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King JK, Kieu A, El-Deyarbi M, Aljneibi N, Al-Shamsi S, Hashim MJ, Östlundh L, King KE, King RH, AB Khan M, Govender RD. Towards a better understanding between non-Muslim primary care clinicians and Muslim patients: A literature review intended to reduce health care inequities in Muslim patients. HEALTH POLICY OPEN 2023; 4:100092. [PMID: 37383881 PMCID: PMC10297732 DOI: 10.1016/j.hpopen.2023.100092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023] Open
Abstract
Although Muslims are a growing population within many non-Muslim countries, there are insufficient Muslim clinicians to care for them. Studies have shown that non-Muslim clinicians have limited knowledge and understanding of Islamic practices affecting health, which may lead to disparities in the quality of healthcare delivery and outcomes when caring for Muslim patients. Muslims come from many different cultures and ethnicities and have variations in their beliefs and practices. This literature review provides some insights which may strengthen therapeutic bonds between non-Muslim clinicians and their Muslim patients resulting in improved holistic, patient-centered care in the areas of cancer screening, mental health, nutrition, and pharmacotherapy. Additionally, this review informs clinicians about the Islamic perspective on childbirth, end of life issues, travel for Islamic pilgrimage, and fasting during the month of Ramadan. Literature was sourced by a comprehensive search in PubMed, Scopus, and CINAHL along with hand screening of citations. Title and abstract screening followed by full-text screening excluded studies including less than 30% Muslim participants, protocols, or reporting results deemed irrelevant to primary care. 115 papers were selected for inclusion in the literature review. These were grouped into the themes of general spirituality, which were discussed in the Introduction, and Islam and health, Social etiquette, Cancer screening, Diet, Medications and their alternatives, Ramadan, Hajj, Mental health, Organ donation and transplants, and End of life. Summarizing the findings of the review, we conclude that health inequities affecting Muslim patients can be addressed at least in part by improved cultural competency in non-Muslim clinicians, as well as further research into this area.
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Affiliation(s)
- Jeffrey K King
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Home Based Primary Care, Division of Extended Care and Geriatrics, Department of Veterans Affairs, Greater Los Angeles area, CA, USA
| | - Alexander Kieu
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Kanad Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Marwan El-Deyarbi
- Ambulatory Health Services, Abu Dhabi, United Arab Emirates
- Department of Pharmacology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Noof Aljneibi
- Emirates Center for Happiness Research, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Saif Al-Shamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | - Muhammad Jawad Hashim
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
| | | | | | - Renee Houjintang King
- Academic Family Medical Center, Ventura County Family Medicine Residency Program, 300 Hillmont Ave, Building 340, Suite 201, Ventura, CA, USA
| | - Moien AB Khan
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
- Primary Care, NHS North West London, London TW3 3EB, United Kingdom
| | - Romona Devi Govender
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
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de-Graft Aikins A, Sanuade O, Baatiema L, Adjaye-Gbewonyo K, Addo J, Agyemang C. How chronic conditions are understood, experienced and managed within African communities in Europe, North America and Australia: A synthesis of qualitative studies. PLoS One 2023; 18:e0277325. [PMID: 36791113 PMCID: PMC9931108 DOI: 10.1371/journal.pone.0277325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/24/2022] [Indexed: 02/16/2023] Open
Abstract
This review focuses on the lived experiences of chronic conditions among African communities in the Global North, focusing on established immigrant communities as well as recent immigrant, refugee, and asylum-seeking communities. We conducted a systematic and narrative synthesis of qualitative studies published from inception to 2022, following a search from nine databases-MEDLINE, EMBASE, PsycINFO, Web of Science, Social Science Citation Index, Academic Search Complete, CINAHL, SCOPUS and AMED. 39 articles reporting 32 qualitative studies were included in the synthesis. The studies were conducted in 10 countries (Australia, Canada, Denmark, France, Netherlands, Norway, Sweden, Switzerland, United Kingdom, and the United States) and focused on 748 participants from 27 African countries living with eight conditions: type 2 diabetes, hypertension, prostate cancer, sickle cell disease, chronic hepatitis, chronic pain, musculoskeletal orders and mental health conditions. The majority of participants believed chronic conditions to be lifelong, requiring complex interventions. Chronic illness impacted several domains of everyday life-physical, sexual, psycho-emotional, social, and economic. Participants managed their illness using biomedical management, traditional medical treatment and faith-based coping, in isolation or combination. In a number of studies, participants took 'therapeutic journeys'-which involved navigating illness action at home and abroad, with the support of transnational therapy networks. Multi-level barriers to healthcare were reported across the majority of studies: these included individual (changing food habits), social (stigma) and structural (healthcare disparities). We outline methodological and interpretive limitations, such as limited engagement with multi-ethnic and intergenerational differences. However, the studies provide an important insights on a much-ignored area that intersects healthcare for African communities in the Global North and medical pluralism on the continent; they also raise important conceptual, methodological and policy challenges for national health programmes on healthcare disparities.
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Affiliation(s)
- Ama de-Graft Aikins
- Institute of Advanced Studies, University College London, London, United Kingdom
- * E-mail:
| | - Olutobi Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kafui Adjaye-Gbewonyo
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom
| | - Juliet Addo
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Gestational diabetes: changed health beliefs in migrant women from five Asian countries living in Sweden: a prospective qualitative study. Prim Health Care Res Dev 2022; 23:e2. [PMID: 35016742 PMCID: PMC8822325 DOI: 10.1017/s1463423621000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: The aim of this study was to explore the temporal development of beliefs about health, illness and health care in migrant women with gestational diabetes (GD) born in Asia residing in Sweden, and the influence on health-related behaviour in terms of self-care and seeking care. Background: Migrant Asian women are a high-risk group for developing GD. Adapting to the culture in the new society and the healthcare system, being diagnosed with GD and becoming a mother is demanding. The question is whether Asian migrants’ patterns of beliefs and behaviour change over time, as no previous study has been revealed on this topic. Method: Qualitative prospective exploratory study. Semi-structured interviews were held on three occasions: during pregnancy and three and fourteen months after delivery, with women born in Asia, diagnosed with GD. Data were analysed with qualitative content analysis. Findings: There was a temporal change of beliefs influencing health-related behaviour, showing a rising curve in risk awareness. An increasing number of persons described developing a healthy diet/lifestyle based on initial advice and shifted focus from the child to worries about the woman’s health and risk of developing type 2 diabetes and being unable to care for the child/family. Also, the number of women perceiving GD as a transient condition decreased and more believed it would last forever. Beliefs about health care were unchanged, the healthcare model was perceived working well but information about GD and follow-ups was requested even after delivery, and competent staff was expected. Health professionals’ beliefs about the seriousness of GD influence patients’ beliefs and need to be considered. Migrant women need support with adequate information, based on their individual beliefs, to continue develop a sustainable healthy lifestyle even after giving birth, to promote health and prevent type 2 diabetes.
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Yılmaz TE, Başara E, Yılmaz T, Kasım İ, Özkara A. Approaches and awareness of family physicians on diabetes management during Ramadan. Int J Clin Pract 2021; 75:e14205. [PMID: 33811792 DOI: 10.1111/ijcp.14205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/31/2021] [Indexed: 11/27/2022] Open
Abstract
AIM This study aimed to determine the approaches of family physicians in Turkey towards the fasting of diabetic patients and whether they used international treatment guidelines when making recommendations. In addition, this study also aimed to increase the awareness of family physicians about this issue before Ramadan, which is a month of fasting. MATERIAL AND METHOD The study herein comprised cross-sectional, observational research. Before Ramadan 2018, a structured questionnaire form, which was unique to this study, was prepared based on the guidelines of the International Diabetes Federation (IDF) and the American Diabetes Association (ADA), through platforms where family physicians gather via social media and mail groups, and sent to family physicians in Turkey via a link using an electronic questionnaire preparation and application programme. Moreover, the total knowledge level, attitude, and approach scores were calculated from the questions prepared from the relevant guidelines. RESULTS Participating in the survey were 262 family physicians. Only 22% of the family physicians stated that they were aware of the international guidelines for Ramadan and diabetes management, and only 10% said that they had read them. The mean knowledge level, attitude, and approach scores were determined to be lower than expected, and a significant difference was found between the scores and academic titles. CONCLUSION The lack of international guidelines on the subject, and of knowledge and experience about Diabetes Mellitus (DM) patient management during the month of fasting, stood out as the biggest problems. This study revealed that the awareness and competence of family physicians in disease management should be increased, in addition to that of fasting before, during, and after Ramadan in patients with DM, which has increasing prevalence in Turkey.
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Affiliation(s)
- Tarık Eren Yılmaz
- Department of Family Medicine, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ekrem Başara
- Department of Family Medicine, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Tuğba Yılmaz
- Department of Family Medicine, Ankara Provincial Health Directorate, Ankara, Turkey
| | - İsmail Kasım
- Department of Family Medicine, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Adem Özkara
- Department of Family Medicine, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Alloh FT, Hemingway A, Turner-Wilson A. Systematic review of diabetes management among black African immigrants, white and South Asian populations. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Al-Murani F, Aweko J, Nordin I, Delobelle P, Kasujja F, Östenson CG, Peterson SS, Daivadanam M, Alvesson HM. Community and stakeholders' engagement in the prevention and management of Type 2 diabetes: a qualitative study in socioeconomically disadvantaged suburbs in region Stockholm. Glob Health Action 2019; 12:1609313. [PMID: 31116096 PMCID: PMC6537701 DOI: 10.1080/16549716.2019.1609313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: Community-based approaches have been identified as an effective strategy to address the growing burden of noncommunicable diseases (NCDs) worldwide. However, little is known about community as a concept among people living in socioeconomically disadvantaged settings and stakeholders' interactions and engagement in NCDs prevention and management. Objective: The aim of this study was to understand; (1) the meaning of community among people living in socioeconomically disadvantaged suburbs in Region Stockholm and (2) how communities interact and engage with stakeholders at local and regional levels for the prevention and management of type 2 diabetes (T2D). Methods: This qualitative study was conducted in three municipalities in Region Stockholm with a high proportion of migrants. Multiple data collection methods were used, including observations of community activities; interviews with community members, representatives of public authorities and NGOs; and group interviews with healthcare providers. Data were analyzed using content analysis. Results: Community was perceived as living in close proximity with shared beliefs, values and resources. Although they recognized its social and cultural diversity, community members focused more on the commonalities of living in their neighborhood and less on their differences in country of birth and languages spoken. Several mismatches between awareness of community needs and the available skills and resources among stakeholders for T2D prevention were identified. Stakeholders expressed awareness of T2D risk and interest in addressing it in a culturally appropriate manner. Conclusion: Interaction between the communities and stakeholders was limited, as was engagement in T2D prevention and management. This highlights barriers in the collaboration between community, healthcare institutions and other stakeholders which consequently affect the implementation of preventive interventions. Innovative ways to link the community to the healthcare sector and other local government institutions are needed to build the capacity of health systems for T2D prevention in socioeconomically disadvantaged communities.
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Affiliation(s)
- F Al-Murani
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - J Aweko
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
| | - I Nordin
- b Department of Food Studies, Nutrition, and Dietetics , Uppsala University , Uppsala , Sweden
| | - P Delobelle
- c School of Public Health , University of the Western Cape , Bellville , South Africa.,d Chronic Disease Initiative for Africa , University of Cape Town , Rondebosch , South Africa
| | - Fx Kasujja
- e Department of Biostatistics and Epidemiology , Makerere University College of Health Sciences, School of Public Health , Kampala , Uganda
| | - C-G Östenson
- f Department of Molecular Medicine and Surgery, Diabetes and Endocrinology Unit , Karolinska Institutet , Stockholm , Sweden
| | - S S Peterson
- g Department of Women's and Children's Health , International Maternal and Child Health, Uppsala University , Uppsala , Sweden
| | - M Daivadanam
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,b Department of Food Studies, Nutrition, and Dietetics , Uppsala University , Uppsala , Sweden
| | - H M Alvesson
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden
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Myers PR, Shoqirat N, Allen DH, Dardas LA. Patients with diabetes observing Ramadan: The experience of Muslims in the United States. Diabetes Res Clin Pract 2019; 150:282-287. [PMID: 30633934 DOI: 10.1016/j.diabres.2018.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/06/2018] [Accepted: 12/17/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Little is known about the experience of Muslims with diabetes while fasting during Ramadan in the United States. Providing quality care for Muslim patients requires being aware of Islamic beliefs and practices, particularly in regard to healthcare ramifications. Therefore, the aims of this study were to (a) explore the beliefs which influence the experience and practices of diabetes management among Muslims in the United States during Ramadan, and (b) explore perspectives of Muslims with diabetes on their experience with healthcare providers providing support during their fasting experience. METHODS Using an exploratory design, semi-structured interviews were conducted for qualitative analyses. A purposive sample of 14 Muslim patients with diabetes was recruited from mosques located across North Carolina. RESULTS Analyses revealed six subthemes on their "feelings" that were inherent to their experiences of managing diabetes while fasting during Ramadan. These were organized into two main themes: (1) having diabetes and fasting during Ramadan and (2) fasting challenges. Having diabetes and fasting during Ramadan focused on the experience of fasting and comprised four "feelings": (1) feeling spiritually connected, (2) feeling socially connected, (3) feeling physically healthy, and (4) feeling religiously obligated. The second theme focused on fasting challenges and included (1) feeling sick and dehydrated, and (2) feeling vulnerable and poorly understood by healthcare providers. CONCLUSION This is the first known study to explore the experience of Muslims with diabetes while fasting during Ramadan in the United States. Our findings offer important insights into how Muslims manage their diabetes while fasting and the missed opportunities for relevant conversations when partnering with healthcare providers during Ramadan. The importance of cultural competency across healthcare systems in the United States cannot be overemphasized. Healthcare providers need to hold conversations embracing shared decision-making to resolve healthcare dilemmas resulting from cultural differences, expand cultural knowledge, and adapt services to meet culturally-unique needs of their patients.
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Affiliation(s)
- Pauline R Myers
- Duke University Hospital, 2301 Erwin Rd, Durham, NC 27710, United States.
| | | | - Deborah H Allen
- Nursing Research & EBP, Duke University Health System, Durham, NC 27710, United States.
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Exploring Drug-Related Problems in Diabetic Patients during Ramadan Fasting in Saudi Arabia: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030499. [PMID: 30754675 PMCID: PMC6388163 DOI: 10.3390/ijerph16030499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 11/16/2022]
Abstract
This study aimed to identify any drug-related problems (DRPs) in diabetic patients during Ramadan fasting in Saudi Arabia. The study used a mixed-methods approach consisting of two phases and was conducted in Makkah, Saudi Arabia from December 2017 to March 2018. The first phase of the study involved qualitative semi-structured individual interviews with diabetic patients. A 13-item questionnaire was used in the second phase to further identify DRPs in the wider population. The data was mainly presented as frequencies and percentages. Inferential statistics was performed using Statistical Package for Social Sciences (SPSS) version 21 to compare relevant variables/questions using the chi-square test. Twenty patients (10 male, 10 female) attended face-to-face interviews during the first phase of the study while 95 (40 male, 55 female) completed the questionnaire in the second phase of the study. Two possible risk factors for DRPs were identified from the qualitative data: patient-related factors, including changes in their medicine intake during fasting, and healthcare professionals-related factors, including lack of advice from healthcare professionals regarding fasting. The quantitative results indicated that 52 (54%) of the 95 participants who observed fasting reported to have changed the way they were taking their medicines. Furthermore, 41% of the participants experienced general healthcare problems such as hypoglycemia, hyperglycemia, fatigue, excessive sweating, and gastrointestinal disturbances. Healthcare professionals need to educate patients who are at risk of DRPs by providing structured education and counseling.
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Aweko J, De Man J, Absetz P, Östenson CG, Swartling Peterson S, Mölsted Alvesson H, Daivadanam M. Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1810. [PMID: 30135373 PMCID: PMC6164476 DOI: 10.3390/ijerph15091810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 12/27/2022]
Abstract
Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.
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Affiliation(s)
- Juliet Aweko
- Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
| | - Jeroen De Man
- Department of Public Health, Institute of Tropical Medicine, 43, 2000 Antwerp, Belgium.
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland.
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, SE-171 77 Stockholm, Sweden.
| | - Stefan Swartling Peterson
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, 751 85 Uppsala, Sweden.
| | - Helle Mölsted Alvesson
- Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
| | - Meena Daivadanam
- Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
- Department of Food, Nutrition and Dietetics, Uppsala University, P.O. Box 560, 751 22 Uppsala, Sweden.
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A qualitative study of developing beliefs about health, illness and healthcare in migrant African women with gestational diabetes living in Sweden. BMC WOMENS HEALTH 2018; 18:34. [PMID: 29402265 PMCID: PMC5800284 DOI: 10.1186/s12905-018-0518-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 01/16/2018] [Indexed: 01/09/2023]
Abstract
Background Gestational diabetes (GDM) is associated with health risks for both mother and child, and is particularly relevant to migrant women and women of African origin. With today’s extensive global migration, contact with the new society and health system confronts the migrant’s culture of origin with the culture of the host country. The question is whether immigrants’ patterns of beliefs about health, illness, and health-related behaviour change over time, as no previous studies have been found on this topic. The purpose was to explore development over time, during and after pregnancy, of beliefs about health, illness and healthcare in migrant women with GDM born in Africa living in Sweden, and study the influence on self-care and care seeking. Methods Qualitative prospective study. Semi-structured interviews, with 9 women (23–40 years), on three different occasions: during pregnancy (gestational weeks 34–38), and 3 and 14 months after delivery managed at an in-hospital diabetes specialist clinic in Sweden. Results Beliefs were rather stable over time and mainly related to individual and social factors. GDM was perceived as a transient condition as health professionals had informed about it, which made them calm. None, except one, expressed worries about relapse and the health of the baby. Instead women worried about being unable to live an ordinary life and being bound to lifestyle changes, particularly diet, developing diabetes and needing insulin injections. Over time knowledge of appropriate diet improved, although no advice was experienced given by the clinic after delivery. The healthcare model was perceived as well functioning with easy access but regular follow-ups were requested as many (decreasing over time) were unsure whether they still had GDM and lacked information about GDM and diet. During pregnancy information was also requested about the healthcare system before/after delivery. Conclusions Beliefs changed to a limited extent prospectively, indicated low risk awareness, limited knowledge of GDM, irrelevant worries about future health, and being unable to live a normal life, associated with problematic lifestyle changes. Beliefs about the seriousness of GDM in health professionals influenced patients’ beliefs and health-related behaviour. The healthcare organisation urgently needs to be improved to deliver appropriate and timely information through competent staff. Electronic supplementary material The online version of this article (10.1186/s12905-018-0518-z) contains supplementary material, which is available to authorized users.
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Ilkilic I, Ertin H. Ethical conflicts in the treatment of fasting Muslim patients with diabetes during Ramadan. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2017; 20:561-570. [PMID: 28444477 DOI: 10.1007/s11019-017-9777-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND For an effective treatment of patients, quality-assured safe implementation of drug therapy is indispensable. Fasting during Ramadan, an essential religious practice for Muslims, affects Muslim diabetics' drug use in a number of different ways. OBJECTIVES Ethical problems arising from fasting during the month of Ramadan for practicing Muslim patients are being discussed on the basis of extant research literature. Relevant conflicts of interest originating in this situation are being analysed from an ethical perspective. MATERIAL AND METHODS A number of databases have been searched systematically in view of the stated objectives to identify relevant studies. Starting point for this review are the following questions: What information is available regarding the fasting behaviour of Muslim diabetics during Ramadan? What kind of ethical problems can be identified in the context of this religious practice? RESULTS The present review established a number of problems concerning medication adherence and drug use of practising Muslim diabetics during Ramadan, notably insufficient compliance, reduced frequency of consultations with their doctor, and inadequate, not sufficiently goal-oriented doctor-patient conversations about fasting. CONCLUSIONS Deficiencies in medical as well as religious knowledge about fasting in Ramadan and a lack of sensitivity have been found among Muslim patients as well as among doctors. Compliance management and drug use in this area can be improved by effective, goal-oriented action plans and projects through which linguistic and cultural barriers can be addressed.
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Affiliation(s)
- Ilhan Ilkilic
- Department of History of Medicine and Ethics, Istanbul University Faculty of Medicine, Hulusi Behçet Kütüphanesi Kat 2, 34093, Istanbul/Capa, Turkey.
| | - Hakan Ertin
- Department of History of Medicine and Ethics, Istanbul University Faculty of Medicine, Hulusi Behçet Kütüphanesi Kat 2, 34093, Istanbul/Capa, Turkey
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Jones V, Crowe M. How people from ethnic minorities describe their experiences of managing type-2 diabetes mellitus: A qualitative meta-synthesis. Int J Nurs Stud 2017; 76:78-91. [DOI: 10.1016/j.ijnurstu.2017.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
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Vanstone M, Rewegan A, Brundisini F, Giacomini M, Kandasamy S, DeJean D. Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis. Chronic Illn 2017; 13:217-235. [PMID: 27884930 DOI: 10.1177/1742395316675024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.
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Affiliation(s)
- Meredith Vanstone
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Alex Rewegan
- 3 MA Program in Social Anthropology, York University, Hamilton, ON, Canada
| | - Francesca Brundisini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,4 Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
| | - Mita Giacomini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sujane Kandasamy
- 5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Deirdre DeJean
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Majeed‐Ariss R, Jackson C, Knapp P, Cheater FM. A systematic review of research into black and ethnic minority patients' views on self-management of type 2 diabetes. Health Expect 2015; 18:625-42. [PMID: 23710892 PMCID: PMC5060817 DOI: 10.1111/hex.12080] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2013] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Eliciting patients' views of type 2 diabetes self-management provides insights on how policy and services might better support the needs of this population. OBJECTIVE To synthesize black and ethnic minority patients' views on the barriers and facilitators influencing the self-management of type 2 diabetes. SEARCH STRATEGY A systematic search of international literature published in nine electronic databases was undertaken in 2008. Search strategies used both MeSH and free-text terms. Two relevant journals were also hand searched. INCLUSION CRITERIA Any primary empirical study published in the English language since 1986 that reported black and ethnic minority patients' views on type 2 diabetes self-management. DATA EXTRACTION AND SYNTHESIS Data were extracted and study quality was formally assessed. Data were analysed using thematic synthesis. MAIN RESULTS Fifty-seven studies were included, of qualitative (n = 54), mixed-method (n = 2) or quantitative (n = 1) design. Studies were from North America (n = 41), Europe (n = 14) and Australia (n = 2), including 1735 participants in total. Three analytical themes emerged: 'Importance of identity'; 'Being understood by others' and 'Making sense of condition', all linked conceptually under the overarching theme 'Sense of self'. The quality of the studies varied. DISCUSSION AND CONCLUSIONS The findings provide insight into what black and minority ethnic people regard as the barriers to, and facilitators of self-management, as opposed to what health professionals, policy makers and trial researchers may have assumed. Recognition of the views of people with diabetes is essential for the design and delivery of patient-centred care and policies.
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Affiliation(s)
| | - Cath Jackson
- School of HealthcareBaines WingUniversity of LeedsUK
| | - Peter Knapp
- School of HealthcareBaines WingUniversity of LeedsUK
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Understanding Cultural Beliefs in Families of Somali Children with Diabetes in the Twin Cities, Minnesota. J Community Health 2015; 40:827-33. [PMID: 25925720 DOI: 10.1007/s10900-015-0006-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Describe cultural beliefs related to diabetes in Minnesota Somali children with type 1 diabetes (T1D), and compare their diabetes control to that of non-Somali children with diabetes. A cross-sectional study involving Somali children ≤ 19 years with T1D at the University of Minnesota Masonic Children's Hospital and Children's Hospitals and Clinics of Minnesota. A survey was administered to parents of all participants and to children aged ≥ 12 years. Data were collected by history and from the medical record. Twenty-five Somali children participated, with 24 parent-child pairs (2 siblings). Mean participant age was 12.2 ± 5.2 (36% female). Seventy-one percent of parents indicated the child was "the same as before" other than having to do diabetes cares. Families were coping well, and the child was not treated differently than siblings. Performance of routine cares was described as the hardest part about having diabetes, but this was not related to traditional culture or religion. One notable exception was difficulty performing carbohydrate counting on Somali foods. Respondents were appreciative of the education provided by the diabetes team. Less than 10% used herbal supplements in addition to insulin. Mean HbA1c in Somali children was higher than the overall pediatric clinic average, 9.5 ± 1.6 % versus 8.8 ± 1.6 (p = 0.01). The difference was largely due to adolescent patients. The majority of Somali families cope well with diabetes and have a positive attitude towards the diabetes education. Glycemic control in adolescents is worse than in non-Somali peers. There is a need for culture-specific dietary instruction materials.
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Amarasekara AATD, Fongkaew W, Turale S, Wimalasekara SW, Chanprasit C. An ethnographic study of diabetes health beliefs and practices in Sri Lankan adults. Int Nurs Rev 2014; 61:507-14. [PMID: 25363651 DOI: 10.1111/inr.12136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Globally, type 2 diabetes is increasingly prevalent; however, unique cultural contexts in each country might affect these diabetes control behaviours. Diabetes is a serious health issue in Sri Lanka and little is known about the impact of sociocultural context on diabetes health behaviours. AIM This first-time qualitative Sri Lankan study explored the health beliefs and practices of adults with diabetes to enhance current nursing care and medical treatment. METHODS An ethnographic approach was used to collect data through participant observations, in-depth interviews with 14 key informants in their homes and field notes. Data were analysed by thematic analysis. RESULTS Findings revealed unique, informative insights into sociocultural worlds of the participants from three Sinhalese, Tamils and Moor ethnic groups. Findings are described under five themes: gaining religious support, changing food habits is a struggle, exercising is challenging, Western medicine causes long-term consequences and Ayurveda/traditional treatments can cure. CONCLUSION In Sri Lankans, the impact of sociocultural context on glycaemic control behaviours is significant and should be taken in consideration when health professionals provide care, treatment and health education. LIMITATIONS Study informants were selected from three ethnic groups and just two communities. Further in-depth research is required using both qualitative and quantitative approaches in individual groups. IMPLICATIONS FOR NURSING AND HEALTH POLICY Culturally relevant policies and protocols for community care and treatment of people with diabetes are urgently required in Sri Lanka to enhance cultural treatment and care and reduce the epidemic of diabetes. These policies need to take into account traditional beliefs and practices of various ethnic groups.
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Affiliation(s)
- A A T D Amarasekara
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand; Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Van Son CR. Developing Culturally Targeted Diabetes Educational Materials for Older Russian-Speaking Immigrants. DIABETES EDUCATOR 2014; 40:418-426. [PMID: 24667951 DOI: 10.1177/0145721714528247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Older adults who immigrate late in life face many challenges adapting to a new country. Immigrants bring their cultural beliefs and behaviors with them, which can influence their ability to make dietary changes required when they have type 2 diabetes. Culturally targeted patient education materials are needed to improve immigrants' health literacy and abilities to self-manage diabetes. Currently, there is a scarcity of diabetes patient education materials to meet the educational needs of the Russian-speaking immigrant group. The purpose of this article is to describe a project in which culturally targeted diabetes education materials for older Russian-speaking immigrants were designed and developed. CONCLUSIONS Culturally targeted patient education materials are essential if they are to be accepted and used by clients from different ethnic minority populations. The creation of culturally relevant materials requires a team effort and community stakeholder input. The availability of materials on the internet facilitates access and use by health care providers. Culturally targeted education materials are an important component in addressing health literacy in ethnic minority populations. Next steps require that these materials be evaluated to test their impact on diabetes self-management behaviors and clinical outcomes such as adherence, amount of physical activity, and blood glucose levels.
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Mygind A, Kristiansen M, Wittrup I, Nørgaard LS. Patient perspectives on type 2 diabetes and medicine use during Ramadan among Pakistanis in Denmark. Int J Clin Pharm 2013; 35:281-8. [PMID: 23354808 DOI: 10.1007/s11096-012-9716-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/08/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Type 2 diabetes is highly prevalent among people of Pakistani background. Studies show that adherence to medicines is complicated for people with type 2 diabetes in general. Also, studies indicate that many people with type 2 diabetes and Muslim background fast during the month of Ramadan without adequate counselling on how to adjust their medicines. OBJECTIVE To explore patient perspectives on medicine use during Ramadan, reasons for fasting and experiences with counselling on medicine use during Ramadan among people of Pakistani background with type 2 diabetes and at least one other chronic condition. SETTING Greater Copenhagen, Denmark. METHOD The analysis is based on a study exploring lived experiences with counselling on medicines using semi-structured interviews and medication reviews. The analysis presented here builds on the subset of patients with Pakistani background (six interviewers). RESULTS All interviewees pointed out that Islam allows ill people to refrain from fasting during Ramadan. However, all had fasted during Ramadan despite being diagnosed with type 2 diabetes. While fasting, they adapted their use of medicines in different ways, e.g. by changing the time of intake or by skipping morning medicines. Fasting during Ramadan meant a feeling of improvement in well-being for all interviewees. Reasons for this improvement included physiological, social and religious aspects. Healthcare professionals were rarely included in the decision-making process on whether or not to fast. Instead, friends and relatives, especially those with type 2 diabetes, were considered important to the decision-making process. CONCLUSION For people with Muslim background and a chronic condition, fasting during Ramadan may mean changes in medicine use that are not always discussed with healthcare professionals. Healthcare professionals should acknowledge that Muslim patients may find fasting during Ramadan beneficial to their well-being and therefore choose to fast despite the Islamic rule of exemption. This patient-centred approach to counselling on medicines may facilitate better medicine use and thus better clinical health outcomes among patients that choose to fast.
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Affiliation(s)
- Anna Mygind
- Section for Social Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen, Denmark.
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Hailu E, Mariam WH, Belachew T, Birhanu Z. Self-care practice and glycaemic control amongst adults with diabetes at the Jimma University Specialized Hospital in south-west Ethiopia: A cross-sectional study. Afr J Prim Health Care Fam Med 2012. [PMCID: PMC4565429 DOI: 10.4102/phcfm.v4i1.311] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The main goal in diabetes care is to improve the patient's quality of life, to maintain satisfactory metabolic control and to retain minimal complications caused by diabetes mellitus (DM). Thus, this study has assessed self-care practice and glycaemic control amongst adults with diabetes mellitus. Setting A facility-based study amongst the diabetic follow-up clinic at Jimma University Specialized Hospital in Ethiopia. Methods A cross-sectional study was conducted from 01 April to 30 April 30 2010. A total of 343 diabetic patients were selected using a systematic sampling method. The data were collected by structured questionnaires and a medical card review; anthropometric measurement was done by trained nurses. Results The study showed that 53% of the respondents had diabetes related knowledge. The study also found that 64% of the respondents were physically less active, and 17% of the respondents were walking on foot for less than 30 minutes per a day. Only 18.1% of the respondents were able to control their Fasting Blood Sugar (FBS) to level below 126 mg/dL. Conclusion The present study illustrates that the level of knowledge about diabetes and self-care practices amongst diabetic patients were meager. In addition, it showed that respondents’ level of physical activity, their educational status, and the dose of oral hypoglycaemic agents taken by the respondents significantly affected glycaemic control.
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Affiliation(s)
| | | | - Tefera Belachew
- Department of Population and Family Health, Jimma University, Ethiopia
| | - Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Jimma University, Ethiopia
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Kumar R, Einstein G. Cardiovascular Disease in Somali Women in the Diaspora. CURRENT CARDIOVASCULAR RISK REPORTS 2012. [DOI: 10.1007/s12170-012-0233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Qualitative research methodology is more recognized and valued in diabetes behavioral research in recent years. Qualitative methods help clinicians answer questions that quantitative research may not be able to answer, such as exploring patients' motivations, perceptions, and expectations. This paper reviews recent (2005-present) rigorous qualitative studies of children, adolescents, and adult patients with type 1 and type 2 diabetes with the aim of answering the following research question: How has qualitative research contributed to our understanding of behavioral diabetes care? We focus on studies exploring patients', health care providers', and families' interpersonal experiences of diabetes as well as patients' psychosocial experiences of diagnosis and treatment, self-care, complications, and cultural factors. After reviewing the research in each area, we conclude by discussing how qualitative research contributes to our increased understanding of behavioral diabetes.
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Björk Brämberg E, Nyström M. To be an immigrant and a patient in Sweden: A study with an individualised perspective. Int J Qual Stud Health Well-being 2010; 5:10.3402/qhw.v5i3.5106. [PMID: 20967139 PMCID: PMC2958086 DOI: 10.3402/qhw.v5i3.5106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2010] [Indexed: 11/14/2022] Open
Abstract
The aim is to describe how experiences of being an immigrant can influence the situation when becoming a patient in Swedish health care. A hermeneutic approach was used. Sixteen persons born in non-Nordic countries were interviewed. The data was analysed with an empirical hermeneutical method. The findings indicate that positive experiences (i.e., establishing oneself in a new home country) enhance the possibilities of taking part in caring situations and vice versa. Hence, there is a need for individually adapted care that takes one's whole life situation into consideration. Consequently, it is suggested that the concept, "cultural competence" merely serves the purpose of illuminating caregivers' need for categorisation. It does not illuminate individual needs in a caring situation.
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Affiliation(s)
| | - Maria Nyström
- School of Health Sciences, University of Borås, Borås, Sweden
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