Rousseau Cécile, Rummens Joanna Anneke, Frounfelker Rochelle L, Yebenes Monica Ruiz Casares, Cleveland Janet
Department of Psychiatry, McGill University, CIUSSS Centre-Ouest de L'Ile-de-Montréal, QC H3N 1Y9 Montreal, Canada.
Nursing Department, Ryerson University, Toronto, ON Canada.
J Int Migr Integr. 2022;23(3):1341-1356. doi: 10.1007/s12134-021-00892-4. Epub 2021 Sep 10.
Health care personnel attitudes toward refugee claimant entitlement to health care are influenced by multilevel factors including institutional and societal culture. Although individual attitudes may be modified through training, macro- and meso-issues require system-level interventions. This paper analyzes the role of individual-, institutional-, and city-level factors in shaping attitudes toward refugee claimants' access to health care among Canadian health care personnel. A total of 4207 health care personnel in 16 institutions located in Montreal and Toronto completed an online survey on attitudes regarding health care access for refugee claimants. We used multilevel logistic regression analysis to identify individual-, institutional-, and city-level predictors of endorsing access to care. Participants who had prior contact with refugee claimants had greater odds of endorsing access to care than those who did not (OR 1.13; 95% CI 1.05, 1.21). Attitudes varied with occupation: social workers had the highest probability of endorsing equal access to health care (.83; 95% CI .77, .89) followed by physicians (.77; 95% CI .71, .82). An estimated 7.97% of the individual variation in endorsement of equal access to health care was attributable to differences between institutions, but this association was no longer statistically significant after adjusting for city residence. Results indicate that the contexts in which health care professionals live and work are important when understanding opinions on access to health care for vulnerable populations. They suggest that institutional interventions promoting a collective mission to care for vulnerable populations may improve access to health care for precarious status migrants.
医护人员对难民申请者获得医疗保健权利的态度受到包括机构和社会文化在内的多层次因素的影响。尽管个人态度可通过培训得到改变，但宏观和中观问题需要系统层面的干预措施。本文分析了个人、机构和城市层面的因素在塑造加拿大医护人员对难民申请者获得医疗保健态度方面所起的作用。蒙特利尔和多伦多16家机构的4207名医护人员完成了一项关于难民申请者获得医疗保健态度的在线调查。我们使用多层次逻辑回归分析来确定支持获得医疗服务的个人、机构和城市层面的预测因素。与难民申请者有过接触的参与者比没有接触过的参与者更有可能支持获得医疗服务（比值比1.13；95%置信区间1.05，1.21）。态度因职业而异：社会工作者支持平等获得医疗保健的可能性最高（0.83；95%置信区间0.77，0.89），其次是医生（0.77；95%置信区间0.71，0.82）。平等获得医疗保健支持率的个体差异中，估计有7.97%可归因于机构之间的差异，但在调整城市居住因素后，这种关联不再具有统计学意义。结果表明，在理解对弱势群体获得医疗保健的看法时，医护专业人员生活和工作的环境很重要。研究结果表明，促进关爱弱势群体集体使命的机构干预措施可能会改善不稳定身份移民获得医疗保健的机会。
