1. 1 School of Public Health, University of Alberta Public Health 2014, May 27, 2014, Toronto, ON by Stephanie Patricia Kowal 1, Dr Cindy Jardine 1, and Dr Tania Bubela 1 “That’s How the Nurse Did It, How She Decided Which Vaccines”

3. Baker et al., 2010; Luman et al. 2005; Smith & Stevenson, 2008

5. 1)Document Vaccination Experiences 1)Understand decision making processes Study Purpose

6. Methods 23 Qualitative Interviews South Asia: n=8 China: n=10 Bhutanese Refugees: n=5

7. Edmonton’s Foreign-Born Population Immigrant Population Make-Up: Edmonton, Alberta Chinese 28% Latin American 5% South Asian 23% South East Asian 6% Black 12% Arab 7% Filipino 11% Other 8% Statistics Canada, censuses of population, 1901 to 2006.

8. Interview Guide Previous vaccine experiences Comprehension of how vaccine technology and regulations

9. Results – Passivity and Trust No. No. No. If they say go, then I’ll just go… Canada places a high importance toward children and won’t cause any harm toward them. So because of that and they have already done research to see what is good for the children, then I’ll just go with them (Chinese Participant)

10. Results - Trust If these vaccination are at the approval of the government and have gone through medical and scientific test and it’s safe, I don’t think it’s a problem… Over here, I feel completely secure. (Chinese Participant)

11. Results: (un)Informed Consent Technical and Regulatory Understandings

12. There was once that after the vaccination, he developed a fever and a second time, he had some reaction… Nothing serious and I think he is accustomed to it. He didn’t cry or fuss about it. I think it’s good. (Chinese Participant) Results: (un)Informed Consent

13. It was nothing like that. On our first visit, we had gone to the nurse and she told us that if we are staying close to the baby, this is the list of vaccines we give…She asked me a few questions. It also depended on which origin you were from…I think that’s how she did it, how she decided which vaccines. (South Asian Participant) Results: Agency

14. Implications for Consent

15. Uncomfortable Issues Meaning in Consent Compliance vs Consent Universality of Consent

16. Uncomfortable Issues Meaning in Consent Compliance vs Consent Universality of Consent

17. Uncomfortable Issues Meaning in Consent Compliance vs Consent Universality of Consent

18. Information in Compliance and Consent

19. References Baker, D. L., Dang, M. T., Ly, M. Y., & Diaz, R. (2010). Perception of Barriers to Immunization among Parents of Hmong Origin in California, American Journal of Public Health, 100(5), 839. Luman, E. T., Barker, L. E., McCauley, M. M., & Drews-Botsch, C. (2005). Timeliness of Childhood Immunizations: A State-Specific Analysis, American Journal of Public Health, 95(8), 1367. Smith, P. J., & Stevenson, J. (2008). Racial/Ethnic Disparities in Vaccination Coverage by 19 Months of Age: An Evaluation of the Impact of Missing Data Resulting from Record Scattering, Statistics in Medicine 27(20), 4107-4118. Statistics Canada (2006) Immigration and Citizenship Highlight Tables, 2006 Census. Available at http://www12.statcan.ca/census-recensement/2006/dp-pd/hlt/97-557/Index-eng.cfmhttp://www12.statcan.ca/census-recensement/2006/dp-pd/hlt/97-557/Index-eng.cfm

20. Thank You! Questions? Acknowledgements Multi-Cultural Health Brokers Cooperative: Yvonne Chiu Shiva Chapagai Lydia Yip Hina Naushad Ravi Hansra Daljit Rupana Funders: CIHR Master’s Award HQCA Summer Studentship WCHRI Qualitative Core Resource WCHRI/CUP CBR Science Shop WCHRI Graduate Studentship Research Participants Contact Info: skowal@ualberta.ca Translators Jian Wang Dr. Amrita Mishra

21. Recommendations for Communications Development 1)Facilitate finding family doctors 1)Create robust information delivery network to reach those not connected with physicians

22. Similarities Among Differences Chinese, Bhutanese, and Indian Contexts