Advancing Our Understanding of Dental Care Pathways of Refugees and Asylum Seekers in Canada: A Qualitative Study

Nazik M Nurelhuda,Mark T Keboa,Mary Ellen Macdonald,Belinda Nicolau,Herenia P Lawrence

doi:10.3390/ijerph18168874

Abstract

The burden of oral diseases and need for dental care are high among refugees and asylum seekers (humanitarian migrants). Canada’s Interim Federal Health Program (IFHP) provides humanitarian migrants with limited dental services; however, this program has seen several fluctuations over the past decade. An earlier study on the experiences of humanitarian migrants in Quebec, Canada, developed the dental care pathways of humanitarian migrants model, which describes the care-seeking processes that humanitarian migrants follow; further, this study documented shortfalls in IFHP coverage. The current qualitative study tests the pathway model in another Canadian province. We purposefully recruited 27 humanitarian migrants from 13 countries in four global regions, between April and December 2019, in two Ontario cities (Toronto and Ottawa). Four focus group discussions were facilitated in English, Arabic, Spanish, and Dari. Analysis revealed barriers to care similar to the Quebec study: Waiting time, financial, and language barriers. Further, participants were unsatisfied with the IFHP’s benefits package. Our data produced two new pathways for the model: transnational dental care and self-medication. In conclusion, the dental care needs of humanitarian migrants are not currently being met in Canada, forcing participants to resort to alternative pathways outside the conventional dental care system.

Highlights

By mid-2020, the number of displaced people globally had exceeded 80 million [1].Among this number are nearly 26.3 million refugees, “individuals who are unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion,” and 4.2 million asylum seekers, individuals who are seeking refugee status [2]
We invited participants who had arrived in Canada as refugees or asylum seekers, were 18 years old and above, and had previous experience with the dental care system in Canada
While we could not include participants from all countries of origin of humanitarian migrants arriving in Canada, we interviewed humanitarian migrants from the four main global regions of origin, and our focus groups were facilitated in the mother tongue of participants

Summary

Introduction

By mid-2020, the number of displaced people globally had exceeded 80 million [1]. Among this number are nearly 26.3 million refugees, “individuals who are unable or unwilling to return to their country of origin owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion,” and 4.2 million asylum seekers, individuals who are seeking refugee status [2]. Canada has welcomed 1,088,015 humanitarian migrants (refugees and asylum seekers) since 1980 [3]. The burden of oral diseases is high in humanitarian migrants, followed by a high need for dental care [4]. The inverse care law in dental care, which describes the principle that those who need treatment the most have the least access to care, continues to exist in Canada [7]

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Conclusion