Patient-reported experiences in primary health care access of Nepalese immigrant women in Canada

• DOI: https://doi.org/10.1108/IJMHSC-03-2021-0028
• Published date: 21 October 2022
• Date: 21 October 2022
• Pages: 315-331
• Subject Matter: Health & social care,Vulnerable groups,Inequalities & diverse/minority groups,Sociology,Race & ethnic studies,Minorities,Multiculturalism,Racial identity,Work,economy & organizations,Labour movements
• Author: Rudra Dahal,Kalpana Thapa Bajgain,Bishnu Bahadur Bajgain,Kamala Adhikari,Iffat Naeem,Nashit Chowdhury,Tanvir C. Turin

Patient-reported experiences in primary

health care access of Nepalese

immigrant women in Canada

Rudra Dahal, Kalpana Thapa Bajgain, Bishnu Bahadur Bajgain, Kamala Adhikari,

Iffat Naeem, Nashit Chowdhury and Tanvir C. Turin

Abstract

Purpose –Canada has a globally recognized universal health-care system. However, immigrants

experience a number of obstacles in obtaining primary health care (PHC) that may differ within

various communities due to the intersection of culture, gender and other identities. To date, no

research has been done on the difficulties Nepalese immigrant wome n in Canada may face

accessing PHC. The purpose of this study was to learn about t heir perceptions of barriers to PHC

access and to share the findings with a wide range of stakeholders, including health-care providers

and policymakers.

Design/methodology/approach –The authors conducted a community-engaged qualitative study in

Calgary,Alberta, Canada. A total of six focus group discussions(FGD) among 34 participants (each FGD

consisted of 5–7 participants) were conducted. The authors collected demographic information before

each focus group. The FGDs were audio recorded and transcribed verbatim. The transcriptions were

coded andanalysed thematically.

Findings –The focus groups identified long wait times as a major barrier to receiving PHC services.

Long wait times in emergencyrooms, unable to see family doctors when they were sick, tediousreferral

procedures, long waits at the clinic even after scheduling an appointment, family responsibilities and

work all impacted their access to PHC. Further, a lack of proficiency in English was another significant

barrier that impededeffective communication between physiciansand immigrant women patients, thus

compromising the qualityof care. Other barriers mentioned included lackof access to medical records

for walk-in doctors, insufficient lab/diagnostic services, a lack of urgent care services and unfamiliarity

with the Canadianhealth-care system.

Originality/value –Accessible PHC is essentialfor the health of immigrant populations in Canada. This

study recognizes the extentof the barriers among a relatively less studied immigrant population group,

Nepalese immigrantwomen, which will help effectively shape public policy and improveaccess to PHC

for the versatileimmigrant population fabric in Canada.

Keywords Access, Barriers, Knowledge translation, Primary health care, Nepalese immigrant women

Paper type Research paper

Background

Migration across countries has risen due to increasing globalization and has influenced

ethnic diversity and multiculturalism practices in the receiving countries. Canadian

immigrant populations come from multiple ethnogeographic backgrounds. Immigrants

leave their countries of origin with various intentions, such as to secure better employment,

escape from natural disasters and war, reunite with their families and obtain a better

education to improve their life (Walton-Roberts, 2011). According to a 2017 report by

Statistics Canada, 7.5 million immigrants reside in Canada, representing 21.9% of the total

population (Mehra et al.,2019). It is predicted that the immigrant population will increase by

(Informationabout the

authorscan be found at the

end of this article.)

Received 18 March 2021

Revised 10 May 2022

22 July 2022

Accepted 21 September 2022

Ethics approval:Thisstudy

received ethicsapproval from the

CHREB of University of Calgary.

Consent to participate: Informed

consent was obtainedfrom all the

participants.

Author contribution:TanvirC.

Turin, Rudra Dahal, and Bishnu

Bahadur Bajgain conceived

research study. Tanvir C. Turin

designed the methodsfor the

study. Rudra Dahal, Kalpana

Thapa Bajgain,Kamala Adhikari,

and Bishnu Bahadur Bajgain

conducted initialcommunity

engagement and mobilisation

initiatives for participant

recruitment andfacilitated the

arrangements ofthe FGDs.

Rudra Dahal and Bishnu

Bahadur Bajgain conducted the

FGDs and compiled the field

notes. Rudra Dahal

transcribed andtranslated the

FGDs. Rudra Dahal, Iffat Naeem,

and Tanvir C. Turin analysedand

interpreted thedata. Kalpana

Thapa Bajgain,Bishnu Bahadur

Bajgain, and Kamala Adhikari

helped contextualisation of the

interpretation by using the ethno-

-cultural lens. Rudra Dahal, Iffat

Naeem, Nashit Chowdhury,and

Tanvir C. Turin draftedthe

manuscript. KalpanaThapa

Bajgain, Bishnu Bahadur

Bajgain, and Kamala Adhikari

critically appraisedthe draft for

intellectualcontribution.

DOI 10.1108/IJMHSC-03-2021-0028 VOL. 18 NO. 4 2022, pp. 315-331, ©Emerald Publishing Limited, ISSN 1747-9894 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jPAGE 315

approximately 30% in 2036 in Canada (Setia et al., 2011). Canada is on track to welcome

record numbers of new immigrants between 2022 and 2024. Despite the pandemic,

Canada welcomed more than 405,000 immigrants in 2021, targeting over 432,000 in 2022

and even more numbers in 2022 and 2023 (Robitaille, 2022).

Canada has a universal, publicly funded health-care system –a model of universal health

coverage (Eriksson and Lundstro

¨m, 2008). An important principle of Canada’s health-care

system is universalism and equity. Studies have shown that immigrants have better health

conditions than the Canadian-born population at the time of arrival, a phenomenon known

as the “healthy immigrant effect” (McDonald and Kennedy, 2004). However, their general

health conditions deteriorate drastically within 10years of immigration (McDonald and

Kennedy, 2004;Ahmed et al.,2016). Canada’s health-care system aims to promote equal

access to adequate health-care services, including primary health care (PHC) for the entire

population, regardless of theirimmigration status and ability to pay (Starfield, 2012). Access

to PHC services implies the timely use of availablehealth services to achieve the best health

outcomes. Adequate access to PHC services is associated with the increased use of PHC

services, improved health outcomes and reduced health-care costs (Starfield, 2012;

Ahmed et al.,2016). In contrast, inadequate access to PHC followed by low utilization

contributes to poorer health outcomes, including increased risk of severe forms of health

problems and complications, compromised quality of life and increased health resource

use or health interventions(Shi, 2012;Starfield, 2012;Starfield et al., 2005).

Understanding health services utilization (HSU) patterns by certain populations is an

essential first step in developing tailoredservices to meet unique public needs. The HSU of

immigrants is unique and presents challenges not faced by native-born populations.

Special factors related to the immigration process, assimilation into the host country and

challenges related to thriving in a new economyand culture present as unique barriers that

modulate immigrants’ HSU (Kao, 2009). A longitudinal study looking at health-care access

in the immigrant population over 12years has found a combination of unique challenges

faced by Canadian immigrants, including barriers at the institutional and policy level,

cultural clashes and social determinants that influence immigrant health at the individual

and community-level (Setia et al.,2011). Studies aiming to understand this population have

faced criticism in applying their findings derived from one or a few immigrant population

groups to the entire immigrant population in Canada (Woodgate et al.,2017). To address

this, our study aims to focus on a seldom-studied Nepalese population. Understanding the

nuances of HSU in this population will not only highlight the diversity of experiences within

Canada but can also inform health policy and targetedsupport for this population.

The number of Nepalese immigrants migrating to Canada has been accelerating. In 2011,

9,870 Nepalese Canadians resided in Canada, and that number reached 14,390 in 2016.

This represents an increase of morethan 47% within five years (O’Neill et al.,2019). Further,

despite having separate languages, religions, cultures, traditions, self-identities and

histories, Nepalese Canadians are considered South Asian immigrants in research and

practice and have not been treated as a distinct immigrant group (O’Neill et al.,2019).

Using a similar lens, a group of researchers conducted separate studies among

Bangladeshi men and women, another understudied South Asian immigrant group (Turin

et al., 2020a,2020b). They found that Bangladeshi women in Canada were not too shy to

access sexual and reproductive health care, unlike the common perception and reports

about South Asian women in other studies (Habib, 2012). Turin et al. (2020a) explained the

difference in the migration pathways of Bangladeshi immigrants, which is mainly economic

migration that essentially accepts only highly educated individuals. Although studies

attempting to understand and document the health of Nepalese individuals in Canada are

scarce, studies have shown that similar to other immigrant populations,

Nepalese–Canadians are affected by many social determinants of health, such as

inadequate employment and beingsingle-income families with a lack of female participation

PAGE 316 jINTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE jVOL. 18 NO. 4 2022