La position sociale : un déterminant révélateur de l’expérience des personnes migrantes sans assurance médicale à Montréal durant la pandémie de COVID-19

Selon les plus récentes estimations, la Loi sur l’assurance maladie laisse 50 000 à 70 000 migrants sans assurance médicale au Québec. L’accès aux soins de santé dans la province canadienne est, entre autres, lié au statut migratoire. Avant la pandémie, diverses barrières à l’accès aux soins (administratives, économiques, linguistiques, culturelles, etc.) avaient été identifiées. En tant que déterminant social de la santé, l’accès discriminatoire aux soins de santé nuit à la santé de ces migrants. Dans le contexte de la crise sanitaire liée à la COVID-19, les inégalités sociales en santé ont semblé s’intensifier pour les personnes issues des diverses communautés migrantes vivant à Montréal et ailleurs dans le monde. Grâce à un projet de recherche qualitatif, nous explorons dans cet article comment la position sociale, en particulier le statut migratoire, se traduit dans l’expérience vécue pendant la pandémie de COVID-19 pour les personnes migrantes sans assurance médicale vivant à Montréal. Pour atteindre cet objectif, nous avons mené des entretiens semi-structurés auprès de 19 personnes lors de la première et de la deuxième vague de pandémie (août 2020 à octobre 2020). Nos résultats suggèrent que le statut migratoire, à l’intersection avec le revenu, les conditions de travail et les rapports de genre, joue un rôle déterminant sur l’expérience vécue des participants avant et pendant la pandémie. Cela met en lumière l’urgence de mettre en place des politiques publiques plus inclusives pour assurer l’accès à l’aide sociale et à l’assurance médicale afin de remédier aux inégalités sociales en santé auxquelles sont confrontées les personnes migrantes sans assurance médicale vivant au Québec

Why urban communities from low-income and middle-income countries participate in public and global health research: protocol for a scoping review

Introduction As the number of people living in cities increases worldwide, particularly in low-income and middle-income countries (LMICs), urban health is a growing priority of public and global health. Rapid unplanned urbanisation in LMICs has exacerbated inequalities, putting the urban poor at increased risk of ill health due to difficult living conditions in cities. Collaboration with communities in research is a key strategy for addressing the challenges they face. The objective of this scoping review is, therefore, to identify factors that influence the participation of urban communities from LMICs in public and global health research.Methods and analysis We will develop a search strategy with a health librarian to explore the following databases: MEDLINE, Embase, Web of Science, Cochrane, Global Health and CINAHL. We will use MeSH terms and keywords exploring the concepts of ‘low-income and middle-income countries’, ‘community participation in research’ and ‘urban settings’ to look at empirical research conducted in English or French. There will be no restriction in terms of dates of publication. Two independent reviewers will screen and select studies, first based on titles and abstracts, and then on full text. Two reviewers will extract data. We will summarise the results using tables and fuzzy cognitive mapping.Ethics and dissemination This scoping review is part of a larger project to be approved by the University of Montréal’s Research Ethics Committee for Science and Health in Montréal (Canada), and the Institutional Review Board of the James P Grant School of Public Health at BRAC University in Dhaka (Bangladesh). Results from the review will contribute to a participatory process seeking to combine scientific evidence with experiential knowledge of stakeholders in Dhaka to understand how to better collaborate with communities for research. The review could contribute to a shift toward research that is more inclusive and beneficial for communities

Considering social inequalities in health in large-scale testing for COVID-19 in Montréal: a qualitative case study

International audienceAbstract Background Evidence continues to demonstrate that certain marginalised populations are disproportionately affected by COVID-19. While many studies document the impacts of COVID-19 on social inequalities in health, none has examined how public health responses to the pandemic have unfolded to address these inequities in Canada. The purpose of our study was to assess how social inequalities in health were considered in the design and planning of large-scale COVID-19 testing programs in Montréal (Québec, Canada). Methods Part of the multicountry study HoSPiCOVID, this article reports on a qualitative case study of large-scale testing for COVID-19 in Montréal. We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using existing literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo. Results Our findings suggest that large-scale COVID-19 testing in Montréal did not initially consider social inequalities in health in its design and planning phases. Considering the sense of urgency brought by the pandemic, participants noted the challenges linked to the uptake of an intersectoral approach and of a unified vision of social inequalities in health. However, adaptations were gradually made to large-scale testing to improve its accessibility, acceptability, and availability. Actors from the community sector, among others, played an important role in supporting the health sector to address the needs of specific subgroups of the population. Conclusions These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programs must tackle structural barriers to accessing healthcare services during health crises. This will be necessary to ensure that pandemic preparedness and response, including large-scale testing, do not further increase social inequalities in health

Fuzzy cognitive mapping in participatory research and decision making: a practice review

Abstract Background Fuzzy cognitive mapping (FCM) is a graphic technique to describe causal understanding in a wide range of applications. This practice review summarises the experience of a group of participatory research specialists and trainees who used FCM to include stakeholder views in addressing health challenges. From a meeting of the research group, this practice review reports 25 experiences with FCM in nine countries between 2016 and 2023. Results The methods, challenges and adjustments focus on participatory research practice. FCM portrayed multiple sources of knowledge: stakeholder knowledge, systematic reviews of literature, and survey data. Methodological advances included techniques to contrast and combine maps from different sources using Bayesian procedures, protocols to enhance the quality of data collection, and tools to facilitate analysis. Summary graphs communicating FCM findings sacrificed detail but facilitated stakeholder discussion of the most important relationships. We used maps not as predictive models but to surface and share perspectives of how change could happen and to inform dialogue. Analysis included simple manual techniques and sophisticated computer-based solutions. A wide range of experience in initiating, drawing, analysing, and communicating the maps illustrates FCM flexibility for different contexts and skill bases. Conclusions A strong core procedure can contribute to more robust applications of the technique while adapting FCM for different research settings. Decision-making often involves choices between plausible interventions in a context of uncertainty and multiple possible answers to the same question. FCM offers systematic and traceable ways to document, contrast and sometimes to combine perspectives, incorporating stakeholder experience and causal models to inform decision-making. Different depths of FCM analysis open opportunities for applying the technique in skill-limited settings