1. 1 Becoming Self-sufficient The Experience of Iranian Immigrants who Access Canadian Health Care Services (Dastjerdi Access Model for Immigrant Populations ) Mahdieh Dastjerdi PhDc University of Alberta / IIQM Dr. Karin Olson Associate Professor of University of Alberta & AHFMR Health Scholar Partially Funded by WRTC/CIHR (University of British Columbia)

2. 2 Becoming Self-sufficient The purpose of this study was to develop a substantive grounded theory (GT) that explained the central issues to this particular group of people

3. 3 Data Gathering Criteria For Participation Eighteen years of ages and above at the time of immigration Speak Persian (Farsi) and /or English Hold immigrant or refugee status (Iranians who have come to Canada as students, tourists or visitors cannot participate in this study) Have used Canadian health care services Live in Edmonton, Canada

4. 4 Data Gathering Seventeen participants (immigrants/refugees) were interviewed at first, 8 took part in second interview, and 4 participants took part in third interview Age 25-49 y (Mean= 35) Gender F/M ( F=11, M=6) Arrival immigration status I/R/U (I=8, R=4, U=5) Years in Canada 2-15 y (Mean= 7.1 y) Education H/B/M/D (H=4, B= 6, M=6, D= 1)

5. 5 Approach : Constructivist Grounded Theory Core Category: Stumbling Blocks of Access Basic Social Process: Becoming Self-sufficient

6. 6 The Process of Accessing HCS: Becoming Integrated and Becoming Self-sufficient Stage 1: Becoming a Stranger (Starting Point) * Ignoring the self * Getting lost * Getting disconnected Stage 2 : Feeling helpless (Entry point) * Becoming in need" of accessing Health care services * Facing barriers Stage 3: Navigating/ Seeking (Transition point) * Realizing need to know * Discovering the differences in the Health care systems * Searching resources Stage 4: Employing Strategies (Turning Point ) * Weighing options, dealing with barriers, (Turing the/a key) * Evaluating outcomes Stage 5: Becoming Integrated and self-sufficient (Turning the corner)

7. 7 Stage 2: Feeling Helpless (Entry Point) * Being in need of accessing H.C.S * Facing barriers Needs Structural Barriers Non Structural Barriers Go to stage3 Go home (Turning off), Get isolated in Canada (Holding on), Get connected elsewhere (Turning back)

8. 8 Needs Structural Barriers Non Structural Barriers Go to stage 4 Go home (Turning off), Get Isolated in Canada (Holding on), Get Connoted elsewhere (Turning back) Stage 3: Navigating and Seeking (Transition point) * Realizing the need" to know * Discovering the differences in the H.C.S * Searching Resources Navigating and Seeking

9. 9 Needs Structural Barriers Non Structural Barriers Go to stage 4 Go home (Turning off), Isolated in Canada (Holding on), Connect elsewhere (Turning back) Stage 3: Navigating and Seeking (Transition point) * Realizing the need" to know * Discovering the differences in the H.C.S * Searching Resources - Inside Resources Outside Resources -

10. 10 + Needs Structural Barriers Non Structural Barriers Go to stage 5 Stage 4: Employing Strategies (Turning point) * Weighing options/dealing with barriers/ Turning the/a key (Utilization) * Evaluating outcomes (Quality) - Inside Resources Outside Resources - Access Use Quality

11. 11 + + Turning the corner Needs Structural Barriers Non Structural Barriers Stage 5: Becoming integrated/ self-sufficient (Turning the corner) - Inside Resources Outside Resources - Access Use Quality

12. 12 + - Needs Structural Barriers Non Structural Barriers Go to stage 5 Back to navigation / Turning back Stage 3 (misuse /overuse of resources) - Inside Resources Outside Resources - Access Use Quality Stage 4: Employing Strategies (Turning point) * Weighing options/dealing with barriers/ Turning the/a key (Utilization) * Evaluating outcomes (Quality )

13. 13 + - Needs Structural Barriers Non Structural Barriers Go to stage 5 Stay in stage 4 (misuse /overuse of HCS) - Inside Resources Outside Resources - Access Use Quality Stage 4: Employing Strategies (Turning point) * Weighing options/dealing with barriers/ Turning the/a key (Utilization) * Evaluating outcomes (Quality)

14. 14 + - - - + Turning the corner Needs Structural Barriers Non Structural Barriers Go to stage 5 Back to navigation Becoming integrated/ / Turning back Self-sufficient stage 3 (misuse (Turning point) /overuse of resources Stay in stage 4 (misuse /overuse of HCS) - Inside Resources Outside Resources - Appropriateness/Acceptability Access Use Quality Stage 3, 4& 5: Navigating and Seeking (Transition point), Employing Strategies (Turning point) & Becoming integrated /self-sufficient (Turning the corner)