What can be learned from patient stories about living with the chronicity of heart illness? A narrative inquiry

The influence of culture on the health beliefs and health behaviours of older Vietnam-born Australians living with chronic disease

AIM

To explore the health beliefs and health behaviours of older Vietnam-born people living with chronic disease in Western Australia.

DESIGN

This study was designed as a focused ethnography guided by the interpretative research paradigm and Leininger's Theory of Culture Care.

METHODS

Data were collected through participant observation and interviews undertaken at participants' homes in Western Australia over 7 months in 2019. Data were analysed using Wolcott's approach for transferring qualitative data, comprising three phases: description, thematic analysis and interpretation.

RESULTS

This study included 12 participants. The health perspectives and practices of older Vietnam-born Australians significantly reflected the traditional Vietnamese values. These included the stigma towards chronic disease as an inevitable consequence of ageing; self-blame thoughts about chronic disease causations and maintained traditional dietary practices. However, some aspects of their health behaviours such as beliefs and practices in traditional medicine, Western medicine and physical exercise reflected a blended approach combining both Vietnamese-oriented and Westernized-orientated practices. Individual factors were also identified as contributing to chronic disease self-care among participants.

CONCLUSION

This study emphasizes culture played a significant role in shaping the way that older Vietnam-born Australians believed and behaved while living with chronic conditions. However, it also indicates that culture is not a stationary concept, it evolves gradually and is socially constructed.

IMPLICATIONS

A better understanding of the health beliefs and practices of older Vietnam-born Australians is expected to contribute to the delivery of culturally safe and effective support for this population. The achievement of culturally safe care requires a systemic approach and collaboration of strategies across sectors.

PATIENT AND PUBLIC CONTRIBUTION

This study encompassed the contribution of 12 older Vietnam-born Australians who offered the researcher the privilege to enter their world and the staff of social care organization who opened the gate for the researcher to approach participants.

"Maybe I would've been more comfortable in my Ignorance?": Exploring future physical therapist's lived experience of an elective pain science course

INTRODUCTION

Through the Master of Physical Therapy program at a Canadian University, Understanding Pain in Rehabilitation (PT9551b) has been an elective option for physical therapy students with the final submission based on a reflective diary. The primary intention of the course is to introduce a critical social science perspective of pain and pain management. A secondary intention is to facilitate student reflection on how they see themselves as 'providers of pain management' or 'providers of physical therapy for people in pain' although at this point, the students' experiences of learning in this way has not been rigorously explored. There has yet to be a systemic examination of how physical therapy students experience learning about pain through such a course, and how the course has impacted their perspectives.

METHOD

This study followed an interpretive phenomenological research design. Single semi-structured in-depth 45-90-minute interviews of recent students were audio recorded and transcribed. In addition, the reflective diaries of students were included in the data set with students' permission. The analysis process followed a detailed reading approach to analysis by reading transcriptions line by line and engaging in critical reflection.

FINDINGS

Six major themes were identified including: 1) Therapeutic Power of Words; 2) Learning through Reflection; 3) Lived Experience with Pain; 4) Patient Partnership; 5) Conceptualizations of Pain; and 6) Pain and Physiotherapy Practice.

CONCLUSION

It is recommended that researchers and educators encourage a continuation of reflective practice to conceptualize new information and as a means for participants to reflect on their personal and professional experiences.

From symptom onset to treatment initiation: protocol for a narrative study exploring the journey of older adults with tuberculosis in the English Midlands, UK

INTRODUCTION

Time from symptom onset to treatment initiation in tuberculosis (TB) remains stubbornly prolonged despite reductions in disease incidence. Delays may contribute to increased morbidity, mortality, onward spread of disease and poor patient experiences. Most delays occur prior to hospital referral. The average primary care healthcare provider in England is unlikely to see TB on a regular basis. Little is known about primary care diagnostic and referral challenges.Adults aged 65 years or older are more likely to experience delays. However, little is known about their journey from symptom onset to treatment initiation.

METHODS AND ANALYSIS

We will carry out a narrative study including adults aged 65 years or older, living in the English Midlands and receiving treatment for active TB. Twelve English and 12 Urdu or Punjabi speakers will be recruited from TB clinics and interviewed. Their primary care records will be accessed, and the primary care story and secondary care letters will be extracted. Each of the data sources will be analysed using dialogical narrative analysis. Data will be triangulated within participants and across the data set.

ETHICS AND DISSEMINATION

This study received approval from the Health Research Authority and the Research Ethics Committee in April 2022. Risk management and equity considerations have been made a priority. Findings will be disseminated through publication in open access peer-reviewed journals, presentations to policy makers, primary healthcare and secondary healthcare professionals, and through public facing materials developed in conjunction with patients, members of the pubic, TB services and charities.

Patient-Centered Care Experiences of First-Generation, South Asian Migrants with Chronic Diseases Living in High-Income, Western Countries: Systematic Review

Background

First-generation migrants from South Asia account for a considerable proportion of the immigrant populations in high-income, western countries and are at a high risk of developing complex, chronic diseases such as cardiovascular disease and diabetes. Yet, previous systematic reviews have not synthesized information about the healthcare needs and preferences of such migrants and the best ways for health services to provide them with appropriate, culturally sensitive, patient-centered care. The aim of this study is to systematically review the international evidence about first-generation, South Asian migrants' healthcare experiences from the patients' perspectives.

Methods

Five databases were searched for qualitative, quantitative, and mixed methods studies published between January 1990 and April 2020. Fourteen thousand, six hundred and forty-four papers were retrieved and screened using pre-determined eligibility criteria. Sixty-one papers were included in this narrative synthesis. Relevant qualitative findings from the included papers were thematically analyzed, and quantitative findings were summarized.

Results

Five themes emerged from findings: 1) Healthcare services engaged; 2) the language barrier; 3) experiences and perceptions of healthcare advice; 4) the doctor-patient relationship; and 5) the role of patients' families in supporting access and delivery of healthcare.

Conclusion

The findings indicate that communication barriers reduce the cultural and linguistic appropriateness of healthcare. Potential solutions include employing healthcare staff from the same cultural background, training healthcare professionals in cultural competence, and proactively including first-generation, South Asian migrants in decision-making about their healthcare. Future research should explore South Asian migrants' experiences of multimorbidity management, continuity of care, interdisciplinary collaboration, the formation of treatment plans and goals as little to no data were available about these issues.

Emotional distress, anxiety and depression in South Asians with long-term conditions: a qualitative systematic review

Background

People with physical–mental comorbidity have a poorer quality of life, worse clinical outcomes, and increased mortality compared with people with physical conditions alone. People of South Asian (SA) origin are the largest minority group in the UK and are more likely to have long-term conditions (LTCs) such as diabetes and heart disease. People of SA origin are less likely to recognise symptoms that may represent mental health problems.

Aim

To explore how people of SA origin with LTCs understand, experience, and seek help for emotional distress, depression, and anxiety.

Design and setting

Systematic review of qualitative studies exploring emotional distress in people of SA origin with diabetes or coronary heart disease, within primary and community care settings worldwide.

Method

Comprehensive searches of eight electronic databases from inception to 1 September 2021 were undertaken. Data extracted included study characteristics, and understanding, experience, and help-seeking behaviour for emotional distress. Thematic synthesis was undertaken. The Critical Appraisal Skills Programme (CASP) checklist for qualitative studies was used to assess quality of articles, and Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) used to determine the overall strength of evidence.

Results

Twenty-one studies from 3165 unique citations were included. Three main themes were identified. Understanding of emotional distress: non-medical terminology used, such as ‘tension’, and a complex relationship between emotional and physical illness. Experiences of emotional distress: multiple forms of inequality, distress at diagnosis of their LTC, cultural factors, and sex differences. Help-seeking behaviour: self-management, support from family, friends, and faith, and inadequate clinical support.

Conclusion

This review provides a greater understanding of the conceptualisation of emotional distress in the context of LTCs by people of SA origin, to support improvement in its recognition and management.

Understanding How Nursing Students Experience Becoming Relational Practitioners: A Narrative Inquiry

Background

Teaching nursing students to become relational practitioners requires theoretical approaches and strategies that engender personal and aesthetic knowing. These qualities closely parallel those that define relational practice. The use of creative self-expression in supporting the development of student capacity for relational practice offers a viable approach.

Purpose

To learn how nursing students’ engagement in creative self-expression activities may impact the construction of their professional identity and capacity for relational practice as novice nurses.

Method

Clandinin and Connelly's narrative inquiry approach was used to explore nursing students’ experiences of learning how to become relational practitioners. Four new nurse graduates engaged in a follow-up focus group using Schwind's narrative reflective process to discuss the impact of a relational practice workshop series.

Findings

Bronwyn's story became the composite of the four participants. Two key narrative patterns emerged: being in service of others and being knowledgeable collaborative leaders. These entailed an intentional engagement in relationships with patients, which required attention to the co-constructed relational space. The creative approaches used to facilitate students’ learning informed their awareness that led to their transformation.

Implications

Educating future nurses who are relational, person-centered practitioners requires a holistic approach to teaching/learning which also includes creative self-expression.