Perception of Health Promotion in African Caribbean Black Communities in the GTA – a Summary Report 

Project Overview  

This community-based research project explored perceptions of health promotion within Toronto’s African Caribbean Black (ACB) communities through a peer-engaged approach. The goal was to understand perceptions of health promotion among ACB individuals in Toronto while identifying gaps in awareness and systemic barriers.  

This study fills a gap by centering community voices to inform equity-driven interventions. It addresses critical gaps in understanding how ACB communities perceive health promotion, revealing systemic challenges like stigma, communication barriers, and socioeconomic disparities that hinder access to care. 

We sought to assess their awareness of health promotion services, evaluate their unique needs, and identify challenges they face in navigating the healthcare system. We aimed to identify systemic barriers, improve health equitable access yto healthcare, and create pathways for culturally responsive care. The ultimate goal was to provide insights that could guide the development of culturally responsive and inclusive healthcare services. 

ACB communities face compounded barriers rooted in historical mistrust, socioeconomic disparities, and underrepresentation in health systems. They face unique barriers to accessing health promotion services such as: 

• Historical mistreatment in medical systems. 
• Socioeconomic constraints that limit access to care. 
• Cultural differences that are overlooked in mainstream healthcare. 

This is consistent with global evidence on social determinants of health (e.g., income, education) and medical mistrust in Black communities. 

What We Found/What We Learned  

Healthcare providers need to create tailored interventions that address these challenges and promote health equity. This includes culturally tailored health promotion strategies, improved provider-patient rapport, building trust in them, and policy reforms to address systemic inequities. These findings inform our own service delivery models and can help other stakeholders develop culturally sensitive health promotion strategies. Recommendations include enhancing community engagement, improving communication channels, and addressing systemic barriers like mistrust and accessibility.  

The study addresses longstanding disparities in healthcare access and outcomes among ACB communities in Toronto. Rooted in systemic racism, economic inequities, and mistrust of medical institutions, these challenges necessitate targeted research to inform equitable healthcare solutions. 

• 45% of participants were unfamiliar with health promotion services.  
• 70% lacked access to open-door programs.  
• 55% did not engage in health activities. 

Barriers include systemic issues (31.5% of responses) such as long wait times and financial constraints. There are also communication gaps, such as language barriers, unclear health messaging. 

Participants urged greater cultural sensitivity, where “Interventions must respect our traditions to build trust.” They also urged prioritizing ACB voices in health service and promotion program design. 

By centering community voices, this research provides a roadmap for equitable health promotion grounded in cultural safety and systemic change. 

Guiding Research Questions & Key Findings  

What are the challenges in accessing health promotion services? 

45% were not familiar with health promotion activities. 43% found accessing health information “somewhat” or “very difficult.” Barriers included language gaps, distrust in healthcare systems, and financial constraints.  

70% lacked access to open-door health programs, and 55% did not participate in health promotion activities due to systemic and cultural mismatches. 

How do ACB communities perceive health promotion? 

Participants primarily viewed health promotion as health awareness (50% of responses) and advocacy for marginalized groups (15%). Suggestions included fostering rapport, creating safe environments, increasing proximity to services, and enhancing cultural sensitivity. Participants stressed the need for interventions aligned with their unique needs. “Health promotion is not just about awareness—it’s about advocating for our community’s unique needs” (Participant theme). 

How can healthcare navigation be improved? 

Only 13% of participants were very familiar with health promotion activities in Toronto. Many relied on healthcare providers or social networks for information. Challenges include stigma, fear, communication issues, and systemic inefficiencies like long wait times. Participants emphasized the importance of tailoring health promotion activities to cultural needs. Systemic fixes like reducing wait times and licensing internationally trained providers were recommended.  

Participants highlighted rapport-building (40%) and proximity to services (15%) as crucial for improving healthcare access and service delivery.  

How is Access Alliance Using This Research? 

The research aligns with Access Alliance’s mission to advance culturally responsive care through community-led research. Actions we commit to include: 

• Enhancing programs to address identified gaps in cultural sensitivity and accessibility. 
• Ensuring research engages and involves Black populations in the analysis and use of data in the development, delivery and monitoring of services. 
• Strengthening partnerships with community leaders to improve outreach and engagement. 
• Informing staff training on cultural competence and trust-building practices. 

How Can Other Stakeholders Use This Research? 

Healthcare Providers: 

• Develop culturally tailored health promotion materials. Collaborate with ACB communities to co-create programs that reflect their needs. 
• Train staff on addressing mistrust and stigma within marginalized communities. 
• Use findings to secure funding for targeted interventions. 

Policy Makers: 

• Address systemic reforms to reduce wait times and improve affordability. 
• Support licensing pathways but also employment opportunities for internationally trained healthcare practitioners. 

Research Overview  

Sampling:  

40 participants self-identifying as African Black, Caribbean Black, or Black North American were recruited via maximal variation sampling (diverse demographics: 72.5% female, 37% Caribbean-born, 47% low-income households). 85% lived in Toronto; 60% primarily spoke English; 72.5% were unemployed, students, or retired. 

Data Collection:  

Eight group discussions (six in-person; two virtual) involving 29 participants. Eleven one-on-one interviews conducted for deeper insights. A peer-engaged design was used to capture diverse perspectives across age, gender, and geographic backgrounds. This approach prioritizes cultural safety and comfort, with data collection methods adapted to participant preferences (e.g., virtual/in-person options). 

Data Analysis:  

Thematic analysis was done following Braun & Clarke’s six-step framework was employed to identify recurring themes such as awareness, barriers, and recommendations. 

Report Authors 

Lead Author: Dr. Akm Alamgir, Director, Organizational Knowledge & Learning, Access AlliancePeer Researchers: Osezua Momoh; Judith Izuka

Related Access Alliance Activities 

Screening for Diabetes and Risks among Black African and Caribbean Residents in Toronto 
The prevalence of diabetes has increased significantly over the last years among younger adults in Canada, with Black individuals being disproportionately affected causing worse complications that include organ damage. Collaborative efforts among community health centres and public health agencies are essential to address this pressing health issue. It is important to do intentional and continuous work toward Black health equity and support in health planning. Key recommended practices include increasing health promotion efforts targeting lifestyle modifications (diet and physical activity) to mitigate diabetes risk among ACB populations. The focus should be on the most at-risk groups identified through community-specific outreach and education initiatives. Ensuring Black populations are engaged in the analysis and use of data in the development, delivery and monitoring of services. It is important to do intentional and continuous work toward Black health equity and support in our health planning. 

Building Capacity for Equity-Informed Planning and Evaluation  
The overall aim of this project was to build organizational level knowledge, commitment and capacity to routinely use a health equity framework and evidence geared at overcoming systemic inequities in healthcare access, healthcare quality and health outcomes. 

Conceptualizing a Pyramid Model on Equity, Diversity and Inclusion (EDI) for Non-Profits and Community Organizations 
In this project, we created a structured framework to conceptualize EDI components with the goal of creating a sense of belonging for everyone we work with and serve. We developed a comprehensive Pyramid Model for understanding and implementing EDI in community-based organizations. The pyramid model frames equity as “our lens of understanding”, diversity as “who we are”, inclusion as “the intentional actions we are taking” and finally, a sense of belonging as “our goal”.