Table Of ContentWalden University
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Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2016
Te Lived Experiences of Immigrant Canadian
Women with the Healthcare System
Salma Debs-Ivall
Walden University
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Salma Debs-Ivall
has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.
Review Committee
Dr. Joyce Haines, Committee Chairperson,
Public Policy and Administration Faculty
Dr. David Milen, Committee Member,
Public Policy and Administration Faculty
Dr. Melanie Smith, University Reviewer,
Public Policy and Administration Faculty
Chief Academic Officer
Eric Riedel, Ph.D.
Walden University
2016
Abstract
The Lived Experiences of Immigrant Canadian Women With the Healthcare System
by
Salma Debs-Ivall
MScN, University of Ottawa, 2002
BSN, American University of Beirut, 1984
Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Policy and Administration
Walden University
September 2016
Abstract
Immigrants to Canada report better health status than the Canadian-born population when
they first arrive in Canada, a phenomenon called the Healthy Immigrant Effect. However,
by the fourth year after immigration, immigrants report a health status that is worse than
that of the Canadian-born population. Visible minority immigrant women report the
largest deterioration in health. The purpose of this qualitative study was to explore the
lived experiences of visible minority immigrant women with encounters with the
Canadian healthcare system to examine the multiplicative impact of gender, ethnicity,
and immigration on their health. This phenomenological study, guided by Crenshaw’s
feminist intersectionality framework, explored the perspectives of a purposive sample of
8 immigrant women in Ottawa, Canada, about their encounters with the healthcare
system. Data were collected through individual interviews. These data were inductively
coded and subjected to thematic analysis following the process outlined by Smith et al.
for interpretative phenomenological analysis. Key findings of the study revealed that
immigrant women define health more holistically and have expectations of the
encounters with healthcare that are not met due to barriers that impact them accessing
healthcare services, experiencing healthcare services, and following the recommended
options. The positive social change implications of this study include recommendations
for public health to consider immigration and racism as determinants of health; and for
Health Canada to undertake system-level lines of inquiry to shed light on the ways
structural discrimination and racism have had an impact on immigrant women’s social
and health trajectory.
The Lived Experiences of Immigrant Canadian Women with the Healthcare System
by
Salma Debs-Ivall
MScN, University of Ottawa, 2002
BSN, American University of Beirut, 1984
Dissertation Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Philosophy
Public Policy and Administration
Walden University
September 2016
Table of Contents
List of Tables ..................................................................................................................... vi
Chapter 1: Introduction to the Study ....................................................................................1
Background ....................................................................................................................2
Problem Statement .........................................................................................................3
Purpose of the Study ......................................................................................................4
Research Questions ........................................................................................................5
Theoretical and Conceptual Framework ........................................................................5
Nature of the Study ........................................................................................................6
Definitions ......................................................................................................................8
Assumptions ...................................................................................................................9
Scope and Delimitations ..............................................................................................10
Limitations ...................................................................................................................11
Significance ..................................................................................................................12
Summary ......................................................................................................................13
Chapter 2: Literature Review .............................................................................................15
Literature Search Strategy ............................................................................................17
Literature Review Related to the Concepts .................................................................20
Immigration Policies in Canada ...................................................................................20
Demographics: Immigrants to Canada .........................................................................21
Demographics: Immigrant Women ..............................................................................24
Demographics: Visible Minority Women ....................................................................25
i
Healthcare System in Canada ......................................................................................26
The “Healthy Immigrant Effect” .................................................................................27
Health Disparities .........................................................................................................30
The Health of Immigrant Women in Canada ...............................................................34
Synthesis of the Literature ...........................................................................................36
The Social Determinants of Health: Multiple Jeopardies ............................................38
Theoretical / Conceptual Framework ...........................................................................40
Summary and Conclusions ..........................................................................................44
Chapter 3: Research Method ..............................................................................................46
Research Design and Rationale ...................................................................................46
Role of the Researcher .................................................................................................49
Methodology ................................................................................................................50
Population ....................................................................................................................51
Instrumentation ............................................................................................................53
Sampling and Data Collection .....................................................................................54
Data Analysis Plan .......................................................................................................56
Issues of Trustworthiness .............................................................................................58
Credibility ....................................................................................................................58
Transferability ..............................................................................................................58
Dependability ...............................................................................................................59
Confirmability ..............................................................................................................59
Criteria Specific to IPA ................................................................................................59
ii
Ethical Procedures .......................................................................................................61
Summary ......................................................................................................................63
Chapter 4: Results ..............................................................................................................65
Introduction ..................................................................................................................65
Setting .........................................................................................................................66
Demographics ..............................................................................................................67
Data Collection ............................................................................................................70
Data Analysis ...............................................................................................................72
Evidence of Trustworthiness ........................................................................................76
Credibility ....................................................................................................................77
Transferability ..............................................................................................................77
Dependability ...............................................................................................................77
Confirmability ..............................................................................................................78
Criteria Specific to IPA ................................................................................................78
Results ..........................................................................................................................80
Thematic Presentation ..................................................................................................80
Summary ....................................................................................................................146
Chapter 5: Discussion, Conclusions, and Recommendations ..........................................148
Introduction ................................................................................................................148
Interpretation of Findings ..........................................................................................149
iii
Question 1: What Meanings Do Immigrant Women in Ottawa, Canada,
Attribute to Health, Healthcare Services, and Access to Health
Services? ........................................................................................................149
Question 2a: How Do They Describe the Impact of the Immigration
Experience on Their Experiences With Healthcare Services? .......................151
Question 2b: How Do They Describe the Impact of Their Ethnicity on Their
Experiences With Healthcare Services? ........................................................154
Question 2c: How Do They Describe the Impact of Their Gender Roles on
Their Experiences With Healthcare Services? ...............................................154
Question 3: How Do They Describe Barriers to Access to Healthcare Services
That They Might Have Experienced Prior to, During, and Following
the Encounter With the Healthcare System? .................................................155
Narrative ....................................................................................................................157
Theoretical Considerations ........................................................................................159
Limitations of the Study .............................................................................................161
Recommendations for Further Research ....................................................................163
Implications for Social Change ..................................................................................165
Conclusion .................................................................................................................167
References ........................................................................................................................168
Appendix A: Conceptual Framework Guiding the Literature Review ............................188
Appendix B: Demographic Questionnaire .......................................................................189
Appendix C: Interview Protocol ......................................................................................191
iv
Appendix D: Field Notes Protocol ...................................................................................192
Appendix E: Reviewer Feedback Form ...........................................................................193
Appendix F: Recruitment Flyer, English text ..................................................................195
Appendix G: Information Letter and Consent Form ........................................................196
v
