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Aim: To explain the process taken by Chinese family care partners of older adults in the Greater Toronto Area, Canada, to access health and social services in their communities. The research question was: What mechanisms and structures impact the agency of Chinese family care partners of older adults, in the process of assisting them to access health and social services? Design: This qualitative study was informed by critical realism. Methods: Chinese family care partners of older adults in the Greater Toronto Area, Canada, were interviewed from August 2020 to June 2021. Transcripts underwent thematic analysis. Findings: Twenty-eight Chinese family care partners expressed a firm commitment to maintain caregiving conditions and to judiciously access health and social services. Their commitment was made up of three parts: (a) legislative and cultural norms of family, work, and society; (b) their perseverance to fill gaps with limited social and financial resources; (c) the quality of their relationship to, and illness trajectory of the older adults. The social structures created tension in how Chinese family care partners made decisions, negotiated resources, and ultimately monitored and coordinated timely access with older adults. Conclusion: Participants' commitment and perseverance were conceptualized as "grit," central to their agency to conform to legislative and cultural norms. Moreover, findings support grit's power to motivate and sustain family caregiving, in order for older adults to age in place as long as possible with finite resources. Implications for the profession: This study highlights the importance of cultural awareness education for nurses, enabling continuity of care at a systems level and for a more resilient healthcare system. Impact: Family care partners' grit may be crucial for nurses to harness when together, they face limited access to culturally appropriate health and social services in a system grounded in values of equity and inclusion, as in Canada. Reporting method: When writing this manuscript, we adhered to relevant EQUATOR guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or public involvement and engagement: No patient or public involvement. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study of the experiences of Portuguese-speaking immigrant women who used a mobile health clinic for their reproductive health care. Background. Upon arrival in Canada, immigrant women often are in better health than their Canadian-born counterparts; however, this health status tends to deteriorate over time. One reason for this change is limited access to services. Method. Data collection during 2004 and 2005 involved individual interviews with seven Portuguese-speaking women who received care in a mobile health clinic in Toronto, Canada, and with four clinic care providers. Non-participant observation of the interaction between clients and care providers was also conducted. Interviews conducted in Portuguese were translated into English and transcribed, along with those conducted in English. Interview transcripts were read and re-read in the context of observational notes to develop codes. Emerging codes were grouped together to develop subcategories and categories. Findings. Participants' experiences of accessing and receiving care in the mobile health clinic were shaped by their perceptions of health, which included physical, mental, social and spiritual aspects, and their pre- and postmigration care experiences. As an alternative model of care delivery, the mobile health clinic was perceived by participants to address their care needs and to help overcome postmigration barriers by providing accessible, holistic, and linguistically and culturally appropriate care. Conclusion. Mobile health clinics should be considered as an alternative care delivery model for immigrant women who may be at a disadvantage because of their socio-economic, cultural, and racialized statuses. [ABSTRACT FROM AUTHOR]

Research on intimate partner violence (IPV) across populations is challenging because of the multiplicity of definitions and lack of clarity about the behaviors that constitute IPV. The purpose of this study was to examine the ways in which Sri Lankan Tamil women in Toronto understand, define, and experience IPV. Focus group interviews were conducted with women representing different ages and stages of life. Findings suggest that definitions of IPV were not culturally specific. Rather, the Tamil women defined IPV broadly and recognized different forms of coercive control. However, psychologically abusive behaviors were identified that held particular meanings for this community. [ABSTRACT FROM AUTHOR]

This interpretive research analyses the discourse of nurses who migrated to Canada and experienced racism. They also experienced reprisals when they formally complained about racism in a context of denial of the problem of racism by colleagues and employers. The present work focuses on two issues arising from the data: the problem of how to make racism visible among those who have a vested interest in denying its existence and the emotional cool of those filing grievances or complaints in contrast with the hot reaction of those being challenged when racism is named. We introduce two theoretical perspectives to address these phenomena called democratic racism and cosmopolitan citizenship, respectively. The former, as defined by Henry et al. (The Colour of Democracy: Racism in Canadian Society. Harcourt Brace, Canada, Toronto, 1996), describes the coexistence of both democratic values and practices that discount people of colour advertently or inadvertently. We outline the notion of cosmopolitan citizenship that is argued by Turner (Politics of the Global City. Routledge, London, 2000) to be an orientation resulting from global microcosms in cities teeming with diversity. The characteristic orientations of cool and stewardship are useful for describing some of the discourse expressed by each participant in our study all of whom challenged racism practices, not on nationalistic grounds, but rather out of concern for universal human rights. Their characteristics qualify them for cosmopolitan citizenship under Turner's perspective. We suggest that anti-racist activists have been cosmopolitan citizens for decades and argue that while cosmopolitan citizenship may have taken root in neo-liberal movements, it appears to have tactical attributes in the struggle with democratic racism. In conclusion, we advocate for a cosmopolitan citizenship ethic to facilitate a rational move toward racial integration in the profession through the sharing of power and privilege. One goal in confronting racism is the accountability for whiteness: immunity from responsibility or apology. [ABSTRACT FROM AUTHOR]

The COVID pandemic brought to light the pressing issues of social isolation and loneliness for older adults. Immigrant older adults' experience of loneliness is even more exacerbated by factors, such as, language barriers, and the loss of cultural community. Key determinants of loneliness in older immigrants are not clear in the literature. A cross-sectional study was conducted in nine cities across Canada to: describe the experience of emotional, social and overall loneliness; and examine the determinants of loneliness among Punjabi, Mandarin, and Arabic-speaking older immigrants. A total of 647 older immigrants participated in the study. Descriptive statistics were used to describe their experience of loneliness, and multiple regression analysis was performed to examine the determinants of loneliness. Most participants had a post-secondary education, were married, and had been in Canada for about 16 years. On average, the participants reported good physical and mental health, and moderate levels of emotional, social, and overall loneliness. Ethnocultural group, emotional wellbeing, and depression were associated with emotional loneliness. Social loneliness was associated with education, depression, psychological distress, age, and ethnocultural group. Determinants of overall loneliness were age, gender, ethnocultural group, self-rated mental health, emotional wellbeing, depression, and psychological distress. Community based interventions that target these key factors must be designed to address loneliness experienced by older immigrants., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: This concept analysis aims to address the gap in knowledge regarding the concept of successful refugee cohabitation with host families. It seeks to develop a conceptual model that integrates holistic nursing and healthcare practices into refugee cohabitation settings to enhance refugee well-being. Methods: A comprehensive literature search was conducted using Walker and Avant's methodology for concept analysis. Findings: Successful refugee cohabitation with host families concept characterized by peaceful coexistence, power dynamics, hospitality, and cultural tolerance. Antecedents include refugee shelter needs, societal acceptance, humanitarian solidarity, and legal support. Consequences include refugee inclusion and integration, societal cohesion, psychological well-being, and refugee-host acceptance. Conclusions: Successful refugee cohabitation is defined as a private hosting arrangement that embodies shared living spaces and peaceful coexistence amid conflict or crises, fostering resilience and support for displaced individuals by local citizens. It combines hospitality, balanced power, and cultural tolerance, driven by refugee needs for shelter and a commitment to successful refugee settlement and integration. This hosting arrangement promotes societal development and cohesion, economic growth, psychological well-being, and foster inclusion and intergroup tolerance. The integration of holistic nursing principles into refugee cohabitation practices can foster more inclusive and healthy communities.

Background: The process of refugee resettlement and integration into new communities is a complex and multifaceted challenge, not only for the refugees themselves but also for the host families involved in homestay housing arrangements. While these homestay arrangements are designed to facilitate smoother transitions and enhance the well-being of refugees, the nuanced dynamics of these interactions and their overall impact on both refugees and their host families remain underexplored. Understanding the experiences of refugees and their host families is vital for effective refugee settlement, integration, and well-being. However, the intricacies of homestay refugee hosting, their interactions with host families, and the impact on their well-being are still unclear and ambiguous., Objective: The aim of this scoping review is to examine the breadth of literature on the experiences of refugees living in homestay arrangements with their host families. This review seeks to understand how these dynamics influence refugee well-being, including their integration, social connections, and mental health. Additionally, this scoping review aims to synthesize existing literature on homestay hosting dynamics, focusing on the experiences of refugees and their host families, to identify gaps in knowledge and suggest areas for future research., Methods: This scoping review follows Joanna Briggs Institute methodology and will search databases such as CINAHL, SOCIndex, MEDLINE through EBSCO; APA PsycInfo, Scopus through OVID; and Web of Science Core Collection, ProQuest Dissertations, and Theses, and SciELO Citation Index, focusing on literature from 2011 onward, in English, in relation to refugee groups in different host countries, including all types of literature. Literature will be screened by 2 independent reviewers, with disagreements resolved by consensus or a third reviewer. A custom data extraction tool will be created by the research team., Results: The results will be organized in tables or diagrams, accompanied by a narrative overview, emphasizing the main synthesized findings related to the dynamics of homestay hosting with host families and refugee well-being. No critical appraisal will be conducted. This scoping review is expected to identify research gaps that will inform the development of homestay refugee hosting models, policies, and practices. It will also offer insights into best practices and policy recommendations to improve homestay hosting programs, ultimately contributing to more effective refugee settlement and integration strategies., Conclusions: Understanding the intricate dynamics of homestay hosting arrangements is crucial for developing policies and programs that support the well-being of refugees and the families that host them. This scoping review will shed light on the current knowledge landscape, identify research gaps, and suggest ways to enhance the homestay hosting experience for all parties involved. Through this work, we aim to contribute to the development of more inclusive, supportive, and effective approaches to refugee hosting, resettlement, and integration., International Registered Report Identifier (irrid): DERR1-10.2196/56242., (©Areej Al-Hamad, Yasin M Yasin, Kateryna Metersky, Sepali Guruge, Khadija Mahsud. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.03.2024.)

Background: The three-month health insurance waiting period in Ontario reinforces health inequities for newcomer women and their babies. Little is known about the systemic factors that shape newcomer women's experiences during the OHIP waiting period., Purpose: To examine the factors that shaped newcomer women's experiences with perinatal care during the three-month health insurance waiting period in Ontario, Canada., Methods: This qualitative study was informed by an intersectional framework, and guided by a critical ethnographic method. Individual interviews were conducted with four newcomer women and three perinatal healthcare professionals. Participant observations at recruitment and interview sites were integral to the study design., Results: The key systemic factors that shaped newcomer women's experiences with perinatal care included social identity, migration, and the healthcare system. Social identities related to gender, race, and socio-economic status intersected to form a social location, which converged with newcomer women's experiences of social isolation and exclusion. These experiences, in turn, intersected with Ontario's problematic perinatal health services. Together, these factors form systems of oppression for newcomer women in the perinatal period., Conclusions: Given the health inequities that can result from these systems of oppression, it is important to adopt an upstream approach that is informed by the Human Rights Code of Ontario to improve accessibility to and the experiences of perinatal care for newcomer women.

Objective: In 2020, the World Health Organization reported that immigrants were the most vulnerable to contracting COVID, due to a confluence of personal and structural barriers. This study explored how immigrants and refugees experienced access to health and social services during the first wave of COVID-19 in Toronto, Canada., Methods: This study analyzed secondary data from a qualitative study that was conducted between May and September 2020 in Toronto that involved semi-structured interviews with 72 immigrants and refugees from 21 different countries. The secondary data analysis was informed by critical realism., Results: The vast majority of participants experienced fear and anxiety during the COVID-19 outbreak but through a combination of self-reliance and community support came to terms with the realities of the pandemic. Some even found the lifestyle changes engendered by the pandemic a positive experience., Conclusions: Self-reliance may hinder help-seeking and augment the threat of COVID-19. This is particularly a concern for the most vulnerable immigrants, who experience multiple disruptions in their health care, have limited material resources and social supports, and perhaps are still dealing with the challenges of settling in the new country.

Background: Although prevalent, limited knowledge is available on the experience of sleep problems (i.e., disturbance in sleep latency and in sleep maintenance) and their determinants in immigrant older adults., Purpose: To compare immigrant and Canadian-born older adults' experiences of: 1) sleep problems, 2) determinants of sleep problems, categorized into precipitating and perpetuating factors, and 3) determinants most significantly contributing to each sleep problem., Methods: Baseline data obtained by the comprehensive cohort of the Canadian Longitudinal Study on Aging were analyzed. Participants 55+ years of age and with complete data on their country of birth comprised the sample, with 18,245 Canadian-born and 4,257 immigrant older adults. Single or multiple items were used to assess the precipitating (chronic condition, sleep disorders, pain, depressive symptoms, psychological distress, education, marital and socio-economic status) and perpetuating (smoking, alcohol consumption, physical activity) factors. Chi-square test and independent sample t-test were used in the comparison and multiple regression was applied to determine the most significant determinant of each sleep problem in each group of older adults., Results: Despite differences in a few determinants of sleep problems, the set of factors contributing to disturbance in sleep latency and maintenance was comparable for Canadian-born and immigrant older adults, and included: having a sleep disorder and high level of depressive symptoms and psychological distress., Conclusion: The findings highlight the importance of public health campaigns to increase older adults' awareness of sleep problems, the factors that may contribute to disturbance in sleep, and strategies to prevent and/or manage sleep problems.

Ingestion of toxic trace elements in the human body has been considered one of the major reasons for renal dysfunction. Chronic kidney disease with uncertain etiological factors (CKDu) is a recently described clinical entity in which the disease is found in geographically isolated pockets in the dry zone of Sri Lanka. In CKDu regions, an increasing number of cases are reported with acute interstitial nephritis without any known reason (AINu). However, recent exposure to certain risk behaviors or nephrotoxins, or both, is suspected for the AINu. Consumption of foods that are contaminated with trace elements is one of the main pathways of human exposure to environmental toxins. The current study was carried out to assess the possibility of trace element-contaminated rice consumption on the etiopathogenesis of AINu. Samples of rice consumed by 32 clinically diagnosed AINu cases were collected and analyzed for possible nephrotoxic trace elements. Out of 32 patients, 26 were histologically confirmed with tubulointerstitial disease. The results revealed that the mean values of Cd, As, and Pb were 0.18, 0.055, and 0.135 mg/kg, with ranges of 0.020-1.06, 0.012-0.222, and 0.003-0.744 mg/kg (on dry weight basis), respectively. This study indicated that the investigated toxic trace element levels of rice consumed by AINu were reasonably below the recommended levels of the Codex Alimentarius Commission of FAO and WHO. Hence, it is less likely that rice consumption is to be a risk factor for the etiology of AINu., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Study Background: The aging population in Canada has been increasing steadily over the past 40 years, however, there is limited information about the meaning of aging well amongst older Brazilian women in Canada., Methods: A Heideggerian interpretive phenomenology study was conducted to understand the meaning of aging well amongst older Brazilian women in the post-migration context living in the Greater Toronto Area (GTA) in Ontario, Canada., Results: Eight older Brazilian women residing in the GTA were recruited through purposive and snowball sampling and participated in individual face-to-face interviews. Through data analysis and the incorporation of Heidegger's four existentials of human existence, the themes that emerged were (a) Embracing being part of a mosaic, (b) Aging with grace, (c) Chasing your dreams and (d) Being a bridge and not a fence. The overarching theme was: Finding the silver lining: Aging well., Conclusion: This study informs nursing practice, research and policy development to advance the health of older immigrant adults in Canada.

Objectives: Elder abuse is a significant concern worldwide. Several factors are reported to increase the risk for elder abuse, but little is known about which factors are most relevant to immigrant communities. This study explored perceptions of risk factors for elder abuse among older immigrants, which is the first step toward designing effective interventions., Methods: This cross-sectional quantitative study was conducted between 2017 and 2019 in the Greater Toronto Area, Ontario, Canada and involved a convenience sample ( N  = 173) of older women and men from Chinese, Korean, Punjabi, and Tamil immigrant communities. Participants completed a questionnaire about the frequency and importance of risk factors of elder abuse in their respective community. Descriptive statistics were used to analyze the data within each immigrant community and analysis of variance to compare the factor ratings across communities., Results: The immigrant communities differed ( p < .05) in their perception of the risk factors. Factors rated as frequent and important (x̅ > 2.0 - midpoint of the rating scale) were social isolation, financial dependence, and lack of knowledge of English for Korean; financial dependence, physical dependence, and emotional dependence for Chinese; lack of knowledge of English, emotional dependence, and physical dependence for Tamil; and social isolation for Punjabi., Conclusion: The findings highlight the need for collaboration among public health and social services to work with immigrant communities in co-designing interventions to address these key risk factors and thereby reduce the risk of elder abuse., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Mental illness stigma has detrimental effects on health and wellbeing. Approaches to address stigma in racialized populations in Western nations need to emphasize inclusivity, social justice, and sociocultural intersectionality of determinants of health. The current paper evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada. Participants received one of four group interventions: psychoeducation, Acceptance and Commitment Therapy (ACT), Contact-based Empowerment Education (CEE), and a combination of ACT+CEE. Self-report measures on stigma (CAMI, ISMI) and social change (SJS) were administered before and after the intervention. A total of 535 Asian men completed the interventions. Overall analyses found that all intervention approaches were successful in reducing stigma and promoting social change. Subscale differences suggest that CEE may be more broadly effective in reducing mental illness stigmatizing attitudes while ACT may be more specifically effective in reducing internalized stigma. More work needs to be done to elucidate mechanisms that contribute to socioculturally-informed mental illness stigma interventions for racialized communities and traditionally marginalized populations.

Parenting is a demanding undertaking, requiring continuous vigilance to ensure children's emotional, physical, and spiritual well-being. It has become even more challenging in the context of COVID-19 restrictions that have led to drastic changes in family life. Based on the results of a qualitative interpretive descriptive study that aimed to understand the experiences of immigrants living in apartment buildings in the Greater Toronto Area, Ontario, Canada, this paper reports the experiences of 50 immigrant parents. During the summer and fall of 2020, semi-structured interviews were conducted by phone or virtually, audio-recorded, then translated and transcribed. The transcripts were analyzed using thematic analysis. Results revealed that parenting experiences during the pandemic entailed dealing with changing relationships, coping with added burdens and pressures, living in persistent fear and anxiety, and rethinking lifestyles and habits. Amid these changes and challenges, some parents managed to create opportunities for their children to improve their diet, take a break from their rushed lives, get in touch with their cultural and linguistic backgrounds, and spend more quality time with their family. While immigrant parents exhibit remarkable resilience in dealing with the pandemic-related meso and macro-levels restrictions, funding and programs are urgently needed to support them in addressing the impact of these at the micro level., Competing Interests: Conflict of interest: All authors declare no conflicts of interest in this paper., (© 2021 the Author(s), licensee AIMS Press.)

ABSTRACTAging and immigration have significantly shaped the population composition in Canada, where immigrants make up increasingly large proportions of the older adult population. This scoping review examines the existing knowledge surrounding older immigrants' access to, and utilization of, primary care physicians, who play a pivotal role in the delivery of primary care, preventive care, and mental health care. We applied Arksey and O'Malley's five-stage framework to search databases for Canadian-based, peer-reviewed English-language articles on the topic and examined 31 articles in detail. Three focus areas emerged: access and utilization of primary care, health promotion and cancer screening, and utilization of mental health services. Older immigrants face intertwining access barriers related to health literacy, language, culture, health beliefs, spatial inequality, and structural circumstances. The review provides a thorough understanding of the status of access to care among older immigrants in Canada, and yields policy implications to address their unmet health needs.

Background: Older adults are the fastest growing age group worldwide and in Canada. Immigrants represent a significant proportion of older Canadians. Social isolation is common among older adults and has many negative consequences, including limited community and civic participation, increased income insecurity, and increased risk of elder abuse. Additional factors such as the social, cultural, and economic changes that accompany migration, language differences, racism, and ageism heighten older immigrants' vulnerability to social isolation., Objective: This mixed-methods sequential (qualitative-quantitative) study seeks to clarify older immigrants' social needs, networks, and support and how these shape their capacity, resilience, and independence in aging well in Ontario., Methods: Theoretically, our research is informed by an intersectionality perspective and an ecological model, allowing us to critically examine the complexity surrounding multiple dimensions of social identity (eg, gender and immigration) and how these interrelate at the micro (individual and family), meso (community), and macro (societal) levels in diverse geographical settings. Methodologically, the project is guided by a collaborative, community-based, mixed-methods approach to engaging a range of stakeholders in Toronto, Ottawa, Waterloo, and London in generating knowledge. The 4 settings were strategically chosen for their diversity in the level of urbanization, size of community, and the number of immigrants and immigrant-serving organizations. Interviews will be conducted in Arabic, Mandarin, and Spanish with older women, older men, family members, community leaders, and service providers. The study protocol has received ethics approval from the 4 participating universities., Results: Quantitative and qualitative data collection is ongoing. The project is funded by the Social Sciences and Humanities Council of Canada., Conclusions: Comparative analyses of qualitative and quantitative data within and across sites will provide insights about common and unique factors that contribute to the well-being of older immigrants in different regions of Ontario. Given the comprehensive approach to incorporating local knowledge and expert contributions from multilevel stakeholders, the empirical and theoretical findings will be highly relevant to our community partners, help facilitate practice change, and improve the well-being of older men and women in immigrant communities., International Registered Report Identifier (irrid): DERR1-10.2196/12616., (©Sepali Guruge, Souraya Sidani, Lu Wang, Bharati Sethi, Denise Spitzer, Margaret Walton-Roberts, Ilene Hyman. Originally published in JMIR Aging (http://aging.jmir.org), 04.03.2019.)

Introduction: Older adults are the fastest growing age group in Canada. Elder abuse has significant individual and societal implications, so it is critical to address. While interest in this topic is increasing, little is known about the risk factors for elder abuse in immigrant communities in Canada, or about culturally relevant strategies to address these risk factors., Methods and Analysis: This mixed-methods study is guided by the intersectionality and ecological frameworks. We will include two long-term (ie, established) and two recent immigrant communities from East Asian and South Asian communities in the Greater Toronto Area: Chinese, Korean, Punjabi and Tamil. Through structured group interviews, we will first identify factors that contribute to elder abuse within and across each of the immigrant communities and then explore culturally relevant strategies to address those risk factors. Group interviews will be conducted separately with five stakeholder groups in each of the four languages: older women, older men, family members, community leaders and service providers. Quantitative and qualitative data will be analysed at the level of the particular interview groups, subgroups and communities, and will be integrated across communities to identify common and unique risk factors and strategies to address elder abuse., Ethics and Dissemination: The study protocol has received ethics approval from the two universities associated with the research team. Given the comprehensive approach to incorporate local knowledge and expert contributions from multi-level stakeholders, the empirical and theoretical findings will facilitate practice change and improve the well-being of older men and women in immigrant communities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The higher prevalence of insomnia in women has been attributed to biological factors, which are less likely than cognitive and behavioral factors to play a role in perpetuating insomnia. Gender differences in perpetuating factors have not been extensively examined. This study compared men's and women's self-reports of factors that perpetuate insomnia; experience of symptoms, perceived severity and impact on daytime functioning; and use of strategies to manage insomnia. Data were collected at baseline, using reliable and valid measures, in a project that evaluated behavioral therapies for insomnia. The sample (N = 739) consisted of women (62.4%) and men (37.6%). Gender differences were found in: 1) perpetuating factors: men took more naps and held more unhelpful beliefs about insomnia, whereas women experienced higher pre-sleep arousal; 2) perception of insomnia severity: higher among women; 3) perceived impact of insomnia: higher fatigue among women; and 4) use of strategies (higher in women) to manage insomnia. Gender differences were of a small size but could be associated with women's stress, expression of somatic symptoms, and interest in maintaining their own health to meet multiple role demands., Competing Interests: Declaration of Interest: All authors report no conflict of interest.

Objective: Access to healthcare is an important part of the (re)settlement process for Syrian refugees in Canada. There is growing concern about the healthcare needs of the 54,560 Syrian refugees who were admitted to Canada by May 2018, 80% of whom are women and children. We explored the healthcare needs of newcomer Syrian women, their experiences in accessing and using health services, and the factors and conditions that shape whether and how they access and utilize health services in the Greater Toronto Area (GTA)., Method: This community-based qualitative descriptive interpretive study was informed by Yang & Hwang (2016) health service utilization framework. Focus group discussions were held with 58 Syrian newcomer women in the GTA. These discussions were conducted in Arabic, audio-recorded with participants' consent, translated into English and transcribed, and analyzed using thematic analysis., Results: Participants' health concerns included chronic, long-term conditions as well as new and emerging issues. Initial health insurance and coverage were enabling factors to access to services, while language and social disconnection were barriers. Other factors, such as beliefs about naturopathic medicine, settlement in suburban areas with limited public transportation, and lack of linguistically, culturally, and gender-appropriate services negatively affected access to and use of healthcare services., Conclusion: Responding to the healthcare needs of Syrian newcomer women in a timely and comprehensive manner requires coordinated, multi-sector initiatives that can address the financial, social, and structural barriers to their access and use of services., Competing Interests: This study has received approval from the Research Ethics Boards of Ryerson University and Women's College Hospital Toronto. Participants were informed that their participation in the study is voluntary, and they could choose whether to be in study or not. Prior to participating participants reviewed and signed informed consent in Arabic. The focus group moderator provided information on how to access suitable agencies and services as needed. Participants had the option to leave the group discussions at any time for any reason. If, after participation in a group discussion, participants decide they no longer wanted to be part of the study, they could choose to exclude data collected from them.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background:: Due to racism, xenophobic nationalism, acculturation pressures and patriarchal social relations, Asian men in Western societies may be particularly susceptible to negative experiences and beliefs regarding mental illness and treatment services., Aims:: We examine factors associated with stigma toward mental illness among Asian men in Canada., Methods:: Between 2013 and 2017, 428 self-identified Asian men living in proximity to Vancouver, Canada, were recruited and completed self-administered questionnaires assessing social stigma and self-stigma. The degree to which these variables were associated with the men's sociodemographic characteristics was analyzed., Results:: Multivariable regression revealed that social stigma was significantly predicted by age, immigration, employment status and experience with mental illness. Together, these variables accounted for 12.36% of variance in social stigma. Interaction terms were added to the regression models to examine whether the effects of immigration on social stigma varied by age and experience with mental illness, but none of the interaction terms were statistically significant. Among the 94 Asian men identified as living with mental illness, self-stigma was predicted by age, immigration and employment status, which together accounted for 14.97% of variance in self-stigma., Conclusion:: These results offer new knowledge about the factors predicting stigma toward mental illness among Asian men in Western societies.

Background: The available evidence on interventions addressing the stigma of mental illness is limited because of small samples, lack of diversity in study samples, and exclusion of people living with mental illness. To date, no published studies have evaluated anti-stigma interventions for Asian men in Canada. Aim This paper describes the protocol of a study to evaluate psychological and collective empowerment interventions (ACT, CEE, and ACT+CEE) in addressing self-stigma and social stigma in Asian communities in three urban settings in Canada: Toronto, Calgary and Vancouver. The study targets Asian men living with or affected by mental illness, and community leaders interested in stigma reduction and advocacy., Methods: Guided by a population health promotion framework and an ecological approach to health, the study will use a repeated measure design with mixed methods for data collection. In total, 2160 participants will be enrolled to detect moderate-to-large effect sizes, while accounting for possible attrition. Participants will be randomly assigned to one of three interventions or a control group, using a randomization matrix. Established measures will be used to collect outcome data at pretest, post-test, and 3 and 6 months follow-up, along with focus group discussions and monthly activity logs. Mixed linear models will compare participants' stigma, psychological flexibility, valued life domains, mindfulness, and empowerment readiness within and between groups., Discussion: The project will generate new knowledge on the applicability and effectiveness of evidence-based psychological and collective empowerment interventions (ACT, CEE, and ACT+CEE) in addressing stigma of mental illness and mobilizing community leadership., (Copyright © 2018 Elsevier Inc. All rights reserved.)

This article reviews the qualitative research on men's self-management of mental and physical chronic diseases, with emphasis on strategies for dealing with risks and promoting wellness. Using Bardin's method of document analysis, it was focused on the findings of Canadian qualitative studies published in French or English from 2005 to 2011. Boltanski's theory on social uses of the body inspired the analysis. Living with a chronic disease threatens men's sense of masculinity and self-image, as well as their perceived ability to fulfill expected social roles. Social images of men's bodies influence how men express their emotions, attributes, and attitudes, or acknowledge the need for and seek social affirmation. Self-management has been documented in Canadian qualitative literature as a complex phenomenon influenced by the social environment, personal capacities, feelings, perceptions, and potentials. The extent of how all these features interact within the scope of men's mental and physical health and illness experiences was partially revealed in this study. The findings underscore the social invisibility of men's bodies, especially those of men facing social inequities. Attending to principles of social justice can ensure that future research on men's health will amplify the range of men's voices and allow them to be heard. Recommendations address also the international scientific community interested in advancing men's health research, especially in those countries that lack a national men's health policy.

Stigma can have detrimental effects on the health and wellbeing of individuals living with a mental illness. This scoping review describes the nature, range, and extent of intervention research aimed at reducing public and self-stigma of mental illness in the Canadian context. The review was guided by Arksey and O'Malley's framework. A search of databases and relevant websites identified 35 primary studies. Most studies used quantitative research methods and included predominantly youth or middle-aged adults, women, and white Canadian-born people. Guided by different conceptualizations of stigma, direct or indirect contact, education, and advocacy-focused interventions, aimed to provide information, and/or develop skills to address self and public stigma. Most studies evaluated interventions' effectiveness short-term. Of the few studies that followed-up participants long-term, some were able to reduce stigmatizing attitudes post-intervention, however, these targeted only specific groups such as students or health care professionals. Lack of diversity among the samples, and limited evidence of long-term effectiveness of interventions, were some of the studies' limitations. What is currently known about interventions aimed at reducing the stigma of mental illness in the Canadian context is not informed by research among vulnerable groups, such as people living with a mental illness, older adults, immigrants, and people of diverse ethnic backgrounds. Interventions that are informed by clear conceptualizations of stigma and rigorously evaluated in a range of ethno-cultural groups would create a knowledge base that is useful for policy-makers, community leaders, and agencies serving various ethnic communities in Canada.

Background: Exposure to armed conflict and/or war have been linked to an increase in intimate partner violence (IPV) against women. A substantial body of work has focused on non-partner rape and sexual violence in war and post-war contexts, but research about IPV is limited, particularly in Asian settings. This paper presents the finding of a study conducted in the Eastern Province of Sri Lanka. The study explored women's experiences of and responses to IPV as well as how health and social service providers perceive the problem. It also explored the IPV-related services and supports available after the end of a 30-year civil war., Method: We conducted in-depth, qualitative interviews with 15 women who had experienced IPV and 15 service providers who were knowledgeable about IPV in the Eastern Province of Sri Lanka. Interviews were translated into English, coded and organized using NVivo8, and analyzed using inductive thematic analysis., Results: Participants described IPV as a widespread but hidden problem. Women had experienced various forms of abusive and controlling behaviours, some of which reflect the reality of living in the post-war context. The psychological effects of IPV were common, but were often attributed to war-related trauma. Some men used violence to control women and to reinstate power when their gender roles were reversed or challenged due to war and post-war changes in livelihoods. While some service providers perceived an increase in awareness about IPV and more services to address it, this was discordant with women's fears, feelings of oppression, and perception of a lack of redress from IPV within a highly militarized and ethnically-polarized society. Most women did not consider leaving an abusive relationship to be an option, due to realistic fears about their vulnerability to community violence, the widespread social norms that would cast them as outsiders, and the limited availability of related services and supports., Implications: These findings revealed the need for more research about IPV in post-war contexts. Women's experiences in such contexts are influenced and may be masked by a complex set of factors that intersect to produce IPV and entrap women in violence. A more nuanced understanding of the context-specific issues that shape women's experiences of IPV- and community responses to it-is needed to develop more comprehensive solutions that are relevant to the local context.

Objective: This study was conducted to understand the experiences of intimate partner violence among women from Portuguese-speaking countries living in the Greater Toronto Area., Method: A social phenomenological study was conducted with ten Portuguese-speaking women who had experienced intimate partner violence who were selected by community centre leaders. The interviews were transcribed, translated and analysed by categories., Results: The consequences of violence included health problems, effects on children, and negative feelings among the victims. Factors preventing the women from leaving abusive partners included religious beliefs, challenging daily jobs, and the need to take care of their husband. Factors that encouraged them to leave included getting support and calling the police. Some women expressed hope for the future either with their husband. Others, desired divorce or revenge. Their plans to rebuild their lives without their husband included being happy, learning English, and being financially stable., Conclusion: Using these findings can implicate in the improvement of care for these women.

Background: A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons' perception of teamwork, team members' roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting., Methods: Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork., Results: Interprofessional teamwork was characterized by low levels of interdependency and integration of work. The demarcation of roles and responsibilities for surgeons, nurses, and anesthetists appeared to be a strong element of interprofessional teamwork in this setting. Various relational factors, such as, professional power, hierarchy, and socialization, as well as contextual factors, such as, patriarchy and gender norms influenced interprofessional collaboration, and created barriers to communication between surgeons and nurses. Junior surgeons derived their understanding of appropriate practices mainly from observing senior surgeons, and there was a lack of formal training opportunities and motivation to develop non-technical skills that could improve interprofessional teamwork in operating rooms., Conclusions: A more nuanced view of interprofessional teamwork can highlight the different elements of such work suited for each specific setting. Understanding the relational and contextual factors related to and influencing interprofessional socialization and status hierarchies can help improve quality of teamwork, and the training and mentoring of junior members.

The purpose of this scoping review is to identify cardiovascular interventions that are designed to address the needs of immigrant women across North America and Europe. The articles retrieved were reviewed independently by both the first author and a trained research assistant. Although the search revealed many articles and resources related to supporting cardiovascular self-management behaviors among individuals, few focused on interventions designed for immigrant women who were diagnosed and living with cardiovascular disease. Also, it was difficult to determine the quality of the literature retrieved, as the main goal of this scoping review was to assess the body of literature and categorize materials by common themes and topics. A more in-depth structured systematic review is needed to determine the quality of evidence being presented and to serve as a rationale for the design and implementation of future culturally sensitive interventions delivered to immigrant women diagnosed with cardiovascular disease., (© The Author(s) 2016.)