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S4AC Case Study: Enhancing Underserved Seniors' Access to Health Promotion Programs
Abstract
The Seniors Support Services for South Asian Community (S⁴AC) project was developed in response to the underutilization of available recreation and seniors' facilities by South Asian seniors who were especially numerous in a suburban neighbourhood in British Columbia. Addressing the problem required the collaboration of the municipality and a registered non-profit agency offering a wide range of services and programs to immigrant and refugee communities. Through creative outreach and accommodation, the project has engaged more than 100 Punjabi-speaking seniors annually in diverse exercise activities. Case study research methods with staff and current and former senior participants of S⁴AC include participant observation, individual interviews, and focus groups. Viewed through the critical interpretive lens of the candidacy framework, findings reveal the myriad ways in which access to health promotion and physical activity for immigrant older adults is a complex iterative process of negotiation at multiple levels.
... Attending to cultural and religious norms and preferences was essential for adherence, satisfaction, and effectiveness of programs (Asdigian et al., 2021;El Masri et al., 2021;Emami et al., 2000;Falgas-Baque et al., 2021;Koehn et al., 2016;Lee et al., 2021;Maxwell et al., 2002;Montayre et al., 2020;Reijneveld et al., 2003;Rogerson & Emes, 2006;Sin et al., 2005;Taylor-Piliae et al., 2006;Zou et al., 2021). These studies describe incorporating cultural activities, foods, and music into intervention designs. ...
... Knowledge users cautioned against essentializing cultural practices and emphasized attending to individual variations within cultural groups. Older immigrant women preferred women-specific exercise spaces and modest dress codes (El Masri et al., 2021;Koehn et al., 2016;Ngongalah et al., 2018;Reijneveld et al., 2003;Rogerson & Emes, 2006), while other older adults avoided unfamiliar exercises that did not reflect premigration experiences (El Masri et al., 2021;Zou et al., 2021). Bicultural and bilingual facilitators hold cultural and linguistic knowledge that bridges cultural divides and ensures cultural sensitivity which increases satisfaction and adherence to PA programs (Alegría et al., 2019;Asdigian et al., 2021;El Masri et al., 2021;Emami et al., 2000;Falgas-Baque et al., 2021;Hau et al., 2016;Holland et al., 2008;Lee et al., 2016;Maxwell et al., 2002;Montayre et al., 2020;O'Driscoll et al., 2014;Qi et al., 2011;Rogerson & Emes, 2006;Sin et al., 2005;Taylor-Piliae et al., 2006;Zou et al., 2021). ...
... Each participant chose which tasks to take part in and was given a booklet (the "Passport") that detailed the tasks and how to earn points. Participants varied in the number of activities completed per week Koehn et al. (2016) Aim: To understand characteristics of the S 4 AC program and program participants and the quality of program components Design: Qualitative case study Mostly South Asian (Punjabi-speaking) older adults in suburban neighborhood in British Columbia, age 53-87 years of age, majority women Sample size: 100 ...
Physical activity program interventions often lack sensitivity to the needs of older immigrant adults. The objective of this systematic realist review is to explain how, why, for whom, and under which circumstances community group-based physical activity programs work for immigrant older adults. The initial program theory was developed using prior research, team expertise, social cognitive theory, and knowledge user consultations. The program theory was tested and refined via a systematic review of the literature. Database searches were conducted in MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Library, Sports Medicine and Education Index, and SPORTDiscus. A total of 22 sources of evidence met inclusion criteria and included intervention studies, systematic reviews, and a discussion paper. Intervention studies were appraised using the Mixed Methods Appraisal Tool. The final program theory constituted eight context–mechanism–outcome configurations that highlight the importance of facilitator characteristics, access to safe spaces, group dynamics, and social support. A limitation was the small number and variable quality of included evidence. Physical activity programs that target immigrant older adults must strengthen physical and psychological safety and maximize opportunities for role modeling and socialization. This research was supported by the Alberta Health Services Seniors Health Strategic Clinical Network and is registered in PROSPERO (ID#258179).
... Whether they are married, or widowed, older Punjabi women typically assume the bulk of childcare responsibilities. These women, particularly widows, who-as we have seen already-are most susceptible to losing power within the family, often become isolated by their caregiving obligations (Koehn 1993;Koehn, Habib, and Bukhari 2016). ...
... The majority of older Punjabi women in my own studies have been from rural India with very little if any formal education. Older women from urban centres are more likely to have received an education and while they share cultural values with their rural counterparts, they have lived vastly different lives both prior to and since immigrating to Canada (Koehn 1999;Koehn, Habib, and Bukhari 2016). ...
... In a study that explored the participation of older immigrants in exercise programmes offered through a partnership between DIVERSEcity Community Services Society and the City of Surrey, we found important differences between older immigrants who have aged in Canada and those who arrive late-in-life (Koehn, Habib, and Bukhari 2016). Initially, the programme was offered at Site 1, where the goal was to integrate South Asian older adults into a pre-existing seniors' centre dominated by Euro-Canadians, some of whom expressed racist sentiments toward the newcomers. ...
Older Punjabi Sikh women are central to their families and communities, but their own needs are often overlooked. Probing the intersections of gender, ethnicity and age and interlocking experiences of sexism, racism and ageism within and beyond their own communities can deepen our understanding of why this happens and what we can do about it. Vertical hierarchies of women that develop in response to male domination, the gendered nature of women’s work and leisure activities, migration patterns that result in generational role reversals, unmet childcare needs, and sponsorship policies that engender dependency and promote isolation of older adults all play a role. These disparate threads are integrated through application of the intersectional life course lens, which recognises the importance of structural influences and oppressions on life course transitions over time and space.
... Numerous studies indicate that non-kin social relationships with peers hosted by community organisations ease the stress of immigration for older adults, but they are inhibited by multiple barriers (e.g. Koehn et al., 2014Koehn et al., , 2016Rote and Markides, 2014). For example, Albanian and Moroccan migrants aged 50 and above living in Italy feel that they lack meaningful relationships with non-related age peers, and hence experience loneliness despite being embedded in tightly knit family networks (Cela and Fokkema, 2017). ...
... In addition to a familiar language, immigrants leave behind familiar placesmosques, tea-housesand ways of being in the world that facilitate their social integration (Cela and Fokkema, 2017;Wright-St Clair and Nayar, in press). Free time is often consumed by domestic and child-care responsibilities that inhibit desired interaction with peers, highlighting the gendered nature of loneliness (King et al., 2014;Koehn et al., 2016;Wright-St Clair and Nayar, in press). ...
... In 2011, 15.1 per cent of immigrants in Canada aged 65+ do not speak either of the official languages (English and French); however, this was true of half (50.1%) of older adults who had immigrated within ten years (The Federal/ Provincial/Territorial Working Group on Social Isolation and Social Innovation, 2018). This is crucial because the inability to speak English, as clearly illustrated by Young Chul, presents a major challenge to accessing services and social supports, activities and involvement in the community (Stewart et al., 2011;Koehn et al., 2016;Li et al., 2018). Linguistic isolation is a key component of both social isolation and loneliness (De Jong Gierveld et al., 2015;Cela and Fokkema, 2017;Gubernskaya and Treas, 2020). ...
Research points to a higher risk for social isolation and loneliness among new immigrant and refugee older adults. Our article draws from a research project that explored the everyday stories of ageing among 19 diverse immigrant older adults in Canada. To capture their experiences of loneliness and social isolation, we use four illustrative cases derived from a structural approach to life-story narrative. To these we apply the intersectional lifecourse analytical lens to examine how life events, timing and structural forces shape our partici-pants' experiences of social isolation and loneliness. We further explore the global and linked lives of our participants as well as the categories of difference that influence their experiences along the continua of loneliness to belonging, isolation to connection. Finally, we discuss how an understanding of sources of domination and expressions of agency and resistance to these forces might lead us to solutions.
... Previous studies have identified that access to dementia care and supports by older immigrants and their families is influenced by complex, intertwining issues across micro, meso and macro levels. The beliefs and knowledge of individuals are shaped by community-level notions of stigma, honor and shame as well as system-level factors such as the configuration and availability of programs (Badger, Koehn, and Friesen 2015;Koehn et al. 2016). A collection of literature reviews examining access to health and social supports (Koehn and Badger 2015) further identified trust as a cross-cutting theme that influences access at many levels. ...
... A collection of literature reviews examining access to health and social supports (Koehn and Badger 2015) further identified trust as a cross-cutting theme that influences access at many levels. Immigrant-serving (IS) agencies play an important role in health promotion for older adults (Koehn, Habib, and Bukhari 2016;Koehn et al. 2014). The purpose of this paper is thus to explore the role of such agencies in facilitating access to dementia services and supports provided by dementia service (DS) agencies (particularly the health authority and local chapters of the Alzheimer Society) through their propensity to develop trusting relationships between staff and clients. ...
... Older immigrants face language barriers, transportation difficulties, lack of knowledge of local resources, and child-minding responsibilities that are compounded by immigration policies, such as those rendering sponsored immigrants dependent on their children for 10-20 years (Koehn, Spencer, and Hwang 2010). Such policies limit their access to services (Ferrer 2015;Lai and Chau 2007), and compromise their health and wellbeing (Guruge, Thomson, and Seifi 2015;Koehn, Habib, and Bukhari 2016). Inappropriate use of emergency services, delayed help-seeking, repetitious but unsatisfactory visits to family doctors and low referral rates attest to their inequitable and ineffective access and represent financial and health costs to healthcare systems and immigrant older adults respectively (Koehn 2009;Manthorpe et al. 2009;Suwal 2011). ...
**Up to 50 e-prints of this article are available from https://www.tandfonline.com/eprint/6VN8VISWHEZCIZXKQ9GY/full?target=10.1080/13557858.2019.1655529**
Objectives: This paper explores the role of immigrant-serving agencies in facilitating access to dementia services and supports provided by dementia service agencies (particularly the health authority and local chapters of the Alzheimer Society) through their propensity to develop trusting relationships between staff and clients.
Design: Our research is a qualitative case study of Punjabi and Korean speakers living in the Lower Mainland of BC, Canada. Data are drawn from interviews with 15 dyads of persons with dementia and their family caregivers (10 Punjabi, 5 Korean), six focus groups (one focus group with each of 8–10 older men, older women, and mixed gender working age adults in each community). We also interviewed 20 managerial and frontline staff of dementia service agencies, i.e. the health authority and the local Alzheimer Society (n = 11) and two immigrant-serving agencies (n = 9), each dedicated to either Punjabi or Korean-speaking clients. We adopted the Candidacy framework for understanding access to dementia services and supports and the concept of trust as guiding precepts in this study.
Results: Families of persons with dementia are pivotal to identification of a problem requiring professional help, navigation to appropriate services and acceptance of services offered. However, trust in family members should not be taken for granted, since family dynamics are complex. Alternative sources of trusted support are therefore needed. Immigrant-serving agencies are more often instrumental in establishing trusted relationships between their staff and clients, but they often lack detailed knowledge about heath conditions, their treatment and management, and they lack power to implement statutory care.
Conclusions: Partnerships between mainstream mental health/dementia services and the community sector have proven successful in increasing the accessibility of specialized resources while maximizing their combined trustworthiness, accessibility and effectiveness. Such partnerships should become fundamental components of health service strategy and provision for vulnerable and underserved immigrant older adults.
... A number of studies explored the barriers to health promotion and preventive care, such as cancer screening, which for older immigrants is primarily delivered or monitored by PHPs. Health illiteracy, language barriers, cultural differences, unavailability of services locally, declining mobility, and lack of transportation act collectively to prevent older immigrants from accessing health promotion programs, seeking cancer information, and participating in cancer screening (Gesink et al., 2014;Koehn, Habib, & Bukhari, 2016;Todd, Harvey, & Hoffman-Goetz, 2011;. Screening for breast and cervical cancers has been studied for different immigrant groups in various Canadian cities and regions. ...
... One of the main barriers to cancer screening for older immigrants, especially women, has been health illiteracy related to the nature of screening, service availability, and service location (Ahmad & Stewart, 2004;Amankwah et al., 2009;Crawford et al., 2015;Donnelly, 2006;Gesink et al., 2014;Gupta et al., 2002;Koehn et al., 2016;Lofters et al., 2010;Vahabi, 2011). Also, some older immigrants have found the Canadian health care system confusing and hard to navigate when seeking primary health care (Chow, 2012;Lai & Chau, 2007;Ngwakongnwi et al., 2012;Ng et al., 2014;Tiagi, 2016). ...
... Geographical barriers result from spatial discordance (or spatial mismatch) between where culturally appropriate health services (such as those provided by PHPs) are located and where older immigrants reside. They have limited access to care for older immigrants with restricted mobility, no means of transportation, poor health status, and low socioeconomic status (Koehn et al., 2016;Lai and Surood, 2010;Páez et al., 2010;Stewart et al., 2011). Clustering of physicians and health services in high density urban neighbourhoods in proximity to large hospitals results in underserved neighbourhoods in terms of access to culturally appropriate care for older immigrants. ...
RÉSUMÉ
Le vieillissement et l’immigration ont significativement transformé la composition démographique au Canada, et les immigrants y représentent une proportion croissante de la population adulte plus âgée. L’accès adéquat aux services de santé est essentiel au bien-être et à l’inclusion sociale de cette population. Cet examen de la portée porte sur les connaissances actuelles concernant l’accès des immigrants d’âge avancé aux médecins omnipraticiens et à leur consultation, considérant que ces médecins jouent un rôle central dans la prestation de soins de première ligne, dans les soins préventifs et les soins de santé mentale. Le modèle en 5 étapes d’Arksey et O’Malley a été utilisé pour effectuer des recherches dans une grande variété de bases de données pour des articles publiés en anglais dans des revues avec comité de pairs concernant ce sujet dans le contexte canadien. Un total de 31 articles répondant aux critères d’inclusion ont été examinés en détail. Ces articles ont été classés en fonction de l’information disponible sur leurs auteurs, la population à l’étude, la méthodologie, le domaine de la santé et les obstacles mentionnés. Trois thèmes principaux ont émergé de cet examen de portée : l’accès et l’utilisation des soins de première ligne, la promotion de la santé et le dépistage du cancer, ainsi que l’utilisation des services de santé mentale. Les immigrants d’âge avancé font face à des obstacles en termes d’accès aux soins et ceux-ci seraient liés à la littératie en santé, à la langue, à la culture, aux croyances en matière de santé, aux inégalités spatiales et à des circonstances structurelles. L’examen de la portée présente de manière détaillée l’accès aux soins des personnes âgées immigrantes au Canada, et permet de dériver des implications sur les politiques qui permettraient de répondre à leurs besoins qui sont non comblés dans le domaine de la santé.
... The National Advisory Council on Aging (2005) has recommended proactive approaches to prevent social isolation, as cultural and linguistic barriers can be reduced through innovative programs to engage ethnic minority seniors more fully in group activities. Community-based programs targeting ethnic seniors have been effective in reaching out to various ethnic groups and have had numerous positive impacts on the participants' health outcomes (Hau et al., 2016;Kim, 2016;Kim, 2013;Koehn, Habib, & Bukhari, 2016). One noteworthy program is the Seniors Support Services for South Asian Community (S 4 AC) program implemented in collaboration with the non-profit local United Way agency in British Columbia to improve access to existing facilities for South Asian older adults. ...
... In their case study of over a hundred Punjabi-speaking seniors, Koehn et al. (2016) found health benefits that accrued to seniors attending exercise classes offered by the S 4 AC program. The reported health benefits not only pertain to physical health such as reduced hypertension and improved balance and flexibility but also extended to mental health and well-being through enhanced social interactions resulting from the program (Koehn et al., 2016). ...
... In their case study of over a hundred Punjabi-speaking seniors, Koehn et al. (2016) found health benefits that accrued to seniors attending exercise classes offered by the S 4 AC program. The reported health benefits not only pertain to physical health such as reduced hypertension and improved balance and flexibility but also extended to mental health and well-being through enhanced social interactions resulting from the program (Koehn et al., 2016). Another community-based exercise and health education program, the Boston, Massachusetts-based Healthy Habits Program (Hau et al., 2016) targeting elderly Chinese immigrants, found clinically meaningful improvements in mobility and cognition of the participants at the end of the 6-month intervention period. ...
RÉSUMÉ
Cette recherche à méthode mixte a évalué l’impact d’un programme pour la communauté culturelle d’aînés immigrants coréens en examinant les bénéfices pour la qualité de vie des participants liée à leur santé (HR-QOL) et leur bien-être en général. Bien que la programmation communautaire soit de plus en plus reconnue comme un moyen de promouvoir la santé et la participation active des individus dans la sphère sociale, peu d’informations sont disponibles concernant l’utilisation et l’impact de tels programmes chez les immigrants aînés des minorités visibles. Dans cette étude, 79 participants ont répondu au questionnaire SF-36v2 à deux reprises dans le cadre de l’évaluation de l’impact du programme du Canada Enoch Senior’s College (CESC) concernant le HR-QOL et leur bien-être. Des améliorations statistiquement significatives ont été observées sur les plans de la santé physique et mentale, notamment dans les dimensions liées à la douleur corporelle, au rôle émotionnel et aux limitations de rôle en raison de problèmes émotionnels. Les données qualitatives provenant des entretiens avec les participants ont confirmé les résultats positifs du sondage, par des améliorations aux niveaux de la vie sociale et de la santé des aînés. Ces résultats suggèrent que le programme CESC contribue à qualité de vie et au bien-être des aînés coréens participants. Cette étude permettra de soutenir des programmes communautaires culturels similaires.
... South Asian mothers in the study provided "family-centric" or "altruistic" rather than personal reasons for self-care (Choudhry, 1998;Koehn, Habib, Bukhari, & Mills, 2013). Most South Asian women tend to put the care of their children and other family members ahead of their own; especially the elderly are more inclined to place low priority on selfcare (Koehn, Habib, & Bukhari, 2016) because the wellbeing of the family is central to their understanding of self-care (Koehn et al., 2013). This gendered and cultural notion of selfcare combined with the material conditions produced by migration-especially the doubleduty of childcare/domestic work and paid work-made it difficult for many to make time for self-care. ...
... As an observant and concerned participant, Camellia also pointed out the limitations of such an approach in educating women of diverse language, educational, and socioeconomic backgrounds: Obviously, language and cultural barriers make healthcare services inaccessible for many immigrant women and men in Canada. However, older South Asian immigrant adults and seniors, especially those coming from rural areas and conservative religious backgrounds, face multiple intersecting barriers to accessing health and social services and community programs, including isolation due to language issues, transportation difficulties, lack of knowledge of local resources, and childminding responsibilities (Koehn et al., 2016). Very few resources and community-based health promotion programs are available to address such barriers and fulfill the unique needs of South Asian subpopulations such as Bengalis or Pakistani Muslim women. ...
This International Workshop on Gender, Diversity, and Inclusion was an outcome of the collaborative effort by the Department of Gender, Sexuality, and Women’s Studies (GSWS) at Simon Fraser University (SFU) in Canada and the Research Center for Gender and Development of Hohai University (HHU) in Nanjing, China. In 2017, a Memorandum of Understanding (MOU) between the SFU Faculty of Arts and Social Sciences (FASS) and the HHU School of Public Administration was signed by both universities. One of the stated objectives was to organize a collaborative international workshop on gender and diversity at SFU in 2019.
... 41,87 Case study 1 illustrates the need for programs that consider the complexity of categories of identity. 186 The compounding effects of age, limited ...
... Programming at a less barriered facility with tailored outreach and language congruent offerings proved successful with this group. 186 social capital and, in some cases, trauma can also influence the ability of and speed with which older women can learn English or French. 63 Programs that address these intersections challenge ageism and cultural essentialism.. Finally, we need to be mindful of perpetuating ageist stereotypes when we only focus on the challenges faced by older immigrants. ...
The goal of this literature review is to understand intersectional discrimination and its effects on older Canadians, with a specific focus on the diverse experiences of ageism across multiple intersections of marginality. The Government of Canada is especially interested in identifying interventions that can address the effects of such discrimination on older adults’ ability to access and maintain employment and income security, secure housing and age in place, and access health care and other social services.
Commissioned by Employment and Social Development Canada's (ESDC) Seniors and Pensions Policy Secretariat's (SPPS)
... In North American research on ethnocultural groups, the term "South Asian" has primarily represented those from India (e.g., Koehn et al., 2016, Oliffe et al., 2009, Tong et al., 2020. It is a strength of our work to have also reached older adults from Bangladesh, Pakistan and Sri Lanka; however, we recognize that our sample does not include individuals from Afghanistan, Bhutan, Maldives or Nepal and cannot be generalized to the experiences of all South Asians ageing in Canada. ...
South Asians are the largest and fastest-growing racialized group in Canada, yet there are limited data on various aspects of health and well-being within this population. This includes the South Asian older adults’ ethnoculturally informed perceptions of ageing. The study aimed to understand how social and cultural forces impact the meaning assigned to healthy ageing amongst older South Asians in Canada. We recruited with purposeful and snowball sampling strategies in Southern Ontario. We conducted in-depth focus group and individual interviews (n = 19) in five South Asian languages, employing a multilingual and cross-cultural qualitative approach. In our analysis, we identified three central themes: (a) taking care of body (b) taking care of mind and heart and (c) healthy ageing through the integration of mind and body. Our study demonstrates that older immigrants are a diverse and heterogeneous population and that their conception of healthy ageing is strongly influenced by their country of origin. This study also demonstrates how racialized foreign-born older adults might provide distinctive perspectives on the ageing process and on social theories of ageing due to their simultaneous immersion in and belonging to global majority and global minority cultures. This research also adds to the limited body of literature on the theories of ageing, despite migration trends, still has a white-centric lens.
... This allows an older adult audience to connect with the subject matter as peers. This approach overcomes a pitfall that other researchers have identified: inadequate socio-cultural and age-appropriate tailoring that serves as a barrier for researchers to connect with individuals about physical activity and health (Brawley, Rejeski, & King, 2003;Koehn, Habib, & Bukhari, 2016;Mendoza-Vasconez et al., 2016). Thus, participants' high-level enjoyment of, and relatability to, I'd Rather Stay helped to diminish these barriers and contributed to this product's KT impact. ...
RÉSUMÉ
Une vaste majorité des Canadiens âgés ne pratiquent pas suffisamment d’activité physique. Le développement de stratégies originales et innovantes encourageant et appuyant les modes de vie actifs est donc urgent. La vidéo est un outil prometteur pour l’application de connaissances (AC) visant l’engagement de divers publics dans la discussion et l’adoption de comportements favorisant la santé. L’Approche systématique pour les vidéos fondées sur des données probantes ( Systematic Approach to Evidence-informed Video , SAEV), qui fournit un cadre pour guider et structurer le développement de vidéos ayant pour objectif l’AC, a été utilisée pour la création et la diffusion d’un documentaire de 19 minutes, I’d Rather Stay ( https://vimeo.com/80503957 ). Quarante-huit participants âgés de 60 ans et plus ont visionné la vidéo, participé à des groupes de discussion et rempli des questionnaires concernant cette vidéo. Les données ont été recueillies après le visionnement et lors d’un suivi organisé six mois plus tard. La vidéo a éduqué, encouragé et mobilisé les personnes âgées sur les questions liées à l’autonomie, à l’activité physique et aux liens sociaux. Nous encourageons les chercheurs à adopter des stratégies d’AC auxquelles les personnes âgées peuvent s’identifier, qui sont accessibles et par lesquelles elles peuvent s’engager à un niveau critique, autant sur le plan émotionnel qu’intellectuel, comme les vidéos basées sur des preuves scientifiques.
... Chinese women experience a transition away from paid work and toward the domestic sphere after international migration: Ho (2009) argues that a "feminization" of domestic work occurs as families and individuals renegotiate work and care roles in their new country. Although this facilitates PA in our sample, a potentially negative aspect of this gendered work within the home is that it may limit women's opportunities and time to more fully participate in the community (Koehn, Habib, & Bukhari, 2016). Here we confirm the Webber model's overall conical design encircled by "gender, culture, and biography": When gendered norms coupled with the immigration experience push and/or keep women working in the domestic sphere, their mobility may be limited to the smaller portions of the cone, the room, and home life spaces. ...
Background and objectives:
The self-reported health of foreign-born older adults (FBOAs) is lower than that of nonimmigrant peers. Physical activity (PA) and mobility enhance health in older age, yet we know very little about the PA and mobility of FBOAs. In this analysis we sought to determine: (a) What factors facilitate PA amongst FBOAs? and (b) How do gender, culture, and personal biography affect participants' PA and mobility?
Research design and methods:
We worked closely with community partners to conduct a mixed-method study in Vancouver, Canada. Eighteen visible minority FBOAs completed an in-depth interview in English, Cantonese, Mandarin, Punjabi, or Hindi.
Results:
Three dominant factors promote participants' PA and mobility: (a) participants walk for well-being and socialization; (b) participants have access to a supportive social environment, which includes culturally familiar and linguistically accessible shops and services; and (c) gender and personal biography, including work history and a desire for independence, affect their PA and mobility behaviors.
Discussion and implications:
We extend the Webber et al. mobility framework, with examples that further articulate the role of gender (e.g., domestic work), culture (cultural familiarity) and personal biography (work history and a desire for familial independence) (Webber, S. C., Porter, M. M., & Menec, V. H. (2010). Mobility in older adults: A comprehensive framework. The Gerontologist, 50, 443-450. doi:10.1093/geront/gnq013). Future programming to support the PA of FBOAs should be culturally familiar and linguistically accessible.
... 40,52,74,81,82 This said, there is considerable variability within the immigrant population with respect to identity, community relationships and the extent to which their social and political capital provides them with the means to combat discriminatory attitudes against them. 79,83,84 Methodology Theoretical Approach The theoretical perspective guiding this research is Critical Gerontology and Intersectionality. Critical Gerontology examines how cultural-contextual factors at the macro-level (e.g., organizational factors: facility size, ownership, geographical location; systemic factors: provincial policies, philosophical approaches to care) shape the micro-level of daily experiences. ...
Objectives: The care provided by a majority of ‘mainstream’ Residential Long-Term Care (RLTC) facilities is incompatible with the needs of immigrant older adults. In British Columbia (BC), Canada, Chinese-origin older adults are a substantial and growing minority and research indicates that RLTC facilities not targeted at this population need direction to assist them in providing culturally competent care. Accordingly, our study seeks to identify which features of RLTC have the greatest impact on the quality of life of this subpopulation. Methods: A qualitative pilot study conducted in BC included 9 in-depth one-to-one interviews in two RLTC facilities with Chinese-origin residents and 11 family members who regularly visit such residents. We captured perspectives on residents’ quality of life (QoL) using an adapted version of an interview protocol established as trustworthy among diverse older adults in the U.K. This framework, developed by the National Centre for Social Research, understands the QoL of older adults to be contingent on their capability to pursue five conceptual attributes: attachment, role, enjoyment, security and control. Results: Participants perceived that the capability of residents to pursue the following dimensions of QoL was influenced by the organizational, social and/or physical features of the facilities in which they resided: Attachment (especially connection to the outside world), Control (especially decision-making), Enjoyment and Safety/Security. Conclusions: Findings concerning both positive and negative influences on older immigrant QoL that the facility can modify will provide direction and highlight priorities for RLTC administrators and policy makers.
This article reports on a series of Stakeholder Outreach Forums hosted in Canadian communities from 2018 to 2019. These forums built on a previous research project, The Lived Experiences of Aging Immigrants, which sought to amplify the voices of older immigrants through Photovoice and life course narratives analyzed through an intersectional life course perspective. The forums used World Café methods to encourage cumulative discussions among a broad range of stakeholders who work with or influence the lives of immigrant older adults. Participants viewed the previously created Lived Experiences of Aging Immigrants Photovoice exhibit, which provided a springboard for these discussions. The forums’ aim was to increase the stakeholders’ awareness of the experiences of immigrants in Canada as they age and to create space for the stakeholders to reflect upon and discuss the experiences of aging immigrants. Here we illustrate how the forums complement the narrative Photovoice research methodology and highlight the potential of Photovoice and targeted outreach strategies to extend academic research findings to relevant stakeholders. Across all forums, participants identified structural and systemic barriers that shape experiences of and responses to social exclusion in the daily lives of immigrant older adults. They further identified challenges and strengths in their own work specific to the issues of social inclusion, caregiving, housing, and transportation. Intersectoral solutions are needed to address the structural and systemic roots of exclusion at the public policy and organizational levels.
Older immigrants are at higher risks for inactivity due to cultural, environmental, and social barriers in the postmigration context. Community-based physical activity (PA) programs increase PA in older adults, yet little is known about approaches that specifically target older immigrants. This scoping review explores the literature on community-based programs that increase PA and physical fitness in immigrant older adults and identifies barriers and facilitators to PA program participation in this population. A systematic search of electronic databases and gray literature was conducted, and a total of 11 articles met the inclusion criteria after full-text screening. A range of populations and PA program characteristics are described, yet there is a lack of studies on older immigrant men, Black older immigrants, and immigrants from Arab and African countries. There is a need for further research to develop evidence-informed PA programs for this diverse population.
Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants’ vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life.
Group-based physical activity (PA) in community-based settings represents a promising avenue for promoting healthy ageing, however, lower levels of adherence have been found to be associated with aspects of social disadvantage. Providers are in a key position to provide important insights about strategies to improve adherence, however, few studies have examined their perspectives. In this study, 30 community service providers were interviewed, and 42 older people participated in focus groups to identify actions perceived as effective for promoting adherence to organised PA, with a focus on factors relevant to older people experiencing socio-economic disadvantage, social isolation, living with a disability or from culturally and linguistically diverse backgrounds. Data were analysed thematically. Adherence barriers included deteriorating health, lack of belonging and loss of motivation. Helpful strategies for addressing deteriorating health included maintaining programme flexibility, facilitating access to health and other services, and supporting participants to adapt to acquired limitations. Belonging can be fostered by creating positive and inclusive experiences, ensuring safe and stigma-free environments, providing opportunities to forge personal connections and demonstrating care. Motivation may be enhanced by ensuring activities are of interest and functional benefit, programme settings are suitable and appealing, and enjoyment is prioritised. In conclusion, a range of strategies is likely to be necessary to mitigate risks to adherence and support continued participation in organised PA among socially disadvantaged older people.
Foreign-born older adults (FBOAs) are at risk for negative health transitions in Canada. Physical activity (PA) enhances health, yet we know very little about the PA habits of FBOAs in Canada. We conducted a mixed-method study, in English, Cantonese, Mandarin, Punjabi and Hindi, with 49 South Asian and Chinese FBOAs in Vancouver, Canada. 49 participants completed surveys; of these 49, 46 wore accelerometers and 18 completed in-depth interviews. Participants' mean daily step count was 7876 (women: 8172, men: 7164, Chinese: 8291, South Asian: 7196). The bulk of their time is spent in light and sedentary activities. PA is principally acquired through walking for errands and work performed in and around the home. This study challenges the assumption that FBOAs are less active than their non-immigrant peers and confirms the key role of "nonexercise" and low activity, rather than moderate to vigorous, in older adults' PA acquisition.
This pilot project asked, how do ethnically diverse older adult residents of Assisted Living (AL) facilities in British Columbia (BC) experience quality of life? And, what role, if any, do organizational and physical environmental features play in influencing how quality of life is experienced? The study was conducted at three AL sites in BC: two ethnoculturally-targeted and one non-targeted. Environmental audits at each site captured descriptive data on policies, fees, rules, staffing, meals, and activities, and the built environment of the AL building and neighbourhood. Using a framework that understands the quality of life of older adults to be contingent on their capability to pursue five conceptual attributes—attachment, role, enjoyment, security and control—we conducted three focus groups with residents (one per site) and six interviews with staff (two per site). Attributes were linked to the environmental features captured in the audits. All dimensions of the environment, especially organizational, influence tenants’ capability to attain the attributes of quality of life, most importantly control. While many tenants accept the trade-off between increased safety and diminished control that accompanies a move into AL, more could be done to minimize that loss. Social workers can advocate for the necessary multi-sectoral changes.
A limited number of free e-prints are available at http://www.tandfonline.com/eprint/3R4UXEXgF5zS4IMzjywx/full
Purpose
– The purpose of this paper is to explore if and how community organizations providing services to late-in-life Punjabi immigrants in British Columbia, Canada, offer services with the potential to promote their mental health or well-being. The authors also wanted to know how Punjabi seniors perceived available services and if they supported their mental well-being.
Design/methodology/approach
– To guide the research, the authors used the VicHealth Framework, which identifies three overarching social and economic determinants of mental health: social inclusion (SI), freedom from violence and discrimination, and access to economic resources and participation. This mixed methods study combines descriptive survey and qualitative focus group data with input from Punjabi seniors and community service providers.
Findings
– All three mental health determinants were identified as important by service providers and seniors, with SI as the most important. Family dynamics (shaped by migration and sponsorship status) influence all three determinants and can promote or diminish mental well-being.
Research limitations/implications
– The pilot study is limited in sample size and scope and further inquiry with different groups of immigrant older adults is warranted.
Practical implications
– Service providers assert that more outreach and sustainable funding are needed to reach the majority of potential beneficiaries unable to participate in community programmes. Information on mental well-being of seniors should be targeted at both seniors and their families.
Originality/value
– The VicHealth Framework provided a unique lens through which to explore the contributions of community organizations to mental health promotion for immigrant older adults.
The concept of systematic inequalities in social and health outcomes has come to form part of contemporary policy discourse. This rhetoric is deployed even in the face of policy decisions widely viewed as iniquitous. Moreover, there is a widespread view, expressed across the political spectrum, that those in more deprived circumstances are less likely than their more affluent counterparts to be in receipt of optimal public services. Such individuals and communities are variously described as excluded, disadvantaged, underserved or hard to reach. Across countries and policy domains the term ‘hard to reach’ is used to refer to those deemed not to be in optimal receipt of public sector services which are intended to increase some aspect of material, social or physical wellbeing. It is increasingly used in health policy documents which aim to address health inequalities. However, it is an ill-defined and contested term. The purpose of this paper is two-fold. First, it offers a critical commentary on the concept of hard-to-reachness and asks: who are viewed as hard to reach and why? Second, using a case-study of a Scottish health improvement programme that explicitly aims to reach and engage the ‘hard to reach’ in preventive approaches to cardiovascular disease, it tests the policy and practice implications of the concept. It finds that a lack of conceptual clarity leads to ambiguous policy and practice and argues for possible theoretical refinements.
We aimed to explore how patients with long-term conditions choose between available healthcare options during a health crisis.
Patients in North-West England with one or more of four long-term conditions were invited to take part in a questionnaire cohort study of healthcare use. Semi-structured interviews were conducted with a sub-sample of fifty consenting patients. Data were analysed qualitatively, using a framework approach.
Patients described using emergency care only in response to perceived urgent need. Their judgements about urgency of need, and their choices about what services to use were guided by previous experiences of care, particularly how accessible services were and the perceived expertise of practitioners.
Recursivity and candidacy provide a framework for understanding patient decision-making around emergency care use. Patients were knowledgeable and discriminating users of services, drawing on experiential knowledge of healthcare to choose between services. Their sense of 'candidacy' for specific emergency care services, was recursively shaped by previous experiences.
Strategies that emphasise the need to educate patients about healthcare services use alone are unlikely to change care-seeking behaviour. Practitioners need to modify care experiences that recursively shape patients' judgements of candidacy and their perceptions of accessible expertise in alternative services.
Taking care of chronic disease: realizing approaches for Canada's aging ethnic population was a
workshop held in Vancouver, British Columbia, Canada in February 2011. The purpose of this
workshop was to begin to address an existing evidence gap on approaches to self management
support that meet the needs of immigrant older adults with chronic conditions. This gap was
identified by participants in a multi-stakeholder forum and subsequent community
consultations with Mandarin- and Punjabi-speaking older adults organized by the Immigrant
Older Adults: Care, Accessibility, Research and Empowerment (ICARE) team.
In response, we conducted an environmental scan that resulted in an annotated bibliography.
From this exercise we concluded that:
(1) Literature on self-management supports for ethnocultural minority older adults is sparse
and varied; (2) Evaluations of U.K. and Australian programs revealed that they predominately
appeal to “white middle-class people with long-term conditions who already viewed
themselves as effective self-managers”; (3) Viable alternative models of self-management
supports for ethnocultural minority older adults are not reported in the literature; and (4)
Individual self-management needs to be situated within a collective understanding of
empowerment.
Our workshop aimed to facilitate the exchange of ideas between a group of 32 diverse
Canadian stakeholders (plus five student volunteers) such as immigrant older adults with
chronic conditions and their friends and family members, policy makers, clinicians, multicultural
settlement workers, and academics. Ultimately, we seek to develop evidence-based
approaches to self-management supports that acknowledge the various challenges faced by
this disadvantaged population and build on existing strengths within our communities.
Reuniting immigrant families has been considered an important goal in Canadian policy (Citizen and Immigration Canada (CIC), 2006). When an elderly relative is sponsored under the Family Class immigration category, the sponsor makes an unconditional undertaking of support for a period of ten years to the Minister of Citizenship and Immigration. This is a longer period than for any other Family Class group. In addition to their legal status as dependents, sponsored seniors–the majority from India and China–are left financially and socially vulnerable by a constellation of cultural, situational and structural factors. Based on case studies of the South Asian and Chinese immigrant populations by authors, Koehn and Hwang, and the legal expertise of author Spencer, we conclude that Canada’s laws and policies have an important effect on intergenerational tension, the senior’s status, social isolation, as well as the risk of abuse and neglect or domestic and workplace exploitation. These factors can influence access to essential services such as housing and health care services. While further evidence is needed, findings from preliminary studies indicate the need for policy-level revisions as well as other approaches to reducing the vulnerability of this significant subpopulation of ethnic minority seniors.
This paper uses an intersectionality theoretical lens to interrogate selected findings of a scoping review of published and grey literature on the health and health care access of ethnocultural minority older adults. Our focus was on Canada and countries with similar immigrant populations and health care systems. Approximately 3300 source documents were reviewed covering the period 1980-2010: 816 met the eligibility criteria; 183 were Canadian. Summarized findings were presented to groups of older adults and care providers for critical review and discussion. Here we discuss the extent to which the literature accounts for the complexity of categories such as culture and ethnicity, recognizes the compounding effects of multiple intersections of inequity that include social determinants of health as well as the specificities of immigration, and places the experience of those inequities within the context of systemic oppression. We found that Canada’s two largest immigrant groups— Chinese and South Asians—had the highest representation in Canadian literature but, even for these groups, many topics remain unexplored and the heterogeneity within them is inadequately captured. Some qualitative literature, particularly in the health promotion and cultural competency domains, essentializes culture at the expense of other determinants and barriers, whereas the quantitative literature suffers from oversimplification of variables and their effects often due to the absence of proportionally representative data that captures the complexity of experience in minority groups.
Canadians currently experience elevated rates of chronic conditions compared with past populations, and ethnic differences in the experience of select chronic conditions have previously been identified. This investigation examined the prevalence of select chronic conditions among an ethnically diverse convenience sample of British Columbian adults. A sample of adults (≥18 years) from around the province of British Columbia, including Aboriginal (n = 991), European (n = 3650), East Asian (n = 466), and South Asian (n = 228), were evaluated. Individuals reported their personal histories of cardiovascular disease and diabetes, and physical activity behaviour. Direct measures of health status included body mass index, waist circumference, resting blood pressure, and nonfasting blood glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, and glycosylated hemoglobin A1C. All ethnic groups were found to have high rates of low HDL (>33%), physical inactivity (>31%), hypertension (>16%), and ethnic-specifically defined obesity (>23%) and abdominal obesity (>33%). Aboriginal and South Asian populations generally demonstrated higher rates of select chronic conditions. The implementation of ethnic-specific body composition recommendations further underscores this poorer health status among South Asian populations. Actions to improve chronic condition rates should be undertaken among all ethnic groups, with particular attention to Aboriginal and South Asian populations.
Background
Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment.
Methods
Two theories informed the study: (1) ‘candidacy’, which explores “the ways in which people’s eligibility for care is jointly negotiated between individuals and health services”; and (2) kanyini or ‘holding’, a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed.
Results
Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is ‘tractable’ and ‘navigable’ to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still constructed as ‘non-ideal users’ and are denied from being ‘held’ by hospital staff.
Conclusions
Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs ‘hold’ their users and enhance their candidacy to health care. Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care.
examine interpretivism, beginning with a general sketch of some critical issues in social science epistemology that shape this family of persuasions / single out several particular interpretivist approaches for a close look at how each defines the purpose of human inquiry / these include Clifford Geertz's view of interpretive anthropology, the Herbert Blumer-G. H. Mead version of symbolic interactionism, and Norman Denzin's reformulation of interpretive interactionism
introduce constructivist thinking through the work of Nelson Goodman [on cognition] / discuss Ernst von Glasersfeld's radical constructivism, Kenneth Gergen's social constructionism, feminist standpoint epistemologies, Egon Guba and Yvonna Lincoln's constructivist paradigm, and Elliot Eisner's aesthetic approach to educational inquiry as illustrations of constructivist thinking / conclude . . . with an overview of several kinds of criticisms often made of both constructivist and interpretivist approaches (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The ‘Barriers to Access to Care for Ethnic Minority Seniors’ (BACEMS) study in Vancouver, British Columbia, found that immigrant families torn between changing values and the economic realities that accompany immigration cannot always provide optimal care for their elders. Ethnic minority seniors further identified language barriers, immigration status, and limited awareness of the roles of the health authority and of specific service providers as barriers to health care. The configuration and delivery of health services, and health-care providers' limited knowledge of the seniors' needs and confounded these problems. To explore the barriers to access, the BACEMS study relied primarily on focus group data collected from ethnic minority seniors and their families and from health and multicultural service providers. The applicability of the recently developed model of ‘candidacy’, which emphasises the dynamic, multi-dimensional and contingent character of health-care access to ethnic minority seniors, was assessed. The candidacy framework increased sensitivity to ethnic minority seniors' issues and enabled organisation of the data into manageable conceptual units, which facilitated translation into recommendations for action, and revealed gaps that pose questions for future research. It has the potential to make Canadian research on the topic more co-ordinated. Also available at http://pubmedcentralcanada.ca/articlerender.cgi?accid=PMC3693980 (open access)
Background. In the UK, most people with mental health problems are managed in primary care. However, many individuals in need of help are not able to access care, either because it is not available, or because the individual's interaction with care-givers deters or diverts help-seeking. Aims. To understand the experience of seeking care for distress from the perspective of potential patients from "hard-to-reach" groups. Methods. A qualitative study using semi-structured interviews, analysed using a thematic framework. Results. Access to primary care is problematic in four main areas: how distress is conceptualised by individuals, the decision to seek help, barriers to help-seeking, and navigating and negotiating services. Conclusion. There are complex reasons why people from "hard-to-reach" groups may not conceptualise their distress as a biomedical problem. In addition, there are particular barriers to accessing primary care when distress is recognised by the person and help-seeking is attempted. We suggest how primary care could be more accessible to people from "hard-to-reach" groups including the need to offer a flexible, non-biomedical response to distress.
To develop an explanatory framework of the problems accessing primary care health services experienced by British South Asian patients with a long-term condition or mental health problem.
This study used meta-ethnographic methods. Published qualitative studies were identified from a structured search of six databases and themes synthesized across studies to develop a new explanatory framework.
Initial searches identified 951 potentially relevant records from which a total of 27 articles were identified that met inclusion and exclusion criteria. Twelve of these articles were chosen on the basis of their quality and relevance. These 12 articles described themes relating to the cultural, spatial and temporal dimensions of patient experiences of accessing and using health care. Our interpretive synthesis showed that access to primary care among British South Asians with diabetes, coronary heart disease and psychological health problems is co-constructed and negotiated over time and space along the key domains of the candidacy model of access: from help-seeking to interactions at the interface to following treatment advice. In the case of each condition, British South Asians' claims to candidacy were constrained where their individual as well as broader social and cultural characteristics lacked fit with professionals' ways of working and cultural typifications.
Interventions that positively affect professionals' capacity to support patient claims to candidacy are likely to help support British South Asians overcome a broad range of barriers to care for physical and mental health problems.
The purpose of this literature review is to describe and assess the cultural barriers to behavior change in migrant South Asians, given the high morbidity and mortality associated with cardiovascular disease in this population. We reviewed studies that explored the relationship between South Asian culture in the Diaspora and lifestyle behaviors. Our review produced 91 studies, of which 25 discussed the relationship between various aspects of South Asians' belief system and their approach to modifying lifestyle habits. We identify 6 specific categories of beliefs which play the largest role in the difficulties South Asians describe with behavior change: gender roles, body image, physical activity misconceptions, cultural priorities, cultural identity, and explanatory model of disease. Future research and interventions should account for these cultural factors to successfully improve dietary habits and physical activity levels in migrant South Asian populations.
Abuse in care relationships is an increasing concern in social policy and service provision. Attention has been drawn to the abuse of cared-for people in their own homes, the abuse of carers by family members and the abuse of people in institutional settings. Drawing on qualitative research with carers/carees from South Asian and African-Caribbean backgrounds, this paper explores a different conceptualization of abuse which moves away from an interpersonal understanding, to one that recognizes structural inequalities as a form of ‘institutional’ abuse of carers and those who receive care. This reconceptualization of abuse gives particular attention to forms of racism and discrimination in the provision of services to minoritized carers/cared-for people. It therefore makes significant contributions to discussions of caring and race equality in the health and social care fields.
Conventional thinking about preventive interventions focuses over simplistically on the "package" of activities and/or their educational messages. An alternative is to focus on the dynamic properties of the context into which the intervention is introduced. Schools, communities and worksites can be thought of as complex ecological systems. They can be theorised on three dimensions: (1) their constituent activity settings (e.g., clubs, festivals, assemblies, classrooms); (2) the social networks that connect the people and the settings; and (3) time. An intervention may then be seen as a critical event in the history of a system, leading to the evolution of new structures of interaction and new shared meanings. Interventions impact on evolving networks of person-time-place interaction, changing relationships, displacing existing activities and redistributing and transforming resources. This alternative view has significant implications for how interventions should be evaluated and how they could be made more effective. We explore this idea, drawing on social network analysis and complex systems theory.
This qualitative study examined the meaning and knowledge of health among older adult Russians who have immigrated to the US. Prior studies have shown that this group has a high rate of chronic disease and low compliance with preventative health behaviors. However, little is known about the knowledge and beliefs about health among Russian immigrants that may be driving their low participation in health behaviors. The goal of the present study was to use a phenomenological approach to gain a deeper understanding of the experience of health in this population. Twelve older adults were recruited through English language classes, and interviewed in focus groups about their experience with health and health care. Qualitative analysis using the phenomenological approach revealed a number of important health themes: participants (1) define health as the absence of disease, (2) feel distrust toward media information about health, (3) experience alienation from their current health care system, and (4) experience a sense of stress and helplessness in the US because they do not understand the English language or the US health care system. These themes may underlie the immigrants' lack of participation in health practices and in seeking out information about health. Information about the Russian immigrants' knowledge about health behavior is also reported. This study represents a first step toward better understanding the barriers facing older adult Russian immigrants in learning about and practicing health behaviors. The study also draws attention to the ways in which beliefs about health may impact health behavior.
Differences in level of physical activity between European, Indian, Pakistani and Bangladeshi populations living in the UK might contribute to differences in the prevalence of diabetes and cardiovascular disease risk markers that exist in these populations.
Type and level of physical activity (measured by a multidimensional index) and its relationship with selected cardiovascular disease and diabetes risk factors were assessed in a cross-sectional, population-based study of European, Indian, Pakistani and Bangladeshi men and women, aged 25-75, resident in Newcastle upon Tyne.
Europeans were found to be more physically active than Indians, Pakistanis or Bangladeshis. On our physical activity index 52 per cent of European men did not meet current guidelines for participation in physical activity compared with 71 per cent of Indians, 88 per cent of Pakistanis and 87 per cent of Bangladeshis. Similar findings are reported for women. In particular, European men and women participated more frequently in moderate and vigorous sport and recreational activities. In general, level of physical activity was inversely correlated with body mass index (BMI), waist measurement, systolic blood pressure, and blood glucose and insulin in all ethnic groups, but did not correlate with high-density lipoprotein (HDL) cholesterol.
South Asians in Newcastle report significantly lower levels of habitual physical activity than Europeans. This is likely to contribute to the higher levels of diabetes and cardiovascular risk in these populations. Measures to increase physical activity in these populations are urgently needed.
Othering is a process that identifies those that are thought to be different from oneself or the mainstream, and it can reinforce and reproduce positions of domination and subordination. Although there are theoretical and conceptual treatments of othering in the literature, researchers lack sufficient examples of othering practices that influence the interactions between patients and health care providers. The purpose of this study was to explore the interactions between health care providers and South Asian immigrant women to describe othering practices and their effects. Ethnographic methods were used involving in-depth interviews and focus group discussions. The analysis entailed identifying uses of othering and exploring the dynamics through which this process took place. Women shared stories of how discriminatory treatment was experienced. The interviews with health care professionals provided examples of how views of South Asian women shaped the way health care services were provided. Three forms of othering were found in informants' descriptions of their problematic health care encounters: essentializing explanations, culturalist explanations, and racializing explanations. Women's stories illustrated ways of coping and managing othering experiences. The analysis also revealed how individual interactions are influenced by the social and institutional contexts that create conditions for othering practices. To foster safe and effective health care interactions, those in power must continue to unmask othering practices and transform health care environments to support truly equitable health care.
Recent studies have established that a healthy immigrant effect operates in Canada-immigrants are generally healthier than Canadian-born persons-but that this effect tends to diminish over time, as the health of immigrants converges to the Canadian norm. Although this effect has been examined by place of birth, language, marital status, socio-economic status, charter-language ability, and category of immigrant status in Canada, less is known about the healthy immigrant effect at different stages of the life course, particularly in mid- to later adulthood, stages at which there is an increased likelihood of decline in physical and mental health status. This study examines how age at immigration affects the health of mid- to later-life immigrants, compared to Canadian-born persons, using data from the 2000-2001 Canadian Community Health Survey. These data indicate that the healthy immigrant effect applies to later mid-life immigrants; that is, new immigrants-those who immigrated less than 10 years ago-aged 45 to 64 have better health than their longer-term counterparts-those who immigrated 10 or more years ago-whose health status is similar to that of Canadian-born persons. Interestingly, a different picture emerges in old age (65 years and over), where recent immigrants have poorer overall health compared to Canadian-born persons. When a number of socio-demographic, socio-economic, and health behaviour factors are controlled, however, this disadvantage largely disappears. The findings are discussed in terms of their implications for Canadian health care policy and program planning for immigrants in the latter stages of the life course.
Type 2 diabetes is at least 4 times more common among British South Asians than in the general population. South Asians also
have a higher risk of diabetic complications, a situation which has been linked to low levels of physical activity observed
amongst this group. Little is known about the factors and considerations which prohibit and/or facilitate physical activity
amongst South Asians. This qualitative study explored Pakistani (n = 23) and Indian (n = 9) patients' perceptions and experiences of undertaking physical activity as part of their diabetes care. Although respondents
reported an awareness of the need to undertake physical activity, few had put this lifestyle advice into practice. For many,
practical considerations, such as lack of time, were interwoven with cultural norms and social expectations. Whilst respondents
reported health problems which could make physical activity difficult, these were reinforced by their perceptions and understandings
of their diabetes, and its impact upon their future health. Education may play a role in physical activity promotion; however,
health promoters may need to work with, rather than against, cultural norms and individual perceptions. We recommend a realistic
and culturally sensitive approach, which identifies and capitalizes on the kinds of activities patients already do in their
everyday lives.
Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK METHODS: This project involved the development and use of the method of Critical Interpretive Synthesis (CIS). This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis.
Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people's eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research.
By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare. This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole. Both the method and the model should be evaluated in other contexts.
In this article, the authors clarify a framework for qualitative research, in particular for evaluating its quality, founded on epistemology, methodology, and method. They define these elements and discuss their respective contributions and interrelationships. Epistemology determines and is made visible through method, particularly in the participant- researcher relationship, measures of research quality, and form, voice, and representation in analysis and writing. Epistemology guides methodological choices and is axiological. Methodology shapes and is shaped by research objectives, questions, and study design. Methodologies can prescribe choices of method, resonate with particular academic disciplines, and encourage or discourage the use and/or development of theory. Method is constrained by and makes visible methodological and epistemic choices. If we define good quality qualitative research as research that attends to all three elements and demonstrates internal consistency between them, standardized checklists can be transcended and innovation and diversity in qualitative research practice facilitated.
We have previously described a method for dealing with missing data in a prospective cardiac registry initiative. The method involves merging registry data to corresponding ICD-9-CM administrative data to fill in missing data 'holes'. Here, we describe the process of translating our data merging solution to ICD-10, and then validating its performance.
A multi-step translation process was undertaken to produce an ICD-10 algorithm, and merging was then implemented to produce complete datasets for 1995-2001 based on the ICD-9-CM coding algorithm, and for 2002-2005 based on the ICD-10 algorithm. We used cardiac registry data for patients undergoing cardiac catheterization in fiscal years 1995-2005. The corresponding administrative data records were coded in ICD-9-CM for 1995-2001 and in ICD-10 for 2002-2005. The resulting datasets were then evaluated for their ability to predict death at one year.
The prevalence of the individual clinical risk factors increased gradually across years. There was, however, no evidence of either an abrupt drop or rise in prevalence of any of the risk factors. The performance of the new data merging model was comparable to that of our previously reported methodology: c-statistic = 0.788 (95% CI 0.775, 0.802) for the ICD-10 model versus c-statistic = 0.784 (95% CI 0.780, 0.790) for the ICD-9-CM model. The two models also exhibited similar goodness-of-fit.
The ICD-10 implementation of our data merging method performs as well as the previously-validated ICD-9-CM method. Such methodological research is an essential prerequisite for research with administrative data now that most health systems are transitioning to ICD-10.
Perceived racial discrimination is one factor which may discourage ethnic minorities from using healthcare. However, existing research only partially explains why some persons do accept health promotion messages and use preventive care, while others do not. This analysis explores 1) the psychosocial characteristics of those, within disadvantaged groups, who identify their previous experiences as racially discriminatory, 2) the extent to which perceived racism is associated with broader perspectives on societal racism and powerlessness, and 3) how these views relate to disadvantaged groups' expectation of mistreatment in healthcare, feelings of mistrust, and motivation to use care.
Using survey data from 576 African-American women, we explored the prevalence and predictors of beliefs and experiences related to social disengagement, racial discrimination, desired and actual racial concordance with medical providers, and fear of medical research. We then used both sociodemographic characteristics, and experiences and attitudes about disadvantage, to model respondents' scores on an index of personal motivation to receive breast cancer screening, measuring screening knowledge, rejection of fatalistic explanatory models of cancer, and belief in early detection, and in collaborative models of patient-provider responsibility.
Age was associated with lower motivation to screen, as were depressive symptoms, anomie, and fear of medical research. Motivation was low among those more comfortable with African-American providers, regardless of current provider race. However, greater awareness of societal racism positively predicted motivation, as did talking to others when experiencing discrimination. Talking was most useful for women with depressive symptoms.
Supporting the Durkheimian concepts of both anomic and altruistic suicide, both disengagement (depression, anomie, vulnerability to victimization, and discomfort with non-Black physicians) as well as over-acceptance (low awareness of discrimination in society) predict poor health maintenance attitudes in disadvantaged women. Women who recognize their connection to other African-American women, and who talk about negative experiences, appear most motivated to protect their health.
In collaborative qualitative research in Asia, data are usually collected in the national language, and this poses challenges for analysis. Translation of transcripts to a language common to the whole research team is time consuming and expensive; meaning can easily be lost in translation; and validity of the data may be compromised in this process. We draw on several published examples from public health research conducted in mainland China, to highlight how language can influence rigour in the qualitative research process; for each problem we suggest potential solutions based on the methods used in one of our research projects in China.
Problems we have encountered include obtaining sufficient depth and detail in qualitative data; deciding on language for data collection; managing data collected in Mandarin; and the influence of language on interpreting meaning.
We have suggested methods for overcoming problems associated with collecting, analysing, and interpreting qualitative data in a local language, that we think help maintain analytical openness in collaborative qualitative research. We developed these methods specifically in research conducted in Mandarin in mainland China; but they need further testing in other countries with data collected in other languages. Examples from other researchers are needed.
This paper examines the differential impact of social forces on the health of men and women aged 65+ using data from the 1994-1995 National Population Health Survey. Multiple regression analysis is used to estimate gender differences in the influence of socio-economic, lifestyle, and psychosocial factors on both self-rated health and overall functional health. Some key findings are: 1) the relationship between income and health is significant for older women, but not for older men, while the opposite occurs for education; 2) having an acceptable body weight is positively associated with health for elderly women only; and 3) stress-related factors are generally much stronger determinants of health for older women. These findings shed light on the processes of healthy aging for men and women.
Diabetes is a public health issue impacting population health and Canadian health systems, with earlier onset and poorer outcomes among nonwhite Canadians—most of whom are immigrants—as compared to European descendants. This review aims to summarize and identify deficiencies in the existing literature on prevalence and risk factors of diabetes in Canadian immigrants who constitute the majority of nonwhite Canadians. Peer-reviewed articles published between January 2000 and May 2011, were retrieved from PubMed. Prevalence of diabetes ranges between 1.3% and 12% among immigrants and varies across ethnocultural groups. Studies tend to uniformly suggest that nonwhite Canadian immigrants particularly from South Asia, the Caribbean, sub-Saharan Africa and Latin America seem to experience a higher burden of diabetes. Risk factors include time since immigration to Canada, ethnicity, gender, immigrant category, income and education level. Some risk factors such as income and education level seem to be mediated by gender. No study has investigated the impact of structural and contextual factors such as discrimination, social and economic inequalities on diabetes. As the immigrant population continues to grow, the impact on the Canadian health system is expected to increase. Therefore, to guide the development of culturally appropriate interventions aimed at reducing the burden of diabetes among immigrants, there is a need to accelerate research pertaining to this issue. Future research on diabetes among Canadian immigrants will benefit from using a perspective that situates the drivers of the disease into a multidimensional framework. Such a multidimensional perspective should go beyond the individual centered approach based on cultural and biological processes, and include the structural and contextual determinants such as poverty, discrimination, racism and “othering.” This is important to gain a better understanding of the multilevel risk factors of diabetes in immigrant populations, and subsequently to inform prevention strategies aimed at reducing their disease burden.RésuméLe diabète est un problème de santé publique ayant des conséquences sur la santé de la population et sur les systèmes de santé canadiens, et ayant un début plus précoce et un moins bon pronostic chez les Canadiens non blancs – dont la plupart sont des immigrants – comparativement aux descendants d’origine européenne. Cette revue a pour objet de résumer et de déterminer les lacunes de la littérature existante sur la prévalence et les facteurs de risque du diabète chez les immigrants Canadiens constituant la majorité des Canadiens non blancs. Les articles évalués par les pairs inclus dans la présente revue de litterature ont été publié entre 2000 et mai 2011 dans PubMed. La prévalence du diabète s’échelonne de 1,3% à 12% chez les immigrants et varie selon les groupes ethnoculturels. Les études tendent à démontrer de manière semblable que les immigrants canadiens non blancs, particulièrement ceux de l’Asie du Sud, des Caraïbes, de l’Afrique subsaharienne et de l’Amérique latine semblent connaître un fardeau de diabète plus élevé. Les facteurs de risque incluent le temps écoulé depuis l’immigration au Canada, l’ethnicité, le sexe, la catégorie d’immigrants, le revenu et le niveau de scolarité. Quelques facteurs de risque comme le revenu et le niveau de scolarité semblent être en lien avec le sexe. Aucune étude n’a examiné les conséquences des facteurs structurels et contextuels sur le diabète comme la discrimination, et les inégalités sociales et économiques. Comme la population immigrante continue de croître, les conséquences sur le système de santé du Canada sont susceptibles d’augmenter. Donc, pour faciliter le développement d’une intervention culturellement appropriée visant à diminuer le fardeau du diabète chez les immigrants, il est nécessaire d’accélérer la recherche portant sur ce problème. Des recherches futures sur le diabète chez les immigrants canadiens bénéficieront de l’utilisation d’une perspective qui situe les facteurs de la maladie dans un cadre multidimensionnel. Une telle perspective multidimensionnelle devrait aller au-delà de l’approche centrée sur la personne selon les processus culturels et biologiques, et inclure les déterminants structurels et contextuels tels que la pauvreté, la discrimination, le racisme, etc. Il est important de mieux comprendre les facteurs de risque multiples du diabète chez les populations immigrantes, et subséquemment orienter les stratégies de prévention visant à diminuer le fardeau de la maladie.
This article presents a study of the social, emotional and physical health lifestyle behaviours of a socially marginalised segment of Canada's population: retired, widowed, immigrant mothers from a South Asian country. Using a narrative research process, we explore how present physical, emotional and social health leisure activities are influenced by behaviours from their childhood, with emphasis on migration to Canada, retirement and widowing as lifestyle behavioural change points. Our sample of immigrant women were living in Halifax, Nova Scotia, Canada during the time of the study. The study employed narrative inquiry, which is often used in migration studies. Our qualitative data analyses uncovered themes that linked present social health activities and early life behaviours and the influence on them of cultural constraints or stimulants. Three forms of sociocultural influences, gender segregation, patriarchal protection and early preparation for marriage, shaped adolescence and adult life as less physically active but more emotionally and socially healthy. Later life events, migration, retirement and widowing, enabled women to gain freedom to renegotiate and reconstruct late-life styles to be more physically and socially active through ethno-cultural social networks they had built after migration. The concluding discussion makes recommendations for health and social programme planning to draw attention to cultural realms that could help these women become physically active after migration without compromising traditional social behaviours.
Although public and institutional policy states that the presence of family to provide care should not limit older people's access to public services, it does occur in practice. When family members are perceived as being able to contribute to the care of their elderly relatives, the frequency and duration of public sector support diminishes. This reality is particularly important to address with respect to ethnic elders where the perception and expectation of increased family involvement by public sector workers is commonplace. This article reports on the findings of a qualitative study addressing the experience of access among ethnic minority elderly women. It highlights the primary role of families in the discourse of home care and the resulting pressures this places on older ethnic women and their families. Suggestions for improving services are also mentioned.
Efforts to understand pathways to a diagnosis of Alzheimer's Disease and Related Dementias (ADRD) are important in light of the benefits of early diagnosis to both patients and families, but very little is known about the ways in which persons with dementia and their family caregivers experience this pathway from the point of initial symptom recognition by family or friends to formal diagnosis seeking, particularly for immigrant older adults. Our team employed qualitative methods and a critical constructionist and intersectional framework to understand this experience from the perspectives of ten Chinese-Canadian dyads of persons with dementia and their caregivers. Situating the decisions made by these dyads relative to their intersecting identities and the power structures that inhibit them steered us away from essentializing attributions of their experiences to their 'culture' or ethnicity. Early signs of dementia were recognized as such in hindsight. There was no evidence of a strong link between culture and symptom appraisal. Knowledge about dementia, which may be influenced by culture, age, income, knowledge of English, and other determinants of health, played a role in symptom appraisal and help seeking. The role of family caregivers in care-seeking was more highly influenced by structural factors than by traditional Chinese cultural norms about family responsibilities and filial piety. Once caregivers realized that the symptoms and behaviors were 'problematic,' they quickly sought out additional information, usually from a family physician. At 1.5 years, the time between symptom onset and diagnosis is comparable to or shorter than that reported in research with other cultural groups. Gender-based power imbalance between female family caregivers and male Chinese-Canadian physicians appear to have contributed to delayed investigations and diagnosis. Sensitivity to such imbalances is important when working with older adults and those from more hierarchical cultures. Essentialized portraits of traditional family structures and cultural beliefs may not accurately reflect the variety of lived experiences of the dementia care-seeking by older Chinese immigrants in Canada.
[advance a comprehensive model of] the management, analysis, and interpretation of qualitative empirical materials / [this] model distinguishes within- from between-case analysis while emphasizing the necessary connection between a theory and its concepts and the empirical indicators that reflect back through the concepts to the theory / show how codes, memos, and diagrams can help a researcher work from field notes to some conceptual understanding of the processes being studied / this model stresses variables and causal links between variables while focusing on an iterative approach that is fully open to discovery and the treatment of negative cases (PsycINFO Database Record (c) 2012 APA, all rights reserved)
interpreters as storytellers tell narrative tales with beginnings, middles, and ends / these tales always embody implicit and explicit theories of causality, where narrative or textual causality is presumed to map the actual goings-on in the real world / how this complex art of interpretation and storytelling is practiced is the topic of this chapter
review several [methods of interpretation of qualitative research in the social sciences], paying special attention to those that have been employed in the most recent past, including the constructivist, grounded theory, feminist, Marxist, cultural studies, and poststructural perspectives / examine problems generic to this process / briefly allude to [the author's personal] perspective, interpretive interactionism (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper serves as a “best practices guide” for researchers interested in applying intersectionality theory to psychological
research. Intersectionality, the mutually constitutive relations among social identities, presents several issues to researchers
interested in applying it to research. I highlight three central issues and provide guidelines for how to address them. First,
I discuss the constraints in the number of identities that researchers are able to test in an empirical study, and highlight
relevant decision rules. Second, I discuss when to focus on “master” identities (e.g., gender) versus “emergent” identities
(i.e., White lesbian). Third, I argue that treating identity as a process situated within social structural contexts facilitates
the research process. I end with a brief discussion of the implications for the study of intersectionality.
The aim of this research review was to portray the correlates of lifestyle physical activity (PA) behavior of healthy South Asian Indian (SAI) immigrants comprehensively by identifying, synthesizing, and critically analyzing the existing research literature.
An integrative review methodology was used. The sample included 11 cross-sectional and 4 qualitative studies.
The physical activity framework for SAI immigrants guided the development of data collection tools that included study measures of PA and background (current health, acculturation, discrimination, social support, environmental) and intrapersonal (motivation) correlates of PA.
Regardless of the PA measure used, all studies reported low PA levels in at least 40% of the participants. The correlates of PA most often studied were sociodemographic variables, current health, and acculturation; female sex; poorer health; and less time since immigration. Few studies focused on social support, environmental factors, or included dynamic motivational factors.
Increased knowledge of the factors that impact lifestyle PA is needed so that public health nurses can develop targeted interventions to increase the lifestyle PA of SAI immigrants at risk for cardiovascular disease, diabetes, and central obesity.
Equitable access to primary care for people with common mental health problems in the UK remains problematic. The experiences of people from hard-to-reach groups offer important insights into barriers to accessing care. In this study, we report on secondary analysis of qualitative data generated within seven previously-reported studies. Thirty-three of ninety-two available transcripts were re-analysed using a new heuristic of access, generated to frame narrative-based comparative case analysis. The remaining transcripts were used to triangulate the findings via a process of collaborative analysis between a secondary researcher, naïve to research findings of the original studies, and primary researchers involved in data generation and analysis within the original studies. This method provided a rich body of 'fine grain' insights into the ways in which problem formulation, help-seeking, use of services and perceptions of service quality are interlinked in a recursive and socially embedded matrix of inequitable access to primary mental health care. The findings indicate both extensive commonalities between experiences of people from different 'hard-to-reach groups', and considerable diversity within each group. An idiographic generalisation and aggregation of this variety of experiences points to one main common facilitator (communicated availability of acceptable mental health services) and two main common barriers (lack of effective information and multiple forms of stigma) to equitable access to primary mental health care. We conclude that there is a need to provide local care that is pluralistic, adaptive, holistic, resonant and socially conscious in order to ensure that equitable access to mental health services can become a reality.
Aim. To report on a study which developed a knowledge of the experiences of South Asian people with diabetes in the UK in relation to socio-cultural and dietary practices, religion and ageing influences on the perception and understanding of risks.
Background. South Asian people have enhanced vulnerability to poor health as a result of diabetes. Risk perception and management is culturally mediated, yet imperative to the behaviour adjustments required for diabetes management.
Method. A grounded theory study with data collected by focus group with ethnic health development workers and individual interviews with 20 older people with diabetes. Where necessary, interpreters were involved in data collection.
Findings. A number of issues influence the perception of risk among South Asian older people with diabetes: beliefs about its cause, perceived severity and its visibility, food and its social function, religion and beliefs about external control over their life span and diabetes management. People weighed up the risks in making decisions about issues such as dietary management and the emphasis placed on diabetes as a pathology.
Conclusion. Good risk communication will maintain the current trend of improving patient's choice and self-management in health care, and there is a need for this to be sensitive to the particular issues faced by South Asians with diabetes in the UK.
Social comparisons influence self-evaluation and social and psychological adjustment to illness but are under-explored in relation to self-skills training group situations.
A longitudinal qualitative study embedded within an RCT of a national programme of lay led self-care support in England (Department of Health, 2001). In-depth interviews were undertaken with a purposeful maximum variation sample of recruits. Data were analysed thematically. Three key themes emerged highlighting (1) the experience of group participation and interaction, (2) the process and (3) function of social comparison.
Data highlight the salience of social comparison as an underlying feature of the group dynamics of self-care skills training. The nature, dimensions and scope of social comparisons extend beyond the cognitive states and dimensions traditionally forming the focus of social-psychological approaches to social comparison to include wider dimensions including entitlement to resources. The results confirm the tendency to make positive comparisons that result in beneficial self-evaluations. However, positive comparisons allow respondents to present themselves as socially and morally worthy, which may act to mask the identification of appropriate need and inequalities.
Social comparisons function both as an accurate representation of internal cognitive states but also constitutes identity work involving competing values and moral requirements. We show that even those who report significant needs will sometimes portray themselves in a way that suggests positive social comparisons, which fit with a rationed and morally prescriptive and acceptable view of entitlement to NHS services. Such insights suggest that social comparisons in initiatives such as the EPP may be beneficial for some but exacerbate rather than alleviate health inequalities in long-term condition management for others.
South Asian people living in the United Kingdom are at increased risk of coronary heart disease, have higher mortality rates and are less likely to be treated when compared to the white population. There is, however, little information about the experiences and needs of this group after discharge from hospital.
To explore the experiences and needs of Gujarati Hindu patients and their partners in the first month after a myocardial infarction.
Using a qualitative research approach, semi-structured interviews were conducted by a Gujarati-speaking researcher with 35 patients and their partners at home during early convalescence.
A number of categories emerged from the data which pertained to a lack of information and advice, poor performance of activity, little lifestyle adjustment, poor expectations, lack of future plans, strong family support, dissatisfaction with the family doctor, and a significant belief in fate.
Experiences and health care needs of Gujarati Hindu patients with myocardial infarction appear different to those of non-Asians. Cardiac aftercare and rehabilitation services should take account of such information
Moderate physical activity is protective against coronary heart disease (CHD) and diabetes, both important public health problems among UK South Asian (Indian, Pakistani and Bangladeshi) ethnic groups. We assessed the evidence that physical activity is lower in South Asian groups than in the general population.
We carried out a systematic literature review of studies describing levels of physical activity and fitness in UK South Asians using MEDLINE, EMBASE, the Cochrane databases, hand searching of relevant journals and review of reference lists.
We identified 12 studies in adults and five in children. Various methods were used to assess physical activity and fitness, but all the studies reported lower levels among South Asian groups. The differences were substantial, particularly among women and older people. For example, the Health Survey for England found that Indian, Pakistani and Bangladeshi men were 14, 30 and 45 per cent less likely than the general population to meet current guidelines for physical activity. Limited information was provided about translation and adaptation of questionnaires.
Levels of physical activity were lower in all South Asian groups than the general population and patterns of activity differed. No studies used validated measures. Insufficient attention has been paid to issues of cross-cultural equivalence. With these caveats, low levels of physical activity among UK South Asian ethnic groups may contribute to their increased risk of diabetes and CHD. Closer attention to validity, translation and adaptation is necessary to monitor changes and assess the effectiveness of interventions to increase physical activity.
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