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Gina Higginbottom

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Gina's research portfolio focuses on ethnic minority populations and immigrant health using participatory models of research. She has a particular focus on the broad issue of social exclusion and equity in health care, lay understandings of health and illness (including traditional medicines), chronic disease management in primary care (hypertension and diabetes), self-care strategies, the cultural congruence of primary health care services, access and utilization of primary health care services, ethnic and cultural diversity in care giving. A second theme in her research portfolio has focused on maternal health and well being including parenting issues, early parenthood and postnatal depression in different ethnic minority groups. Her research has included collaborations with researchers in the UK, Sweden, Spain, Germany and other EU nation states. She supervises graduate students in Canada, England and Sweden. Gina leads an international team of researchers and postdoctoral fellows in the Faculty of Nursing at the University of Alberta.

Gina Higginbottom

Ethnicity and Health Collaborative Research Program

Tel: 1.780.492.6761
Fax: 1.780.492.2551

  • Associate Professor
  • Canada Research Chair

  • - 20 years clinical experience
  • - Nurse
  • - Midwife
  • - Health visitor
  • - Affiliated Associate Professor of Nursing at the Karolinska Institute, Stockholm, Sweden
  • - Visiting Professor at Sheffield Hallam University
  • - Assistant Editor of Ethnicity and Health journal
  • - Chair/co-Chair of the 2008-2010th IIQM Advances in Qualitative Methods conference in Vancouver
  • - Member of the ICCHNR International Executive group

  • - Mary Seacole Leadership Award in 1997
  • - National Primary Care Fellowship in 2000 to support her doctoral studies (the first health visitor to receive this award)

Subject areas and related deposits

  • African-origin populations

    • Contributions and challenges of cross-national comparative research in migration, ethnicity and health: insights from a preliminary study of maternal health in Germany, Canada and the UK

      Background: Public health researchers are increasingly encouraged to establish international collaborations and to undertake cross-national comparative studies. To-date relatively few such studies have addressed migration, ethnicity and health, but their number is growing. While it is clear that divergent approaches to such comparative research are emerging, public health researchers have not so far given considered attention to the opportunities and challenges presented by such work. This paper contributes to this debate by drawing on the experience of a recent study focused on maternal health in Canada, Germany and the UK. Discussion: The paper highlights various ways in which cross-national comparative research can potentially enhance the rigour and utility of research into migration, ethnicity and health, including by: forcing researchers to engage in both ideological and methodological critical reflexivity; raising awareness of the socially and historically embedded nature of concepts, methods and generated 'knowledge'; increasing appreciation of the need to situate analyses of health within the wider socio-political setting; helping researchers (and research users) to see familiar issues from new perspectives and find innovative solutions; encouraging researchers to move beyond fixed 'groups' and 'categories' to look at processes of identification, inclusion and exclusion; promoting a multi-level analysis of local, national and global influences on migrant/minority health; and enabling conceptual and methodological development through the exchange of ideas and experience between diverse research teams. At the same time, the paper alerts researchers to potential downsides, including: significant challenges to developing conceptual frameworks that are meaningful across contexts; a tendency to reify concepts and essentialise migrant/minority 'groups' in an effort to harmonize across countries; a danger that analyses are superficial, being restricted to independent country descriptions rather than generating integrated insights; difficulties of balancing the need for meaningful findings at country level and more holistic products; and increased logistical complexity and costs. Summary: In view of these pros and cons, the paper encourages researchers to reflect more on the rationale for, feasibility and likely contribution of proposed cross-national comparative research that engages with migration, ethnicity and health and suggests some principles that could support such reflection.

  • Alienation

    • The mediating role of alienation in self-reported health among Swedish adolescents

      The purpose of this study was to investigate the relationship between a sense of alienation and self reported health. A sample consisting of a total of 446 high school students aged 15-19 (Mean age = 16.95, SD = 1.01, Female = 59%), with a participation rate of 91%. The Jessor and Jessor alienation scale and the Nottingham Health Profile of self reported health were used to gather data. To analyze the relationship between sense of alienation and self reported health, a path model was created and tested using structural equation modeling. The results suggest that sense of alienation is importantly related to the domain of self-reported health. The alienation variable mediates between mental health (energy level, sleep and emotional reaction) and physical health (pain pain and physical mobility).

  • ATLAS.ti software

  • Birth outcomes

    • Food choices and practices during pregnancy of immigrant and Aboriginal women in Canada: a study protocol

      Background: Facilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the women's ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners. Methods/Design: This four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2) with semi-structured photo-elicited interviews (in Phase 3). The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the city's most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge translation plan has been formulated. Discussion: The findings of this study will provide practitioners with an understanding of the cultural differences that affect women's dietary choices during maternity. We expect that the developed resources will be of immediate use within the women's units and will enhance counseling efforts. Wide dissemination of outputs may have a greater long term impact in the primary and secondary prevention of these high risk conditions.

  • Ethnicity

    • Ethnicity, policy and teenage parenthood in England: Findings from a qualitative study

      Ethnicity and racialised identity have been salient themes in USA research and policy on teenage parenthood, in contrast with the UK context. This article presents findings from interviews with professionals in support services for young parents, with three main conclusions. Firstly, appropriate data collection systems are not in place to establish whether minority young parents face specific barriers in accessing services. Secondly, professionals’ accounts converge with young parents’ accounts, emphasising age rather than ethnicity as shaping patterns of identification and stigmatisation. Lastly, professional ‘ecologies of practice’ exist in some tension with the homogenising emphasis of UK national policy discourses.

  • Ethnography

    • Guidance on performing focused ethnographies with an emphasis on healthcare research.

      Focused ethnographies can have meaningful and useful application in primary care, community, or hospital healthcare practice, and are often used to determine ways to improve care and care processes. They can be pragmatic and efficient ways to capture data on a specific topic of importance to individual clinicians or clinical specialties. While many examples of focused ethnographies are available in the literature, there is a limited availability of guidance documents for conducting this research. This paper defines focused ethnographies, locates them within the ethnographic genre, justifies their use in healthcare research, and outlines the methodological processes including those related to sampling, data collection and maintaining rigour. It also identifies and provides a summary of some recent focused ethnographies conducted in healthcare research. While the emphasis is placed on healthcare research, focused ethnographies can be applicable to any discipline whenever there is a desire to explore specific cultural perspectives held by sub-groups of people within a context-specific and problem-focused framework.

  • FamCHAT, cultural competence, hospital, nursing assessment

    • Does the FamCHAT Tool Enhance the Ethno-Cultural Dimensions of Nursing Assessment at the Royal Alexandra Hospital (RAH)?

      The RAH is located in one of Edmonton’s most ethnoculturally diverse neighbourhoods. Their interpretive service responds to >800 requests annually for > 30 languages. RAH staff requested identification and evaluation of a culturally-sensitive assessment tool suitable for enhancing nursing assessments. Identification of cultural needs is crucial during diagnosis, treatment and management of a health event, and for building and sustaining a positive provider-client relationship. Without culturally appropriate care, a negative trajectory of events may ensue ranging from simple miscommunication to life-threatening incidents. Numerous cultural assessment tools and models have been developed since the 1950’s, often based on the work by seminal theorist Leininger. The Family Cultural Heritage Assessment Tool (FamCHAT) was developed for use in primary care settings and has been empirically tested, although not in a hospital setting. After an integrative review, we consider the FamCHAT to be succinct, user-friendly, and having underpinning principles with high pertinence and transferability to acute/hospital settings.

  • Grey literature

  • Health equity

  • Immigrant

  • Immigrant women

    • Optimizing hospital and community based maternity care for immigrant and minority women in Alberta

      Alberta is a popular Canadian destination for new immigrants, including childbearing families. Although evidence suggests that immigrant women can have difficulty utilizing maternity care services, researchers have little knowledge of how factors such as ethnic group, English-language skills, cultural norms, or pre-migration histories intersect and influence maternal outcomes. Our overarching research question is how can we reduce or eliminate the disparity experienced by immigrant women in accessing and navigating maternity care services? To this end, the study highlights the perspectives of the women themselves, health professionals, policy makers and key stakeholders. We conducted a focused ethnography conducting focus group and individual interviews with 22 immigrant newcomer women (self-assigned ethnicities of Sudanese, Chinese, South Asian, Columbian, Tajikistan), 15 health care professionals and 7 policy makers and social services providers. Data was analyzed with the aid of ATLAS.ti qualitative data analysis software and guided by Roper and Shapira’s analysis framework. Preliminary themes include lack of choice, navigation of the system, transportation, expensive medication, engagement with care providers, interactions within the healthcare system, issues with interpreters, cultural norms, and racial profiling and stereotyping. Although often satisfied with the medical aspects of their maternity care, the lack of antenatal and postpartum social support tended to negatively colour the immigrant women’s experiences. Many of the resettlement issues (e.g. social isolation and depression) noted by social services providers intersect to produce negative maternal outcomes. For optimal maternal health of immigrant women, targeted interventions to improve maternal outcomes must involve input from health care professionals, social service providers and immigrant communities.

  • Immigrants

  • Immigration

    • Optimizing Health Literacy and Community Engagement in Relation to Active Living with Edmonton’s Newcomer Young People and their Families

      Canada is a multicultural country where immigration plays an important role in population growth and the country’s economy. Despite this, some newcomers such as those who hold refugee status, experience greater ill-health than the general population. Moreover, many immigrants and refugees (both considered newcomers) may not have sufficient health literacy. Our purpose was to obtain an understanding of health literacy and active living amongst young newcomers, and of factors that promote engagement of newcomer families in active living and healthy eating. We utilized a mixed methodological approach using a systematic review, a quality-of-life tool, photovoice, and interviews. Photo-assisted focus group interviews were employed with 36 youth, representing 22 ethnocultural backgrounds, while they attended summer leadership programs provided by the public school board and community/ ethnocultural organizations. Nineteen of the youth’s parents were interviewed individually. Roper and Shapira’s framework guided qualitative data analysis and ATLAS.ti software was utilized. Immigrant and refugee families experience barriers to participation in recreational activities due to i) financial and time constraints, ii) lack of transportation, iii) cultural differences in perceptions of active living, and iv) experiences of discrimination/racism in public recreational facilities. While many families take initiative to contact available organizations to obtain information, many cannot easily access Canadian health literacy information due to lack of awareness of resources, language barriers, and limited social and institutional networks. Perceptions of what constitutes health literacy are culture specific and newcomers typically undergo an acculturation process towards understanding Canadian standards of health literacy.

  • Intercultural communication

    • Sociocultural and linguistic boundaries influencing intercultural communication between nurses and Moroccan patients in southern Spain: A focused ethnography.

      Background During the last 25 years, cultural diversity has increased substantially with global migration. In more recent years this has become highly evident in the south of Spain with its steadily increasing Moroccan population. The accompanying differences in ethnocultural values and traditions between the host and newcomer populations may greatly impact healthcare interactions and thus also effective provision of care. This landscape provides for excellent exploration of intercultural communication in healthcare settings and elucidation of possible ways to overcome existing barriers to provision of culturally competent care by nurses. This study aimed to ascertain how nurses perceive their intercultural communication with Moroccan patients and what barriers are evident which may be preventing effective communication and care. Methods A focused ethnography was conducted with semi-structured interviews of 32 nurses in three public hospitals in southern Spain. Interviews were audio-recorded and transcribed verbatim before undergoing translation and back-translation between Spanish and English. Data was managed, classified and ordered with the aid of AQUAD.6 (Günter L. Huber, Tübingen, Germany) qualitative data analysis software. Results As an important dimension of cultural competence, findings from the interviews with nurses in this study were interpreted within the framework of intercultural communication. Various barriers, for which we have termed “boundaries”, seem to exist preventing effective communication between nurses and their patients. The substantial language barrier seems to negatively affect communication. Relations between the nurses and their Moroccan patients are also marked by prejudices and social stereotypes which likely compromise the provision of culturally appropriate care. Conclusions The language barrier may compromise nursing care delivery and could be readily overcome by implementation of professional interpretation within the hospital settings. Moreover, it is essential that the nurses of southern Spain are educated in the provision of culturally appropriate and sensitive care.

  • International nursing

  • Maternity services

    • Navigating maternity health care: A survey of the Canadian prairie newcomer experience.

      Background Immigration to Canada has significantly increased in recent years, particularly in the Prairie Provinces. There is evidence that pregnant newcomer women often encounter challenges when attempting to navigate the health system. Our aim was to explore newcomer women’s experiences in Canada regarding pregnancy, delivery and postpartum care and to assess the degree to which Canada provides equitable access to pregnancy and delivery services. Methods Data were obtained from the Canadian Maternity Experiences Survey. Women (N = 6,241) participated in structured computer-assisted telephone interviews. Women from Alberta, Saskatchewan and Manitoba were included in this analysis. A total of 140 newcomers (arriving in Canada after 1996) and 1137 Canadian-born women met inclusion criteria. Results Newcomers were more likely to be university graduates, but had lower incomes than Canadian-born women. No differences were found in newcomer ability to access acceptable prenatal care, although fewer received information regarding emotional and physical changes during pregnancy. Rates of C-sections were higher for newcomers than Canadian-born women (36.1% vs. 24.7%, p = 0.02). Newcomers were also more likely to be placed in stirrups for birth and have an assisted birth. Conclusion Although newcomers residing in Prairie Provinces receive adequate maternity care, improvements are needed with respect to provision of information related to postpartum depression and informed choice around the need for C-sections.

  • Meta-ethnography

  • Minorities

    • Migration, minorities and maternity services: a three-country comparison

      A study project group from Germany, Canada, and the United Kingdom undertook a range of activities to scope out and compare in a holistic manner the experience of migration and maternity in the three countries. Emphasis was placed on examining how migration and consequent diversity have been problematized and responded to within respective health care systems.

  • Narrative synthesis

    • Immigrant women's experiences of postpartum depression in Canada: A protocol for systematic review using a narrative synthesis.

      Background Literature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women. There exists a need to synthesize information on the contextual factors and social determinants of health that influence immigrant women’s reception of and behavior in accessing existing mental health services. Our research question is: what are the ethnoculturally defined patterns of help-seeking behaviors and decision-making and other predictive factors for therapeutic mental health care access and outcomes with respect to postpartum depression for immigrant women in Canada? Methods/design Our synthesis incorporates a systematic review using narrative synthesis of reports (peer- and non-peer reviewed) of empirical research and aims to provide stakeholders with perspectives on postpartum mental health care services as experienced by immigrant women. To reach this goal we are using integrated knowledge translation, thus partnering with key stakeholders throughout the planning, implementation and dissemination stages to ensure topic relevancy and impact on future practice and policy. The search and selection strategies draw upon established systematic review methodologies as outlined by the Centre for Reviews and Dissemination and also incorporate guidelines for selection and appraisal of gray literature. Two search phases (a database and a gray literature phase) will identify literature for screening and final selection based on an inclusion/exclusion checklist. Quality appraisal will be performed using the tools produced by the Centre for Evidence Based Management. The narrative synthesis will be informed by Popay et al. (2006) framework using identified tools for each of its four elements. The integrated knowledge translation plan will ensure key messages are delivered in an audience-specific manner to optimize their impact on policy and practice change throughout health service, public health, immigration and community sectors. Discussion The narrative synthesis methodology will facilitate understandings and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socio-economic status, pre-migration history and geographical location. Our review aims to have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the context of postpartum mental health of immigrant women.

    • Immigrant Women’s Experiences of Maternity Care Services in Canada: A Narrative Synthesis

      Difficulties can exist for immigrant women when accessing and navigating health and maternity care services. Our research question is what are the experiences of immigrant women in Canada accessing maternity care services? Focus will be placed on, a) accessibility and acceptability as experienced by immigrant women, and b) birth and postnatal outcomes. We are conducting a systematic review using a narrative synthesis approach which synthesizes qualitative, quantitative and mixed-method research. Integrated knowledge translation is central to this project, thus we are partnering with key stakeholders to ensure topic relevancy and to tailor recommendations for effective translation into future policy and practice/programming. Two search phases (including electronic database and grey literature searching) and a three-staged selection process have been conducted. Articles will be assessed for quality by two reviewers. The narrative synthesis will be informed by Popay et al’s (2006) approach which relies primarily on words/text to summarize and explain findings, and incorporates four elements: a) developing a theory of why and for whom, b) developing a preliminary synthesis (textual description, tabulation, grouping/clustering), c) exploring relationships in the data (thematic analysis, ideas webbing, concept mapping), and d) assessing the robustness of the synthesis (weight of evidence, critical reflection). We will be utilizing Atlas.ti software for managing the articles and synthesizing the findings. Article selection is complete and preliminary findings will be shared. Carefully interpreted findings will allow for knowledge users within multiple sectors to strategically enhance maternity care services and professional development, to ensure provision of culturally congruent maternity care.

  • Narrative systhesis

    • Immigrant women's experiences of maternity-care services in Canada: a protocol for systematic review using a narrative synthesis

      Background: Canada’s diverse society and statutory commitment to multiculturalism means that the synthesis of knowledge related to the health care experiences of immigrants is essential to realize the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for tailoring of services to user needs. We are therefore assessing the experiences of immigrant women in Canada accessing maternity-care services. We are focusing on: 1) accessibility and acceptability (as an important dimension of access) to maternity-care services as perceived and experienced by immigrant women, and 2) the birth and postnatal outcomes of these women. Methods: The aim of this study is to use a narrative synthesis, incorporating both a systematic review using narrative synthesis of reports of empirical research (qualitative, quantitative, and mixed-method designs), and a literature review of non-empirically based reports, both of which include ‘grey’ literature. The study aims to provide stakeholders with perspectives on maternity-care services as experienced by immigrant women. To achieve this, we are using integrated knowledge translation, partnering with key stakeholders to ensure topic relevancy and to tailor recommendations for effective translation into future policy and practice/programming. Two search phases and a three-stage selection process are being conducted (database search retrieved 1487 hits excluding duplicates) to provide evidence to contribute jointly to both the narrative synthesis and the non-empirical literature review. The narrative synthesis will be informed by the previous framework published in 2006 by Popay et al., using identified tools for each of its four elements. The non-empirical literature review will build upon the narrative-synthesis findings and/or identify omissions or gaps in the empirical research literature. The integrated knowledge translation plan will ensure that key messages are delivered in an audience-specific manner to optimize their effect on policy and practice change throughout the health service, and the public health, immigration and community sectors. Discussion: Narrative-synthesis methods of systematic review facilitate understanding and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socioeconomic status, and geographical location. They also enable understanding of the shaping of differences between reported outcomes and study designs related to childbearing populations, and the development and implementation of maternity services and health interventions across diverse settings.

  • Nursing

    • Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethnocultural groups: an integrative review of the literature

      Background: High income nations are currently exhibiting increasing ethno-cultural diversity which may present challenges for nursing practice. We performed an integrative review of literature published in North America and Europe between 1990 and 2007, to map the state of knowledge and to identify nursing assessment tools/models which are have an associated research or empirical perspective in relation to ethno-cultural dimensions of nursing care. Methods: Data was retrieved from a wide variety of sources, including key electronic bibliographic databases covering research in biomedical fields, nursing and allied health, and culture, e.g. CINAHL, MEDline, PUBmed, Cochrane library, PsycINFO, Web of Science, and HAPI. We used the Critical Appraisal Skills Programme tools for quality assessment. We applied Torraco’s definition and method of an integrative review that aims to create new knowledge and perspectives on a given phenomena. To add methodological rigor with respect to the search strategy and other key review components we also used the principles established by the Centre for Reviews and Dissemination. Results: Thirteen thousand and thirteen articles were retrieved, from which 53 full papers were assessed for inclusion. Eight papers met the inclusion criteria, describing research on a total of eight ethno-cultural assessment tools/models. The tools/models are described and synthesized. Conclusions: While many ethno-cultural assessment tools exist to guide nursing practice, few are informed by research perspectives. An increased focus on the efficiency and effectiveness of health services, patient safety, and risk management, means that provision of culturally responsive and competent health services will inevitably become paramount.

  • Nursing assessment

    • Evaluating the utility of the FamCHAT ethnocultural nursing assessment tool at a Canadian tertiary care hospital: a pilot study with recommendations for hospital management

      Objectives: The multicultural nature of Canadian society and the decline in health of immigrants after relocation to Canada prioritizes a commitment to ensure equity in health care access and outcomes. An important feature shaping health care access and outcomes is the reception of culturally safe and competent care. Partnering with senior management at a tertiary care hospital, this pilot study aimed to investigate whether an identified cultural assessment tool, the Family Cultural Heritage Assessment Tool (FamCHAT), validated for use in a rural primary care setting, was suitable for use in tertiary care. The objectives were to investigate: 1) whether using the FamCHAT enabled the nurses to elicit assessment information from their patients who represent diverse ethnocultural groups, and 2) the nurses’ perspectives on the practical use of this form in their clinical practice. Methods: Nurses purposively selected from the Women’s, Surgery and Medicine units were asked to complete the FamCHAT form with all patients admitted during a three-month period in 2009. Focus group interviews were then held to learn the nurses’ perspectives related to the form’s constructs and its use in their practice. The data from the completed FamCHAT forms were tabulated and analyzed using descriptive statistics to determine the extent of completion and accuracy, and the sample characteristics. The interview data was analyzed using qualitative analytical software (ATLAS.ti Scientific Software Development, GmbH, Germany) and Roper and Shapira’s framework for analysis of ethnographic data. Results: The nurses filled out forty-four FamCHAT forms with patients having a diverse ethnocultural profile. In many forms, several questions were either left blank or answered incorrectly with regard to the guidance notes containing categorical answers for the variables of family size and language. Nine nurses participated in two focus groups (n = 4 and n = 5) and one in an individual interview. Five themes emerged from the qualitative data analysis: feasibility of using the FamCHAT in acute care practice; ethnocultural awareness needs of the participating nurses; perspectives of nurses about patient concerns; potential for enhancement to nursing care assessments; and suggestions for enhancing and facilitating a new tool or approach. Nurses participating in the interviews thought that the constructs within FamCHAT could be useful for enhancing nursing assessments in their practice, but thought the tool was too long, was repetitive to some of their current assessment data, and had questions many patients were uncomfortable answering. One option suggested in both focus groups was to embed the most useful constructs into existing assessment frameworks. Some of the variables were thought to be of limited relevancy for some nursing specialties. Conclusions: The findings provided valuable information for the hospital management in their efforts to revise nursing assessment tools. Consideration is being given to integrating some of the constructs into their existing nursing assessment, with recognition that each unit might benefit from different approaches. Other, systematic, approaches to enhancing cultural competency also need to be considered. This study highlights the importance of validating practice tools for use in settings that differ from those used for their original development.

  • Nursing training

    • The transitioning experiences of internationally-educated nurses into a Canadian healthcare system: A focused ethnography

      Background: Beyond well-documented credentialing issues, internationally-educated nurses (IENs) may need considerable support in transitioning into new social and health care environments. This study was undertaken to gain an understanding of transitioning experiences of IENs upon relocation to Canada, while creating policy and practice recommendations applicable globally for improving the quality of transitioning and the retention of IENs. Methods: A focused ethnography of newly-recruited IENs was conducted, using individual semi-structured interviews at both one-to-three months (Phase 1) and nine-to-twelve months post-relocation (Phase 2). A purposive sample of IENs was recruited during their orientation at a local college, to a health authority within western Canada which had recruited them for employment throughout the region. The interviews were recorded and transcribed, and data was managed using qualitative analytical software. Data analysis was informed by Roper and Shapira’s framework for focused ethnography. Results: Twenty three IENs consented to participate in 31 interviews. All IENs which indicated interest during their orientation sessions consented to the interviews, yet 14 did not complete the Phase 2 interview due to reorganization of health services and relocation. The ethno-culturally diverse group had an average age of 36.4 years, were primarily educated to first degree level or higher, and were largely (under) employed as “Graduate Nurses”. Many IENs reported negative experiences related to their work contract and overall support upon arrival. There were striking differences in nursing practice and some experiences of perceived discrimination. The primary area of discontentment was the apparent communication breakdown at the recruitment stage with subsequent discrepancy in expected professional role and financial reimbursement. Conclusions: Explicit and clear communication is needed between employers and recruitment agencies to avoid employment contract misunderstandings and to enable clear interpretation of the credentialing processes. Prearrival orientation of IENs including health care communications should be encouraged and supported by the recruiting institution. Moreover, employers should provide more structured and comprehensive workplace orientation to IENs with consistent preceptorship. Similar to findings of many other studies, diversity should be valued and incorporated into the professional culture by nurse managers.

  • Nutrition

    • Protocol for a qualitative study on promoting dietary change and positive food choices for poor people with low income who experience cardiovascular disease in Pakistan.

      Introduction There is a misconception that cardiovascular disease (CVD) is the burden of wealthy nations, but, in fact, it is the leading cause of death and disability-adjusted life worldwide. Healthy diets are an essential factor in the prevention of CVD. However, promoting healthy diet is challenging, particularly for people with low-socioeconomic status (SES), because poverty is linked with many risk behaviours such as smoking, unhealthy eating and obesity. Multiple factors, cultural values and beliefs interact and make healthy eating very challenging. The effects of these factors in the context of low-SES populations with CVD are largely unknown. To address this gap, this study will examine the factors that affect decisions about consuming healthy diet in Pakistanis with low SES who suffer from CVD. Methods and analysis A qualitative method of interpretive description will be used. 25 participants will be selected from two cardiac rehabilitation (CR) centres in Karachi, Pakistan. Face-to-face interviews using a critical realist framework will be used to understand individual and contextual factors in the food choices of people with low SES and CVD. ATLAS.ti qualitative data analysis software will be used to identify themes and patterns in the interview data. Ethics and discussion Ethical approvals were received from the Ethics Review board of University of Alberta, Canada and Aga Khan University, Karachi Pakistan. The findings will generate new knowledge about which and how factors influence the food choices of Pakistanis with CVD and low SES to provide an insight into the development of an operational framework for designing interventions for prevention of CVD. For knowledge-translation purposes, we will publish the findings in highly accessed, peer-reviewed scientific and health policy journals at the national and international level. This research protocol received IRDC (International Development Research Centre) doctoral award from International Development Research Centre, Ottawa, Canada.

  • Sudanese

  • Sudanese women

    • "I have to do what I believe": Sudanese women's beliefs and resistance to hegemonic practices at home and during experiences of maternity care in Canada.

      Background Evidence suggests that immigrant women having different ethnocultural backgrounds than those dominant in the host country have difficulty during their access to and reception of maternity care services, but little knowledge exists on how factors such as ethnic group and cultural beliefs intersect and influence health care access and outcomes. Amongst immigrant populations in Canada, refugee women are one of the most vulnerable groups and pregnant women with immediate needs for health care services may be at higher risk of health problems. This paper describes findings from the qualitative dimension of a mixed-methodological study. Methods A focused ethnographic approach was conducted in 2010 with Sudanese women living in an urban Canadian city. Focus group interviews were conducted to map out the experiences of these women in maternity care, particularly with respect to the challenges faced when attempting to use health care services. Results Twelve women (mean age 36.6 yrs) having experience using maternity services in Canada within the past two years participated. The findings revealed that there are many beliefs that impact upon behaviours and perceptions during the perinatal period. Traditionally, the women mostly avoid anything that they believe could harm themselves or their babies. Pregnancy and delivery were strongly believed to be natural events without need for special attention or intervention. Furthermore, the sub-Saharan culture supports the dominance of the family by males and the ideology of patriarchy. Pregnancy and birth are events reflecting a certain empowerment for women, and the women tend to exert control in ways that may or may not be respected by their husbands. Individual choices are often made to foster self and outward-perceptions of managing one’s affairs with strength. Conclusion In today’s multicultural society there is a strong need to avert misunderstandings, and perhaps harm, through facilitating cultural awareness and competency of care rather than misinterpretations of resistance to care.