To summarize information obtained from original research about barriers to access of primary healthcare by Canadian immigrants’ and to identify research gaps. Electronic databases of primary research articles and grey literature were searched without restricting the time period. The preferred reporting items for systematic reviews and meta-analyses statement was followed for literature selection. Articles were selected based on three criteria: (a) the study population was Canadian legal immigrant(s), (b) the research was about the barriers to accessing primary healthcare in Canada, and (c) the article was written in English. Relevant information from the articles was extracted into tabular format and classified for thematic analysis. Identified barriers were grouped into five themes: cultural, communication, socio-economic status, healthcare system structure and immigrant knowledge. The barriers to accessing primary healthcare in each of these categories can provide insight and subsequent direction for changes needed to improve immigrant care and mitigate their deterioration in health status. The demographic and ethno-cultural distributions of the study populations across the provinces highlight the need to expand research to encompass more varied immigrant groups across more regions of Canada, including more research on male immigrants and immigrant seniors, and to increase research related to health care providers’ perspectives on the barriers.
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C. Citizenship and Immigration Canada. Annual report to parliament on immigration. 2003. http://www.cic.gc.ca/english/resources/publications/annual-report-2013/index.asp.
McDonald JT, Kennedy S. Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Soc Sci Med. 2004;59:1613–27.
Hyman I. Immigration and health. Health policy working paper series, vol 01–05. 2001.
Dunn JR, Dyck I. Social determinants of health in Canada’s immigrant population: results from the national population health survey. Soc Sci Med. 2000;51:1573–93.
Laroche M. Health status and health services utilization of Canada’s immigrant and non-immigrant populations. Can Public Policy. 2000;26:51–75.
Ng E, Wilkins R, Gendron F, Berthelot J-M. Dynamics of immigrants health in Canada: evidence from the National Population Health Survey. Healthy today, healthy tomorrow? Findings from the National Population Health Survey. 2005.
Carter T, Polevychok C, Friesen A, Osborne J. The housing circumstances of recently arrived refugees: the Winnipeg experience. Edmonton: University of Alberta; 2008.
Wu Z, Penning MJ, Schimmele CM. Immigrant status and unmet health care needs. Can J Public Health/Revue Canadienne de Sante’e Publique. 2005;96:369–73.
Asanin J, Wilson K. “I spent nine years looking for a doctor”: exploring access to health care among immigrants in Mississauga, Ontario, Canada. Soc Sci Med. 2008;66:1271–83.
Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73:526–35.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32.
Caulford P, Vali Y. Providing health care to medically uninsured immigrants and refugees. CMAJ. 2006;174:1253–4.
McMurray J, Breward K, Breward M, Alder R, Arya N. Integrated primary care improves access to healthcare for newly arrived refugees in Canada. J Immigr Minor Health. 2014;16:576–85.
Oxford University Press. The Oxford American college dictionary. New York: G.P. Putnam’s Sons; 2002.
Hofstede G. Culture and organizations. Int Stud Manag Organ. 1980;10:15–41.
Parrish P, Linder-VanBerschot J, Cultural dimensions of learning: addressing the challenges of multicultural instruction. Int Rev Res Open Distrib Learn. 2010;11:1–19.
Hamilton J. Multicultural health care requires adjustments by doctors and patients. CMAJ. 1996;155:585–7.
Brar S, Tang S, Drummond N, Palacios-Derflingher L, Clark V, John M, et al. Perinatal care for South Asian immigrant women and women born in Canada: telephone survey of users. J Obstet Gynaecol Can: JOGC. 2009;31:708–16.
George P, Terrion JL, Ahmed R. Reproductive health behaviour of Muslim immigrant women in Canada. Int J Migr Health Soc Care. 2014;10:88–101.
Lee T-Y, Landy CK, Wahoush O, Khanlou N, Liu Y-C, Li C-C. A descriptive phenomenology study of newcomers’ experience of maternity care services: Chinese women’s perspectives. BMC Health Serv Res. 2014;14:114.
Reitmanova S, Gustafson DL. “They can’t understand it”: maternity health and care needs of immigrant Muslim women in St. John’s, Newfoundland. Matern Child Health J. 2008;12:101–11.
Chugh U, Dillmann E, Kurtz SM, Lockyer J, Parboosingh J. Multicultural issues in medical curriculum: implications for Canadian physicians. Med Teach. 1993;15:83–91.
Donnelly TT. Challenges in providing breast and cervical cancer screening services to Vietnamese Canadian women: the healthcare providers’ perspective. Nurs Inq. 2008;15:158–68.
Ng C, Newbold KB. Health care providers’ perspectives on the provision of prenatal care to immigrants. Cult Health Sex. 2011;13:561–74.
Brotto LA, Chou AY, Singh T, Woo JS. Reproductive health practices among Indian, Indo-Canadian, Canadian East Asian, and Euro-Canadian women: the role of acculturation. J Obstet Gynaecol Can: JOGC. 2008;30:229–38.
Matuk LC. Pap smear screening practices in newcomer women. Women’s Health Issues. 1996;6:82–8.
Teng L, Blackmore ER, Stewart DE. Healthcare worker’s perceptions of barriers to care by immigrant women with postpartum depression: an exploratory qualitative study. Arch Women’s Ment Health. 2007;10:93–101.
Wu H, Yim C, Chan A, Ho M, Heathcote J. Sociocultural factors that potentially affect the institution of prevention and treatment strategies for hepatitis B in Chinese Canadians. Can J Gastroenterol. 2009;23:31–6.
Reitmanova S, Gustafson DL. Primary mental health care information and services for St. John’s visible minority immigrants: gaps and opportunities. Issues Ment Health Nurs. 2009;30:615–23.
Liu R, So L, Quan H. Chinese and white Canadian satisfaction and compliance with physicians. BMC Fam Pract. 2007;8:11.
Cave A, Maharaj U, Gibson N, Jackson E. Physicians and immigrant patients. Cross-cultural communication. Can Fam Physician. 1995;41:1685–90.
Dastjerdi M. The case of Iranian immigrants in the greater Toronto area: a qualitative study. Int J Equity Health. 2012;11:9.
Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2002;40:52–9.
Lofters AK, Moineddin R, Hwang SW, Glazier RH. Predictors of low cervical cancer screening among immigrant women in Ontario, Canada. BMC Women’s Health. 2011;11:20.
Blake C. Ethical considerations in working with culturally diverse populations: the essential role of professional interpreters. CPA Bulletin de l’APC, Montreal, Quebec. 2003;6:21–23.
Papic O, Malak Z, Rosenberg E. Survey of family physicians’ perspectives on management of immigrant patients: attitudes, barriers, strategies, and training needs. Patient Educ Couns. 2012;86:205–9.
Weerasinghe S, Mitchell T. Connection between the meaning of health and interaction with health professionals: caring for immigrant women. Health Care Women Int. 2007;28:309–28.
Masi R, Disman M. Health care and seniors. Ethnic, racial, and cultural dimensions. Can Fam Physician. 1994;40:498–504.
Marshall EG, Wong ST, Haggerty JL, Levesque J-F. Perceptions of unmet healthcare needs: what do Punjabi and Chinese-speaking immigrants think? A qualitative study. BMC Health Serv Res. 2010;10:46–53.
Poureslami I, Rootman I, Doyle-Waters MM, Nimmon L, Fitzgerald JM. Health literacy, language, and ethnicity-related factors in newcomer asthma patients to Canada: a qualitative study. J Immigr Minor Health. 2011;13:315–22.
Setia MS, Quesnel-Vallee A, Abrahamowicz M, Tousignant P, Lynch J. Access to health-care in Canadian immigrants: a longitudinal study of the National Population Health Survey. Health Soc Care Community. 2011;19:70–9.
Dunlop S, Coyte PC, McIsaac W. Socio-economic status and the utilisation of physicians’ services: results from the Canadian National Population Health Survey. Soc Sci Med. 2000;51:123–33.
Lai DW, Chau SB. Predictors of health service barriers for older Chinese immigrants in Canada. Health Soc Work. 2007;32:57.
Stewart MJ, Neufeld A, Harrison M, Spitzer D, Hughes K, Makwarimba E. Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors. Health Soc Care Community. 2006;14:329–40.
Williamson DL, Stewart MJ, Hayward K, Letourneau N, Makwarimba E, Masuda J, et al. Low-income Canadians’ experiences with health-related services: implications for health care reform. Health Policy. 2006;76:106–21.
Merry LA, Gagnon AJ, Kalim N, Bouris SS. Refugee claimant women and barriers to health and social services post-birth. Can J Public Health/Revue Canadienne de Sante Publique. 2011;102:286–90.
Chalmers B, Omer-Hashi K. What Somali women say about giving birth in Canada. J Reprod Infant Psychol. 2002;20:267–82.
Cauch-Dudek K, Victor JC, Sigmond M, Shah BR. Disparities in attendance at diabetes self-management education programs after diagnosis in Ontario, Canada: a cohort study. BMC Public Health. 2013;13.
Hislop TG, Teh C, Lai A, Ralston JD, Shu J, Taylor VM. Pap screening and knowledge of risk factors for cervical cancer in Chinese women in British Columbia, Canada. Ethn Health. 2004;9:267–81.
Hogg PW. Constitutional law of Canada. Toronto: Thomson Carswell; 2007.
Newbold KB. Self-rated health within the Canadian immigrant population: risk and the healthy immigrant effect. Soc Sci Med. 2005;60:1359–70.
Derose KP, Escarce JJ, Lurie N. Immigrants and health care: sources of vulnerability. Health Aff (Millwood). 2007;26:1258–68.
Murray SB, Skull SA. Hurdles to health: immigrant and refugee health care in Australia. Aust Health Rev. 2005;29:25–9.
Newbold B. The short-term health of Canada’s new immigrant arrivals: evidence from LSIC. Ethn Health. 2009;14:315–36.
Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000;49:147–52.
Richmond BJ. Turning up the volume on the health concerns of marginalized women. Ontario Women’s Health Network. 2006.
C. Citizenship and Immigration Canada. Facts and figures 2013: immigration overview: permanent residents. 2013. http://www.cic.gc.ca/english/resources/statistics/facts2013/index.asp.
Durst D. More snow on the roof: Canada’s immigrant seniors. Can Issues/Themes Can. 2005:34–37.
Flores G, Gee D, Kastner B. The teaching of cultural issues in US and Canadian medical schools. Acad Med. 2000;75:451–5.
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Ahmed, S., Shommu, N.S., Rumana, N. et al. Barriers to Access of Primary Healthcare by Immigrant Populations in Canada: A Literature Review. J Immigrant Minority Health 18, 1522–1540 (2016). https://doi.org/10.1007/s10903-015-0276-z
- Primary healthcare