Ethnic boundary-making in health care: Experiences of older Pakistani immigrant women in Norway

Arora, Sanjana; Straiton, Melanie Lindsay; Rechel, Bernd; Bergland, Astrid

doi:10.1016/j.socscimed.2019.112555

Cited by 17 publications

(27 citation statements)

References 37 publications

(37 reference statements)

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“…For example, patients not knowing the guidelines on limiting the use of antibiotics may interpret a GP's refusal to prescribe antibiotics differently from patients who are familiar with this goal. In a qualitative study among Pakistani women in Norway, participants opined that Norwegian doctors do not prescribe medicines as often as they would like [19]. Poor experiences with the health care system among Polish immigrants in Norway have been related to a more paternalistic GP role in Poland than in Norway [16].…”

Section: Discussionmentioning

confidence: 99%

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Kjøllesdal¹,

Indseth²,

Iversen³

et al. 2020

BMC Health Serv Res

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Background Patient experience is an important indicator of quality of health care. In Norway, little is known about the quality of health care for immigrants. The aim of this study was to compare patient-reported experiences with general practice between the Norwegian-born population and immigrant groups. Methods We performed secondary analyses of data from a national survey on patient experiences with general practice, including assessments of general practitioners (GPs) and their GP offices. The survey was carried out in Norway in 2018–19. The total number of respondents was 2029, with a response rate of 42.6%. Region of birth was available for 1981 participants, and these were included in the analyses (“Norway” (N = 1756), “Asia, Africa or South America” (N = 95), “Eastern Europe” (N = 70) and “Western Europe, North America or Oceania” (N = 60)). Five indicators of patient experiences were used as dependent variables in bivariate and multivariate analyses, with region of birth as the main exposure variable and other background variables about the patient as adjustment variables: “the GP” (measures related to communication and competency), “auxiliary staff” (politeness, competency, organization), “accessibility” (waiting times), “coordination” (with other services) and `enablement` (GP facilitates coping with/understanding illness). Results Immigrants as a whole reported poorer experiences with general practice than the majority population, with significantly poorer scores on four of five patient experience indicators. Patients from Asia/Africa/South America reported poorer experiences than those from Norway on the indicators “GP”, “auxiliary staff”, “accessibility” and “coordination”: on a scale from 0 to 100 where 100 is the best, the difference ranged from 7.8 (GP) to 20.3 (accessibility). Patients from Eastern Europe reported lower scores on “GP” and patients from Western Europe/North America/Oceania reported lower scores on “auxiliary staff”. These associations were still significant after adjustment for sex, age, self-rated physical and mental health, number of contacts with the GP and education. Conclusions For countries with a substantial proportion of foreign-born patients in the health system, immigrant background is an important parameter in quality improvement work. Immigrant background is also an important parameter in health service research.

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Section: Discussionmentioning

confidence: 99%

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Kjøllesdal¹,

Indseth²,

Iversen³

et al. 2020

BMC Health Serv Res

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“…This study is part of a larger project on older Pakistani women's access to healthcare services in Norway [32] and was approved by the official data protection body at the Norwegian Centre for Research Data (Project number: 52078). All participants received written and verbal information about the study, its purpose and provided informed written consent.…”

Section: Methodsmentioning

confidence: 99%

Female Pakistani carers’ views on future formal and informal care for their older relatives in Norway

Arora

Rechel

Bergland

et al. 2020

BMC Health Serv Res

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Background: The aging of Pakistani immigrants in Norway raises questions related to their increased need for care and help from relatives, as well as those concerning what future formal and informal care and healthcare accessibility for older immigrants may look like. The hidden nature of family caregiving means that the circumstances of carers, their views and their dilemmas related to future care are largely invisible. In this study, we explored female Pakistani carers' views of future care and healthcare accessibility for their older relatives in Norway. Methods: Our data included interviews with family carers between the ages of 23 and 40 years old, living in Oslo, Norway. We recruited ten family carers, out of which eight were daughters and two were daughters-in-law. Interviews were conducted by the first author in Urdu or English and were recorded and transcribed verbatim. Results: Our findings revealed several factors that influenced participants' perceptions about formal and informal caregiving, which can be organised into the following themes: 1) caring for family in Norway as in Pakistan, 2) worries about being 'dropped off' at a care home, 3) concerns about being cared for by outsiders, 4) questions about what other people might say and 5) adhering to society's expectations of a 'good' carer. Conclusion: Family carers' traditional views of filial piety do not entirely determine the use of or access to healthcare services of their older relatives. There is a need to develop culturally sensitive healthcare systems so that immigrant families and their carers have more options in choosing care in old age, which in turn will ease their families' care burden. Healthcare professionals and policymakers should not assume that immigrant families will take care of their own older members but should instead secure adequate support for older immigrants and their family carers.

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“…On the other hand, as immigrants from poor countries, social acculturation takes place in a highly disadvantageous economic and political context. These different but interlinked social positions can give rise to different subjective experiences [59].…”

Section: The Effect Of Acculturationmentioning

confidence: 99%

“…It is defined by an asymmetric power relationship that is reinforced during intercultural communication, thus promoting the perpetuation of imposed norms of thought, behavior and interaction [68]. The social positions of patient and immigrant, which already establish a power imbalance on their own, are simultaneously intertwined with other social traits such as gender, age and class, thus shaping the asymmetric relationship (Arora et al 2019). Several authors touch on the concept of intersectionality, explaining that an individual's various social positions mold his/her experience [59], in this case, of communication with the nurse, while other social positions such as ethnicity, gender, age and social standing are simultaneous categories of oppression that constitute power imbalances [59,69].…”

Section: Rebalancing the Care Relationshipmentioning

confidence: 99%

“…This means that the availability and gender of the health provider is important, especially among South Asian, Chinese and Muslim women. Immigrant women prefer women health professionals for their care in general but especially for reproductive health and physical examinations [41,59]. The literature shows that women health professionals have a more personal, emotional and fair communication style [73].…”

Section: Health Communication and Gendermentioning

confidence: 99%

See 1 more Smart Citation

Intercultural Communication between Long-Stay Immigrants and Catalan Primary Care Nurses: A Qualitative Approach to Rebalancing Power

Ramos-Roure

Feijoo-Cid

Manresa-Domínguez

et al. 2021

IJERPH

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There is a gap between the preferences of immigrant patients and their experiences with intercultural communication. This study aims to explore the experiences and perspectives of long-stay immigrants on intercultural communication in encounters with primary care (PC) nurses. Participants were selected by purposive sampling at the Maresme Primary Care Center. A focus group and five in-depth interviews with long-stay immigrants from eight countries were carried out. Data collection was guided by a script previously validated by a group of experts. We conducted a qualitative analysis following Charmaz’s approach, and data saturation was reached with 11 patients (one focus group and five interviews). Long-stay immigrants would like closer and more personalized communication exchanges with greater humanity, as well as polite and respectful manners as they perceive signs of an asymmetrical care relationship. Those who had negative communication experiences tried to justify some of the behaviors as a result of having free access to public health services. This is one of the few existing studies from the point of view of long-stay immigrants. Achieving effective intercultural communication requires a process of self-reflection, awareness-raising and commitment, both on a personal and institutional level, to eliminate the asymmetry in the nurse-patient relationship. Nurses should be trained in person-centered intercultural communication.

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Ethnic boundary-making in health care: Experiences of older Pakistani immigrant women in Norway

Cited by 17 publications

References 37 publications

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey

Female Pakistani carers’ views on future formal and informal care for their older relatives in Norway

Intercultural Communication between Long-Stay Immigrants and Catalan Primary Care Nurses: A Qualitative Approach to Rebalancing Power

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