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Alemi Q, Panter-Brick C, Oriya S, Ahmady M, Alimi AQ, Faiz H, Hakim N, Sami Hashemi SA, Manaly MA, Naseri R, Parwiz K, Sadat SJ, Sharifi MZ, Shinwari Z, Ahmadi SJ, Amin R, Azimi S, Hewad A, Musavi Z, Siddiqi AM, Bragin M, Kashino W, Lavdas M, Miller KE, Missmahl I, Omidian PA, Trani JF, van der Walt SK, Silove D, Ventevogel P. Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions. BJPsych Open 2023; 9:e125. [PMID: 37424447 PMCID: PMC10375890 DOI: 10.1192/bjo.2023.502] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/23/2022] [Accepted: 01/20/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Four decades of war, political upheaval, economic deprivation and forced displacement have profoundly affected both in-country and refugee Afghan populations. AIMS We reviewed literature on mental health and psychosocial well-being, to assess the current evidence and describe mental healthcare systems, including government programmes and community-based interventions. METHOD In 2022, we conducted a systematic search in Google Scholar, PTSDpubs, PubMed and PsycINFO, and a hand search of grey literature (N = 214 papers). We identified the main factors driving the epidemiology of mental health problems, culturally salient understandings of psychological distress, coping strategies and help-seeking behaviours, and interventions for mental health and psychosocial support. RESULTS Mental health problems and psychological distress show higher risks for women, ethnic minorities, people with disabilities and youth. Issues of suicidality and drug use are emerging problems that are understudied. Afghans use specific vocabulary to convey psychological distress, drawing on culturally relevant concepts of body-mind relationships. Coping strategies are largely embedded in one's faith and family. Over the past two decades, concerted efforts were made to integrate mental health into the nation's healthcare system, train cadres of psychosocial counsellors, and develop community-based psychosocial initiatives with the help of non-governmental organisations. A small but growing body of research is emerging around psychological interventions adapted to Afghan contexts and culture. CONCLUSIONS We make four recommendations to promote health equity and sustainable systems of care. Interventions must build cultural relevance, invest in community-based psychosocial support and evidence-based psychological interventions, maintain core mental health services at logical points of access and foster integrated systems of care.
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Affiliation(s)
- Qais Alemi
- School of Behavioral Health, Loma Linda University, California, USA
| | - Catherine Panter-Brick
- Jackson Institute for Global Affairs and Department of Anthropology, Yale University, Connecticut, USA
| | | | - Mariam Ahmady
- Department of Counselling, Faculty of Psychology and Educational Sciences, Kabul University, Afghanistan
| | | | - Hafizullah Faiz
- Jalalabad Regional Management Office, Swedish Committee for Afghanistan, Jalalabad, Afghanistan
| | - Nadia Hakim
- Migration Health Unit, International Organization for Migration, Kabul, Afghanistan
| | | | | | - Roman Naseri
- Mental Health and Psychosocial Support Unit, International Medical Corps, Kabul, Afghanistan
| | | | - Sayed Javid Sadat
- Mental Health and Peacebuilding Program, International Assistance Mission, Herat, Afghanistan
| | | | - Zalmai Shinwari
- Mental Health and Psychosocial Support Unit, HealthNet TPO, Kabul, Afghanistan
| | | | - Rohullah Amin
- Faculty of Humanities and Social Sciences, Helmut-Schmidt University, Germany
| | - Sayed Azimi
- Independent Mental Health Specialist, Geneva, Switzerland
| | - Atal Hewad
- Department of Ipso Academy and Quality Management, International Psychosocial Organisation, Konstanz, Germany
| | - Zeinab Musavi
- Behrawan Research and Psychology Services Organization, Kabul, Afghanistan
| | | | - Martha Bragin
- Silberman School of Social Work, The City University of New York, New York, USA
| | - Wataru Kashino
- Prevention Treatment and Rehabilitation Section, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Michalis Lavdas
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Norway
| | | | - Inge Missmahl
- International Psychosocial Organisation, Konstanz, Germany
| | | | | | - Sarah Kate van der Walt
- Mental Health and Psychosocial Support Unit, Première Urgence – Aide Médicale Internationale, Kabul, Afghanistan
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Australia
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
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Siddiq H, Alemi Q, Lee E. A Qualitative Inquiry of Older Afghan Refugee Women's Individual and Sociocultural Factors of Health and Health Care Experiences in the United States. J Transcult Nurs 2023; 34:143-150. [PMID: 36695336 DOI: 10.1177/10436596221149692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Approximately 132,000 Afghans have resettled in the United States since the 1980s and are now aging. As older adults, sociocultural factors influence health and health-related behaviors. This study aimed to explore older Afghan refugee women's perceptions of individual and sociocultural factors of health and health care experiences. METHODS A focused ethnography methodology was conducted with 27 semi-structured interviews with older Afghan refugee women, family members, and community key informants in Southern California. Recorded interviews were transcribed and analyzed using inductive thematic analysis. RESULTS Five themes were identified as key to health promotion in the post-migration setting: (a) health promotion through Islam, (b) the centrality of family, (c) ongoing stressors that impact health, (d) needing support in navigating health services, and (e) miscommunication leading to mistrust of health care providers. DISCUSSION Health interventions should consider social and cultural contexts and faith-based and family-centered approaches when addressing older Afghan refugee women's long-term health and well-being.
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Affiliation(s)
- Hafifa Siddiq
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Eunice Lee
- University of California, Los Angeles, USA
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Kaptan SK, Yilmaz B, Varese F, Andriopoulou P, Husain N. What works? Lessons from a pretrial qualitative study to inform a multi-component intervention for refugees and asylum seekers: Learning Through Play and EMDR Group Traumatic Episode Protocol. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:361-381. [PMID: 35700344 PMCID: PMC10084026 DOI: 10.1002/jcop.22908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
Almost half of the trials failed to recruit their targeted sample size of which 89% could be preventable. Successful implementation of mental health trials in a context of forcibly displaced individuals can be even more challenging. Mental health difficulties have the potential to impact parenting skills, which are linked to poor development in children, while parenting interventions can improve parents' mental health and parenting behaviors. However, the evidence on parenting interventions for refugees is limited. A parenting intervention, Learning Through Play Plus Eye Movement Desensitization and Reprocessing Group Treatment Protocol, has been designed to address parental mental health. This pretrial qualitative study, conducted with refugees, asylum seekers and professionals, aimed to explore their perceptions of the intervention and to identify barriers and recommendations for better engagement, recruitment, and delivery. Three themes were generated from thematic analysis: the content of the intervention, suggestions for improvement and implementation, and understanding the role of the facilitator. These themes provided insights into the issues that might predict the barriers for delivery of the intervention and offered several changes, including destigmatization strategies to improve engagement.
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Affiliation(s)
- Safa Kemal Kaptan
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Betul Yilmaz
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Filippo Varese
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
- Complex Trauma and Resilience Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
| | | | - Nusrat Husain
- School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
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Dumitrache L, Nae M, Mareci A, Tudoricu A, Cioclu A, Velicu A. Experiences and Perceived Barriers of Asylum Seekers and People with Refugee Backgrounds in Accessing Healthcare Services in Romania. Healthcare (Basel) 2022; 10:2162. [PMID: 36360503 PMCID: PMC9690378 DOI: 10.3390/healthcare10112162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 08/31/2023] Open
Abstract
Traditionally a country of emigration, Romania recently experienced an increased migration influx, although it is more a country of transit than a destination for refugees and irregular migrants. Refugees often face difficulties when trying to meet their needs and access essential services. This study aims to explore the experiences and barriers of asylum seekers and people with refugee backgrounds in accessing healthcare services in Romania. It is an exploratory study with a qualitative research design, which uses an inductive and deductive approach, with thematic analysis being applied in order to grasp the difficulties and barriers that asylum seekers and people with refugee backgrounds experience in accessing essential social services. The research was based on seven in-depth interviews with representatives of significant national or international non-governmental organisations assisting refugees and asylum seekers in Romania and 129 semi-structured interviews with different categories of people with refugee backgrounds from Southwest Asia, Eastern Africa and Ukraine. One of the most salient themes we identified relates to accessing the healthcare system. Participants talked about what information they needed to access medical services, where they looked for this information, and what barriers they faced in the process. Cultural, linguistic, structural, and financial barriers were perceived as the most significant. Improved public awareness, a better understanding of asylum issues, and stronger community support are essential to addressing inequalities experienced by this vulnerable population.
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Affiliation(s)
| | - Mariana Nae
- Faculty of Geography, University of Bucharest, 010041 Bucharest, Romania
| | - Alina Mareci
- Faculty of Geography, University of Bucharest, 010041 Bucharest, Romania
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Houwen J, de Bont OA, Lucassen PL, Rosmalen JGM, Stappers HW, Olde Hartman TC, van Dulmen S. Development of a blended communication training program for managing medically unexplained symptoms in primary care using the intervention mapping approach. PATIENT EDUCATION AND COUNSELING 2022; 105:1305-1316. [PMID: 34561144 DOI: 10.1016/j.pec.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/29/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND General practice (GP) training in how to communicate with patients with medically unexplained symptoms (MUS) is limited. OBJECTIVE Development, implementation and evaluation of an evidence-based communication training program for GP residents focused on patients with MUS in primary care. METHODS We used the intervention mapping (IM) framework to systematically develop the MUS training program. We conducted a needs assessment to formulate change objectives and identified teaching methods for a MUS communication training program. Next, we developed, implemented and evaluated the training program with 46 residents by assessing their self-efficacy and by exploring their experiences with the training. RESULTS The resulting program is a blended training with an online course and two training days. After attending the training program, GP residents reported significantly higher self-efficacy for communication with patients with MUS at four weeks follow up compared to baseline. Furthermore, GP residents experienced the training program as useful and valued the combination of the online course and training days. CONCLUSION AND PRACTICE IMPLICATIONS We developed an evidence-based communication training program for the management of patients with MUS in primary care. Future research should examine the effect of the training on GP residents' communication skills in MUS consultations in daily practice.
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Affiliation(s)
- Juul Houwen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands.
| | - Olga A de Bont
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Peter Lbj Lucassen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Judith G M Rosmalen
- University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Hugo W Stappers
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Sandra van Dulmen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands; Nivel (Netherlands institute for health services research), Utrecht, The Netherlands
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Nowak AC, Namer Y, Hornberg C. Health Care for Refugees in Europe: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031278. [PMID: 35162300 PMCID: PMC8834962 DOI: 10.3390/ijerph19031278] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/19/2022] [Indexed: 12/31/2022]
Abstract
Background: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. Methods: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. Results: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. Conclusions: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care.
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Affiliation(s)
- Anna Christina Nowak
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
- Correspondence:
| | - Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany;
| | - Claudia Hornberg
- Department of Sustainable Environmental Health Sciences, Faculty of Medicine, Bielefeld University, 33615 Bielefeld, Germany;
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Peñuela-O'Brien E, Wan MW, Edge D, Berry K. Health professionals' experiences of and attitudes towards mental healthcare for migrants and refugees in Europe: A qualitative systematic review. Transcult Psychiatry 2022; 60:176-198. [PMID: 34986056 PMCID: PMC10074763 DOI: 10.1177/13634615211067360] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals' attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals' emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants' needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status.
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Affiliation(s)
- E Peñuela-O'Brien
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester.,9022Greater Manchester Mental Health NHS Foundation Trust
| | - M W Wan
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester
| | - D Edge
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester.,9022Greater Manchester Mental Health NHS Foundation Trust
| | - K Berry
- Division of Psychology and Mental Health, School of Health Sciences, 5292University of Manchester.,9022Greater Manchester Mental Health NHS Foundation Trust
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Communication Experiences in Primary Healthcare with Refugees and Asylum Seekers: A Literature Review and Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041469. [PMID: 33557234 PMCID: PMC7913992 DOI: 10.3390/ijerph18041469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/03/2022]
Abstract
Refugee and asylum seeker population numbers are rising in Western countries. Understanding the communication experiences, within healthcare encounters, for this population is important for providing better care and health outcomes. This review summarizes the literature on health consultation communication experiences of refugees and asylum seekers living in Western countries. Seven electronic databases were searched from inception to 31 March 2019. Studies were included if they aimed to improve, assess or report on communication/interaction in the primary health care consultation setting with refugees or asylum seekers, and were conducted in Western countries. A narrative synthesis of the literature was undertaken. Thematic analysis of the 21 included articles, showed that refugees and asylum seekers experience a range of communication challenges and obstacles in primary care consultations. This included practical and relational challenges of organizing and using informal and formal interpreters and cultural understanding of illness and healthcare. Non-verbal and compassionate care aspects of communication emerged as an important factor in helping improve comfort and trust between healthcare providers (HCP) and refugees and asylum seekers during a healthcare encounter. Improvements at the systems level are needed to provide better access to professional interpreters, but also support compassionate and humanistic care by creating time for HCPs to build relationships and trust with patients.
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Ahmad F, Othman N, Lou W. Posttraumatic Stress Disorder, Social Support and Coping Among Afghan Refugees in Canada. Community Ment Health J 2020; 56:597-605. [PMID: 31832819 DOI: 10.1007/s10597-019-00518-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
Posttraumatic-stress-disorder (PTSD) is one of the common mental health conditions among Afghan refugees resettled in developed countries. The current study explores how social support, coping and other factors correlate with PTSD in this population. A survey was conducted with 49 adult Afghan refugees (males 41%, female 59%) who completed Harvard Trauma Questionnaire during their visit to a Community Health Centre in Toronto. Bivariate analysis and structural-equation-modeling (SEM) were used to examine associations and pathways between PTSD and other variables. Mean PTSD score was 2.53 (SD 0.92) with 53% showing symptoms of PTSD which was significantly associated with age, unemployment, social support and self-rated health. SEM showed that higher social support scores were significantly associated with lower PTSD scores, and the effect of coping and English language were mediated through social support. The high prevalence of PTSD, its association with social support and self-rated health are important issues to be considered for refugee resettlement programs.
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Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, Rm 414, Toronto, ON, M3J 1P3, Canada.
| | - Nasih Othman
- School of Health Policy and Management, York University, Toronto, Canada
| | - Wendy Lou
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Robertshaw L, Dhesi S, Jones LL. Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research. BMJ Open 2017; 7:e015981. [PMID: 28780549 PMCID: PMC5629684 DOI: 10.1136/bmjopen-2017-015981] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries. DESIGN Systematic review and qualitative thematic synthesis. METHODS Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs. RESULTS Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes. CONCLUSIONS A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group.
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Affiliation(s)
- Luke Robertshaw
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Surindar Dhesi
- Department of Earth and Environmental Sciences, School of Geography, University of Birmingham, Birmingham, UK
| | - Laura L Jones
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
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Shenouda JEA, Cooper MJF. "One Big Family": Pastoral Care and Treatment Seeking in an Egyptian Coptic Church in England. JOURNAL OF RELIGION AND HEALTH 2017; 56:1450-1459. [PMID: 28342143 DOI: 10.1007/s10943-017-0381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Little is known about Coptic migrants' chronic disease health beliefs and treatment-seeking behaviours. Interviews to explore these issues and their relationship with church membership were conducted with 15 Coptic migrants in Southern England. Obesity and cardiovascular disease (CVD) were most frequently identified as health risks for Coptic migrants. CVD was ascribed to stress and considered amenable to spiritual healing. Lay referral to medical practitioners who were church members was common but may devalue perceptions of family medicine. The Coptic Church functions as a community that addresses members' wider vulnerability. Central to this is the "parish nurse" role of the priest.
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Affiliation(s)
- John E A Shenouda
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton, BN1 9PH, England, UK.
| | - Maxwell J F Cooper
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton, BN1 9PH, England, UK
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Refugee experiences of general practice in countries of resettlement: a literature review. Br J Gen Pract 2016; 65:e171-6. [PMID: 25733438 DOI: 10.3399/bjgp15x683977] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Refugees and asylum seekers often struggle to use general practice services in resettlement countries. AIM To describe and analyse the literature on the experiences of refugees and asylum seekers using general practice services in countries of resettlement. DESIGN AND SETTING Literature review using systematic search and narrative data extraction and synthesis methodologies. International, peer-reviewed literature published in English language between 1990 and 2013. METHOD Embase, Ovid MEDLINE, PsycINFO, CSA Sociological Abstracts, and CINAHL databases were searched using the terms: refugee, asylum seeker, experience, perception, doctor, physician, and general practitioner. Titles, abstracts and full texts were reviewed and were critically appraised. Narrative themes describing the refugee or asylum seeker's personal experiences of general practice services were identified, coded, and analysed. RESULTS From 8722 papers, 85 were fully reviewed and 23 included. These represented the experiences of approximately 864 individuals using general practice services across 11 countries. Common narrative themes that emerged were: difficulties accessing general practice services, language barriers, poor doctor-patient relationships, and problems with the cultural acceptability of medical care. CONCLUSION The difficulties refugees and asylum seekers experience accessing and using general practice services could be addressed by providing practical support for patients to register, make appointments, and attend services, and through using interpreters. Clinicians should look beyond refugee stereotypes to focus on the needs and expectations of the individual. They should provide clear explanations about unfamiliar clinical processes and treatments while offering timely management.
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13
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Maatz A, Wainwright M, Russell AJ, Macnaughton J, Yiannakou Y. What's 'difficult'? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms. J Psychosom Res 2016; 90:1-9. [PMID: 27772554 DOI: 10.1016/j.jpsychores.2016.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. DESIGN Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term 'difficult'. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored. SETTING Three NHS trust secondary care hospitals in North-East England. PARTICIPANTS 17 senior clinicians from seven medical and two surgical specialities. RESULTS Unsolicited use of the term 'difficult' was common. 'Difficult' was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used 'difficult' to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of 'difficult'. Participants also reported experiences that were rewarding and positive. CONCLUSIONS This study shows that blanket statements such as 'difficult patients' mask the complexity of doctors' experiences in the context of MUS. Our nuanced analysis of the use of 'difficult' challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS.
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Affiliation(s)
- Anke Maatz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, Zurich CH-8032, Switzerland.
| | - Megan Wainwright
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Andrew J Russell
- Department of Anthropology, Durham University, Durham DH1 3LE, United Kingdom
| | - Jane Macnaughton
- Centre for Medical Humanities, Durham University, Durham DH1 1SZ, United Kingdom
| | - Yan Yiannakou
- County Durham and Darlington NHS Foundation Trust, Durham DH1 5TW, United Kingdom
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Alemi Q, James S, Montgomery S. Contextualizing Afghan refugee views of depression through narratives of trauma, resettlement stress, and coping. Transcult Psychiatry 2016; 53:630-53. [PMID: 27507761 DOI: 10.1177/1363461516660937] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study explored how Afghan refugees conceptualize frames of mind that may reflect depression in general and as it relates to trauma they experienced. We performed in-depth interviews with 18 Afghans residing in the San Diego area. Views regarding the causes, symptoms, and perceived treatments of depression were gathered through free-listing techniques, and supplemented with narratives relating to pre- and post-resettlement stressors and coping mechanisms. Data were analyzed with standard qualitative content analysis methods. Items endorsed with relation to depression causality included pre-migration war traumas, notably separation from family, and post-migration stressors including status dissonance and cultural conflicts that ranged from linguistic challenges to intergenerational problems. Depressive symptoms were viewed as highly debilitating, and included changes in temperament, altered cognitions, avoidance and dissociative behaviors, and somatic complaints. Relief was sought through family reunification and community support, reliance on prayer, and the academic success of their children in the US. The findings underscore the need for practitioners to take into account situational stressors, cultural aspects of mourning and symptomatology, and existing coping mechanisms in developing interventions that are based on refugees' articulated needs.
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Development of an Interview Guide Identifying the Rehabilitation Needs of Women from the Middle East Living with Chronic Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12043-56. [PMID: 26404332 PMCID: PMC4626954 DOI: 10.3390/ijerph121012043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/09/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to develop an interview guide for use by primary healthcare professionals to support them in identifying the rehabilitation needs of forced resettled women from the Middle East living with chronic pain. Previous findings together with the existing literature were used as the basis for developing the interview guide in three steps: item generation, cognitive interviews, and a pilot study. The study resulted in a 16-item interview guide focusing on patients' concerns and expectations, with consideration of pre-migration, migration, and post-migration factors that might affect their health. With the help of the guide, patients were also invited to identify difficulties in their daily activities and to take part in setting goals and planning their rehabilitation. The current interview guide provides professional guidance to caretakers, taking a person-centered participative point of departure when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staff members working in primary healthcare, with the aim of contributing to continuity of care and multi-professional collaboration.
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Alemi Q, James S, Siddiq H, Montgomery S. Correlates and Predictors of Psychological Distress among Afghan Refugees in San Diego County. ACTA ACUST UNITED AC 2015; 8:274-288. [PMID: 26543500 DOI: 10.1080/17542863.2015.1006647] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The psychological effects of war and resulting displacement continue to negatively impact Afghan refugees. The purpose of this study was to investigate factors that are associated with and predict psychological distress symptoms among Afghan refugees. We analyzed data from a diverse sample of 130 Afghan refugees recruited through non-random sampling in the San Diego area. Participants completed self-report questionnaires consisting of a culturally validated measure of psychological distress, the Afghan Symptom Checklist [ASCL] alongside standardized measures of acculturation, social support, and perceived stress. In bivariate analyses, older age, older age at migration, female gender, being widowed, having lower education, being unemployed, unable to comfortably pay monthly bills, lower acculturation and social support, and higher levels of perceived stress were associated with psychological distress. However, only few variables - female gender, being widowed, unable to comfortably pay monthly bills, and perceived stress - remained significant in multivariate analysis. The findings from this study contribute to understanding the social determinants of distress that affect Afghans in exile even after long-term resettlement in the US. These reported outcomes support the need for continued research with Afghans, alongside the implementation of culturally relevant psychosocial interventions that emphasize prevention of post-resettlement stressors immediately upon resettlement.
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Affiliation(s)
- Qais Alemi
- Loma Linda University, Social Work & Social Ecology, 1898 Business Ctr. Dr., San Bernardino, 92408 United States
| | - Sigrid James
- Loma Linda University, Social Work & Social Ecology, San Bernardino, United States
| | - Hafifa Siddiq
- University of California Los Angeles, Nursing, Los Angeles, United States
| | - Susanne Montgomery
- Loma Linda University, Social Work & Social Ecology, San Bernardino, United States
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Zander V, Eriksson H, Christensson K, Müllersdorf M. Rehabilitation of women from the Middle East living with chronic pain--perceptions from health care professionals. Health Care Women Int 2014; 36:1194-207. [PMID: 25513750 DOI: 10.1080/07399332.2014.989439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Meeting patients from other countries constitutes a challenge for health care. The purpose of this study was to increase knowledge about tacit understandings of treatment in practice by determining the perceptions of chronic pain and rehabilitation directed to resettled women from the Middle East, from a variety of health care professionals within primary care. Based on the results, we find a need to support and increase knowledge among health care professionals to involve the patient and consider her beliefs, expectations, background, current life situation, and spirituality, and to involve family in rehabilitation.
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Affiliation(s)
- Viktoria Zander
- a Department of Women's and Children's Health, Karolinska Institutet, Stockholm; and Centre for Clinical Research Sörmland , Uppsala University , Uppsala , Sweden
| | - Henrik Eriksson
- b Department of Nursing and Care, The Swedish Red Cross University College , Stockholm , Sweden
| | - Kyllike Christensson
- c Department of Women's and Children's Health , Karolinska Institutet , Stockholm , Sweden
| | - Maria Müllersdorf
- d School of Health, Care, and Social Welfare , Eskilstuna , Västerås , Sweden
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Alemi Q, James S, Cruz R, Zepeda V, Racadio M. Psychological distress in afghan refugees: a mixed-method systematic review. J Immigr Minor Health 2014; 16:1247-61. [PMID: 23784146 PMCID: PMC3912229 DOI: 10.1007/s10903-013-9861-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mental health problems disproportionately affect Afghan refugees and asylum seekers who continue to seek international protection with prolonged exposure to war. We performed a systematic review aimed at synthesizing peer-reviewed literature pertaining to mental health problems among Afghans resettled in industrialized nations. We used five databases to identify studies published between 1979 and 2013 that provided data on distress levels, and subjective experiences with distress. Seventeen studies met our inclusion criteria consisting of 1 mixed-method, 7 qualitative, and 9 quantitative studies. Themes from our qualitative synthesis described antecedents for distress being rooted in cultural conflicts and loss, and also described unique coping mechanisms. Quantitative findings indicated moderate to high prevalence of depressive and posttraumatic symptomatology. These findings support the need for continued mental health research with Afghans that accounts for: distress among newly resettled groups, professional help-seeking utilization patterns, and also culturally relevant strategies for mitigating distress and engaging Afghans in research.
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Affiliation(s)
- Qais Alemi
- Department of Social Work and Social Ecology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA,
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Lunt N, Smith RD, Mannion R, Green ST, Exworthy M, Hanefeld J, Horsfall D, Machin L, King H. Implications for the NHS of inward and outward medical tourism: a policy and economic analysis using literature review and mixed-methods approaches. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BackgroundThe study examined the implications of inward and outward flows of private patients for the NHS across a range of specialties and services.ObjectivesTo generate a comprehensive documentary review; to better understand information, marketing and advertising practices; examine the magnitude and economic and health-related consequences of travel; understand decision-making frames and assessments of risk; understand treatment experience; elicit the perspectives of key stakeholder groups; and map out medical tourism development within the UK.Design and participantsThe study integrated policy analysis, desk-based work, economic analysis to estimate preliminary costs, savings and NHS revenue, and treatment case studies. The case studies involved synthesising data sources around bariatric, fertility, cosmetic, dental and diaspora examples. Overall, we drew on a mixed-methods approach of qualitative and quantitative data collection. The study was underpinned by a systematic overview and a legal and policy review. In-depth interviews were carried out with those representing professional associations, those with clinical interests and representative bodies (n = 16); businesses and employees within medical tourism (n = 18); NHS managers (n = 23); and overseas providers. We spoke to outward medical travellers (46 people across four treatment case studies: bariatric, fertility, dental and cosmetic) and also 31 individuals from UK-resident Somali and Gujarati populations.ResultsThe study found that the past decade has seen an increase in both inward and outward medical travel. Europe is both a key source of travellers to the UK and a destination for UK residents who travel for medical treatment. Inward travel often involves either expatriates or people from nations with historic ties to the UK. The economic implications of medical tourism for the NHS are not uniform. The medical tourism industry is almost entirely unregulated and this has potential risks for those travelling out of the UK. Existing information regarding medical tourism is variable and there is no authoritative and trustworthy single source of information. Those who travel for treatment are a heterogeneous group, with people of all ages spread across a range of sociodemographic groups. Medical tourists do not appear to inform their decision-making with hard information and consequently often do not consider all risks. They make use of extensive informal networks such as treatment-based or cultural groups. Motivations to travel are in line with the findings of other studies. Notably, cost is never a sole motivator and often not the primary motivation for seeking treatment abroad.LimitationsOne major limitation of the study was the abandonment of a survey of medical tourists. We sought to avoid an extremely small survey, which offers no real insight. Instead we redirected our resources to a deeper analysis of qualitative interviews, which proved remarkably fruitful. In a similar vein, the economic analysis proved more difficult and time consuming than anticipated. Data were incomplete and this inhibited the modelling of some important elements.ConclusionsIn 2010 at least 63,000 residents of the UK travelled abroad for medical treatment and at least 52,000 residents of foreign countries travelled to the UK for treatment. Inward referral and flows of international patients are shaped by clinical networks and longstanding relationships that are fostered between clinicians within sender countries and their NHS counterparts. Our research demonstrated a range of different models that providers market and by which patients travel to receive treatment. There are clearly legal uncertainties at the interface of these and clinical provision. Patients are now travelling to further or ‘new’ markets in medical tourism. Future research should: seek to better understand the medium- and long-term health and social outcomes of treatment for those who travel from the UK for medical treatment; generate more robust data that better capture the size and flows of medical travel; seek to better understand inward flows of medical travellers; gather a greater level of information on patients, including their origins, procedures and outcomes, to allow for the development of better economic costing; explore further the issues of clinical relationships and networks; and consider the importance of the NHS brand.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Neil Lunt
- Department of Social Policy and Social Work, University of York, York, UK
| | | | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Stephen T Green
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mark Exworthy
- School of Management, Royal Holloway, University of London, London, UK
| | | | - Daniel Horsfall
- Department of Social Policy and Social Work, University of York, York, UK
| | - Laura Machin
- The York Management School, University of York, York, UK
| | - Hannah King
- Department of Social Policy and Social Work, University of York, York, UK
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Zander V, Müllersdorf M, Christensson K, Eriksson H. Struggling for sense of control: everyday life with chronic pain for women of the Iraqi diaspora in Sweden. Scand J Public Health 2013; 41:799-807. [PMID: 23761934 DOI: 10.1177/1403494813492033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND As dispersed ethnic populations in Swedish society expand, the healthcare system need to adapt rehabilitation services according to their needs. The experiences of trauma and forced resettlement have a continuing impact on health and musculoskeletal pain, as well as the intersecting structures that prerequisite the possibilities in the new country. To understand the specific needs of women from the Iraqi diaspora in Sweden, there is a need to elucidate the effects of pain on their everyday life. AIMS To elucidate everyday life with chronic pain from the perspective of women from the Iraqi diaspora in Sweden. METHODS Qualitative interview study according to Glaser's grounded theory. RESULTS The results from 11 interviews suggest that pain was associated with dependency on society as well as on family. It resulted in a struggle for sense of control, framed by faith in God, influenced by the healthcare system, and with support from family. The women's testimony of lack of continuity of care, resulting in recollection of lived traumas in every visit, is a vital sign of the unconscious power relations within health care and how representatives from health care, instead of being the ones who help the women forward, become the ones who hold them back. CONCLUSIONS The results show the importance of challenging the normative assumptions embedded in health care and treatment for patients with chronic pain and of including the voice of "others".
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Affiliation(s)
- Viktoria Zander
- 1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Troy AS, Wilhelm FH, Shallcross AJ, Mauss IB. Seeing the silver lining: cognitive reappraisal ability moderates the relationship between stress and depressive symptoms. ACTA ACUST UNITED AC 2011; 10:783-95. [PMID: 21058843 DOI: 10.1037/a0020262] [Citation(s) in RCA: 227] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Individuals differ in their adjustment to stressful life events, with some exhibiting impaired functioning, including depression, while others exhibit impressive resilience. The present study examined the hypothesis that the ability to deploy a particularly adaptive type of emotion regulation-cognitive reappraisal-may be a protective factor. It expands upon existing research in three ways. First, participants' ability to use reappraisal (cognitive reappraisal ability: CRA) was measured by using a behavioral challenge that assessed changes in experiential and physiological domains, rather than questionnaires. Second, all participants had been exposed to one or more recent stressful life events, a context in which emotion regulation may be particularly important. Third, a community sample of 78 women aged 20 to 60 was recruited, as opposed to undergraduates. Results indicate that, at low levels of stress, participants' CRA was not associated with depressive symptoms. However, at high levels of stress, women with high CRA exhibited less depressive symptoms than those with low CRA, suggesting that CRA may be an important moderator of the link between stress and depressive symptoms.
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Affiliation(s)
- Allison S Troy
- Department of Psychology, University of Denver, Denver, CO 80208, USA.
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Müllersdorf M, Zander V, Eriksson H. The magnitude of reciprocity in chronic pain management: experiences of dispersed ethnic populations of Muslim women. Scand J Caring Sci 2011; 25:637-45. [PMID: 21371070 DOI: 10.1111/j.1471-6712.2011.00872.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dispersed ethnic populations believe their health to be worse than the ethnic majority group in Sweden. Most studies in rehabilitation exclude dispersed ethnic populations who can not read or speak the national language although this group seems to be in need of rehabilitation to a larger extent than privileged majority groups. The aim of the study was to examine the experience of living with musculoskeletal pain and experience of health care among dispersed ethnic populations of Muslim women. The method used was inspired by Grounded Theory in this study. Interviews were made with five first-generation Muslim immigrant women who had come to Sweden via Iraq as refugees. Two interviews were performed with interpreters. A preliminary core category 'The magnitude of reciprocity' based on three categories emerged from the analysis: (1) Impact of pain, (2) Managing pain and (3) Facing health care. Chronic pain limited the informants physically and emotionally, as well as impacting on their everyday life. Informants managed their pain primarily through medicine and physical activity, which gave at least temporary relief. Health care providers were perceived as doing their best but experiences of bad meetings were also witnessed. The factors important in achieving a good meeting in this study appeared to be; time, dialogue, honesty and understanding. Communication skills, feelings of being taken seriously and a sense of security were additional factors. Not being properly examined, or offered optimal treatment, not being believed or understood, were all seen as signs of dismissal within health care. The limitations of this study are primarily concerned with language difficulties resulting in various shortcomings. Reciprocal recognition and support connected to the specific life experiences of women that come with forced resettlement from the Muslim world to the European diaspora is a vital part of a holistic approach to pain management.
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Affiliation(s)
- Maria Müllersdorf
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden.
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Svenberg K, Mattsson B, Skott C. ‘A person of two countries’. Life and health in exile: Somali refugees in Sweden. Anthropol Med 2009; 16:279-91. [DOI: 10.1080/13648470903295984] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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