Early childhood education and care (ECEC) can have substantial beneficial effects on overall child development and educational success for children from disadvantaged backgrounds. Unfortunately, it is well documented that they are underrepresented in quality ECEC programs. In order to improve access to quality ECEC, it is important to understand the factors leading to these inequities. This paper is based on a synthesis of published literature on interventions aimed at improving access to ECEC. We propose a framework identifying the spectrum of factors influencing access to quality ECEC for disadvantaged populations. We also present, in the context of our proposed framework, different interventions that have been taken to improve access to ECEC opportunities for children from low socioeconomic and/or new immigrant backgrounds. We believe that the framework proposed in this paper serves not only as a framework by which to understand the overlapping processes, factors, and stages affecting access to ECEC, but also as a model to help decision makers coordinate their efforts and maximize their impact towards more equity in access to quality early childhood education.
Few studies have integrated the concept of empowerment in their analysis of the interaction between formal services and informal caregivers. This study was conducted among 32 female informal caregivers living in a district served by a Montreal local community service centre (CLSC). It was designed to identify those aspects of formal services that either empowered caregivers or increased their powerlessness. Three major issues were identified: norms applicable to care giving; access to and control over resources and services; and power relationships with practitioners. Depending on their context and their perception of their role as a caregiver, caregivers reported that their recourse to services was either an empowering experience or one that increased their powerlessness.
Background
The province of Quebec (Canada) has implemented a breast cancer screening program to diagnose this cancer at an early stage. The strategy is to refer women 50 to 69 years old for a mammogram every two years by sending an invitation letter that acts as a prescription. Ninety per cent (90%) of deaths due to breast cancer occur in women aged 50 and over. Numerous studies have shown social inequalities in health for most diseases. With breast cancer, a significant paradox arises: its incidence is lower among disadvantaged women and yet, more of them die from this disease. The health care system might play a role in this inequality. The scientific literature documents the potential for creating such inequalities when prevention does not consider equity among social groups. Immigrant women are often disadvantaged. They die of breast cancer more than non-immigrants. Studies attribute this to late-stage diagnosis due to poor adherence to mammography screening programs.
Purpose of the study
The main objective of our research is to assess how Haitian immigrant women in Montreal are reached by the Quebec Breast Cancer Screening Program, and specifically how they perceive the mammogram referral letter sent by the program.
Methods
The study uses a two-step qualitative method: i) In-depth interviews with influential community workers to identify the most relevant issues; ii) Focus groups with disadvantaged women from Montreal’s Haitian community.
Results
A mammogram referral letter from the Breast Cancer Screening Program may be a barrier to compliance with mammography by underprivileged Haitian women in Montreal. This might be attributable to a low level of literacy, poor knowledge of the disease, and lack of financial resources.
Conclusion
Barriers may be underestimated in underprivileged immigrant and non-immigrant communities. A preventive strategy must be adapted to different sub-groups and must also take into account lower literacy levels. To increase mammography uptake, it is crucial that the benefits of prevention be clearly identified and described in understandable terms. Finally, economic access to follow-up measures should be considered.
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