“If They Tell Me To Get It, I’ll Get It,” - Immigrant Mothers’ Immunization Decision-Making

by Stephanie Patricia Kowal1, Dr Cindy Jardine1, and Dr Tania Bubela1

1 School of Public Health, University of AlbertaPublic Health 2014, May 27, 2014, Toronto, ON

Statistics Canada, censuses of population, 1901 to 2006.

7

6

5

4

3

2

1

0

millions percentage25%

20%

15%

10%

5%

0%1901 1911 1921 1931 1941 1951 1961 1971 1981 1986 1991 1996 2001 2006

Census Year

Proportion of Foreign-Born Population in Canada

Canada’s Foreign-Born Population

Canada’s Foreign-Born Population

Foreign-Born Population in Edmonton, Alberta

Edmonton: 22.9%

Alberta: 16.2%

Canada: 19.8%

Statistics Canada, censuses of population, 1901 to 2006.

Immigrant Women as a Vulnerable Population

• Barriers to health systems• Language• Economic situations

• Pregnant Women • Increased risk to infectious

disease

Health Protection through Vaccination

• Disparities among children

• Disparities among women

• Varied experiences and what this means as an immigrant?

Jenista, 2001; Meints & Chescheir, 2010; McElroy et al., 2009

Health Protection through Vaccination

• Disparities among children

• Disparities among women

• Varied experiences and what this means as an immigrant?

Jenista, 2001; Meints & Chescheir, 2010; McElroy et al., 2009

1) Understand decision making processes

2) Assess information needs

Study Purpose

1) Vaccine knowledge learned from origin countries.

2) How that knowledge applied in Canada.

3) How to develop effective risk communication.

Research Questions

Methods

23 Qualitative Interviews

South Asia: n=8

China: n=10

Bhutanese Refugees: n=5

Sample: Participating Communities

1) China-, South Asia-, or Bhutan-born2) Pregnant and/or have children under 8 years old3) Immigrated to Canada in the last 8 years4) Living in Edmonton, Alberta, Canada

Edmonton’s Foreign-Born Population

Immigrant Population Make-Up: Edmonton, Alberta

Chinese 28%

Latin American 5%

South Asian 23%South East Asian 6%

Black 12%

Arab 7%

Filipino 11%

Other 8%

Statistics Canada, censuses of population, 1901 to 2006.

Interview Guide

• Previous vaccine experiences

• Comprehension of how vaccine technology and regulations

• Vaccine information access and use

Results - Passivity

I just walked into the medi-centre and did not have much interaction with any doctor so I’m not really sure. Maybe if I had a family doctor they would have suggested vaccines. (South Asian Participant)

Results: Immunization Decision-Making Processes

I went to the doctor because I had a flu and I think because it wasn’t necessary so that was why I was not advised to take it. I didn’t ask. If my doctor tells me to take it, I will take it. But if my doctor doesn’t then... (Chinese Participant)

30

They give it on paper, they give it on the phone once or twice at the beginning. I just listen to what they have to say.(South Asian Participant)

Results: Immunization Decision-Making Processes

I don’t know if the doctor will say [vaccination] is a must, but yes, if the doctor says your should get it done, you should because they are telling you for your own good. (South Asian Participant)

Results: Immunization Decision-Making Processes

Implications for Communication

Doctors’ Visits

Effective Information Delivery

Uptake of Recommendations

Implications for Communication

Back to H1N1

Implications for Communication

Example of Canadian Refugee Health Policies

Doctors’ Visits

Effective Information Delivery

Uptake of Recommendations

Must Account for Unique Information Gathering and Decision-Making to Build Effective Communication

References

Jenista J. The Immigrant, Refugee, or Internationally Adopted Child. Pediatrics in Review. 2001; (22)12: 419-429.

McElroy R, Laskin M, Jiang D, Shah R, Ray J. Rates of Rubella Immunity Among Immigrant and Non-Immigrant Pregnant Women. Journal of Obstetric Gynaecology Canada. 2009; 31(5): 409-413.

Meints L, Chescheir N. Screening for infectious diseases in pregnant, foreign-born women from multiple global areas. Journal of Reproductive Medicine, 2010; 55(9-10): 382-6.

Statistics Canada (2006) Immigration and Citizenship Highlight Tables, 2006 Census. Available at http://www12.statcan.ca/census-recensement/2006/dp-pd/hlt/97-557/Index-eng.cfm

Thank You!Questions?

AcknowledgementsMulti-Cultural Health Brokers Cooperative: Yvonne Chiu Shiva Chapagai Lydia Yip Hina Naushad Ravi Hansra Daljit Rupana

Funders:• CIHR Master’s Award• HQCA Summer Studentship• WCHRI Qualitative Core Resource• WCHRI/CUP CBR Science Shop• WCHRI Graduate Studentship• SRA International Student Travel

Award

Research Participants

Contact Info: skowal@ualberta.ca

TranslatorsJian WangDr Amrita Mishra

Similarities Among Differences

Chinese, Bhutanese, and Indian Contexts