Leadership and System Transformation: Advancing the Role of Community Health Nursing

It is widely recognized that structural and social determinants of health (SDoH) account for a large proportion of health inequities in Canada. According to the Public Health Agency of Canada (PHAC), many health actors are required to provide leadership and direction in tackling health inequities. In this paper we argue that community health nurses (CHNs) are well situated to play a critical role in health system transformation in Canada. CHNs are known for having a holistic and collaborative approach with competencies beneficial for the reduction of health inequities. However, to become more consistently effective advocates of health equity, CHNs require competencies in the principles of equity and social justice, community engagement, communication, coalition building, and system transformation. Having a critical mass of CHNs with appropriate leadership skills in knowledge generation and mobilization, advocacy, and collaboration is fundamental to effectively addressing health inequities in Canada

The Mental Health of Refugee Children in Canada

This paper reviews the literature on sources of stress, and the personal and social resources refugee youth use to cope with adversity. Preliminary findings from the Clarke Institute/University of Toronto Department of Psychiatry Southeast Asian (SEA) Refugee Youth Project, a study of the mental health and adaptation of SEA youth to Canada, are used to supplement findings from the literature. The review highlights research needs as well as possibilities for programs that could help promote the successful adaptation of refugee youth in Canada.Cet article passe en revue la documentation décrivant les tensions vécues par les jeunes réfugiés, et les ressources individuelles et sociales dont ils disposent pour faire face à l'adversité. Nous complétons les données provenant de la documentation déjà disponible à l'aide d'informations préliminaires tirées d'une étude sur la santé mentale et l'adaptation de jeunes du Sud-Est asiatique à l'environnement canadien, menée conjointement par l'Institut Clarke et le Département de Psychiatrie de l'Université de Toronto (Southeast Asian Refugee Youth Project). L'article met en relief le besoin pour des recherches plus approfondies et explore les possibilités de mise sur pied de programmes qui pourraient aider à faire la promotion d'une intégration réussie des jeunes réfugiés au Canada

Integration, Clarification, Substantiation: Sex, Gender, Ethnicity and Migration as Social Determinants of Women’s Health

The aim of this paper was to examine, via a scoping review, how the literature focusing on immigrant women’s health, based on selected criteria, has been able to capture not only sex and gender differences but also the other socially grounded determinants of health. Using selected health databases as well as a diversity of keywords, a final sample of 59 was obtained after a number of steps to increase validity and credibility of the process were taken. Since “women” was one of the main keywords, all of the studies included women either by themselves (n=20/59) or along with men (n=39/59). In 34 (57.6%) of the papers reviewed, gender was defined above and beyond “sex” (i.e. some discussion was provided regarding the social context of the study population prior to the presentation of the goal of the study). Ethnicity was merely mentioned without being expanded upon and at times being substituted with race in 26 (44%) of the papers reviewed. Migration was defined in 22 (37.2%) of the papers and was predominantly operationalized by length of stay in the country. While the concepts at hand represent important units of analysis within women’s health research, most studies neglected to either capture gender specificities beyond sex as a biological variable, or to define migration experiences beyond ethnic identity. Anchored within women’s health scholarship seeking for conceptual clarity and accuracy, this paper pleads for an improved consideration of the multiple and interactive social and biological determinants of health, as well as structural conditions at the basis of structural inequities; If the production of socially grounded women’s health research depends upon accurate, fully integrated and applied conceptualizations of relevant dimensions, how can this be facilitated by policy-makers, health research funding bodies, the researchers themselves and ultimately by health care practitioners

Physician-related determinants of cervical cancer screening among Caribbean women in Toronto

BACKGROUND: Minority women in Canada are less likely to be screened for cervical cancer than their counterparts in the general population, despite the fact that the proportion of these women who consult a general practitioner about their health each year is similar to minority women. This study examined the physician and practice characteristics associated with Pap testing and perceived barriers to Pap testing of family physicians serving the Caribbean community of Toronto. METHODS: A mail-back questionnaire was sent to Toronto family physicians practicing in neighborhoods with a high proportion of Caribbean Canadians. RESULTS: Although 79.7% of the 64 participating physicians reported that they were \u27very likely to include Pap testing during an annual check-up, nearly half did not believe that the majority of Caribbean patients were actually screened. The amount of time a physician spent on patient education was significantly associated with his/her likelihood of screening. Male physicians who reported a high proportion of Caribbean female patients in their practices were significantly less likely to screen for cervical cancer than those who saw fewer Caribbean patients. CONCLUSION: These findings suggest that an increased emphasis on patient education is important to increase screening practice and that physician gender may be of major importance to the Caribbean community

Towards a Global Interdisciplinary Evidence-Informed Practice: Intimate Partner Violence in the Ethiopian Context

Background. Intimate partner violence is a global health issue and is associated with a range of health problems for women. Nurses, as the largest health workforce globally, are well positioned to provide care for abused women. Objectives. This nursing-led interdisciplinary project was conducted to understand the current state of knowledge about intimate partner violence in Ethiopia and make recommendations for country-specific activities to improve response to intimate partner violence through practice changes, education, and research. Methods. The project involved two phases: review of relevant literature and an interdisciplinary stakeholder forum and a meeting with nurse educators. Findings. The literature review identified the pervasiveness and complexity of intimate partner violence and its sociocultural determinants in the Ethiopian context. Two significant themes emerged from the forum and the meeting: the value of bringing multiple disciplines together to address the complex issue of intimate partner violence and the need for health care professionals to better understand their roles and responsibilities in actively addressing intimate partner violence. Conclusions. Further research on the topic is needed, including studies of prevention and resilience and “best practices” for education and intervention. Interdisciplinary and international research networks can support local efforts to address and prevent intimate partner violence

The Association Between Length of Stay in Canada and Intimate Partner Violence Among Immigrant Women

Objective. We examined the prevalence of intimate partner violence (IPV) among recent (0–9 years) and nonrecent (≥ 10 years) immigrant women in Canada to determine whether differences in IPV were associated with length of stay in Canada. Methods. We analyzed data from the 1999 General Social Survey, a national cross-sectional telephone survey. We used weighted logistic regression analysis to examine the effect of length of stay in Canada on IPV and controlled for socio-cultural and other factors associated with IPV. Results. The crude prevalence of IPV was similar among recent and nonrecent immigrant women. However, after adjustment, the risk for IPV was significantly lower among recent immigrant women compared with nonrecent immigrant women. Country of origin, age, marital status, and having an activity limitation (physical/mental disability or health problem) also were associated with a higher risk for IPV. Conclusions. Our findings have important implications for both prevention and detection of IPV among immigrant women