“At this age, a Moroccan woman’s life’s work is over”-older Moroccan-Dutch migrant women’s perceptions of health and lifestyle, with a focus on Ramadan experiences: qualitative research integrating education and consultation

Abstract

Background: Older Moroccan-Dutch migrant women exhibit high rates of diabetes, hypertension, overweight and obesity which is further compounded by their high risk of multi-morbidity. Healthcare professionals' efforts to encourage this group to adopt a healthier lifestyle have little success. We ask ourselves whether the concepts used in health education and promotion relate to these women's experiences and beliefs. Today's pluralistic Dutch society requires a more differentiated and applied approach, not in an essentialist way but in awareness that translation of rather individualized concepts like health and lifestyle is not always adequate, as the meaning and interpretation of such concepts may differ and may be related to women's other (fundamental) perceptions. This can have practical consequences for health promotion and education. The aim of this explorative, qualitative research, conducted between April and September 2015 and taking an intersectional approach, was to explore older Moroccan-Dutch women's perceptions of health and lifestyle and to analyse these in a broader context, related to other fundamental forms of identity such as gender, culture and religion. Methods: We recruited women with Moroccan backgrounds by approaching Moroccan women's organisations and using the snowballing method (chain-referral sampling). Seven 'natural' group discussions were held (amongst women who regularly meet each other, aged between 22 and 69 years), and twelve in-depth interviews and an observation day (with women from 40 to 66 years). The transcripts were then analysed using thematic content analysis. Results: Five major themes were identified. Health was perceived of in the terms used in prevailing health promotion discourses in the Netherlands, but lifestyle was interpreted in a much broader sense than the current health promotion debate allows; it is not seen as an individual responsibility or as something an individual could control on their own, and the social benefits of health behaviours appear to outweigh the health benefits themselves. Lifestyle was located in three main social identities of the women: Moroccan, Muslim and mother. Finally, Ramadan played a huge and dominant role in the lifestyle experience of older Moroccan women and was central in this research.

Self-reported prevalence of periodontal disease among the Spanish population and immigrants: 2006, 2011/12 and 2017: a population-based study

“…There was a high proportion of immigrants aged between 25 and 65 years; this result coincides with those of other studies in which the migration of people of working age to other countries is frequent [23,24].…”

Perspectives of older women in the Netherlands: identifying motivators and barriers for healthy lifestyles and determinants of healthy aging

“…In addition, with regard to their perspectives on determinants of healthy aging, Turkish-Dutch and Moroccan-Dutch women mentioned that aging is (also) in the hands of Allah, thereby describing a more limited reach of the influence of a healthy lifestyle, although recognized as important. Both differences are in line with previous findings demonstrating that religion based views influence the healthy lifestyle and perception of determinants of healthy aging among Moroccan-Dutch and Turkish-Dutch women aged 40 to 70 years [25,37,39].…”

“…Only a few studies demonstrated differences in motivators and barriers for physical activity among older adults (65 years and older) between ethnic groups in America and Australia [23,24], but these studies did not specifically focus on women or differentiated according to sex. A recent focus group study in the Netherlands demonstrated that Moroccan-Dutch women (aged 44 to 60 years) have a different perception of healthy lifestyles and health compared to older native Dutch women [25]. They view their health as a gift from God, whereas native Dutch older women view it more as an individual responsibility and as something they can control themselves [25].…”

“…A recent focus group study in the Netherlands demonstrated that Moroccan-Dutch women (aged 44 to 60 years) have a different perception of healthy lifestyles and health compared to older native Dutch women [25]. They view their health as a gift from God, whereas native Dutch older women view it more as an individual responsibility and as something they can control themselves [25]. This suggests that when investigating motivators and barriers for different lifestyle behaviors, migration background should be taken into account.…”

Ramadan fasting and diabetes (2020): The year in review

“…Koudstaal et al [41] reported on Moroccan-Dutch migrant women's perceptions of health and lifestyle, focusing on Ramadan experiences using qualitative research integrating education and consultation. The context was that older Moroccan-Dutch migrant women exhibit high rates of diabetes, hypertension, overweight, and obesity, further compounded by their high risk of multimorbidity.…”