Purpose The purpose of this study is to examine knowledge and perceptions of risk surrounding chronic inflammatory diseases (CIDs) and intergenerational development, as well as practices used to acquire CID information among unaffected first- and second-generation South Asian immigrant parents and children in the Greater Toronto Area, Ontario. Design/methodology/approach Fifty-four in-depth interviews with parents and children (18 parents, 36 children) were conducted by trained facilitators, recorded, transcribed and analyzed qualitatively. Findings Findings reveal that although CIDs disproportionately affect South Asian immigrants, this group has low knowledge and awareness of CID symptoms, risk factors and conditions. Yet when equipped with some knowledge about CIDs, participants linked their increased risk of CIDs to perceived risks in their broader environments such as climate variations, pollution, unhealthy food environments and health system neglect, that although yearning to change these factors, felt unable to modify their risks as factors were beyond their control. Although information is critical to manage CIDs, the findings reveal important and divergent knowledge pathways and practices used among first- and second-generation parents and children, particularly related to health-care settings and academic resources, underscoring generational disparities in knowledge acquisition. Originality/value The findings suggest that a multi-sector, multi-tiered approach built around a series of structural interventions, programs and policy changes is needed to address CID knowledge and awareness gaps and entrenched culturally insensitive health care to create more equitable access to healthy, safe and responsive environments and care systems for CID management.

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Although immigrants are disproportionately impacted by growing chronic inflammatory disease (CIDs) rates, yet suffer barriers to access health care, little attention has been given to their primary healthcare or specialist healthcare access as it relates to complex, chronic diseases in Canada, a country with universal health care. This study aims to investigate CID health care use and barriers to care among first- and second-generation immigrant South Asian children and parents in the Greater Toronto Area, Ontario. Drawing on analysis of 24 in depth interviews with children and parents (14 children, 10 parents), the results reveal that although CIDs disproportionately affects South Asian immigrants, they encounter health system, geographic, interpersonal, and knowledge barriers to access requisite care. These barriers exist despite participants having a GP, and are compounded further by limited familial systems, culturally insensitive care, and structural inequities that in some instances make parents choose between health access or other basic needs. Although all participants recognized the importance of specialized care, only 11 participants regularly accessed specialized care, creating new schisms in CID management. The findings suggest that a multisectoral approach that address individual and structural level socio-structural drivers of health inequities are needed to create more equitable healthcare access.