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Negotiating candidacy: ethnic minority seniors' access to care

Published online by Cambridge University Press:  21 April 2009

SHARON KOEHN
SHARON KOEHN*
Affiliation:
Centre for Healthy Aging at Providence, Vancouver, British Columbia, Canada.
*
Address for correspondence: Sharon Koehn, Centre for Healthy Aging at Providence, c/o Honoria Conway Assisted Living, 4875 Heather Street, Vancouver, BC, V57 0A7, Canada. E-mail: skoehn@providencehealth.bc.ca
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Abstract

The ‘Barriers to Access to Care for Ethnic Minority Seniors’ (BACEMS) study in Vancouver, British Columbia, found that immigrant families torn between changing values and the economic realities that accompany immigration cannot always provide optimal care for their elders. Ethnic minority seniors further identified language barriers, immigration status, and limited awareness of the roles of the health authority and of specific service providers as barriers to health care. The configuration and delivery of health services, and health-care providers' limited knowledge of the seniors' needs and confounded these problems. To explore the barriers to access, the BACEMS study relied primarily on focus group data collected from ethnic minority seniors and their families and from health and multicultural service providers. The applicability of the recently developed model of ‘candidacy’, which emphasises the dynamic, multi-dimensional and contingent character of health-care access to ethnic minority seniors, was assessed. The candidacy framework increased sensitivity to ethnic minority seniors' issues and enabled organisation of the data into manageable conceptual units, which facilitated translation into recommendations for action, and revealed gaps that pose questions for future research. It has the potential to make Canadian research on the topic more co-ordinated.

Keywords

seniorsimmigrantsaccess to servicescontinuing careBritish Columbiacandidacy model
Type
Research Article
Information
Ageing & Society , Volume 29 , Issue 4 , May 2009 , pp. 585 - 608
Copyright
Copyright © 2009 Cambridge University Press

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References

Ahmad, W. I. U. and Walker, R. 1997. Asian older people: housing, health and access to services. Ageing & Society, 17, 2, 141–65.CrossRefGoogle Scholar
Ahmad, F., Shik, A., Vanza, R., Cheung, A. M., George, U. and Stewart, D. E. 2004. Voices of South Asian women: immigration and mental health. Women and Health, 40, 4, 113–30.CrossRefGoogle ScholarPubMed
Ajrouch, K. J. 2005. Arab-American immigrant elders' views about social support. Ageing & Society, 25, 5, 655–73.CrossRefGoogle Scholar
Aroian, K. J., Wu, B. and Tran, T. V. 2005. Health care and social service use among Chinese immigrant elders. Research in Nursing and Health, 28, 2, 95–105.CrossRefGoogle ScholarPubMed
Aziz, S. J. and Campbell-Taylor, I. 1999. Neglect and abuse associated with under-nutrition in long-term care in North America: causes and solutions. Journal of Elder Abuse and Neglect, 10, 1, 91–117.CrossRefGoogle Scholar
BC Stats 2002. Mother Tongue and Home Language. Immigration Highlights 02-3, Government of British Columbia, Victoria. Available online at www.bcstats.gov.bc.ca/pubs/immig/imm023sf.pdf [Accessed 25 January 2007].Google Scholar
BC Stats 2006. Family Immigrants to British Columbia. Immigration Highlights 05-4, Government of British Columbia, Victoria. Available online at www.bcstats.gov.bc.ca/pubs/immig/imm054sf.pdf [Accessed 25 January 2007].Google Scholar
Bennett, M. 2005. Annotated Bibliography of Aboriginal Women's Health and Healing Research. Aboriginal Women's Health and Healing Group, Vancouver, British Columbia.Google Scholar
Bowen, S. 2001. Language Barriers in Access to Health Care. Health Canada, Ottawa. Available online at http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2001-lang-acces/2001-lang-acces-eng.pdf [Accessed 8 September 2008].Google Scholar
Bowes, A. M. and Dar, N. S. 2000. Researching social care for minority ethnic older people: Implications of some Scottish research. British Journal of Social Work, 30, 3, 305–21.CrossRefGoogle Scholar
Brotman, S. 2002. The primacy of family in elder care discourse: home care services to older ethnic women in Canada. Journal of Gerontological Social Work, 38, 3, 19–51.CrossRefGoogle Scholar
Brotman, S. 2003. The limits of multiculturalism in elder care services. Journal of Aging Studies, 17, 2, 209–29.CrossRefGoogle Scholar
Browne, A. J., and Fiske, J. A. 2001. First Nations women's encounters with mainstream health care services. Western Journal of Nursing Research, 23, 2, 126–47.CrossRefGoogle ScholarPubMed
Cambridge, A. 1996. The beauty of valuing black cultures. In Amit-Talai, V. and Knowles, C. (eds), Re-situating Identities: The Politics of Race, Ethnicity, and Culture. Broadview, Peterborough, Ontario, 161–83.Google Scholar
Canadian Association of Community Care and Canadian Ethnocultural Council (CACCEC) 1998. A Feasibility Study on Multicultural Community Care: Identifying Barriers and Finding Solutions. CACCEC, Ottawa.Google Scholar
Cancian, F. 1975. What Are Norms? A Study of Beliefs and Action in a Maya Community. Cambridge University Press, Cambridge.Google Scholar
Chen, A. W. and Kazanjian, A. 2005. Rate of mental health service utilization by Chinese immigrants in British Columbia. Canadian Journal of Public Health, 96, 1, 49–51.CrossRefGoogle ScholarPubMed
Chiu, L. F. and Knight, D. 1999. How useful are focus groups for obtaining the views of minority groups? In Barbour, R. S. and Kitzinger, J. (eds), Developing Focus Group Research: Politics, Theory, and Practice. Sage, London, 99–112.CrossRefGoogle Scholar
Citizenship and Immigration Canada 2005. Family Class Immigration. Citizenship and Immigration Canada, Ottawa. Available online at http://www.cic.gc.ca/english/sponsor/index.html [Accessed 25 January 2007].Google Scholar
Conrad, M. M. and Pacquiao, D. F. 2005. Manifestation, attribution, and coping with depression among Asian Indians from the perspectives of health care practitioners. Journal of Transcultural Nursing, 16, 1, 32–40.CrossRefGoogle ScholarPubMed
Dempsey, C. 2004. Elderly immigrants: income sources and compositions. Horizons, 7, 2, 58–65.Google Scholar
DesMeules, M., Gold, J., Kazanjian, A. M. D., Payne, J., Bissandjee, B., McDermott, S. and Mao, Y. 2004. New approaches to immigrant health assessment. Canadian Journal of Public Health, 95, 3, I22–I26.CrossRefGoogle ScholarPubMed
Dixon-Woods, M., Kirk, M. D., Agarwal, M. S., Annandale, E., Arthur, T., Harvey, J., Hsu, R., Katbamna, S., Olsen, R. and Smith, L. 2005. Vulnerable Groups and Access to Health Care: A Critical Interpretive Review. National Co-ordinating Centre for NHS Service Delivery and Organisation, London. Available online at http://www.menshealthforum.org.uk/uploaded_files/SDOvulnerablegroups2005.pdf [Accessed 20 February 2008].Google Scholar
Dixon-Woods, M., Cavers, D., Agarwal, M. S., Annandale, E., Arthur, T., Harvey, J., Hsu, R., Katbamna, S., Olsen, R., Smith, L. K., Riley, R. and Sutton, A. J. 2006 a. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6, 35 (doi: 10.1186/1471-2288-6-35). Available online at http://www.biomedcentral.com/1471-2288/6/35 [Accessed 25 January 2007].CrossRefGoogle ScholarPubMed
Dixon-Woods, M., Williams, S. J., Jackson, C. J., Akkad, A., Kenyon, S. and Habiba, M. 2006 b. Why do women consent to surgery, even when they do not want to? An interactionist and Bourdieusian analysis. Social Science and Medicine, 62, 11, 2742–53.CrossRefGoogle ScholarPubMed
Evans, R. G. 2002. Raising the Money Options: Consequences, and Objectives for Financing Health Care in Canada. Commission on the Future of Health Care in Canada, Ottawa.Google Scholar
Fontana, A. and Frey, J. H. 1994. Interviewing: the art of science. In Denzin, N. K. and Lincoln, Y. S. (eds), Handbook of Qualitative Research. Sage, Thousand Oaks, California, 361–76.Google Scholar
Forbat, L. 2004. The care and abuse of minoritized ethnic groups: the role of statutory services. Critical Social Policy, 24, 3, 312–31.CrossRefGoogle Scholar
Friesen, C. and Hyndman, J. 2004. A System in Crisis: 2004 Inter-Provincial Report Card on Language and Settlement Services in Canada. Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada. Available online at http://www.immigrantsandrefugees.ca [Accessed 27 January 2007].Google Scholar
Gee, E. M., Kobayashi, K. M. and Prus, S. G. 2004. Examining the healthy immigrant effect in mid- to later life: findings from the Canadian Community Health Survey. Canadian Journal on Aging, 23, supplement 1, S61–9.CrossRefGoogle ScholarPubMed
Gerrish, K. 2001. The nature and effect of communication difficulties arising from interactions between district nurses and South Asian patients and their carers. Journal of Advanced Nursing, 335, 5, 566–74.CrossRefGoogle Scholar
Government of British Columbia (GoBC) 2002. BC's New Residential Care Access Policy. Health Services, GoBC, Vancouver. Available online at http://www.hlth.gov.bc.ca/hcc/pdf/residentialpolicy.pdf [Accessed 25 January 2007].Google Scholar
Grewal, S., Bottorff, J. L. and Hilton, B. A. 2005. The influence of family on immigrant South Asian women's health. Journal of Family Nursing 11, 3, 242–63.CrossRefGoogle ScholarPubMed
Gupta, R. 2002. Consideration of nursing home care placement for the elderly in South Asian families. Journal of Immigrant Health, 4, 1, 47–56.CrossRefGoogle ScholarPubMed
Guruge, S. and Khanlou, N. 2004. Intersectionalities of influence: researching the health of immigrant and refugee women. Canadian Journal of Nursing Research, 36, 3, 32–47.Google ScholarPubMed
Hallett, T. 2003. Symbolic power and organizational culture. Sociological Theory, 21, 2, 128–49.CrossRefGoogle Scholar
Ineichen, B. 1990. The mental health of Asians in Britain. British Medical Journal, 300, 1669.CrossRefGoogle ScholarPubMed
Ip, D., Lui, C. W. and Chui, W. H. 2007. Veiled entrapment: a study of social isolation of older Chinese migrants in Brisbane, Queensland. Ageing & Society, 27, 5, 719–38.CrossRefGoogle Scholar
Janzen, J. A., Silvius, J., Jacobs, S., Slaughter, S., Dalziel, W. and Drummond, N. 2006. What is a health expectation? Developing a pragmatic conceptual model from psychological theory. Health Expectations: International Journal of Public Participation in Health Care and Health Policy, 9, 1, 37–48.CrossRefGoogle ScholarPubMed
Johnson, J. L., Bottorff, J. L., Browne, A. J., Grewal, S., Hilton, B. A. and Clarke, H. 2004. Othering and being othered in the context of health care services. Health Communication 16, 2, 255–71.CrossRefGoogle ScholarPubMed
Katbamna, S., Ahmad, W., Bhakta, P., Baker, R. and Parker, G. 2004. Do they look after their own? Informal support for South Asian carers. Health and Social Care in the Community, 12, 5, 398–406.CrossRefGoogle ScholarPubMed
Keefe, J. 2000. The impact of ethnicity on helping older relatives: findings from a sample of employed Canadians. Canadian Journal on Aging, 19, 3, 317–42.CrossRefGoogle Scholar
Kirmayer, L. J. 1989. Cultural variations in the response to psychiatric disorders and emotional distress. Social Science and Medicine, 29, 3, 327–39.CrossRefGoogle ScholarPubMed
Kleinman, A. 1987. Anthropology and psychiatry: the role of culture in cross-cultural research on illness. British Journal of Psychiatry, 151, 4, 447–54.CrossRefGoogle ScholarPubMed
Kobayashi, K. M. 2000. The nature of support from adult sansei third generation children to older nisei second generation parents in Japanese-Canadian families. Journal of Cross-Cultural Gerontology, 15, 3, 185–205.CrossRefGoogle ScholarPubMed
Koehn, S., Cormier, R. and Sachova, P. 2004. Engaging Ethnic Minority Groups in Action Research: Social Contextual Considerations Impacting Participants' Co-construction of Focus Group Data. Paper presented at the 33rd Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, October 21–23, Victoria, British Columbia.Google Scholar
Koehn, S. 1999. A Fine Balance: Family, Food, and Faith in the Health Worlds of Elderly Punjabi Women. Doctoral dissertation, University of Victoria, Victoria, British Columbia.Google Scholar
Koehn, S. 1993. Negotiating New Lives and New Lands: Elderly Punjabi Women in British Columbia. Master's thesis, University of Victoria, Victoria, British Columbia.Google Scholar
Krause, I. B., Rosser, R. M., Khiani, M. L. and Lotay, N. S. 1990. Psychiatric morbidity among Punjabi medical patients in England measured by general health questionnaire. Psychological Medicine, 20, 3, 711–9.CrossRefGoogle ScholarPubMed
Lindesay, J., Jagger, C., Hibbett, M. J., Peet, S. M. and Moledina, F. 1997. Knowledge, uptake and availability of health and social services among Asian Gujarati and white elderly persons. Ethnicity and Health, 2, 1, 59–69.CrossRefGoogle ScholarPubMed
Littlewood, R. 1990. From categories to contexts: a decade of the ‘new cross-cultural psychiatry’. British Journal of Psychiatry, 156, 3, 308–27.CrossRefGoogle ScholarPubMed
Manthorpe, J. and Hettiaratchy, P. 1993. Ethnic minority elders in the UK. International Review of Psychiatry, 5, 2, 171–8.CrossRefGoogle Scholar
Marwaha, S. and Livingston, G. 2002. Stigma, racism or choice: why do depressed ethnic elders avoid psychiatrists? Journal of Affective Disorders, 72, 3, 257–65.CrossRefGoogle ScholarPubMed
Matthews, S. H. 1993. Collecting qualitative data through interviews with ethnic older people. Canadian Journal on Aging, 12, special issue, Qualitative Methods, 216–32.Google Scholar
National Advisory Council on Aging Canada 2005. Seniors on the Margins: Seniors from Ethnocultural Minorities. Minister of Public Works and Government Services Canada, Ottawa. Available online at http://www.naca.ca/margins/ethnocultural/pdf/margins-ethnocultural_e.pdf [Accessed 26 April 2007].Google Scholar
Newbold, K. B. 2005. Self-rated health within the Canadian immigrant population: risk and the healthy immigrant effect. Social Science and Medicine 60, 6, 1359–70.CrossRefGoogle ScholarPubMed
Neysmith, S. M. 1999. Critical Issues for Future Social Work Practice with Aging Persons. Columbia University Press, New York.Google Scholar
Ostbye, T., Yarnall, K. S. H., Krause, K. M., Pollak, K. I., Gradison, M. and Michener, J. L. 2005. Is there time for management of patients with chronic diseases in primary care? Annals of Family Medicine, 3, 3, 209–14.CrossRefGoogle ScholarPubMed
Pereira, I., Lazarowich, N. M. and Wister, A. 1996. Ethnic content in long-term care facilities for Portuguese and Italian elderly. Canadian Ethnic Studies, 28, 2, 82–97.Google Scholar
Polyakova, S. A. and Pacquiao, D. F. 2006. Psychological and mental illness among elder immigrants from the former Soviet Union. Journal of Transcultural Nursing, 17, 1, 40–9.CrossRefGoogle ScholarPubMed
Policy Research Institute on Ageing and Ethnicity (PRIAE) 2003. Minority Elderly Health and Social Care in Europe. PRIAE, Leeds, West Yorkshire, UK. Available online at http://www.priae.org/docs/MEC%20European%20Summary%20Findings2.pdf [Accessed 2 February 2008].Google Scholar
Richards, L. 1999. Using NVivo in Qualitative Research. Sage, London.Google Scholar
Sadavoy, J., Meier, R. and Ong, A. Y. 2004. Barriers to access to mental health services for ethnic seniors: the Toronto study. Canadian Journal of Psychiatry, 49, 3, 192–9.CrossRefGoogle ScholarPubMed
Sasso, A. 2004. Achieving Equal Access in Health Care. Affiliation of Multicultural Service Agencies and Societies, Vancouver, British Columbia. Available online at http://www.amssa.org/publications/healthacessreport.pdf [Accessed 25 January 2007].Google Scholar
Sörensen, S., and Pinquart, M. 2000. Preparation for future care needs: styles of preparation used by older eastern German, United States, and Canadian women. Journal of Cross-Cultural Gerontology, 15, 4, 349–81.CrossRefGoogle ScholarPubMed
Statistics, Canada 2005. Longitudinal Survey of Immigrants to Canada: A Portrait of Early Settlement Experiences. Report 89-614-XIE, Minister of Industry, Ottawa. Available online at http://www.statcan.ca/bsolc/english/bsolc?catno=89-614-XIE [Accessed 27 April 2007].Google Scholar
Statistics Canada 2001. 2001 Census of Canada. Catalogue 95F0363XCB2001004, Statistics Canada, Ottawa.Google Scholar
Stokes, T., Dixon-Woods, M. and Williams, S. 2006. Breaking the ceremonial order: patients' and doctors' accounts of removal from a general practitioner's list. Sociology of Health and Illness, 28, 5, 611–36.CrossRefGoogle ScholarPubMed
Temple, B. and Edwards, R. 2002. Interpreters/translators and cross-language research: reflexivity and border crossings. International Journal of Qualitative Methods, 1, 1, 2–22.CrossRefGoogle Scholar
Torres, S. 2001. Understandings of successful ageing in the context of migration: the case of Iranian immigrants in Sweden. Ageing & Society, 21, 3, 333–55.CrossRefGoogle Scholar
Vancouver Coastal Health 2005. A Health and Social Profile of Community Health Area 3. Vancouver Coastal Health, Vancouvera, British Columbia. Available online at http://www.vch.ca/community/Docs/comm_health_area3.pdf [Accessed 27 April 2007].Google Scholar
Williams, R. and Hunt, K. 1997. Psychological distress among British South Asians: the contribution of stressful situations and subcultural differences in the west of Scotland Twenty-07 study. Psychological Medicine, 27, 5, 1173–81.CrossRefGoogle ScholarPubMed
Wister, A. V. and Moore, C. 1998. First Nations elders in Canada: issues, problems, and successes in health care policy. In Gutman, G. M. and Wister, A. V. (eds), Health Systems and Aging in Selected Pacific Rim Countries: Cultural Diversity and Change. Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, 103–24.Google Scholar
Wong, S. T., Yoo, G. J. and Stewart, A. L. 2006. The changing meaning of family support among older Chinese and Korean immigrants. Journals of Gerontology: Psychological Sciences and Social Sciences, 61, 1, S4–9.CrossRefGoogle ScholarPubMed