SETTING: A study carried out in 1996 in four districts representing south and north as well as urban and rural areas of Vietnam. OBJECTIVE: To explore gender differences in knowledge, beliefs and attitudes towards tuberculosis and its treatment, and how these factors influence patients' compliance with treatment. DESIGN: Sixteen focus group discussions were performed by a multi-disciplinary research team from Vietnam and Sweden. Analysis was performed using modified Grounded Theory technique, specifically evaluating gender differences. RESULTS: Women were believed to be more compliant than men. Insufficient knowledge and individual cost during treatment were reported as main obstacles to compliance among men (poor patient compliance), while sensitivity to interaction with health staff and stigma in society (poor health staff and system compliance) were reported as the main obstacles among women. CONCLUSIONS: It is time to adopt a more comprehensive and gender-sensitive approach to compliance, which incorporates patient compliance, doctor compliance and system compliance, in order to fully support individual patients in their efforts to comply with treatment.
Like most indigenous populations throughout the world who have undergone innumerable cultural changes, the mental health care needs of American Indians are great. Some surveys conducted by the Indian Health Service show high rates of suicide, mortality, depression and substance abuse. Little is known about effective mental health care among American Indians due, in part, to the lack of culturally appropriate models of mental health in American Indians. This article presents a cultural framework in order to understand the mental health care needs of American Indians and discusses barriers to providing effective mental health services to American Indians.
Childbirth for many Aboriginal women living in remote communities of the Northwest Territories, Canada, includes separation from their family and community for weeks at a time. This colonialization of childbirth, enforced for decades, is true for Dogrib Dene. Colonialization produces serious social consequences on the everyday lives of pregnant Aboriginal women, which results in lower health outcomes. This article provides a literature review of colonialization in Canada's far north establishing the position that colonialization is a determinant of health. The purpose of this article is to generate knowledge that will inform health professionals and ultimately reduce health disparities as experienced and evident among Dogrib women. By highlighting the concept of colonialization and establishing this concept as a determinant of health, nurses and midwives will identify disparities created through stressors of power and control. From there, culturally meaningful health promotion strategies will be developed and implemented within their nursing practice.
AIM: The aim was to analyse the construction of masculinities among men aged 85 and older. BACKGROUND: All societies have a gender order, constructed from multiple ideas of what is seen as feminine and masculine. As the group of men aged 85 and older is increasing in size and their demand for care will increase, we must recognize the importance of studying these men and various discourses of masculinities. DESIGN: Qualitative explorative. METHODS: Qualitative content analysis was used to analyse thematic narratives. Masculinity theories provided the point of departure for the analysis. RESULTS: The analysis coalesced into three masculinities. 'Being in the male centre', developed from subthemes as: taking pride in one's work and economic situation; being in the centre in relation to others; regarding women as sexual objects; and belonging to a select group. 'Striving to maintain the male facade' developed from subthemes as: emphasizing 'important' connections; having feelings of loss; striving to maintain old norms and rejecting the fact of being old. 'Being related' was formulated from subthemes as: feeling at home with domestic duties; being concerned; accepting one's own aging; and reflecting on life. CONCLUSIONS: Our study indicates the importance of being aware of the existence of multiple masculinities, in contrast to the generally unproblematic and unsubtle particular healthcare approaches which consider men as simply belonging to one masculinity. Relevance to clinical practice. Diverse masculinities probably affect encounters between men and healthcare providers and others who work with an older population and therefore our results are of importance in a caring context.
Cultural challenges in end-of-life care: reflections from focus groups' interviews with hospice staff in Stockholm During the past few decades, Swedish society has changed from a society with a few ethnic groups to one with over a hundred groups of different ethnic backgrounds, languages and religions. As society is becoming increasingly multicultural, cultural issues are also becoming an important feature in health care, particularly in end-of-life care where the questions of existential nature are of great importance. However, cultural issues in health care, especially at hospices, have not been studied sufficiently in Sweden. The purpose of this study was to gather reflections about cultural issues among hospice staff after a 3-day seminar in multicultural end-of-life care, by using a qualitative focus groups method. The 19 participants (majority nurses) were divided into three groups, one per hospice unit. A discussion guide was developed with the following themes: 1) post-training experiences of working with patients with multicultural background; 2) experiences gained by participating in the course of multicultural end-of-life care; 3) post-training reflections about one's own culture; 4) ideas or thoughts regarding work with patients from other cultures arising from the training; and 5) the need for further training in multicultural end-of-life care. One of the study's main findings was that to better understand other cultures it is important to raise awareness about the staff's own culture and to pay attention to culture especially in the context of the individual. The findings from focus groups provide insight regarding the need for planning flexible training in cultural issues to match the needs of the staff at the hospice units studied.
The On the Margins project investigated health status, health-care delivery, and use of health services among African-Canadian women residing in rural and remote regions of the province of Nova Scotia. A participatory action research approach provided a framework for the study. Triangulation of data-collection methods--interviews, focus groups, and questionnaires--formed the basis of data generation. A total of 237 in-depth one-on-one interviews were conducted and coded verbatim. Atlas-ti data-management software was used to facilitate coding and analysis. Six themes emerged from the data: Black women's multiple roles, perceptions of health, experiences with the health-care system, factors affecting health, strategies for managing health, and envisioning solutions. The authors focus on 1 of these themes, factors affecting Black women's health, and discuss 3 subthemes: race and racism, poverty and unemployment, and access to health care.
This exploration of the racial power dynamics in a participatory action research project with women who had experienced intimate partner violence discusses the challenges inherent in doing participatory action with antiracist intent and offers suggestions for overcoming these challenges. To engage in this type of research, explicit commitment to the goals of an antiracist intent needs to be shared as widely as possible. Fostering such shared commitment demands that the social locations of all involved be interrogated continuously. Such interrogation, however, needs to be prefaced with understanding that individuals are not representative of particular power positions or social identities or locations and with critical attention to how language and social structures shape racism and other forms of dominance. Being inclusive must be understood as complex and the influence of diverse agendas and perspectives acknowledged and taken into account. In the face of such complexity, "success" in research may need redefinition.
Recent systematic reviews of measurement strategies have identified a striking lack of data to support the validity of most questionnaires used with multiethnic, migrant populations. In the context of two ongoing research studies examining the reproductive health needs of migrant women in Canada, cultural validation was required for proposed study questionnaires and protocols in a total of 13 languages. Multilingual, multiethnic women with various migrant profiles were recruited from the community to review research materials in a series of focus groups. Recommendations by these women were made in relation to consent and interpretation procedures, development of trust in research, home visits after birth, approaches to sensitive topics, inclusion of discrimination as a research variable, and reimbursement of participants. Preliminary work applying focus-group methods to mixed ethno-cultural groups yielded valuable information on appropriateness of planned research.
The aim of the study was to describe how foreign-born and Swedish born families living in Sweden perceive psychosis care. Eleven foreign-born and 15 Swedish-born family members were interviewed and the data were analyzed using a phenomenographic approach. The findings showed three main descriptive categories: taking responsibility, access to care, and attitudes to psychosis. The degree of responsibility in the family decreased if there was easy access to care and support from health-care staff. Knowledge of psychosis was considered to be important in order to counteract prejudiced attitudes in the family and the community. Foreign-born families did not want to be treated differently from Swedes and stressed the importance of finding ways to communicate despite communication barriers. Foreign-born families also were affected by their experiences of psychiatric care and different beliefs about psychosis in their home country. The results indicate how important it is that health-care staff members treat families on equal terms. It is necessary to take the time to identify how to communicate in a good manner and to identify families' previous experiences of and beliefs about psychosis care in order to help families face prejudice in society and to see beyond the psychosis.
Black women bear a disproportionate burden of HIV/AIDS in North America. The purpose of this investigation was to explore Black Canadian women's perspectives on HIV risk and prevention. Four 90-minute focus groups (n=26) and six key informant interviews were conducted in Toronto with Black women of African and Caribbean descent and low socioeconomic status. Data analysis revealed a number of potent barriers to existing HIV preventive interventions: stigma, cultural disconnections, lack of engagement of Black religious institutions, and multiple intersecting forms of discrimination. Recommended HIV prevention opportunities included the Black church, mainstreaming, health care providers, and ethno-specific agencies. HIV prevention strategies for North American Black women, rather than focusing on HIV and individual risk behaviors, may benefit from a primary focus on social and structural factors (e.g., promoting gender equality, economic opportunity, women-controlled prevention technologies and combating racism in health care) thereby integrating HIV prevention into the larger context of community health and survival.