BackgroundThe role of obesity in the prevalence and clustering of multimorbidity, the occurrence of two or more chronic conditions, is understudied. We estimated the prevalence of multimorbidity by obesity status, and the interaction of obesity with other predictors of multimorbidity.MethodsData from adult respondents (18 years and over) to the Health Quality Council of Alberta 2012 Patient Experience Survey were analyzed. Multivariable regression models were fitted to test for associations.ResultsThe survey sample included 4803 respondents; 55.8% were female and the mean age was 47.8 years (SD, 17.1). The majority (62.0%) of respondents reported having at least one chronic condition. The prevalence of multimorbidity, including obesity, was 36.0% (95% CI, 34.8 – 37.3). The prevalence of obesity alone was 28.1% (95% CI 26.6 – 29.5). Having obesity was associated with more than double the odds of multimorbidity (odds ratio = 2.2, 95% CI 1.9 – 2.7) compared to non-obese.ConclusionsThe prevalence of multimorbidity in the general population is high, but even higher in obese than non-obese persons. These findings may be relevant for surveillance, prevention and management strategies for multimorbidity.

Visible minority women in Canada may not be participating in regular Pap testing because of cultural beliefs and a lack of an understanding of the importance of Pap testing. A culturally appropriate cervical cancer screening intervention program that involves members of visible minority communities may increase participation of this subgroup of Canadian women. This study provides preliminary information on why visible minority women in Canada do not participate in cervical cancer screening. However, the lumping together of all visible minority may obscure differences between different ethnic groups. Therefore, further research on each ethnic group is required to develop tailored culturally appropriate intervention.

French speakers residing in predominantly English-speaking communities have been linked to difficulties accessing health care. This study examined health care access experiences of immigrants and non-immigrants who self-identify as Francophone or French speakers in a mainly English speaking province of Canada. We used semi-structured interviews to gather opinions of recent users of physician and hospital services (N = 26). Language barriers and difficulties finding family doctors were experienced by both French speaking immigrants and non-immigrants alike. This was exacerbated by a general preference for health services in French and less interest in using language interpreters during a medical consultation. Some participants experienced emotional distress, were discontent with care received, often delayed seeking care due to language barriers. Recent immigrants identified lack of insurance coverage for drugs, transportation difficulties and limited knowledge of the healthcare system as major detractors to achieving health. This study provided the groundwork for future research on health issues of official language minorities in Canada.

nderstanding and reducing health disparities as well as promoting equality for ethnic or racial population health have become important priorities among researchers and governments as populations of western countries are becoming ethnically and racially diverse. For example, to date, over 5 million (16.2%) Canadians consider themselves non-White and non-Aboriginal (i.e., visible minorities) and it is estimated that this number will steadily increase over the next decade due to immigration. 1 Therefore, researchers are either analyzing available data or are collecting ethnic or racial information to document ethnic/racial disparities and monitor population health.Ethnicity/racial information is not commonly collected in Canada (such as in hospital discharge abstract data) as it presents challenges due to the sensitivity and ethical responsibilities when acquiring this information from individuals. To fully use the available secondary administrative data, surnames, geographic codes and country of birth indicators have been used in research as proxies to define ethnicity or race. 2-4 However, these methods are limited due to misclassification of ethnicity for some individuals. Thus, many researchers are relying on primary data collection through various survey methods, such as the Canadian Community Health Survey or the National Population Health Survey that collected selfreported ethnicity.Obtaining valid information from a representative sample is crucial for primary data collection. As there is no systematic review on this subject, we questioned whether minority ethnic populations participate in surveys as actively as the majority ethnic population, which in developed countries is most commonly Whites. The rationale for raising this question among ethnic minority populations is related to: limited language capacity, limited interests in research, inexperience in participation in studies, as well as cultural differences and sensitivities. This paper describes a systematic literature review to document response rates across racial and ethnic populations in order to provide evidence to estimate potential response bias of ethnic study populations. METHODS

Background: Health services utilization (HSU) is an important health outcome indicator, a surrogate measure of access to healthcare, that influences the outcomes of health status and consumer satisfaction, is a surrogate measure of access to healthcare. To most healthcare providers, understanding patterns of HSU is important for health system resource planning and allocation. In studies of HSU, the ethnicity variable is key especially in multicultural societies such as Canada where a significant proportion of the population consists of visible minorities, who, often are referred to in research studies as 'underserved' or as 'hard-to-reach' in the sampling context. Approach: This article discusses the relevance and utility of some frameworks for studying access to healthcare. It is intended to set the stage for a future study comprehensive systematic literature review of models of access to care and models of health system performance that address access as a criterion. To achieve this, I present selected published research on frameworks for access to medical care and HSU, including their characteristics and appropriateness for health services research. Subsequently, I briefly examine two studies that explore HSU, in Canada and the United States to determine the extent to which the selected framework or its components were employed. Finally, I describe ethnicity as a variable in the framework for HSU and conclude with limitations of this review. Conclusions: This paper has highlighted the approaches to health services utilization and the application of the Aday-Andersen framework for studies on access to care. Although this paper draws on relevant and some important contributions in the field, the assessment presented here is not exhaustive and warrants a more comprehensive review that includes recent literature on the subject.

In the early 90s, the Cameroon Ministry of Health implemented a National Health Information System (NHIS) based on a bottom-up approach of manually collecting and reporting health data. Little is known about the implementation and functioning of the NHIS. The purpose of this study was to assess the implementation of the NHIS by documenting experiences of individual stakeholders, and to suggest recommendations for improvement. We reviewed relevant documents and conducted face-to-face interviews (N=4) with individuals directly involved with data gathering, reporting and storage. Content analysis was used to analyze textual data. We found a stalled and inefficient NHIS characterized by general lack of personnel, a labor-intensive process, delay in reporting data, much reliance on field staff, and lack of incentives. A move to an electronic health information system without involving all stakeholders and adequately addressing the issues plaguing the current system is premature.

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Part of the strategic response to HIV in Cameroon, West Africa, has been the institutionalisation of voluntary testing and counselling (VCT) for HIV services across the country. The study addresses the general level of awareness and use of VCT centres in Cameroon. The data were extracted from the national, cross-sectional, 2004 Cameroon Demographic and Health Survey (DHS). The survey collected information on respondents' demographic characteristics and awareness and utilisation of VCT services, through a standard behavioural surveillance survey, administered in face-to-face interviews with males aged 15 years or older and females aged 15 to 49 years. Chi-square and logistic regression were employed for data analysis. A total of 5 280 males and 10 656 females responded to the 2004 Cameroon DHS. More of the male than female respondents had a secondary or higher education (51.8% versus 39%), slightly more of the males than females resided in urban areas (57.3% versus 54.8%), and males were more likely than females to have heard of VCT centres (37.8% versus 26.8%) and were also much more likely to have had an HIV test at a VCT centre (5.9% males versus 1.3% females). The findings indicate that awareness and use of centres offering VCT for HIV is very low in Cameroon. Further research in Cameroon is needed to assess individuals' reasons for not using VCT, as well as studies to identify patterns of information flow regarding the dissemination of knowledge about HIV and AIDS and about VCT centres.