Access to relevant, timely, and appropriately presented information may become an increasingly important resource for recent immigrants who are learning to navigate and negotiate a largely unknown health care system and are at high risk of becoming underserved. Users’ informational needs are also a powerful reflection of the complexity and multifaceted nature of their interactions with the immediate social surroundings and the health care system. Focusing on information needs, therefore, represents a potentially useful approach to better understand what is needed to build a health care system that is truly responsive to the needs of the population it aims to serve.
The objectives of this thesis are to:
- obtain a snapshot of callers of 211 Toronto, a free information and referral service, understanding how representative they are of Toronto’s general population;
- understand how 211 Toronto callers seeking health-related information use the information they obtain when contacting the service and their overall level of satisfaction, and;
- better understand the experience and information needs of recent immigrants struggling to navigate an unfamiliar health care system.
The study had three phases:
- a cross-sectional phone interview with 211 Toronto callers;
- a follow-up phone interview of 211 Toronto callers who had asked health-related questions; and,
- qualitative interviews with callers who were Spanish speakers from Latin American countries.
Participants were randomly selected adult callers living within the boundaries of Toronto’s Census Metropolitan Area (CMA). Respondents were compared with the general adult population living in Toronto’s CMA, using 2001 Census data, to identify under- or overrepresented population groups. A sub-set of callers who had asked health-related questions was followed up to understand how they had used the information received and their level of satisfaction with the service. Qualitative interviews were conducted with callers who were recent immigrants and native Spanish speakers from Latin America to explore their post-migration experiences.
Recent immigrants experience significant information challenges. Health-related questions reflect the multifaceted nature of the concept of health in the experience of users. Negative experiences with the health care system are common. Recent immigrants have access to disorganized, confusing, often poor quality information. 211 Toronto represents an efficient and effective way to gain access to information but does not achieve its full potential.
Newcomers should receive timely, appropriate, and reliable information on existing health and health-related services as soon as possible after they relocate to Canada. Appropriate information should also be made available to potential immigrants in their countries of origin. Information and communication technologies should be used to support newcomers, increasing the efficiency and effectiveness of services such as 211 Toronto.
Some key findings
- 211 Toronto represents a useful case study to learn about the immigration experience in this city and the information needs of newcomers. Callers, in fact, reflect quite closely the ethno-linguistic make up of the general population of immigrants living in Toronto and show comparable trends, over time, in terms of geographical origins and distribution across different immigration categories. In addition, the survey population seems to be representative of the larger population of users who have historically contacted 211 Toronto by phone, as shown by comparing survey results and historical data routinely collected by Findhelp.
- The results of this study emphasize the information challenges faced by recent immigrants. The information needs of recent immigrants are complex and multifaceted. Many of them probably come to Canada knowing very little about this country and with unrealistic expectations. Once here, they have to tackle several, intertwined problems, all at the same time, while facing language and other cultural barriers and struggling not to get lost, both literally and metaphorically. The challenge can be overwhelming and the results not necessarily positive. Negative experiences with many aspects of life in Canada are common, particularly with respect to the health care system, as shown in the accounts of many interviewed participants.
- Recent immigrants face a vast amount of disorganized, often confusing, and sometimes poor quality information that reaches them through a dispersed constellation of disjointed sources. Mainly learning by trial and error, they often fall prey to people who take advantage of their desperate need for guidance.
- The study suggests that while 211 Toronto represents an efficient and effective way to gain access to information on a broad variety of topics, including health and health-related services, and solve even complex problems with the support of highly trained counsellors who act as knowledge brokers, the service does not achieve its full potential. The main problem seems to be a lack of knowledge of the service, which is often ‘discovered’ by accident through word of mouth, and a limited understanding of the richness of information 211 Toronto can offer and of the complexity of problems it may help solve.
- Language was confirmed as the most fundamental barrier experienced by participants when accessing health services. Yet, it wasn’t the only barrier and, as several respondents clearly explained, other cultural barriers were present and poor communication practices on both their side and providers’ were also to blame.
- Appropriate information should also be made available to potential immigrants, in their countries of origin, well before they make the final decision to move to Canada, to
ensure they get a realistic idea of the opportunities and challenges they are going to experience once here.
- The effort to support newcomers should become a collective one: community organizations serving immigrants, libraries, and appropriate government services should be all involved in the dissemination of the manual and in using other elements of the information dissemination toolkit to maximize the chances of reaching all new immigrants.
- Information and communication technologies could also play a role in supporting recent immigrants. For example, they could be used to create and maintain a virtual community of newcomers built on the Wikipedia’s model, sharing ‘survival tips’ and solutions to common problems, that would take to the next level the casual ‘information chains’ described by some of the study participants.
- 211 Toronto should aggressively reach out to newcomers and make sure they find out about it as early as possible after moving to Canada and make the most of the service. The aim should be for 211 Toronto to become the information ‘entry point’ for newcomers.