Acculturation in Preventive Health for Immigrants: A Systematic Review on Influenza Vaccination Programs in a Socio Ecological Framework

The immigrant population is a significant and diverse segment of the Canadian public. One fifth of Canadians are foreign born individuals from over 200 countries (Statistics Canada, 2013) Immigrants tend to experience a decline in health status as their years in the host community increase (Health Canada, 2010) Therefore, it is essential to engage immigrants in appropriate preventive health programs before the onset of health problems. We propose a socioecological framework for cultural adaptation for preventive health programs by arguing: (a) preventive health behaviours involve a cultural negotiation between an immigrant and the host community's social environment during acculturation within the health care life domain; and (b) immigrant status is distinct from ethnic or racial minority status in an increasingly diverse population. Chinese immigrants and influenza vaccination provide an interesting case study to demonstrate these arguments.Acculturation, Culture, and Preventive Health in ImmigrantsAccording to Redfield, Linton, and Herskovits (1936) "Acculturation comprehends those phenomena which result when groups of individuals having different cultures come into continuous first hand contact, with subsequent changes in the original cultural patterns of either or both groups" (p. 149) Although classic acculturation models (e.g. unidimensional model, bidimensional model, and Interactive Acculturation Model) help advance research on acculturation, a key drawback of these models is that they assume individuals are fixed in their acculturation strategies. In a culturally plural society, acculturating individuals negotiate resources and strategies from the heritage culture and the host culture to aid in adaptation in different life domains (Birman et al. 2014) The life domain approach posits that acculturation is a multidimensional process involving language, behaviour, and identity. The direction, rate, and outcome of acculturation differ based on the acculturation demands of the particular life domain.The decline in immigrants' health status with increased time spent in the host community highlights the importance of focusing on the mechanisms that are related to preventive health behaviours during acculturation. Further, health disparities are unequally distributed among immigrants such that immigrants who are visible minorities and allophones, as well as immigrants who have low socioeconomic status (SES) are at an increased risk of transitioning into poor health (Health Canada, 2010; Vang, Sigouin, Flenon, Gagnon, 2015) Additionally, health care is a cultural transaction in health beliefs, values, expectations, and practices between the immigrants and the host community (Kemp Rasbridge, 2004; Waxler Morrison, Anderson, Richardson, Chambers, 2005) During acculturation, immigrants may negotiate resources and strategies from the heritage culture and the host culture to decide the course of action for their health. Because immigrants come from diverse backgrounds, immigrants from different subgroups may have different health care needs, concerns, and experiences. All in all, these observations underline a need for targeted and tailored approaches within preventive health programs.Influenza Vaccination and Chinese ImmigrantsAnnually, 3,697 deaths in the United States and 606 deaths in Canada are related to seasonal influenza (Centers for Disease Control and Prevention, 2015; Public Health Agency of Canada, 2015) Influenza outbreaks have multilevel repercussions including mortality, economic burden, absenteeism, disruptions in the delivery of vital services, and overburdened health care system (World Health Organization, 2015) Accordingly, influenza prevention through vaccination has become a salient topic for public health and safety. Immigrants are more susceptible to influenza complications because they are less likely to be vaccinated for influenza (Burnett, Genao, Wong, 2005; Gilmour Hofmann, 2010; Nguyen Altshuler, 2011)