Abstract
Background: Parc-Extension is one of the poorest neighborhoods in Montreal, with the greatest population density and immigrant population. During Québec’s first vaccination rollout, Parc-Extension had a lower proportion of vaccinated individuals compared to the city’s average. However, by August 2021, Parc-Extension’s first dose vaccination rate surpassed Montreal’s (77.9% vs 74%). This is attributable to building vaccine knowledge, acceptance, and uptake through community-led strategies that addressed the already existing language barrier as social determinant of health impacting immigrant communities.
Methodology: We approached our research using a critical realist paradigm. Using convenience and purposive sampling, we conducted semi-structured interviews with residents who had lived in Parc-Extension during the pandemic. We explored which social determinants of health contributed to their vaccine decision making and accessibility to health and social services. The interviews were audio recorded and transcribed using transcription software. Transcripts were corrected manually by the co-authors. The research team inductively developed a codebook and performed thematic content analysis, and coding was done by two co-authors and analysis meetings were held to discuss discrepancies.
Results: We conducted 46 semi-structured interviews (27 in French, 16 in English, and 3 in Urdu) between June and August 2022. We interviewed 31 community residents and 15 community organizers. Two salient themes were identified: (i) language barriers influence vaccine decision making and access to essential services and care (ii) inadequate governmental support for immigrants and asylum seekers contributes to inaccessibility to vaccine information and access to healthcare and social services.
Discussion: Parc-Extension residents reported language barrier as a critical social determinant of health that influences their vaccine decision-making and limits their access to healthcare and social services. Due to language barriers and inadequate support at the governmental level, there is an unjust burden placed on community organizations to ensure that residents are receiving translated and culturally adapted vaccine information, social support services and adequate care. Improving access to services such as COVID-19 vaccines amongst immigrant groups requires a holistic approach and trustable partnerships between governments and community organizations that consider addressing language barrier as a major social determinants of health.