Health and Learning: Experiences of
Adults with Literacy Challenges and
Immigrants & Refugees
Hélène Grégoire, PhD
Adjunct Assistant Professor
Department of Public Health Sciences,
University of Toronto
CPHA Conference
June 2, 2008
Context for the consultations
Adult Working Group, Health & Learning
Knowledge Centre, Canadian Council on Learning
Developing a knowledge agenda to advance health
& learning of adults in Canada
Environmental Scan
State of the Field Review
Support from National Collaborating Centre on
Determinants of Health
Preliminary research
Environmental scan: Fields of adult
learning and health generally disconnected
(2006 with update in 2007)
State of the field: Wealth of research on
the health of Canadians and the social
determinants of health but little on role that
education/learning might play in improving
health of Canadians
Purpose of consultations
To find out how immigrants/refugees and people
with low literacy experience health, learn about
health and access health care services
To identify themes/gaps/needs related to health
and learning and make recommendations for
policy, practice, and research
Consultation methodology
Worked with local partners across Canada:
1. Montreal, Quebec
2. Vancouver, British Columbia
3. Toronto, Ontario
4. Regina, Saskatchewan
5. Truro, Nova Scotia
The AWG conducted focus groups with
community members and providers who work
with them.
Consultation participants
Total of 180 participants in first year
64 immigrants and refugees
21 providers who work with immigrants and
refugees
74 adults with literacy challenges
21 providers who work with them
Types of questions
what health means
how community members keep in good
health
how they learn about health and get
information they need
their experiences with the healthcare system
who should learn what
what else needs to be done
Emergent themes
Participants saw physical, mental and spiritual
health as interconnected.
Participants named many barriers to being in
good health; poverty is foremost among them.
Their experiences with the health care system
were largely negative.
Community members tended to rely on people
they know for information about health.
Barriers to being healthy
For both groups:
 Poverty
 Racism and discrimination
 Lack of access to health care services
For immigrants and refugees:
 Adjustment
 Lack of recognition of foreign credentials and
unemployment
 Poor housing
Experiences with health
services
Racism and discrimination
Communication with doctors
Cost of health care
Lack of doctors and access to services
Lack of interpreters and services in own
language
Difficulty navigating the health care
system
Participants’ recommendations
Multi-faceted strategies to promote health
Plain language information
Communication & learning with interpreters or
in one’s own language
Discussion groups and workshops:
Understanding rights
Health topics
Workshops on men’s health
Health learning needed to help children
Cooking and grocery shopping
Recommendations (cont’d)
Poverty reduction
Affordable and secure housing
Affordable, appropriate and accessible health
care services
Recognition of credentials of foreign doctors
Access to jobs and recognition of foreign
credentials
Learning for health providers: sensitivity and
awareness training
Language training and skills upgrading
Trauma counselling
The participants’ recommendations show
that it is not just a matter of providing
more information or education about
health or providing it in clearer, more
effective ways.
It is critical to address the broader
social determinants of health.
So who needs to do the
learning?
Access to health information by immigrants and
people with literacy challenges is not enough
Poverty and discrimination need to be addressed
Health care providers need to be prepared to
offer more appropriate and accessible services
Population as a whole needs to be sensitized
(e.g., employers, decision-makers, tax-payers)
Adult education
Supporting these communities in gaining
control over the factors that affect their
health
Consciousness-raising among general
population, health care providers and
decision-makers
Next Steps
Reports on consultations with people
living with HIV/AIDS and those living in
rural/remote communities
Forum to bring stakeholders together and
take collective action
Acknowledgements
Adult Working Group, especially Sue
Folinsbee, Wendy Kraglund-Gauthier and
Allan Quigley.
For more details
Folinsbee, S., Kraglund-Gauthier, W. L., Grégoire, H. &
Quigley, A. (with the Adult Working Group Advisory
Committee) (2007). Adult Working Group’s Cross-
National Consultations on Health and Learning: Final
Report. Victoria, BC: Health & Learning Knowledge
Centre. Available at: http://www.cclcca.ca/CCL/AboutCCL/KnowledgeCentres/HealthandLear
ning/OurWork/WorkingGroups.htm?Language=EN
Contact:
Hélène Grégoire
helenegregoire@hotmail.com