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Living with diabetes within the framework of Swedish primary health care: Somalian and professional perspectives
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to provide knowledge on the one handSomalian-born immigrants´ experiences of living with diabetes mellitus (DM)in a new cultural environment, on the other hand their encounter with Swedishdiabetic care – this from both their own point of view and that of the health-care professionals. There was an endeavour to describe methodological aspectsof the interpreter´s role in respect of the trustworthiness of research performedin multicultural societies. A descriptive design was used, involving threequalitative interview studies with an interpreter (Studies II-IV) and onesystematic literature review (Study I). The latter served as a foundation forconducting the interviews with an interpreter and the Matrix Method was used.The same 19 patients with diabetes of Somalian origin participated in StudiesII-IV, joined by five health-care professionals in Study IV. The interviews weresubjected to qualitative content analysis in the case of Studies II and III, and to phenomenograpic analysis in the case of Study IV.

In Study I, 13 empirical cross-cultural interview studies with aninterpreter involved were scrutinized. The findings showed that the interpreter’srole in the research process was given little attention. There was usually noaccount either of the style of interpreting, the interpreter’s previous experienceor the seating arrangements for the interviews. On the other hand most of thestudies offered direct or indirect information about the interpreter’s knowledgeof the aim of the research or participation in the transcription of the text or data analysis. The most frequent techniques used to established trustworthiness were prolonged engagement and member checks.

A prominent problem for the participants in Study II was to give uptraditional eating habits. Difficulty in managing everyday life was mentionedespecially by women in connection with the need to keep to the diet regimebecause of a lack of understanding and support from family and friends. Tochanging lifestyle was considered as a hard work and a number of barriers wasmentioned especially when it comes to eating habits. The findings showed avariation how the participants managed the fasting month of Ramadan. Thosewho fasted did not see the diabetes as an obstacle, others did so and indicated that fasting was not compulsory for a sick person.

In study III the findings showed that women used more supernaturalbeliefs than men when they described their experiences in connection with thediagnosis and their health beliefs. Most of the experiences of receiving thediagnosis consisted of ways of managing this information. Commonlymentioned by the participants, irrespective of gender, when they receiving thediagnosis was a attempt to find some advantages, or positive comparison. Other participants tried to repress the diagnosis and doubted it. Most of theparticipants, irrespective of gender, did not immediately respond with shock orother strong emotion when they received the diagnosis.

In study IV the patients conceived the diabetes care as being of highquality but they also conceived limitation with the care. They conceived unmetneeds such as too long waiting times for appointments, not encountering thesame physician every time, lack of contact with specialists and failure toculturally adapt dietary advice. Health-care professionals conceived severalcultural challenges in the encounter such as managing language barriers,illiteracy and traditions such as fasting during Ramadan.

In conclusion, this thesis generate knowledge which can serve as afoundation to securing the quality of diabetes care for this patient group andcontribute to working out local diabetic programmes for patients with anotherbackground than the Swedish. In addition the thesis can contribute to makingimprovements when it comes to working with an interpreter in qualitativeinterview studies as well as in clinical settings.

Place, publisher, year, edition, pages
Jönköping: Hälsohögskolan , 2009. , p. 76
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 6
Keywords [en]
cross-cultural interviews, diabetes, experiences, encounter, ethnic minority, health beliefs, health-care professionals, interpreter, literature review, qualitative method
Identifiers
URN: urn:nbn:se:hj:diva-7904ISBN: 9789185835058 (print)OAI: oai:DiVA.org:hj-7904DiVA, id: diva2:173822
Public defence
2009-02-27, Kurt Johanssonaulan, Hälsohögskolan, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-02-18 Created: 2009-02-17 Last updated: 2010-09-01Bibliographically approved
List of papers
1. Cross-cultural interview studies using interpreters: systematic literature review.
Open this publication in new window or tab >>Cross-cultural interview studies using interpreters: systematic literature review.
2006 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 55, no 6, p. 723-735Article in journal (Refereed) Published
Abstract [en]

AIM: This paper reviews how the interpreter's role is described in empirically based, qualitative cross-cultural interview studies and how trustworthiness is determined. BACKGROUND: Increased immigration during the past decades has created a multiethnic society in many countries. This development poses a challenge to healthcare staff, in that they need to understand how people from different cultures experience health and illness. One way to assess immigrants' experiences is through cross-cultural interview studies, involving an interpreter. Thorough knowledge of the interpreter's role is needed in order to increase the trustworthiness of this kind of nursing research. METHOD: Literature searches were conducted from October to November 2004 using PubMed, CINAHL, Psycinfo, Sociological abstract, Your Journals@ovid, and Eric databases. Qualitative interview studies written in English and performed with an interpreter were included. The Matrix Method was used to review the literature. FINDINGS: In almost all of the 13 relevant papers found, the role of the interpreter(s) in the research process was only sparsely described. In addition, all studies except one employed different techniques to established trustworthiness. The most common techniques were prolonged engagement, member check or triangulation, the latter performed either on the data, investigators or methods. CONCLUSION: Methodological issues with respect to interpreters have received only limited attention in cross-cultural interview studies. Researchers in the field of nursing need to consider (1) the interpreter's role/involvement in the research process; (2) the interpreter's competence and the style of interpreting; (3) the interpreter's impact on the findings. This information is a prerequisite when trying to determine the trustworthiness of a cross-cultural study.

Keywords
Etnicitet, literature review, qualitative interviews, interpreters, validity
National Category
Nursing Nursing International Migration and Ethnic Relations
Identifiers
urn:nbn:se:hj:diva-2121 (URN)16925621 (PubMedID)
Available from: 2008-07-08 Created: 2008-07-08 Last updated: 2017-12-12Bibliographically approved
2. Diabetes: a cross-cultural interview study of immigrants from Somalia.
Open this publication in new window or tab >>Diabetes: a cross-cultural interview study of immigrants from Somalia.
2007 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, no 11C, p. 305-314Article in journal (Refereed) Published
Abstract [en]

Aim: To describe how diabetic immigrants from Somalia experience everyday life in Sweden and how they manage diabetes-related problems, with inclusion of a gender perspective. Background: To treat and care for minority populations successfully, healthcare staff in Sweden must thoroughly understand the illness experiences of different ethnic groups. However, no studies have so far been reported that focus on immigrants from Somalia with diabetes. Design: Descriptive, qualitative interview study with 19 diabetic adults born in Somalia and now living in Sweden. Method: Cross-cultural interviews with the aid of an interpreter. The transcribed interviews were subjected to qualitative latent content analysis, resulting in sub-themes and themes. Results: Four themes emerged: experience of distress in everyday life; everyday life continues as before; comprehensibility gives a feeling of control; and being compliant. A major finding was the variation in how the participants managed the fasting month of Ramadan. Several participants fasted and did not see the diabetes as an obstacle, others did see it as an obstacle or indicated that fasting was not compulsory for a sick person. Conclusions: This study provides healthcare staff with information about how a minority group experience and manage diabetes. The results indicate the importance of considering cultural background, as well as religious traditions such as Ramadan, in diabetes care. They also indicate that men and women differ in their reaction to diabetes and that care should be adapted to this. Relevance for clinical practice: It is important to develop evidence-based guidelines for diabetes care in ethnic groups that are fasting during Ramadan to prevent complications and promote relevant self-care. Further, the prescribed dietary advice must be culturally appropriate.

Keywords
Diabetic immigrants, everyday life, cross-cultural interviews, latent content analysis, gender perspective
National Category
Nursing International Migration and Ethnic Relations Social Anthropology Nursing
Identifiers
urn:nbn:se:hj:diva-5025 (URN)17931324 (PubMedID)
Available from: 2007-12-26 Created: 2007-12-26 Last updated: 2017-12-12Bibliographically approved
3. From diagnosis to health: a cross-cultural interview study with immigrants from Somalia
Open this publication in new window or tab >>From diagnosis to health: a cross-cultural interview study with immigrants from Somalia
2010 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, p. 357-365Article in journal (Refereed) Published
Identifiers
urn:nbn:se:hj:diva-7901 (URN)10.1111/j.1471-6712.2009.00729.x (DOI)000277713500020 ()
Available from: 2009-02-17 Created: 2009-02-17 Last updated: 2021-04-01Bibliographically approved
4. Conceptions of the encounter in diabetes care on the part of patients of Somalian origin and health-care professionals: a qualitative study
Open this publication in new window or tab >>Conceptions of the encounter in diabetes care on the part of patients of Somalian origin and health-care professionals: a qualitative study
2009 (English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-7903 (URN)
Available from: 2009-02-17 Created: 2009-02-17 Last updated: 2014-08-06

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