title: Encouraging understanding or increasing prejudices: A cross-sectional survey of institutional influence on health personnel attitudes about refugee claimants' access to health care.
abstract: BACKGROUND
  This paper investigates the personal, professional and institutional predictors of health institution personnel's attitudes regarding access to healthcare for refugee claimants in Canada.
  
  
  METHODS
  In Montreal, the staff of five hospitals and two primary care centres (n = 1772) completed an online questionnaire documenting demographics, occupation, exposure to refugee claimant patients, and attitudes regarding healthcare access for refugee claimants. We used structural equations modeling to investigate the associations between professional and institutional factors with latent functions of positive and negative attitudes toward refugee's access to healthcare.
  
  
  RESULTS
  Younger participants, social workers, participants from primary care centres, and from 1st migrant generation had the lowest scores of negative attitudes. Respondents who experienced contact with refugees had lower scores of negative attitudes (B = -14% standard deviation [SD]; 95% CI: -24, -4%). However, direct contact with refugees increased scores of negative attitudes in the institution with the most negative attitudes by 36% SD (95% CI: 1, 71%).
  
  
  CONCLUSIONS
  Findings suggest that institutions influence individuals' attitudes about refugee claimants' access to health care and that, in an institutional context of negative attitudes, contact with refugees may further confirm negative perceptions about this vulnerable group.
authors.affiliation: Department of Social and Cultural Psychiatry, McGill University, Montreal, Quebec, Canada.
authors.forename: Cécile
authors.initials: C
authors.lastname: Rousseau
authors.affiliation: Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Oulhote
authors.affiliation: Department of Social and Cultural Psychiatry, McGill University, Montreal, Quebec, Canada.
authors.forename: Mónica
authors.initials: M
authors.lastname: Ruiz-Casares
authors.affiliation: Research Centre of the University Institute with Regard to Cultural Communities, CIUSSS Centre-Ouest de l'Ile de Montreal, Montreal, Quebec, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Cleveland
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Greenaway
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012036:Refugees