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Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants' vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life. [ABSTRACT FROM AUTHOR]

Objectives. This paper will explore the social history of the transnational migration of foreign-trained doctors to western countries in the post-WWII era, by examining, as a case study, South Asian-trained doctors who were first licensed in the Canadian province of Nova Scotia between 1961 and 1971.Design. This article draws on both quantitative and qualitative primary sources. First, we analyzed the 1966 and 1971 copies of the Canadian Medical Directories (CMD), the annual compendium of all licensed practitioners in the country (over 20,000 practitioners). These CMD entries were supplemented by the annual returns of ‘intended occupation’ (those designated as ‘physician’ or ‘surgeon’) of landed immigrants to Canada, as compiled by the federal Department of Manpower and Immigration. Secondly, we analyzed testimony of 26 oral histories and narrative accounts of foreign-trained doctors being compiled as part of an ongoing multiyear program of research on the immigration of foreign-trained doctors to Canada. We have interviewed 14 doctors who, at one point in their career, practiced in Nova Scotia, 8 of whom were South Asian-trained medical practitioners. These oral interviews provide personal reflections on the process of professional and social acculturation that occurred as these foreign doctors settled in Canada.Results.The results of this paper indicate that the social history of the immigration of South Asian-trained doctors to Canada in the 1960s must be seen within a larger and more complicated pattern of the international migration of health care professionals. Indeed, the demand for foreign-trained doctors in Britain was in part a reflection of the out-migration of British-born doctors who were leaving the National Health Service for Canada, the USA, and Australia. And the demand in Canada for doctors was itself a reaction to the drift of a certain number of Canadian-trained doctors for advanced training in the USA.Conclusions. In this way, this article sheds important historical perspectives on the globalization of health human resources and the complicated, multiple migrations that continue to animate international health human resources today. [ABSTRACT FROM AUTHOR]

This paper investigates wealth disparities among first-generation immigrants using data from the 2012 Survey of Financial Security. We apply logistic and linear regression models to estimate disparities in homeownership and household equivalent net worth by immigrant status, region of origin, and time since arrival. By focusing on immigrant families from different regions who entered Canada at different points in time, this research applies theories related to assimilation, human capital, and structural barriers to wealth. Our findings demonstrate that even though many immigrant families transition into homeownership and grow their wealth over time, certain first-generation immigrant groups continue to experience wealth disparities many years after their arrival to Canada. In particular, immigrant families from African, Asian, and Middle Eastern countries experienced the largest wealth gaps. [ABSTRACT FROM AUTHOR]

Background: Increasing immigration in the world today leads to more intercultural interactions. This is a particularly crucial fact in doctor-patient relationships, which often become more complex and suboptimal within an intercultural context. Since acculturation is a particularly important factor in this process, and the doctor-patient relationship is a key component in patient health outcomes, this study investigates the interrelation of individual immigrant acculturation orientations with the quality of the doctor-immigrant patient relationship, the patients' perceived quality of care, and how this relates to immigrant health behaviours and quality of life of the patients.Methods: 171 immigrant patients of various backgrounds participated in a paper and pencil questionnaire to assess the role of acculturation orientations (AO) on patients' perceived expectations of their doctor, perceived quality of care (PQOC), health behaviours and quality of life. Data were analyzed using ANOVA, regression and correlation procedures with SPSS statistical software.Results: Significant correlations were found between all AOs and measures of the participant feeling connected to the host or home culture, thereby verifying the measure of AO. All four AOs were significantly interrelated directly with the patient's perception of what the doctor expects of him/her, and the patients' quality of life. Patients' perceived expectations of their doctors were significantly related to the patients' PQOC, and PQOC was associated with improved health behaviours (adherence to doctor recommendations, physical activity maintenance self-efficacy).Conclusions: AO may be an important factor in the doctor-immigrant patient relationship, via a complex process involving the patients' perceptions of doctors' expectations and perceived quality of care. This has important implications, since such an understanding can be used to create interventions for both doctors and immigrant patients to learn about their own AO, how it can relate to the quality of their relationship, and ultimately, the quality of care, health and quality of life of the patient. [ABSTRACT FROM AUTHOR]

This paper examines the relationships between self-reported loneliness and living arrangements. A structured questionnaire with some open-ended questions was administered face-to-face in English, Hindi or Punjabi to a sample of 161 elderly South Asian immigrants 60 or more years of age living in Edmonton, Alberta, Canada in 2003. The majority of respondents said that they never felt lonely. More than one in three (37.3%) respondents indicated that they felt lonely occasionally, frequently or all of the time. Those living alone were significantly more likely to report feeling lonely at least occasionally than were those living with others, especially those living with their spouse in an extended family. The fact that South Asian immigrant seniors typically lived with others, often in an extended family with or without their spouse, and rarely lived alone protected them to some extent from loneliness. However, our findings showed that among those living with others, it was the amount of waking time spent alone at home and the quality of family relationships rather than living arrangement per se that significantly predicted self-reported loneliness. Nevertheless, living in a larger household was associated with spending less time alone. We discuss plausible influences of culture on expectations regarding family and social relationships and on the meaning of being alone, as well as practical implications for addressing loneliness in a multi-cultural society. [ABSTRACT FROM PUBLISHER]

Immigration presents a major life challenge, especially when the move is both geographical and across wide cultural divides. One of the areas of greatest challenge is in adjustments in gender and marital roles, perhaps because both of these are so close to the core of identity, self esteem, and sense of place in the world. This paper reports on research conducted with immigrants from Iran to Canada that examined how their experiences post-immigration affected their marital roles and relationship. Fifteen men and fifteen women who were born in Iran, immigrated to Canada, and were currently in heterosexual marriage or marriage- like relationships participated in in-depth interviews. Participants were well-educated, with none having less than 12 years of schooling and most having post-secondary training. Three highly imbricated areas of influence on their couple relationships emerged in the interviews: gender role adjustments, labour force difficulties, and changes in family structure. Consistent with the literature on immigrant adjustments, both men and women found each of these 3 posed challenges to their couple relationships. Men had difficulty accepting the freedom their wives had to dress, socialize and make decisions for themselves. Women also identified shortcomings to the "freedoms" they were afforded in Canada. The greatest challenge to men's identities as "good husbands" was their loss of the breadwinner role. Women and men both faced difficulties integrating into the Canadian labour force, with these difficulties leading some to express a desire to return to Iran. The loss of extended family support and social networking were linked to loneliness and absence of wise mediators to help with couple-conflicts, but were also described as contributing to greater mutuality and closeness in couples. Couples spoke of creating a new, bicultural, identity and lifestyle to counter the stresses and tensions of acculturation. [ABSTRACT FROM AUTHOR]

Ethno-racial minority families who come in contact with child protection services face unique challenges that include different ideas about appropriate child rearing practices, possibly different definitions of child maltreatment, the possibility of racial biases and service provision that does not address their particular needs. Ethno-racial minority immigrants encounter additional barriers to services associated with the challenges of settlement in a new cultural environment. Although considerable research has explored these issues, knowledge of the experiences of ethno-racial families who have been in contact with child protection is limited. The current paper provides insights from a qualitative study that explored the experiences of one ethno-racial group (South Asians) in Canada. Findings suggest a variety of reasons that families come into contact with the child protection system, and the characteristics of the sample highlight their difficult financial and employment circumstances. Themes include participants' desire to be better informed about the reasons for child protection involvement and about what they can expect from the worker and the agency. They also identified a wish for services that not only recognize their cultural diversity but also respond to the needs of the whole family. In-home services were especially appreciated. The findings reveal the resilience and personal agency among participants that can be enhanced through strength-based approaches to practice. Helping others, establishing community networks and developing needed services were avenues of resilience identified. [ABSTRACT FROM AUTHOR]

Abstract: Immigrants in Canada constitute approximately 20% of the total population and will continue to account for a significant portion of the country''s population in the future. Accordingly, a growing body of research has focused on examining the disparity in health status between the increasing foreign-born and the Canadian-born populations. The healthy immigrant effect, in particular, acknowledges that immigrants have better health status than their Canadian-born counterparts upon arrival in the country. However, studies have shown that over time the health of immigrants declines to a level on par with the Canadian-born population. There is much speculation as to the reasons for this decline including acculturation (i.e., uptake of unhealthy lifestyles) and a lack of access to health care. Yet, there have been few studies to examine possible reasons for potential declines in health, especially from the perspective of immigrants themselves. This study is one of the first to qualitatively examine perceived changes in health status and reasons for health status change among immigrants. The paper presents the results of 23 in-depth interviews with adults with recent (less than 3 years of residency), mid-term (3–10 years), and long-term (more than 10 years) immigrants living in the Greater Toronto Area. The results reveal that the majority of the participants believed their health had remained stable or even improved over time due to improved living standards and lifestyle behaviours in Canada. Those who perceived their health to have worsened over time attributed the change to the stress associated with migration, and the aging process rather than the adoption of an unhealthy lifestyle. Additionally, while the vast majority of participants reported improved access to resources upon migration, there were mixed reviews in terms of how beneficial these resources were or could be for health. The findings highlight the need for research to incorporate mental health into studies on changing immigrant health status and to focus on those factors contributing to high levels of stress among more recent immigrants. [Copyright &y& Elsevier]

Using Canada as an example, we examine the extent to which immigrants take on the ethnic identity of their host country, thus displaying either an assimilated, integrated, or neither assimilated nor integrated ethnic identity. We pay particular attention to the impact of economic integration, years since migration, ethnic origin and visible minority status on ethnic identity. Surprisingly, our findings reveal that indicators of economic success such as employment status, occupation and prior earnings do not have an impact on whether immigrants will assume the identity of their host society. The statistical analysis for this paper is situated within the existing acculturation literature. [ABSTRACT FROM AUTHOR]

To facilitate intercultural understanding by centralizing forced immigrant youths' voices in the knowledge development phase of a community-based participatory action research (CBPAR) project. The aim of this paper is to reveal the role of sport in forced immigrant youths' acculturative journeys in different communities. We utilized 'get-to-know-you' arts-based conversational interviews (m time = 38 min) held at the onset of a community-based participatory action research project. A polyphonic (i.e., multi-voiced) vignette is used to portray an interpretive account of the stories told by 22 refugee and asylum seeking (i.e., forced immigrant) youth (m age – 13.4 years) developed through a reflexive thematic analysis. The three-scene polyphonic vignette stories the role sport has played, and continues to play, in forced immigrant youths' life journeys. The opening scene brings to light stories related to home country sport involvement. The second scene depicts how sport was engaged in during their journey to their current host community. The third scene completes the story focusing on how youth engage in sport during resettlement in their host Canadian community. The meaning of sport, and what it means to be safe in sport, changes over the course of forced immigrant youths' acculturative journeys. Feeling safe in sport offers a unique opportunity for youth to feel a sense of sharing their acculturative journey with those around them. • We examined the role of sport during forced immigrant youths' acculturative journeys. • We (re-)present sport-related stories from pre--, during, and post-resettlement.. • The benefits of E−, ethno-centric, informal, and formal sport contexts are examined.. • We discuss how meaning attributed to safety and engagement in sport changes. • The sharing of cultural values through storytelling approaches is proposed.. [ABSTRACT FROM AUTHOR]