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Msoka EF, Bunn C, Msoka P, Yongolo NM, Laurie E, Wyke S, McIntosh E, Mmbaga BT. Rapid ethnographic appraisal of community concepts of and responses to joint pain in Kilimanjaro, Tanzania. BMJ Glob Health 2024; 9:e013245. [PMID: 38296532 PMCID: PMC10831465 DOI: 10.1136/bmjgh-2023-013245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Musculoskeletal disorders, experienced as joint pain, are a significant global health problem, but little is known about how joint pain is categorised and understood in Tanzania. Understanding existing conceptualisations of and responses to joint pain is important to ensure both research and interventions are equitable and avoid biomedical imposition. METHODS Rapid ethnographic appraisal was conducted in a periurban and rural community in Kilimanjaro, documenting language used to describe joint pain, ideas about causes, understandings of who experiences such pain, the impacts pain has and how people respond to it. We conducted 66 interviews with community leaders, traditional healers, community members and pharmacists.Photographs were taken and included in fieldnotes to supplement the interview data and develop thick descriptions. Data were analysed by constant comparison using QDA Miner software. RESULTS Across the sample, dominant concepts of joint pain were named ugonjwa wa baridi, cold disease; ugonjwa wa uzee, old age disease; rimatizim, disease of the joints; and gauti, gout. Causes mentioned included exposure to the cold, old age, alcohol and red meat consumption, witchcraft, demons and injuries/falls. Age, gender and occupation were seen as important factors for developing joint pain. Perceived impacts of joint pain included loss of mobility, economic and family problems, developing new health conditions, death, reduction in sexual functioning and negative self-perceptions. Responses to joint pain blended biomedical treatments, herbal remedies, consultations with traditional healers and religious rituals. CONCLUSIONS Conceptualisations of and responses to joint pain in the two communities were syncretic, mixing folk and biomedical practices. Narratives about who is affected by joint pain mirror emerging epidemiological findings, suggesting a strong 'lay epidemiology' in these communities. Anthropological methods can support the decolonisation of global health by decentring the imposition of English language biomedicine and pursuing synthetic, dignified languages of care.
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Affiliation(s)
- Elizabeth F Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Perry Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Emma Laurie
- School of Geographical & Earth Sciences, University of Glasgow, Glasgow, UK
| | - Sally Wyke
- School of Health & Wellbeing Social Sciences, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- School of Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Rasweswe MM, Peu MD, Mulaudzi FM. The importance of local language in healthcare: naming and defining dysmenorrhea. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:205-214. [PMID: 37401880 DOI: 10.1080/17538068.2022.2094690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Using local language improves the quality of healthcare and patient safety but little has been done to understand and use local language in naming and defining conditions such as dysmenorrhea. Many indigenous African women value their language especially when communicating about women's health. METHOD In this exploratory study, we wanted to understand the local language used to construct and conceptualize dysmenorrhea and highlight the importance of local language when healthcare practitioners engage with women experiencing dysmenorrhea guided by Africana Womanism Theory. Data were collected from 15 Black indigenous women using a Lekgotla discussion group and in-depth interviews. Data were thematically analyzed. RESULTS Participants described how local language is important in naming and seeking healthcare. Drawing from their descriptions three themes emerged: (1) Self-naming and self-defining dysmenorrhea using a local language; (2) Types of local words, phrases, and terms used to name and define dysmenorrhea; (3) The importance of self-naming and self-defining dysmenorrhea in a local language. CONCLUSIONS Communication between healthcare seekers and healthcare providers is at the heart of effective healthcare provision. Poor communication due to language barriers contributes to misunderstanding, misdiagnoses, poor or incomplete patient assessment, and delayed treatment. Therefore, communicating healthcare issues in a local language would promote culturally sensitive care.
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Affiliation(s)
- Melitah Molatelo Rasweswe
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Mmapheko Doriccah Peu
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Fhumulani Mavis Mulaudzi
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
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Cultural factors influencing self-care by persons with cardiovascular disease: An integrative review. Int J Nurs Stud 2019; 116:103383. [PMID: 31353026 DOI: 10.1016/j.ijnurstu.2019.06.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/30/2019] [Accepted: 06/28/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Self-care is critical for maintaining health, minimizing disease complications, and improving quality of life. Understanding valid, culturally-specific practices and their influence on self-care behaviors can inform development of interventions to improve outcomes for individuals living with cardiovascular disease (CVD). To date, the influence of culture on self-care behaviors has not been adequately examined in different CVD populations. AIM The aim of this review was to synthesize past empirical literature examining cultural factors influencing self-care in patients with CVD. METHOD An integrative review method was used. A literature search was conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Anthropology Plus, and the International Bibliography of the Social Sciences (IBBS) computerized databases. No limit was placed on publication date. Articles were included if they were: (1) peer-reviewed original primary research studies, (2) published in English with full-text availability, (3) conducted in adults (≥19 years), (4) addressed culture related to health and health behaviors, (5) related to self-care or elements of self-care, and (6) related to CVD. Fourteen articles met the inclusion criteria and were included in this review. RESULTS Culture influences self-care in general, but predominantly self-care maintenance behaviors. In African American and South Asian populations, cultural beliefs such as fatalism, collectivism and traditional gender roles clashed with dietary adherence. Traditional beliefs and ideas, collectivism, family and kinship ties, fatalism, cultural norms and normative thinking played critical roles in medication adherence and use of complementary/alternative medicine. Similarly, cultural beliefs and social norms influenced how individuals interpreted and responded to their symptoms. CONCLUSION The findings shed light on the importance of understanding cultural factors that help or hinder self-care behaviors among individuals with CVD. Understanding such influences is anticipated to facilitate the design of effective, tailored interventions.
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Stephani V, Opoku D, Beran D. Self-management of diabetes in Sub-Saharan Africa: a systematic review. BMC Public Health 2018; 18:1148. [PMID: 30268115 PMCID: PMC6162903 DOI: 10.1186/s12889-018-6050-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of diabetes in sub-Saharan Africa has increased rapidly over the last years. Self-management is a key element for the proper management, but strategies are currently lacking in this context. This systematic review aims to describe the level of self-management among persons living with type 2 diabetes mellitus in sub-Saharan Africa. METHOD Relevant databases including PubMed, Web of Science and Google Scholar were searched up to September 2016. Studies reporting self-management behavior of people with type 2 diabetes mellitus and living in sub-Saharan Africa were included. RESULTS A total of 550 abstracts and 109 full-text articles were assessed. Forty-three studies, mainly observational, met the inclusion criteria. The studies showed that patients rarely self-monitored their glucose levels, had low frequency/duration of physical activity, moderately adhered to recommended dietary and medication behavior, had poor level of knowledge regarding diabetes related complications and sought traditional or herbal medicines beside of their biomedical treatment. The analysis also revealed a lack of studies on psychosocial aspects. CONCLUSION Except for the psychosocial area, there is a good amount of recent studies on self-management behavior of type 2 diabetes mellitus sub-Saharan Africa. These studies indicate that self-management in sub-Saharan Africa is poor and therefore a serious threat to the health of individuals and the health systems capacity.
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Affiliation(s)
- Victor Stephani
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Daniel Opoku
- Department of Health Care Management, Technical University of Berlin, Berlin, Germany
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Genève, Switzerland
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Ray M, Wallace L, Mbuagbaw L, Cockburn L. Functioning and disability in recent research from Cameroon: a narrative synthesis. Pan Afr Med J 2017; 27:73. [PMID: 28819494 PMCID: PMC5554653 DOI: 10.11604/pamj.2017.27.73.12167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/15/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction People living with disabilities in Cameroon face many barriers to daily functioning and social participation. However, there is limited research on disabilities and their impact. We sought to examine the research related to disability from Cameroon. Methods We conducted a systematic review, bibliometric analysis, and narrative synthesis of research related to disability, functioning, and social participation from Cameroon published during 2005-2014. The articles were screened in duplicate to identify articles addressing impacts of disability on functioning. Disability was contextualized using the International Classification of Functioning, Disability and Health (ICF) framework. Data were analyzed narratively per identified themes using an inductive data-driven approach. Results A total of 46 studies were included following full-text review of which 36 addressed non-communicable diseases and conditions, 7 addressed infectious diseases and 3 addressed neglected tropical diseases. Among ICF Activity and Participation Restrictions, work and employment was the highest reported category (19 studies), followed by intimate relationships (14 studies), and looking after one's health (8 studies). Among ICF Environmental Factors, societal attitudes were the highest reported category (21 studies), followed by health services, systems and policies (14 studies) and support and relationships (11 studies). Among other common themes, knowledge and awareness was the highest reported category (22 studies), closely followed by traditional beliefs (20 studies) and financial barriers (9 studies). Conclusion There is a small body of primary research from Cameroon on disability. The main themes related to disability are stigma, limited knowledge and awareness, poor quality of care and hindered employment opportunities. Further efforts are required to investigate the complexities of living with a disability in Cameroon and strategies to enhance adequate participation in activities of daily life.
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Affiliation(s)
- Minal Ray
- University of Toronto, Department of Occupational Science & Occupational Therapy, Toronto, Canada
| | - Lorena Wallace
- University of Toronto, Department of Occupational Science & Occupational Therapy, Toronto, Canada
| | - Lawrence Mbuagbaw
- McMaster University, Department of Health Research Methods Evidence and Impact, Hamilton, ON, Canada.,Centre for the Development of Best Practices in Health, Yaoundé, Cameroon
| | - Lynn Cockburn
- University of Toronto, Department of Occupational Science & Occupational Therapy, Toronto, Canada
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Metta E, Bailey A, Kessy F, Geubbels E, Hutter I, Haisma H. "In a situation of rescuing life": meanings given to diabetes symptoms and care-seeking practices among adults in Southeastern Tanzania: a qualitative inquiry. BMC Public Health 2015; 15:224. [PMID: 25886626 PMCID: PMC4358854 DOI: 10.1186/s12889-015-1504-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 02/04/2015] [Indexed: 11/28/2022] Open
Abstract
Background Diabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals. Methods To explore collective views on the meanings given to diabetes symptoms, we conducted nine focus group discussions with adult diabetes patients and members of the general community. To gain a better understanding of how the meanings in the community inform the care-seeking practices of individuals, 19 in-depth interviews were conducted with diabetes patients. The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework. Results In the communities and among the patients, knowledge and awareness of diabetes are limited. Both people with diabetes and community members referred to their prevailing cultural meaning systems and schemas for infectious diseases to interpret and assign meaning to the emerging symptoms. Diabetes patients reported that they had initially used anti-malarial medicines because they believed their symptoms—like headache, fever, and tiredness—were suggestive of malaria. Schemas for body image informed the meaning given to diabetes symptoms similar to those of HIV, like severe weight loss. Confusion among members of the community about the diabetes symptoms instigated tension, causing patients to be mistrusted and stigmatized. The process of meaning-giving and the diagnosis of the diabetes symptoms was challenging for both patients and health care professionals. Diabetes patients reported being initially misdiagnosed and treated for other conditions by medical professionals. The inability to assign meaning to the symptoms and determine their etiologies informed the decision made by some patients to consult traditional healers, and to associate their symptoms with witchcraft causes. Conclusion The meanings given to diabetes symptoms and the care-seeking practices described in the study are shaped by the prevailing cultural schemas for infectious diseases and their treatments. Efforts to educate people about the symptoms of diabetes and to encourage them to seek out appropriate care should build on the prevailing cultural meaning system and schemas for diseases, health and illness. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1504-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emmy Metta
- Ifakara Health Institute, Box 78373, Dar es Salaam, Tanzania. .,Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Ajay Bailey
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Flora Kessy
- Mzumbe University, Box 20226, Dar es Salaam, Tanzania.
| | | | - Inge Hutter
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
| | - Hinke Haisma
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9742 AK, Groningen, The Netherlands.
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Airhihenbuwa CO, Ford CL, Iwelunmor JI. Why culture matters in health interventions: lessons from HIV/AIDS stigma and NCDs. HEALTH EDUCATION & BEHAVIOR 2013; 41:78-84. [PMID: 23685666 DOI: 10.1177/1090198113487199] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Theories about health behavior are commonly used in public health and often frame problems as ascribed or related to individuals' actions or inaction. This framing suggests that poor health occurs because individuals are unable or unwilling to heed preventive messages or recommended treatment actions. The recent United Nations call for strategies to reduce the global disease burden of noncommunicable diseases like diabetes requires a reassessment of individual-based approaches to behavior change. We argue that public health and health behavior intervention should focus more on culture than behavior to achieve meaningful and sustainable change resulting in positive health outcomes. To change negative health behaviors, one must first identify and promote positive health behaviors within the cultural logic of its contexts. To illustrate these points, we discuss stigma associated with obesity and human immunodeficiency virus and acquired immune deficiency syndrome. We conclude that focusing on positive behaviors and sustaining cultural and personal transformations requires a culturally grounded approach to public health interventions, such as that provided by the PEN-3 model.
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BeLue R, Okoror TA, Iwelunmor J, Taylor KD, Degboe AN, Agyemang C, Ogedegbe G. An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective. Global Health 2009; 5:10. [PMID: 19772644 PMCID: PMC2759909 DOI: 10.1186/1744-8603-5-10] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 09/22/2009] [Indexed: 02/07/2023] Open
Abstract
Background Sub-Saharan African (SSA) countries are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors. This has resulted in an increase in the incidence of non-communicable diseases, especially cardiovascular disease (CVD). This double burden of communicable and chronic non-communicable diseases has long-term public health impact as it undermines healthcare systems. Purpose The purpose of this paper is to explore the socio-cultural context of CVD risk prevention and treatment in sub-Saharan Africa. We discuss risk factors specific to the SSA context, including poverty, urbanization, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors. Methodology We conducted a search on African Journals On-Line, Medline, PubMed, and PsycINFO databases using combinations of the key country/geographic terms, disease and risk factor specific terms such as "diabetes and Congo" and "hypertension and Nigeria". Research articles on clinical trials were excluded from this overview. Contrarily, articles that reported prevalence and incidence data on CVD risk and/or articles that report on CVD risk-related beliefs and behaviors were included. Both qualitative and quantitative articles were included. Results The epidemic of CVD in SSA is driven by multiple factors working collectively. Lifestyle factors such as diet, exercise and smoking contribute to the increasing rates of CVD in SSA. Some lifestyle factors are considered gendered in that some are salient for women and others for men. For instance, obesity is a predominant risk factor for women compared to men, but smoking still remains mostly a risk factor for men. Additionally, structural and system level issues such as lack of infrastructure for healthcare, urbanization, poverty and lack of government programs also drive this epidemic and hampers proper prevention, surveillance and treatment efforts. Conclusion Using an African-centered cultural framework, the PEN3 model, we explore future directions and efforts to address the epidemic of CVD risk in SSA.
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Affiliation(s)
- Rhonda BeLue
- Department of Health Policy and Administration, 604 Ford Building, The Pennsylvania State University, University Park, PA, USA
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