Introduction
Background
Migration factors
Social, environmental, cultural and medical factors
Migration to Canada
Methods
Cross-cultural instrument development, translation and validation
1) Identification of the variables (based on the literature and input from migration/health experts) | Advisory committees consisting of healthcare professionals, representatives from non governmental organizations, and government officials all interested in migration and the reproductive health of migrant women are consulted |
2) Identifying/drafting questionnaires | Questionnaires are identified by an extensive review of the literature |
3) Assessing readability | Readability is assessed by counting the number of polysyllable words in each question1 |
4) Translation | To maximize the application of each translation to a broad population using the same language, translators with different backgrounds for each language are identified (e.g., Colombian and Mexican backgrounds for Spanish). The purpose and context of the studies in which the tool(s) will be administered are explained to translators Translators are instructed to use simple language and to avoid idioms and regional terms/expressions.2 |
5) Blind back translation | "Blind back-translation" is translation back into the source language by an independent translator unfamiliar with the original version of the questionnaire; Back-translated versions are compared to the original language version and discrepancies in wording noted and each item discussed and debated until agreement is reached on the optimal wording for the translated versions. When clarity is lacking in the original questionnaire, adjustments are made across all versions (original and translated). |
6) Discussion groups with representatives from different ethno cultural communities | Migrant women representing a mix of ethno-cultural communities (Asia, South America, Africa, Europe) are asked to qualitatively assess the content validity and acceptability of the questions (i.e., feasibility to complete and cultural appropriateness); Groups generally consist of 5-10 participants |
7) Administration of the translated questionnaires with monolingual individuals | Individuals who speak one of the 'translation languages' but not the original source language of the questionnaire, are asked to assess grammar, and ease of understanding of the translated version; They also assess the practical aspects of administration; 5-10 participants per language |
8) Reliability testing (test retest and internal consistency as appropriate) of each language version as well as between the English and translated versions. | Reliability testing is completed via administration of the original and translated versions to persons fluent in both languages to ensure all language versions are understood in the same way and are equivalent |
MRQ
PDPMQ
Results
Migration variables in the MRQ: Challenges and solutions in their measurement
Country of birth
Length of time in country
Language fluency
Immigration status
Ethnicity
General considerations
Original Questions | Input from key players | Input through «blind-back-translation» | Input from «ethno-cultural liaison groups (ECLGs)» | Input through «non-response rates from initial administration & additional feedback from key players» | Final Questions |
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COUNTRY OF BIRTH/LENGTH OF TIME IN CANADA
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-In which country were you born? -What date did you leave your country of birth? -Was Canada the first country you came to after leaving your own country? -If no, to what other countries did you go? -When did you arrive in Canada? - Did you spend any time living in one or more refugee camps? | -To fully capture the sequence and content of the migration experience a more detailed question on the number and name of countries where women lived was important to add. To know in which countries women spent time in camps was also important. New question:-To the best of your recollection, list in order all the countries you have ever lived in (including Canada) and when: a _______country of birth, ______month _ _ _ _ year to ______month _ _ _ _ year. Were you in a refugee camp? Yes No ** The question asked women to list every country beginning with the country of birth. There were 12 response spaces (i.e. a to l). | -"refugee camp" didn't translate correctly in some languages (e.g., the Dari back translation of refugee camp was "immigration camp"). | ECLG suggested: -the question appeared too long (i.e. too many spaces to fill in). - women would not remember dates - the question about camp experience should be asked further down the questionnaire, grouped with other sensitive questions and should be preceded by a statement explaining why we are asking the information. | -Women had difficulty remembering specific dates and consequently did not complete the information. -Many women simply did not answer the question. - Further simplifying of the wording was suggested ("As much as you can remember" vs. "To the best of your recollection"). | -As much as you can remember, list in order all the countries in which you have ever lived (including Canada) and for how long: a ____________, _____ years. country ** The list was reduced to five response spaces. -The questions on spending time in camp were moved and grouped with other questions on camp experiences, a question on time spent in a detention center and a question on whether time was spent in a country in armed conflict. An introductory statement was added: ..."These questions may be upsetting, but will help us further understand your migration experience and how it has affected your health... |
IMMIGRATION CLASS
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-Under which category did you come to Canada? ❑ Refugee ❑ Refugee claimant ❑ Immigrant ❑ Minister's permit ❑ Student ❑ Other _______ ❑ Husband sponsored ❑ Other ______ | -Citizenship and Immigration Canada (CIC) provided more detailed information on the different immigration categories that exist. -To capture changes in immigration statuses an additional question was added. -There was interest to have migration information on the father of the baby as well. Same questions asked to the mother were added in a section of questions on the father. These additional data were also thought to be helpful to confirm the woman's status. New questions: When completing the rest of the questionnaire please answer in relation to the first time you came to Canada with the intention of staying for more than just a visit. 1- Did you come to Canada as a: ○ Temporary resident ○ Permanent resident ○ Refugee claimant 2- What was your immigration status? ○ Refugee (government sponsored) ○ Refugee (privately sponsored) ○ Refugee claimant/asylum seeker ○ Post-determination refugee ○ Independent immigrant (permanent resident/landed status) ○ Live-in caregiver ○ Student visa ○ Temporary worker ○ Provincial nominee ○ Minister's permit ○ Other specify_____________ ** An extensive list was provided so women could choose the one that applies to them. 3- Please read the following list and complete. Was your status ever: a Refugee (government sponsored) Yes No ___month _ _ _ _ year to ___ month _ _ _ _ year ** An extensive list of possible immigration statuses was provided. | -Translators thought that some women might have difficulty understanding the official CIC terms. -"Provincial nominee" was found to be a confusing term. Given the translators' feedback and that it is rare for women to come under this category this term was removed from the list ('other' was still left as an option so women under this category could write it in if it applied to them). -Similarly, "post-determination refugee" was thought to be a confusing term and is uncommon so was removed from the questionnaire. -"Live-in caregiver" didn't translate easily in certain languages (e.g., Somali back-translation was "dependent"; the Punjabi back-translation was "care-taker"; the Dari back-translation was "helper/volunteer"; in Russian the back-translation was "family educator"). Since this is a common migration category, it was kept and the best translation was determined together with the translators. | ECLG suggested: - questions were repetitive and too long - questions were asking too much detailed information (i.e. dates) -women may be reluctant to provide status information - felt that women would need to be reassured before answering these questions -suggested adding an introductory statement that would reassure women that information would remain confidential - -felt that the immigration categories were difficult to understand | - Women reported that the questions were repetitive and lengthy. Some women answered the first status question but not the subsequent questions. - Women needed assistance to complete the immigration status questions correctly [e.g. answered they came as refugee claimant in first question then responded they came as refugee (government sponsored) in second question]. - Many women left the "Was your status ever: " question incomplete. -Dates were also often left blank. | - To ensure women have the needed time and assistance to complete the questionnaire it will be administered in a home visit with a well-trained interviewer. - An introductory statement was added to the beginning of the questionnaire explaining why the information is being collected and reassuring women that the information will remain confidential and will not be passed on to CIC. -Question: "What was your immigration status?" was removed. - The list of immigrant categories was reduced even further (e.g., Minister's permit was removed). Final questions: -Did you come to Canada as a (please check one): ○ Immigrant (permanent resident/landed status) ○ Refugee ○ Refugee claimant/Asylum seeker ○ Temporary worker ○ Student ○ Visitor in Canada (no status) ○ Live-in caregiver ○ Other, specify_____________ -Has your immigration status changed since you arrived in Canada? Yes No -If your immigration status changed, what is your current status? (please check one) ○ Immigrant (permanent resident/landed status) ○ Refugee ○ Refugee claimant/Asylum seeker ○ Temporary worker ○ Student ○ Visitor in Canada (no status) ○ Live-in caregiver ○ Canadian citizen ○ Other, specify ____________ -How long have you had this status? ______________ (number of years) |
ETHNICITY
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"What is your ethnicity?" _____ | -Originally the question was grouped with the migration questions. The question was subsequently moved to the General Information questionnaire so that ethnicity data would be collected for all women, not just migrant women, -Response options were added to facilitate answering the question: ○ African ○ African-Canadian (American) ○ Asian & Pacific ○ Asian- Canadian (American) ○ Eastern-European ○ Western-European ○ Scandinavian ○ European-Canadian (American) ○ Jewish ○ Latin-American ○ Hispanic ○ Middle Eastern ○ Native Canadian (American) ○ Canadian ○ Other_________ | -Suggested removing "(American)" -Suggested adding "Caribbean" as an option -Term "ethnicity" wasn't understood and came back in the back-translation as: race, nationality, ethnic belonging, ethnic origin -Generally there was difficulty across all languages to translate these terms: e.g., Native Canadian was understood as "born in Canada" rather than being understood as referring to "Aboriginal people" - Some of the terms didn't exist in certain languages e.g. There is no word for "Hispanic" in Urdu | -"I am not sure how to interpret this. I am not sure what I would put myself in the responses." -Women didn't understand what was really meant by "ethnicity" & were confused by the response options because they felt they represented geographical areas rather than ethnicity -They had difficulty answering the question themselves. | -Before the questionnaire was used in the study the response options were removed & the question was left open-ended -Women in the study didn't understand the question & many women left it blank | - The question was removed. |