Abstract
BackgroundThis paper investigates the personal, professional and institutional predictors of health institution personnel's attitudes regarding access to healthcare for refugee claimants in Canada.MethodsIn 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.ResultsYounger 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%).InterpretationFindings 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.
Highlights
Public representations of refugees in North America and Europe have progressively shifted from vulnerable individuals deserving protection to potential criminals and fraudsters seeking to abuse host country resources, in particular the health care system [1]
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%)
Summary
Public representations of refugees in North America and Europe have progressively shifted from vulnerable individuals deserving protection to potential criminals and fraudsters seeking to abuse host country resources, in particular the health care system [1]. As the health impact of these policy changes on refugees is beginning to be documented, [4] it becomes evident that the obstacles to health care access related to these transformations are multilayered and should be analyzed within a systemic framework. Gee & Ford [5] showed how immigration policy influences health disparities both by modulating direct access through the introduction of different levels of coverage and through indirect obstacles stemming from racism manifesting as xenophobia. The racialization of immigration and the intersection of race, ethnicity or religion with socioeconomic and migratory status may constitute an important obstacle to health care access given that all of these factors have been shown to unconsciously bias clinicians, sometimes affecting their practices [6,7,8,9]. This paper investigates the personal, professional and institutional predictors of health institution personnel’s attitudes regarding access to healthcare for refugee claimants in Canada
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