Implementing social interventions in primary care

Gary Bloch; Linda Rozmovits

doi:10.1503/cmaj.210229

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RE: Implementing social interventions in primary care
Brenda C Guerra Alejos [MD]

Posted on: 14 March 2022
An Evidence-Base for Hijab
Muzamillah M. Jeelani [MA] and Najla Abdur-Rahman [MD, FAAP]

Posted on: 22 December 2021

Posted on: (14 March 2022)
Page navigation anchor for RE: Implementing social interventions in primary care
RE: Implementing social interventions in primary care
Brenda C Guerra Alejos [MD], Master of Public Health Student, Simon Fraser University
Primary care-based social interventions are necessary as public health measures, especially when it comes to populations where systemic barriers and race, gender, or other intersectional identities are heightened. Immigrants and refugees comprised 21.9% of the total population in 2016. Given the known barriers of healthcare access for immigrants, primary-care policies and social interventions should include education of the Social Determinants of Health that newcomers could’ve faced before migrating to Canada. Being an International Medical Graduate who’s studying Public Health, I’ve found that navigating the Canadian healthcare system is complex, particularly when it comes to accessing primary-care in British Columbia. It’s even worse when moving within Canada with different coverages between provinces. These particularities with the healthcare system can seem daunting for new immigrants. I agree that community development models should be included in primary-care however, more can be done to include Foreign-trained physicians, nurses, or allied health professionals in these models. First-hand experience and cultural knowledge of healthcare systems of immigrants home-countries, can be of substantial support for the host country. Provincial health ministries could improve the merging of migrant health workers, where many face credential recognition barriers to practice, and prevent the brain waste through promoting community-focused interventions and reduce barriers of pat...
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Primary care-based social interventions are necessary as public health measures, especially when it comes to populations where systemic barriers and race, gender, or other intersectional identities are heightened. Immigrants and refugees comprised 21.9% of the total population in 2016. Given the known barriers of healthcare access for immigrants, primary-care policies and social interventions should include education of the Social Determinants of Health that newcomers could’ve faced before migrating to Canada. Being an International Medical Graduate who’s studying Public Health, I’ve found that navigating the Canadian healthcare system is complex, particularly when it comes to accessing primary-care in British Columbia. It’s even worse when moving within Canada with different coverages between provinces. These particularities with the healthcare system can seem daunting for new immigrants. I agree that community development models should be included in primary-care however, more can be done to include Foreign-trained physicians, nurses, or allied health professionals in these models. First-hand experience and cultural knowledge of healthcare systems of immigrants home-countries, can be of substantial support for the host country. Provincial health ministries could improve the merging of migrant health workers, where many face credential recognition barriers to practice, and prevent the brain waste through promoting community-focused interventions and reduce barriers of patients. It’s easier to access health services when someone with a common background understands the steps to access primary-care in both native and host countries. Countries have a responsibility to include immigrant health workforce into their system, even if it’s not equivalent to their training.
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Competing Interests: None declared.
References
Gary Bloch, Linda Rozmovits. Implementing social interventions in primary care. CMAJ 2021;193:E1696-E1701.
Government of Canada, S. C. The Daily — Immigration and ethnocultural diversity: Key results from the 2016 Census. https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025b-eng.htm?indid=14428-4&indgeo=0 (2017).
Pandey, M., Kamrul, R., Michaels, C. R. & McCarron, M. Identifying Barriers to Healthcare Access for New Immigrants: A Qualitative Study in Regina, Saskatchewan, Canada. J Immigr Minor Health 24, 188–198 (2022).
Rolfe, D. E., Ramsden, V. R., Banner, D. & Graham, I. D. Using qualitative Health Research methods to improve patient and public involvement and engagement in research. Research Involvement and Engagement 4, 49 (2018).
Neiterman, E., Bourgeault, I. L. & Covell, C. L. What Do We Know and Not Know about the Professional Integration of International Medical Graduates (IMGs) in Canada? Healthcare Policy 12, 18–32 (2017).
Posted on: (22 December 2021)
Page navigation anchor for An Evidence-Base for Hijab
An Evidence-Base for Hijab
Muzamillah M. Jeelani [MA], PhD Candidate, International Institute of Islamic Thought and Civilization, International Islamic University of Malaysia
Other Contributors:
Najla Abdur-Rahman, Pediatrician; Medical Director
We commend CMAJ for their efforts in promoting belonging. The beautiful picture on the cover of this issue of CMAJ (vol 193; issue 44) shows one girl with afro puffs and another with hijab, both of which are othered, policed, and politicized by society. This image creates inclusion and embodies Drs. Bloch and Rozmovits’ article highlighting the importance of social conditions in determining health.(1) Inclusion as a social condition has a personal and powerful significance to us. One of the authors faced discrimination for wearing the hijab including having it pulled off by a classmate. Another author was expelled from school for choosing to wear it. An etiologic factor underlying marginalizing social conditions is unfamiliarity with the mentality of the othered leading to perceptual narrowing and stereotypes supported by myths and anecdotes.

Fortunately, the mentality underlying hijab-wearing is not opaque and has been well characterized in research. A study of 231 US Muslim women found that the most common driver for wearing hijab centered around personal commitments to faith, modesty, and identity.(2) Another study found motivations related to defining identity, performing behavior checks, resisting sexual objectification, affording respect, preserving intimate relationships, and providing freedom.(3)

Studies have also clarified whether these positive mentalities for wearing hijab translate into positive outcomes. A study of 587 British Muslim women foun...
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We commend CMAJ for their efforts in promoting belonging. The beautiful picture on the cover of this issue of CMAJ (vol 193; issue 44) shows one girl with afro puffs and another with hijab, both of which are othered, policed, and politicized by society. This image creates inclusion and embodies Drs. Bloch and Rozmovits’ article highlighting the importance of social conditions in determining health.(1) Inclusion as a social condition has a personal and powerful significance to us. One of the authors faced discrimination for wearing the hijab including having it pulled off by a classmate. Another author was expelled from school for choosing to wear it. An etiologic factor underlying marginalizing social conditions is unfamiliarity with the mentality of the othered leading to perceptual narrowing and stereotypes supported by myths and anecdotes.

Fortunately, the mentality underlying hijab-wearing is not opaque and has been well characterized in research. A study of 231 US Muslim women found that the most common driver for wearing hijab centered around personal commitments to faith, modesty, and identity.(2) Another study found motivations related to defining identity, performing behavior checks, resisting sexual objectification, affording respect, preserving intimate relationships, and providing freedom.(3)

Studies have also clarified whether these positive mentalities for wearing hijab translate into positive outcomes. A study of 587 British Muslim women found that women who wore hijab held a more positive body image and body appreciation, had lower internalization of media messages about beauty standards, had lower pressure to attain ideals from peers and media, and placed less importance on appearance than women who did not wear hijab.(4) A replication of that study among French Muslim women found that those who wore hijab reported significantly lower weight discrepancy, body dissatisfaction, drive for thinness, social physique anxiety, and internalization of thin and muscular ideals.(5) Both studies concluded that hijab is a protective factor for British and French Muslim women.

Research on body-dissatisfaction and depression shows that normative social influences reinforce appearance-dependent mental models and is quite literally killing our girls. Though young girls are not required in Islam to wear hijab before reaching an age when they can make choices (typically taken to be the age of puberty), research shows that children model parental behavior and even adopt their mental models related to body image and appearance. The evidence-base for hijab shows that it creates liberating mental models; functions as an instrument of liberation from social norms of body types, weights, and shapes; and allows the wearer to engage with society on their own terms. Taken in the context of Drs. Bloch and Rozmovits’ article on vulnerable populations and social risk factors, aren’t liberating mental models exactly what we need?
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Competing Interests: None declared.
References
1. Gary Bloch, Linda Rozmovits. Implementing social interventions in primary care. CMAJ 2021;193(44):E1696-E1701.
2. Tolaymat, Lana D., and Bonnie Moradi. US Muslim women and body image: Links among objectification theory constructs and the hijab. Journal of Counseling Psychology 2011; 58(3):383.
3. Droogsma, Rachel Anderson. Redefining Hijab: American Muslim women's standpoints on veiling. Journal of Applied Communication Research 2007; 35(3): 294-319.
4. Swami V, Miah J, Noorani N, Taylor D. Is the hijab protective? An investigation of body image and related constructs among British Muslim women. Br J Psychol. 2014;105(3):352-63.
5. Kertechian, Sevag K., and Viren Swami. The hijab as a protective factor for body image and disordered eating: A replication in French Muslim women. Mental Health, Religion & Culture 2016; 19(10):1056-1068.