Promoting Mental Health Through Empowerment and Community Capacity Building

Effective mental health promotion must consider the social determinants of health and integrate the principles of social inclusion, access and equity into health programs. Attention to issues of ‘cultural competence’ and ‘cultural sensitivity’ is not enough.York's Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. This summary was written by Naoko Ikeda. [email protected] www.researchimpact.c

East and Southeast Asian Men and Bathhouses in Toronto

HIV prevention needs to reflect the diverse experiences of gay men at bathhouses, especially those from ethno-racial groups.York's Knowledge Mobilization Unit provides services and funding for faculty, graduate students, and community organizations seeking to maximize the impact of academic research and expertise on public policy, social programming, and professional practice. It is supported by SSHRC and CIHR grants, and by the Office of the Vice-President Research & Innovation. [email protected] www.researchimpact.c

Co-designing a Sexual Health App With Immigrant Adolescents: Protocol for a Qualitative Community-Based Participatory Action Research Study

BACKGROUND: Canada is one of the world's most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents' sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents' SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. OBJECTIVE: The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. METHODS: We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype), we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. RESULTS: Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. CONCLUSIONS: Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/45389

Empowerment through community participation, a case study of the Raising Sexually Healthy Children Chinese Peer Parent Leader Project

grantor: University of TorontoThis study explored the relationship between community participation and empowerment at the individual and community levels. Guided by the concepts of health promotion and empowerment, a descriptive single-case study was used to explore the phenomenon of empowerment in the Raising Sexually Healthy Children Chinese Peer Parent Leader Project in Toronto. Data collection included project documents, focus groups and individual interviews with 10 peer parent leaders, 4 service providers and 2 training participants. Major findings of this study suggest that systemic racism and sexism create structural, social and economic barriers that prevent racialized immigrants from integrating successfully into Canadian society. Community participation is an important venue for social integration, especially among racialized immigrants. Parenting programs tend to be the entry points for immigrant women to connect with their communities. Health promotion programs that use multiple strategies such as community participation, mutual support, empowerment education, community partnership and intersectoral collaboration contribute to empowerment at the individual and community levels.M.Sc

Being-doing-becoming Manly Men: A Bourdieusian Exploration of the Construction of Masculine Identities and Sexual Practices of Young Men

Dominant discourses on youth sexual health construct young people as at-risk subjects who engage in risky behaviours due to ignorance or poor decision-making. This dissertation challenges the prevailing assumption embedded in these discourses that young people’s sexual behaviours are based on individual rational choices. Drawing on Pierre Bourdieu’s theory of practice and R. W. Connell’s notion of hegemonic masculinity, this dissertation uses an interpretive approach to analyze the narratives and resonant texts of 24 young men in Toronto. It explores how young men construct and perform their masculine identities in the context of their socio-spatial environment; it also examines the strategies that young men use to compete for cultural capital and dominant positions in the homosocial and (hetero)erotic fields. The analysis yields a number of findings. First, it shows that gender identity is a state of being-doing-becoming. Guided by their gender-class-race habituses, young men engage in an unceasing process of defining, affirming, declaring, and validating not only their sense of who they are (self-identity) and where they belong (collective identity), but also the boundary that differentiates the ‘Self’ from the ‘Other’. Second, there is a dialectical relationship between the young men’s masculine habituses and their sexual practices. While all the young men engaged in hegemonic masculine practices to gain ‘respect’ from their peers, their practices varied according to their classes and ethnoracial backgrounds. At the same time, their (hetero)erotic practices are intricately intertwined with their homosocial practices, whereby the intra-group masculine expectations coupled with the broad hegemonic masculine discourses assert significant influences on their interactions with both young women and other young men. Finally, hetero-guy-talk constitutes an important everyday social interaction in which young men actively engage in the (re)production and/or resistance of hegemonic masculine discourses and practices. These results suggest that effective sexual health promotion (SHP) must go beyond the focus on individual sexual behaviours to address the historical, cultural, economic, and political contexts that shape the collective sexual health practices of young men. Furthermore, it may be useful to explore ‘hetero-guy-talk’ as an important ‘third’ space where young men are invited to interrogate and resist misogynist, masculinist, and homophobic practices and be supported to engage in humanizing sexual practices.Ph

Caught between a rock and a hard place: mental health of migrant live-in caregivers in Canada

Abstract Background Canada depends on Temporary Foreign Workers (TFWs), also known as migrant workers, to fill labour shortage in agriculture, hospitality, construction, child/senior care, and other low-skilled occupations. Evidence shows that TFWs, especially women live-in caregivers (LC), constitute a vulnerable population. Their health is compromised by the precarious and harsh working and living conditions they encounter. There is a paucity of research on the mental health of LCs, their support systems and access to mental health services. Method In this community-based exploratory study, we used mixed methods of survey and focus groups to explore the work related experiences and mental health of migrant live-in caregivers in the Greater Toronto Area in Ontario, Canada. Convenience and snowball sampling were used to recruit participants. The inclusion criteria were: being 18 years or older, initially migrated to Canada as TFWs under LC program, resided in the Greater Toronto Area, and able to understand and converse in English based on self-report. This paper reports on the focus group results derived from inductive thematic analysis. Results A total of 30 women LCs participated in the study. Most of them were from the Philippines. A number of key themes emerged from the participants’ narratives: (1) precarious migration-employment status (re)produces exploitation; (2) deskilling and downward social mobility reinforce alienation; (3) endurance of hardship for family back home; (4) double lives of public cheerfulness and private anguish; and (4) unrecognized mental health needs. The study results reflected gross injustices experienced by these women. Conclusion A multi-faceted approach is required to improve the working and living conditions of this vulnerable group and ultimately their health outcomes. We recommend the following: government inspection to ensure employer compliance with the labour standards and provision of safe working and living conditions; change immigration policy to allow migrant caregivers to apply for permanent residence upon arrival; the TFWs Program to establish fair wages and subsidized housing so that caregivers can truly access the live-out option; and local ethno-specific, settlement and faith organizations be leveraged to provide TFWs with social support as well as information about their rights and how to access health and social care

More than Mental Illness: Experiences of Associating with Stigma of Mental Illness for Chinese College Students

From existing empirical research, we identified that Chinese college students commonly experience stigma surrounding mental illness and found some factors that support them in resisting the stigma and achieving psychological health. However, less research provides qualitative data involving individual experiences and insights on mental illness within this group of college students. This study, based on Linking Hearts (an internationally cooperative research-sharing project between China and Canada), was conducted in Shandong, Jinan, and aims to promote the mental health of college students by empowering interdisciplinary professionals and students. Through the research project, this study analyzed the materials from 24 focus groups, explored the understanding of mental illness and prevalence of mental illness stigma in Chinese colleges at the present time, administered a background questionnaire, and provided statistical support for some revealed themes. The final themes are as follows: mental illness is stereotyped as “severe, pathetic, and complicated”; the misconception of “visiting a psychological counselor is scary”; from public stigma to self-stigma; barriers deterring students from seeking help or accessing services; two sides of the same coin: peer support versus peer pressure

Migration and young people’s mental health in Canada: a scoping review

Background: Young people's mental health is a public health priority. Given the influences of migration and resettlement on mental health, synthesis of current research with young people from migrant backgrounds can help inform mental health promotion initiatives that account for and are responsive to their needs.Aims: This article distils the results of a review of published literature on the mental health of adolescent immigrants (ages 10-19) living in Canada.Method: Scoping review methods were used to define inclusion and exclusion criteria; inform the search strategies; and extract and synthesize key findings.Results: Fourteen articles met criteria for inclusion. Analysis of the studies indicate diversity in mental health indicators, e.g., mental distress, emotional problems and behavioral problems, as well as a wide range of influences on mental health from age at migration and length of stay to place of residence, income and discrimination.Conclusions: Findings support the need to account for the array of influences on young people's mental health in relation to migration and to augment initiatives beyond the level of individual intervention

Fecal occult blood test screening uptake among immigrants from Muslim majority countries: A retrospective cohort study in Ontario, Canada

Abstract Background Colorectal cancer (CRC) is the second and third highest cause of cancer deaths among Canadian men and women, respectively. Population‐based screening through fecal occult blood testing (FOBT) has been proven to be effective in reducing CRC morbidity and mortality. Although participation in Ontario's organized CRC screening program has been increasing steadily since 2008, its uptake remains low among recent immigrant populations despite the known benefits of screening. To promote participation in CRC screening, it is imperative to understand both individual and system level barriers and enablers. Although a number of immigrant and nonimmigrant factors have been associated with low participation, there is a dearth of knowledge related to the religious affiliation in CRC screening uptake. Our study is among the first to examine this issue in Ontario, one of the most ethnically diverse Canadian provinces and preferred settlement destinations for immigrants. Methods We conducted a population‐based retrospective cohort study using linked health care administrative databases. Our cohort included Ontario residents, age 50‐74 who were eligible for FOBT from 1 April 2013 to 31 March 2015. Results We found that immigrants from the Middle East and North Africa and Eastern Europe and Central Asia had the lowest rates of screening. Furthermore, being born in a Muslim‐majority country was associated with lower FOBT screening even after controlling for other confounders including world region and income (ie, overall adjusted relative risk (ARR) of screening 0.92 [95% CI 0.90‐0.93]). Moreover, being enrolled in a primary care model, having a female primary care provider and having an internationally trained physician were associated with increased screening among immigrants from Muslim‐majority countries. Conclusions These findings can inform future efforts to improve screening uptake like: enhancing access to primary care providers and enrollment in primary care models, targeted FOBT education for male providers and providers not in a primary care model, development of culturally sensitive and appropriate educational materials, and use of interactive approaches for communication of cancer screening information

Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment

BackgroundDuring a global pandemic, it is critical to rapidly deploy a psychological intervention to support the mental health and resilience of highly affected individuals and communities. ObjectiveThis is the rationale behind the development and implementation of the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training, an online, blended, skills building intervention to increase the resilience and well-being of participants while promoting their individual and collective empowerment and capacity building. MethodsBased on acceptance and commitment therapy (ACT) and social justice–based group empowerment psychoeducation (GEP), we developed the Acceptance and Commitment to Empowerment (ACE) model to enhance psychological resilience and collective empowerment. The PACER program consists of 6 online, interactive, self-guided modules complemented by 6 weekly, 90-minute, videoconference, facilitator-led, group sessions. ResultsAs of August 2021, a total of 325 participants had enrolled in the PACER program. Participants include frontline health care providers and Chinese-Canadian community members. ConclusionsThe PACER program is an innovative intervention program with the potential for increasing resilience and empowerment while reducing mental distress during the pandemic. International Registered Report Identifier (IRRID)DERR1-10.2196/3349