Jo Hunter-Adams

A Qualitative study of language barriers between South African health care providers and cross-border migrants

BackgroundCommunication with health care providers represents an essential part of access to health care for the over 230 million cross-border migrants around the world. In this article, we explore the complexity of health communication from the perspective of cross-border migrants seeking antenatal care in Cape Town, South Africa in order to highlight the importance of high quality medical interpretation.MethodsAs part of a broader study of migrant maternal and infant nutrition, we conducted a secondary data analysis of semi-structured in-depth interviews (N = 23) with Congolese (n = 7), Somali (n = 8) and Zimbabwean (n = 8) women living in Cape Town, as well as nine focus group discussions (including men: n = 3 and women: n = 6) were conducted with migrant Somalis, Congolese, and Zimbabweans (N = 48). We first used content analysis to gather all data related to language and communication. We then analysed this data thematically.ResultsZimbabwean participants described how the inability to speak the local South African language (IsiXhosa) gave rise to labelling and stereotyping by healthcare staff. Congolese and Somali participants described medical procedures, including tubal ligation, which were performed without consent. Partners often tried to play the role of interpreter, which resulted in loss of income and non-professional medical interpretation. Participants’ highlighted fears over unwanted procedures or being unable to access care. Challenges of communication without a common language (and without professional medical interpretation), rather than outright denial of care by healthcare professionals, mediated these encounters.ConclusionAlthough there are several factors impeding cross-border migrants’ access to health care, effective communication is a prerequisite for quality care. Free-to-patient professional medical interpretation would not only benefit migrant populations but would benefit the broader community where language and health literacy are barriers to accessing health care. Novel approaches to language access may include technology-enabled professional interpretation.

Perceptions related to breastfeeding and the early introduction of complementary foods amongst migrants in Cape Town, South Africa

BackgroundInfant feeding recommendations are of health importance, yet the extent to which migrant communities in low- and middle-income countries know or implement these recommendations is poorly understood. This study explores the perspectives of infant feeding amongst cross-border migrants in Cape Town, South Africa.MethodsBetween February and October 2013, semi-structured in-depth interviews (n = 23) were conducted face-to-face with Congolese, Somali and Zimbabwean mothers living in Cape Town. To assess commonly identified narratives of infant feeding, nine focus group discussions (three with men and six with women) were conducted with migrant Somalis, Congolese, and Zimbabweans.ResultsThree dominant themes framed infant feeding. 1) Pragmatism in feeding choices drove responses to baby’s cues, including cries, sleeping patterns, and weight gain (2). Formula feeding was normative in the South African context, whereas lack of commercial infant milk back home was described in terms of expense (3). Low rates of breastfeeding were explained in terms of work responsibilities including household work and lack of breastmilk supply resulting from stress and poor diet. However, women participants typically did not consider their feeding choices to negatively affect their baby’s health.ConclusionsThe reasons for early introduction of both commercial infant milk and solid foods were complex. Breastfeeding was not prioritized despite an awareness of medical recommendations. Rather than emphasizing specific breastfeeding intentions, participants favoured an approach that reacted to their baby’s perceived changing needs. The practical challenges of breastfeeding described by cross-border migrant women reflect one way in which socio-economic and health inequalities may currently be perpetuated for marginalised populations.

Acculturation and a Potential Relationship with Oral Health Outcomes Among Somali Refugees in Massachusetts

This paper explores the relationship between acculturation and oral health in a study of Somali refugees. This cross-sectional survey included structured surveys and dental examinations of a convenience sample of 439 Somali adults living in Massachusetts. Associations between an acculturation scale and: (1) lifetime history of caries and (2) access to oral health services were calculated. In bivariate analyses, many individual questions in the scale were associated with outcomes. In multivariate analysis, speaking English (OR 0.5, CI 0.28–0.84) was associated with better access to, and utilization of, dental health services while reading American books and newspapers in English was associated with increased lifetime history of dental disease (OR 2.6, CI 1.1–6.0). As specific elements of acculturation have different relationships with oral health among Somali refugees, a summary acculturation scale may have limited utility. Ongoing efforts to remove language barriers may improve oral health.

Connecting the dots: Cultivating a sustainable interdisciplinary discourse around migration, urbanisation, and health in Southern Africa

This chapter describes our experiences in connecting a group of emerging Southern African scholars around the inherently interdisciplinary field of migration, urbanisation and health. South Africa, as with other countries in the region, is witnessing multiple simultaneous and interconnected transitions – health, demographic, social, economic and political. Defining, measuring and better understanding the dynamics and complexities of these transitions is a fundamental step in the professionalizing of next-generation scholars in the area of migration, urbanisation and health. In this chapter we discuss themes, definitions and the process of forming group discourse at the nexus of migration, urbanisation and health. Driven by substantive questions derived from studies of the lived experiences of urban migrants in South Africa, specifically the intertwining of migration trajectories and health histories, a central goal of our collaborative endeavour was ‘to connect the dots’ – key concepts, data, measures and methods – in order to identify common themes and research priorities that will facilitate the participation of next-generation scholars in developing innovative and new research agendas. We report on the themes that emerged from a 2015 workshop held at the University of the Witwatersrand in Johannesburg that brought together senior and early-career scholars to discuss ways of engaging with migration, urbanisation and health in the Southern African context. We close with a discussion of the opportunities and challenges for early-career scholars in this field, identifying next steps to develop and sustain in-country capacity to influence both research and public policy.

Relationships Between English Language Proficiency, Health Literacy, and Health Outcomes in Somali Refugees

Little is known about the impacts of health literacy and English proficiency on the health status of Somali refugees. Data came from interviews in 2009–2011 of 411 adult Somali refugees recently resettled in Massachusetts. English proficiency, health literacy, and physical and mental health were measured using the Basic English Skills Test Plus, the Short Test of Health Literacy in Adults, and the Physical and Mental Component Summaries of the Short Form-12. Associations were analyzed using multiple linear regression. In adjusted analyses, higher English proficiency was associated with worse mental health in males. English proficiency was not associated with physical health. Health literacy was associated with neither physical nor mental health. Language proficiency may adversely affect the mental health of male Somali refugees, contrary to findings in other immigrant groups. Research on underlying mechanisms and opportunities to understand this relationship are needed.

Fault lines in food system governance exposed: reflections from the listeria outbreak in South Africa

ABSTRACT According to the World Health Organization (WHO), South Africa recently experienced the largest ever recorded outbreak of listeria (Listeria monocytogenes), with almost 1049 confirmed cases and 209 deaths between 1 January 2017 and 5 June 2018. South Africa’s listeria outbreak provides an opportunity to interrogate the relative power of the state and the private sector in shaping the food system and to re-evaluate the issues of traceability and broader governance. It also provides an opportunity to consider the determinants of diets and consequent health outcomes of the poor, and to develop policy and programmatic inventions better attuned to the lives of the poor and aligned for the creation of health.

The dimensionality of disclosure of HIV status amongst post-partum women in Cape Town, South Africa

Disclosure of HIV status to sexual partners and others has been presented as positive health behaviour and is widely encouraged by antiretroviral treatment (ART) programmes, providers and policies. However, disclosure is also highly contextual and its positive effects are not universal. We explore the dimensions of disclosure amongst post-partum women who initiated ART during pregnancy in Cape Town, South Africa. Forty-seven semi-structured interviews with post-partum women were conducted as part of the Maternal Child Health-Antiretroviral Therapy (MCH-ART) study. Primary elements of disclosure were coded and interpreted according to dominant themes and subthemes. Disclosure was commonplace in the sample, ranging from widely disclosing status (rare); to disclosing to some family, friends and partners; to tacit disclosure, where participants took medication in front of others without explicitly discussing their status. Women described reasons for non-disclosure in terms of not being ready, fear of negative reactions (including violence and loss of financial support), and fear of their status being widely known. Self-reported adherence was uniformly high throughout the range of disclosure. Even those who made special efforts to avoid disclosure, such as attending clinics distant from their homes, reported good adherence. Those who disclosed experienced a range of responses to their disclosure, from support to shunning. Despite access to ART, stigma remained a persistent feature in descriptions of disclosure, particularly in relation to partner disclosure. Our findings suggest that disclosure is not always positive and adherence can be maintained within a wide range of disclosure behaviours. It is important that clinic settings allow women to retain control over their disclosure process.

Erratum to: Urban Health Research in Africa: Themes and Priority Research Questions

Oni is with the Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Smit and Parnell are with the African Centre for Cities, University of Cape Town, Cape Town, South Africa; Matzopoulos is with the Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Hunter-Adams and Alaba are with the Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Pentecost is with the Department of Anthropology, University of Cape Town, Cape Town, South Africa; Pentecost is with the Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK; Rother is with the Division of Environmental Health and Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Albertyn is with the Children’s Institute, Department of Paediatrics, University of Cape Town, Cape Town, South Africa; Behroozi is with the Primary Health Care Directorate, University of Cape Town, Cape Town, South Africa; Kaba is with the Division of Health Economics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Kaba is with the Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa; van der Westhuizen is with the Alan J Flisher Centre for Public Mental Health, Department of Psychiatry andMental Health, University of Cape Town, Cape Town, South Africa; Shung-King is with the Division of Health Policy and Systems, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Levitt is with the Chronic Disease Initiative for Africa and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Lambert is with the Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa. Correspondence: Tolu Oni, Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. (E-mail: tolullah.oni@uct.ac.za) The online version of the original article can be found at doi:10.1007/s11524-016-0050-0.