Health Equity

The Health Equity Area of Excellence (AoE) provides leadership in the creation of a community of scholars within the Faculty of Nursing that foster discourse and inquiry to examine issues related to social determinants of health as conditions for social advantage/ disadvantage and systematic disparities in health.
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  1. Parenting and Mental Health Promotion Practices of African Immigrants in Alberta [Download]

    Title: Parenting and Mental Health Promotion Practices of African Immigrants in Alberta
    Creator: Salami, Bukola
    Description: Parenting practices are known predictors of child health and social outcomes. Yet very little is known about the parenting practices of African immigrants in Canada and their impact on child health and wellbeing, including mental health. This dearth of knowledge exists despite widespread understanding that black and African immigrant children experience some of the poorest mental health outcomes in Canada. Funded by the M.S.I. Foundation, this project was designed and implemented in Alberta to address this paucity of knowledge. The population of African immigrants in Alberta is rapidly increasing; understanding their parenting practices and challenges is a crucial step towards supporting child health in this growing community. Following ethics approval from the University of Alberta Health Research Ethics Board, we conducted interviews and focus groups over a 12-month period with a purposive sample of 76 stakeholders from diverse social and professional backgrounds. These participants included 32 African immigrant parents, 14 community leaders, 12 service providers and policymakers, and 18 focus group participants of varying backgrounds. All interviews and focus groups were audio-recorded and transcribed verbatim prior to analysis. We employed a transnational feminist theoretical framework to aid our analysis and interpretation of the data. This theoretical lens allowed us to consider how culture, gender, race, class, and power converge to produce structural barriers to successful parenting among African immigrants. Our findings demonstrate how the pervasiveness of structural barriers affects access to income opportunities, parent–child relationships, parent–child communication, disciplinary practices, and support services. Our findings further demonstrate how these challenges and their multiple impacts on parenting practices, in turn, affect the mental, emotional, and material wellbeing of African immigrant children and their families. In this vein, we present policy recommendations that can help address some of the challenges identified, in particular the poor access to services. Some of our policy and practice recommendations include: (1) capitalizing on the strengths, resilience, and cultural values of African immigrant communities to engender successful parenting; (2) hiring African immigrants as service providers and policymakers to address cultural barriers to services; (3) addressing the social determinants of African immigrant child health, particularly income; (4) implementing mental health awareness programs in African immigrant communities; (5) improving access to culturally sensitive mental health and counselling services for immigrant families; and (6) providing pre-immigration counselling to families on the transitioning process, including on issues of child wellbeing. Implementation of these recommendations will transform institutional practices affecting African immigrant parenting and lead to improved child health and social outcomes.
    Subjects: Child health, Child wellbeing, Mental health, African immigrant communities, Policy and practice recommendations, Parenting practices
    Date Created: 2017/11
  2. African Immigrant Child & Family Well-Being in Alberta First Stakeholders Meeting Proceedings [Download]

    Title: African Immigrant Child & Family Well-Being in Alberta First Stakeholders Meeting Proceedings
    Creator: Salami, Bukola
    Description: Summary of Proceedings: In collaboration with partners and individuals from the African immigrant community, the Health and Immigration Policies and Practices (HiPP) Research Unit at the Faculty of Nursing, University of Alberta, convened a meeting of diverse stakeholders to deliberate on strategies to strengthen child and family wellbeing in the African immigrant community in Alberta. The meeting, which was the first of its kind in the province, brought together around 150 stakeholders from diverse backgrounds, including African immigrant parents, service providers, policymakers, and researchers. Funding for the event was provided by the M.S.I. Foundation, Kule Institute for Advanced Study, and the Women and Children Research Institute (WCHRI).
    Subjects: African immigrant communities, Family health, Family wellbeing, Child health, Child wellbeing, Mental health
    Date Created: 2017/08/12
  3. Migrant nurses and federal caregiver programs in Canada: Migration and health human resources paradox [Download]

    Title: Migrant nurses and federal caregiver programs in Canada: Migration and health human resources paradox
    Creator: Salami, B.
    Description: Despite the links between health human resources policy, immigration policy, and education policy, silos persist in the policy making process that complicate the professional integration of internationally educated nurses in Canada. Drawing on the literature on nurse migration to Canada through the Live-in Caregiver Program, this paper sheds light on the contradictions between immigration and health human resources policy and their effect on the integration of internationally educated nurses in Canada. The analysis reveals a series of paradoxes within and across immigration and health human resources policy that affect the process of professional integration of this group of health professionals into the nursing workforce in Canada. I will further link the discussion to the recently implemented Caregiver Program, which provides a unique pathway for healthcare workers, including nurses, to migrate to Canada. Given recent introduction of the Canadian Caregiver Program, major policy implications include the need to bridge the gap between health human resources policy and immigration policy to ensure the maximum integration of migrant nurses in Canada.
    Subjects: Health Human Resources, Home Caregivers, Internationally Educated Nurses, Immigration Policy, Migrant Caregivers, Nurse Migration
    Date Created: 2016
  4. Human resources for health challenges in Nigeria and nurse migration [Download]

    Title: Human resources for health challenges in Nigeria and nurse migration
    Creator: Salami, B.
    Description: The emigration of sub-Saharan African health professionals to developed Western nations is an aspect of increasing global mobility. This paper focuses on the human resources for health challenges in Nigeria and the emigration of nurses from Nigeria as the country faces mounting human resources for health challenges. Human resources for health issues in Nigeria contribute to poor population health in the country, alongside threats from terrorism, infectious disease outbreaks, and political corruption. Health inequities within Nigeria mirror the geographical disparities in human resources for health distribution and are worsened by the emigration of Nigerian nurses to developed countries such as the United States and the United Kingdom. Nigerian nurses are motivated to emigrate to work in healthier work environments, improve their economic prospects, and advance their careers. Like other migrant African nurses, they experience barriers to integration, including racism and discrimination, in receiving countries. We explore the factors and processes that shape this migration. Given the forces of globalization, source countries and destination countries must implement policies to more responsibly manage migration of nurses. This can be done by implementing measures to retain nurses, promote the return migration of expatriate nurses, and ensure the integration of migrant nurses upon arrival in destination countries.
    Subjects: Foreign-Trained Nurses, Immigrant Nurses, Human Resources for Health, Internationally Educated Nurses, Migration, Nigeria
    Date Created: 2016
  5. Interrogating the Impact of Recent Changes to the Temporary Foreign Worker Program on Temporary Foreign Workers in Alberta [Download]

    Title: Interrogating the Impact of Recent Changes to the Temporary Foreign Worker Program on Temporary Foreign Workers in Alberta
    Creator: Bukola Salami
    Description: Following a peak in the number of migrants admitted to Canada via its Temporary Foreign Worker Program, the program underwent significant changes in 2014 and 2015 that will undoubtedly affect the lives of temporary foreign workers in Canada. These changes include a limitation on the length of time temporary foreign workers are allowed to remain in the country, a greater distinction between high- and low-wage workers, and more restricted rights for low-wage workers. So far, the impacts of these recent policy changes on temporary foreign workers in Canada have not been the subject of much research. Thus, we sought to examine the impact of recent policy changes of the Temporary Foreign Worker Program on these migrants specifically in Alberta. Using a critical qualitative research methodology, we conducted three focus groups with thirty-five temporary foreign workers in Alberta. Interviews were transcribed verbatim and thematically analyzed with the aid of an NVivo qualitative data analysis software. Findings from the focus groups reveal that the recent changes to the Temporary Foreign Worker Program policy have created a burden for temporary foreign workers as well as their employers, intensified the exploitation of migrant workers, and contributed to a high level of anxiety and poor mental health status among these workers. This study has two major policy recommendations: (1) grant open work permits to temporary foreign workers, and (2) create pathways to citizenship for low-skilled temporary foreign workers in Alberta. The study also recognizes a need for future action research.
    Subjects: Temporary Foreign Workers, Migrant Workers, Foreign Workers, Migration
    Date Created: 2016/03/22
  6. Correctional nursing: A study protocol to develop an educational intervention to optimize nursing practice in a unique context. [Download]

    Title: Correctional nursing: A study protocol to develop an educational intervention to optimize nursing practice in a unique context.
    Creator: Almost, J.
    Description: Background Nurses are the primary healthcare providers in correctional facilities. A solid knowledge and expertise that includes the use of research evidence in clinical decision making is needed to optimize nursing practice and promote positive health outcomes within these settings. The institutional emphasis on custodial care within a heavily secured, regulated, and punitive environment presents unique contextual challenges for nursing practice. Subsequently, correctional nurses are not always able to obtain training or ongoing education that is required for broad scopes of practice. The purpose of the proposed study is to develop an educational intervention for correctional nurses to support the provision of evidence-informed care. Methods A two-phase mixed methods research design will be used. The setting will be three provincial correctional facilities. Phase one will focus on identifying nurses’ scope of practice and practice needs, describing work environment characteristics that support evidence-informed practice and developing the intervention. Semi-structured interviews will be completed with nurses and nurse managers. To facilitate priorities for the intervention, a Delphi process will be used to rank the learning needs identified by participants. Based on findings, an online intervention will be developed. Phase two will involve evaluating the acceptability and feasibility of the intervention to inform a future experimental design. Discussion The context of provincial correctional facilities presents unique challenges for nurses’ provision of care. This study will generate information to address practice and learning needs specific to correctional nurses. Interventions tailored to barriers and supports within specific contexts are important to enable nurses to provide evidence-informed care.
    Subjects: learning needs, education intervention, evidence-informed care, work environments, nursing, prisons
  7. Nurses Engagement in AIDS Policy Development. [Download]

    Title: Nurses Engagement in AIDS Policy Development.
    Creator: Richter, M.S.
    Description: Background: A multidisciplinary team of 20 researchers and research users from six countries – Canada, Jamaica, Barbados, Kenya, Uganda and South Africa – are collaborating on a 5-year (2007–12) program of research and capacity building project. This program of research situates nurses as leaders in building capacity and promotes collaborative action with other health professionals and decision-makers to improve health systems for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) nursing care. One of the projects within this program of research focused on the influence of workplace policies on nursing care for individuals and families living with HIV. Nurses are at the forefront of HIV prevention and AIDS care in these countries but have limited involvement in related policy decisions and development. In this paper, we present findings related to the barriers and facilitators for nurses’ engagement in policymaking. Methods: A participatory action research design guided the program of research. Purposive sampling was used to recruit 51 nurses (unit managers, clinic and healthcare managers, and senior nurse officers) for interviews. Findings: Participants expressed the urgent need to develop policies related to AIDS care. The need to raise awareness and to ‘protect’ not only the workers but also the patients were critical reason to develop policies. Nurses in all of the participating countries commented on their lack of involvement in policy development. Lack of communication from the top down and lack of information sharing were mentioned as barriers to participation in policy development. Resources were often not available to implement the policy requirement. Strong support from the management team is necessary to facilitate nurses involvement in policy development. Conclusions: The findings of this study clearly express the need for nurses and all other stakeholders to mobilize nurses’ involvement in policy development. Long-term and sustained actions are needed to address gaps on the education, research and practice level.
    Subjects: nurses, Jamaica, Uganda, facilitators, Canada, Kenya, South Africa, barriers, AIDS, policy development
  8. Confidentiality and treatment decisions of minor clients: a health professional’s dilemma & policy makerschallenge. [Download]

    Title: Confidentiality and treatment decisions of minor clients: a health professional’s dilemma & policy makerschallenge.
    Creator: Jackson, M. K.
    Description: Issues relating to confidentiality and consent for physical and mental health treatment with minor clients can pose challenges health care providers. Decisions need to be made regarding these issues despite the absence of clear, direct, or comprehensive policies and legislation. In order to fully understand the scope of this topic, a systemic review of several pieces of legislation and guidelines related to this topic are examined. These include the: Canadian Human Rights Act, Children’s Rights: International and National Laws and Practices, Health Information Act, Gillick Competence and Medical Emancipation, Freedom of Information and Protection of Privacy Act, Child, Youth and Family Enhancement Act, Common Law Mature Minor Doctrine, and Alberta Health Services Consent to Treatment/Practice(s) Minor/Mature Minor. In order to assist health professionals with decisions regarding confidentiality and treatment with minor clients a case study and guide for decision-making is also presented.
    Subjects: decision making, policy, systematic reviews, confidentiality
    Date Created: 2014
  9. Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case–control study [Download]

    Title: Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case–control study
    Creator: Heaman, Maureen I.
    Description: Background: The reasons why women do not obtain prenatal care even when it is available and accessible are complex. Despite Canada’s universally funded health care system, use of prenatal care varies widely across neighborhoods in Winnipeg, Manitoba, with the highest rates of inadequate prenatal care found in eight inner-city neighborhoods. The purpose of this study was to identify barriers, motivators and facilitators related to use of prenatal care among women living in these inner-city neighborhoods. Methods: We conducted a case–control study with 202 cases (inadequate prenatal care) and 406 controls (adequate prenatal care), frequency matched 1:2 by neighborhood. Women were recruited during their postpartum hospital stay, and were interviewed using a structured questionnaire. Stratified analyses of barriers and motivators associated with inadequate prenatal care were conducted, and the Mantel-Haenszel common odds ratio (OR) was reported when the results were homogeneous across neighborhoods. Chi square analysis was used to test for differences in proportions of cases and controls reporting facilitators that would have helped them get more prenatal care. Results: Of the 39 barriers assessed, 35 significantly increased the odds of inadequate prenatal care for inner-city women. Psychosocial issues that increased the likelihood of inadequate prenatal care included being under stress, having family problems, feeling depressed, “not thinking straight”, and being worried that the baby would be apprehended by the child welfare agency. Structural barriers included not knowing where to get prenatal care, having a long wait to get an appointment, and having problems with child care or transportation. Attitudinal barriers included not planning or knowing about the pregnancy, thinking of having an abortion, and believing they did not need prenatal care. Of the 10 motivators assessed, four had a protective effect, such as the desire to learn how to protect one’s health. Receiving incentives and getting help with transportation and child care would have facilitated women’s attendance at prenatal care visits. Conclusions: Several psychosocial, attitudinal, economic and structural barriers increased the likelihood of inadequate prenatal care for women living in socioeconomically disadvantaged neighborhoods. Removing barriers to prenatal care and capitalizing on factors that motivate and facilitate women to seek prenatal care despite the challenges of their personal circumstances may help improve use of prenatal care by inner-city women.
    Subjects: Access to care, Motivators, Prenatal care, Pregnancy, Health care utilization, Barriers, Facilitators, Inner-city women
    Date Created: 2014/10/20
  10. Researching ethnic inequalities. [Download]

    Title: Researching ethnic inequalities.
    Creator: Salway, S.
    Subjects: ethnicity, social research, health equity
    Date Created: 2009