Profile
Sepali Guruge's program of research focuses on the health of immigrants who constitute a significant proportion of urban communities in Canada. Within this broader program of research, she has investigated a range of key health concerns including aging, elder abuse, mental health, HIV/AIDS, cancer, diabetes, cardiovascular health, tuberculosis, and interpersonal violence, in the context of the health inequities resulting from: socio-economic marginalization, limited access to healthcare, education, employment, and language training, housing insecurity, unsafe neighbourhoods, racism and discrimination. Her research program connects these key local urban health concerns to those occurring at global levels. To this end, she has worked on a number of related projects with colleagues in several other countries. Her work has been supported by a range of funding agencies, and her research findings have been disseminated in over 10 languages, making her work accessible beyond English-speaking audiences. Her research has gained national and international recognition, and in 2014, she was selected to be part of the inaugural cohort of the College of the New Scholars, Artists, and Scientists of the Royal Society of Canada.
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Aging in Third Places: Creating Community Spaces and Building Social Infrastructure for Senior Immigrants Toronto Metropolitan University Publication 2024-09-30 Guruge, S. & Sidani, S. (2023). Determinants of loneliness in older immigrants: A scoping review. International Health Trends and Perspectives, 3(2), 243-262. Toronto Metropolitan University Publication 2024-07-28 Healthcare Practices among Refugee Older Adults: A Scoping review protocol TRS1 1.9 Toronto Metropolitan University, University of Alberta Publication 2024-06-29 Catallo, C. , Dr Lixia Yang,
Guruge, S. ,
Al-Hamad, A. , Zhixi Cecilia Zhuang, Yasin M Yasin,
Wang, L. ,
Salma, J. ,
Metersky, K. TRS1 1.9 Transnational Healthcare Practices Among Migrants: A Concept Analysis TRS1 1.9 Toronto Metropolitan University, University of Alberta Publication 2024-01-01 Metersky, K. ,
Guruge, S. ,
Wang, L. , Areej Al‐Hamad, Yasin M Yasin,
Catallo, C. ,
Yang, L. ,
Salma, J. , Zhixi C Zhuang, Monica Chahine,
Kirkwood, M. , Ayah Al‐Anani
TRS1 1.9 Healthcare practices among refugee older adults: A protocol for a scoping review TRS1 1.9 University of Doha for Science and Technology, Toronto Metropolitan University, University of Alberta Publication 2024-01-01 Yasin, Y. ,
Al-Hamad, A. ,
Guruge, S. ,
Metersky, K. ,
Catallo, C. ,
Wang, L. ,
Yang, L. , Zhixi Cecilia Zhuang,
Salma, J. , Fiona MacKenzie-Ede, Krista Charbonneau, Anojini Ravichandran
TRS1 1.9 The 27th Canadian Ethnic Studies Association's Conference (CESA) 2024: Colonial Legacies, Contemporary Crises and Contested Futures: Canada in an Interconnected World TRS1 1.9 Toronto Metropolitan University, University of Doha for Science and Technology, University of Alberta Conference 2024-11-14 Metersky, K. ,
Guruge, S. ,
Wang, L. ,
Al-Hamad, A. ,
Yasin, Y. ,
Catallo, C. ,
Yang, L. ,
Salma, J. ,
Zhuang, Z. , Monica Chahine,
Al-Anani, A. ,
Kirkwood, M. TRS1 1.9 Refugee older adults’ use of social media for transnational health practices: A scoping review TRS1 1.9 Toronto Metropolitan University, University of Doha for Science and Technology, University of Alberta Conference 2024-11-11 Catallo, C. ,
Guruge, S. ,
Metersky, K. ,
Wang, L. ,
Al-Hamad, A. ,
Yasin, Y. ,
Salma, J. , Samantha Pejic, Alanna De Fry
TRS1 1.9 Canadian Association on Gerontology (CAG) 2024: Agents of Change: Unraveling Complexity and Advancing Transformation Conference TRS1 1.9 Toronto Metropolitan University, University of Doha for Science and Technology, University of Alberta Conference 2024-10-24 Metersky, K. ,
Guruge, S. ,
Al-Hamad, A. ,
Yasin, Y. ,
Catallo, C. ,
Wang, L. ,
Yang, L. ,
Zhuang, Z. ,
Salma, J. , Monica Chahine,
Al-Anani, A. ,
Kirkwood, M. TRS1 1.9 Neighbourhood Social Influences on Loneliness in Older Immigrants in Two Canadian Provinces Abstract Loneliness is a major health concern for immigrant older adults. This study explores social influences on loneliness in neighbourhoods among immigrant older adults across five major urban centres in Ontario and Alberta, Canada. Data were collected from 435 older immigrants who participated in the Inclusive Communities for Older Immigrants (ICOI) Project. Data were analysed using multiple linear regression (MLR) to identify the influences of neighbourhood factors, family support, duration of residency in Canada, English proficiency, and gender. Results indicate that increased engagement in ethnic enclaves, not being reliant on transportation for social interactions, and perceptions of neighbourhood cohesion are associated with a significant reduction in loneliness. These associations remain significant after accounting for family support and language proficiency. This calls for further research into the interconnections among interpersonal factors, neighbourhood-level factors, and family and community-level support to address key influences on loneliness in this population. University of Alberta, Toronto Metropolitan University Publication 2025-08-01 Elisabetta Mazzullo,
Salma, J. , Christine A Walsh, Alesia Au, Souraya Sidani,
Agrawal, S. , Okan Bulut,
Guruge, S. “Home Away From Home”: A Critical Metaphor Analysis of Displaced Ukrainian Women’s Experiences With Their Canadian Hosts Displaced by the Russian invasion, Ukrainian women face complex challenges in adapting to new environments. This study explores their experiences living in homestay arrangements in Canada, drawing on Conceptual Metaphor Theory and Critical Metaphor Analysis to examine how they express displacement, adaptation, and integration. Eighteen women participated through photo-elicitation interviews, metaphor-building activities using AI-generated images, and focus group discussions. The participants created metaphors to represent their hosting experiences, which were analyzed using Charteris-Black’s framework for Critical Metaphor Analysis alongside thematic narrative analysis. Metaphors such as “The Cardboard House,” “Ferris Wheel of Photos,” and “Warm Safe House” captured their resilience, vulnerability, and evolving sense of belonging. These metaphors informed three central themes: the search for stability, safety, and peace; the process of adaptation and expressions of gratitude; and the emotional dislocation tied to homeland connections. The findings highlight the emotional complexity of homestay experiences and the need for culturally sensitive, structured hosting models. For nursing, this underscores the value of trauma- and culturally-informed care to support displaced women’s psychosocial well-being. Toronto Metropolitan University Publication 2025-07-01 Social Participation Among Older Immigrants: A Cross-Sectional Study in Nine Cities in Canada Background/Objectives: Social participation is important for healthy aging but challenging for older immigrants because of factors such as the loss of cultural community, language and transportation barriers, ageism, and racism. This study aimed to examine (1) the type of social activities in which older immigrants from Arabic (Arab), Mandarin (East Asian), and Punjabi-speaking (South Asian) communities in Canada engage; (2) their desire for more participation in social activities; and (3) factors they perceive as preventing their engagement in more social activities. Methods: Using a cross-sectional design, we collected data, using existing measures, from 476 older immigrants between fall 2022 and winter 2023. Descriptive statistics were used to analyze the data. Results: More than 75% of participants reported engagement in three solitary activities (having a hobby, going on a day trip; and using the internet and/or email) and more than 85% participated in community-based activities with family inside and outside and with friends outside the household. Most (71%) expressed a desire to participate in more social activities in the community, but they were prevented from doing so due to factors such as language barriers or not wanting to go alone. Conclusions: Interventions are needed to facilitate community-based participation among older immigrants and improve their quality of life. Toronto Metropolitan University Publication 2025-06-20 The Role of Technology Use in the Context of Social Isolation Among Immigrant Older Adults Technology has been integrated into every aspect of life for interpersonal support and connections and social isolation has become a hotspot topic for health promotion in nursing among various populations, but little attention has been paid to immigrant older adults using technology to overcome social isolation. The purpose of this narrative review is to comprehend the role of technology use in the context of social isolation, including the predisposing factors, encountered by immigrant older adults to support their psychosocial wellbeing. By studying relevant peer-reviewed articles published in professional databases from 2013 to 2024, 26 articles met the criteria and were accessed for this narrative review, despite an unexpected participant selection preference of older Asian immigrants living in a North American context among these eligible papers. It is discovered that technology use has improved the mental health of socially-isolated immigrant older adults. However, the benefits of technology use for these individuals are constrained by cultural and linguistic differences as well as educational backgrounds. Therefore, technology adaptation should be promoted in this population through a collaborative partnership with healthcare practitioners, educators, researchers and policymakers. There should be further exploration of the interrelationships between technology use and psychosocial support and continuous striving for the most suitable approach for social isolation prevention among immigrant older adults. Toronto Metropolitan University Publication 2025-06-02 Metersky, K. , P H Lin,
Guruge, S. ,
Zhuang, Z. ,
Catallo, C. ,
Chandrasekaran, K. Successful Refugee Cohabitation With Host Families: A Concept Analysis and Model Development Purpose: This concept analysis aims to address the gap in knowledge regarding the concept of successful refugee cohabitation with host families. It seeks to develop a conceptual model that integrates holistic nursing and healthcare practices into refugee cohabitation settings to enhance refugee well-being. Methods: A comprehensive literature search was conducted using Walker and Avant's methodology for concept analysis. Findings: Successful refugee cohabitation with host families concept characterized by peaceful coexistence, power dynamics, hospitality, and cultural tolerance. Antecedents include refugee shelter needs, societal acceptance, humanitarian solidarity, and legal support. Consequences include refugee inclusion and integration, societal cohesion, psychological well-being, and refugee–host acceptance. Conclusions: Successful refugee cohabitation is defined as a private hosting arrangement that embodies shared living spaces and peaceful coexistence amid conflict or crises, fostering resilience and support for displaced individuals by local citizens. It combines hospitality, balanced power, and cultural tolerance, driven by refugee needs for shelter and a commitment to successful refugee settlement and integration. This hosting arrangement promotes societal development and cohesion, economic growth, psychological well-being, and foster inclusion and intergroup tolerance. The integration of holistic nursing principles into refugee cohabitation practices can foster more inclusive and healthy communities.
Toronto Metropolitan UniversityPublication 2025-03-24 Homestay Hosting Dynamics and Refugee Well-Being: Scoping Review Background: Homestay accommodations aim to support a smoother transition for refugees; yet, the intricate nature of relationships between refugees and their hosting families can make this process complex, which, in turn, can affect their health and well-being. It is crucial to grasp the experiences of both refugees and their host families in order to foster effective settlement, integration, and well-being.
Objective: The purpose of this scoping review is to explore the dynamics of homestay or hosting with a focus on understanding the experiences of both refugees and their hosting families to identify gaps in the literature and propose directions for future research.
Methods: We used the Joanna Briggs Institute methodology and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to guide this scoping review. Searches were conducted in MEDLINE via EBSCO, Scopus via OVID, CINAHL, SOCIndex, Web of Science Core Collection, ProQuest Dissertations and Theses, the SciELO Citation Index, and APA PsycInfo. Literature written in English and published from 2011 to 2024 that focused on homestay hosting contexts for refugees was included.
Results: The results of this review illuminate the multifaceted and dynamic nature of homestay hosting for refugees. The findings include motivations and barriers for homestay hosting, factors influencing host-refugee relations, and psychological and social outcomes of homestay hosting.
Conclusions: The results of this scoping review demonstrated the need for tailored support for refugees to improve homestay programs for the benefit of both refugees and host families and highlighted the need of more inclusive, supportive, and effective strategies for the hosting, resettlement, and integration of refugees.
Toronto Metropolitan UniversityPublication 2025-03-24 Picturing the ambiguity of homestay: a photovoice exploration of Ukrainian refugee women’s experiences with their Canadian hosts in Toronto This study explores the experiences of Ukrainian refugee women hosted by Canadian families in the Greater Toronto Area, focusing on the dynamics of this unique living arrangement amidst Toronto’s challenging housing situation. Using Feminist Standpoint Theory and a research-creation approach through Photovoice, eighteen Ukrainian refugee women shared and reflected on their experiences via photo elicitation interviews. The analysis, combining visual and narrative elements, highlights three key themes: Host-Guest Dynamics in Shared Spaces, which sheds light on the complexities of navigating interpersonal relationships within shared living environments; Adaptation through Coexistence, emphasizing the mutual adjustments and cultural exchanges between hosts and guests; and Refining the Path of Refugee Hosting, which reflects on the evolving practices and lessons learned from these hosting arrangements. These findings underscore the importance of centering refugee women’s voices to better understand the social, cultural, and political factors shaping their hosting experiences and contribute to advancing the discourse on refugee hosting practices.
Toronto Metropolitan UniversityPublication 2025-03-24 Immigrant older adults’ perceived acceptability of interventions for social isolation: A mixed methods study protocol (Preprint) BACKGROUND Immigrant older adults experience a sense of social isolation which negatively impacts their health. It is therefore important to develop interventions to reduce isolation and promote health. The application of the intervention mapping process resulted in the selection of 8 interventions that address determinants of isolation in older immigrants of East Asian, South Asian and Arab communities who are the fastest growing in Canada. However, it is unclear if the selected interventions are acceptable to the three communities. Acceptability is known to influence the uptake, engagement and adherence to interventions. OBJECTIVE The proposed study aims to 1) examine the acceptability of the selected interventions and 2) explore modifications that are required to enhance the cultural appropriateness of the interventions. METHODS A mixed-method, concurrent quantitative and qualitative, design will be used. Participants will be informed of each intervention; requested to rate its acceptability; and invited to a semi-structured interview to explore their perspectives on the cultural appropriateness and possible modifications of the intervention. Older immigrants will be recruited, using active and passive strategies, from 9 Canadian cities. They will be eligible to participate in the study if they are > 60 years, self-identify with the East Asian, South Asian or Arab communities, are community-dwelling and able to provide informed consent. The total sample size will be 450 to 800, balanced across immigrant communities and cities. Acceptability will be measured with 5 items adapted from the Treatment Acceptability and Preference instrument that demonstrated reliability and validity. Open-ended questions inquire about participants’ views on the cultural appropriateness of the intervention and modifications needed to enhance its acceptability. Descriptive statistics will be used to analyzed acceptability ratings. Responses to the open-ended questions will be content analyzed. Interventions with rating scores > 2 and qualitative comments indicating their fit with participants’ beliefs and values will be considered acceptable. RESULTS Data collection will begin soon. The project is funded by the Social Sciences and Humanities Research Council of Canada. CONCLUSIONS Results will help understand which of the selected interventions are acceptable and which ones require modifications before evaluating them for their effectiveness in addressing the respective determinants of social isolation among Mandarin, Punjabi, and Arabic-speaking older immigrants. This information is critical in helping reduce older immigrant's isolation, foster social connectedness, and ultimately, improve quality of life among older immigrants. Toronto Metropolitan UniversityPublication 2025-01-30 An Exploration of Demographic, Health, Social, and Environmental Factors Associated with Loneliness Among Immigrant Older Adult: A Cross-Sectional Study in Canada Toronto Metropolitan University Publication 2025-01-01 Author response for “Transnational Healthcare Practices Among Migrants: A Concept Analysis” Toronto Metropolitan University, University of Alberta Publication 2024-11-29 Metersky, K. ,
Guruge, S. ,
Wang, L. , Areej Al‐Hamad, Yasin M Yasin,
Catallo, C. ,
Yang, L. ,
Salma, J. ,
Zhuang, Z. , Monica Chahine, Melissa L Kirkwood, Ayah Al‐Anani
TORONTO’S MANDARIN, PUNJABI, AND ARABIC-SPEAKING OLDER IMMIGRANTS’ EXPERIENCES OF SOCIAL ISOLATION: FOCUS ON HEALTH Toronto Metropolitan University Publication 2024-11-01 Guruge, S. , Nishana Chandrasekaran, Nivashi Arulventh, Roberta Liti, Ehsan Ahmed,
Chandrasekaran, K. ,
Metersky, K. ,
Zhuang, Z. , Amanda Grenier,
Catallo, C. , Oona St-Amant, John Shields
A CALL FOR INTERPROFESSIONAL EDUCATION AND COLLABORATION TO PREVENT SUICIDE IN IMMIGRANT AND REFUGEE COMMUNITIES IN CANADA Toronto Metropolitan University Publication 2024-11-01 SOCIAL ISOLATION AMONG CHINESE OLDER IMMIGRANTS IN CANADA: A SCOPING REVIEW Toronto Metropolitan University Publication 2024-11-01 A SCOPING REVIEW ON SOCIAL ISOLATION AND LONELINESS AMONG OLDER ADULTS DURING THE COVID-19 PANDEMIC: IMPLICATIONS FOR INTERPROFESSIONAL EDUCATION Toronto Metropolitan University Publication 2024-11-01 COVID-19 restrictions: experiences of immigrant parents in Toronto Parenting is a demanding undertaking, requiring continuous vigilance to ensure children's emotional, physical, and spiritual well-being. It has become even more challenging in the context of COVID-19 restrictions that have led to drastic changes in family life. Based on the results of a qualitative interpretive descriptive study that aimed to understand the experiences of immigrants living in apartment buildings in the Greater Toronto Area, Ontario, Canada, this paper reports the experiences of 50 immigrant parents. During the summer and fall of 2020, semi-structured interviews were conducted by phone or virtually, audio-recorded, then translated and transcribed. The transcripts were analyzed using thematic analysis. Results revealed that parenting experiences during the pandemic entailed dealing with changing relationships, coping with added burdens and pressures, living in persistent fear and anxiety, and rethinking lifestyles and habits. Amid these changes and challenges, some parents managed to create opportunities for their children to improve their diet, take a break from their rushed lives, get in touch with their cultural and linguistic backgrounds, and spend more quality time with their family. While immigrant parents exhibit remarkable resilience in dealing with the pandemic-related meso and macro-levels restrictions, funding and programs are urgently needed to support them in addressing the impact of these at the micro level.
Toronto Metropolitan UniversityPublication 2024-10-15 Guruge, S. , Paula Lamaj, Charlotte Lee, Charlene Ronquillo, Souraya Sidani, Ernest Leung, Andrew Ssawi, Jason Altenberg,
Amanzai, H. , Lynn Morrison
Lessons Learned from Recruiting Socially Isolated Older Immigrants for a Survey-based Study in Toronto [para. 1]: " The COVID-19 pandemic brought to the forefront the detrimental health and social consequences of social isolation (Hosseinzadeh et al., 2022). For many older immigrant adults, these consequences are all too familiar. The loss of familiar social networks that resulted from immigrating to and settling in a new country coupled with systemic racism, language discordance, financial precarity, acculturation stress, limited mobility during winter months, costs of or lack of (accessible) transportation, and a lack of access to information and community resources, among other factors, contribute to their social isolation (Guruge et al., 2019; Sidani et al., 2022). Even though COVID-related public health restrictions have been lifted and there is return to ‘normalcy,’ older immigrant adults continue to experience social isolation. In this paper, opportunities, and challenges of reaching out to socially-isolated older immigrant adults in a research context are presented."
Toronto Metropolitan UniversityPublication 2024-10-15 Homestay Hosting Dynamics and Refugee Well-Being: Protocol for a Scoping Review Background: The process of refugee resettlement and integration into new communities is a complex and multifaceted challenge, not only for the refugees themselves but also for the host families involved in homestay housing arrangements. While these homestay arrangements are designed to facilitate smoother transitions and enhance the well-being of refugees, the nuanced dynamics of these interactions and their overall impact on both refugees and their host families remain underexplored. Understanding the experiences of refugees and their host families is vital for effective refugee settlement, integration, and well-being. However, the intricacies of homestay refugee hosting, their interactions with host families, and the impact on their well-being are still unclear and ambiguous.
Objective: The aim of this scoping review is to examine the breadth of literature on the experiences of refugees living in homestay arrangements with their host families. This review seeks to understand how these dynamics influence refugee well-being, including their integration, social connections, and mental health. Additionally, this scoping review aims to synthesize existing literature on homestay hosting dynamics, focusing on the experiences of refugees and their host families, to identify gaps in knowledge and suggest areas for future research.
Methods: This scoping review follows Joanna Briggs Institute methodology and will search databases such as CINAHL, SOCIndex, MEDLINE through EBSCO; APA PsycInfo, Scopus through OVID; and Web of Science Core Collection, ProQuest Dissertations, and Theses, and SciELO Citation Index, focusing on literature from 2011 onward, in English, in relation to refugee groups in different host countries, including all types of literature. Literature will be screened by 2 independent reviewers, with disagreements resolved by consensus or a third reviewer. A custom data extraction tool will be created by the research team.
Results: The results will be organized in tables or diagrams, accompanied by a narrative overview, emphasizing the main synthesized findings related to the dynamics of homestay hosting with host families and refugee well-being. No critical appraisal will be conducted. This scoping review is expected to identify research gaps that will inform the development of homestay refugee hosting models, policies, and practices. It will also offer insights into best practices and policy recommendations to improve homestay hosting programs, ultimately contributing to more effective refugee settlement and integration strategies.
Conclusions: Understanding the intricate dynamics of homestay hosting arrangements is crucial for developing policies and programs that support the well-being of refugees and the families that host them. This scoping review will shed light on the current knowledge landscape, identify research gaps, and suggest ways to enhance the homestay hosting experience for all parties involved. Through this work, we aim to contribute to the development of more inclusive, supportive, and effective approaches to refugee hosting, resettlement, and integration.
Toronto Metropolitan UniversityPublication 2024-10-15 Intimate partner violence in the post-war context: Women’s experiences and community leaders’ perceptions in the Eastern Province of Sri Lanka Background
Exposure to armed conflict and/or war have been linked to an increase in intimate partner violence (IPV) against women. A substantial body of work has focused on non-partner rape and sexual violence in war and post-war contexts, but research about IPV is limited, particularly in Asian settings. This paper presents the finding of a study conducted in the Eastern Province of Sri Lanka. The study explored women’s experiences of and responses to IPV as well as how health and social service providers perceive the problem. It also explored the IPV-related services and supports available after the end of a 30-year civil war.
Method
We conducted in-depth, qualitative interviews with 15 women who had experienced IPV and 15 service providers who were knowledgeable about IPV in the Eastern Province of Sri Lanka. Interviews were translated into English, coded and organized using NVivo8, and analyzed using inductive thematic analysis.
Results
Participants described IPV as a widespread but hidden problem. Women had experienced various forms of abusive and controlling behaviours, some of which reflect the reality of living in the post-war context. The psychological effects of IPV were common, but were often attributed to war-related trauma. Some men used violence to control women and to reinstate power when their gender roles were reversed or challenged due to war and post-war changes in livelihoods. While some service providers perceived an increase in awareness about IPV and more services to address it, this was discordant with women’s fears, feelings of oppression, and perception of a lack of redress from IPV within a highly militarized and ethnically-polarized society. Most women did not consider leaving an abusive relationship to be an option, due to realistic fears about their vulnerability to community violence, the widespread social norms that would cast them as outsiders, and the limited availability of related services and supports.
Implications
These findings revealed the need for more research about IPV in post-war contexts. Women’s experiences in such contexts are influenced and may be masked by a complex set of factors that intersect to produce IPV and entrap women in violence. A more nuanced understanding of the context-specific issues that shape women’s experiences of IPV- and community responses to it—is needed to develop more comprehensive solutions that are relevant to the local context.
Toronto Metropolitan UniversityPublication 2024-10-15 Guruge, S. , Marilyn Ford‐Gilboe, Colleen Varcoe, Vathsala Jayasuriya-Illesinghe, Mahesan Ganesan, Sivagurunathan Sivayogan, Parvathy Kanthasamy, Pushparani Shanmugalingam, Hemamala Vithanarachchi
Newcomer Women’s Experiences with Perinatal Care During the Three-Month Health Insurance Waiting Period in Ontario, Canada Background: The three-month health insurance waiting period in Ontario reinforces health inequities for newcomer women and their babies. Little is known about the systemic factors that shape newcomer women's experiences during the OHIP waiting period.
Purpose: To examine the factors that shaped newcomer women's experiences with perinatal care during the three-month health insurance waiting period in Ontario, Canada.
Methods: This qualitative study was informed by an intersectional framework, and guided by a critical ethnographic method. Individual interviews were conducted with four newcomer women and three perinatal healthcare professionals. Participant observations at recruitment and interview sites were integral to the study design.
Results: The key systemic factors that shaped newcomer women's experiences with perinatal care included social identity, migration, and the healthcare system. Social identities related to gender, race, and socio-economic status intersected to form a social location, which converged with newcomer women's experiences of social isolation and exclusion. These experiences, in turn, intersected with Ontario's problematic perinatal health services. Together, these factors form systems of oppression for newcomer women in the perinatal period.
Conclusions: Given the health inequities that can result from these systems of oppression, it is important to adopt an upstream approach that is informed by the Human Rights Code of Ontario to improve accessibility to and the experiences of perinatal care for newcomer women.
Toronto Metropolitan UniversityPublication 2024-10-15 Developing a comprehensive understanding of elder abuse prevention in immigrant communities: a comparative mixed methods study protocol Introduction: Older adults are the fastest growing age group in Canada. Elder abuse has significant individual and societal implications, so it is critical to address. While interest in this topic is increasing, little is known about the risk factors for elder abuse in immigrant communities in Canada, or about culturally relevant strategies to address these risk factors.
Methods and analysis: This mixed-methods study is guided by the intersectionality and ecological frameworks. We will include two long-term (ie, established) and two recent immigrant communities from East Asian and South Asian communities in the Greater Toronto Area: Chinese, Korean, Punjabi and Tamil. Through structured group interviews, we will first identify factors that contribute to elder abuse within and across each of the immigrant communities and then explore culturally relevant strategies to address those risk factors. Group interviews will be conducted separately with five stakeholder groups in each of the four languages: older women, older men, family members, community leaders and service providers. Quantitative and qualitative data will be analysed at the level of the particular interview groups, subgroups and communities, and will be integrated across communities to identify common and unique risk factors and strategies to address elder abuse.
Ethics and dissemination: The study protocol has received ethics approval from the two universities associated with the research team. Given the comprehensive approach to incorporate local knowledge and expert contributions from multi-level stakeholders, the empirical and theoretical findings will facilitate practice change and improve the well-being of older men and women in immigrant communities.
Toronto Metropolitan UniversityPublication 2024-10-15 Guruge, S. , Souraya Sidani, Atsuko Matsuoka, Guida Man, Diane Pirner
Resettlement of Older Syrian Refugees in Canada: Key Individual Factors of Social Inclusion Existing literature documents how older refugees are at risk of social exclusion and isolation, yet few researchers have investigated the social inclusion of recently (re)settled older Syrian refugees in Canada. Here we apply the social inclusion model to older migrants to analyze the social inclusion of 360 Syrian refugee older adults (51+ years) in Canada. Results indicate that older Syrian refugees tend to have good health, a strong sense of belonging, regular communication with others, and supportive relationships; therefore, they are likely to experience social inclusion, despite education and language challenges. We conclude by discussing the positive structural elements in their resettlement experiences.
Toronto Metropolitan University, York UniversityPublication 2024-10-15 Jill Hanley, Mahmudul Hassan, Adnan Al Mhamied,
Guruge, S. , Oula Hajjar,
Hynie, M. , Rabih Jamil, Erfaneh Razavipour
Sociodemographic and Health Determinants of Loneliness in Older Immigrants in Canada: A Cross-Sectional Study The COVID pandemic brought to light the pressing issues of social isolation and loneliness for older adults. Immigrant older adults’ experience of loneliness is even more exacerbated by factors, such as, language barriers, and the loss of cultural community. Key determinants of loneliness in older immigrants are not clear in the literature. A cross-sectional study was conducted in nine cities across Canada to: describe the experience of emotional, social and overall loneliness; and examine the determinants of loneliness among Punjabi, Mandarin, and Arabic-speaking older immigrants. A total of 647 older immigrants participated in the study. Descriptive statistics were used to describe their experience of loneliness, and multiple regression analysis was performed to examine the determinants of loneliness. Most participants had a post-secondary education, were married, and had been in Canada for about 16 years. On average, the participants reported good physical and mental health, and moderate levels of emotional, social, and overall loneliness. Ethnocultural group, emotional wellbeing, and depression were associated with emotional loneliness. Social loneliness was associated with education, depression, psychological distress, age, and ethnocultural group. Determinants of overall loneliness were age, gender, ethnocultural group, self-rated mental health, emotional wellbeing, depression, and psychological distress. Community based interventions that target these key factors must be designed to address loneliness experienced by older immigrants. Toronto Metropolitan University Publication 2024-10-07 Canadian Men’s Self-Management of Chronic Diseases: A Literature Analysis of Strategies for Dealing With Risks and Promoting Wellness This article reviews the qualitative research on men’s self-management of mental and physical chronic diseases, with emphasis on strategies for dealing with risks and promoting wellness. Using Bardin’s method of document analysis, it was focused on the findings of Canadian qualitative studies published in French or English from 2005 to 2011. Boltanski’s theory on social uses of the body inspired the analysis. Living with a chronic disease threatens men’s sense of masculinity and self-image, as well as their perceived ability to fulfill expected social roles. Social images of men’s bodies influence how men express their emotions, attributes, and attitudes, or acknowledge the need for and seek social affirmation. Self-management has been documented in Canadian qualitative literature as a complex phenomenon influenced by the social environment, personal capacities, feelings, perceptions, and potentials. The extent of how all these features interact within the scope of men’s mental and physical health and illness experiences was partially revealed in this study. The findings underscore the social invisibility of men’s bodies, especially those of men facing social inequities. Attending to principles of social justice can ensure that future research on men’s health will amplify the range of men’s voices and allow them to be heard. Recommendations address also the international scientific community interested in advancing men’s health research, especially in those countries that lack a national men’s health policy.
Toronto Metropolitan UniversityPublication 2024-10-02 Margareth Santos Zanchetta, Christine Maheu, Olesya Kolisnyk, Mohamed Mohamed,
Guruge, S. , Diana Kinslikh, Joneet Christopher, Melissa Stevenson, CaroLine SanJose, Terry Sizto, Aaron Byam
Intersections of Aging and Immigration: The Promise and Paradox of a Better Life This book examines the intersections of aging and immigration in Canada, examining the unique challenges faced by older immigrants. Section 1 introduces critical issues related to aging and immigration, highlighting health disparities shaped by social determinants such as gender, racism, and access to services. Chapters 1 and 2 explore how these structural barriers affect the health and well-being of older immigrants, with a focus on social exclusion and systemic inequities. Section 2 discusses the health statuses of older immigrant women and men, emphasizing the need for culturally tailored services. Section 3 addresses socioeconomic factors like social isolation and housing insecurity, illustrating how older immigrants navigate these challenges in Canada. Section 4 focuses on caregiving, examining family care partners' roles and the mismatches between caregiver needs and available support. Section 5 tackles service access, identifying key barriers and exploring potential interventions for improving elder care in immigrant communities. Section 6 concludes by addressing research and policy considerations, particularly the importance of inclusive, community-based research and the role of social infrastructure in promoting well-being. Together, these sections provide a comprehensive understanding of the multifaceted experiences of older immigrants in Canada, urging for systemic change and more equitable support structures.
Toronto Metropolitan UniversityPublication 2024-09-30 Breaking Siloed Policies: Applying a Gender-Based Analysis Plus (GBA+) to Homelessness during Pregnancy in Canada Amongst women and gender diverse (WGD) populations experiencing homelessness in Canada, one of the most vulnerable and understudied subgroups are those who are pregnant. A key barrier to accessing housing for this population are policies that lead to siloed sector work and complicated and inaccessible services. Frequent relocation and fragmented access to essential prenatal and postnatal support are the result. Experiences of homelessness for WGD people are distinct from that of cisgender men; the former tend to experience ‘hidden homelessness’ and are more likely to rely on relational, precarious, and sometimes dangerous housing options. The homelessness sector, its policies, and services tend to be cis-male-centric because of the greater visibility of homelessness in cis-men and fail to meet pregnant WGD people’s needs. This paper describes the findings from a one-day symposium that was held in Toronto, Canada, in June 2023 that aimed to address the siloed approach to housing provision for pregnant WGD people experiencing homelessness. A key focus was to understand how to incorporate a gendered and intersectional discourse into practice and policy. Adopting a gender-based analysis plus (GBA+) approach within policymaking can help illuminate and address why certain groups of WGD people are disproportionately affected by homelessness, including Indigenous Peoples, recent immigrants, racialized people, and those experiencing intimate partner violence, poverty, and substance use. Toronto Metropolitan University Publication 2024-09-13 Barbara Chyzzy,
Guruge, S. , Kaitlin Schwan, Joon Lee, Stacia Stewart
Reframing goals and strategies for delivering humanized obstetric care in Brazil Introduction: Despite the long-lasting efforts to promote the quality of obstetric care, Brazil requires robust changes in the care practices throughout the prenatal-labour-postpartum continuum. The ongoing National Program for the Humanization of Prenatal and Childbirth (PHPN) efforts address the fight against obstetric violence (OV), the improvement in the quality of obstetric care, but its implementation has faced obstacles and difficulties, such as responding to cultural values and operating with a weak infrastructure. This research explored Brazilian health and social service professionals’ perceptions of the PHPN’s recommendations regarding innovation, policy and practice changes necessary to respect women’s human rights to receive a high quality, dignifying obstetric care. Methods: An online multi-site survey in which data were collected (Jun 2019-Mar 2020) from health professionals working in the public health system in Brazil. Data analysis used descriptive statistics and thematic analysis. Analytical themes were Perceptions of Program effectiveness to minimize obstetric violence and Program’s gaps, inadequacies and needed changes. Results: Respondents (n=369) disclosed their perceptions about the Program’s nature, utility, and gaps towards an improved implementation. Key issues were rooted in the outdated university education, reduced accountability, and governance in services’ management; unfavourable work conditions and climate; professional power-imbalance; population’s lack of information about the Program; underutilization of obstetric nurses’ and midwives’ skills; neglect of professional development; no denunciation & re-education, and culture of quality improvement. Conclusions: Firmness, hope and determination will be needed to transform society’s culture of silence about OV, awakening the public awareness and mobilizing to enhance collective health and political literacy to ensure professional accountability while protecting women and newborns. There is a need for a realignment of work processes, an investment in professional education, and education within women’s social networks for women to become partners in the active process of improvement of quality of obstetric care. Toronto Metropolitan University Publication 2024-07-29 Margareth Santos Zanchetta, Walterlânia Silva Santos, Vanessa Rodrigues Pina, Rebecca Zimmerman, Dakota Carrie, Francesca Aviv, Ivone Evangelista Cabral, Alecssandra de Fátima Silva Viduedo, Audrey Vidal Pereira, Aldrin de Sousa Pinheiro, Hilary Hwu, Hannah Stahl, Hannah Argumedo-Stenner, Ingryd Cunha Ventura Felipe, Delmar Teixeira Gomes, Zuleyce Maria Lessa Pacheco, Waglânia de Mendonça Faustino e Freitas, Ana Luiza de Oliveira Carvalho, Mônica Chiodi Toscano de Campos, Karline Wilson‐Mitchell, Vanessa Fofie, Dorin Adria d’Souza, Milena Oliva, John Christian Tadeo, Oona M St-Amant,
Guruge, S. , Henry Parada
Health citizenship reveals ‘extra’ work managing biopolitical risk for immigrants in Canada during COVID ‐19: A qualitative study Abstract One's health security (i.e., the ability to minimize risks and respond to public health threats) is a conferred right of citizenship but individuals construct identities during the process of securing their health. However, how this occurs, in relationship to the state, remains largely implicit or taken‐for‐granted. The Coronavirus Disease 2019 (COVID‐19)' provided a unique opportunity to explore the relationship between oneself and governing social norms of health citizenship. We drew on secondary analysis of data from a previous (published) qualitative descriptive study that was conducted during May to September 2020 of COVID‐19, to explore 72 immigrants' experience (from 21 countries) of health security in the Greater Toronto Area, Canada. Data were collected through semi‐structured interviews and analysed using critical realism. The majority of participants were women. We demonstrate how individuals implicitly engaged in ‘extra’ work—gendered and driven by mechanisms of good citizenship—connected to the will to health, against ethopolitical work to regulate risks, of and for themselves, in public discourse. Public discourse tended to follow racialized hegemonic norms, which also reproduced systemic cultural racism. We argue that empathetic understanding of this process is conducive to enhancing one's resistance to stereotypes, and to bolstering immigrants' resilience to seeking health security during public health emergencies. Toronto Metropolitan University Publication 2024-07-01 Homestay Hosting Dynamics and Refugee Well-Being: Scoping Review (Preprint) BACKGROUND Homestay accommodations aim to support a smoother transition for refugees; yet, the intricate nature of relationships between refugees and their hosting families can make this process complex, which, in turn, can affect their health and well-being. It is crucial to grasp the experiences of both refugees and their host families in order to foster effective settlement, integration, and well-being. OBJECTIVE The purpose of this scoping review is to explore the dynamics of homestay or hosting with a focus on understanding the experiences of both refugees and their hosting families to identify gaps in the literature and propose directions for future research. METHODS We used the Joanna Briggs Institute methodology and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to guide this scoping review. Searches were conducted in MEDLINE via EBSCO, Scopus via OVID, CINAHL, SOCIndex, Web of Science Core Collection, ProQuest Dissertations and Theses, the SciELO Citation Index, and APA PsycInfo. Literature written in English and published from 2011 to 2024 that focused on homestay hosting contexts for refugees was included. RESULTS The results of this review illuminate the multifaceted and dynamic nature of homestay hosting for refugees. The findings include motivations and barriers for homestay hosting, factors influencing host-refugee relations, and psychological and social outcomes of homestay hosting. CONCLUSIONS The results of this scoping review demonstrated the need for tailored support for refugees to improve homestay programs for the benefit of both refugees and host families and highlighted the need of more inclusive, supportive, and effective strategies for the hosting, resettlement, and integration of refugees. CLINICALTRIAL
INTERNATIONAL REGISTERED REPORT RR2-10.2196/56242 Toronto Metropolitan UniversityPublication 2024-03-20 Shared Space: A Photovoice Tale of Ukrainian Refugee Women and Canadian Hosts in Toronto Many Ukrainian refugees have been hosted in the homes of Canadian families. But this hosting model, as generous as it is, brings with it a complexity that requires further exploration. Through the lens of photovoice, a method that empowers women to capture their hosting experiences through photography, we have endeavored to unravel these complexities.
Toronto Metropolitan UniversityPublication 2024-02-26 Homestay Hosting Dynamics and Refugee Well-Being: Protocol for a Scoping Review (Preprint) BACKGROUND The process of refugee resettlement and integration into new communities is a complex and multifaceted challenge, not only for the refugees themselves but also for the host families involved in homestay housing arrangements. While these homestay arrangements are designed to facilitate smoother transitions and enhance the well-being of refugees, the nuanced dynamics of these interactions and their overall impact on both refugees and their host families remain underexplored. Understanding the experiences of refugees and their host families is vital for effective refugee settlement, integration, and well-being. However, the intricacies of homestay refugee hosting, their interactions with host families, and the impact on their well-being are still unclear and ambiguous. OBJECTIVE The aim of this scoping review is to examine the breadth of literature on the experiences of refugees living in homestay arrangements with their host families. This review seeks to understand how these dynamics influence refugee well-being, including their integration, social connections, and mental health. Additionally, this scoping review aims to synthesize existing literature on homestay hosting dynamics, focusing on the experiences of refugees and their host families, to identify gaps in knowledge and suggest areas for future research. METHODS This scoping review follows Joanna Briggs Institute methodology and will search databases such as CINAHL, SOCIndex, MEDLINE through EBSCO; APA PsycInfo, Scopus through OVID; and Web of Science Core Collection, ProQuest Dissertations, and Theses, and SciELO Citation Index, focusing on literature from 2011 onward, in English, in relation to refugee groups in different host countries, including all types of literature. Literature will be screened by 2 independent reviewers, with disagreements resolved by consensus or a third reviewer. A custom data extraction tool will be created by the research team. RESULTS The results will be organized in tables or diagrams, accompanied by a narrative overview, emphasizing the main synthesized findings related to the dynamics of homestay hosting with host families and refugee well-being. No critical appraisal will be conducted. This scoping review is expected to identify research gaps that will inform the development of homestay refugee hosting models, policies, and practices. It will also offer insights into best practices and policy recommendations to improve homestay hosting programs, ultimately contributing to more effective refugee settlement and integration strategies. CONCLUSIONS Understanding the intricate dynamics of homestay hosting arrangements is crucial for developing policies and programs that support the well-being of refugees and the families that host them. This scoping review will shed light on the current knowledge landscape, identify research gaps, and suggest ways to enhance the homestay hosting experience for all parties involved. Through this work, we aim to contribute to the development of more inclusive, supportive, and effective approaches to refugee hosting, resettlement, and integration. CLINICALTRIAL
INTERNATIONAL REGISTERED REPORT DERR1-10.2196/56242 Toronto Metropolitan UniversityPublication 2024-01-10 EXPERIENCES OF SOCIAL ISOLATION BY MANDARIN AND PUNJABI-SPEAKING OLDER IMMIGRANTS LIVING IN CALGARY Abstract Loneliness and social isolation have continued to be risk factors for the health and overall quality of life of older adults globally. The impact of loneliness on healthy ageing may even be more profound for older immigrants in Western countries like Canada, where there is a different language and culture from that of their home countries. As part of the Inclusive Communities for Older Immigrants (ICOI), which seeks to create knowledge about social isolation and improve social connectedness among older immigrants across Canada, we examined the experiences of social isolation amongst older Mandarin and Punjabi-speaking immigrants aged 60 years and over living in Calgary. Quantitative data was collected from 64 (33 Mandarin-speaking and 31 Punjabi-speaking) older adults in Calgary, Alberta. The data were cleaned and analysed using descriptive analysis with the aid of Statistical Packages for Social Sciences (SPSS), and findings showed that older immigrants conceptualised social isolation as limited participation in various community activities. Our results also showed that older immigrants perceived physical and mental health status, social conditions and environmental conditions as significant factors predisposing older immigrants to social isolation. The study, therefore, recommends designing interventions that will increase older immigrants’ participation in community activities considering their age, language, disabilities, health, and social conditions. Toronto Metropolitan University Publication 2023-12-01 Prince Chiagozie Ekoh, Change Zhu, Christine A Walsh,
Guruge, S. Chinese family care partners of older adults in Canada have grit: A qualitative study Abstract Aim To explain the process taken by Chinese family care partners of older adults in the Greater Toronto Area, Canada, to access health and social services in their communities. The research question was: What mechanisms and structures impact the agency of Chinese family care partners of older adults, in the process of assisting them to access health and social services? Design This qualitative study was informed by critical realism. Methods Chinese family care partners of older adults in the Greater Toronto Area, Canada, were interviewed from August 2020 to June 2021. Transcripts underwent thematic analysis. Findings Twenty‐eight Chinese family care partners expressed a firm commitment to maintain caregiving conditions and to judiciously access health and social services. Their commitment was made up of three parts: (a) legislative and cultural norms of family, work, and society; (b) their perseverance to fill gaps with limited social and financial resources; (c) the quality of their relationship to, and illness trajectory of the older adults. The social structures created tension in how Chinese family care partners made decisions, negotiated resources, and ultimately monitored and coordinated timely access with older adults. Conclusion Participants' commitment and perseverance were conceptualized as “grit,” central to their agency to conform to legislative and cultural norms. Moreover, findings support grit's power to motivate and sustain family caregiving, in order for older adults to age in place as long as possible with finite resources. Implications for the profession This study highlights the importance of cultural awareness education for nurses, enabling continuity of care at a systems level and for a more resilient healthcare system. Impact Family care partners' grit may be crucial for nurses to harness when together, they face limited access to culturally appropriate health and social services in a system grounded in values of equity and inclusion, as in Canada. Reporting method When writing this manuscript, we adhered to relevant EQUATOR guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ). Patient or public involvement and engagement No patient or public involvement. Toronto Metropolitan University Publication 2023-10-12 Doris Leung, Charlotte Lee, S Y J Chu, Fu Siong Ng, Patrick Y Wen, Jing Fan, Daphne Sze Ki Cheung, Lisa Seto Nielsen,
Guruge, S. , Janice Wong