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Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey.

https://arctichealth.org/en/permalink/ahliterature169088
Source
Am J Public Health. 2006 Jul;96(7):1300-7
Publication Type
Article
Date
Jul-2006
Author
Karen E Lasser
David U Himmelstein
Steffie Woolhandler
Author Affiliation
Department of Medicine, The Cambridge Health Alliance and Harvard Medical School, Cambridge, Mass, USA. klasser@challiance.org
Source
Am J Public Health. 2006 Jul;96(7):1300-7
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada - epidemiology
Delivery of Health Care - economics - standards - utilization
Emigration and Immigration
Ethnic Groups
Female
Health Services Accessibility - economics - statistics & numerical data
Health services needs and demand - economics - statistics & numerical data
Health Status Indicators
Humans
Income
Life expectancy
Logistic Models
Male
Middle Aged
Multivariate Analysis
National Health Programs - economics - standards - utilization
Patient Satisfaction - ethnology
Quality of Health Care
Socioeconomic Factors
United States - epidemiology
Universal Coverage
Abstract
We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status.
We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures.
In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States.
United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care.
Notes
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PubMed ID
16735628 View in PubMed
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American Indian and Alaska Native Cancer Patients' Perceptions of a Culturally Specific Patient Navigator Program.

https://arctichealth.org/en/permalink/ahliterature289968
Source
J Prim Prev. 2017 Apr; 38(1-2):121-135
Publication Type
Journal Article
Date
Apr-2017
Author
Carol Grimes
Jenine Dankovchik
Megan Cahn
Victoria Warren-Mears
Author Affiliation
Northwest Portland Area Indian Health Board, 918 NE Rosa Parks Way, Portland, OR, 97211, USA.
Source
J Prim Prev. 2017 Apr; 38(1-2):121-135
Date
Apr-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Alaska Natives - psychology
Attitude to Health - ethnology
Cultural Competency
Female
Humans
Idaho
Indians, North American - psychology
Interviews as Topic
Male
Middle Aged
Models, organizational
Neoplasms - ethnology - psychology
Oregon
Patient Navigation - methods - organization & administration - standards
Patient Satisfaction - ethnology
Qualitative Research
Young Adult
Abstract
Lack of access to care, funding limitations, cultural, and social barriers are challenges specific to tribal communities that have led to adverse cancer outcomes among American Indians/Alaska Natives (AI/AN). While the cancer navigator model has been shown to be effective in other underserved communities, it has not been widely implemented in Indian Country. We conducted in-depth interviews with 40 AI/AN patients at tribal clinics in Idaho and Oregon. We developed the survey instrument in partnership with community members to ensure a culturally appropriate semi-structured questionnaire. Questions explored barriers to accessing care, perceptions of the navigator program, satisfaction, and recommendations. AI/AN cancer patients reported physical, emotional, financial, and transportation barriers to care, but most did not feel there were any cultural barriers to receiving care. Navigator services most commonly used included decision making, referrals, transportation, scheduling appointments, and communication. Satisfaction with the program was high. Our study provides a template to develop a culturally appropriate survey instrument for use with an AI/AN population, which could be adapted for use with other indigenous patient populations. Although our sample was small, our qualitative analysis facilitated a deeper understanding of the barriers faced by this population and how a navigator program may best address them. The results reveal the strengths and weakness of this program, and provide baseline patient satisfaction numbers which will allow future patient navigator programs to better create evaluation benchmarks.
Notes
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PubMed ID
27838858 View in PubMed
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Cervical cancer screening in ethnocultural groups: case studies in women-centered care.

https://arctichealth.org/en/permalink/ahliterature193443
Source
Women Health. 2001;33(3-4):29-46
Publication Type
Article
Date
2001
Author
J L Bottorff
L G Balneaves
L. Sent
S. Grewal
A J Browne
Author Affiliation
School of Nursing, University of British Columbia, Vancouver, Canada. Bottorff@nursing.ubc.ca
Source
Women Health. 2001;33(3-4):29-46
Date
2001
Language
English
Publication Type
Article
Keywords
Adult
Aged
Asia - ethnology
Canada
Cultural Diversity
Ethnic Groups - psychology
Female
Humans
Indians, North American
Interviews as Topic
Mass Screening - organization & administration
Middle Aged
Organizational Case Studies
Patient Satisfaction - ethnology
Patient-Centered Care
Physician-Patient Relations
Uterine Cervical Neoplasms - ethnology - prevention & control
Vaginal Smears - psychology
Women's Health Services - organization & administration - standards
Abstract
The purpose of this study was to identify and describe critical elements of women-centered care within the context of providing cervical screening to three ethnocultural groups in Canada: Asian, South Asian and First Nations.
Data for this collective case study included open-ended interviews with purposive samples of women and key informants from each target group. Following thematic analysis, cross-case analysis was completed by comparing and contrasting issues and contextual factors influencing women's and providers' experiences.
Cervical screening services for each group were shaped by attention to ethnocultural values, women's desire for thorough explanations, and the importance of a comfortable setting. While participation rates varied across clinics, women were positive about their experiences in obtaining cervical screening. Some women's expectations that they could address a range of health concerns with female health providers at the clinics were stymied by structural barriers that prevented staff from addressing issues beyond those directly related to cervical screening. Cross-case analysis revealed three key elements of women-centered care: respectful and culturally appropriate interactions between women and health providers, the importance of providing acceptable alternatives for women, and the need for comprehensive health services.
While the establishment of Pap test clinics for ethnocultural groups has the potential to enhance participation in cervical screening, changes in health policy and the structure of health services are required for existing programs to fully implement the elements of women-centered health care identified in this study. Other models of providing health care to women in ethnocultural groups, including the use of clinics staffed by nurse practitioners, should be evaluated.
PubMed ID
11527105 View in PubMed
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Childbirth in the north. A qualitative study in the Moose Factory zone.

https://arctichealth.org/en/permalink/ahliterature221320
Source
Can Fam Physician. 1993 Apr;39:781-8
Publication Type
Article
Date
Apr-1993
Author
G. Webber
R. Wilson
Author Affiliation
Department of Family Medicine, Queen's University, Kingston, Ont.
Source
Can Fam Physician. 1993 Apr;39:781-8
Date
Apr-1993
Language
English
Publication Type
Article
Keywords
Adult
Aircraft
Attitude to Health - ethnology
Choice Behavior
Educational Status
Female
Health Policy
Health Services Research
Humans
Indians, North American - psychology
Maternal Health Services - organization & administration - standards
Medically underserved area
Ontario
Parity
Patient Satisfaction - ethnology
Questionnaires
Transportation of Patients - methods - standards
Abstract
Cree women from the Moose Factory zone were asked about their views on evacuation for childbirth. Significant concerns cited were separation from children, loneliness, boredom, and the hospital accommodations. Shopping, the medical staff and equipment, and the opportunity to visit relatives were considered positive factors. Suggested improvements were to bring along family members, to provide alternative accommodation, and to have activities to occupy the time.
Notes
Cites: CMAJ. 1987 Dec 1;137(11):1017-213676945
PubMed ID
8495136 View in PubMed
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Chinese and white Canadian satisfaction and compliance with physicians.

https://arctichealth.org/en/permalink/ahliterature164517
Source
BMC Fam Pract. 2007;8:11
Publication Type
Article
Date
2007
Author
Richard Liu
Lawrence So
Hude Quan
Author Affiliation
Faculty of Medicine and Dentistry, University of Alberta, Canada. ryliu@ualberta.ca
Source
BMC Fam Pract. 2007;8:11
Date
2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alberta - epidemiology
Asian Americans - statistics & numerical data
Cross-Sectional Studies
Emigration and Immigration - classification - statistics & numerical data
European Continental Ancestry Group - statistics & numerical data
Female
Humans
Male
Middle Aged
Patient Compliance - ethnology
Patient Satisfaction - ethnology
Population Surveillance
Primary Health Care - standards - statistics & numerical data
Abstract
Patient satisfaction has become an important indicator of primary care and healthcare system performance. Ethnic disparities in patient satisfaction and compliance with physician care have been studied in several countries. However, this issue has not received significant attention in Canada. The unique characteristics of the Canadian healthcare system and ethnic population make it worthwhile to examine this issue in this population. Therefore, we conducted a survey among Chinese and Whites in a Canadian city to determine their reported satisfaction, and perceptions of physicians.
The survey was conducted in English, Mandarin and Cantonese in 2005 among Chinese and White Canadians, 18 years of age or older, who had visited at least one physician in Canada.
We analyzed 746 Chinese and 711 Whites in the general practitioner (GP) visit group and 485 Chinese and 637 Whites in the specialist visit group. A lower proportion of Chinese compared to Whites reported that they were very satisfied or satisfied with GP (73.7% vs. 92.8%) and specialist care (75.5% vs. 85.6%) and the differences between the two groups remained after adjustment for demographic variables and chronic conditions (risk adjusted OR: 0.70, 95%CI: 0.42-1.18 for the GP visit group and OR: 0.77, 95%CI: 0.48-1.23 for the specialist visit group). A similar proportion of Chinese and Whites reported that they always followed a physician's advice (59.4% vs. 59.6% for the GP visit group and 67.2% vs. 62.8% for the specialist visit group). Non-English speaking Chinese and recent arrivals in Canada were less likely to be satisfied with GPs than Chinese born in Canada [risk adjusted OR: 0.5, 95%CI: 0.3-0.9, 0.2 and 0.1-0.7, respectively].
Chinese Canadians reported lower satisfaction with physicians and perceived physicians slightly more negatively than White Canadians. Particularly, Chinese with limited English and short length of stay in Canada were less satisfied than Canadian born Chinese.
Notes
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PubMed ID
17376235 View in PubMed
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The effect of patient origin and relevance of contact on patient and caregiver satisfaction in the emergency room.

https://arctichealth.org/en/permalink/ahliterature87088
Source
Scand J Public Health. 2008 Jan;36(1):76-83
Publication Type
Article
Date
Jan-2008
Author
Mygind Anna
Norredam Marie
Nielsen Anette S
Bagger Jens
Krasnik Allan
Author Affiliation
Department of Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Source
Scand J Public Health. 2008 Jan;36(1):76-83
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Denmark - ethnology
Emergency Service, Hospital - statistics & numerical data - utilization
Emigrants and Immigrants
Female
Humans
Job Satisfaction
Male
Middle Aged
Middle East - ethnology
Patient Satisfaction - ethnology
Professional-Patient Relations
Questionnaires
Socioeconomic Factors
Abstract
AIMS: This study examined (1) whether patient and caregiver satisfaction in the emergency room (ER) varies according to patient origin, and (2) whether relevance of visit can explain any variation. METHODS: Data were obtained from a questionnaire survey of walk-in patients and their caregivers at four ERs in Copenhagen. The patient questionnaire was available in nine languages, and addressed patient satisfaction. The caregiver questionnaire addressed caregiver satisfaction and relevance of the patient contact in the ER. A total of 3,809 patients and 3,905 caregivers responded. The response rate among patients was 54%. Only data with both patient and caregiver responses and with patient country of birth were included in the analyses (n=3,426). The effect of patient origin was examined using bivariate, stratified analyses and tested for independence. RESULTS: Patients and caregivers had lower satisfaction rates when patients were of Middle Eastern compared with Danish origin. Satisfaction of both groups was associated with the relevance of the visit as assessed by the caregiver. Visits by patients of Middle Eastern origin were less often assessed as being relevant, but caregivers were less satisfied with visits by these patients even after controlling for relevance. Differences in patient satisfaction by patient origin were no longer significant when stratifying by relevance. CONCLUSIONS: Patient and caregiver satisfaction among patients of foreign origin can be improved by lowering the number of irrelevant visits among patients of foreign origin, e.g. by improving access to general practitioners. Training of caregivers in dealing with patients of different origins might reduce differences in caregiver satisfaction according to patient origin.
PubMed ID
17852971 View in PubMed
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Evaluating a diabetes self-management support peer leader training programme for the English- and Punjabi-speaking South-Asian community in Vancouver.

https://arctichealth.org/en/permalink/ahliterature115452
Source
Diabet Med. 2013 Jun;30(6):746-52
Publication Type
Article
Date
Jun-2013
Author
T S Tang
P S Sohal
A K Garg
Author Affiliation
Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. tricia.tang@vch.ca
Source
Diabet Med. 2013 Jun;30(6):746-52
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Asian Continental Ancestry Group
British Columbia
Cohort Studies
Community Health Workers - education
Diabetes Mellitus, Type 2 - ethnology - therapy
Feasibility Studies
Health Behavior - ethnology
Humans
India - ethnology
Language
Leadership
Middle Aged
Pakistan - ethnology
Patient Education as Topic
Patient Satisfaction - ethnology
Peer Group
Pilot Projects
Self Care
Social Support
Urban Health - ethnology
Abstract
The purpose of this single-cohort study was to implement and evaluate a programme that trains peers to deliver a diabetes self-management support programme for South-Asian adults with Type 2 diabetes and to assess the perceived efficacy of and satisfaction with this programme.
We recruited eight South-Asian adults who completed a 20-h peer-leader training programme conducted over five sessions (4 h per session). The programme used multiple instructional methods (quizzes, group brainstorming, skill building, group sharing, role-play and facilitation simulation) and provided communication, facilitation, and behaviour change skills training. To graduate, participants were required to achieve the pre-established competency criteria in four training domains: active listening, empowerment-based facilitation, five-step behavioural goal-setting, and self-efficacy. Participants were given three attempts to pass each competency domain.
On the first attempt six (75%), eight (100%), five (63%) and five (63%) participants passed active listening, empowerment-based facilitation, five-step behavioural goal-setting, and self-efficacy, respectively. Those participants who did not pass a competency domain on the first attempt were successful in passing on the second attempt. As a result, all eight participants graduated from the training programme and became peer leaders. Satisfaction ratings for programme length, balance between content and skills development, and preparation for leading support activities were uniformly high. Ratings for the instructional methods ranged between effective and very effective.
Findings suggest it is feasible to train and graduate peer leaders with the necessary skills to facilitate a diabetes self-management support intervention.
PubMed ID
23506520 View in PubMed
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Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP).

https://arctichealth.org/en/permalink/ahliterature116122
Source
BMC Public Health. 2013;13:160
Publication Type
Article
Date
2013
Author
Charlotte A Jones
Alykhan Nanji
Shefina Mawani
Shahnaz Davachi
Leanne Ross
Ardene Vollman
Sandeep Aggarwal
Kathryn King-Shier
Norman Campbell
Author Affiliation
Department of Medicine, University of Calgary, Libin Cardiovascular Institute, TRW Building GE89, 3280 Hospital Drive NW, Calgary, AB, Canada. charlotte.jones@ubc.ca
Source
BMC Public Health. 2013;13:160
Date
2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Asian Continental Ancestry Group - statistics & numerical data
Canada
Cardiovascular Diseases - ethnology
Community Health Services - organization & administration
Cultural Competency
Feasibility Studies
Female
Follow-Up Studies
Humans
Male
Mass Screening - methods
Middle Aged
Patient Satisfaction - ethnology - statistics & numerical data
Program Evaluation
Qualitative Research
Religion
Risk factors
Abstract
South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population.
South Asians (= 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or = 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar's test (proportions) and paired t-tests (continuous measures).
Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff.
SA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer-led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies.
Notes
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PubMed ID
23432996 View in PubMed
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Identifying the needs of Innu and Inuit patients in urban health settings in Newfoundland and Labrador.

https://arctichealth.org/en/permalink/ahliterature4804
Source
Can J Public Health. 2002 Mar-Apr;93(2):149-52
Publication Type
Article
Author
Maura C Hanrahan
Author Affiliation
Division of Community Health, Faculty of Medicine, Health Sciences Centre, Memorial University of Newfoundland, St. John's, NF A1B 3V6. maura@primus.ca
Source
Can J Public Health. 2002 Mar-Apr;93(2):149-52
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Culture
Diet
Female
Health Services Accessibility
Humans
Inuits - psychology
Language
Male
Needs Assessment
Newfoundland
Patient Satisfaction - ethnology
Research Support, Non-U.S. Gov't
Urban Health Services - standards
Abstract
BACKGROUND: Labrador's Innu and Inuit live in nine small, isolated villages, and must travel to the urban centres of Goose Bay, Labrador and/or St. John's, Newfoundland for most health services. This study responds to anecdotal evidence of Aboriginal dissatisfaction with these services from the St. John's Native Friendship Centre Association (SJNFCA); it describes Aboriginal experiences and identifies relevant needs. METHODS: The study consisted of qualitative interviews (N = 143), conducted by trained local researchers, and nine focus groups. The interviews were narrative-based, appropriate to the Aboriginal culture of participants. Participants were recruited from the client list of the SJNFCA. FINDINGS: Almost all study participants experience significant difficulties including profound disorientation, language and communication difficulties, inadequate accommodations, and altered diets. Cross-cultural relations are particularly problematic for the Innu. CONCLUSIONS: These findings, and 19 recommendations made to the provincial government (8 main recommendations appear in Table II), could lead to improved services for Innu and Inuit using urban health services. Workshops in development could mean more awareness among health care practitioners.
PubMed ID
11963522 View in PubMed
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Illness management strategies among Chinese immigrants living with arthritis.

https://arctichealth.org/en/permalink/ahliterature188136
Source
Soc Sci Med. 2002 Nov;55(10):1795-802
Publication Type
Article
Date
Nov-2002
Author
Jinjin Zhang
Marja J Verhoef
Author Affiliation
Naval Health Research Center, P O Box 85122, San Diego, CA 92186-5122, USA.
Source
Soc Sci Med. 2002 Nov;55(10):1795-802
Date
Nov-2002
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alberta
Arthritis - ethnology - psychology
China - ethnology
Chronic Disease - psychology
Culture
Disease Management
Educational Status
Ethnic Groups - psychology
Female
Holistic Health
Humans
Interviews as Topic
Male
Medicine, Chinese Traditional - utilization
Middle Aged
Patient Acceptance of Health Care - ethnology
Patient Satisfaction - ethnology
Physician-Patient Relations
Qualitative Research
Self Care - utilization
Social Support
Abstract
The purpose of this qualitative study was to explore arthritis management strategies among Chinese immigrants in Calgary, Canada, and to assess factors, that impact on these strategies. Purposive sampling was used to select 19 Chinese immigrants living with arthritis. Data were collected by means of in-depth interviews. The interview data were analyzed according to the following steps: (1). transcribing interview materials, (2). developing codes, categories and themes, (3). theoretical coding, and (4). laying out the theoretical framework. The results of this study describe factors, that impacted on illness management strategies. These include arthritic symptoms, beliefs about arthritis, beliefs about Western medicine based on treatment experience, beliefs about Chinese medicine, perceived barriers to using Chinese or Western medicine and social support. The emerging process of illness management shows that immigrants usually started using self-care remedies, followed by consulting Western physicians, consulting Chinese healers, and then returning to Western medicine. The results illustrate that disease management strategies among Chinese immigrants are impacted by disease, personal and cultural factors. These factors suggest helpful directions to providing culturally sensitive care, which can lead to greater satisfaction and well being for Chinese immigrants with arthritis.
PubMed ID
12383463 View in PubMed
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