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The cultural epidemiology of stigma among people with schizophrenia : Adaptation and cross-cultural validation of the Explanatory Model Interview Catalogue (EMIC), in Dialectal Arabic (Darija), Morocco. Rev Epidemiol Sante Publique 2022; 70:177-182. [PMID: 35623932 DOI: 10.1016/j.respe.2022.03.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/29/2021] [Accepted: 03/10/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Stigma underlies the violation of certain social, economic, and cultural rights of patients with schizophrenia, including their access to treatment and care. Measurement of stigma remains as complex and multifaceted as the phenomenon itself. Several measurement tools are available to assess the prevalence, intensity and qualities of stigma. The aim of the study was to carry out a cross-cultural adaptation of the Explanatory Model Interview Catalogue (EMIC), in the Moroccan Arabic dialect commonly known as "Darija". PATIENTS AND METHOD The study was conducted in three psychiatric departments of public hospitals in the Souss-Massa region, located in southern Morocco. For the diagnosis of schizophrenia, the study was based on the decisions of the psychiatrists practicing at the study sites. The cross-cultural adaptation in Moroccan Darija of the stigma scale developed by Michel Weiss in the EMIC was carried out according to the six-step scientific method developed by Dorcas et al. RESULTS Cronbach's alpha (internal consistency) was 0.845. Convergent validity determined by Pearson's coefficient showed a significant inter-item correlation and the intra-class correlation coefficient (test-retest) was 0.975 (0.993; 0.991). The item added in relation to the COVID-19 situation presented psychometric values similar to the others. CONCLUSION The Darija version is culturally acceptable and can be used to approach the phenomenon of stigmatization in Morocco.
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Abstract
BACKGROUND Cancer is a family disease, affecting the individual patient and the family. For Chinese patients and their families in Canada, adjusting to cancer may be particularly distressing when culture and language are not congruent with the mainstream model of care delivery. OBJECTIVE In view of the limited research on the cancer experience of Chinese families, this study aims to examine the interrelatedness of patients and family caregivers' distress among a Chinese-speaking cancer population in Canada. METHODS Semi-structured interviews were conducted with a purposive sample of 10 Chinese-speaking cancer patients and 6 family caregivers. Qualitative analysis of the interview data was conducted to construct cross-cutting themes regarding the experiences of distress after a cancer diagnosis. RESULTS Four overarching themes emerged from the analysis: (1) misconception about cancer, (2) tensions in disclosure, (3) patient and family caregiver distress, and (4) concealing emotion in patient and family caregiver. Notably, the interrelatedness of patients and family caregivers' distress was highlighted, as patients and family caregivers both sought to regulate their own emotions to protect one another's mental well-being. CONCLUSION The study provides insights into the distress of living with cancer and the impact on family relationships. Understanding the patients and family members' cultural and social contexts also provides the foundation for patient- and family-centered care. IMPLICATIONS FOR PRACTICE Healthcare professionals can provide culturally appropriate care by recognizing the needs, values, and beliefs of cancer patients and their families. Furthermore, the patient-family-caregiver dyad needs to be considered as the unit of care.
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Zou P, Dennis CL, Lee R, Parry M. Hypertension Prevalence, Health Service Utilization, and Participant Satisfaction: Findings From a Pilot Randomized Controlled Trial in Aged Chinese Canadians. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2017; 54:46958017724942. [PMID: 28853303 PMCID: PMC5798669 DOI: 10.1177/0046958017724942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Responding to high prevalence of hypertension and patients' preference of integrating traditional Chinese medicine for blood pressure control, the Dietary Approach to Stop Hypertension With Sodium Reduction for Chinese Canadian (DASHNa-CC) intervention was newly designed as a culturally sensitive dietary educational intervention to facilitate middle-aged and senior Chinese Canadians' blood pressure control in community. The aim of this study was to report the hypertension prevalence rate according to the data from blood pressure screening events, to describe the characteristics of health service utilization among aged Chinese Canadians, and to report the evaluation of participant satisfaction to the DASHNa-CC intervention. This study was designed as a pilot randomized controlled trial with a sample size of 60. Among 618 Chinese Canadians participated in blood pressure screening events, 54.5% (n = 337) having various levels of hypertension. Across 2 months, 38 (63.3%) participants made a total of 47 visits to see their family physicians; 20 (33.3%) participants consulted their family members 224 times for lifestyle modifications and hypertension self-management. Various forms of Chinese media were frequently used as sources of health care information, and English media were rarely accessed. Participants highly satisfied with the contents, delivery approaches, and integration of traditional Chinese medicine in the intervention. Results indicated that middle-aged and senior Chinese Canadians have high hypertension prevalence and specific characteristics of health service utilization. It is important to implement interventions, which are culturally tailored, language appropriate, using proper technology and incorporating traditional Chinese medicine, in Chinese Canadian community for hypertension control.
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Affiliation(s)
- Ping Zou
- Nipissing University, Toronto, Ontario, Canada
- Ping Zou, Assistant Professor, School of Nursing, Nipissing University, 750 Dundas Street West, Toronto, Ontario, Canada M6J 3S3.
| | | | - Ruth Lee
- McMaster University, Hamilton, Ontario, Canada
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Grønseth AS. Experiences of Tensions in Re-orienting Selves: Tamil Refugees in Northern Norway Seeking Medical Advice. Anthropol Med 2016; 13:77-98. [PMID: 26868613 DOI: 10.1080/13648470500516303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Research among refugee populations tends to focus on the dramas of war and trauma. This paper instead brings attention to the more mundane everyday aspects of Tamil refugee resettlement in a fishing village along the arctic coast of Norway. Here, many Tamils experience various diffuse aches and pains that the local health personnel find difficult to diagnose and treat. In response to the difficulties, this study aims to investigate health and sickness as embedded in social life and cultural values. Data were generated during two different fieldwork periods: between 1996 and 1999 the author did short field visits in the region and conducted in-depth interviews and participant observation amongst Tamils and local health care workers, including observing health care consultations; and between September 1999 and September 2000 intensive fieldwork was undertaken amongst Tamil refugees in a small fishing village. A sample of two case studies illustrates Tamils' experience of being misunderstood as individuals and overlooked as social persons. Rather than looking at illness as symptoms of physiological or psychological malfunctions, the article suggests an understanding that allows an active, perceptive body and views the self as an orienting point of 'being in the world'. The Tamils are seen to live in a tension in which the self and the body are forced to re-orient themselves in the new social world. Tamils' illnesses are thus proposed rather to express a challenge and collapse in habituated patterns for constituting meaning and social practices.
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Roman G, Gramma R, Enache A, Pârvu A, Moisa ŞM, Dumitraş S, Ioan B. The health mediators-qualified interpreters contributing to health care quality among Romanian Roma patients. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:843-856. [PMID: 23378171 DOI: 10.1007/s11019-013-9467-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In order to assure optimal care of patients with chronic illnesses, it is necessary to take into account the cultural factors that may influence health-related behaviors, health practices, and health-seeking behavior. Despite the increasing number of Romanian Roma, research regarding their beliefs and practices related to healthcare is rather poor. The aim of this paper is to present empirical evidence of specificities in the practice of healthcare among Romanian Roma patients and their caregivers. Using a qualitative exploratory descriptive design, this study is based on data gathered through three focus groups with 30 health mediators in the counties of Iasi and Cluj (Romania). We identified various barriers to access to healthcare for Roma patients: lack of financial resources and health insurance coverage, lack of cognitive resources or lack of personal hygiene, but also important cultural issues, such as the shame of being ill, family function, disclosure of disease-related information, patient's autonomy, attitudes towards illness and health practices, that should be considered in order to create a culturally sensitive environment in Romanian medical facilities:… The role of the health mediators within the context of cultural diversity is also discussed, as cultural brokers contributing to health care quality among Romanian Roma patients Bridging cultural differences may improve patient-healthcare provider relationships, but may have limited impact in reducing ethnic disparities, unless coupled with efforts of Roma communities to get involved in creating and implementing health policies.
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Crooks VA, Agarwal G, Harrison A. Chronically ill Canadians' experiences of being unattached to a family doctor: a qualitative study of marginalized patients in British Columbia. BMC FAMILY PRACTICE 2012; 13:69. [PMID: 22799280 PMCID: PMC3412741 DOI: 10.1186/1471-2296-13-69] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 07/16/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Unattached patients do not have a regular primary care provider. Initiatives are being developed to increase attachment rates across Canada. Most existing attention paid to patient unattachment has focused on quantifying the problem and health system costs. Our purpose is to qualitatively identify the implications of chronically ill patients' experiences of unattachment for health policy and planning to provide policy-relevant insights for Canadian attachment initiatives. METHODS Three focus groups were conducted with marginalized chronically ill individuals residing in a mid-sized city in British Columbia who are unattached to a family doctor. We use the term marginalized as a descriptor to acknowledge that by virtue of their low socio-economic status and lack of attachment the participants are marginalized in Canada's health care system Focus groups were structured as an open conversation organized around a series of probing questions. They were digitally recorded and transcribed verbatim. Thematic analysis was employed. RESULTS Twenty-six individuals participated in the focus groups. The most common chronic illnesses reported were active drug addiction or recovery (and their associated symptoms), depression, arthritis, and hepatitis C. Participants identified life transitions as being the root cause for not having a family doctor. There was a strong sense that unsuccessful attempts to get a family doctor reflected that they were undesirable patients. Participants wanted to experience having a trusting relationship with a regular family doctor as they believed it would encourage greater honesty and transparency. One of the main health concerns regarding lack of access to a regular family doctor is that participants lacked access to preventative care. Participants were also concerned about having a discontinuous medical record due to unattachment. CONCLUSIONS Participants perceived that there are many benefits to be had by having attachment to a regular family doctor and that experiencing unattachment challenged their health and access to health care. We encourage more research to be done on the lived experience of unattachment in order to provide on-the-ground insights that policy-makers require in order to develop responsive, patient-centred supports and programs.
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Affiliation(s)
- Valorie A Crooks
- Department of Geography, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1 S6, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 L8, Canada
| | - Angela Harrison
- Department of Geography, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1 S6, Canada
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Nieuwsma JA, Pepper CM, Maack DJ, Birgenheir DG. Indigenous perspectives on depression in rural regions of India and the United States. Transcult Psychiatry 2011; 48:539-68. [PMID: 22021105 DOI: 10.1177/1363461511419274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression is a major health concern in India, yet indigenous Indian perspectives on depression have often been disregarded in favor of Western conceptualizations. The present study used quantitative and qualitative measures modeled on the Explanatory Model Interview Catalogue (EMIC) to elicit beliefs about the symptoms, causes, treatments, and stigma associated with depression. Data were collected from 92 students at a university in the Himalayan region of Northern India and from 97 students at a university in the Rocky Mountain region of the United States. U.S. participants in this study were included primarily to approximate a "Western baseline" (in which professional conceptions of depression are predominantly rooted) from which to elucidate Indian perspectives. Compared to U.S. participants, Indian participants were more likely to view restive symptoms (e.g., irritation, anxiety, difficulty thinking) as common features of depression, to view depression as the result of personally controllable causes (e.g., failure), to endorse social support and spiritual reflection or relaxation (e.g., yoga, meditation) as useful means for dealing with depression, and to associate stigma with depression. Efforts aimed at reducing depression among Indians should focus more on implementing effective and culturally acceptable interventions, such as yoga, meditation, and increasing social support.
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Affiliation(s)
- Jason A Nieuwsma
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Department of Veterans Affairs-VA- Mid-Atlantic Mental Illness Research, Education and Clinical Center-MIRECC, 508 Fulton Street, Durham, NC 27705, USA.
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Sargent C, Larchanché S. Transnational Migration and Global Health: The Production and Management of Risk, Illness, and Access to Care. ANNUAL REVIEW OF ANTHROPOLOGY 2011. [DOI: 10.1146/annurev-anthro-081309-145811] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Globalization, including the global flows of people, is clearly linked to disease transmission and vulnerability to health risks among immigrant populations. Anthropological research on transnational migration and health documents the implications of population movements for health and well-being. Studies of immigrant health reveal the importance of the social, political, and economic production of distress and disease as well as the structures and dynamics that produce particular patterns of access to health services. This review points to underlying political, economic, and social structures that produce particular patterns of health and disease among transnational migrants. Both critical and phenomenological analyses explore ideas of alterity and community, which underlie the production and management of immigrant health. Research on immigrant health underscores the importance of further attention to policies of entitlement and exclusion, which ultimately determine health vulnerabilities and accessibility of health care.
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Affiliation(s)
- Carolyn Sargent
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri 63130
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Jette S, Vertinsky P. ‘Exercise is medicine’: Understanding the exercise beliefs and practices of older Chinese women immigrants in British Columbia, Canada. J Aging Stud 2011. [DOI: 10.1016/j.jaging.2010.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Paralikar V, Agashe M, Sarmukaddam S, Deshpande S, Goyal V, Weiss MG. Cultural epidemiology of neurasthenia spectrum disorders in four general hospital outpatient clinics of urban Pune, India. Transcult Psychiatry 2011; 48:257-83. [PMID: 21742952 DOI: 10.1177/1363461511404623] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disorders emphasizing symptoms of fatigue and/or weakness, collectively termed Neurasthenia Spectrum Disorders (NSDs), typically emphasize a biological basis in the West and social origins in East Asia. In India, explanatory concepts are diverse. To clarify, 352 outpatients in Psychiatry, Medicine, Dermatology, and Ayurved clinics of an urban hospital were interviewed with a version of the Explanatory Model Interview Catalogue. Comparisons of categories and narratives of illness experience and meaning across clinics indicated both shared and distinctive features. Explanatory models of NSDs highlighted social distress, ''tensions,'' and both general and clinic-specific physical, psychological, and cultural ideas. Findings indicate the importance of social contexts and cultural meaning in explanatory models of neurasthenia, as well as the potential clinical relevance of the construct of Neurasthenia Spectrum Disorder.
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Craig SR, Chase L, Lama TN. Taking the MINI to Mustang, Nepal: methodological and epistemological translations of an illness narrative interview tool. Anthropol Med 2010; 17:1-26. [DOI: 10.1080/13648471003602566] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Drachler MDL, Leite JCDC, Hooper L, Hong CS, Pheby D, Nacul L, Lacerda E, Campion P, Killett A, McArthur M, Poland F. The expressed needs of people with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. BMC Public Health 2009; 9:458. [PMID: 20003363 PMCID: PMC2799412 DOI: 10.1186/1471-2458-9-458] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 12/11/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to review systematically the needs for support in managing illness and maintaining social inclusion expressed by people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) METHODS: We carried out a systematic review of primary research and personal ('own') stories expressing the needs of people with CFS/ME. Structured searches were carried out on Medline, AMED, CINAHL, EMBASE, ASSIA, CENTRAL, and other health, social and legal databases from inception to November 2007. Study inclusion, data extraction and risk of bias were assessed independently in duplicate. Expressed needs were tabulated and a conceptual framework developed through an iterative process. RESULTS Thirty two quantitative and qualitative studies, including the views of over 2500 people with CFS/ME with mainly moderate or severe illness severity, met the inclusion criteria. The following major support needs emerged: 1) The need to make sense of symptoms and gain diagnosis, 2) for respect and empathy from service providers, 3) for positive attitudes and support from family and friends, 4) for information on CFS/ME, 5) to adjust views and priorities, 6) to develop strategies to manage impairments and activity limitations, and 7) to develop strategies to maintain/regain social participation. CONCLUSIONS Although the studies were heterogeneous, there was consistent evidence that substantial support is needed to rebuild lives. Gaining support depends - most importantly - on the ability of providers of health and social care, colleagues, friends and relatives, and those providing educational and leisure services, to understand and respond to those needs.
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Affiliation(s)
| | | | - Lee Hooper
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Chia Swee Hong
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Derek Pheby
- Plaishetts House, Hadspen, Castle Carey, BA7 7LR, UK
| | - Luis Nacul
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Eliana Lacerda
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Peter Campion
- Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
| | - Anne Killett
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Maggie McArthur
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Fiona Poland
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
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Lassetter JH, Callister LC. The impact of migration on the health of voluntary migrants in western societies. J Transcult Nurs 2009; 20:93-104. [PMID: 18840884 DOI: 10.1177/1043659608325841] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The authors reviewed literature on the health of voluntary migrants to Western societies and factors affecting their health. Health indicators include mortality rates and life expectancy, birth outcomes, risk of illness, patterns of deteriorating health, cardiovascular disease, body mass index, hypertension, and depression. Multiple factors explain variability, including length of residence and acculturation, disease exposure, life style and living conditions, risky behaviors, healthy habits, social support networks, cultural and linguistic barriers, experiences with racism, and levels of awareness of cultural health practices among health care providers. Evidence exists for superior health among many migrants to Western countries relative to native-born persons, but the differential disappears over time. Migration is a dynamic, extended process with effects occurring years after physical relocation. Systemic change is required, including health policies that ensure equity for migrants, culturally appropriate health promotion, and routine assessment of migration history, cultural health practices, and disease exposure.
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Roth MA, Kobayashi KM. The use of complementary and alternative medicine among Chinese Canadians: results from a national survey. J Immigr Minor Health 2008; 10:517-28. [PMID: 18386179 DOI: 10.1007/s10903-008-9141-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examines the relationship between Chinese Canadian ethnicity and the use of complementary and alternative medicine (CAM) and explores some of the factors that contribute to CAM use among this visible minority group. Using data from cycle 2.1 of the Canadian Community Health Survey (2003), we use multivariate logistic regression to investigate the extent to which CAM use varies among Chinese Canadians and non-Chinese Canadians. Two three-way interactions, which demonstrate how the combination of certain identity markers increases their predictive value within the model, are also examined. The use of CAM varies according to ethnicity, with Chinese Canadians being more likely to use than non-Chinese Canadians. The findings also indicate that cultural factors play a key role in establishing the necessary conditions for increasing the likelihood of CAM use for Chinese Canadians. Findings are discussed in terms of their implications for health care policy and program development.
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Affiliation(s)
- Marilyn A Roth
- Department of Sociology, University of Victoria, Victoria, BC, Canada, V8W3P5
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Abstract
AIM This paper is a report of a concept analysis of chronic fatigue. BACKGROUND Fatigue is a prevalent symptom encompassing both acute and chronic manifestations. It is chronic fatigue that is most problematic because of its duration and impact on life quality. The rise in prevalence of chronic conditions will result in a need to address coexistent symptoms, clarification of which is needed. Chronic fatigue is one of the most common symptoms in chronic illness. Clarification of the concept and an understanding of its use by discipline are needed. DATA SOURCES The evolutionary method of concept analysis was used to ascertain the attributes, antecedents, consequences and surrogate terms for chronic fatigue. A review of the literature published between 1966 and 2007 was carried out to determine the contextual use of the concept of chronic fatigue among disciplines. Sources used for this analysis included CINAHL, Medline, PsychINFO and Social Work Abstracts and the search yielded 66 papers. RESULTS The chronic fatigue experience is associated with a multitude of physical, psychological and social factors. The defining attributes of chronic fatigue are constancy, abnormality, whole-body experience, inexplicability and disabling. The antecedents of chronic fatigue are physical disease, psychopathology, female gender and a history of abuse. Consequences found include social isolation and stigmatization, physical inactivity, psychological disturbances and a reduced quality of life. CONCLUSION Further research is needed to identify the aetiology of chronic fatigue and to address the social context of living with this disabling symptom.
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Lu C, Sylvestre J, Melnychuk N, Li J. East meets West: Chinese-Canadians' perspectives on health and fitness. Canadian Journal of Public Health 2008. [PMID: 18435385 DOI: 10.1007/bf03403735] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chinese-Canadians comprise one of Canada's largest and fastest-growing ethnocultural groups. This exploratory qualitative study examined how Chinese-Canadians' views of health and fitness, and their understanding of mainstream Western health care and fitness programs, influence their health behaviours, health beliefs, and use of health care services. This issue is explored against the backdrop of immigration and processes of integration to understand how this immigrant population reconciles conceptions of health acquired in their originating cultures with their experiences in Western society. METHODS Semi-structured interviews were conducted with 10 first-generation Chinese-Canadians to elicit their views and experiences with the concepts of health and fitness. Interview transcripts were analyzed using an inductive analytic approach involving constant comparison of emerging themes to the data. RESULTS The analysis revealed that participants had integrated some Canadian health and fitness practices in their daily lives, particularly in their diet and use of health care services. Nonetheless, Chinese-Canadians retained their view of the superiority of Eastern conceptions of health and health practices. Both positive and negative changes in their health practices attributed to their immigration experiences. INTERPRETATION The integration of some Western health and fitness practices does not appear to be based on changes in values and beliefs. The evolution and pattern of Chinese-Canadians' practice of health and fitness is complex over the course of immigration and acculturation. The findings of this study suggest the importance of attending to actual practices as a way of understanding how immigration may affect health behaviour and health status.
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Affiliation(s)
- Chunlei Lu
- Department of Preservice Education, Brock University, St. Catharines, ON.
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Karasz A, Dempsey K, Fallek R. Cultural differences in the experience of everyday symptoms: a comparative study of South Asian and European American women. Cult Med Psychiatry 2007; 31:473-97. [PMID: 17985219 DOI: 10.1007/s11013-007-9066-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper describes a study of medically ambiguous symptoms in two contrasting cultural groups. The study combined a qualitative, meaning-centered approach with a structured coding system and comparative design. Thirty-six South Asian immigrants and thirty-seven European Americans participated in a semistructured health history interview designed to elicit conceptual models of medically unexplained illness. The groups reported similar symptoms, but the organization of illness episodes and explanatory models associated with these episodes differed sharply. A variety of cultural variables and processes is proposed to account for observed differences, including somatization, the role of local illness categories, and the divergent core conflicts and values associated with gender roles. It is argued that the comparative design of the study provided insights that could not have been achieved through the study of a single group.
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Affiliation(s)
- Alison Karasz
- Albert Einstein College of Medicine/Montefiore Medical Center, The Bronx, NY 10467, USA.
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Parkar SR, Dawani V, Weiss MG. Clinical diagnostic and sociocultural dimensions of deliberate self-harm in Mumbai, India. Suicide Life Threat Behav 2006; 36:223-38. [PMID: 16704326 DOI: 10.1521/suli.2006.36.2.223] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients' accounts complement psychiatric assessment of deliberate self-harm (DSH). In this study we examined psychiatric disorders, and sociocultural and cross-cultural features of DSH. SCID diagnostic interviews and a locally adapted EMIC interview were used to study 196 patients after DSH at a general hospital in Mumbai, India. Major depression was the most common diagnosis (38.8%), followed by substance use disorders (16.8%), but 44.4% of patients did not meet criteria for an enduring Axis-I disorder (no diagnosis, V-code, or adjustment disorder). Psychache arising from patient-identified sociocultural contexts and stressors complements, but does not necessarily fulfill, criteria for explanatory psychiatric disorders.
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Affiliation(s)
- Shubhangi R Parkar
- Department of Psychiatry, KEM Hospital and Seth GS Medical College, Mumbai, India
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Abstract
Alexander Leighton's seminal work has clearly demonstrated how ethnographic experience provides the rich cultural context in which epidemiological data are best interpreted. This article reviews recent trends in cultural epidemiology, and especially the emergence of the EMIC (Explanatory Model Interview Catalogue) as a quantitatively oriented tool designed to assess culture. It is suggested that such efforts do not reflect more recent trends in culture theory, and tend to view 'cultures' as easily bounded and largely homogenous units to facilitate the generation of quantitative data. It is argued that cultural epidemiologists should take a step back and ask, 'what is the culture in question here?' and 'how do I know if it is appropriate to place any given member of my sample into a specific cultural category?' before proceeding with any 'culturally appropriate' instrument. The answer to these questions begins with a return to ethnography as a means to elucidate and describe culture within the context in which it is being presented and studied.
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Affiliation(s)
- James B Waldram
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada.
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Abstract
OBJECTIVES To compare whether unmet health needs differ between immigrants and non-immigrants, and examine whether help-seeking characteristics account for any unmet needs disparities. METHODS The data are from the Canadian Community Health Survey Cycle 1.1, conducted by Statistics Canada in 2000-2001. The study sample includes 16,046 immigrants and 102,173 non-immigrants aged 18 and older from across Canada. The study employs logistic regression models to examine whether help-seeking behaviours explain unmet needs differences. RESULTS Logistic regression analysis indicates that immigrants have a 12% (95% CI: 6-18) lower all-cause unmet needs risk (odds ratio) than non-immigrants after controlling for differences in help-seeking characteristics. The unmet needs risk among long-term immigrants (15 years of residence and more), however, is similar to non-immigrants after considering these characteristics. We found differences between immigrants and non-immigrants in reasons for unmet needs, with more immigrants believing that the care would be inadequate, not knowing where to access health care, and having foreign language problems. CONCLUSIONS The Canadian health care system delivers sufficient health care to immigrants, even though the poverty rate and proportion of visible minorities are comparatively higher within this subpopulation. Nonetheless, these results indicate that some immigrant-specific health care access barriers may exist.
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Taïeb O, Heidenreich F, Baubet T, Moro MR. [Finding a meaning for illness: from medical anthropology to cultural epidemiology]. Med Mal Infect 2005; 35:173-85. [PMID: 15914285 DOI: 10.1016/j.medmal.2005.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Accepted: 02/18/2005] [Indexed: 11/20/2022]
Abstract
Every illness raises questions concerning its causes and even more its meaning. Why me? Why him? Why now? These questions call for an interpretation which goes beyond a simple application to the individual body and the medical diagnosis. This search for meaning is by no means an archaic attitude and does not only concern the cryptic fields of medicine as several studies in medical anthropology and transcultural psychiatry have shown. A review of literature in anthropology points out the basic concepts of "health care system", "explanatory models", "etiological theories", and "causality of illness". The contribution of these studies to epidemiology and public health of infectious and tropical diseases is discussed through the development of so called cultural epidemiology based on the methodology of the Explanatory Model Interview Catalogue.
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Affiliation(s)
- O Taïeb
- Service de psychopathologie de l'enfant et de l'adolescent et psychiatrie générale (Pr M.R. Moro), hôpital Avicenne (AP-HP), université Paris-XIII, 125, rue de Stalingrad, 93000 Bobigny, France.
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Ahmad F, Shik A, Vanza R, Cheung A, George U, Stewart DE. Popular health promotion strategies among Chinese and East Indian immigrant women. Women Health 2005; 40:21-40. [PMID: 15778130 DOI: 10.1300/j013v40n01_02] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To advance understanding about the popular health promotion strategies and factors associated with the successful transfer and uptake of health messages among Chinese and Indian immigrant women. METHODS Eight focus groups were conducted with 46 immigrant women, 24 from Mainland China and 22 from India, who had lived less than 5 years in Canada. Audiotaped data were transcribed, translated and analyzed by identification of themes and subcategories within and between groups. RESULTS In both ethnic groups, discussions on promoting health messages had five major themes, i.e., sources, barriers, facilitators, credibility and ways to improve access along with group specific sub-themes. Despite identification of several diverse sources of health information in the adopted country, Indian and Chinese immigrant women perceived most strategies as not very effective. The reasons of perceived ineffectiveness were barriers to accessing and comprehending the health messages; and limited prior exposure to institution based or formal health promotion initiatives. These women were more familiar with informal means of obtaining health information such as social networks, mass media and written materials in their mother tongue. CONCLUSION Existing health communication and health promotion models need to be re-orientated from a one-way information flow to a two-way dialogue model to bridge the gap between program efficacy and effectiveness to reach underserved immigrant women. An "outside the box" approach of non-institutional informal health promotion strategies needs to be tested for the studied groups.
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Affiliation(s)
- Farah Ahmad
- Women's Health Program at University Health Network, University of Toronto, Toronto, ON, Canada.
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Joly P, Taïeb O, Abbal T, Baubet T, Moro MR. Représentations culturelles, itinéraires thérapeutiques et santé mentale infantile en Guadeloupe. PSYCHIATRIE DE L ENFANT 2005. [DOI: 10.3917/psye.482.0537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Tzeng WC, Lipson JG. The cultural context of suicide stigma in Taiwan. QUALITATIVE HEALTH RESEARCH 2004; 14:345-358. [PMID: 15011902 DOI: 10.1177/1049732303262057] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In the ethnographic study on which this article is based, the authors investigate experiences after a suicide attempt from the perspective of patients and their family members in Taiwan. Thirty-four patients and 49 family members or colleagues participated in interviews from the point of patients' hospitalization to their return to the community. The postsuicide stigma suffered by patients and their families was based on such cultural themes as Suicide is bu-hsiao (non-filial piety), Suicide results in an inability to transmigrate the soul, and Suicide is inherited. Patients, family members, and colleagues cope with the stigma through explaining suicide as due to "bad luck" or "a kan-huo (hot energy) problem," or by insisting that it was "not a true suicide." These findings suggest that health professionals can move closer to patients and their families and suggest appropriate health care policy through understanding the patient's and the family's explanation of suicide experiences.
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Affiliation(s)
- Wen-Chii Tzeng
- Tri-Service General Hospital, National Defense Medical Center, National Defense University, Taipei, Taiwan.
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