Exploring the impact of health care provider cultural competence on new immigrant health-related quality of life: A cross-sectional study of Canadian newcomers.
Open accessAbstract
Introduction: New immigrants underutilize health care because of multiple barriers. Although culturally competent health care improves access, it is typically assessed by providers, not newcomers whose perceptions matter most. Methodology: Surveys that included measures of cultural competence and health-related quality of life (QOL) were completed by 117 new immigrants in Windsor, Ontario, Canada. A series of stepwise linear regression analyses were conducted to identify independent predictors of QOL and its four domains: physical health, psychological, social relationships, and environment. Results: Our adjusted results suggest that experiences of discrimination was negatively associated with overall QOL (β = −.313; p < .001) and its psychological (β = −.318; p < .001), social (β = −.177; p = .048), and environmental (β = −.408; p < .001) domains. Discussion: Discrimination negatively influences new immigrant QOL. Provider cultural competency training should emphasize the influence of provider discrimination on immigrant health and explore learners’ values and biases.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The lower EOHCS-Episodic scores among people who have English as their first language may be explained in part by research showing that newcomers whose first language is not English tend to rate their satisfaction with care highly, reflecting appreciation for access to care that may be less accessible in their countries of origin.
“The lower scores among people who have English as their first language may be explained, in part, by research showing that newcomers whose first language is not English tend to rate their satisfaction with care quite highly, reflecting some peoples’ appreciation for access to care that may be less accessible in their countries of origin [81–84].”
From Using a health equity lens to measure patient experiences of care in diverse health care settings (2024) · cites this paper as [82]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007) · Behavior Research Methods · doi:10.3758/bf03193146 · Cited by 65,971 · see citing works
Hosmer, D. W., & Lemeshow, S. (2000) · doi:10.1002/0471722146 · Cited by 20,302 · see citing works
Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment
THE WHOQOL GROUP (1998) · Psychological Medicine · doi:10.1017/s0033291798006667 · Cited by 7,933 · see citing works
Skevington, S. M., Lotfy, M., & O'Connell, K. A. (2004) · Quality of Life Research · doi:10.1023/b:qure.0000018486.91360.00 · Cited by 4,686 · see citing works
Discrimination and racial disparities in health: evidence and needed research
Williams, D. R., & Mohammed, S. A. (2009) · Journal of Behavioral Medicine · doi:10.1007/s10865-008-9185-0 · Cited by 3,371 · see citing works
The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review
Flores, G. (2005) · Medical Care Research and Review · doi:10.1177/1077558705275416 · Cited by 1,676 · see citing works
Karliner, L., Jacobs, E. A., Chen, A. H., & Mutha, S. (2006) · Health Services Research · doi:10.1111/j.1475-6773.2006.00629.x · Cited by 1,538 · see citing works
Common mental health problems in immigrants and refugees: general approach in primary care
Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., Hassan, G., Rousseau, C., Pottie, K., & for the Canadian Collaboration for Immigrant and Refugee Health (CCIRH) (2011) · Canadian Medical Association Journal · doi:10.1503/cmaj.090292 · Cited by 1,505 · see citing works
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003) · Public Health Reports · doi:10.1016/s0033-3549(04)50253-4 · Cited by 1,437 · see citing works
Understanding how discrimination can affect health
Williams, D. R., Lawrence, J. A., Davis, B. A., & Vu, C. (2019) · Health Services Research · doi:10.1111/1475-6773.13222 · Cited by 853 · see citing works
Rethinking cultural competence
Kirmayer, L. J. (2012) · Transcultural Psychiatry · doi:10.1177/1363461512444673 · Cited by 708 · see citing works
Cultural Competence And Health Care Disparities: Key Perspectives And Trends
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Park, E. R. (2005) · Health Affairs · doi:10.1377/hlthaff.24.2.499 · Cited by 707 · see citing works
Ngo‐Metzger, Q., Sorkin, D. H., Phillips, R. S., Greenfield, S., Massagli, M. P., Clarridge, B. R., & Kaplan, S. H. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0340-z · Cited by 439 · see citing works
Cultural humility: Essential foundation for clinical researchers
Yeager, K. A., & Bauer‐Wu, S. (2013) · Applied Nursing Research · doi:10.1016/j.apnr.2013.06.008 · Cited by 412 · see citing works
Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services
Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E.-L. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.5.866 · Cited by 399 · see citing works
Discrimination and sleep: a systematic review
Slopen, N. B., Lewis, T. T., & Williams, D. R. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.01.012 · Cited by 397 · see citing works
Perceived Racial Discrimination and Hypertension: A Comprehensive Systematic Review
Dolezsar, C. M., McGrath, J. J., Herzig, A. J. M., & Miller, S. B. (2014) · Health Psychology · doi:10.1037/a0033718 · Cited by 385 · see citing works
Traylor, A. H., Schmittdiel, J. A., Uratsu, C. S., Mangione, C. M., & Subramanian, U. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1424-8 · Cited by 363 · see citing works
Reducing barriers to interprofessional training: Promoting interprofessional cultural competence
Pecukonis, E. V., Doyle, O., & Bliss, D. L. (2008) · Journal of Interprofessional Care · doi:10.1080/13561820802190442 · Cited by 257 · see citing works
A Global Perspective on Happiness and Fertility
Margolis, R., & Myrskylä, M. (2011) · Population and Development Review · doi:10.1111/j.1728-4457.2011.00389.x · Cited by 255 · see citing works
The deterioration of health status among immigrants to Canada
Maio, F. G. D., & Kemp, E. (2009) · Global Public Health · doi:10.1080/17441690902942480 · Cited by 233 · see citing works
Migration and health in Canada: health in the global village
Gushulak, B. D., Pottie, K. C., Roberts, J. H., Torres, S., & DesMeules, M. (2010) · Canadian Medical Association Journal · doi:10.1503/cmaj.090287 · Cited by 232 · see citing works
Cultural Competence or Cultural Humility? Moving Beyond the Debate
Greene‐Moton, E., & Minkler, M. (2019) · Health Promotion Practice · doi:10.1177/1524839919884912 · Cited by 222 · see citing works
Discrimination and drinking: A systematic review of the evidence
Gilbert, P. A., & Zemore, S. E. (2016) · Social Science & Medicine · doi:10.1016/j.socscimed.2016.06.009 · Cited by 210 · see citing works
The short-term health of Canada's new immigrant arrivals: evidence from LSIC
Newbold, B. (2009) · Ethnicity & Health · doi:10.1080/13557850802609956 · Cited by 166 · see citing works
Edge, S., & Newbold, K. B. (2012) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-012-9640-4 · Cited by 158 · see citing works
Gee, G. C., & Ponce, N. A. (2010) · American Journal of Public Health · doi:10.2105/ajph.2009.178012 · Cited by 155 · see citing works
Leu, J., Yen, I. H., Gansky, S. A., Walton, E. C., Adler, N. E., & Takeuchi, D. T. (2008) · Social Science & Medicine · doi:10.1016/j.socscimed.2007.11.028 · Cited by 150 · see citing works
Systemic Inflammation in Midlife: Race, Socioeconomic Status, and Perceived Discrimination
Štěpáníková, I., Bateman, L. B., & Oates, G. R. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2016.09.026 · Cited by 141 · see citing works
Assessment of Trust in Physician: A Systematic Review of Measures
Müller, E., Zill, J. M., Dirmaier, J., Härter, M. C., & Scholl, I. (2014) · PLoS ONE · doi:10.1371/journal.pone.0106844 · Cited by 136 · see citing works
Translating Primary Care Practice Climate into Patient Activation
Becker, E. R., & Roblin, D. W. (2008) · Medical Care · doi:10.1097/mlr.0b013e31817919c0 · Cited by 132 · see citing works
Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty
Hughes, V., Delva, S., Nkimbeng, M. J., Spaulding, E. M., Turkson‐Ocran, R., Cudjoe, J., Ford, A. D., Rushton, C. H., D’Aoust, R., & Han, H. (2019) · Journal of Professional Nursing · doi:10.1016/j.profnurs.2019.06.005 · Cited by 111 · see citing works
Stewart, M. J., Neufeld, A., Harrison, M. J., Spitzer, D. L., Hughes, K. D., & Makwarimba, E. (2006) · Health & Social Care in the Community · doi:10.1111/j.1365-2524.2006.00627.x · Cited by 98 · see citing works
Negative health care experiences of immigrant patients: a qualitative study
Suurmond, J., Uiters, E., de Bruijne, M. C., Stronks, K., & Essink‐Bot, M. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-10 · Cited by 90 · see citing works
Dean, J. A., & Wilson, K. (2010) · Social Science & Medicine · doi:10.1016/j.socscimed.2010.01.009 · Cited by 83 · see citing works
Subedi, R. P., & Rosenberg, M. W. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.06.021 · Cited by 72 · see citing works
Reducing the Use of Ad Hoc Interpreters at a Safety-Net Health Care System
Paradise, R. K., Hatch, M., Quessa, A., et al. (2019) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2019.01.004 · Cited by 68 · see citing works
Weech-Maldonado, R. J., Carle, A. C., Weidmer, B. A., Hurtado, M. P., Ngo‐Metzger, Q., & Hays, R. D. (2012) · Medical Care · doi:10.1097/mlr.0b013e318263134b · Cited by 62 · see citing works
Immigrant Economic and Social Outcomes in Canada: Research and Data Development at Statistics CanadaPreprint
Picot, G. (2008) · RePEc: Research Papers in Economics · Cited by 61 · see citing works
Immigrant health, place effect and regional disparities in Canada
Wang, L., & Hu, W. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.08.040 · Cited by 59 · see citing works
Setia, M. S., Lynch, J. W., Abrahamowicz, M., Tousignant, P., & Quesnel‐Vallée, A. (2011) · Health & Place · doi:10.1016/j.healthplace.2011.01.006 · Cited by 47 · see citing works
How Culture Is Understood in Faculty Development in the Health Professions: A Scoping Review
Lewis, L. D., & Steinert, Y. (2019) · Academic Medicine · doi:10.1097/acm.0000000000003024 · Cited by 41 · see citing works
Interpersonal discrimination and markers of adiposity in longitudinal studies: a systematic review
Bernardo, C., Bastos, J. L., González‐Chica, D. A., Peres, M. A., & Paradies, Y. (2017) · Obesity Reviews · doi:10.1111/obr.12564 · Cited by 40 · see citing works
Can Cultural Competency Reduce Racial and Ethnic Health Disparities? a Review and Conceptual Model
Brach, C., & Fraserirector, I. (2000) · Medical Care Research and Review · doi:10.1177/1077558700574009 · Cited by 31 · see citing works
Wang, L. (2014) · Applied Geography · doi:10.1016/j.apgeog.2014.03.010 · Cited by 24 · see citing works
Advances in Measuring Culturally Competent Care
Stern, R. J., Fernández, A., Jacobs, E. A., et al. (2012) · Medical Care · doi:10.1097/mlr.0b013e31826410fb · Cited by 18 · see citing works
Reaching for cultural competence
Smith, L. S. (2013) · Nursing · doi:10.1097/01.nurse.0000429794.17073.87 · Cited by 15 · see citing works
Trust and Perceptions of Physicians’ Nonverbal Behavior Among Women with Immigrant Backgrounds
Hillen, M. A., de Haes, H. C. J. M., Verdam, M. G. E., et al. (2017) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-017-0580-x · Cited by 12 · see citing works
Kolapo, T. F. (2017) · Canadian Journal of Community Mental Health · doi:10.7870/cjcmh-2017-034 · Cited by 6 · see citing works
The Case for Cultural Competence in Health Professions Education
Shaya, F. T., & Gbarayor, C. M. (2006) · American Journal of Pharmaceutical Education · doi:10.1016/s0002-9459(24)08279-2 · Cited by 6 · see citing works
Cultural competence in healthcare: Our learning from 2017-2020 will shape our future
Biles, J. M. (2020) · The Australian Nursing and Midwifery Journal · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Hyman I. (2009). Racism as a determinant of immigrant health: Ottawa: Strategic Initiatives and Innovations Directorate of the Public Health Agency of Canada. https://www.researchgate.net/profile/Ilene_Hyman/publication/255654375_Racism_as_a_determinant_of_immigrant_health/links/54abee2a0cf2bce6aa1dd292/Racism-as-a-determinant-of-immigrant-health.pdf
- Pollock G. Newbold B. Lafrenière G. Edge S. (2011). Perceptions of discrimination in health services experienced by immigrant minorities in Ontario. https://pdfs.semanticscholar.org/6685/1b66064ecc1da40d7b1f3911c51279c0c9dc.pdf
Cited by
Sorted by citations
Using a health equity lens to measure patient experiences of care in diverse health care settings
Browne, A. J., Varcoe, C., Ford-Gilboe, M., Wathen, C. N., Wilson, E., Bungay, V., & Perrin, N. (2024) · PLOS ONE · doi:10.1371/journal.pone.0297721 · Cited by 17 · see citing works
Urzúa, A., Henríquez, D., Caqueo-Urízar, A., & Landabur, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010174 · Cited by 14 · see citing works
Volunteerism and Cultural Competence: A Qualitative Study of Tzu Chi’s Immigrant Healthcare Model
Chen, I.-C., & Phanumartwiwath, A. (2025) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-025-01741-7 · Cited by 2 · see citing works
Senior, M. A., Alfred, M., Akintunde, T., & Montague, E. (2026) · Ergonomics · doi:10.1080/00140139.2026.2740202
- Authors
- Zghal, A., El-Masri, M., McMurphy, S., & Pfaff, K.
- Affiliations
- University of Windsor (CA)
- Ryerson University, Toronto, Ontario, Canada
- Corresponding author
- Pfaff, Kathryn
- Venue
- Journal of Transcultural Nursing
- Publisher
- SAGE Publications
- Published
- 2020-10-23
- Volume
- 32
- Issue
- 5
- Pages
- 508-517
- ISSN
- 1043-6596 (ISSN-L)
- 1552-7832
- PMC
- PMC8404719
- OpenAlex
- W3094286602
- Cited by
- 46
- References
- 51
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 13 · 2023: 7 · 2022: 7 · 2021: 2
- FWCI
- 5.35
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Transcultural Nursing (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Scholarship at UWindsor (University of Windsor) (submittedVersion, cc-by-nc)
- Funders
- university of windsor
- Topics
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Sociology and Political Science › Migration, Identity, and Health
- Keywords
- cultural competence, healthcare workers, new immigrants, health-related quality of life, discrimination, immigrant health, barriers to care, provider bias, cultural competence training
- MeSH terms
- Cross-Sectional Studies, Health Personnel, Humans, Ontario, Quality of Life, Emigrants and Immigrants, Cultural Competency
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
