Navigating Visibility: Health Care Access and Experiences of Older Adult Arab Immigrants and Family Caregivers in Ontario

This dissertation investigates the healthcare access and experiences of older adult Arab immigrants and family caregivers in Ontario, Canada. Guided by critical constructivist grounded theory and a critical ecological systems framework, the study addresses how factors intersect to shape health care navigation. The research highlights the unique barriers faced by Arab immigrants, including a lack of linguistic and culturally congruent services, system navigation challenges, and the pervasive influence of Orientalist stereotypes. These stereotypes, rooted in regressive and racialized perceptions of Arab populations, inform public and health care provider attitudes, further complicating access to equitable care. This research provides a critical ecological perspective, analyzing how micro-, meso-, exo-, and macro-level systems influence health care access. Incorporating family caregivers’ perspectives broadens the understanding of the ecosystem in which older adults function and highlights the caregivers’ essential role in health system navigation. The dissertation also explores the researcher’s positionality, applying a post-colonial lens to examine insider and outsider dynamics within the research process. This reflexive approach acknowledges the colonial histories academia and the research process. Both older adult immigrant Arabs and family caregivers negotiated their visibility and being seen in the context of accessing health care. The subcategories co-constructed and grounded in the data resulted in the grounded theory of being seen. The 4 subcategories included: 1) Being seen as family, 2) Being seen by the Arab community, 3) Being seen in their countries of origin, 4) Being seen as foreign. We also explored how Arab older adult immigrants and family caregivers describe their relationships with their family doctors. They described sharing community with Arab family physicians as facilitating care. However non-Arab family doctors were able to establish effective relational practices.