Uncovering the Role of Community Health Worker/Lay Health Worker Programs in Addressing Health Equity for Immigrant and Refugee Women in Canada: An Instrumental and Embedded Qualitative Case Study
Creators: name: Torres Ospina, Sara
Publisher: name: Université d'Ottawa / University of Ottawa
Year: 2013
Subjects: subject: Canada
subject: Case Study
subject: Inequity
subject: Immigrants
subject: Refugees
subject: Community Capacity Building
subject: Alberta Health Services
subject: Multicultural Health Brokers
subject: Health Human Resources Workforce
subject: Health Brokers
subject: Lay Health Promoters
subject: Lay Health Workers
subject: Authoritative Knowledge
subject: Experiential Knowledge
subject: Feminist
subject: Families
subject: Qualitative Research
subject: Child Welfare
subject: Cultural Brokering
subject: Community Health Workers
subject: Models
subject: Multicultural Health Brokers Co-operative
subject: Co-operatives
subject: Women
subject: Women's Urban Citizenship
subject: Empowerment
subject: Embedded Case Study Research
subject: Social Determinants of Health
subject: Social Change
subject: Social Work
subject: FOS: Sociology
subject: FOS: Sociology
subject: Urban Citizenship
subject: Universal Programs
subject: Unregulated Health Care Workers
subject: Theory
subject: Typology
subject: Perinatal Health
subject: Racialized
subject: Gender
subject: Race
subject: Class
subject: Discrimination
subject: Diversity
subject: Health Worker Co-operatives
subject: Policy Makers
subject: Access to Health Services
subject: Equity
subject: Access to Social Services
subject: Cultural Competence
subject: Racism
subject: Canada Prenatal Nutrition Program
subject: Public Health
subject: Primary Care
subject: Health Promotion
subject: Violence Prevention
subject: Immigrant Health Care Workers
subject: Immigrant Community Health Workers

description: “Why do immigrants and refugees need community health workers/lay health workers (CHWs) if Canada already has a universal health care system?” Abundant evidence demonstrates that despite the universality of our health care system marginalized populations, including immigrants and refugees, experience barriers to accessing the health system. Evidence on the role of CHWs facilitating access is both lacking and urgently needed. This dissertation contributes to this evidence by providing a thick description and thorough analytical exploration of a CHW model, in Edmonton, Canada. Specifically, I examine the activities of the Multicultural Health Brokers Co-operative (MCHB Co-op) and its Multicultural Health Brokers from 1992 to 2011 as well as the relationship they have with Alberta Health Services (AHS) Edmonton Zone Public Health. The research for this study is based on an instrumental and embedded qualitative case study design. The case is the MCHB Co-op, an independently-run multicultural health worker co-operative, which contracts with health and social services providers in Edmonton to offer linguistically- and culturally-appropriate services to marginalized immigrant and refugee women and their families. The two embedded mini-cases are two programs of the MCHB Co-op: Perinatal Outreach and Health for Two, which are the raison d’être for a sustained partnership between the MCHB Co-op and AHS. The phenomenon under study is the Multicultural Health Brokers’ practice. I triangulate multiple methods (research strategies and data sources), including 46 days of participant and direct observation, 44 in-depth interviews (with Multicultural Health Brokers, mentors, women using the programs, health professionals and outsiders who knew of the work of the MCHB Co-op and Multicultural Health Brokers), and document review and analysis of policy documents, yearly reports, training manuals, educational materials as well as quantitative analysis of the Health Brokers’ 3,442 client caseload database. In addition, data include my field notes of both descriptive and analytical reflections taken throughout the onsite research. I also triangulate various theoretical frameworks to explore how historically specific social structures, economic relationships, and ideological assumptions serve to create and reinforce the conditions that give rise to the need for CHWs, and the factors that aid or hinder their ability to facilitate marginalized populations’ access to health and social services. Findings reveal that Multicultural Health Brokers facilitate access to health and social services as well as foster community capacity building in order to address settlement, adaptation, and integration of immigrant and refugee women and their families into Canadian society. Findings also demonstrate that the Multicultural Health Broker model is an example of collaboration between community-based organizations and local systems in targeting health equity for marginalized populations; in particular, in perinatal health and violence against women. A major problem these workers face is they provide important services as part of Canada’s health human resources workforce, but their contributions are often not recognized as such. The triangulation of methods and theory provides empirical and theoretical understanding of the Multicultural Health Brokers’ contribution to immigrant and refugee women and their families’ feminist urban citizenship.