Lack of access to care, funding limitations, cultural, and social barriers are challenges specific to tribal communities that have led to adverse cancer outcomes among American Indians/Alaska Natives (AI/AN). While the cancer navigator model has been shown to be effective in other underserved communities, it has not been widely implemented in Indian Country. We conducted in-depth interviews with 40 AI/AN patients at tribal clinics in Idaho and Oregon. We developed the survey instrument in partnership with community members to ensure a culturally appropriate semi-structured questionnaire. Questions explored barriers to accessing care, perceptions of the navigator program, satisfaction, and recommendations. AI/AN cancer patients reported physical, emotional, financial, and transportation barriers to care, but most did not feel there were any cultural barriers to receiving care. Navigator services most commonly used included decision making, referrals, transportation, scheduling appointments, and communication. Satisfaction with the program was high. Our study provides a template to develop a culturally appropriate survey instrument for use with an AI/AN population, which could be adapted for use with other indigenous patient populations. Although our sample was small, our qualitative analysis facilitated a deeper understanding of the barriers faced by this population and how a navigator program may best address them. The results reveal the strengths and weakness of this program, and provide baseline patient satisfaction numbers which will allow future patient navigator programs to better create evaluation benchmarks.
Cites: Cancer Epidemiol Biomarkers Prev. 2012 Oct;21(10):1673-81 PMID 23045542
Cites: MMWR Surveill Summ. 2004 Jun 4;53(3):1-108 PMID 15179359
Causal attributions of mental health problems play a crucial role in shaping and differentiating illness experience in different sociocultural and ethnic groups. The aims of this study were (a) to analyze older Somali refugees' causal attributions of mental health problems; (b) to examine the associations between demographic and diagnostic characteristics, proxy indicators of acculturation, and causal attributions; and (c) to analyze the connections between causal attributions and the manifestation of somatic-affective and cognitive depressive symptoms. A sample of 128 Somali refugees aged 50-80 years living in Finland were asked to list the top three causes of mental health problems. Depressive symptoms were analyzed using the Beck Depression Inventory (BDI). The results showed that the most commonly endorsed causal attributions of mental health problems were jinn, jealousy related to polygamous relationships, and various life problems. We identified five attribution categories: (a) somatic, (b) interpersonal, (c) psychological, (d) life experiences, and (e) religious causes. The most common causal attribution categories were life experiences and interpersonal causes of mental health problems. Men tended to attribute mental health problems to somatic and psychological causes, and women to interpersonal and religious causes. Age and proxy indicators of acculturation were not associated with causal attributions. Participants with a psychiatric diagnosis and/or treatment history reported more somatic and psychological attributions than other participants. Finally, those who attributed mental health problems to life experiences (e.g., war) reported marginally fewer cognitive depressive symptoms (e.g., guilt) than those who did not. The results are discussed in relation to biomedical models of mental health, service use, immigration experiences, and culturally relevant patterns of symptom manifestation.
The purpose of this study was to assess whether similar environmental factors predict adolescents' smoking in two different cultures: in the Pitkäranta district in Russian Karelia and in eastern Finland. The data were gathered by self-administered questionnaires from ninth-grade students in 10 comprehensive schools in Pitkäranta (n = 385) and from age-matched students in 24 schools in eastern Finland (n = 2,098). Structural equation modeling (SEM) was used to test whether similar path structures fit for boys and for girls in Pitkäranta and in eastern Finland, and to test whether regression coefficients were similar between the cultures by sex. Smoking by family members and best friends was positively related to adolescents' smoking both directly and indirectly. Environmental factors were similar predictors of smoking between the cultures for boys. For girls, different regression coefficients in Pitkäranta and in eastern Finland were found. Best friend's smoking was the most important predictor of adolescents' own smoking in every sub-sample. When indirect relationships were identified, the significance of parents' and siblings' smoking, in addition to smoking by best friends, was strongly supported.
To describe immigrant women's postpartum health, service needs, access to services, and service use during the first 4 weeks following hospital discharge compared to women born in Canada.
Data were collected as part of a larger cross-sectional study.
Women were recruited from 5 hospitals purposefully selected to provide a diverse sample.
A sample of 1,250 women following vaginal delivery of a healthy infant; approximately 31% were born outside of Canada.
Self-reported health status, postpartum depression, postpartum needs, access to services, service use.
Immigrant women were significantly more likely than Canadian-born women to have low family incomes, low social support, poorer health, possible postpartum depression, learning needs that were unmet in hospital, and a need for financial assistance. However, they were less likely to be able to get financial aid, household help, and reassurance/support. There were no differences between groups in ability to get care for health concerns.
Health care professionals should attend not only to the basic postpartum health needs of immigrant women but also to their income and support needs by ensuring effective interventions and referral mechanisms.
Recent studies have demonstrated the importance of considering acculturation when investigating the sexuality of East Asian women in North America. Moreover, bidimensional assessment of both heritage and mainstream cultural affiliations provides significantly more information about sexual attitudes than simple unidimensional measures, such as length of residency in the Western culture.
The goal of this study was to extend the findings in women to a sample of East Asian men.
Self-report measures of sexual behaviors, sexual responses, and sexual satisfaction.
Euro-Canadian (N = 124) and East Asian (N = 137) male university students privately completed a battery of questionnaires in exchange for course credit. Results. Group comparisons revealed East Asian men to have significantly lower liberal sexual attitudes and experiences, and a significantly lower proportion had engaged in sexual intercourse compared with the Euro-Canadian sample. In addition, the East Asian men had significantly higher Impotence and Avoidance subscale scores on the Golombok Rust Inventory of Sexual Satisfaction, a measure of sexual dysfunction. Focusing on East Asian men alone, mainstream acculturation, but not length of residency in Canada, was significantly related to sexual attitudes, experiences, and responses.
Overall, these data replicate the findings in women and suggest that specific acculturation effects over and above length of residency should be included in the cultural assessment of men's sexual health.
Over the past 30 years, women have been the target of intense advertising focused on hormone replacement therapy. The author takes a critical look at the distorting nature of this approach, which has succeeded in convincing many Western women that menopause is an illness, and hormone replacement therapy a panacea. Through studies she has consulted, and discussions on the economic situation associated with age and poverty among the elderly, the author underlines that menopause is a lucrative industry. She advances several relevant issues for discussion.
Although many health concerns of women in India differ from those of Indian women in Canada, both groups of women have a high incidence of low birthweight babies. The question of how best to improve the health status of pregnant Indo-Canadian women and consequently improve pregnancy outcomes is a complex one. It involves the availability and allocation of financial and human resources, the integration of Indian cultural beliefs and attitudes with Western biomedical knowledge, the status of women in Indian culture, and Canadian social and economic issues such as demographic changes, changes in the role of the family, government policies, economic restructuring and so on.
Given the paradox of the success of modern medical technology and the growing patient dissatisfaction with present-day medicine, critics have called for a reevaluation of contemporary medical practice. This paper offers a phenomenological analysis of traditional Navajo healers and their ceremonies to highlight key aspects of healing. A phenomenological view of medical practice takes into account three key features: the lifeworld, the lived body, and understanding. Because of their closeness to a phenomenological view, traditional Navajo mythology and healing practices offer insight into the healing process. Contemporary physicians can appreciate the phenomenological elements of Navajo healing ceremonies, including the Mountain Chant. Navajo healers help patients make sense of their illnesses and direct their lives accordingly, an outcome available to contemporary practitioners, who are also gifted with the benefits of new technologies. By examining scientific medicine, Navajo healing practices, and phenomenology as complementary disciplines, the authors provide the groundwork for reestablishing a more therapeutic view of health.
The aim of this study was to explore nurses' perceptions of their encounters with multicultural families in intensive care units in Norwegian hospitals. Immigrants from non-Western countries make up 6.1% of the population in Norway. When a person suffers an acute and critical illness the person's family may experience crises. Nurses' previous experiences of caring for culturally diverse patients and families is challenging due to linguistic differences, and contextual factors. Family members should be near their critically ill spouse to reduce the impact from a frightening environment. The study had a descriptive exploratory qualitative design with a retrospective focus. Three multistage focus groups consisting of 16 nurses were set up in intensive care units. The data were analysed by interpretive content analysis. The theme 'Cultural diversity and workplace stressors' emerged. This theme was characterised by four categories: 'impact on work patterns'; 'communication challenges'; 'responses to crises' and 'professional status and gender issues'. In conclusion, nurses' perception of their encounters with multicultural families in intensive care units seem to be ambiguous with challenges in interaction, and the nurses' stressors emanating from linguistic, cultural and ethnic differentness. To diminish cultural diversity the nurses strive for increased knowledge of different cultures and religions.
The major purpose of this paper is to examine how 'race' and racialization operate in health care. To do so, we draw upon data from an ethnographic study that examines the complex issues surrounding health care access for Aboriginal people in an urban center in Canada. In our analysis, we strategically locate our critical examination of racialization in the 'tension of difference' between two emerging themes, namely the health care rhetoric of 'treating everyone the same,' and the perception among many Aboriginal patients that they were 'being treated differently' by health care providers because of their identity as Aboriginal people, and because of their low socio-economic status. Contrary to the prevailing discourse of egalitarianism that paints health care and other major institutions as discrimination-free, we argue that 'race' matters in health care as it intersects with other social categories including class, substance use, and history to organize inequitable access to health and health care for marginalized populations. Specifically, we illustrate how the ideological process of racialization can shape the ways that health care providers 'read' and interact with Aboriginal patients, and how some Aboriginal patients avoid seeking health care based on their expectation of being treated differently. We conclude by urging those of us in positions of influence in health care, including doctors and nurses, to critically reflect upon our own positionality and how we might be complicit in perpetuating social inequities by avoiding a critical discussion of racialization.