Fabreau, GabrielMcBrien, KerryNorrie, Eric Culham2023-05-052023-05-052023-05-03Norrie, E. C. (2023). Decade of turmoil: a characterization of a specialized refugee health clinic 2011-2020 (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.http://hdl.handle.net/1880/116171https://dx.doi.org/10.11575/PRISM/dspace/41016Background: Canadian refugee healthcare has been impacted by periodic upheavals including federal funding cuts, Syrian and Yazidi resettlement programs, and COVID-19. These upheavals may have led to changes in clinic use, demographics, clinic policy, or may impact provider wellness. Refugees are a vulnerable population with specific biopsychosocial health needs. One model of care that can address these needs is a specialized refugee health clinic. Understanding the impacts of recent upheavals on a specialized refugee health clinic’s utilization, its staff and clinicians is critical. Methods: We used a mixed methods sequential explanatory case study design to investigate changes (including patient demographic characteristics, clinic utilization, and care adaptations), at a specialized refugee health clinic in Calgary from 2011 to 2020, across five time periods: Pre-Interim Federal Health Program (IFHP) Cuts, IFHP Cuts, Syrian Surge, Yazidi Period, and COVID-19. We used segmented linear regression (SLR), Kruskal-Wallis, and chi-square analyses to assess quantitative changes to utilization and demographics across these time periods. Then we conducted semi-structured interviews with clinic leadership which we analyzed thematically. Finally, we merged our quantitative and qualitative findings, by assessing which of our qualitative themes converged with our quantitative findings during each time period. Results: We included 10,661 patients in our quantitative analysis; 48.2% were female and the mean age was 24.4 years (SD: 17.0). The most common region of origin was first East Africa, and then West Asia after the Syrian period. Total monthly appointments increased 576% from 478/month to 2752/month over 10 years. The mean appointments/month increased significantly (p<0.05) during each time period, but the rate of increase varied. Our qualitative and merged results converged with and expanded upon these quantitative results, especially by emphasizing the impact of health system upheavals on provider wellness. Conclusion: Utilization increased greatly over different policy changes and a pandemic, at a specialized refugee clinic over ten years. These upheavals challenged clinic leadership and providers to adapt. Qualitative participants consistently indicated that the stress of these upheavals negatively impacted staff wellness and patient care. Canada and other countries of resettlement should consider how health policies and other upheavals may have downstream consequences.enUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.Refugee healthRefugee health utilizationMixed methodsSpecialized Refugee Health ClinicSyriaCOVID-19Health utilizationRefugeeHealth services researchHealth Care ManagementHealth SciencesMental Healthmaster thesis