Browsing by Author "Neiterman, Elena"

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"...but I know something's not right here": Exploring the diagnosis and disclosure experiences of persons living with ALS
(Public Library of Science (PLOS), 2024) Foldvari, Kathleen M.; Stolee, Paul; Neiterman, Elena; Boscart, Veronique; Tong, Catherine
Background Amyotrophic Laterla Sclerosis (ALS), an incurable motor neuron disease, primarily affects those between the ages of 60-79, and has an approximate post-diagnosis life-expectancy of only two to five years. The condition has an unpredictable but ultimately terminal trajectory that poses challenges for patients, caregivers and healthcare providers. While the diagnosis and disclosure are critical periods for intervention and support, knowledge regarding the relational, communicational and psychodynamic forces that occur within the process of diagnostic disclosure is relatively limited. Objectives The purpose of this study was to explore the experiences of persons living with ALS in the diagnosis and disclosure of that condition, with the support of their caregivers. Methods We conducted a focus group and in-depth individual interviews with people living with ALS (n=9), and caregivers (n=9). The interviews were transcribed, cleaned, and anonymized, and then entered into NVivo 11 for thematic analysis. Results Participants discussed the diagnostic process, including inklings and subtle changes prior to diagnosis, attempts at self-diagnosis, and the lengthy assessment process. Time was also a consideration in the diagnostic disclosure process, in which participants shared how the disclosure was the product of longstanding conversations with their care providers. It was described as rarely a shock to finally have confirmation. Participants shared their information seeking strategies and needs for a diagnosis that, for them, typically came with insufficient information on the disease, prognosis, and next steps. Significance This project serves as a step in bridging the relevant gaps in our knowledge and understanding towards improved person-centered care practices in the diagnosis and disclosure of ALS.
“Even if we want help, there is no help”: Exploring Perceptions and Barriers in Home Care Services within the South Asian Communities
(University of Waterloo, 2024-01-23) Subbiah, Krithika; Neiterman, Elena
Abstract Background: In Canada, the demand for home care services continues to increase due to the ongoing growth of the aging population. This aging population is marked not only by the increase in the number of older adults but also by its significant diversity (National Advisory Council on Aging, 2005). There is a growing need to address disparities in the utilization of home care services among immigrant older adults (Wellesley Institute, 2016). Despite the importance of home care services, little is known about how ethnic minorities perceive home care services in Ontario, specifically South Asian communities – who are the largest minority in Canada. Therefore, recognizing this overarching context, my research aimed to explore South Asian communities’ nuanced perceptions about home care services in Ontario, barriers they face when accessing these services and recommendations on how home care services in Ontario can be structured to address their unique needs. Specific Aims: The study aimed to explore South Asian communities' nuanced perceptions about home care services in Ontario and the barriers they experience when they access home care services. Additionally, it sought recommendations from these communities on how to enhance home care services for older adults, aiming to improve the provision of culturally aligned home care services for South Asian communities in Ontario. Methods: This study employed an exploratory qualitative research design to investigate the nuanced perceptions about home care services in Ontario, barriers they face when accessing these services and recommendations on how home care services in Ontario can be structured to address their unique needs. Thirteen participants, including seven care partners, three South Asian older adults, and three social workers who engaged with South Asian older adults, contributed to the study. A Reflexive Thematic Analysis was utilized to engage with the data and generate themes for the study. This method facilitated a rigorous and reflexive examination of participants' narratives, enhancing the depth and richness of the study findings. Results: The participants emphasized a significant demand for home care services within South Asian communities. In shedding light on the barriers faced by these communities in accessing home care services, various challenges experienced by care partners and older adults in Ontario were revealed. The findings also revealed the impact of duration of residency in Canada on openness to formal home care, the presence of stigma hindering care-seeking, and a lack of awareness about available home care services. Evolving gender roles and care partner burdens were discussed, emphasizing the necessity of culturally tailored support services. Preferences for culturally competent and humble care, language concordance, and alignment with care providers' gender and ethnicity emerged as significant themes. Additionally, the study participants offered valuable recommendations to improve home care services for South Asian communities. These suggestions, ranging from enhancing accessibility to customizing services, aim to align with the cultural needs of the South Asian communities. Discussion: The study reinforced the notion that the South Asian communities are a diverse and heterogeneous group. Perceptions of home care services differed based on the extent of Western cultural adaptation and lived experiences. The research also underscored that while the general population faces obstacles in accessing home care, these challenges are more pronounced within the South Asian communities due to factors like cultural expectations, language barriers, and financial constraints. Additionally, it highlighted the need for culturally tailored home care services to meet the specific needs of an increasingly diverse aging population. Conclusion: This study significantly contributed to ethnogerontological knowledge by examining South Asian communities' nuanced perceptions about home care services in Ontario, barriers they face when accessing these services and recommendations on how home care services in Ontario can be structured to address their unique needs. Recommendations included targeted awareness strategies and culturally sensitive services for South Asian communities. The study advocated for a holistic home care model, patient-centered care, and cautioning against reliance on cultural stereotypes. Future research suggestions included exploring perceptions among recent immigrants, those with dementia, and an intersectional analysis. Additionally, investigating cultural factors like filial piety and their impact on long-term care decisions within the South Asian communities is recommended.
Exploring the Journeys of People Accessing Abortion Care in Ontario, Canada
(University of Waterloo, 2024-08-23) Slofstra, Kathleen Nicole; Neiterman, Elena
Background: Abortion has been a contentious socio-political issue throughout Canada’s history. Despite the decriminalization of abortion in 1988 and the approval of medication abortion in 2015, challenges to accessing abortion in Ontario still exist. There is a dearth of research on people’s experiences of accessing abortion, especially in an Ontario context. Research Questions: What are the experiences of people accessing and receiving an abortion in Ontario? When reflecting on their abortion care journeys, how do people who have obtained an abortion perceive their care encounters? How can the provision of abortion care be improved in the Ontario health care system? Methods: This research project used a qualitative research design, drawing on 16 in-depth, semi-structured narrative interviews from racially and gender diverse participants across Ontario. Participants were recruited through social media accounts of reproductive care organizations. Individuals were eligible to participate in the study if they had received a procedural and/or medication abortion in Ontario in the last 3 years (2020-2023). Interviews were conducted virtually or over the telephone and lasted 1-1.5 hours. This study also employed a novel technique of healthcare journey mapping during interviews to visually depict key healthcare encounters. Narrative-thematic analysis was used to capture themes from participants’ stories. Findings: Five individuals’ stories and abortion care journey maps are highlighted, demonstrating multiple routes to accessing care and the differential complexity of navigating care. In the next chapter, participants’ accounts are structured into four main themes by story plot element. Most participants encountered difficulties and/or stress accessing care, which posed as the first complicating action in their journeys. The next complicating action stemmed from their interactions with abortion care professionals during diagnostics and assessment of the pregnancy. A range of interactions with care professionals were narrated, fluctuating between services being perceived as restrictive, rushed, and shame-inducing to caring, connective, and, non-judgemental. All participants received at least one abortion, categorized as the plot climax of their story. Participants often found the process of receiving an abortion emotional and/or physically painful. Lastly, the degree of “resolution” of participants’ stories was impacted by the quality of post-abortion care they received for their ongoing physical or emotional needs. Conclusions: This study is one of the first to blend narrative inquiry with the novel technique of healthcare journey mapping to people’s experiences of abortion care, identifying the gaps in services to provide clients with non-judgemental care. By highlighting a few abortion care maps and stories, it suggests that space needs to be carved out in the healthcare system to provide individualized care sensitive to clients’ emotional, physical, and spiritual needs. It makes several recommendations as to how abortion practice and policy can be improved to be more trauma-informed, abortion-focused, and client-centered.
Exploring the lived experiences of women in larger bodies who access and use contraception in Ontario
(University of Waterloo, 2021-12-16) Boyce, Tierney Marie; Neiterman, Elena
Background: Contraception is widely used by women to prevent pregnancy and for other health-related reasons. In Canada, many contraceptive users may be living in larger bodies. While there is a growing interest in the reproductive health care experiences of women in larger bodies, less attention has been paid to contraception. Research suggests that women in larger bodies may receive inadequate contraceptive counselling and care; however, women’s voices are rarely captured in this research. Objectives: This study aimed to understand the lived experiences of women in larger bodies who access and use female-oriented contraception in Ontario. Specifically, this study examined: (1) How is contraceptive use embodied by women in larger bodies; (2) How do women in larger bodies navigate contraceptive care; and (3) How can women in larger bodies’ experiences with contraception be improved? Methods: This phenomenological study explored the lived experiences of 19 women in larger bodies who accessed and used female-oriented methods of contraception in Ontario within the last five years. In-depth interviews were conducted with participants and the data were analyzed by applying a feminist lens to interpretive phenomenological analysis. Results: There was significant diversity in women in larger bodies’ lived experiences with contraception. The notion of control was central to participants’ embodied experiences with routine contraceptive use, whereas experiences with contraceptive care were shaped by feelings of (dis)empowerment. While many participants felt supported in some capacity, women in larger bodies also suggested that their contraceptive counselling and care needs were not always met. Finally, three major stages of participants’ experiences with emergency contraception were detailed, revealing the significance of personal context in shaping their surrounding experiences. Conclusion: This study highlights the complexity and diversity of women in larger bodies’ lived experiences with routine and emergency contraception. The findings suggest that non-judgemental, patient-centred approaches to contraceptive counselling and care are needed to better support women in larger bodies.
Exploring the Role of Public Health in Climate Change Initiatives and the Mining Industry in Ontario, Canada
(University of Waterloo, 2023-08-10) Hutchuk, Nicole; Neiterman, Elena
Background: Climate change is a global crisis that is impacting population health. With its significant expansion, the mining industry in Ontario, Canada has the potential to contribute to the development of green energy technologies, but can also threaten the climate and population health. Research has begun to explore the impact of extractive industries on climate change but has not examined the barriers for climate change initiatives and policy implementation in Ontario in relation to population and environmental health. This research aims to address the role public health can play in promoting climate change initiatives and policies in extractive industries in Ontario. Objectives: The objectives of this research are to (1) understand the role that public health could play in mitigating the impact of Ontario’s mining industry on the environment; (2) understand what barriers might prevent public health from playing a more active role in climate action within the mining industry in Ontario; and (3) explore what key actions could be taken to address barriers to allow public health to take an active role in the extractive industry in Ontario. Methods: This study employed a qualitative methodological approach using semi-structured interviews as a primary method of data collection. Interviews were conducted with 12 key stakeholders, including policy makers, representatives of public health units, government workers, researchers and not for profit agencies. Data was analyzed utilizing a critical realist lens using inductive, thematic analysis. Findings: This study displayed the complexity of the government priorities in the green energy transition and opposing viewpoints of environmental and health advocates. The findings suggest that public health should play a larger role in advocating for health to be at the forefront of climate change initiatives in the mining industry in Ontario. It highlighted how to mitigate barriers and tensions to public health interventions while seeking to utilize or implement health frameworks that have not yet been applied in the mining sector in Ontario. Conclusion: There is potentially a role for public health to have in regard to policy creation, advocacy and implementation in public health units across Ontario. Public Health Ontario could be viewed as a body to provide scientific knowledge and evidence for industries and public health units in relation to climate change initiatives and the mining industry. There is a lack of collaboration between industry, health units, government and community. Current regulations and policy do not reflect the needs of surrounding, impacted communities and the climate crisis.
Improving Spaces for Women First Responders: Investigating women’s occupational experiences using a comparative grounded theory
(University of Waterloo, 2022-08-10) Gregory, Kelly B.; Neiterman, Elena; Mielke, John
Background: First response work has historically been designed for and performed by men; yet more women than ever are conducting this work. Research suggests women first responders face unequal access to resources and advancement, increased mental health challenges, and unsupportive workplace cultures. Methods: This work explores the occupational experiences of women paramedics, police officers, and firefighters (n = 20) from Southern Ontario. Semi-structured interviews explored the individual life course of participants, focusing on resiliency and stress, diversity and inclusion, and gender and the role of professional identity. Constructivist grounded theory and a Gender Based Analysis Plus approach was utilized to understand experiences within and across the three professions. Results: Participants attested to significant improvements to women’s inclusion in first response work, however specific challenges continue to persist. While some environments were described as highly supportive, many women still face sexism and glass ceilings. Despite this, women are deeply passionate about their work, and actively encourage other women to join the field. This investigation further examined the nuances of trailblazers, embodiment perspectives, the impacts of paramilitarism, and the intersection of promotion pathways and public opinion. Conclusion: For recruitment and retention, women identified high-intensity work, protecting community, dynamic environments, and the power to address crisis as the best parts of their jobs. Recommendations include improving access to uniforms and equipment, on-the-job training to improve access to promotions, flexible scheduling and childcare supports, and legislating EDI training for all leaders and workers. This comparative investigation provides a unique pulse-check into the EDI goals of Canadian public services.
“My pharmacist”: Creating and maintaining relationship between physicians and pharmacists in primary care settings
(Elsevier, 2020-01) Mercer, Kathryn; Neiterman, Elena; Guirguis, Lisa; Burns, Catherine; Grindrod, Kelly
Background Pharmacists and physicians are being increasingly encouraged to adopt a collaborative approach to patient care, and delivery of health services. Strong collaboration between pharmacists and physicians is known to improve patient safety, however pharmacists have expressed difficulty in developing interprofessional working relationships. There is not a significant body of knowledge around how relationships influence how and when pharmacists and physicians communicate about patient care. Objectives This paper examines how pharmacists and primary care physicians communicate with each other, specifically when they have or do not have an established relationship. Methods Thematic analysis of data from semi-structured interviews with nine primary care physicians and 25 pharmacists, we examined how pharmacists and physicians talk about their roles and responsibilities in primary care and how they build relationships with each other. Results We found that both groups of professionals communicated with each other in relation to the perceived scope of their practice and roles. Three emerging themes emerged in the data focusing on (1) the different ways physicians communicate with pharmacists; (2) insights into barriers discussed by pharmacists; and (3) how relationships shape collaboration and interactions. Pharmacists were also responsible for initiating the relationship as they relied on it more than the physicians. The presence or absence of a personal connection dramatically impacts how comfortable healthcare professionals are with collaboration around care. Conclusion The findings support and extend the existing literature on pharmacist-physician collaboration, as it relates to trust, relationship, and role. The importance of strong communication is noted, as is the necessity of improving ways to build relationships to ensure strong interprofessional collaboration.
Navigating early pregnancy loss within Ontario's healthcare system: A qualitative exploratory study of the experiences of midwifery clients and midwives
(University of Waterloo, 2020-09-11) Freeman, Angela; Neiterman, Elena
Background: Miscarriage occurs in approximately 25% of all pregnancies. About 80% of all pregnancy losses occur in the first trimester. Patient experiences of seeking and receiving healthcare for early pregnancy loss can have long-term implications on their well-being. While individuals often present to emergency departments (ED) with early pregnancy loss symptoms, evidence suggests patient needs are not being met within this setting. There is a dearth of research on women’s experiences utilizing the midwifery care as an option for early pregnancy loss. Research Questions: This exploratory qualitative study examines two primary research questions: (1) What are the experiences of Ontario midwifery clients accessing and receiving healthcare in cases of early pregnancy loss (EPL); and (2) What are the experiences of midwives in providing early pregnancy loss care for their clients? The overall objective of this study is to understand how the healthcare-related experiences can be improved in cases of early pregnancy loss. Methods: Semi-structured qualitative interviews were conducted with midwifery clients (n=14) and midwives (n=10). Two analytic approaches were taken for the analysis of participant interview data: healthcare journey mapping and thematic network techniques. Findings: Both the healthcare trajectories and experiences of clients accessing and receiving midwifery care for early pregnancy loss varied considerably. Four main themes were identified as the aspects of midwifery care that made the biggest differences on clients’ experiences of receiving care for early pregnancy loss: (1) Accessing care for early pregnancy loss, (2) Continuity and following-through, (3) Compassionate and supportive care, and (4) Knowledge, information and choice. Overall, the findings suggest clients benefit from compassionate, individualized support during their early pregnancy loss. Midwives’ experiences constraints related to their workload, clinic culture, local resources available, and compensation model that impacted their ability to respond to clients’ needs and expectations. Conclusion: Interventions to improve client care should look beyond client-provider interactions and consider ways to improve midwives’ experiences and their ability to meet their client needs. Furthermore, to improve women’s experiences, a more coordinated, patient-centered response at a systems level is needed. As this is the first study to examine the midwifery model of care for early pregnancy loss, findings from this study contribute to recommendations for practice, policy, and research.
A qualitative examination of the impact of social restrictions during COVID-19 pandemic on social relations and social interactions of adolescents aged 12-18 years in Ontario, Canada
(University of Waterloo, 2022-10-24) Imanzi, Liza; Neiterman, Elena
Background: The novel coronavirus outbreak (COVID-19) was declared a global pandemic by the World Health Organization (WHO) in March 2020 (WHO, 2020). The government of Ontario declared a stay-at-home order where schools were closed, and remote learning was used as an alternative to in-person learning. Adolescents were affected by these measures in many aspects, including experiencing elongated social isolation, social deprivation and losing in-person interaction with their peers (Orben et al.,2020). Adolescents undergo physiological changes, including changing neurotransmitters such as serotonin and dopamine, which affect the volatility and frequency at which their emotions changes (Bailen et al., 2019). Adolescents also experience change within their interpersonal relationships and interactions, mainly with their peers and parents (Brechwald & Prinstein, 2011). There is a need, therefore, to further research and understand how COVID-19-related stressful experiences such as social isolation could have potentially affected adolescents’ relationships. Objectives: This study aimed to examine how school closures, social distancing, and other types of social restrictions applied during the COVID-19 pandemic in Ontario, affected social relationships and social interactions of adolescents aged 12-18. Methods: In this qualitative study, Interpretative Phenomenological Analysis (IPA) was used to enable the researcher to examine the lived experiences of adolescents during the pandemic, focusing specifically on the changes in their relationships and social interactions. This goal was achieved through conducting open-ended interviews with 7 adolescents (ages 15-18) who live in Ontario. Participants were recruited through social media, emails and posters. Interviews lasted be-tween 60-90 minutes in length were conducted through Microsoft Teams Video Tool, and the data was recorded and analyzed inductively using IPA. Results: A difference between the male and female gender was observed, where male participants were less likely to mention their need for social interactions than female participants. The study also found that for adolescents, friends played a role in coping with the pandemic. Finally, the participants started to overcompensate for social interactions after the pandemic restrictions were relaxed, because of the opportunities they felt they missed out on during isolation. Conclusion: Throughout the pandemic, adolescents' relationships were affected due to lack of social interactions during lockdowns. This study can be used to guide future policies to have less of a negative impact on adolescents as a further step to prepare for future potential social isolation situations. The findings can also be used as a baseline for future studies to understand the long-term effects adolescents have when exposed to long periods of social isolation.
Sex and Intimacy in the Postpartum Period: A Qualitative Reddit Analysis of Women’s and Men’s Experiences
(University of Waterloo, 2020-09-22) Harrison, Lauren Nicole; Neiterman, Elena
Background: After a birth, physical, mental, social, and structural changes are common, and this may impact parents’ experiences of sex and intimacy. Women often report increased sexual morbidity and a decline in sexual desire, sexual satisfaction and sexual frequency. While much is known about women’s sexual dysfunction postpartum, less is known about experiences of intimacy and the meaning parents attach to the changes in sex and intimacy. Additionally, very little is known about men’s experiences of sex and intimacy postpartum. Research Questions: This study aimed to explore women’s and men’s experiences of sex and intimacy following the birth of a child by asking the following questions: (1) what (if any) changes do women and men experience in sex and/ or intimacy during the postpartum period?; (2) how do parents negotiate these changes?; and (3) how is the return to sex negotiated by men and women after birth? Methods: This was a qualitative study that used the online public forum Reddit to conduct a secondary data analysis. Constructivist grounded theory was used to analyze posts by men and women. Results: Reddit posts shared by men and women showed that they experienced significant changes in sex and intimacy postpartum that were often difficult to navigate. Parents identified a variety of barriers to sex and intimacy, and this often negatively impacted their well-being and relationships. Gender norms shaped the experiences of sex and intimacy as parents followed sexual scripts within heterosexual relationships, and women’s and men’s experiences were sometimes perceived differently based on gender roles by the members of the Reddit community. The transition into parenthood and new parenting responsibilities often conflicted with women’s and men’s roles as romantic partners. Additionally, the sex education women and men received prior to the postpartum period had a significant impact on their experiences and left some parents unprepared. Conclusion: The transitions that occur in the postpartum period provide a variety of challenges for parents that may negatively impact their experiences of sex and intimacy. Health care providers should initiate conversations with parents about sex and intimacy in the postpartum period to normalize common experiences and educate parents about additional resources should they be required.
Shades of Care: Understanding how BIPOC mothers and children experience paediatric care in Ontario, Canada
(University of Waterloo, 2021-12-09) Ladha, Raisa; Neiterman, Elena
BACKGROUND: Race and ethnicity are determinants of health which play significant roles in shaping the quality of care and health outcomes for a child. In Canada’s increasingly diversifying patient populations, it has been observed that definitions and experiences of health vary. Lack of understanding of these variations within the context of paediatric care can set children on a trajectory for negative health outcomes in the future, whereas their acknowledgement and active incorporation in care has the potential to orient children on a path towards holistic wellness. OBJECTIVES: The purpose of this study was to gain an understanding of how BIPOC mothers and children experience paediatric care in Ontario. It additionally aimed to explore how BIPOC mothers perceive the provider-patient relationship and what their needs and expectations are in these encounters in order to positively engage with and receive paediatric healthcare services. METHODS: The participant sample consisted of BIPOC mothers residing in Ontario who have required paediatric care for their children (ages 0- 5). Fourteen semi-structured interviews occurred via video call or over-the-phone. Semi-structured interviews were conducted to allow participants the opportunity to authentically share their experiences, safely and without judgement. Participants’ stories were inductively coded and examined through narrative analysis to discern how BIPOC mothers represent their experiences of acquiring paediatric care. RESULTS: Participants shared multi-dimensional definitions of health in the context of their own children, which influenced their perceptions of healthcare experiences. Provider-patient interactions were ultimately a central component of the patient experience, with needs such as respect and compassionate bedside manner being universal. Positive experiences within the provider-patient relationship tended to be as a result of individual providers’ efforts and commitment to their patients. Healthcare providers were described as influencing participants’ abilities to lay a strong foundation for their children’s future. This is of particular significance as BIPOC mothers have expressed an increased sense of responsibility in advocating for and working towards optimal states of wellness for their children. Participants recalled building or engaging with communities of support to ensure their children’s wellness, and healthcare providers were suggested to become a central part of these communities, as opposed to simply existing on the periphery. CONTRIBUTIONS: This study enables a comprehensive understanding of how BIPOC mothers conceptualize “health” for their children, as well as how they experience paediatric care in Ontario and how they feel about these interactions. Contributions of this research are 3-pronged: (1) enhancing cross-cultural understanding in paediatric care; (2) identifying the healthcare needs of paediatric patients and their families; and (3) informing clinical practice. This study also provides direction as to what sorts of approaches must be taken in order to sustainably implement culturally collaborative paediatric care in Ontario.
Understanding the Dynamics of Informal, Community-Based Care Among LGBTQ2+ Young Adults in Southwestern Ontario
(University of Waterloo, 2022-09-26) Reis, Logan; Dolson, Mark; Neiterman, Elena
Background: Historically, North American health care has been developed through predominantly a hetero- and cis-normative, and white, lens which has led to the social exclusion of LGBTQ2+ individuals through institutional heterosexism, racism, homophobia, and transphobia (Brotman, Ferrer, Sussman, Ryan, & Richard, 2015; Gahagan & Colpitts, 2017; Hudson & Romanelli, 2019; Pepper, 2015; Warner, 2002). Non-inclusive health care services have the potential to compromise the well-being LGBTQ2+ young adults and influence their willingness to seek health care services, which can lead to additional adverse health outcomes (Burch, 2008; Gahagan & Colpitts, 2017; Hudson & Romanelli, 2019; Zay Hta et al., 2021). Emerging research presents evidence that a sense of community care develops among marginalized groups struggling with similar adversities; however, there are several uncertainties surrounding the experiences of informal community-based care that LGBTQ2+ young adults provide or receive in the absence of inclusive, professional health care services (Gahagan & Colpitts, 2017; Garcia, 2010; Kleinman & Van der geest, 2009; Sturman & Matheson, 2020). Specific aims: The goal of this research is to explore whether LGBTQ2+ young adults in Southwestern Ontario receive and provide informal community-based care for one another in the potential and/or perceived absence of sexuality-inclusive and trans/non-binary gender competent health care services. My research sought to identify which informal, community-based care practices might be enacted amongst this marginalized population, as well as determining what prompts these young adults to offer and receive this type of emergent care. Methods: This study included qualitative semi-structured interviews with young adults in Southwestern Ontario who identify as a part of the LGBTQ2+ community. The interviews explored their experiences within the formal health care system and community-based care. Calls for the participation of LGBTQ2+ community members to were advertised via flyers (see Appendix. A) that were distributed online through LGBTQ2+ networks, social media forums, LGBTQ2+ servers (Twitter, Discord, Reddit). Zoom video conferencing software was used to conduct the interviews. Abductive reasoning was applied during the narrative analysis of the participants’ responses to identify potential motivations and ways in which LGBTQ2+ young adults promote well-being amongst themselves. Autoethnographic reflection pieces were utilized throughout the study and during the analysis to provide further experiential insights as well as my own voice in the findings. Results: Responses garnered from 10 interviews with LGBTQ2+ young adults (24-27) living in southwestern Ontario are included in the results of this study to demonstrate their experiences with formal health care services and informal community-based care. These experiences provide reasonings for the reluctance to rely on formal health care as well as impetuses for turning to informal community-based care. The most common methods of informal community-based care included forms of emotional, physical and epistemic care. Lastly, the results of this study illuminated the existence of a sense of watchfulness and social obligation to care for fellow members of the LGBTQ2+ community that transcend social, economic and geographic differences. Conclusion: The results from the study illustrate how sex, sexuality, trans/ non-binary gender, and variation of gender identity or expression, can shape young peoples’ experiences with or their willingness to seek out health care services. The findings of the study demonstrate the potential reluctance for LGBTQ2+ young adults to solely rely on mainstream health care practices by illuminating the prevalent barriers to inclusive services. This study is one of the first to identity some of the potential approaches that LGBTQ2+ young adults might employ to provide care to, or receive care from, fellow community members (alternatively to, or in tandem with, formal health care). Lastly, the study describes the possible impetuses beyond the unwillingness to pursue formalized health care services, for the utilization of informal community-based care.
“When you add Black and Female, it’s almost like a double whammy”: The Gendered and Racialized Experiences of Professional Integration among Internationally Educated Health Professionals in Canada
(University of Waterloo, 2022-04-20) Boroto, Christiane Mugishe Marie Jeanne; Neiterman, Elena
Background: Scholars have noted that migration of health professionals is a global phenomenon. According to the World Health Organization, the immigration of internationally educated health professionals (IEHPs) to Organization for Economic Co-operation and Development (OECD) countries has increased in the past decade by 60 percent (WHO, 2022). Canada is one of the OECD countries that IEHPs may find attractive. While academics have identified the many barriers for professional integration IEHPs in Canada, there is a gap in the literature in relation to how gender shapes the experiences of professional integration within the Canadian context. My thesis aimed to fill this gap in the literature. Specific Aims: The specific aim of the study was to determine how gender and race shape the professional integration experiences of IEHPs in Canada by focusing on the intersection of gender, race and ethnicity. Methods: The study employed a qualitative research design and was informed by feminist methodology. Theoretically, the research was grounded in the theory of intersectionality. Semi-structured interviews were conducted with 20 IEHPs. The analysis applied Winker & Degele’s (2011) framework for an intersectional multi-level analysis. Results: Six stories of IEHPs working in different fields of the Canadian health care setting are featured in the results to describe the participants’ experiences. The stories draw on comparisons with other participants’ accounts and illuminate the complexity of the immigration process and the institutional barriers to professional integration. They also show how race and country of education shape the process of professional integration. Lastly, the stories illustrate how gendered roles, and in particular motherhood, shape the process of professional integration of IEHPs, while revealing the unique challenges IEHPs who are also women of colour may encounter. Conclusion: The results from the study illustrate how the intersection of gender, race and professional identity create unique contexts for IEHPs, as they seek out their professional integration. This study is one of the first studies to explore how gender shapes professional integration of internationally educated health professionals within Canada . The findings of the study illustrate how social identities may enable or hinder peoples’ experiences of professional integration. Lastly, the study demonstrates how racist ideologies are embedded in regulatory policies and practices and hinder professional integration of some IEHPs.