"To Remember Is to Live Again": Geragogical Approaches to Online Storytelling With Older Immigrants.

The purpose of this study was to explore multilevel factors affecting older Korean immigrants' health-seeking behaviours. Although studies have documented significant issues related to healthcare access and utilisation issues among older immigrants, a noted limitation of current research is its failure to explore multiple factors related to their health-seeking behaviours. A qualitative study using interview data from two previous studies. We performed a qualitative analysis of focus groups and individual interviews using inductive coding methods. The socioecological model provided a useful framework to guide this study. The sample included 17 community-dwelling older Korean immigrants aged ≥65years living in the metropolitan area of Seattle, WA, USA. Findings revealed various factors at the individual (e.g., perception of health and illness, mistrust, cultural values and norms, length of residency in the United States, language barriers and ageing experiences), interpersonal (e.g., peers, family and primary care physicians), community (e.g., ethnic community centres and organisations, home care helpers and interpretation services) and policy (e.g., lack of affordability and health benefits coverage) levels. Each of these factors played a role as either a barrier to or facilitator of older Korean immigrants' health-seeking behaviours. Several factors, such as language barriers and lack of available information, were intertwined. Findings indicate the importance of considering four major areas when designing culturally appropriate, community-based interventions for older immigrants. Also, utilising peers or trusted human resources in the community is critical to the design and implementation of health promotion interventions for older immigrants. Examining intrapersonal, interpersonal, community, and policy level factors that affect older immigrants' health-seeking behaviours informs the design of community-based health promotion interventions for older immigrants.

Community-based organizations (CBOs) serving older ethnic minority adults, especially older immigrants, are vital to satisfy their complex social, health, and behavioral health needs. This study uses organizational theories and a case study approach to examine how the organizational responses to the multifaceted impact of the COVID-19 pandemic and progress beyond the pandemic-related responses. Four CBOs serving older Chinese immigrants in New York City were examined. Results indicate that driven by unmet psychosocial needs of older Chinese immigrants and public health measures, CBOs modified practice protocols and established (or strengthened) collaborative relationships with medical providers and other CBOs. COVID-19 responses include CBOs’ transformations in organizational structures (e.g. collaboration) and operational activities (e.g. telehealth). Successful transformations of CBOs were primarily due to prior adaptiveness to integrated care reform and assured needed resources before the pandemic; the transformation reflected orderly organizational progress rather than a temporary management strategy.

<p>Ontario’s demographic structure is changing, and the senior population is expected to nearly double from 2020 to 2046 (2.6 to 4.5 million), leading to increased demand for healthcare services. Older immigrants are more likely to face spatial and aspatial barriers accessing healthcare. Spatial-quantitative analysis is used to explore the potential spatial accessibility to same-language family physicians (FP) for older Chinese immigrants living in the Toronto CMA. Enhanced 2-step floating catchment area (E2SFCA) modeling reveals areas with poor to very high accessibility. To gain a further understanding of spatial accessibility and use of care, survey data from older Chinese immigrants were analyzed to reveal individual experiences in accessing primary care prior and during the COVID pandemic. The study highlights the role of spatial access and other neighbourhood and individual characteristics in older immigrants’ access to health care services, as well as the value of integrating spatial analysis with empirical data in health care research involving older immigrants.</p>

<p>Ontario’s demographic structure is changing, and the senior population is expected to nearly double from 2020 to 2046 (2.6 to 4.5 million), leading to increased demand for healthcare services. Older immigrants are more likely to face spatial and aspatial barriers accessing healthcare. Spatial-quantitative analysis is used to explore the potential spatial accessibility to same-language family physicians (FP) for older Chinese immigrants living in the Toronto CMA. Enhanced 2-step floating catchment area (E2SFCA) modeling reveals areas with poor to very high accessibility. To gain a further understanding of spatial accessibility and use of care, survey data from older Chinese immigrants were analyzed to reveal individual experiences in accessing primary care prior and during the COVID pandemic. The study highlights the role of spatial access and other neighbourhood and individual characteristics in older immigrants’ access to health care services, as well as the value of integrating spatial analysis with empirical data in health care research involving older immigrants.</p>

Older immigrants in affordable housing have unique sets of challenges during the COVID-19 pandemic posed by limited English proficiency and resources. The aggregated living condition could increase their risk of being exposed to the contagious disease. This symposium reports empirical findings of the social Network of Immigrant Chinese older adults in affordable Housing Environment (NICHE) project, which focused on the influence of COVID-19 on underprivileged Chinese older immigrants. We conducted 27 semi-structured interviews with foreign-born older Chinese immigrants (mean age 78.1, 69.23% female) in an affordable housing in Los Angeles to learn about their lived experiences and coping strategies during the COVID-19 pandemic. The first presentation focused on the changes in older Chinese immigrants’ social life after the onset of the pandemic and aimed to understand the pandemic’s impact on their depressive symptoms and loneliness. The second presentation describes older Chinese immigrants’ perceived pandemic-related stressors and resilience across phases of the pandemic, including at the beginning, after they got vaccinated, and the rising of delta variant. The participants explained what supportive services had been helpful and what support they wished they could have over the past two years in the pandemic. The third presentation reports the experience of being discriminated against during the pandemic, the Chinese older adults’ attitudes towards these discriminatory events, and coping strategies. Together, these three presentations will depict the lived experience of Chinese immigrants over two years during the pandemic and discuss intervention strategies and policy considerations for preparing for future crisis like the COVID-19 pandemic.

The critical role of virtual care during the COVID-19 pandemic has raised concerns about the widening disparities to access by vulnerable populations including older immigrants. This paper aims to describe virtual care use in older immigrant populations residing in Ontario, Canada. In this population-based, repeated cross-sectional study, we used linked administrative data to describe virtual care and healthcare utilization among immigrants aged 65 years and older before and during the COVID-19 pandemic. Visits were identified weekly from January 2018 to March 2021 among various older adult immigrant populations. Among older immigrants, over 75% were high users of virtual care (had two or more virtual visits) during the pandemic. Rates of virtual care use was low (weekly average <2 visits per 1000) prior to the pandemic, but increased for both older adult immigrant and non-immigrant populations. At the start of the pandemic, virtual care use was lower among immigrants compared to non-immigrants (weekly average of 77 vs 86 visits per 1000). As the pandemic progressed, the rates between these groups became similar (80 vs 79 visits per 1000). Virtual care use was consistently lower among immigrants in the family class (75 visits per 1000) compared to the economic (82 visits per 1000) or refugee (89 visits per 1000) classes, and was lower among those who only spoke French (69 visits per 1000) or neither French nor English (73 visits per 1000) compared to those who were fluent in English (81 visits per 1000). This study found that use of virtual care was comparable between older immigrants and non-immigrants overall, though there may have been barriers to access for older immigrants early on in the pandemic. However, within older immigrant populations, immigration category and language ability were consistent differentiators in the rates of virtual care use throughout the pandemic.

As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two-staged research design was used. Stage 1 explored the participants' experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty-four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title 'Bridge People'. Bridge People have different backgrounds: family and friends, public sector workers and staff from community-based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.

Vast spatial mobility changes happened globally during the COVID-19 pandemic, profoundly affecting older adults' well-being and active aging experience. This study aims to examine how the virtual environment and cyberspace, in conjunction with the physical and social neighbourhood environments, influence outdoor activities and spatial mobility for older immigrants. Four online focus groups were conducted with 25 older Chinese immigrants aged 65 and over in the Greater Toronto Area, Canada. The focus groups explored coping strategies during the pandemic and spatial mobility patterns related to different activity types such as grocery shopping, leisure activities and physical exercises, social and familial activities, and healthcare. Qualitative thematic analysis was conducted guided by the neighbourhood and health theoretical framework. The overall engagement of older Chinese immigrants in various types of outdoor activities declined drastically and the spatial mobility pattern was complex. This change was shaped largely by the intersecting physical/built (e.g., residential conditions, access to public spaces), social (e.g., social support, interpersonal cohesion) and virtual (e.g., online communities and internet-based resources) environmental factors, as well as individual risk perceptions towards COVID-19 and public health interventions during the pandemic. Virtual environment emerged as an important domain that compensates for the heavily reduced spatial mobility of the group during the pandemic. It functioned as a vital channel for older Chinese immigrants to sustain the necessary leisure, social, and healthcare-related activities and maintain well-being during the pandemic. The study provides implications for addressing neighbourhood-level factors in policymaking and implementing initiatives to enhance active ageing experience of older Chinese immigrants.

Digital collaborative storytelling can be supported by an online learning-management system like Moodle, encouraging prosocial behaviors and shared representations. This study investigated children’s storytelling and collaborative behaviors during an online storytelling activity throughout the 2020 SARS-CoV-2 home confinement in Spain. From 1st to 5th grade of primary school, one-hundred-sixteen students conducted weekly activities of online storytelling as an extracurricular project of a school in Madrid. Facilitators registered participants’ platform use and collaboration. Stories were audio-recorded, transcribed verbatim, and analyzed using the Bears Family Story Analysis System. Three categories related to the SARS-CoV-2 pandemic were added to the story content analysis. The results indicate that primary students worked collaboratively in an online environment, with some methodology adaptations to 1st and 2nd grade. Story lengths tended to be reduced with age, while cohesion and story structure showed stable values in all grades. All stories were balanced in positive and negative contents, especially in characters’ behavior and relationships, while story problems remained at positive solution levels. In addition, the pandemic theme emerged directly or indirectly in only 15% of the stories. The findings indicate the potential of the online collaborative storytelling activities as a distance-education tool in promoting collaboration and social interactions.

Incidents of anti-Asian racism sharply increased during the COVID-19 pandemic. Regarding direct and indirect (vicarious) racism during the COVID-19 pandemic, perceived discrimination contributes to adverse mental health in older Korean immigrants. Thus, it is important to better understand the experiences of anti-Asian racism among older Korean immigrants in the USA and their coping strategies during the pandemic. Therefore, in this study, we qualitatively explored how older Korean immigrants perceived discrimination related to their ethnicity and race and how they coped with the discrimination experiences during the pandemic. We recruited 18 older Korean immigrants with perceived discrimination from church sites and non-profit organizations in rural and urban areas in the USA and invited them to participate in focus group sessions. We conducted the thematic analysis using ATLAS.ti software to reconstruct and categorize the qualitative data. Older Korean immigrants experienced direct and vicarious discrimination before and during the COVID-19 pandemic, which evoked feelings of anxiety, anger, sadness, and displeasure. They coped with adverse mental health by staying home or doing religious activities. Participants who had no coping strategies to alleviate their discrimination-related stress tended to discriminate against people of Chinese descent. Future studies are required to investigate the mechanism of reproduced discrimination against people of Chinese descent among older non-Chinese Asians with a lack of coping strategies and healthcare resources in the community.

Social programs run by community organizations provide an important outlet for social connectedness among older adults. However, these programs were disrupted by the COVID-19 pandemic restrictions. In this study, we aimed to understand how community organizations used digital technologies to continue running social programs online for older adults during COVID-19. We conducted semi-structured interviews with 12 staff members from local councils, libraries, community groups and care providers. We found that the use of technology benefited organizations by revealing new program delivery opportunities, and by strengthening their social bonds with older adults. However, organizations experienced challenges when transitioning social programs online. Some organizations lacked financial and human resources to support online programs; staff needed to upskill themselves and put significant effort into transferring older adults online; and it was difficult to replicate in-person experiences in online settings. Staff developed ad-hoc strategies to help older adults participate by providing extra guidance and training to increase digital literacy, and by offering accessible technical support. We discuss the significance of continuing online social programs beyond the pandemic and the importance of scaffolding to enable the online participation of older people in social programs. We outline design considerations for technology-mediated social programs run by community organizations.

As patients grow older, accurate communication with health care providers about cancer becomes increasingly important. However, little is known about the cancer communication experiences of older Asian immigrants. To learn about the cancer-related communication experiences of older Vietnamese immigrants from the insider perspective. Qualitative study (grounded theory, constant comparative method) using individual interviews with older Vietnamese immigrants with the purpose of discussing how they learn about cancer. Interviews were conducted in Vietnamese. Vietnamese immigrants aged 50-70 years, recruited through community-based organizations. Most had low education and limited English proficiency. The sample size of 20 was sufficient to achieve theoretical saturation. We identified 3 categories of themes concerning informants' experiences with cancer communication in the health care setting: (1) attitudes about addressing screening with providers, (2) issues/problems communicating with physicians about cancer, and (3) language/translation difficulties. There was substantial overlap between informants who mentioned each theme category, and 40% of the participants mentioned all 3 categories. Clinicians should be aware of and act upon specific cancer communication needs/challenges of their older immigrant patients. Moreover, health care systems need to be prepared to address the needs of an increasingly multiethnic and linguistically diverse patient population. Finally, community-level interventions should address baseline knowledge deficits while encouraging immigrant patients to engage their doctors in discussions about cancer screening.

Racial discrimination against Chinese immigrants to various countries worldwide has risen sharply during the COVID-19 pandemic, but limited research exists regarding the pathways through which racial discrimination impacts older immigrants' mental health. This study explored the relationship of perceived discrimination to depression among older Chinese immigrants living in Aotearoa New Zealand, through pathways of chronic health conditions, language barriers, and COVID-19 risks while taking into account the effects of anxiety and loneliness. Descriptive and regression analysis was conducted from a convenience sample of 1159 older Chinese immigrants aged between 55 and 80. While there was no significant direct effect of perceived discrimination to depression, the results showed a significant indirect effect of perceived discrimination, chronic illnesses, COVID-19 risks, and language barriers on depression, which was mediated by anxiety and loneliness. Ageing policies and interventions must address anti-racism to reduce the social and health inequalities faced by older ethnic people.

Street clowning is another practice of begging and is still relatively new in the city of Makassar with 1.427 million inhabitants. Poverty and inequality are the main reasons for the presence of this new profession. This is also inseparable from the impact caused by the COVID-19 pandemic. With that, this research aims to analyze the factors that cause the emergence of street clowns in Makassar City and how community participation sees this problem. This research uses a qualitative method with a case study approach and a purposive sampling technique. The data in this research was obtained through interviews, field observations, and literature studies which were then analyzed using fishbone analysis. The results of this research show that four factors caused the emergence of street clowns in Makassar City: economic factors, education and work environment, environment, and family. In addition, the forms of community participation in this problem are participation for material intensive, participation with consultation, participation with resource contribution, and participation in the form of programs.

IntroductionPeople living with HIV (PLHIV) relied on community-based organizations (CBOs) in accessing HIV care and support during the COVID-19 pandemic in China. However, little is known about the impact of, and challenges faced by Chinese CBOs supporting PLHIV during lockdowns.MethodsA survey and interview study was conducted among 29 CBOs serving PLHIV in China between November 10 and November 23, 2020. Participants were asked to complete a 20-minute online survey on their routine operations, organizational capacity building, service provided, and challenges during the pandemic. A focus group interview was conducted with CBOs after the survey to gather CBOs’ policy recommendations. Survey data analysis was conducted using STATA 17.0 while qualitative data was examined using thematic analysis.ResultsHIV-focused CBOs in China serve diverse clients including PLHIV, HIV high-risk groups, and the public. The scope of services provided is broad, ranging from HIV testing to peer support. All CBOs surveyed maintained their services during the pandemic, many by switching to online or hybrid mode. Many CBOs reported adding new clients and services, such as mailing medications. The top challenges faced by CBOs included service reduction due to staff shortage, lack of PPE for staff, and lack of operational funding during COVID-19 lockdowns in 2020. CBOs considered the ability to better network with other CBOs and other sectors (e.g., clinics, governments), a standard emergency response guideline, and ready strategies to help PLHIV build resilience to be critical for future emergency preparation.ConclusionChinese CBOs serving vulnerable populations affected by HIV/AIDS are instrumental in building resilience in their communities during the COVID-19 pandemic, and they can play significant roles in providing uninterrupted services during emergencies by mobilizing resources, creating new services and operation methods, and utilizing existing networks. Chinese CBOs’ experiences, challenges, and their policy recommendations can inform policy makers on how to support future CBO capacity building to bridge service gaps during crises and reduce health inequalities in China and globally.