TRS 1.7 Advancing Health Equity Among Racialized Immigrant LGBTQ+ Older Adults

Lead: Josephine P. Wong

Members: Community Alliance for Accessible Treatment (>35 organization; Maurice Poon of York Social Work; Desmond Chuang of National Taiwan Normal University; early career researchers and trainees from 3 BD partner universities).

1. Rationale and Research Questions

Canada’s population is aging. It is estimated that at least 400,000 older adults in Canada belong to LGBTQ+ communities.[2] LGBTQ+ older adults (65+) grew up before the Stonewall era when there was no protection of basic human rights. Despite gay rights activism, they have been an invisible population excluded in health care planning in Canada.[2]While government, healthcare institutes, and researchers have begun to engage LGBTQ+ older adults in consultation and research, members who are racialized immigrants have seldom been included.[3] Evidence indicates that homophobia, transphobia, ageism, stigma and discrimination contribute to social isolation and health disparities among 2SLGBTQ+ older adults; these oppressions are also key barriers to health and social care.[4] Racialized immigrant LGBTQ+ older adults face additional challenges associated with racism and xenophobia within and outside of the LGBTQ+ communities, integration stress, language barriers and cultural exclusion.[5] Furthermore, many have experienced persecution and violence prior to migration to Canada. The lack of engagement with racialized immigrant LGBTQ+ older adults in research and health care planning perpetuates health disparities, inequitable access to safe care and misses the opportunity to gain knowledge on resilience strategies held by racialized immigrant LGBTQ+ older adults.

This study is based on preliminary discussion among racialized immigrant LGBTQ+ older adults and community stakeholders in Toronto. It meets the Bridging Divide objectives of promoting immigrant health equity, co-creating models of best practices in policy action, and building a pan-Canadian, interdisciplinary and multi-sectoral network of research excellence in immigrant integration. The overarching research question is: What are the sociocultural and structural determinants of bio-psycho-social wellbeing of immigrant LGBTQ+ older adults in Canada? Specifically, we will study:

What are the experiences of racialized immigrant LGBTQ+ older adults in accessing currently available senior care?
To what extent are racialized immigrant LGBTQ+ older adults included in current health and social care research, service planning and policy development?
What is the best practices model / framework to guide inclusive health and social care planning and implementation for racialized immigrant LGBTQ+ older adults?

2. Research Design and Methodology

This study is guided by the principles of equity, access, and social justice, which are essential components of critical populations health promotion.[6-7] It is also underpinned by the concepts of meaningful engagement,[8] collective self-determination,[9] capacity building,[10] and collective empowerment.[11-12] To address the research questions, we will use a mixed methods approach that includes scoping reviews, program scans, focus groups (FG), individual interviews (IDI), questionnaires, and arts informed community re-imagination and co-creation sessions. We will engage four groups of participants: racialized immigrant LGBTQ+ older adults (aged 55+) in East, Southeast and South Asian; African, Caribbean and Black; Latinx and MENA diasporic communities; community leaders/advocates from these communities, health and social care providers working with LGBTQ+ older adults and/or racialized immigrant older adults; decision-makers and policy makers in the health and social care sectors. The following table outlines our research activities and timelines. Our key research activities include:

two scoping reviews on: (a) the aging experiences of racialized immigrant LGBTQ+ older adults in Canada and countries with similar contexts of immigration and integration as Canada; and (b) best practice models/framework of inclusive health and social care for racialized immigrant LGBTQ+ older adults in Canada;
program and policy scan on the extent of inclusion/exclusion of racialized immigrant LGBTQ+ older adults in health and social care planning and delivery in Canada;
Focus groups and individual interviews with racialized immigrant LGBTQ+ older adults (aged 55+) to explore their experiences of ageing in Canada; their bio-psycho-social needs; their perspectives on collective flourishing; and their experiences in accessing senior services;
focus groups and individual interviews with community leaders/advocates, service providers, and policy/decision makers on their understanding of health equity among racialized immigrant LGBTQ+ older adults; their perspectives on the facilitators and barriers to providing inclusive resources, programming and policy;
engage the four groups of participants in critical interpretation of study results.
engage racialized immigrant LGBTQ+ older adults in the Reimagination Of Collective Flourishing using arts-based strategies selected by participants (e.g., graphic dialogue, poetry, photovoice, visual arts, digital storytelling, virtual reality, etc.) to enhance participant-centred knowledge generation;
engage all four groups of participants in the co-creation of a Best Practices Framework to inform the development and implementation of inclusive health/social care resources, practice and policy; and
apply integrative knowledge translation (iKT) to sustain engagement with communities.

3. Expected Outcomes:

This study will generate new knowledge on the complex interlocking effects of social marginalization experienced by racialized immigrant LGBTQ+ older adults and strategies to reduce social and health inequities, and to promote flourishing in this population. Specifically, the expected outcomes include:
A best practices model/framework to inform the planning and implementation of inclusive health and social care for racialized immigrant LGBTQ+ older adults;
Strategies and KT products generated by participants in the Reimagination Of Collective Flourishing have the potential to be transformed into innovative arts-based intervention to promote wellbeing among racialized immigrant LGBTQ+ older adults, and to promote inclusive practices in programming and policy in the senior services sectors.
Motivation for collective self-determination and active engagement in policy/practice change to promote health equity;
Establishment of local, provincial, and national networks of collaboration and knowledge exchange
Capacity building of at least 3 research staff/trainees and 6 community peer research associates.
A community report, at least 3 peer review publications, 3 infographics, and multiple arts-based KT products created by participants, 2 media interviews, 2 community presentations / webinars, and 3 conference presentations
A community KT forum and promotion of follow-up action

4. Additional information:

This study is informed by a beginning dialogue in the racialized immigrant LGBTQ+ communities. None of the research activities has been funded or taken up by any group. It is important to note that the results of this study may have potential implications for the themes of Place and Infrastructure, and Citizenship and Civic Participation.

References

Wilson, K., Stinchcombe, A., Ismail, M., & Kortes-Miller, K. (2019). LGBTQ2+ aging in Canada: Building the evidence and informing action. The Canadian Journal of Human Sexuality, 28(3), 257–260. 2. Wilson, K., Stinchcombe, A., & Regalado, S. M. (2021). LGBTQ+ Aging Research in Canada: A 30-Year Scoping Review of the Literature. Geriatrics (Basel), 6(2), 60.
Chen, J., McLaren, H., Jones, M., & Shams, L. (2022). The Aging Experiences of LGBTQ Ethnic Minority Older Adults: A Systematic Review. The Gerontologist, 62(3), e162–e177.
Brotman, S., Ferrer, I., Sussman, T., Ryan, B., & Richard, B. (2015). Access and equity in the design and delivery of health and social care to LGBTQ older adults: A Canadian perspective. In N. A. Orel & C. A. Fruhauf (Eds.), The lives of LGBT older adults: Understanding challenges and resilience (pp. 111–140). American Psychological Association. https://doi-org.ezproxy.lib.torontomu.ca/10.1037/14436-006
Chen, J., McLaren, H., Jones, M., & Shams, L. (2022). The Aging Experiences of LGBTQ Ethnic Minority Older Adults: A Systematic Review. The Gerontologist, 62(3), e162–e177. 6. Hamilton, N., & Bhatti, T. (1996). Population health promotion: an integrated model of population health and health promotion. Retrieved from Public Health Agency of Canada website: http://www.phac-aspc.gc.ca/ph-sp/php-psp/index-eng.php
Rootman, I., Pederson, A. P., Frohlich, K. L., & Dupéré, S. (2017). Health promotion in Canada: New perspectives on theory, practice, policy, and research (Fourth ed.) Canadian Scholars.
Suarez-Balcazar, Y. (2020). Meaningful engagement in research: Community residents as co-creators of knowledge. American Journal of Community Psychology, doi:10.1002/ajcp.12414 9. Moore, M. (2019). The Moral Value of Collective Self‐Determination and the Ethics of Secession. Journal of Social Philosophy, 50(4), 620–641.
Chaskin, R. J., Brown, P., Venkatesh, S., & Vidal, A. (2001). Building community capacity. New York: Aldine de Gruyter.
Wallerstein, N. (1992). Powerlessness, empowerment and health: Implications for health promotion programs. American Journal of Health Promotion, 6(3), 197-205.
Christens, B. D. (2019). Community power and empowerment. Oxford University Press.
Chaskin, R. J., Brown, P., Venkatesh, S., & Vidal, A. (2001). Building community capacity. New York: Aldine de Gruyter.
Wallerstein, N. (1992). Powerlessness, empowerment and health: Implications for health promotion programs. American Journal of Health Promotion, 6(3), 197-205.
Christens, B. D. (2019). Community power and empowerment. Oxford University Press.

Theme:	Employment and Lifelong Learning (TRS2)
StatusStatut:	Ended
Start DateDate de début:	2023-11-15
End DateDate de fin:	2030-11-15

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Leveraging ADT in skills training, labour market entry, and employer support (TRS2 2.1)

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Leveraging ADT in skills training, labour market entry, and employer support (TRS2 2.1)

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