June 3, 2015

Aging in a Foreign Land Exploring current and emerging support needs

of South Asian Immigrants 65+ living in Halton and Peel

Report submitted to: Gurpreet Malhotra, Executive Director India Rainbow Community Services of Peel

India RainbowCommunity Services of Peel

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Project Team

Sheridan Center for Elder Research Marta Owsik (Project Lead) Kristy Webber (student Research Assistant) Pat Spadafora (Director) Lia Tsotsos (Principal Researcher) India Rainbow Community Services of Peel (IRCS) Kamalesh Visavadia (Director, Health Services) Kiran Rehan (Senior Manager) Kiran Saini (Activity Coordinator) Manjinder Singh (Lead Activity Coordinator) Anoop Thukral1 Gurpreet Malhotra (Executive Director) Without the support of the staff of India Rainbow Community Services of Peel (IRCS), this study would not have been possible. Their understanding of language and cultural nuances, familiarity with the South Asian community and the trust of their constituents paved the way for the Centre for Elder Research to be able to conduct the study in a culturally sensitive manner. We believe this study is a fine example of a successful college-community partnership in which both parties brought their unique experiences, knowledge and expertise to the table, resulting in meaningful research that would have been very difficult for either organization to successfully engage in on their own. We would also like to thank the over 300 older adults who so graciously participated in the study. We are grateful to be able to present your collective voice in this report. Finally, we would like to acknowledge and thank the Mississauga Halton Local Health Integration Network (MH LHIN) for their financial support and for having the foresight to recognize the importance of health equity, ensuring that everyone has access to health and social services. Sincerely, The Centre for Elder Research study team

1 Anoop was a member of the project team and employed at India Rainbow. Mid-way through the project, Anoop completed her employment with the organization but continued as a volunteer consultant for part of the research study.

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About the Sheridan Centre for Elder Research

The Centre for Elder Research conducts innovative Lab to LifeTM research that enhances the quality of life of older adults while serving as an education and research

hub for Sheridan and the broader community.

The Centre for Elder Research was launched in 2003 at the Oakville, Ontario campus of Sheridan College. The Centre has an established track record in applied research and a reputation as a leader that challenges traditional thinking, creating possibilities that transcend historical boundaries. The applied research conducted at the Centre has contributed to the implementation and evaluation of programming at all levels of society, from the general public, to industry partners, all the way to regional and municipal policy-makers. Embracing an interdisciplinary approach and, working with faculty and staff from all departments of the college, the Centre is able to directly support the scholarship of teaching and learning at Sheridan, enhancing the student experience and giving all students the opportunity to broaden their horizons through applied research. Our applied focus, Sheridan’s institutional strengths and our strong network of community and industry stakeholders positions the Centre to ensure that knowledge is effectively translated into goods, services, programs and policies that directly benefit older adults and their families.

For more information, please contact:

Sheridan Centre for Elder Research, 1430 Trafalgar Road, Oakville, ON L6H 2L1

Pat Spadafora, MSW, Director Lia Tsotsos, PhD, Principal Researcher

(905) 845-9430 ext. 8615 (905) 845-9430 ext. 2407

pat.spadafora@sheridancollege.ca lia.tsotsos@sheridancollege.ca

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Table of Contents 1. Introduction

1.1. Background 1.2. Current Project

2. Methodology

2.1. Research Design 2.2. Sampling 2.3. Methods and Procedures 2.4. Ethical Considerations 2.5. Data Analysis

3. Results

3.1. Demographic Data 3.2. Qualitative Themes 3.3. Validity and Reliability 3.4. Limitations

4. Discussion and recommendations for culturally sensitive service improvements 5. Conclusions 6. References 7. Appendices:

Appendix A: Demographic Data Summary Appendix B: Survey Appendix C: Focus Group Vignettes and Probing Questions Appendix D: Promotional Flyer Appendix E: Newspaper ads Appendix F: Survey and focus group sites Appendix G: Letter of Information Consent Form Appendix H: Consent Form Appendix I: Practical Suggestions for Conducting Community Based Research with Culturally Diverse Communities Appendix J: IRCS facilitator guide

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Despite the realities of a rapidly aging population and the particular vulnerabilities experienced by many older immigrants, there is relatively little research focused on the needs and interests of older immigrants and, in this instance, older South Asian immigrants. The purpose of this study, conducted by the Sheridan Centre for Elder Research in collaboration with India Rainbow Community Services of Peel (IRCS), was to determine current and emerging health and social support needs of South Asian immigrants aged 65+ living in the Regions of Halton and Peel. The study was open to both male and female settled immigrants (lived in Canada 6+ years) as well as recent immigrants (5 years or less) from South Asia. It is anticipated that the results may inform an action plan to assist the Mississauga Halton Local Health Integration Network (MH LHIN) and their community partners in responding to local priorities related to health equity.

1. Introduction

1.1. Background Population aging is a defining characteristic of the times in which we live. In 2011, an estimated five million Canadians were 65+; that number is expected to more than double to 10.4 million by 2036. By 2051, about one in four Canadians are expected to be 65+ (Human Resources and Skills Development Canada, 2011). This demographic shift – its speed, impact and implications – will dominate the Canadian social, health, education, political and economic landscape for the foreseeable future.

The Regions of Halton and Peel are experiencing increases in both their older adult and immigrant populations. According to the Mississauga Halton (MH) LHIN website, the percentage of people aged 75+ will grow by approximately 55% over the next 10 years (compared to a 40% growth across Ontario). In addition, while only 28.5% of Ontarians identify themselves as immigrant, 44.3% of the MH LHIN population identifies themselves as immigrant.

Similarly, the Central West (CW) LHIN, as reported on their website, projects a significant increase in older adults. The CW LHIN has the lowest proportion of adults 65+ in the province, comprising just 11% of the LHIN’s total population compared to 14% for Ontario. However, the CW LHIN anticipates huge growth in the 65+ population, rising 64% by 2021 (compared to the 43% growth expected for Ontario). The CW LHIN also represents one of the most diverse communities in Ontario. Over half of the local residents belong to visible minority groups (the provincial average is 26%); almost half are immigrants (47%) and 13% are newcomers to Canada, arriving within the past five years. These numbers are compelling; Bernhard et al. (2010) highlight the importance of implementing and supporting regional-level programs, policies and strategies in addressing these needs.

Ethnically diverse older adults are under-represented in all areas of research across North America (Acharya and Northcott 2007; Newbold and Filice 2006) and there is little research addressing their needs. Immigration represents a major life transition that may be made more challenging by language barriers, loss of status (real or perceived), disrupted social networks, conflicting family values and social and cultural isolation. In

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addition, many older immigrants, living in their adult children’s homes, are constrained by lack of mobility and transportation options. In addition, multi-generational homes may increase the potential for conflict (Hossen, 2012). Many older immigrants report feeling lonely and socially isolated despite ways to maintain ongoing contact with their homeland (e.g. increased availability of air travel, inexpensive international phone service) (Simon et al., 2014). Further, loneliness and social isolation may lead to health problems. Research has demonstrated that loneliness can be as harmful to our health and quality of life as smoking 15 cigarettes a day (Holt-Lunstad, 2010 – UK Campaign for Combating Loneliness website). For these and, other reasons, it is imperative that healthcare providers and social service organizations seek strategies to ensure equal access to their services by older immigrants.

1.2. Current Project As referenced in the preceding section, the Regions of Halton and Peel are experiencing growth in their older adult populations, in general, and specifically with their older immigrant populations. In 2011, the majority of South Asians in the Region of Peel were immigrants2. At that time, Brampton had the largest (200,220) South Asian population in Peel while Mississauga had the largest percentage of the immigrant population (52.9%). The majority of immigrants in Peel were from India. The large number of immigrants in the Region of Peel underscores the need to provide culturally appropriate social supports and health services. While the number of South Asian adults 65+ living in the Region of Halton is dramatically less, according to researchers at Community Development Halton, an increasing number of immigrants are choosing to settle in the Region. This study, then, focused on South Asian adults 65+ living in the Regions of Peel and Halton. The purpose of the study was to identify current and emerging community support and health needs as experienced by older immigrants. 2. Methodology 2.1. Research Design In this study, a mixed methods approach was adopted. The research team utilized both quantitative (survey) and qualitative (focus group) methodologies. The survey (Appendix B) was designed to collect data about the experiences of South Asian adults 65+ accessing health and community services. In addition to the surveys, focus groups (please see Appendix C for vignettes and probing questions) were used in this study. 2.2. Sampling Participants were recruited in multiple ways including: a. Through staff at specific agencies (IRCS, Punjabi Community Health Services, Dixie-Bloor Neighbourhood Centre in Mississauga as well as local community centres). b. Visits and in-person recruitment at faith-based organizations (Vaishno Devi temple and Halton Gurudwara both in Halton)

2 Report prepared by the Social Planning Council of Peel for IRCS and Punjabi Community Health Services, 2013.

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c. Promotional flyers (Appendix D) d. Newspaper ads (Appendix E) This variety of recruitment strategies allowed for a more diverse sample. As expected, convenience sampling resulted in the greatest number of participants. Newspaper ads were also used in an effort to engage those individuals who were not already receiving services from the agencies involved in the study. The method of snowball sampling was also introduced by providing surveys with mail-back (postage paid) envelopes and encouraging participants to share the opportunity to participate with their family and friends. This method did not result in as many new participants as the convenience sampling. However, it was considered an important method to try to reach people who may be difficult to reach through traditional communication channels. The exercise of recruiting participants was, in itself, an interesting learning and community relationship building opportunity. The research-agency collaboration was integral to the success of this project and was built on common goals. Participants were more receptive and more likely to participate when a trusted community agency was involved in the project and/or was promoting it. For the surveys and, even more importantly, for the focus groups, which required a certain level of discussion, the main inclusion criteria for participation was a relatively high comfort level (subjectively determined) with spoken and written English. This decision was made to minimize the challenges that can come with translation and to increase the reliability of the data. Although the focus of the study was on those aged 65+, age was not a strict inclusion criterion. 2.3. Methods and procedures A mixed methods approach was used, consisting of a survey and focus groups. The survey included items about demographics and questions about use of health and community services. Community services for the purposes of this survey were defined as those offered formally or informally by community agencies/organizations and providing recreational/social activities or support for general wellbeing. The survey was designed by the research team based on both background research and previously used survey instruments created and used by the Centre. The draft survey was sent to the IRCS team for their feedback about cultural and linguistic appropriateness. Feedback from the IRCS team was integrated into the final survey design. Prior to the formal data collection, the survey was field tested with a group of individuals participating in an IRCS wellness program in a Sikh temple in Peel. Additional modifications to the process and the survey, acknowledging cultural nuances and English language familiarity, were made after this field test. The results of the pilot test were not included in the data analysis. Following the field test, the survey was then distributed to 12 groups of participants at 8 different community sites (see Appendix F for a complete list of survey and focus group sites). The surveys were distributed in-person and a letter of information (LOI) (Appendix G) was given to each participant prior to them completing the survey. The LOI was

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reviewed along with obtaining written consent (Appendix G), at the beginning of the survey sessions. Translation assistance provided, as necessary, from IRCS interpreters. Surveys were completed in the presence of staff representing both IRCS and the Sheridan Centre for Elder Research. IRCS staff members were always available to provide both language and cultural interpretation. The focus groups were designed to complement information obtained through surveys by exploring specific topics in a deeper way that can realistically be achieved through surveys. The three situations explored were ones identified as important by the staff of IRCS and focused on elder abuse, social isolation/loneliness and housing. Vignettes were created to encourage discussion about these topics. The rationale for using a vignette approach was the belief that participants might feel more comfortable sharing their views about potentially sensitive subject matter if this was done as a third party. As with the survey, the vignettes were reviewed by the IRCS team for appropriateness before they were used in the research. The focus groups were audio recorded for the purpose of verifying the accuracy of the notes taken. Participants’ written consent was obtained before recording.

Although the focus group process was not field tested in a traditional sense, following the first group, the research and IRCS project team made a few adjustments to improve the process. At the end of every focus group, participants were also invited to provide their feedback regarding the process and the topics of the focus groups.

The Centre’s research team kept field notes during all phases of data collection. These notes included procedural learning related to community-based research and observations about conducting research with diverse groups of older adults. The themes from the field notes were used to inform suggestions for working with diverse older adults (see Appendix H)

2.4. Ethical Considerations This study was approved by the Sheridan College Research Ethics Board. A thorough explanation of the proposed research was discussed with the staff of IRCS, prior to recruiting participants, and this explanation was again presented at the beginning of each survey collection and focus group. Informed consent was given, with assistance from the IRCS representative when needed, prior to data collection. The Centre for Elder Research prepared a brief guide for IRCS staff participating on the project team (Appendix I).

2.5. Data Analysis Results from the surveys were analyzed and summarized by theme by looking at frequencies and responding patterns. As a result of time constraints, a computer program to assist with data analysis of the focus group data was not used. Two members of the Centre’s team co-facilitated the groups with one member manually recording the discussion. Notes were then cross-referenced against audio recordings of the discussions and the data were analyzed by the identification of major themes both within and across groups. These same two members of the Centre’s team independently analyzed the data with a third Centre team member reviewing both reports to determine the degree of congruency in theme identification

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3. Results 3.1. Demographic Data Most participants (58.89%) were between 65 and 74 years old. The sample was 50.38% male, and 49.62% female. Most participants (80.85%) were born in India and the most commonly reported spoken languages were Punjabi by 60.58% of participants followed by Hindi (54.01%), English (47.45%), Gujarati (20.44%), Urdu (18.25%) and Tamil (12.04%). The highest proportion of participants (58.84%) rated their understanding of spoken and written English as “good” (a 3 on a 5-point scale from “poor” to “excellent”). The second highest proportion (49.53%) rated their understanding of spoken and written English as “not very good”. A slightly higher proportion of participants reported having poor understanding of written English (17.54%) than of spoken English (14.5%) Most participants (89.96%) were settled immigrants (having lived in Canada for more than 6 years) and 61.71% of those individuals had lived in Canada for more than 15 years. Most participants had between 9 and 17 years of education in their home country and/or Canada (65.13%). Only 10.55% of this sample reported living alone; the remainder reported a variety of living arrangements including living with their spouse (59.27%) and/or with the children (53.09%); 28% of participants also reported living with their grandchildren. About half of the participants (51.67%) rated their health as “good” (a 3 on a 5-point scale from “poor” to “excellent”). Slightly more participants (28.63%) rated their health on the lower end of the scale (“not very good” or “poor”) than on the higher end of the scale (“very good” or “excellent”) (20.45%). For a full summary of the demographic characteristics of the participants in this study see Appendix A. 3.2. Health Service Use Nearly all the participants (99.88%) had a family doctor and this was the most frequently used health service as reported by participants on the survey (91.28% had visited their doctor in the past 6 months). The second most commonly used health service was the pharmacy, used by 84% of participants in the past 6 months. About half of the participants (57.81%) had visited the eye doctor in the past 6 months as well. The least commonly used health services as reported by participants included “other health practitioners” (such as naturopaths, chiropractors, acupuncturists) and the hospital (including Emergency Services). These services were not used at all by 85.09% and 70.55% of participants respectively. See Figure 1 below for a depiction of the health services used by participants in the past 6 months. Overall, 68.16% of the sampled reported being “satisfied” or “very satisfied” with the health care services they receive.

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Figure 1. Health Services Used in the Past 6 Months (n=275)

When asked to describe when they use health services, 51.03% of participants reported using services to get treatment once a problem had already occurred; 48.15% reported using health services to manage an ongoing health problem and 37.86% reported accessing health services to prevent a health problem from occurring (Figure 2 below). Figure 2. Reasons for Accessing Health Services (n=243)

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3.3. Community Service Use The most commonly used social service, identified by 75.64% of participants were social/cultural programs (i.e. social clubs, prayer groups). The groups surveyed in the Halton region reported a need for more social/cultural groups or programs in that area. The second most commonly used service was recreation programs (used by 54.19% of participants). The community services that were not used at all by most participants included: counselling, immigration, food and employment services (see Figure 3 below). Figure 3. Community Services Used in the Past 6 Months (n=275)

3.4. Service Access and Barriers When asked how they most commonly access information about health or community services, out of 246 responses most participants (62.2%) received information, word-of-mouth from a friend or family member or from their doctor (56.91%). When it came to the media, the most commonly used sources of information were newspapers/magazines (46.75%) or television (41.87%). A smaller proportion (24.8%) of participants accessed the information they need about services from the Internet. From 193 responses, the most commonly reported barriers to accessing services included financial (reported by 50.78%) and transportation (reported by 50.78%). Many participants also reported language barriers (i.e. not being able to find services in their language) (43.01%) and physical difficulties (40.41%) (i.e. hearing/vision/mobility) restricting their access to services.

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Figure 4. Barriers to Accessing Services (n=193)

When asked what would help them to obtain the services they need, 220 participants responded and most selected “more services near my home” (67.73%). Many participants also identified the need for one place that has all the information they need (63.64%) and services or information offered in their language (57.27%) Figure 5. Participant-reported Service Needs (n=220)

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Space was provided on the survey for participants to make additional comments about the services they currently access or wish to access. The 114 comments were grouped thematically and these results are presented below:

Qualitative survey data themes (n=114) • 52.63% of comments referred to the need for better transportation services/free

transportation services for seniors. • 39.47% of participants talked about the need for free eye care, dental care • 25.44% reported a need for free medications/health aids. • 22.81% of participants commented on the need for more senior’s clubs,

recreation clubs or activities in their area (as mentioned earlier, many of these comments were made by participants from Halton Region).

• Other comments included: the need for South Asian specific services such as food services, in-home services and retirement/long term care homes, need for computer classes, the difficulties with long wait times, the need for more in-home care/services and the difficulty finding the information needed to access services.

3.5. Focus Group Data Five focus groups were held with 27 participants attending in total (3-6 participants per group). Focus group discussions were initiated through three case studies (vignettes) designed to encourage conversation about certain situations potentially encountered by older South Asian individuals. The topics of the vignettes were: 1. Housing 2. Social Isolation/Loneliness and 3. Elder Abuse (financial). The topics were never explicitly expressed by facilitators, leaving interpretation of each scenario open to the participants (see Appendix C for the vignettes used along with probing questions). The following focus group results are presented individually for each of the three vignettes. In addition, the data is presented as an aggregate from all five focus groups. Some participant quotes are included. Housing: The first vignette was an older individual exploring housing options. Housing options discussed during the focus groups included long-term care homes, downsizing, remaining at home (with in-home support) and living with adult children. The primary themes that emerged related to housing included:

a. Barriers to living in long-term care homes b. The need for ethno-specific care homes c. Family/cultural dynamics that influence housing choices

Within these themes, the following results emerged from the focus group conversations:

a. Barriers to living in long-term care homes • South Asian older adults shared stories about their experiences within Canadian

long-term care homes and retirement homes. It was universally expressed that South Asians are likely to encounter difficulties with the language, food, and

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cultural orientation of mainstream facilities. Some participants reported the experience of loneliness and social isolation within these environments.

“He was very excited to move there [retirement home]…He thought he would have company and companionship but the problem that he came across was that he was the only one from the [South Asian] community”

• Another commonly cited concern for South Asian older adults is access to financial resources, depending on whether they have a pension.

b. The need for ethno-specific care homes • The lack of a South Asian culturally specific long-term care home and/or

retirement home was universally expressed to be an issue. Participants identified a need for a South Asian care homes with traditional food and staff that speak the language and understand the culture.  

• Some participants also spoke about the importance of independence and stated that most people are happier at home (whether that is alone or living with their own family). There was an expressed need for more home supports to continue to allow older adults to age independently in the community.

• When the discussion turned into a choice between living in a care home versus living at home, it appeared the preference for living at home was linked to the comforts of shared language and culture. If cultural and language needs could be met in care homes, many participants expressed preference for this housing option because of the benefits of having care services available and having opportunities for socialization and planned activities.

c. Family/cultural dynamics that influence housing choices • A common theme discussed by participants was the role of family expectations in

the South Asian community. Participants explained that they have strong family obligations to take care of their grandchildren and support their adult children/in-laws, often living with them to do so. When South Asian older adults live with their children, participants described the ways in which this arrangement can either be a positive experience or a source of conflict depending on the relationship between the older adult and their children/in-laws. In many instances, as they described it, adult children are busy and expect their parents to care for the grandchildren and the housework. In these cases, the older adults feel the expectations of them are too much. They themselves may require care and they want freedom and respect.

• Since living with and helping children is a cultural phenomenon, many expressed the belief that individuals do not want to move out and additionally, may not want

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to access government help for a variety of reasons, including lack of information/awareness about the system.

“A lot of our people, they don’t want to move, they want to suffer at home. They don’t want to take advantage of the government facilities”

“The Indian and Pakistani community is naïve about how it works (long-term care home cost). They need education”

Social Isolation: Loneliness and social isolation were discussed within the context of a vignette about a newcomer with no social connections in Canada. Participants identified this as a real and problematic scenario and identified several solutions, with a particular emphasis on the importance of a person to serve as a ‘broker’ connecting the older individual to the community and/or services they may need. The primary themes that emerged related to social isolation included:

a. Cultural dynamics that can create social isolation b. The role of family and the South Asian community c. The role of faith-based organizations d. The need for ethno-specific services

Within these themes, the following results emerged from the focus group conversations: a. Cultural dynamics that can create social isolation • Participants reported a cultural preference not to discuss their personal life or

family problems with others from their community, as it is perceived to be a disgraceful act. Participants cited feeling shame about discussing personal matters openly.

• Participants talked about several instances in which older South Asian immigrants may experience loneliness and/or face social isolation. These included: A parent being brought over by adult children to care for grandchildren and being dependent on their children to connect them with the community/services; the newcomer who does not speak English and may not know what services are available for them and an older South Asian individual who is staying in a ‘mainstream’ retirement or long-term care home.

• Participants spoke about the importance of having a strong sense of community, and preference for company and companionship with people of their own (or similar) religious and cultural background, being able to speak their own language and to eat their traditional foods. Participants referred to this as a difficulty when accessing ‘mainstream’ services.

b. The ‘broker’ role of family and the South Asian community • The role of the family and other individuals from the South Asian community (i.e.

neighbours) was discussed with respect to providing information to and

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connecting older immigrants (particularly newcomers) to the community and the services they may need.

“Canada is the best country in the world, you can get everything over here. But the newcomer, somebody has to tell them, because they don’t know.”

• There was a commonly expressed social value of people looking out for one another (community members, neighbours, friends, etc.). Participants often expressed both an expectation to receive help from their community, as well as a willingness to offer help and support to others in their community.

c. The role of faith-based organizations • Participants spoke highly about the importance of having gurdwaras, mosques,

temples and churches to attend for various types of support (not solely for religious purposes). These are places that participants stated that they would go to receive guidance, to learn about a new community, to make friends, and also to seek refuge in times of personal crisis.

• Faith-based organizations were also suggested as a good place to share information about community/health services that may be of need to older South Asian immigrants. Participants gave examples of times where they saw pamphlets about relevant services at their temple and suggested that community organizations should promote their services there to reach out/educate older immigrants about the services available to them. It was further suggested that even the isolated newcomer might attend religious activities and thus might be connected with the help they may need.

d. The need for ethno-specific services • Many participants reported that, when they were newcomers, they joined ethno-

specific seniors groups, and cited this as being an important resource to learn about services, including what is available. In this context again, the important role of a family member, friend or community member to act as the ‘broker’ (sharing information and connecting the individual with the service) was discussed.

• Participants expressed the importance of having English classes and encouraged other older adults to learn the language if they were new to the country. They also talked about the value of having groups/services offered in their home language to fulfill the needs of those with poorer English language skills or no access to English classes.

Elder Abuse (financial): This vignette presented a situation in which an older adult was being financially and, possibly, physically abused by a family member. In all the focus groups, participants quickly identified this as an abuse case, and reported that this is a common situation facing older South Asians.

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The primary themes that emerged related to elder abuse included: a. Family/cultural dynamics that may lead to abuse b. Internal family matters versus external help c. The need for education/information

Within these themes, the following results emerged from the focus group conversations:

a. Family/cultural dynamics that may lead to abuse • Participants talked again about the expectation placed upon older adults to

support their adult children and grandchildren in terms of childcare and housekeeping (cooking and cleaning).

• Some South Asian older adults stated that they see it as their role and/or ‘job’ to support the family and fulfill this role. However, it was also acknowledged that within this role, some older adults feel disrespected or ‘used’ by their family.

“It’s going on in every house, they want you to work for free. The expectation is too high...And they also take our money, keep our pension”

• Many participants acknowledged that older adults are being “exploited and

abused” by family members. It was suggested that this problem is not often recognized or talked about by the community.

• This particular family dynamic was often discussed in relation to how many older adults have care needs as they age, and that often these needs go unsupported. Participants stated that adult children are seen to have a responsibility to aging parents; however it is also acknowledged that adult children are very busy with their own work outside the home.

• Participants talked about the serious consequences they might face in choosing not to fulfill their family duty/obligation. One specific example provided was the potential threat that the older adult would not be able to see his/her grandchildren if they refused to help or wanted to move out of the family home.

“If you don’t do – you are out on the street.”

• In addition, participants talked again about the cultural barrier of talking about situations that might bring shame to the family.

“In our community people don’t want to tell what is happening to them, they will die but they won’t tell”

• It was suggested that women and mothers in particular would not want to report their sons.

• It was also suggested that, in cases of abuse, some individuals might find it more comfortable to receive help from someone who is not from their culture;

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however, the importance of shared language and cultural understanding was still highlighted.

b. Family matter versus external help • Participants varied in their responses as to whether or not external help (i.e.

police involvement) should be considered. Some participants acknowledged the need for police reporting, while others said that this was a family matter and that police involvement would complicate matters.

• Even if participants were supportive of police involvement, there was an expression of fear surrounding police reporting in potential elder abuse/family conflict situations. Some expressed fear at the police not having the cultural understanding or language to fully understand an individual’s circumstances.

• Several participants talked about the responsibility of the government to establish stricter regulations to ensure that adult children are taking care of their aging parents and not mistreating them.

• Participants also recognized the complexity involved in situations like this, and recognized a place for professional counselling and social workers as a potential support.

c. The need for education/information • Participants expressed some uncertainty as to where to find professional

counsellors/social workers, but ideas included – IRCS, Punjabi Community Health Services, the Community Care Access Centre (CCAC) and government social services.

• Participants felt that there needs to be more education within the South Asian community about elder abuse (for both older adults and adult children). It was expressed that there needs to be more information shared about these situations being unacceptable and how to reach out for help.

• Participants expressed again, that the South Asian community should get involved to help each other (i.e. share information through word-of-mouth about services and help available).

• It was discussed once more about how faith-based organizations can be a source of information and support in abuse cases.

Additional needs and challenges experienced by South Asians older adults in Peel and Halton:

• Participants often expressed experiencing tension between their own culture/traditions and feeling a pressure to assimilate to the Canadian way of living.

• Participants expressed difficulties with the winter months in Canada, and indicated that they struggle with getting out of the house during this season.

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• As a whole, the focus group participants were able to collectively identify a continuum of services/supports available to older adults in Peel/Halton; however, there appeared to be an emphasis on CCAC or IRCS, specifically, to provide information and help to navigate the system.

• Specific services cited by participants including the following: IRCS, Punjabi Community Health Services, Punjabi Heritage, CCAC, seniors clubs, day programs, trans help, libraries, community centers, homecare (PSW/Nursing), and Meals on Wheels.

• Participants expressed a need for expansion and improvement to accessibility of transportation services (specifically, more cost effective/subsidized options).

• They also addressed the need for more education and advertising of health and social services to help South Asian older adults know where to go for supports.

3.6. Validity and Reliability Several circumstances may have affected the reliability of the data collected through the surveys. However, due to the nature of cross-cultural, community-based research, many of them may have been unavoidable. Language and translation challenges, cultural differences, as well as unfamiliarity with research processes, may have biased the data collected. During the data collection phase, as these circumstances were identified, measures were taken to minimize the impact they may have had on the data. The focus group data was coded individually by two members of the research team and cross-referenced to ensure high inter-rater reliablility. 3.4. Limitations This study primarily included participants living in the Region of Peel who were accessed through convenience sampling, through staff members at IRCS, Punjabi Community Health Services and the Dixie Bloor Neighbourhood Centre in Mississauga. Most of the participants were settled immigrants, in relatively good health, who were already engaged with service agencies. There are, without a doubt, older immigrants living in the Region of Peel whose voices were not heard. While focused efforts were made to reach older adults who were not affiliated with a specific agency, finding and connecting with them was challenging and would have required a much longer time frame than was available for conducting this study. Recruiting participants in the Region of Halton was considerably more challenging as ethno-specific agencies do not exist to serve the needs of older South Asian adults. We did experience some success through the Vaishno Devi Temple in Oakville and through contacts of the research centre at the Halton Multicultural Council. The Halton experience was not unexpected given the relatively greater number of older South Asian people living in Peel. In addition, there are limitations to conducting focus group research because the generalizability of results is restricted. Recognizing that one cannot guarantee complete confidentiality or anonymity, focus group sessions may result in limited perspectives, particularly for socially and historically vulnerable older immigrants. The reality of the two

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Sheridan co-faciliators not speaking the language and, having a third IRCS interpreter present, may have influenced the comfort of participants in sharing their views. The need for a translator presents an additional complexity as translations may not fully capture nuances of responses. 4. Discussion and recommendations for culturally sensitive service improvements Some recommendations for culturally sensitive service improvements that can be drawn from the research results are presented below:

1. Continue to provide ethno-specific service options that reflect the heterogeneity of large groups like the South Asian population: While several community agencies provide ethno-specific services for the South Asian community, as this population continues to grow in Canada, there will be an increasing need for services that represent the vast cultural/religious and linguistic diversity in this group. Our data show a particular need for South Asian clubs and services in the area of Halton.

2. Provide more ethno-specific care home options: Although culturally, many older South Asian individuals choose to live with their families, many of the participants in this study said that, if ethno-specific care homes were available, this housing option could be expected to be accessed by many individuals. Providing ethno-specific care homes may also play an important role in minimizing social isolation and loneliness or even abuse within the South Asian community by providing an alternative to living with adult children or independently.

3. Improve accessibility to affordable transportation options for older adults: Lack of transportation was a highly reported barrier to accessing services, particularly for older adults who do not have needed services near their home or for those who are dependent on their adult children for transportation. The difficultly of social isolation during the winter months can also be addressed by transportation service improvements.

4. Provide more financial assistance for older adults to be able to access eye and dental care: Many participants expressed the financial difficulties in receiving regular eye and dental care. In situations in which older immigrants are financially dependent on their adult children or lack a pension, they may require financially assistance to receive this kind of health care.

5. Build and support the capacity of the South Asian community and to help each other: The survey results showed that most participants receive information

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about health and community services through word-of-mouth and information sharing with family, friends and/or community members. Focus group participants spoke often about how the South Asian community should help each other, and how many older immigrants (particularly newcomers) need someone to connect them with the services they may need. This role was often reported as filled by a family member/community member or by a community agency providing ethno-specific services. Given the cultural and linguistic nuances that are best understood by people from the South Asian community, agencies, programs, services and approaches that support the community in helping each other should continue to be developed. Most importantly, the South Asian community needs to be well-informed about the services available to them so they can share this information with those in their community who are in need.

6. Promote access to education and information within the South Asian community: The importance of education and information sharing within the South Asian community was identified as integral to not only meeting individuals’ service needs, but also as a means to combat some of the cultural stigma that can leave some older South Asian adults living in poor quality-of-life conditions or even in abusive situations. Individuals who participated in the focus groups unanimously identified social isolation and elder abuse as real and common issues within their community. They often explained these situations with reference to the family dynamics and expectations that come from living with adult children. They expressed the need for more education for adult children about their responsibilities and for older adults with respect to their options access to help.

7. Consider the role of faith-based organizations in providing services/support/information: In several instances, faith-based organizations were cited as the informal places that anyone, in any situation could go to for help/guidance. It was also suggested that these organizations might play a role in disseminating information and education to the most vulnerable.

5. Conclusions

This was an exploratory study of the emerging health and social support needs of older South Asian immigrants in the Regions of Peel and Halton. The results from this study provided valuable insights in to the experiences and needs of older South Asian adults living in these areas and can be used both to identify gaps in service provision and to improve culturally sensitive services.

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References Acharya, M., Northcott, H. (2007). Mental Distress and the Coping Strategies of Elderly Immigrant Women. Transcultural Psychiatry. (December).

Bernhard, J.K., Hyman, I., Tate, E. (2010). Meeting the Needs of Immigrants Throughout the Lifecycle. Region of Peel Immigration Discussion Paper. Department of Citizenship and Immigration Canada.

Campaign to End Loneliness: Connections in Older Age. United Kingdom http://www.campaigntoendloneliness.org/

Hossen, A. (2012). Social Isolation and Loneliness Among Elderly Immigrants: The Case of South Asian Elderly Living In Canada. Journal of International Social

Issues, Vol. 1 (1) 1-10.

Newbold, K., B., Filice, J., K. (2006). Health status of older immigrants to Canada. Canadian Journal on Aging/La Revue Canadienne Du Vieillissement, 25(3),

305-319.

Ontario Local Health Integration Network. Demographics. Mississauga Halton LHIN. Retrieved from: http://www.mississaugahaltonlhin.on.ca/aboutus/demographics.aspx Retrieved on January 15, 2015

Ontario Local Health Integration Network. Central West LHIN Population Profile. Central West LHIN. Retrieved from: http://www.centralwestlhin.on.ca/About%20Us/The%20Landscape/Population%20Profile.aspx Retrieved on January 15, 2015

Simon, M., Chang, E., Zhang, M., Ruan, J. and Dong, X. (2014) The Prevalence of Loneliness Among U.S. Chinese Older Adults. Journal of Aging and Health 26

Social Planning Council of Peel. (2013). South Asian Research Statistics, 2006-2011. (Prepared for India Rainbow Community Services of Peel and Punjabi Community Health Services).

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Appendix A: Demographic Data Summary

Demographic characterist ics N=275

Characterist ic

Age (n=270) Response

Percent (%) Response Count

64 or younger 7.04 19 65-74 58.89 159 75-84 28.89 78 85+ 5.19 14 Gender (n=264) Male 50.38 133 Female 49.62 131 Place of birth (n=235) India 80.85 190 Sri Lanka 13.62 32 Pakistan 2.98 7 Africa 2.55 6

Length of residence in Canada (n=269) 5 years or less 10.04 27 6-10 years 11.15 30 11-15 years 17.10 46 More than 15 years 61.71 166 Language(s) most comfortable speaking (n=274) Punjabi 60.58 166 Hindi 54.01 148 English 47.45 130 Gujarati 20.44 56 Urdu 18.25 50 Tamil 12.04 33 *Participants could select more than one language Understanding of English (n=269) Spoken English Excellent 15.99 43 Very good 14.50 39 Good 29.74 80 Not very good 26.02 70 Poor 14.50 39 Written English Excellent 15.30 41 Very good 15.30 41 Good 29.10 78 Not very good 23.51 63 Poor 17.54 47

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Living arrangement (n=275) With spouse 59.27 163 With children 53.09 146 With grandchildren 28.00 77 Alone 10.55 29 Other 9.81 27 *Participants could select more than one option Education (n=261) Less than 1 year 3.45 9 1-8 years 13.03 34 9-13 years 33.33 87 14-17 years 31.80 83 More than 17 years 16.48 43 I did not attend formal school 1.92 5 Self-rated health status (n=269) Excellent 3.35 9 Very good 17.10 46 Good 51.67 139 Not very good 24.91 67 Poor 3.72 10

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Appendix B: Survey

The use of health and community services by South Asian immigrants age 65+ Please complete the questions below as thoroughly as possible. You do not have to answer any question that makes you feel uncomfortable; no one except the Sheridan researchers will see what you write and your responses are confidential. “Services” means either free or paid for activities offered by community agencies/organizations that help people improve their health and wellbeing. 1. How old are you? 65-74 75-84 85+ 2. Male Female 3. In what country were you born? ……………………………………………………………………………………………………… 4. How long have you lived in Canada?

5 years or less 6-10 years 11-15 years More than 15 years 5. Which language(s) do you feel most comfortable speaking?

Hindi Tamil Urdu Other Punjabi Gujarati English

6. How would you rate your understanding of spoken English?

Excellent Very good Good Not very good Poor 7. How would you rate your understanding of written English?

Excellent Very good Good Not very good Poor 8. Who lives with you? (Please check all that apply)

No one – it is only me Spouse (husband or wife) Sibling (brother or sister) Children

Grandchildren Extended family members (cousin,

aunt/uncle, niece/nephew) Other. Please explain.

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9. How many years of education do you have? (From your home country and/or Canada)?

Less than 1 year 1 - 8 years

14 - 17 years More than 17 years

9 – 13 years I did not attend formal school 10. How would you rate your overall health?

Excellent Very good Good Not very good Poor 11. Do you have a family doctor?

Yes No 12. Below are some examples of health services; please tell us how many times you have used them in the last 6 months. (Please check all that apply) Doctor (family doctor or specialist)

Not at 1-2 3-4 4-5 More than 5 Hospital (including Emergency Services)

Not at all 1-2 3-4 4-5 More than 5 Pharmacy

Not at all 1-2 3-4 4-5 More than 5 Community Health Clinic (e.g. walk-in clinic, flu clinic)

Not at all 1-2 3-4 4-5 More than 5 Dentist

Not at all 1-2 3-4 4-5 More than 5 Eye doctor

Not at all 1-2 3-4 4-5 More than 5 Other health practitioner (e.g. naturopath, chiropractor, acupuncturist)

Not at all 1-2 3-4 4-5 More than 5 13. Which situation best describes when you use health services?

To prevent a health problem from developing

To get treatment for a health problem after it has occurred

To manage an ongoing health problem

To get information or referrals for other treatment

Other. Please explain:

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14. How satisfied are you with the health care you receive? Very satisfied Satisfied Good Unsatisfied Very unsatisfied

15. Below are some examples of community services; please tell us how many times you have used them in the last 6 months. (Please check all that apply) Recreation programs (e.g. physical activity programs, hobby group)

Not at all 1-2 3-4 4-5 More than 5 English language classes

Not at all 1-2 3-4 4-5 More than 5 Social/cultural programs (e.g. social clubs, prayer group)

Not at all 1-2 3-4 4-5 More than 5 Counselling services (e.g. individual, family)

Not at all 1-2 3-4 4-5 More than 5 Immigration/Settlement Support Services

Not at all 1-2 3-4 4-5 More than 5 Transportation Services (e.g. buses, taxis, TransHelp)

Not at all 1-2 3-4 4-5 More than 5 Food Services (e.g. Meals on Wheels, food bank)

Not at all 1-2 3-4 4-5 More than 5 Employment services

Not at all 1-2 3-4 4-5 More than 5 * If you use community services that are not in this list, please tell us about them below. ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… 16. How do you find information about the health or community services you need? (Please check all that apply)

Television

Radio

Newspapers or magazines

My doctor

A family member/friend

Telephone Information line (i.e. 211)

The Internet

Other. Please explain:

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17. Have you experienced any of these difficulties when you need health or community services? (Please check all that apply)

I do not know where to get the help I need

I cannot pay the fee/cost

I do not have transportation

I have physical difficulties (hearing/vision/mobility)

I cannot find services provided in my language

I do not feel my culture/religion is being respected

I do not feel comfortable asking for help

Other difficulties. Please explain.

18. What would help you to get the services you need? (Please check all that apply)

A person to help me find the services I need

One place that has all the information I need

More services near my home

Services that better understand my cultural practices or religious beliefs

Services offered by a trusted professional with whom I feel comfortable

Services or information offered in my language

Better understanding of English

Other things that would help? Please explain:

19. Is there anything else you would like to tell us about the health and community services you currently use or want to use?

Thank you for your time!

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Appendix C: Focus Group Vignettes and Probing Questions

1) Housing Scenario A: Mr. C. is a 80 year-old man from Pakistan who uses a walker and has poor vision. He was living in a large house with his wife, but after she passed away he was having more difficulty taking care of himself and all the housework. His son and daughter-in-law live in the same town. Mr. C is considering moving out of his home Questions:

1. What do you think Mr. C should consider in choosing a new place to live? Follow-up question: What services/supports might he want to have available? 2. Perhaps Mr. C staying in his home is a possibility. Follow-up question: If yes, what supports might he need to stay in his home? How can he get this support? 3. In some cultures, it might be assumed that Mr. C. would move in with his son and daughter-in-law. Follow-up question: In your culture is it common for older people to live with the children? What are the benefits of living with family? The challenges? Do you think living with family is changing in today’s world? Where might you want to live as you grow older? 4. Anything to add?

Additional Conversation Starters: What housing options are available in your community? What kind of care services can you have in your home?

2) Loneliness/Social Isolation Case Study:

Scenario B: Mrs. S. is a 69 year-old widowed woman who lives with her adult son. She moved to Canada from Sri Lanka one year ago after her husband passed away. Mrs. S. does not know anyone in the community and has trouble going out on her own because of health problems, she cannot speak English well and she has difficulty using public transportation. She says that she often feels lonely and is too nervous to go out on her own. Mrs. S’s son works at night and is often sleeping during the day. She has no other family in the area.

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Questions: 1. How can Mrs. S make friends in her community? Follow-up questions: How did you make friends when you first came to Canada? 2. Should her son be doing anything to help her? If yes, what? 3. If Mrs. S was living in your community how could she find out about social activities that she can attend? Follow-up questions: How do you find out about social activities? What kind of social activities might be comfortable/enjoyable for her? 4. If Mrs. S was living in your community where could she go for information about or help with her health problems? Follow-up: If asked, her health problems are: back and knee pain, diabetes. 5. Where can Mrs. S access information in her own language? Follow-up questions: Should Mrs. S learn to speak English? How/where can she learn? 6. How can Mrs. S’s transportation problems be solved? 7. Can you see any other difficulties Mrs. S might experience in her situation? What are the solutions? 8. Anything to add? Additional conversation starters: What are some agencies/organizations in your community that offer social activities? Faith-based? Informal groups?

3) Elder Abuse Scenario C: Mrs. R. is a 73 year old woman from India who lives with her son and daughter-in-law. Her son brought her to Canada two years ago, and for the past year, he has kept her money for himself to cover household expenses. Mrs. R. recently tried to talk to her son about her money during a family dinner but he refused to talk about it. After dinner, the son went to his mother’s room and threatened to send her back to India if she continued to cause him any trouble. Mrs. R. had bruises on her arms because of her son grabbing her arms and shaking her. You are Mrs. R’s friend and you notice that she looks upset. You ask her about the bruises on her arms, she says she bumped into something but you are still worried.

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Questions: 1. If you saw bruises on Mrs. R again, what would you do? Follow-up questions: What would you say to Mrs. R? Would you share any information with her? 2. If Mrs. R told you that her son hurt her and she is afraid, would you tell someone? Who? 3. Is there somewhere in your community for Mrs. R to go if she is being hurt?

4. Anything to add?

Additional conversation starters: Who in the community is responsible for everyone’s safety? Are there specific services for individuals who are being hurt by friends/family? Are there counseling services in your community? Who are they for?

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Appendix D: Promotional Flyer

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Appendix E: Newspaper ads

Please note that the ad that appeared in the Brampton Guardian is the same as one that appeared in the Brampton Guardian South Asian Newspaper. In total, three newspaper ads were placed in an effort to recruit focus group participants.

Appendix F: Survey and focus group sites Survey distribution We met with 13 groups to complete the surveys face to face (the first group was our “pilot test” group)

• 12 groups contributed to the final data set • 275 survey were completed in the final data set • At 6 of the groups mail back surveys were also distributed • A total of 89 mail back surveys were distributed • 15 surveys were returned by mail from 5 of the 6 groups where they were

distributed

Survey sites: Agencies: Dixie-Bloor Neighbourhood Centre, Mississauga India Rainbow Community Services – Brampton and Mississauga sites Faith-based organizations: Halton Gurdwara, Oakville (facilitated by Halton Multicultural Council) Vaishno Devi Temple, Oakville Community Centres: Snelgroove Community Center, Brampton South Fletcher Library, Brampton Malton Library, Mississauga Focus groups

• We had 5 focus groups with 27 individuals in total attending (between 3 and 7 per group)

• 3 focus groups were organized at agencies and participants were recruited through the agency

• 2 focus groups were organized at 2 Sheridan College campuses (Brampton and Oakville) recruitment was conducted by placing ads in local (and where possible ethno-specific) newspapers

• Recruited for a group at Sheridan College Trafalgar Campus (Oakville) through local newspaper, however no one registered for this group

Focus group sites: Agencies X2 India Rainbow – Mississauga and Brampton locations Punjabi Community Health Services Sheridan College X2 Sheridan College Davis Campus (Brampton)

Appendix G: Letter of Information

Letter of Information The use of health and community services by South Asian immigrants age 65+ in Peel and Halton Please read this information form carefully. If you have any questions, please ask before signing the consent form. You have been invited to participate in a research project exploring health and community service use and needs of South Asian immigrants age 65+ who moved to Canada as adults and currently live in Peel or Halton. This project is supervised by Pat Spadafora and Lia Tsotsos, Director and Principal Researcher at the Centre for Elder Research; also on the research team are, Marta Owsik and Paulina Camino, Project Coordinators, Kathryn Warren-Norton, Communications Coordinator and Kristy Webber, practicum student. This project is being conducted in collaboration with India Rainbow Community Services of Peel and is supported by funding from the Mississauga-Halton Local Health Integration Network (MH-LHIN) PURPOSE OF THE STUDY The specific purpose of this research study is to explore the health and community service use and needs of South Asian immigrants age 65+ in Peel and Halton. We will investigate how health and community services are currently being used by older South Asian immigrants and any barriers they may experience. CONFIDENTIALITY Any information that is obtained in connection with this study will remain confidential. You will never be identifiable based on your data. Your consent form and any forms filled out by you will be stored in a secure location that will be accessible by key only to Pat Spadafora, the Director of the Centre for Elder Research, Lia Tsotsos, Principal Researcher and Marta Owsik, Project Coordinator. PROCEDURE You will be invited to complete a confidential survey answering some personal questions relating to your daily life and the health and community services you use. This survey will take approximately 30 – 45 minutes to complete and will be conducted in a variety of community locations. Researchers from the Centre for Elder Research will be present and other individuals will be available to assist with translation if necessary. POTENTIAL RISKS AND DISCOMFORTS There is the possibility that you may feel uncomfortable answering some of the questions asked. You are not required to answer any question if you feel uncomfortable doing so.

You may also withdraw from the research at any time. POTENTIAL BENEFITS All participants will have the opportunity to contribute to the body of knowledge related to the health and community service use and needs of older South Asian immigrants. This knowledge can help us understand the unique needs of older South Asian immigrants as well as identify the gaps in health and community services in Peel and Halton. PARTICIPATION AND WITHDRAWAL Your participation in this project is voluntary. You are under no pressure to participate in the project, and if you choose to participate you are free to stop at any time, with no penalty to yourself. You may also exercise the option of removing your information from the study. If you have any questions or concerns about the research, please feel free to contact: Marta Owsik, Project Coordinator, Sheridan Centre for Elder Research 905-845-9430, ext. 4282; marta.owsik@sheridancollege.ca Pat Spadafora, Director, Sheridan Centre for Elder Research 905-845-9430, ext. 8615; pat.spadafora@sheridancollege.ca RIGHTS OF RESEARCH PARTICIPANTS You may withdraw your consent at any time and discontinue participation without penalty. You are not waiving any legal claims, rights or remedies because of your participation in this research study. This study has been reviewed and received ethics clearance through the Sheridan Research Ethics Board (SREB). If you have questions regarding your rights as a research participant, contact: Dr. Kirsten Madsen, Chair, Sheridan Research Ethics Board 905-845-9430, ext. 2795 kirsten.madsen2@sheridancollege.ca 1430 Trafalgar Road Oakville, Ontario L6H 2L1

Appendix H: Consent Form

Consent Form

SIGNATURE OF PARTICIPANT I understand the information provided for The use of health and community services by South Asian immigrants age 65+ in Peel and Halton study as described herein. My questions have been answered to my satisfaction, and I agree to participate in this study. I have been given a copy of this form. _____________________________________ ________ ________ Name of Participant Age Gender _____________________________________ ______________ Signature of Participant Date SIGNATURE OF INVESTIGATOR In my judgment, the participant is voluntarily and knowingly giving informed consent and possesses the legal capacity to give informed consent to participate in this study. ______________ ______________________________________ Name of Investigator Location ______________________________________ ______________ Signature of Investigator Date

Appendix I

Practical Suggestions for Conducting Community Based Research With Culturally Diverse Communities

1. The research team should educate themselves about the cultural and religious customs of the community that they will be working with prior to beginning the research. Increased sensitivity will help to ensure a process that is respectful of cultural beliefs and practices.

2. Be aware that you may encounter barriers gaining access to some communities and plan strategies to overcome these potential challenges.

3. Encourage the involvement of community partners in the planning and implementation stages of your project. Essentially these partners are the key to your entry into the community. It is most often the community partners that are familiar with and, have the trust of, their constituent groups. In situations where research participants have limited English language proficiency, they will also be the ones with knowledge of the language.

4. Related to #3, provide a research briefing/orientation to your community partners so that will fully understand their role in the research process and what you are inviting research participants to do. This will help the community partners on the project team to more accurately translate for you during the data collection phase.

5. Be flexible with the research process. You may find that activities take longer to complete or that methods need to be changed in order to better meet the needs of the specific cultural group with whom you are working. If possible, build extra time into your timelines to accommodate potential changes. Participant recruitment, depending on the nature of the study, your target population and your familiarity with the community, may be more difficult than originally anticipated.

6. When possible, be informed about the participants’ level of understanding of the English language before meeting with them directly. This will help you to plan accordingly in terms of ensuring availability of translators.

7. Be prepared for variations in how you are received into the community. Sometimes, you will be welcomed with open arms and, at other times, you may be met with understandable hesitancy, mistrust and even refusal to participate.

8. Be understanding of the various reasons for apprehensiveness expressed by cultural groups in terms of their participation. It is not uncommon to hear about cultural groups having negative experiences with people outside of their own

community. Engaging in a meaningful way with a community partner(s) may help to ease this path for researchers.

9. Be prepared to answer questions about the research process. Participants are likely to ask you questions about your methods, such as why you have chosen to do something a certain way or your anticipated results. Again, this relates back to the need to build relationships and credibility with your participants.

10. You may notice differences in terms of how males and females communicate with you, and with each other in a group setting. This may vary in different communities but it will be important for you, as the researchers, to respect cultural norms and customs and to adapt your process accordingly. Be clear about what aspects of the data collection are integral to the integrity and rigour of the research and, after that, be flexible with your process.

11. You may notice differences between males and females in terms of education levels, roles, their level of English language comprehension, and how they dress according to their cultural/religious background. Again, it is your responsibility to make yourself aware of these differences if they impact the research process.

12. Recognize the cultural importance of sharing food as a means to help build

community and relationships. The concept of reciprocity (mutual give and take) may be an important cultural value within the community.

Additional points that are good “takeaways” from this research project: • Be mindful of possible differences in expectations when entering well-

established social groups to conduct research (for example, they are there to engage in a social activity and you are there to do ‘work’).

• Make a conscious effort to be aware of and to reduce your own cultural biases by checking your personal cultural beliefs and ideals throughout the research process.

Appendix J: IRCS Facilitator Guide

Information for site staff

Research Project: The Use of Health and Community Services by South Asian Immigrants age 65+ in Peel and Halton

Thank you for working with us on this exciting project! Below is information you might find helpful. Please feel free to email Marta at marta.owsik@sheridancollege.ca with questions or concerns.

Who are we? We are from the Sheridan Centre for Elder Research at Sheridan College, we conduct research that enhances the quality of life of older adults.

Project Context The Mississauga-Halton Local Health Integration Network (MH-LHIN) has given funding to India Rainbow and The Centre for Elder Research to work together to learn more about the health and community services that older South Asian immigrants (age 65+) need and use. “Services” are being defined as free or paid activities or programs offered by agencies that help people improve their health and wellbeing.

Purpose of the Study

The specific purpose of this project is to determine what health and community services older South Asian immigrants are using in Peel and Halton and what barriers/challenges they may experience to getting the services they need.

Procedure

Starting with the senior’s groups at India Rainbow, we will be meeting different groups in different community locations and asking them to complete a survey. The survey is written in English, so we may require your assistance with translation. The goal is to collect up to 200 survey responses in March. We will also be holding 5 small focus groups in community locations (6-8 individuals per group) to talk in more detail about some specific topics related to health and community services.

Data Collection

We will explain all the project details to participants (please help us translate if necessary). To improve the quality of information collected from participants, please help us maintain the following: - Participants should understand that they do not have to complete the survey or answer any questions if they prefer not to - Participants should sign a consent form and return it to us before they complete the survey - Participants should keep their answers on the survey confidential (i.e. where possible, they should not copy or share their answers with their peers)