for submission to an international journal • Abstract accepted at International Nursing Research Conference in Spain, November, 2014 • Information gathered from this study has been used to inform the Bridge Clinic program review committee and to aid in the procurement of a casual Somali-speaking nurse to aid low-literacy African families in obtaining family doctors in their home communities