Health Resilience in Arabic-speaking Adult Refugees With Type 2 Diabetes: A Grounded Theory Study During the COVID-19 Pandemic

OBJECTIVES

This qualitative study aimed to describe the lived experiences of Arabic-speaking refugees in managing their type 2 diabetes mellitus (T2DM) while resettling during the COVID-19 pandemic, and to generate a grounded theory of how resilience is used to facilitate living well while facing multiple health stressors.

METHODS

A grounded theory approach was used to conceptualize the dynamic process of resilience in living well with diabetes. Five recently resettled adult refugees with T2DM (2 women and 3 men) participated in unstructured individual interviews in Arabic in New Brunswick, Canada, during the pandemic's second wave (October 2020 to March 2021). Interview data were transcribed and analyzed thematically using open, axial, and core category coding followed by member checking.

RESULTS

Participants identified self-reliance as the core driver for decision-making, actions, and interpretations in health management while experiencing unplanned instability. The process was found to be facilitated by 4 distinct constructs: knowledge seeking, positive outlook, self-care, and creativity.

CONCLUSIONS

The substantive model derived from this study supports a strengths-based approach to clinical assessment and care of refugees with T2DM, notably during disrupted access to primary and preventive services due to forced resettlement and pandemic mitigation measures. More research is needed to increase understanding of how self-reliance can be optimized in resilience-promoting interventions to facilitate diabetes management among populations in posttraumatic circumstances.

The Role of Primary Care Nurse Practitioners in Reducing Barriers to Cervical Cancer Screening: A Literature Review

Nearly all cases of cervical cancer (CC) are caused by persistent infection by human papillomavirus (HPV). CC remains the second most prevalent carcinoma among women and, in 2017, Canada’s screening rates were off target by 19%. For example, screening rates as low as 57.6% were observed in low-income neighbourhoods in Ontario, compared to 70% in highest-income neighbourhoods. Complex, multifactorial barriers affect women’s participation in cervical cancer screening (CCS). The most common barriers to screening are directly linked to disparities within determinants of health, including belonging to a minority ethnic group, low socioeconomic status, lack of education, and lack of access to healthcare. Nurse Practitioners (NPs) can reduce these barriers by providing innovative, evidence-based, culturally competent women-friendly care while building trusting relationships with patients and, thus, play a greater role in preventing the disease. The objective of this literature review is to summarize barriers to CCS and the role Canadian NPs can have in reducing them. Keywords: cervical cancer, cancer screening, nurse practitioner, barriers

Rôle des infirmières praticiennes en soins primaires pour aplanir les obstacles au dépistage du cancer du col : revue de la littérature

Presque tous les cas de cancer du col (CC) sont causés par une infection persistante au virus du papillome humain (VPH). Le cancer du col est le deuxième carcinome en importance chez les femmes; malgré tout, les taux de dépistage pour le Canada en 2017 ont raté l’objectif par 19 %. On a, par exemple, observé des taux aussi bas que 57,6 % dans les quartiers défavorisés de l’Ontario, comparativement à 70 % dans les quartiers aisés. Des obstacles complexes et multifactoriels nuisent à la participation des femmes au dépistage du cancer du col (DCC). Les écueils les plus courants sont directement liés aux disparités dans les déterminants de santé, notamment l’appartenance à une minorité ethnique, le faible statut socio-économique, une moins grande éducation, et la difficulté d’accès aux soins de santé. Les infirmières praticiennes (IP) peuvent aplanir ces obstacles en prodiguant des soins d’avant-garde, fondés sur la recherche, respectueux de la culture et attentifs aux besoins des femmes tout en établissant des liens de confiance avec les patientes, jouant ainsi un rôle plus vaste dans la prévention de la maladie. L’objectif de la présente revue de littérature est de résumer les contraintes au DCC et le rôle que peuvent jouer les IP canadiennes pour les alléger. Mots-clés : cancer du col, dépistage du cancer, infirmière praticienne, obstacles

Cumulative lifetime violence severity, social determinants and anxiety in a national sample of Canadian men

BACKGROUND

Despite anxiety disorders being the ninth leading cause of disability and associated with social inequities, little attention has been given to how intersections among social determinants of health and chronic stressors such as cumulative lifetime violence affect the likelihood of experiencing anxiety disorders. Our purpose was to explore the relationships among cumulative lifetime violence severity as target and perpetrator, social determinants of health and generalized anxiety disorder in Canadian men.

METHODS

Using a community sample of 592 Canadian men who self-identified as having experienced violence, we developed and tested an evidence-based model of generalized anxiety disorder including indicators of cumulative lifetime violence, gender, social location, socio-economic disparity, personal resources and other chronic stressors using logistic regression.

RESULTS

Most men (76.4%, n = 452) reported experiences as both target and perpetrator. The model accounted for 50.8% of the variance in anxiety severity χ2 (8) = 264.43, p = .000). The prevalence of probable generalized anxiety disorder was 30.9%, a rate higher than that found among Canadian men in general in the same period. Remarkably, the likelihood of generalized anxiety disorder increased by a factor of 5.30 for each increase of 1 in cumulative lifetime violence severity, and six-fold for feeling overwhelmed by demands of everyday life (aOR = 6.26). Masculine discrepancy stress, having been born in Canada, unemployment, and food insecurity also contributed significantly to increasing the likelihood of generalized anxiety disorder. Both social support and mastery had significant aORs < 1, suggesting possible protective effects. Together these findings delineate characteristics and social determinants that may heighten vulnerability to generalized anxiety disorder and influence its progression among men who have experienced lifetime violence.

CONCLUSIONS

These findings are the first evidence that Canadian men with lifetime violence histories are a sub-group disproportionately affected by chronic stressors and socio-economic disparities and that together the presence and/or severity of these factors increases their vulnerability to generalized anxiety disorder. Our results highlight the importance of strengths-based trauma- and violence-informed approaches to care, including practical resources to reduce the stress of everyday life, improve social support, and reinforce personal control and choice.

Kenyan Youth Understanding of Cancer, Cancer Risk and Cancer Prevention: An Ethnographic Study

Background: Cancer incidence and mortality continues to rise worldwide including in Kenya. Among the groups that are likely to get cancer in future are Kenyan youth that engage in behavior that can increase their lifetime cancer risk. Despite this awareness, little is known about Kenyan youth's understanding of cancer, cancer risk, and cancer prevention. Such awareness is needed to inform germane cancer prevention and health promotion initiatives. Aim: The purpose of this ethnographic study was to explore Kenyan youth's understanding of cancer, cancer risk, and cancer prevention. Methods: Fifty-three youth (ages 12-19) took part in individual interviews and focus group discussions. Results: In their conceptualization of cancer, youth described cancer in ways that are grouped into two themes: there is no other disease like it and lay understanding through metaphors. In their conceptualization of cancer risk, youth described cancer in ways that are grouped as cancer risk as lifestyle factors and the process of risk perception. Finally, in conceptualization of cancer prevention, youth described cancer prevention in ways that are grouped into the following themes: avoiding cancer risk factors, avoiding peers who partake in risk factors, and being healthy. Conclusion: This study is the first of its kind to be conducted in Kenya and adds to the body of knowledge in this area. Despite limited cancer control plans, youth described the grim consequences of getting cancer, their chances of getting the disease, and proposed opportunities for prevention. The study results will create a platform for future cancer prevention research and health promotion programs in Kenya and other part of Africa.