Date of Award

6-12-2023

Publication Type

Dissertation

Degree Name

Ph.D.

Department

Social Work

Keywords

healthcare;immigration;settlement;social support

Supervisor

Kevin Gorey

Rights

info:eu-repo/semantics/openAccess

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Healthcare is only a protective factor regarding health outcomes if it is used. While differences exist across various populations regarding healthcare utilization, this study focuses on people born outside of Canada, specifically landed immigrants (permanent residents), using the Canadian Community Health Survey 2017/2018 (CCHS). Those born outside of Canada are an increasingly large segment of the Canadian population. Therefore, their healthcare use represents an increasing portion of healthcare utilization. For a variety of sociodemographic and systemic reasons, utilization rates for this population are likely to vary. This study explores two potentially protective factors and their interaction in predicting healthcare access, and ultimately utilization: social support and length of time in country. An exploration of the predictive power of social support was undertaken the lenses of social cognitive and social capital theories. These theories come together to help understand motivations for and supports of healthcare utilization. The three hypotheses in this study were: social support and the length of time in country both protectively predict health care utilization (i.e., new(er) comers were at relative risk of low healthcare utilization), and social support and time in country interact such that the protective effect of social support is larger among more potentially vulnerable or at-risk people who landed more recently (i.e., new(er)comers). Each hypothesis was systematically tested across three outcome indicators of healthcare utilization: has a regular healthcare provider, has a place to go for a minor health problem, has an unmet healthcare need. Outcome descriptions suggested that 10% to 20% of landed immigrants (permanent residents) may not be utilizing healthcare as per the variables chosen in this study. The unique, diverse and potentially underserviced (but with noted strengths and resiliencies), study sample of 3,977 adult landed Canadian immigrants was observed to be demographically vulnerable (prevalent racialized people and those speaking other than an official language), yet relatively well educated and healthy with relatively strong social supports compared with other Canadian residents. Furthermore, within this unique and diverse sample, more recent immigrants (landed less than 10 years ago) were even more demographically vulnerable, and additionally socioeconomically vulnerable, yet still relatively healthy and reporting high levels of social supports. Among relative newcomers, those with strong social supports were 56% more likely than those less well supported to have ready healthcare access. However, this protective association was not observed among those who landed more than 10 years ago. Findings suggest that social support has implications for healthcare utilization, and even more implications for the most vulnerable, more recently arrived immigrants to Canada. Subsequently, harnessing social support for increased healthcare utilization can be a powerful in the support of healthy communities. This study culminates in recommendations for social work research, practice, and education, allowing for current and future social workers and educators to best understand how to connect to clients at the intersections of these critical issues. In finding creative solutions, like increased social support, to better access and utilize healthcare, social workers can approach clients from strength based, anti-oppressive approaches that are at the core of our profession. Keywords: healthcare, social support, immigration, settlement

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