Feeling misidentified: Understanding migrant's readiness to engage in health care screening

Abstract

Rationale: For developed countries there has been a significant, fast-paced rise in migrant populations. Society has a vested interest in these members of the population being aware of their risk of a communicable disease, and seeking health screening. Currently, screening interventions rely heavily upon socio-cognitive, majority-orientated theories that may not account for cultural factors differentially affecting migrant groups. Objective: To develop an inductive theory to explain processes underlying the readiness of migrants to engage in health screening. In understanding why some groups engage in screening more than others we examined the U.K. South Asian population, and screening for hepatitis B and C. Method: We conducted eight focus groups with first-generation South Asian migrants. Results were analysed using a three stage, process-orientated methodology based on the principles of grounded theory, with the explicit aim of developing new theory. Results: A theory of 'readiness to engage' is presented; embedded within participants' testimonies. The results highlight personal identity, family identity and the collective identity of the South Asian community; with family and community conceptualised as a singular force, acting to either silence or support. Identity issues and screening readiness were also strongly related to interactions with the healthcare-system, with participants often feeling misidentified, misunderstood, or under personal threat. 2 Conclusions: Our theoretical model takes account of the complex, interlocking relationship between the individual, the community, and healthcare system, and provides practical implications for healthcare providers of screening interventions. Airhihenbuwa, C. O. (1990). A conceptual model for culturally appropriate health education programs in developing countries.

An examination of how to engage migrants in the research process: building trust through an ‘insider’ perspective

“…Research volunteers express the need to be 'socially comfortable', respected and appreciated (Morris andBalmer 2006 p.1005). This perception of being 'valued' by researchers is especially important for migrant communities who may be rendered a social threat by medial portrayals (Esses, Medianu and Lawson 2013) or feel misidentified (Hendy et al 2019); and who may already experience feeling of differentiation and 'otherness' when navigating the healthcare system (Szczepura 2005, Fang et al 2015. Participants from minority groups need to identify with the research process and consider the process is about them, for them and for people like them.…”

“…Most people feel comfortable in terms of voicing their opinion in groups they feel aligned to (Greenwood, Ellmers and Holley 2014) and in spaces where they feel enabled (de Freitas and Martin 2015). However, creating this shared 'insider' perspective of common knowledge, identity and experiences (Ogilvie, Burgess-Pinto and Caufield 2008) can be challenging particularly if healthcare researchers belong to a majority culture that is unable to interpret minority health behaviors and choices (Sullivan et al 2001, Hendy et al 2019.…”

Improving uptake of hepatitis B and hepatitis C testing in South Asian migrants in community and faith settings using educational interventions—A prospective descriptive study

“…The aims of this study were (1) to determine the feasibility of recruiting South Asian migrants residing in South-East England to view a short educational film based on qualitative data collected during a previous study (Ahmed et al, 2019;Hendy et al, 2019); (2) to determine the effect of this educational intervention on (i) the uptake of CVH testing in community settings and (ii) understanding of viral hepatitis; and (3) to identify methodological issues that may compromise the acceptability and feasibility of a definitive randomized controlled trial (RCT) of this intervention (Figure 1).…”

“…Eight focus groups were undertaken with men (n = 26) and women (n = 27) from South Asian communities to understand their knowledge and views on CVH and the role of community-based testing. Thematic analysis led to the generation of key areas to address in the film (Ahmed et al, 2019;Hendy et al, 2019).…”

“…However, culturally relevant interventions including the importance of faith, language, and culturally sensitive settings and those that minimize logistical issues may be more effective at engaging minority groups (Kelly et al, 2018). We have developed a short, culturally and linguistically tailored educational film based on qualitative data collected regarding the knowledge, perceptions, barriers, and fears of CVH infection and testing in South Asian populations (Ahmed et al, 2019;Hendy et al, 2019). In this article we report on the feasibility of recruiting members of South Asian communities in England to view the film and subsequently accept CVH screening.…”