Jalal Safipour

“I have to do what I believe”: Sudanese women’s beliefs and resistance to hegemonic practices at home and during experiences of maternity care in Canada

BackgroundEvidence suggests that immigrant women having different ethnocultural backgrounds than those dominant in the host country have difficulty during their access to and reception of maternity care services, but little knowledge exists on how factors such as ethnic group and cultural beliefs intersect and influence health care access and outcomes. Amongst immigrant populations in Canada, refugee women are one of the most vulnerable groups and pregnant women with immediate needs for health care services may be at higher risk of health problems. This paper describes findings from the qualitative dimension of a mixed-methodological study.MethodsA focused ethnographic approach was conducted in 2010 with Sudanese women living in an urban Canadian city. Focus group interviews were conducted to map out the experiences of these women in maternity care, particularly with respect to the challenges faced when attempting to use health care services.ResultsTwelve women (mean age 36.6 yrs) having experience using maternity services in Canada within the past two years participated. The findings revealed that there are many beliefs that impact upon behaviours and perceptions during the perinatal period. Traditionally, the women mostly avoid anything that they believe could harm themselves or their babies. Pregnancy and delivery were strongly believed to be natural events without need for special attention or intervention. Furthermore, the sub-Saharan culture supports the dominance of the family by males and the ideology of patriarchy. Pregnancy and birth are events reflecting a certain empowerment for women, and the women tend to exert control in ways that may or may not be respected by their husbands. Individual choices are often made to foster self and outward-perceptions of managing one’s affairs with strength.ConclusionIn today’s multicultural society there is a strong need to avert misunderstandings, and perhaps harm, through facilitating cultural awareness and competency of care rather than misinterpretations of resistance to care.

An ethnographic study of communication challenges in maternity care for immigrant women in rural Alberta

BACKGROUND many immigrant and ethno-cultural groups in Canada face substantial barriers to accessing health care including language barriers. The negative consequences of miscommunication in health care settings are well documented although there has been little research on communication barriers facing immigrant women seeking maternity care in Canada. This study identified the nature of communication difficulties in maternity services from the perspectives of immigrant women, health care providers and social service providers in a small city in southern Alberta, Canada. METHODS a focused ethnography was undertaken incorporating interviews with 31 participants recruited using purposive and snowball sampling. A community liaison and several gatekeepers within the community assisted with recruitment and interpretation where needed (n=1). All interviews were recorded and audio files were transcribed verbatim by a professional transcriptionist. The data was analysed drawing upon principles expounded by Roper and Shapira (2000) for the analysis of ethnographic data, because of (1) the relevance to ethnographic data, (2) the clarity and transparency of the approach, (3) the systematic approach to analysis, and (4) the compatibility of the approach with computer-assisted qualitative analysis software programs such as Atlas.ti (ATLAS.ti Scientific Software Development GmbH, Germany). This process included (1) coding for descriptive labels, (2) sorting for patterns, (3) identification of outliers, (4) generation of themes, (5) generalising to generate constructs and theories, and (6) memoing including researcher reflections. FINDINGS four main themes were identified including verbal communication, unshared meaning, non-verbal communication to build relationships, and trauma, culture and open communication. Communication difficulties extended beyond matters of language competency to those encompassing non-verbal communication and its relation to shared meaning as well as the interplay of underlying pre-migration history and cultural factors which affect open communication, accessible health care and perhaps also maternal outcomes. CONCLUSION this study provided insights regarding maternity health care communication. Communication challenges may be experienced by all parties, yet the onus remains for health care providers and for those within health care management and professional bodies to ensure that providers are equipped with the skills necessary to facilitate culturally appropriate care.

Constructing a questionnaire for assessment of awareness and acceptance of diversity in healthcare institutions

BackgroundTo develop a healthcare environment that is congruent with diversity among care providers and care recipients and to eliminate ethnic discrimination, it’s important to map out and assess caregivers’ awareness and acceptance of diversity. Because of a lack of standardized questionnaires in the Swedish context, this study designed and standardized a questionnaire: the Assessment of Awareness and Acceptance of Diversity in Healthcare Institutions (AAAD, for short).MethodThe questionnaire was developed in four phases: a comprehensive literature review, face and content validity, construct validity by factor analysis, and a reliability test by internal consistency and stability assessments.ResultsResults of different validity and reliability analyses suggest high face, content, and construct validity as well as good reliability in internal consistency (Cronbach’s alpha: 0.68 to 0.8) and stability (test-retest: Spearman rank correlation coefficient: 0.60 to 0.76). The result of the factor analysis identified six dimensions in the questionnaire: 1) Attitude toward discrimination, 2) Interaction between staff, 3) Stereotypic attitude toward working with a person with a Swedish background, 4) Attitude toward working with a patient with a different background, 5) Attitude toward communication with persons with different backgrounds, 6) Attitude toward interaction between patients and staff.ConclusionThis study introduces a newly developed questionnaire with good reliability and validity values that can assess healthcare workers’ awareness and acceptance of diversity in the healthcare environment and healthcare delivery.

Migration status and self-reported health among high school students in Stockholm: A cross-sectional study

This article aims to determine the self-reported health status of Swedish high school students with respect to gender and immigrant background. The sample was randomly selected from high school students aged 15–19, and 446 students participated in this study. The Nottingham Health Profile (NHP) was used for capturing health status. The results showed that the most common problem was related to energy level (23%) and the least to physical mobility (1%). The proportion for other domains ranged from 2% to 14%. Self-reported health problems were more common among immigrants than native Swedes. Female students reported more problems on all aspects of health than males. Female gender and first-generation immigrants were found to be important factors associated with feelings of ill health among the target population. Gender disparity was more important among the students with an immigrant background.

Feelings of social alienation: a comparison of immigrant and non‐immigrant Swedish youth

Purpose – The objective of the study is to investigate the social alienation status of Swedish high school students with respect to gender and immigrant background.Design/methodology/approach – The sample was randomly selected from high school students aged 15‐19, and 446 students participated in the study. The Jessor and Jessor general alienation questionnaire was used to explore feelings of social alienation. Sequential multiple regression analyses were performed to examine the relationships between alienation, age, sex, and immigrant background.Findings – The results demonstrated a significant association between immigrant background and alienation. It was found that first‐generation immigrants felt more alienated than second‐generation immigrants and second‐generation immigrants felt more alienated than natives. Adolescents who were first‐generation immigrants had higher scores on the social isolation subscale than second generation immigrants and native Swedes. However, second generation immigrants h...

The mediating role of alienation in self-reported health among Swedish adolescents

The purpose of this study was to investigate the relationship between a sense of alienation and self reported health. A sample consisting of a total of 446 high school students aged 15–19 (Mean age = 16.95, SD = 1.01, Female = 59%), with a participation rate of 91%. The Jessor and Jessor alienation scale and the Nottingham Health Profile for self reported health were used to gather data. To analyze the relationship between sense of alienation and self reported health, a path model was created and tested using structural equation modeling. The results suggest that sense of alienation is importantly related to the domain of self-reported health. The alienation variable mediates between mental health (energy level, sleep and emotional reaction) and physical health (pain pain and physical mobility).

Socioeconomic factors and mental health of Swedish adolescents – a cross-sectional study among Stockholm high-school students aged 15–19 years

Adolescence is a period of rapid biological and behavioral changes that may increase the risk of mental health problems. This study investigates the path between self-reported mental health, feeling of alienation, and self-reported physical health by examining the role of demographic factors and socioeconomic variables. Participants were recruited from high schools in Stockholm, Sweden. In total, 445 students participated, aged 15–19 years (SD = 1.01, mean = 17.00); 263 (59.4%) were female and 180 were (40.6%) male. The Nottingham Health Profile and Jessor and Jessor alienation scale were used, and statistical analysis was performed by using regression and path analysis. The results revealed a significant correlation between feeling of alienation and mental health, and found alienation to be a mediating factor between mental health problems and physical health. Female students reported more problems than males. The relationship between neighborhood characteristics (geographical location and type of home) and mental health was also significant. An immigrant background was also found to be one of the important variables for self-reported mental health. The results indicated that having a Swedish mother and father was associated with lower mental health problems, whereas having a father and mother from the Middle East was associated with greater self-reported mental health problems.

Immigrant women’s food choices in pregnancy: perspectives from women of Chinese origin in Canada

ABSTRACT Objective: Following migration, pregnant immigrant women may encounter social, cultural, and economic challenges that negatively affect their food choices and subsequent health outcomes. Culturally appropriate health care is crucial during the perinatal period to ensure the health of immigrant mothers and their children. This project aims to explore and understand how the health beliefs and practices of Chinese immigrant women affect their food choices during the perinatal period. Design: This qualitative study used the methodology of focused ethnography. Women participated in one semi-structured interview, followed by a second photo-assisted, semi-structured interview which incorporated photographs taken by the women themselves. Results: The food choices and health behaviors of immigrant women were influenced by their general health beliefs, cultural knowledge concerning particular types of foods, traditional Chinese medical beliefs, social advice and information, and socio-economic factors. Conclusion: The provision of culturally appropriate health care is crucial during the perinatal period, as it is not only a vulnerable life stage for women and their children but also a sensitive period of interaction with the Canadian health-care system. Understanding these intersecting factors can help to ensure culturally appropriate care and optimized health outcomes for Chinese immigrant women during the perinatal period.