1. “If They Tell Me To Get It, I’ll Get It,” - Immigrant Mothers’ Immunization Decision-Making by Stephanie Patricia Kowal 1, Dr Cindy Jardine 1, and Dr Tania Bubela 1 1 School of Public Health, University of Alberta Public Health 2014, May 27, 2014, Toronto, ON

3. Statistics Canada, censuses of population, 1901 to 2006. 7654321076543210 millionspercentage 25% 20% 15% 10% 5% 0% 1901 1911 1921 1931 1941 1951 1961 1971 1981 1986 1991 1996 2001 2006 Census Year Proportion of Foreign-Born Population in Canada Canada’s Foreign-Born Population

4. Foreign-Born Population in Edmonton, Alberta Edmonton: 22.9% Alberta: 16.2% Canada: 19.8% Statistics Canada, censuses of population, 1901 to 2006.

5. Immigrant Women as a Vulnerable Population Barriers to health systems Language Economic situations Pregnant Women Increased risk to infectious disease

6. Health Protection through Vaccination Disparities among children Disparities among women Varied experiences and what this means as an immigrant? Jenista, 2001; Meints & Chescheir, 2010; McElroy et al., 2009

7. Health Protection through Vaccination Disparities among children Disparities among women Varied experiences and what this means as an immigrant? Jenista, 2001; Meints & Chescheir, 2010; McElroy et al., 2009

8. 1) Understand decision making processes 2) Assess information needs Study Purpose

9. 1)Vaccine knowledge learned from origin countries. 2)How that knowledge applied in Canada. 3)How to develop effective risk communication. Research Questions

10. Methods 23 Qualitative Interviews South Asia: n=8 China: n=10 Bhutanese Refugees: n=5

11. Sample: Participating Communities 1)China-, South Asia-, or Bhutan-born 2)Pregnant and/or have children under 8 years old 3)Immigrated to Canada in the last 8 years 4)Living in Edmonton, Alberta, Canada

12. Edmonton’s Foreign-Born Population Immigrant Population Make-Up: Edmonton, Alberta Chinese 28% Latin American 5% South Asian 23% South East Asian 6% Black 12% Arab 7% Filipino 11% Other 8% Statistics Canada, censuses of population, 1901 to 2006.

13. Interview Guide Previous vaccine experiences Comprehension of how vaccine technology and regulations Vaccine information access and use

14. Results - Passivity I just walked into the medi-centre and did not have much interaction with any doctor so I’m not really sure. Maybe if I had a family doctor they would have suggested vaccines. (South Asian Participant)

15. Results: Immunization Decision-Making Processes I went to the doctor because I had a flu and I think because it wasn’t necessary so that was why I was not advised to take it. I didn’t ask. If my doctor tells me to take it, I will take it. But if my doctor doesn’t then... (Chinese Participant) 30

16. They give it on paper, they give it on the phone once or twice at the beginning. I just listen to what they have to say. (South Asian Participant) Results: Immunization Decision-Making Processes

17. I don’t know if the doctor will say [vaccination] is a must, but yes, if the doctor says your should get it done, you should because they are telling you for your own good. (South Asian Participant) Results: Immunization Decision-Making Processes

18. Implications for Communication Doctors’ Visits Effective Information Delivery Uptake of Recommendations

19. Implications for Communication Back to H1N1

20. Implications for Communication Example of Canadian Refugee Health Policies Doctors’ Visits Effective Information Delivery Uptake of Recommendations

21. Must Account for Unique Information Gathering and Decision-Making to Build Effective Communication

22. References Jenista J. The Immigrant, Refugee, or Internationally Adopted Child. Pediatrics in Review. 2001; (22)12: 419-429. McElroy R, Laskin M, Jiang D, Shah R, Ray J. Rates of Rubella Immunity Among Immigrant and Non-Immigrant Pregnant Women. Journal of Obstetric Gynaecology Canada. 2009; 31(5): 409-413. Meints L, Chescheir N. Screening for infectious diseases in pregnant, foreign-born women from multiple global areas. Journal of Reproductive Medicine, 2010; 55(9-10): 382-6. Statistics Canada (2006) Immigration and Citizenship Highlight Tables, 2006 Census. Available at http://www12.statcan.ca/census-recensement/2006/dp-pd/hlt/97-557/Index-eng.cfmhttp://www12.statcan.ca/census-recensement/2006/dp-pd/hlt/97-557/Index-eng.cfm

23. Thank You! Questions? Acknowledgements Multi-Cultural Health Brokers Cooperative: Yvonne Chiu Shiva Chapagai Lydia Yip Hina Naushad Ravi Hansra Daljit Rupana Funders: CIHR Master’s Award HQCA Summer Studentship WCHRI Qualitative Core Resource WCHRI/CUP CBR Science Shop WCHRI Graduate Studentship SRA International Student Travel Award Research Participants Contact Info: skowal@ualberta.ca Translators Jian Wang Dr Amrita Mishra

24. Similarities Among Differences Chinese, Bhutanese, and Indian Contexts