title: An ethnographic investigation of the maternity healthcare experience of immigrants in rural and urban Alberta, Canada.
abstract: BACKGROUND
  Canada is among the top immigrant-receiving nations in the world. Immigrant populations may face structural and individual barriers in the access to and navigation of healthcare services in a new country. The aims of the study were to (1) generate new understanding of the processes that perpetuate immigrant disadvantages in maternity healthcare, and (2) devise potential interventions that might improve maternity experiences and outcomes for immigrant women in Canada.
  
  
  METHODS
  The study utilized a qualitative research approach that focused on ethnographic research design and data analysis contextualized within theories of organizational behaviour and critical realism. Data were collected over 2.5 years using focus groups and in-depth semistructured interviews with immigrant women (n = 34), healthcare providers (n = 29), and social service providers (n = 23) in a Canadian province. Purposive samples of each subgroup were generated, and recruitment and data collection - including interpretation and verification of translations - were facilitated through the hiring of community researchers and collaborations with key informants.
  
  
  RESULTS
  The findings indicate that (a) communication difficulties, (b) lack of information, (c) lack of social support (isolation), (d) cultural beliefs, e) inadequate healthcare services, and (f) cost of medicine/services represent potential barriers to the access to and navigation of maternity services by immigrant women in Canada. Having successfully accessed and navigated services, immigrant women often face additional challenges that influence their level of satisfaction and quality of care, such as lack of understanding of the informed consent process, lack of regard by professionals for confidential patient information, short consultation times, short hospital stays, perceived discrimination/stereotyping, and culture shock.
  
  
  CONCLUSIONS
  Although health service organizations and policies strive for universality and equality in service provision, personal and organizational barriers can limit care access, adequacy, and acceptability for immigrant women. A holistic healthcare approach must include health informational packages available in different languages/media. Health care professionals who care for diverse populations must be provided with training in cultural competence, and monitoring and evaluation programs to ameliorate personal and systemic discrimination.
authors.affiliation: Mary Seacole Professor of Ethnicity and Community Health School of Health Sciences, University of Nottingham, Rm 1976, A Floor, South Block Link Queen's Medical Centre, Nottingham, NG7 2HA, UK. Gina.Higginbottom@nottingham.ac.uk.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Higginbottom
authors.affiliation: University of Alberta, Alberta, Canada. jalal.safipour@lnu.se.|Department of Health and Caring Sciences, Linnaeus University, Building: K2244, 35195 Vaxjo, Linnaeus, Sweden. jalal.safipour@lnu.se.
authors.forename: Jalal
authors.initials: J
authors.lastname: Safipour
authors.affiliation: Department of Educational Psychology, University of Alberta, 6-107D Education North, Edmonton, Canada. sophie.yohani@ualberta.ca.
authors.forename: Sophie
authors.initials: S
authors.lastname: Yohani
authors.affiliation: Faculty of Nursing, University of Alberta, 3rd Floor Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton, T6G 1C9, Canada. beverley.obrien@ualberta.ca.
authors.forename: Beverly
authors.initials: B
authors.lastname: O'Brien
authors.affiliation: School of Publin Health, University of Alberta, 3rd Floor Edmonton Clinic Health Academy, 11405 87th Avenue, Alberta, T6G 1C9, Canada. zubia.mumtaz@ualberta.ca.
authors.forename: Zubia
authors.initials: Z
authors.lastname: Mumtaz
authors.affiliation: Alberta Health Services, College and Association of Registered Nurses of Alberta, 11620 168 Street, Edmonton, T5M 4A6, Canada. tpaton@nurses.ab.ca.
authors.forename: Patricia
authors.initials: P
authors.lastname: Paton
authors.affiliation: Multicultural Health Brokers Coop, # 301, 9955-114 Street, Edmonton, T5K 1P7, Canada. yvonnchiu@shaw.ca.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Chiu
authors.affiliation: University of Alberta, Alberta, Canada. rubina.barolia@aku.edu.|School of Nursing and Midwifery, Aga Khan University, stadium Road, Karachi, 74800, Pakistan. rubina.barolia@aku.edu.
authors.forename: Rubina
authors.initials: R
authors.lastname: Barolia
mesh_terms: D000328:Adult; D000416:Alberta; D000884:Anthropology, Cultural; D003144:Communication Barriers; D003469:Culture; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services; D011247:Pregnancy; D012424:Rural Population; D012944:Social Support; D000068217:Social Workers / Q000523:psychology; D014505:Urban Population
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