Reducing health inequities affecting immigrant women: a qualitative study of their available assets

Identification of Cultural and Transcultural Health Assets Among Moroccan, Romanian and Spanish Adolescents Through Photovoice

The health assets model focuses on recognizing the strengths, capacities and resources of individuals and their communities to improve health control processes. This study focuses on identifying and comparing the transcultural and cultural assets in health as accounted for by 45 young Romanians, Moroccans and Spaniards living in southern Spain. The research uses a photovoice method to understand what young people consider to boost their health. Of all the photographs taken, each young person selected the six most relevant images, and individual interviews were carried out. Both images and interviews were analysed qualitatively using Atlas Ti. We identified 40 transcultural assets in health that were common among the 3 cultural groups and 7 cultural assets that were specific to cultural groups. The seven assets include religion and spirituality, cultural symbols, medicine, traditional food, thinness, freedom/autonomy and plants. The definition of transcultural and cultural health assets facilitates the development of educational health interventions that reinforce the strengths of others in a culturally sensitive manner.

Supporting the mobilization of health assets among older community dwellers residing in senior-only households in Singapore: a qualitative study

BACKGROUND

Care activities provided by community health practitioners for older adults primarily focused on disease prevention and management. However, healthy longevity can go beyond disease prevention and management and promote greater well-being by tapping into the accrual of resources that older adults possess using the salutogenic approach. This study explored how health resources are used among older adults who are residing in senior-only households to promote and maintain health, with the intent of providing insights into how community health practitioners can support these older adults via asset-based strategies.

METHODS

We adopted a descriptive qualitative study design using focus group discussions. Twenty-seven older adults who either lived alone or with their spouses were purposively sampled from an elderly populated residential estate in Singapore. Six focus group discussions, conducted from December 2016 to May 2017, were audio-recorded, transcribed, and analyzed using thematic analysis.

RESULTS

The themes that emerged were 'tapping on internal self-care repository', 'maintaining and preserving informal social support', and 'enabling self by using environmental aids', and an eco-map of aging assets was used to capture an overview of internal and external resources. With the repository of personal strengths, knowledge, and experiences, these older adults were generally resourceful in navigating around their resource-rich environments to cope with everyday life stressors and promote health. However, they were occasionally limited by individual factors that affected their comprehension, access, maintenance, and utilization of resources.

CONCLUSION

The eco-map of aging assets can be used as an assessment framework by community health practitioners to recognize, consider, and build a repertoire of resources among these older adults. It serves as a gentle reminder to adopt an ecological approach in considering and tapping into older adults' wide-ranging personal, social, and environmental resources. Community health practitioners can support resource integration as resource facilitators via cognitive, behavioral, and motivational salutogenic pathways to overcome resource mobilization barriers faced by older adults. Such an approach helps older adults to find their internal capabilities and abilities to know who, where, what, and how to seek external resources to identify solutions, creating the intrinsic value to sustain their actions on resource utility.

The Salutogenic Management of Pedagogic Frailty: A Case of Educational Theory Development Using Concept Mapping

This paper explores the development of educational theory (pedagogic frailty) that has emerged through the application of concept maps to understand teachers’ conceptions of their roles within the complex higher education environment. Within this conceptual paper, pedagogic frailty is reinterpreted using the lens offered by the concept of salutogenesis to place the model in a more positive frame that can offer greater utility for university managers. This development parallels changes in the consideration of mental health literacy (MHL) across university campuses and avoids misapplication of a deficit model to the professional enhancement of teaching quality. For a detailed explication of this wider perspective of pedagogic health literacy (PHL), the connections with related and supporting concepts need to be explained. These include ‘assets’, ‘wellness’ and a ‘sense of coherence’. Links between these concepts are introduced here. This reframing of the model has used concept mapping to explore the relationship between two complex ideas—pedagogic frailty and salutogenesis. It emphasizes pedagogic health as a continuum operating between frailty and resilience. Brief implications for academic development are included.

Pregnant with possibility: The importance of visual data in (re)presenting queer women’s experiences of reproduction

In this article, I discuss a queer method for uniting visual sociology, digital sociology, and constructivist grounded theory to conduct innovative research into how lesbian couples experience the transition to first-time parenthood, based on my longitudinal doctoral research in sociology. I first attend to the complex and unexpected unfolding of the research design, which evolved with the needs of the population to move from adapted photovoice interviews to the use of textual–visual online pregnancy journal data in a process emblematic of queer methodology. I then consider the contributions that visual data can make to the study of reproduction, especially where marginalized populations are concerned, by using my data to demonstrate how visuals create what is possible, rework oppressive versions of time, and challenge controlling images imposed on reproducing bodies. I argue here not just for the significance of images but for the significance of taking seriously the products and processes that communities find meaningful, and for evolving our research methods and methodologies to centralize marginalized ways of existing, knowing, and archiving experiences of reproduction and family life.

[Social integration and gynecologic cancer screening of immigrant women in Spain]

OBJECTIVE

To explore the association between immigrant status and performance of pap-smear and mammography, and to study the potential effect of social integration on that association.

METHOD

Secondary analysis of the National Health Survey of Spain 2012. Individual data from 8944 women aged 18-75 were analyzed. Dependent variables were the performance of pap-smear tests and mammographies according to the guidelines of the state of residence. The level of integration in Spain was estimated through perceived social support (Duke-UNC scale) and the number of years living in Spain. Logistic regressions were used in order to obtain odds ratios (OR) and their 95% confidence intervals (95%CI), adjusted for confounders (sociodemographic and health-status).

RESULTS

Compared to natives, immigrant women were more likely to not adhere to cervical cancer screening (OR: 1.31; 95%CI: 1.06-1.63) or breast cancer screening (OR:=3.13; 95%CI: 2.14-4.58). Additional adjustment by social support and length of residence in Spain attenuated the association, consequently losing statistical significance (OR: 1.08, 95%CI: .77-1.52 for pap-smear; OR: 1.62, 95%CI: .97-2.74 for mammographies).

CONCLUSIONS

The probability of participating in the screening programs for gynecological cancer was lower if women were born abroad. Perceived social support and time living in Spain of immigrant women explained to a large extent the differences between immigrants and natives.

Perspectives of women experiencing Menorrhagia: A descriptive qualitative study

OBJECTIVE

To describe the perspectives and support needs of women experiencing menorrhagia in Singapore.

BACKGROUND

Women with menorrhagia lack awareness regarding the severity of menorrhagia. There is a dearth of literature understanding the support needs of women with menorrhagia.

DESIGN

A descriptive qualitative study design was adopted. The Consolidated crieteria for Reportig Qualitative Research (COREQ) was used to report the findings of this study.

METHODS

The study was conducted at a tertiary public hospital in Singapore from July 2017-October 2017. Semi-structured interviews were used to collect data from 16 women who were diagnosed with menorrhagia. The total number of interviews was concluded based on data saturation. The interviews were transcribed verbatim, and thematic analysis was used to analyse the interview transcripts. The COREQ was used to report the findings of this study.

RESULTS

Participants reported that they were unaware about menorrhagia and its severity. Various internal and external factors influenced the participants' awareness and understanding of menorrhagia. Although the participants received support to cope with menorrhagia, the support was deemed insufficient. The women shared that menorrhagia had affected their lives physically, emotionally, socially and financially. They used both external and internal coping mechanisms to cope with their conditions and looked for information through close contacts and the Internet. They longed to learn more about their conditions.

CONCLUSION

Multiethnic Singaporean women with menorrhagia lacked awareness about their conditions and the severity, which affected their lives negatively. There should be greater efforts to raise the public's awareness of menorrhagia so that women can seek medical help early and minimise its negative influence on their lives.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers need to pay greater attention to menorrhagia in order to provide more holistic care and support for those experiencing this condition. Healthcare professionals should understand their patients' experiences with menorrhagia and evaluate their current support resources in order to create a strong support system.

Health inequalities between male and female immigrants in Spain after the beginning of the economic crisis

The aim of this study was to analyse health inequalities in the immigrant population in Spain in 2014, while differentiating between immigrant and native-born men and women. We have designed a cross-sectional study on the population aged over 15 years resident in Spain and the data were obtained from the 2014 European Health Survey in Spain (n = 22,842). Among immigrant men and women, we observed a lower risk of having a Chronic Physical Problem (CPP) or a Mental Health Problem (MHP) and a lower consumption of psychiatric drugs. We also observed a higher risk of lack of medical care in immigrant men compared to native-born. The country of origin was not significantly related to self-perception of health or use of Primary Care (PC) and Emergency Care services. In conclusion, we observed that now that the peak of the crisis has passed it seems that the "healthy immigrant" effect is being recovered, although the gender inequalities observed in the general population are transferred to the immigrant population. We need to approach the feminisation of migration from a new perspective and understand how inequalities affect immigrant women.

Immigration Basics for Nurses

The United States is known as a nation of immigrants and a land of promise that welcomes the needy, poor, and oppressed. Immigrants represent some of the most vulnerable in society. It is vital that nurses and other health care providers possess knowledge of social, economic, and political factors related to health care for immigrant populations. This article provides definitions of the various immigrant populations, addresses health needs within this group, and offers suggestions for nursing practice and advocacy.

Using Photo-Elicitation Methods to Understand Resilience Among Ultra-Poor Youth and Their Caregivers in Malawi

Unconditional cash transfer programs are a form of structural intervention to address poverty, a "fundamental cause" of disease. Such programs increasingly aim to build resilience to sustain improved outcomes and provide a solid foundation for longer term transformations. As such, there is a need to understand what resilience means in specific contexts. The goal of this formative study was to explore local experiences of resilience and vulnerability among 11 youth-caregiver dyads ( n = 22) who were beneficiaries of the Malawi Social Cash Transfer Program in Balaka district. We used a photo-elicitation approach informed by the participatory, visual methodology photovoice to guide the study and conducted an iterative content analysis using thematic coding of transcripts and photos. Participants took pictures of their daily struggles and shocks and participated in audio-recorded discussions to reflect on the photos using an adapted version of the SHOWeD method. We found that participants characterized resilience as a tireless process of using all available individual, family, and community resources at all times in pursuit of survival and well-being. In the context of daily struggles, resilience was an essential part of survival. Shocks, mostly health-related, were depicted through staged images candidly highlighting individual and environmental vulnerabilities. Community support was an essential component of resilience for both daily struggles and shocks. Using photo-elicitation methods facilitated an intergenerational, community-driven reflection on the meaning of resilience and the multilevel determinants of health in a context of extreme poverty. Findings can inform the design of resilience-focused cash transfer programs to improve health equity.

Voices and Views of Congolese Refugee Women: A Qualitative Exploration to Inform Health Promotion and Reduce Inequities

Refugees have recently been thrust into the spotlight worldwide. The strikingly negative rhetoric currently surrounding refugees calls for increased action from public health educators. In 2016, the largest proportion of refugees to the United States came from the Democratic Republic of Congo. This presents the opportunity to explore health needs as Congolese refugees resettle in the United States, with women taking priority due to health disparities linked to gender-based discrimination, trauma, sexual and gender-based violence, lower literacy rates, and less access to learning English. Insight into experiences of Congolese women in the United States is critical for the proactive development of socioculturally relevant health promotion rather than reaction interventions once health inequities are exacerbated. Therefore, to better understand perceptions and experiences of Congolese women in Indianapolis related to health and health care, a community-based participatory research study with an anthropological approach was conducted in collaboration with a refugee resettlement agency utilizing photovoice and semistructured interviews. Sixteen women participated in six photovoice sessions and home-based interviews. Selected photos, photo stories, and interview transcripts were analyzed using ethnographic content analysis. Major themes were health care system issues, social support, and daily experiences of health. Findings provide needed insight into the sociocultural context of health for Congolese refugees in the United States for both health educators and resettlement agencies. Findings also revealed specific priority areas for culturally tailoring health education and assets on which to build when promoting health for this population. Additionally, lessons were learned about the power of an anthropological, community-based participatory research approach to qualitative research for promoting health equity.