Punita Chowbey

Migration and maternity: insights of context, health policy, and research evidence on experiences and outcomes from a three country preliminary study across Germany, Canada, and the United Kingdom

A group from Germany, Canada, and the United Kingdom undertook country-specific scoping reviews and stakeholder consultations before joining to holistically compare migration and maternity in all three countries. We examined four interlinking dimensions to understand how international migrant/minority maternal health might be improved upon using transnational research: (a) wider sociopolitical context, (b) health policy arena, (c) constellation, outcomes, and experiences of maternity services, and (d) existing research contexts. There was clear evidence that the constellation and delivery of services may undermine good experiences and outcomes. Interventions to improve access and quality of care remain small scale, short term, and lacking in rigorous evaluation.

Engaging minorities in researching sensitive health topics by using a participatory approach

AIM To report the use of a community participatory approach (PA) in a project investigating tuberculosis (TB) in UK Somali migrants. BACKGROUND It is crucial to address health inequalities and persistent health problems, particularly in groups who are often excluded or seem hard to reach. TB is an illness stigmatised in the Somali population, making it a difficult topic for research. In this study, a community PA was used to investigate TB and members of the Somali community were recruited as co-researchers. DATA SOURCES Four community researchers (CRs), eight focus groups (n=48), interviews with members of the community (n=24), people with TB and ex-TB patients (n=14), and healthcare practitioners (n=18). REVIEW METHODS This is an informative paper. Discussion The paper describes the approach used in the recruitment of community researchers and how engaging early with community leaders using oral communication made it possible to research TB in the Somali community. CONCLUSION The PA led to capacity building, trust and a longer sustainable partnership with members of the Somali community. The success of the approach in the study suggests that there are valuable lessons for those researching similar topics with minority groups. IMPLICATIONS FOR PRACTICE/RESEARCH Involving people in health research topics with a stigma is possible. This paper highlights how this could be achieved using a community PA and the recruitment of community members as co-researchers. However, the PA is time-consuming and will depend on the skills of academic researchers in knowing and engaging with the community.

Researching health inequalities with Community Researchers: practical, methodological and ethical challenges of an 'inclusive' research approach

AbstractPlain English summaryPublic health research sometimes uses members of communities as researchers. These are called Community Researchers. The advantage of using Community Researchers is that it enables people who live in communities to participate in research by designing the research, gathering data and being involved in analysis. This ‘participatory’ approach also has the potential to reach communities that might otherwise not be included in research. There are few studies that report the experiences of Community Researchers who take part in such research. This study helps fill this gap by exploring the issues and challenges faced by Community Researchers involved in a study of health and poverty in ethnically mixed areas of east London, UK. Through the accounts of 12 researchers, the study reveals that being a community ‘insider’ had advantages: many felt they had been able to gain the trust of respondents and access people for the research that would have otherwise been missed. The role of Community Researcher was, however, difficult to manage with some researchers feeling burdened by their role and the increased knowledge they had about the lives of those in their community. In addition to the personal challenges for the Community Researchers, the findings raise various ethical and methodological issues that need consideration in participatory research.AbstractBackground Inclusive research approaches are increasingly employed by public health researchers. Recent methodological development includes the engagement of Community Researchers (CRs), who use their knowledge and networks to facilitate research with the community with which they identify. Few studies have explored the experiences of CRs in the research process, an important element of any comprehensive assessment of the pros and cons of such research endeavours. We report here on the experiences of CRs engaged in a study of health inequalities and poverty in ethnically diverse and disadvantaged areas of London, UK. Methods We draw on the experiences of 12 CRs. Two sets of data were generated, analysed and integrated: debriefing/active reflection exercises throughout the 18-month research process and individual qualitative interviews with CRs, conducted at the end of the project (n = 9). Data were organised using NVivo10 and coded line-by-line using a framework developed iteratively. Synthesis and interpretation were achieved through a series of reflective team exercises involving input from 4 of the CRs. Final consolidation of key themes was conducted by SS and ES. Results Being an ‘insider’ to the communities brought distinct advantages to the research process but also generated complexities. CRs highlighted how ‘something would be lost’ without their involvement but still faced challenges in gathering and analysing data. Some CRs found it difficult to practice reflexivity, and problems of ethnic stereotyping were revealed. Conflict between roles as community members and investigators was at times problematic. The approach promoted some aspects of personal empowerment, but CRs were frustrated by the limited impact of the research at the local level. Conclusions Working with CRs offers distinct practical, ethical and methodological advantages to public health researchers, but these are limited by a range of challenges related to ‘closeness’, orthodox research structures and practices and the complexities of dynamic identities. For research of this type to meet its full potential and avoid harm, there is a need for careful support to CRs and long-term engagement between funders, research institutions and communities.

Long-term ill health and the social embeddedness of work: a study in a post-industrial, multi-ethnic locality in the UK

Against the background of an increasingly individualising welfare-to-work regime, sociological studies of incapacity and health-related worklessness have called for an appreciation of the role of history and context in patterning individual experience. This article responds to that call by exploring the work experiences of long-term sick people in East London, a post-industrial, multi-ethnic locality. It demonstrates how the individual experiences of long-term sickness and work are embedded in social relations of class, generation, ethnicity and gender, which shape peoples formal and informal routes to work protection, work-seeking practices and responses to worklessness. We argue that this social embeddedness requires greater attention in welfare-to-work policy.

Supporting fathers in multi-ethnic societies: insights from British Asian fathers

Abstract There is concern that current UK policy and intervention aimed at supporting fathers remains primarily informed by dominant White middle-class values and experiences, and therefore fails to respond adequately to the needs of Britains diverse fathers. This paper contributes to understanding of ethnic diversity in fathering contexts, practices and experiences, by reporting findings from a qualitative study of British Asian fathers, involving in-depth interviews with fifty-nine fathers and thirty-three mothers from Bangladeshi Muslim, Pakistani Muslim, Gujarati Hindu and Punjabi Sikh background, and over eight additional respondents engaged through Key Informant interviews, ethnographic interviews and group discussions. The paper highlights four areas that require greater recognition by policy-makers and practitioners to appropriately meet the needs of fathers from diverse ethnic and socio-economic backgrounds. These are: recognising that fathers and mothers do not necessarily constitute an autonomous unit; appreciating diversity in fathers’ understandings of desirable child outcomes; addressing additional obstacles to achieving similar outcomes for children; and understanding that the boundaries and content of fathering are not universally recognised. Policies that are less normative and more responsive to diversity are essential to ensure that all fathers can be effectively supported.

Women's narratives of economic abuse and financial strategies in Britain and South Asia

Objectives: The objectives of the paper are to (a) extend current conceptualizations of economic abuse by incorporating diverse perspectives from South-Asian women in Britain, India, and Pakistan and (b) present a typology of financial strategies used by the women to deal with economic abuse. Method: Using a constructivist grounded theory approach, 84 married women with dependent children from South-Asian backgrounds were recruited through community networks in Britain (Pakistani Muslims n = 23; Gujarati Hindus n = 12), India (Gujarati Hindus n = 26), and Pakistan (Pakistani Muslims, n = 23) for in-depth interviews. Results: The women’s accounts included 4 kinds of economic abuse recognized in current literature, (a) preventing the acquisition of economic resources, (b) preventing the use of resources, (c) refusing to contribute, and (d) exploiting women’s resources and/or generating economic costs, as well as 2 unique abuses, (e) exploiting women’s customary marriage gifts including jahez/dahej, haq meher, bari, and streedhan, and (f) jeopardizing women’s long-term finances (e.g., through transnational investments). In addition, the results illuminate 4 financial strategies used by the women that have not previously been identified in the literature. These can be typified as (a) material, (b) confrontational, (c) mediational, and (d) developmental. Conclusions: This paper contributes new understandings on the globally pervasive but understudied phenomenon of economic abuse by including the perspectives of South-Asian women living in Britain and in South Asia. It challenges notions that South-Asian women are submissive or victims by highlighting the financial strategies they used in agentic resistance to economic abuse.

Employment, masculinities, and domestic violence in 'fragile' contexts: Pakistani women in Pakistan and the UK

ABSTRACT This article investigates women’s experiences of domestic violence, in two contexts rated as fragile and stable in global indices: Pakistan and the UK. The research shows the importance of understanding how intersectional disadvantages, based on gender and ethnic minority status among others, can lead to some groups of women experiencing life as inhabitants of a ‘fragile context within a stable state’.

What is Food Without Love? The Micro-politics of Food Practices Among South Asians in Britain, India, and Pakistan

This article draws on Morgan’s theorisation of family life as consisting of political, moral, and emotional economies to examine the interplay of women’s control over resources, gender norms, and expectations of intimacy in the context of household food consumption. The research that informs the article focuses on findings from 84 interviews with two South Asian groups: Pakistani Muslim and Gujarati Hindu women with at least one dependent child and from a variety of occupations and household compositions. In examining everyday food consumption, the research demonstrates how gender hierarchies are reproduced by parallel, mutually reinforcing, political, moral, and emotional economies. The women in the study sometimes struggled to subvert gender oppression and negotiate more powerful positions within the household through food management and/or employing manipulative and deceptive tactics. The article argues that, while access to economic resources is important if women are to achieve desirable food and nutritional outcomes, it is not in itself sufficient to meet this aim. Instead, the interplay of resources, gender norms, and conjugal relations are central to household food consumption.

Improving capacity in ethnicity and health research: report of a tailored programme for NHS Public Health practitioners

Aim To determine whether an intervention designed to enhance research capacity among commissioners in the area of ethnicity and health was feasible and impactful, and to identify programme elements that might usefully be replicated elsewhere. Background How healthcare commissioners should be equipped to understand and address multiethnic needs has received little attention to-date. Being able to mobilise and apply evidence is a central element of the commissioning process that requires development. Researching ethnicity and health is widely recognised as challenging and several prior interventions have aimed to enhance competence in this area. These have, however, predominantly taken place in North America and have not been evaluated in detail. Methods An innovative research capacity development programme was delivered to public health staff within a large healthcare commissioning organisation in England. Evaluation methodology drew on ‘pluralistic’ evaluation principles and included formative and summative elements. Participant evaluation forms gave immediate feedback during the programme. Participants also provided feedback at two weeks and 12 months after the programme ended. In addition, one participant and one facilitator provided reflective accounts of the programmes strengths and weaknesses, and programme impact was traced through ongoing partnership work. Findings The programme was well received and had a tangible impact on knowledge, confidence and practice for most participants. Factors important to success included: embedding learning within the participants’ work context; ensuring a balance between theory and practical tips to enhance confidence; and having sustained interaction between trainers and participants. Despite positive signs, the challenging nature of the topic was highlighted, as were wider structural and cultural factors that impede progress in this area. Although it is unrealistic to expect such programmes to have a major impact on commissioning practices, they may well make an important contribution to raising the confidence and competence of staff to undertake work in this area.

Influences on diagnosis and treatment of eating disorders among minority ethnic people in the UK

Purpose – Evidence, though limited, suggests that UK minority ethnic individuals have lower referral rates for eating disorders than their White British counterparts. Missed or delayed diagnosis may be an important contributory factor. This paper seeks to identify key areas that require attention for early detection and treatment of eating disorders in minority ethnic people.Design/methodology/approach – The approach taken was a community‐based qualitative study in Sheffield, England: interviews with relatives of people with eating disorders (n=3); key informant interviews (n=15); group discussions with community members aged 18‐24 (n=4, 24 participants).Findings – Several factors appear to influence the recognition of, and response to, eating disorders among minority ethnic people with potential implications for timely diagnosis and treatment. Low public awareness was an important barrier to seeking medical attention. Norms and ideals relating to food and body image, as well as some religious practices, ...