Transcript Presentation - Canadian Public Health Association

“If They Tell Me To Get It, I’ll Get It,” Immigrant Mothers’ Immunization Decision-Making
by Stephanie Patricia Kowal1, Dr Cindy Jardine1, and Dr Tania Bubela1
1
School of Public Health, University of Alberta
Public Health 2014, May 27, 2014, Toronto, ON
Canada’s Foreign-Born Population
Proportion of Foreign-Born Population in Canada
millions
percentage
7
6
25%
20%
5
15%
4
3
10%
2
5%
1
0%
0
1901
1911 1921
1931 1941
1951
1961 1971
Census Year
Statistics Canada, censuses of population, 1901 to 2006.
1981
1986 1991
1996
2001
2006
Canada’s Foreign-Born Population
Foreign-Born Population in Edmonton, Alberta
Edmonton:
Alberta:
Canada:
Statistics Canada, censuses of population, 1901 to 2006.
22.9%
16.2%
19.8%
Immigrant Women as a Vulnerable Population
• Barriers to health systems
• Language
• Economic situations
• Pregnant Women
• Increased risk to infectious
disease
Health Protection through Vaccination
•
Disparities among children
•
Disparities among women
•
Varied experiences and what
this means as an immigrant?
Jenista, 2001; Meints & Chescheir, 2010;
McElroy et al., 2009
Health Protection through Vaccination
•
Disparities among children
•
Disparities among women
•
Varied experiences and
what this means as an
immigrant?
Jenista, 2001; Meints & Chescheir, 2010;
McElroy et al., 2009
Study Purpose
1) Understand decision
making processes
2) Assess information
needs
Research Questions
1) Vaccine knowledge learned from origin countries.
2) How that knowledge applied in Canada.
3) How to develop effective risk communication.
Methods
23 Qualitative Interviews
South Asia: n=8
China: n=10
Bhutanese Refugees: n=5
Sample: Participating Communities
1)
2)
3)
4)
China-, South Asia-, or Bhutan-born
Pregnant and/or have children under 8 years old
Immigrated to Canada in the last 8 years
Living in Edmonton, Alberta, Canada
Edmonton’s Foreign-Born Population
Immigrant Population Make-Up: Edmonton, Alberta
Other 8%
Filipino 11%
Chinese 28%
Arab 7%
Latin American 5%
Black 12%
South East Asian 6%
Statistics Canada, censuses of population, 1901 to 2006.
South Asian 23%
Interview Guide
• Previous vaccine experiences
• Comprehension of how vaccine technology and regulations
• Vaccine information access and use
Results - Passivity
I just walked into the medi-centre and did not have much
interaction with any doctor so I’m not really sure. Maybe if I had
a family doctor they would have suggested vaccines.
(South Asian Participant)
Results: Immunization Decision-Making Processes
I went to the doctor because I had a flu and I think because it
wasn’t necessary so that was why I was not advised to take it. I
didn’t ask. If my doctor tells me to take it, I will take it. But if my
doctor doesn’t then...
(Chinese Participant)
30
Results: Immunization Decision-Making Processes
They give it on paper, they give it on the phone once or twice at
the beginning. I just listen to what they have to say.
(South Asian Participant)
Results: Immunization Decision-Making Processes
I don’t know if the doctor will say [vaccination] is a must, but yes,
if the doctor says your should get it done, you should because
they are telling you for your own good.
(South Asian Participant)
Implications for Communication
Doctors’ Visits
Effective Information Delivery
Uptake of Recommendations
Implications for Communication
Back to H1N1
Implications for Communication
Example of Canadian Refugee Health Policies
Doctors’ Visits
Effective Information Delivery
Uptake of Recommendations
Must Account for Unique
Information
Gathering
and
Decision-Making
to
Build
Effective Communication
References
Jenista J. The Immigrant, Refugee, or Internationally Adopted Child. Pediatrics in Review.
2001; (22)12: 419-429.
McElroy R, Laskin M, Jiang D, Shah R, Ray J. Rates of Rubella Immunity Among Immigrant and
Non-Immigrant Pregnant Women. Journal of Obstetric Gynaecology Canada. 2009;
31(5): 409-413.
Meints L, Chescheir N. Screening for infectious diseases in pregnant, foreign-born women
from multiple global areas. Journal of Reproductive Medicine, 2010; 55(9-10): 382-6.
Statistics Canada (2006) Immigration and Citizenship Highlight Tables, 2006 Census. Available
at http://www12.statcan.ca/census-recensement/2006/dp-pd/hlt/97-557/Index-eng.cfm
Thank You!
Questions?
Acknowledgements
Multi-Cultural Health Brokers Cooperative:
Yvonne Chiu
Funders:
Shiva Chapagai
Research
• CIHR Master’s Award
Lydia Yip
Participants
• HQCA Summer Studentship
Hina Naushad
• WCHRI Qualitative Core Resource
Ravi Hansra
• WCHRI/CUP CBR Science Shop
Daljit Rupana
Translators
• WCHRI Graduate Studentship
Jian Wang
• SRA International Student Travel
Dr Amrita Mishra
Award
Contact Info: [email protected]
Chinese, Bhutanese, and
Indian Contexts
Similarities Among Differences