Bodil Hansen Blix

“The Old Sami” – who is he and how should he be cared for? A discourse analysis of Norwegian policy documents regarding care services for elderly Sami

Abstract This study examined four policy documents published by the Norwegian government from 1995 to 2009 describing issues regarding the provision of public services to elderly Sami in Norway. Adopting a Foucauldian discourse analytic approach, we explored how the statements regarding elderly Sami and care services in these documents are situated within contemporary ethno-political and healthcare discourses. The documents exhibited two major and interrelated trends: the predominant portrayal of the Sami and the ethos of cultural congruent care. The analysis demonstrated a high degree of discursive continuity throughout the four documents, with the image of the elderly Sami constructed in the earliest document reproduced to a large extent in the newer documents. We suggest that a critical cultural perspective offers an alternative to the understanding of culture and the concept of cultural congruent care found in the documents. From a critical cultural perspective, culture is seen as relational, changing over time, and dependent on social context, history, gender, and other factors. In this view, cultural competence does not involve learning a fixed, coherent body of knowledge comprising “the Sami culture”. A critical cultural perspective challenges those who provide care to the elderly Sami to become aware of social, political, and historical processes while simultaneously acknowledging that the impacts of these processes on the lives of the individuals they encounter can never be fully known. Furthermore, this perspective prompts healthcare providers to reflect on how their assumptions about the people they encounter are shaped by their own social, cultural, economic, and professional backgrounds. We suggest that the authorities initiate a new policy document based on current insights into the everyday experiences of the current cohort of elderly Sami as well as contemporary social, ethno-political, and healthcare discourses.

Shared decision making from the service users’ perspective: A narrative study from community mental health centers in northern Norway

ABSTRACT This article aims to contribute to the understanding of shared decision making as an important aspect of user involvement in mental health care from the perspectives of service users. A thematic analysis of interviews with 25 individual service users in three different community mental health centers in Norway identified different understandings of shared decision making. Shared decision making was identified as essential in four contexts: 1) during admission, 2) in individualized treatment, 3) in different treatment contexts, and 4) in user-professional relationships. We consider shared decision making to be intertwined with treatment from the service user perspective.

“They take care of their own”: healthcare professionals’ constructions of Sami persons with dementia and their families’ reluctance to seek and accept help through attributions to multiple contexts

ABSTRACT Background: Norwegian government white papers have stated that the Sami population is reluctant to seek help from healthcare services and has traditions of self-help and the use of local networks. Objective: In this article we explore healthcare professionals’ discursive constructions of Sami persons with dementia and their families’ reluctance to seek and accept help from healthcare services. Design: The article is based on an analysis of focus group interviews with healthcare professionals (n = 18) in four municipalities in Northern Norway with multiethnic populations. A narrative context analysis, which involved an examination of sequences of discourse, was employed. Results: Reluctance to seek and accept help among Sami service users and assumptions about self-support were recurring themes in the focus groups. The reluctance was attributed to macro contexts, such as socio-historical processes and cultural norms, and to micro contexts, such as individual and interpersonal factors including the healthcare professionals’ cultural backgrounds and language competence. The healthcare professionals’ positioning as insiders or outsiders (Sami or non-Sami) affected their attributions. Conclusions: Local healthcare professionals are at the front line for providing and assessing service users’ needs for healthcare services. Consequently, their perceptions of service users’ needs are pivotal for achieving equity in healthcare. The established opinion that Sami “take care of their own” and are reluctant to seek and accept help may lead to omissions or neglect. Healthcare professionals’ awareness about how present encounters in healthcare settings are framed and shaped by the service users’ previous and prevailing experiences of marginalisation and subordination is crucial to avoid omissions or neglect resulting from assumptions about cultural preferences. Discursively shaped boundaries and differences between groups may create the impression that the distance between the groups is too wide to traverse, which in turn may lead to further marginalisation of service users in healthcare encounters.

“Something Decent to Wear” Performances of Being an Insider and an Outsider in Indigenous Research

The point of departure for this article is the commitment in Indigenous research to reflect Indigenous contexts and worldviews. Based on an analysis of a story from my research, I argue that Indigenous contexts (rather than being things-unto-themselves that pre-exist description) are complex constructions comprised of social structures, historical events, and cultural meta-narratives that are rendered relevant in local interview contexts by both the interviewees and the interviewers. Such contexts are relevant for the interviewers’ performances as insiders and outsiders in interview situations. I argue that as a consequence of applying a performance perspective to Indigenous research, one must accept that the complex question regarding insiderness and outsiderness cannot be finalized. Rather, the researcher’s identities are performed continuously in every interview situation.

‘When the saints go marching in’: constructions of senior volunteering in Norwegian government white papers, and in Norwegian senior volunteers’ and health-care professionals’ stories

ABSTRACT This study explores policy makers’, health-care professionals’ and senior volunteers’ perceptions of senior volunteers. Two Norwegian government white papers regarding older adult care and welfare services, which were published over a period of 19 years, were selected for close examination. Furthermore, focus group interviews with a purposeful sample of five senior volunteers and 15 health-care professionals were conducted. The study explores the discursive formations of senior volunteers in the government white papers and how they are negotiated in the senior volunteers’ and the health-care professionals’ narratives. Two dominant discourses were presented in the white papers: a prevention discourse (in which volunteering was presented primarily as a means to prevent volunteers’ loneliness and need for care services) and a sustainability discourse (in which the volunteers were presented as instrumental in future sustainable care services). Both discourses echo a common overarching discourse about a capacity crisis due to the ageing population. The senior volunteers were positioned as partners and active agents in both their own narratives and the health-care professionals’ narratives. Their position as independent and as spokespersons for the less empowered were evident only in the senior volunteers’ own narratives. Only the health-care professionals referenced the prevention discourse and capacity issues. The senior volunteers presented themselves as competent, efficient political actors, and they resisted both the prevention and sustainability discourses. In the senior volunteers’ narratives, social and political participation were interrelated. The study demonstrates that new discursive landscapes must be created to capture the diversity among senior volunteers and their efforts. While senior volunteers must be meaningfully involved in decision making, planning and design, their positions as independent and active agents must also be ensured. Authentic partnerships between senior volunteers and public care services involve a balance between involvement and independence.