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In the United Kingdom, people with non-white ethnicities are more likely to report being in worse health conditions and have poorer experiences of healthcare services than white counterparts. The voices of those of Black ethnicities are often merged in literature among other non-white ethnicities. This literature review aims to analyse studies that investigate Black participant experiences of primary care in the UK. We conducted a systematic literature review searching Medline, Web of Science, EMBASE, SCOPUS, Social Policy and Practice, CINAHL plus, Psych INFO and Global Health with specific search terms for appropriate studies. No publish date limit was applied. 40 papers (39 articles and 1 thesis) were deemed eligible for inclusion in the review. A number of major themes emerged. Patient expectations of healthcare and the health seeking behaviour impacted their interactions with health systems in the UK. Both language and finances emerged as barriers through which some Black participants interacted with primary care services. (Mis)trust of clinicians and the health system was a common theme that often negatively impacted views of UK primary care services. The social context of the primary care service and instances of a cultural disconnect also impacted views of primary care services. Some papers detail patients recognising differential treatment based on ethnicity. The review included the voices of primary care professionals where descriptions of Black patients were overwhelmingly negative. Views and experiences of Black groups may be radically different to other ethnic minorities and thus, should be teased out of broader umbrella terms like Black and Asian Minority Ethnic (BAME) and Black Minority Ethnic (BME). To address ethnicity-based health inequalities, culturally sensitive interventions that engage with the impacted community including co-designed interventions should be considered while acknowledging the implications of being racialised as Black in the UK. [ABSTRACT FROM AUTHOR]

This paper synthesises critique from Māori patients with Bipolar Disorder (BD) and their whānau to identify barriers and propose changes to improve the structure and function of the New Zealand mental health system. A qualitative Kaupapa Māori Research methodology was used. Twenty-four semi-structured interviews were completed with Māori patients with BD and members of their whānau. Structural, descriptive and pattern coding was completed using an adapted cultural competence framework to organise and analyse the data. Three key themes identified the impact of structural features of the New Zealand mental health system on health equity for Māori with BD. Themes involved the accessibility, delivery and scope of the current health system, and described how structural features influenced the quality, utility and availability of BD services for Māori patients and whānau. Structural barriers in the existing design, and potential changes to improve the accessibility, delivery and scope of BD services for Māori, were proposed including a redesign of operational, environmental, staffing, and navigation points (information, transition, fatigue) to better meet the needs of Māori with BD. A commitment to equity when implementing structural change is needed, including ongoing evaluation and refinement. This paper provides specific recommendations that should be considered in health service redesign to ensure the New Zealand mental health system meets the needs of Māori patients with BD and their whānau. [ABSTRACT FROM AUTHOR]

Objectives:This paper presents the findings of a qualitative study exploring White and British Indian informal stroke carers’ experiences of caring, factors contributing to their stress, and strategies used to overcome stress. Design:A qualitative approach involving in-depth interviews was used to explore informal carers’ experiences of caring for stroke survivors and the stress of caring at one and three to six months from the onset of stroke. Interviewers bilingual in English and Gujarati or Punjabi conducted interviews with carers. Socio-demographic data of carers and stroke survivors were collected at one, and three to six months by dedicated stroke research nurses. Results:A total of 37 interviews with carers caring for stroke survivors with a wide range of physical and mental impairments were completed. A majority of carers had assumed the task of caring within a few weeks of the stroke. Irrespective of ethnicity, carers’ emotional and physical well-being was undermined by the uncertainty and unpredictability of caring for stroke survivors, and meeting their expectations and needs. The strain of managing social obligations to care was common to all carers irrespective of gender and ethnicity, but the higher levels of anxiety and depression reported by Indian British female carers appeared to stem from the carers’ pre-existing physical ailments, their cultural and religious beliefs, and household arrangements. Carers’ strain in extended households was exacerbated by the additional responsibility of caring for other dependent relatives. Conclusion:Since the role of carers is clearly indispensable in the successful rehabilitation of survivors, it is vital to ensure that their well-being is not undermined by a lack of information and training, and that their need for professional support is prioritised. [ABSTRACT FROM PUBLISHER]

Objectives.New Zealand has a unique tool, Te Tiriti o Waitangi, the Treaty of Waitangi, for addressing health disparities. Indigenous Māori have compromised health status compared to other groups. This paper investigates ways in which public health units (PHUs) and non-governmental organisations (NGOs) use Te Tiriti o Waitangi in service delivery to Māori. Design.A nationwide telephone survey of primary health providers (n=162) was conducted in 2014-15. Participants were asked about effectiveness and monitoring of their service delivery to Māori. Results.PHUs reported actively working with Māori, and Te Tiriti o Waitangi to reduce health disparities. Direct Māori engagement with development and delivery of programmes was viewed as essential. Strategies included designated PHU staff in positions of responsibility, formal partnerships with Māori, and providing operational and strategic guidance. Some PHUs supported development of cultural competencies. NGO responsiveness to Māori was variable. Some NGOs described prioritising service delivery and programmes for Māori. Others reported the focus of their service was European or other non-Māori ethnicities. Lack of resources or past difficulties engaging with Māori were barriers. Conclusion.Public health has an ethical commitment to reduce health disparities. Advancing Te Tiriti obligations in everyday practice has the potential to address inequalities. [ABSTRACT FROM AUTHOR]

Objective.To date, there is a paucity of research and information on Hispanic men cancer survivors (HMCS), who comprise part of the largest and fastest growing racial/ethnic minority group in the country. The purpose of this paper is to provide a deeper understanding of the supportive care needs of HMCS. Design.Three focus groups with a community sample of HMCS (n = 18) and interviews with providers (n = 5) were conducted to explore the supportive care needs of Hispanic men who had been diagnosed with cancer within the last five years. The data were analyzed using applied thematic analysis techniques. Results.Findings from focus groups and interviews are presented concurrently. The overarching themes that emerged were the need for: culturally sensitive cancer care and better communication with providers; cancer treatment-related information and comprehensive survivorship care; support and to connect with other cancer survivors and the need to negotiate changing gender role expectations and still provide for their family. Conclusion.Study findings contribute to the literature by presenting the supportive care needs of HMCS and illustrate the need for continued research to address disparities in access to cancer information and in the provision of culturally sensitive care. We provide recommendations and suggestions to address the supportive care needs of HMCS. [ABSTRACT FROM PUBLISHER]

ObjectiveFollowing arguments made in the USA, the UK and New Zealand regarding the importance of population-level ethnicity data in understanding health and healthcare inequities, health authorities in several Canadian provinces are considering plans to collect ethnicity data from patients at the point of care within selected healthcare organizations. The purpose of this paper is to examine the potential quality, utility and relevance of ethnicity data collected at an organizational level as a means of addressing health and healthcare inequities. DesignWe draw on findings from a recent Canadian study that examined the implications of collecting ethnicity data in healthcare contexts. Using a qualitative design, data were collected in a large city, and included interviews with 104 patients, community and healthcare leaders, and healthcare workers within diverse clinical contexts. Data were analyzed using interpretive thematic analysis. ResultsOur results are discussed in relation to discourses reflected in the current literature that require consideration in relation to the potential utility and relevancy of ethnicity data collected at the point of care within healthcare organizations. These discourses frame excerpts from the ethnographic data that are used as illustrative examples. Three key challenges to the potential relevance and utility of ethnicity data collected at the level of local healthcare organizations are identified: (a) issues pertaining to quality of the data, (b) the fact that data quality is most problematic for those with the greatest vulnerability to the negative effects of health inequities, and (c) the lack of data reflecting structural disadvantages or discrimination. ConclusionThe quality of ethnicity data collected within healthcare organizations is often unreliable, particularly for people from racialized or visible minority groups, who are most at risk, seriously limiting the usefulness of the data. Quality measures for collecting data reflecting ethnocultural identity in specific healthcare organizations may be warranted – but only if mechanisms exist or are developed for linking ethnicity with measures of perceived discrimination, stigmatization, income level, and other known contributors to inequities. Methods for linking these kinds of data, however, remain underdeveloped or non-existent in most healthcare organizations. [ABSTRACT FROM AUTHOR]

Rates of HPV infection and HPV-related cancers are elevated in the Black population of the US. Efforts to promote HPV vaccination and cervical cancer screening are important to reducing the cancer burden among Black populations. The purpose of this qualitative descriptive study guided by social ecological model (SEM) was to describe from the perspective of key informants, the challenges and opportunities for HPV vaccination and cervical cancer screening promotion among Black adults. Twenty-three key informants participated in individual interviews over zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy prior to data analysis. Two qualitatively trained researchers analyzed the data using content analysis. Participants were aged 50 ± 4.1 years, 12 were females, and 18 identified as Black. Participants included health care providers, teachers, church and community leaders. Themes included HPV and cancer literacy, influence of religion, health care provider recommendations, social and cultural influences, accessibility and availability of services, economic constraints, limited community resources, and HPV vaccine mandates. SEM factors contribute to low HPV vaccine uptake and cervical cancer screening and these factors need to be addressed. Interventions addressing SEM factors peculiar to Black populations may promote HPV vaccination and cancer screening in this population. [ABSTRACT FROM AUTHOR]

Research on dementia literacy in Chinese societies is still emerging, and this is especially the case among racially minoritized groups. The present study explored the knowledge, causal beliefs, and help-seeking behaviors of South Asian migrants in Hong Kong about dementia. It also investigated existing community barriers related to dementia knowledge and help-seeking. We conducted a qualitative study from a purposive sample of 38 older people and family caregivers from India, Pakistan, and Nepal who lived in Hong Kong. Focus groups and individual in-depth interviews were used to gather information, while thematic analysis was employed to analyze the data. Five main themes were identified: normalization with stigmatization of dementia; spiritual and psychosocial attributions of dementia; familial responsibility despite potential caregiving burden; uncertainties versus openness to professional care; and barriers and opportunities in dementia literacy. Ethnic minorities recognized dementia as a disease of normal aging or a mental disorder. They also perceived spiritual and psychosocial factors as their main causes. While participants recognized the potential burden of dementia caregiving, families were their first point of help-seeking, as many of them expressed contrasting feelings of confidence or doubt toward professional services. Utilization of health education strategies, together with collaboration with community leaders, could address the barriers to dementia literacy. This is the first study to explore how ethnic minorities in Asia perceive dementia and its related help-seeking behaviors in their communities. South Asian migrants in Hong Kong have a limited understanding of dementia and may experience delays in obtaining relevant community services. While culture influenced their knowledge, health education may address their misperceptions and help-seeking behaviors toward dementia. Culture- and language-specific programs could also improve dementia knowledge and health service access. [ABSTRACT FROM AUTHOR]

We examined Latinx immigrants' perceptions of US policy related to restrictions on immigrants' use of public resources and their thoughts about the influence of these on immigrants' healthcare utilization. A series of 16 focus group discussions with Latinx immigrant men and women (documented and undocumented) (N = 130) were conducted between May and July 2017 across four US cities. Four central themes emerged: participants attributed the limited resources available for affordable healthcare for many uninsured US immigrants (both documented and undocumented) to the US government's view of immigrants as burdens on public resources and its subsequent unwillingness to dedicate funds for their care; participants expressed concerns, some unfounded, about negative immigration ramifications arising from diagnosis with health conditions perceived to be serious and/or expensive to treat; participants noted that some immigrants avoided using health programs and services to which they were entitled because of immigration concerns; finally, participants described how access to information on immigration laws and healthcare resources, and conversely, misinformation about these, influenced healthcare utilization. Participants were acutely aware of the image of immigrants as public charges or potential burdens on government resources that underlies US immigration policy. In some cases, participants came to inaccurate and potentially harmful conclusions about the substance of laws and regulations based on their beliefs about the government's rejection of immigrants who may burden public resources. This underscores the importance of ensuring that immigrants have access to information on immigration-related laws and regulations and on healthcare resources available to them. Participants noted that access to information also fostered resilience to widespread misinformation. Importantly, however, participants' beliefs had some basis in US immigration policy discourse. Law and policy makers should reconsider legislation and political commentary that frame self-reliance, the guiding principle of US immigration policy, in terms of immigrants' use of publicly funded healthcare resources. [ABSTRACT FROM AUTHOR]

For a decade, the Lake Chad Basin (LCB) region, which is at the intersection of four countries and home to ethnic groups in Cameroon, Chad, Niger and Nigeria, has been occupied by Boko Haram. The lax borders and deprivation in the region contributed to the emergence and expansion of Boko Haram's insurgency. While much is known about the human casualties of the invasion, little is known about the accessibility of healthcare for the displaced persons. This qualitative study adopted Penchansky and Thomas' ([1981]. "The Concept of Access: Definition and Relationship to Consumer Satisfaction." Medical Care 19 (2): 127–140) theory of access as its conceptual framework (with the following components: geographical accessibility, availability, financial accessibility, acceptability and accommodation) to explore the experiences of the displaced persons in the LCB with respect to access to healthcare. One-on-one interviews (n = 51) and two focus group discussions (n = 16) were conducted with 67 refugees and internally displaced persons recruited from nine host communities in Nigeria and Cameroon, who shared their perceptions of their healthcare access. The displaced persons faced barriers to their access to the healthcare in the LCB. It was found that for each of the components of the theory of access, the study participants encountered barriers to healthcare access. For example, with regard to financial accessibility (affordability), poverty was identified as the main personal barrier to the displaced persons' healthcare access, and with regard to acceptability, it was communication that was reported to be a barrier. The limitations of the study, the recommendations for future research and the implications of the findings are discussed in detail. [ABSTRACT FROM AUTHOR]

eHealth has growing potential to enhance access to HIV prevention for hard to reach populations, including young Latino immigrant men who have sex with men (MSM) in the United States. We examined the feasibility and acceptability of using eHealth tools, specifically social media platforms, to facilitate HIV testing and pre-exposure prophylaxis (PrEP) uptake among this population. We utilized a community sensitive approach to conduct 30 in-depth interviews and five focus groups with young Latino immigrant MSM in Seattle, WA. Data were analyzed using thematic analysis with both data-driven inductive and a priori deductive approaches. Participants were open to receiving HIV information via social media platforms. Participants recommended that social media content be tailored with their language preferences, cultural norms, and beliefs about HIV testing and PrEP in mind. Further, participants emphasized that content avoid stigmatizing HIV or Latino MSM's complex identities. Results have implications for utilizing social media platforms and developing HIV prevention interventions for Latino immigrant MSM. Findings highlight that HIV prevention content should acknowledge how identities as an emerging adult, Latino, immigrant, and MSM, warrant unique consideration. [ABSTRACT FROM AUTHOR]

COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. Twenty-five semi-structured interviews were conducted (October 2020–January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake. [ABSTRACT FROM AUTHOR]

The disparities that Black/African-American women experience in health care are persistent and staggering. Findings from health outcomes research continue to demonstrate poorer outcomes for African-American women compared to women of other race/ethnicity in several conditions. These racial/ethnic and gender health disparities observed are complex, heavily nuanced and multi-factorial. To understand these, there is a need to apply an 'intersectionality' lens. Intersectionality refers to the experience of persons with multiple intersecting statuses. The objective of this exploratory study was to gain insight into the healthcare experiences of low-income African-American women. In-depth one-on-one interviews were conducted with 22 women and 2 focus group discussions with community leaders and advocates. Investigators conducted a thematic analysis of the transcripts. The thematic analysis revealed four major themes, which tell the story of the intersectional invisibility experienced by low-income AA women in the healthcare system. These included (1) the perception of 'not feeling heard'; (2) patient as 'expert of her own body'; (3) disregard of patient preferences; and (4) the need for self-advocacy. Black/African-American women, and particularly those with socioeconomic disadvantage, experience intersectional invisibility resulting from provider implicit bias, stereotypical assumptions, and systemic structures that enable discriminatory practices in healthcare delivery. Healthcare provider education that more explicitly addresses these biases and stereotypes should be complemented with system-level interventions that aim to dismantle the structural racism inherent in healthcare policies and practices. [ABSTRACT FROM AUTHOR]

Objectives: Examine the social influence of adult children on the cardiovascular-related health behaviors of older South Asian (SA) immigrants to inform lifestyle interventions. Design: This mixed-methods study used data from an ancillary study of social networks (2014–2018) in the Mediators of Atherosclerosis in South Asians Living in America cohort. Phase 1 was a quantitative analysis of self-reported diet and physical activity among SA adults (n = 448, mean age = 58 years, SD 8.4) who named at least one adult child to their social network. The Alternative Healthy Eating Index (AHEI) was used to measure parents' diet; higher numbers indicate a healthier diet (range 0–110). Phase 2 was a thematic content analysis of in-depth qualitative interviews from a subsample of these parents (n = 23, mean age = 55, SD 7.6). Results: Parents with an adult child in their network who consumed uncooked vegetables daily had mean parental AHEI score 1.5 points higher (adjusted p-value = 0.03) than those who had a child in the network who ate uncooked vegetables less often. When at least one adult child in their network ate fresh fruit daily compared to less frequently or when at least one child ate non-SA food daily compared to less frequently, mean parental AHEI scores were higher by 2.0 (adjusted p-value = 0.01) and 1.6 (adjusted p-value = 0.03) points respectively. Parents with an adult child in their network who exercised at least weekly were more likely to meet guideline-recommended physical activity levels than parents with children who exercised less often (76% v. 56%, adjusted p-value = 0.02). Adult children provided social support and were seen as 'role models' for healthy behavior, especially when adopting Western health behaviors. Conclusion: Positive role modeling and support from adult children were important facilitators of healthy behavior change in older SA immigrants and can inform health behavior interventions for SA adults. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the experience of women of culturally and linguistically diverse (CALD) backgrounds in relation to breast reconstruction following mastectomy as treatment for their breast cancer. The aim of this study was to explore the factors that influenced Vietnamese- and English-speaking women's decisions about breast reconstruction post-mastectomy for their breast cancer, in Australia. Design: The participants in this study comprised of Vietnamese-speaking women of Vietnamese heritage, and English-speaking women from mixed ethnicities (Vietnamese included). In this qualitative study, Vietnamese-speaking and English-speaking women who had breast cancer treated by mastectomy with or without breast reconstruction participated in in-depth interviews. Interviews were undertaken in the woman's chosen language (Vietnamese or English), audio-recorded, transcribed/translated and analysed using thematic analysis. Results: Fourteen Vietnamese-speaking and 13 English-speaking patients were recruited. Participants identified age, lack of information, concerns regarding surgical procedure, fears about complications and cancer recurrence as barriers to breast reconstruction. Many more Vietnamese-speaking participants identified lack of information about breast reconstruction as a barrier compared to English-speaking participants. Both groups described the ability to wear clothing of their choice, partner influence, and the need to feel 'normal' as facilitators to having breast reconstruction. Vietnamese-speaking participants in particular identified doctor recommendation of breast reconstruction as a major facilitator. Conclusion: Lack of information about reconstruction was a persistent theme, though it was identified by more Vietnamese women as a barrier to having breast reconstruction. The results reinforce the importance of doctors' recommendations in helping particularly the Vietnamese women make an informed decision about reconstruction following mastectomy as treatment for their breast cancer. [ABSTRACT FROM AUTHOR]

Objective: African Americans are disproportionately affected by stroke in the United States (US). The purpose of this study is to explore experiences, wants, and needs of African Americans with stroke and their family caregivers residing in the stroke belt across the care continuum using the 'Timing It Right' (TIR) framework as a conceptual guide. Design: We conducted a series of focus groups among 20 African Americans living with stroke and 19 family caregivers. Focus groups were audio-recorded and transcribed verbatim. For this secondary analysis, we coded qualitative data using the TIR framework. Results: Participants in this sample identified pre-stroke needs in addition to the TIR phases that span across the care continuum and into community living. We identified four important contextual factors and real-world conditions that operate in the background and influence the post-stroke needs of this specific population across the TIR framework: (1) religion, faith, and church, (2) healthcare delivery, (3) community, and (4) sentinel events. Conclusions: We propose a TIR model that expands upon the original TIR framework which includes factors important for consideration when developing and delivering community-based interventions among African Americans with stroke and family caregivers in the southeastern US. [ABSTRACT FROM AUTHOR]

Objective: In the United States, 26,534 young women (≤45 years) were diagnosed with breast cancer in 2017. Young African American (AA) women have higher incidence and mortality rates than Whites and Hispanics. Yet, few published studies describe survivorship (life after breast cancer diagnosis) experiences among this group. Here, we explore the lived experience of young AA breast cancer survivorship (via quality of life [QOL]). Design: This phenomenological study was framed by the QOL Applied to Breast Cancer model. Fifteen young AA survivors from the Southern U. S. participated in two semi-structured interviews. Methods of transcendental phenomenology were used for data collection and analysis. Results: Five themes emerged from participants' (mean age = 35 years; survivorship = 4 years) descriptions of survivorship experience: (1) actively managing spiritual self, (2) actively managing physical self, (3) actively managing psychological self, (4) actively managing social self, and (5) seeking survivorship knowledge. Participants perceived survivorship as a labile 'new normal' and 'ongoing struggle,' in which spirituality and survivorship knowledge were key to restructuring their lives. Conclusions: Survivorship among young AA survivors was more fluid and complex than the QOL model explained. Findings describe young AA breast cancer survivorship and indicate areas of potential strengths and distress. Healthcare providers and ancillary staff must exercise cultural competence to assess and anticipate young AA survivors' needs and concerns. Implementing targeted survivorship interventions, accounting for cultural contexts (e.g. high spirituality) and need for age-specific survivorship information, may improve QOL among young AA survivors. [ABSTRACT FROM AUTHOR]

Objective: This study utilises Kleinman's theory of explanatory models of health and illness to explore the experience of chronic hepatitis B (CHB) among Vietnamese people living in Australia. It examines how these explanatory models are formed and shaped by the broader community, and the extent to which this influences understandings and responses to CHB. Design: This study is based on semi-structured interviews with 22 Vietnamese people with CHB in Melbourne, Australia. The individual interviews ranged from 30 minutes to 1.5 hours in length, and were electronically recorded, translated where necessary and transcribed verbatim. Transcripts were thematically coded using NVivo 10, with coding themes guided by categories identified in Kleinman's explanatory models framework. Results: Fundamental to most participants' narratives was the profound impact of cultural, social and economic environments on their understandings and responses to CHB. Regardless of socio-demographic background, most participants juxtaposed biomedical elements of CHB with their own existing humoral-based health belief system. In the context of a chronic asymptomatic condition that, for the most part, does not require pharmaceutical treatment, a humoral-based health belief system provided a familiar conceptual framework from which participants could immediately respond and take control of their infection. This was observed through changes in diet and lifestyle, and the use of traditional herbal medicine in an attempt to 'cure' or halt the progression of their infection. Conclusions: By speaking to people living with CHB directly, it became clear that there is a disjuncture between what is commonly assumed by the biomedical model of CHB and what is understood by individuals with the infection. The public health burden of CHB will continue unless the healthcare system, including public health policies, deliver a hepatitis B model of care that is responsive to the needs and expectations of priority populations. [ABSTRACT FROM AUTHOR]

Objectives: Though several studies have focused on risk factors associated with excess weight gain, little is known about the extent to which socio-cultural beliefs about body sizes may contribute to risk of excess weight gain, especially in non-Western migrant communities. Drawing on socio-cultural and attribution theories, this study mainly explored socio-cultural beliefs about an ideal body size among Australian residents who were born in sub-Saharan Africa (SSA). Implications of body size beliefs for risk of excess weight gain after immigration have also been discussed. Design: Employing a qualitative design, 24 in-depth interviews were conducted with Australian residents who were born in SSA. Thematic content analysis was undertaken to ensure that participants' experiences and views were clearly captured. Results: According to the participants, a moderately large body size is idealised in the SSA community and post-migration weight gain is commonly regarded as evidence of well-being. While desirability of a moderately large body size was noted by some participants, others were concerned about health risks (e.g. high blood pressure) associated with excess weight gain. Moreover, body size ideals seemed to be different for men and women in the SSA community and these ideals were mainly promoted by family and friends. Participants reported that women with very slim (skinny) body sizes are often regarded as persons suffering from health problems, whereas those with 'plumpy' body types are often considered beautiful. Participants also noted that men are expected to look well-built and muscular while those with big bellies are often seen as financially rich. Conclusions: Participants' interpretation of post-migration weight gain as evidence of well-being calls for urgent intervention as risk of excess weight gain appear to be high in this immigrant group. [ABSTRACT FROM AUTHOR]

Objective: Black men are three times more likely to develop prostate cancer (PCa), to do so at a younger age and to experience a more aggressive form than White men. This study aims to understand the experiences of African-Caribbean men with respect to their discharge to primary care following successful PCa treatment and the challenges associated with survivorship. Design: Eight African-Caribbean men, who had been successfully treated for PCa, were recruited through the charity BME Cancer Communities. They participated in a focus group, which took place on the premises of the charity and was audio-recorded. The recording was transcribed and the data were analysed employing thematic analysis. Results: Three overarching themes were developed: Discharge – misconceptions and uncertainties; Survivorship – challenges and ways of coping; Black men and PCa: real and potential discrimination. Participants expressed concerns regarding the lack of information and clarity about what discharge meant, the quality of follow-up care, especially the levels of specialist knowledge among GPs, and the impact of side-effects, particularly erectile dysfunction (ED). Participants linked ED with stereotypes of Black male sexuality, particularly in relation to difficulties of expressing their emotions and psychological distress. African-Caribbean men face particular challenges in dealing with the side-effects of treatment for PCa, which are linked to socially-constructed ideas of masculinity. Conclusion: There needs to be a greater focus in primary care on understanding these issues and providing individualised culturally-sensitive care. In particular, GPs should be aware of sensitivities concerning help-seeking related to culturally-mediated understandings of masculinity. [ABSTRACT FROM AUTHOR]

Objective: Somali refugee women are known to have poor health-seeking behavior with a higher proportion of adverse pregnancy outcomes compared to US-born women. Yet unknown is how they avoid obstetrical interventions. This study sought to identify perceived protective mechanisms used to avoid obstetric interventions as well as the underpinning factors that influence aversion to obstetrical interventions by Somali refugee women. Design: A descriptive, exploratory qualitative study purposively sampled Somali refugee women recruited via snowball technique in Franklin County, Ohio, United States. Data were collected through audio-recordings of individual interviews and focus groups conducted in English and Somali languages. The collected data were transcribed and analyzed using thematic analyses. Results: Forty Somali refugee women aged 18–42 years were recruited. Participants reported engaging in four perceived protective mechanisms to avoid obstetrical interventions during pregnancy and childbirth: (1) intentionally not seeking or misleading prenatal care, (2) changing hospitals and/or providers, (3) delayed hospital arrival during labor, and (4) refusal of care. Underpinning all four avoidance mechanisms were their significant fear of obstetrical interventions, and perceived lack of choice in their care processes as influenced by cultural and/or religious beliefs, feeling judged or undervalued by service providers, and a lack of privacy provided to them while receiving care. Conclusion: Like every woman, Somali women also have a right to choose or refuse care. If the intention is to improve access to and experiences with care for this population, building trust, addressing their fears and concerns, and respecting their culture is a critical first step. This should be well established prior to the need for critical decisions surrounding pregnancy and childbirth wherein Somali women may feel compelled to refuse necessary obstetrical care. Bridging gaps between Somali women and their providers is key to advance health equity for this vulnerable population. [ABSTRACT FROM AUTHOR]

Objectives: Chinese American women living in linguistically isolated communities are among the least likely to utilize healthcare services. Qualitative research methods can help identify health system vulnerability points to improve local healthcare delivery for this population. Design: We conducted 6 focus groups among 56 Chinese-speaking adult women in Chicago's Chinatown between July and August 2014 to explore their perceptions of experiences receiving medical care and interacting with healthcare providers in Chinatown healthcare settings. Results: Health system/clinic infrastructure and patient–provider communications were perceived barriers to care at Chinatown healthcare settings. Chinese participants reported long wait times, difficulty scheduling appointments, and poor front desk customer service. Communication difficulties at Chinatown healthcare settings involved language barriers with non-Chinese-speaking providers, but consideration for healthcare providers, provider demeanor, and reliance on provider recommendation also hindered patient–provider communications. Conclusions: Findings improve understanding of barriers to care experienced by Chinese immigrant women in one urban Chinatown community. [ABSTRACT FROM AUTHOR]

Objective: To build on Evans-Campbell's [2008. "Historical Trauma in American Indian/Native Alaska Communities: A Multilevel Framework for Exploring Impacts on Individuals, Families, and Communities." Journal of Interpersonal Violence 23 (3): 316–338. doi:.] multilevel framework of historical trauma and health by focusing on the cycle of fetal alcohol spectrum disorders (FASD) in the socio-cultural, historical, and interpersonal context of trauma shared by American Indian and Alaska Native (AI/AN) peoples. Methods: We analyzed qualitative data from focus groups with seventy four urban AI/ANs who were 15 years of age and older. Community-based participatory research methods were used for data collection and analysis. Our study explored knowledge and attitudes about FASD, perspectives on FASD risk factors, and culturally relevant approaches to FASD prevention and healthcare. Results: According to our study's participants, efforts to address FASD among urban AI/ANs should align with and emerge from community values, promote healing, consider the broader context that influences behaviors, and reflect the community's understanding that FASD risk behaviors are inextricably linked with historical and contemporary trauma. Conclusion: Effective, multiple-level FASD prevention approaches for AI/ANs may include prioritizing Indigenous culture, supporting intergenerational cohesion, focusing on non-stigmatic healing of traumas, and authentically engaging community knowledge. This work draws on community and cultural strengths in an effort to reduce the occurrence of substance-exposed pregnancies, and encourages transformational changes in systems that serve AI/AN peoples to promote a healthy and thriving community and future generations. [ABSTRACT FROM AUTHOR]

Introduction: There is a paucity of information on cancer among Indigenous populations in Latin America. Methods: Guided by tenets of community engaged research and syndemic theory, we conducted eight focus groups (n = 59) with Kichwa men and women in the province of Imbabura, Ecuador. Data were analyzed using applied thematic analysis techniques. Results: Cancer emerged as an important health problem and was reported as a growing concern. Kichwa participants in this study attributed the rise in cancer to (1) exposure to chemicals and pesticides, (2) urbanization and development, and (3) the rise of innutritious, westernized diets. Conclusion: Our findings suggest that the Kichwa are attuned to the global phenomena in which traditional diet has been replaced by western, processed foods and fast food, which result in higher levels of chronic diseases such as cancer. More research is needed to understand the cancer burden among Indigenous peoples in Latin America. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine perceptions of COVID-19 related to prevention, coping, and testing of African American residents in under-resourced communities in Alabama. Guided by the PRECEDE-PROCEED model, virtual focus groups were conducted in five urban and rural Alabama communities using secure Zoom meetings. Community residents and stakeholders (N = 36 total) participated; meetings were audio- and video-recorded, transcribed, and analyzed according to Thematic Analysis. Themes were organized by the PRECEDE portion of the model in Predisposing, Reinforcing, and Enabling barriers and facilitators in three focus areas: prevention, coping, and testing. Prevention barriers included apathy, difficulty with social distancing, lack of information, mixed messages from authority figures, and lack of personal protective equipment (PPE). Prevention facilitators included concerns about contracting COVID-19, clear and consistent messages from trusted sources, contact tracing, and the provision of PPE. Coping barriers included food insecurity, mental health issues, isolation, economic hardships, lack of health care access, and issues with virtual schooling and church services, which were exacerbated by the inability to connect to the internet. Facilitators to coping included religious faith, increased physical activity, and a sense of hope. Testing barriers included misunderstanding, fear, mistrust, testing restrictions, and location of testing sites. Facilitators to testing included incentives, clear information from trusted sources, convenient testing locations, and free tests. Gaining community members' perspectives can identify barriers and facilitators to prevention, coping, and testing and potentially improve outcomes. While addressing the social determinants of health (e.g. income, education, medical trust) would be an effective path by which to diminish health disparities related to COVID-19, there is an urgent need to mitigate the spread and severity of COVID-19 in vulnerable populations. Interventions should focus on downstream determinants, such as those emerging from our study. [ABSTRACT FROM AUTHOR]

Mexico's indigenous communities continue to experience higher levels of mortality and poorer access to health care services than non-indigenous regions, a pattern that is repeated across the globe. We conducted a two-year ethnographic study of pregnancies and childbirth in an indigenous Wixárika community to explore the structural causes of this excess mortality. In the process we also identified major differences between official infant mortality rates, and the numbers of infants born to women in our sample who did not survive. We interviewed 67 women during pregnancy and followed-up after the birth of their child. At baseline, socio-demographic data was collected as well as information regarding birthing intentions. In depth-interviews and semi-structured interviews were conducted with 62 of these women after the birth of their child, using a checklist of questions. Women were asked about choices regarding, and experiences of childbirth. Of the 62 women we interviewed at follow-up 33 gave birth at home without skilled attendance and five gave birth completely alone in their homes. Five neonates died during labour or the perinatal period. Concerns about human resources, the structure of service delivery and unwanted interventions during childbirth all appear to contribute to the low institutional childbirth rate. Our data also suggests a low rate of death registration, with the custom of burying infants where they die. This excess mortality, occurring in the context of unnecessary lone and unassisted childbirth are structurally generated forms of violence. [ABSTRACT FROM AUTHOR]

Objective: To understand what motivates sedentary indigenous and ethnic minority men to become more physically active. Design: We use thematic analysis to present data from a qualitative study exploring 23 sedentary indigenous Māori (New Zealand) men's experiences of completing a 12-week exercise intervention to improve their metabolic health. Results: Four themes emerged: The Bros – having fellowship and mutual motivation; Being better informed about exercise; Impacting overall wellbeing; and Disseminating the findings beyond the study Exercise interventions informed by indigenous Māori cultural values and knowledge increased its relevance to their daily lives. The motivation for these indigenous men was more culturally-based external factors than an inherent desire to lose weight. Conclusion: Indigenous and minority men in many developed countries have high morbidity and premature mortality related to sedentary lifestyles. The low uptake of physical activities possibly relates to focusing more on outcomes such as weight loss which lacks cultural relevance. When offering health promotion interventions for marginalized populations these findings highlight the importance of culturally tailoring interventions to the unique sources of motivation for each group to increase activity to improve their efficacy. [ABSTRACT FROM AUTHOR]

Objective: Colorectal cancer (CRC) screening efforts have effectively reduced CRC morbidity and mortality, yet screening remains relatively low among Latinos. The study's purpose was to document the awareness/knowledge of Fecal Immunochemical Test (FIT) among Latinos, gain better understanding of patient and health care provider perceptions about FIT, and explore the feasibility of adoption/uptake. Design/Methods: The study was guided by qualitative, ethnography design and methods. Eight focus groups (FG) with patients who self-identified as Hispanic/Latino between 50–75 years of age and key informant interviews with providers (N = 10) were conducted followed by a brief demographic questionnaire. Results: Awareness levels varied based on prior screening experiences among patients and providers. Both patients and providers believed the FIT is simple and easy to use; although, a minority of patients expressed doubts about the efficacy of the FIT when compared to colonoscopy. Conclusions: Despite the increasing acceptance of the FIT among the health care community, a significant lag time still exists among our study's populations. Study findings speak to novelty of the FIT test among underserved populations and the health disparity gap between health innovations/discoveries. Increased awareness and education efforts about the efficacy coupled with information about its accessibility, ease, and user instructions may increase the adoption of FIT. [ABSTRACT FROM AUTHOR]

Objectives: Global evidence suggests that individuals who experience intimate partner violence (IPV) can have accelerated risk for HIV transmission. The U.S. Virgin Islands (USVI) has high per capita rates of HIV and IPV that can have devastating effects on women's health. Catalysts for these health disparities may be shaped by cultural and social definitions of conventional masculinity. Thus, understanding USVI men's perceptions about HIV risks and IPV are a necessary component of developing strategies to improve women's health. This study aimed to describe perceptions of HIV risks and IPV among USVI men. Design: We conducted two focus groups with 14 men living on St. Thomas and St. Croix, USVI. The focus group interview guide was culturally relevant and developed using findings from research conducted about these issues on USVI. Thematic analysis was used to analyze focus group data. Transcripts were coded and categorized by four research team members and discrepancies were reconciled. Themes were developed based on the emerging data. Results: Focus group participants were all US citizens born on the USVI, had a median age range of 20–25, 86% (12) were of African descent and 14% (2) were Hispanic. Themes emerging from the data were: (1) validating status, (2) deflecting responsibility, and (3) evoking fear and distrust. These ideas underscored the ways that attitudes and beliefs informed by gender and social norms influence IPV and sexual behavior between intimate partners. Conclusion: USVI society could benefit from interventions that aim to transform norms, promote healthy relationships, and encourage health-seeking behavior to improve the health of women partners. [ABSTRACT FROM AUTHOR]

Objectives: Heterosexually active Black men are alleged to endorse masculine norms that increase their and their female partners' vulnerability to HIV. These norms include Black men's inability or reluctance to productively engage their own health-related personal and interpersonal vulnerabilities. We draw on data from the iSpeak research study in Ontario, Canada, to assess whether and how heterosexual Black men cope with personal and inter-personal vulnerability, namely that heterosexual Black men: avoid emotionally supportive relationships with other men (and women), which diminishes their capacity to productively acknowledge and resolve their health-related challenges; are reticent to productively acknowledge and address HIV and health on a personal level; and are pathologically secretive about their health, which compounds their vulnerability and precipitates poor health outcomes. Design: iSpeak was implemented in 2011 to 2013, and included two focus groups with HIV-positive and HIV-negative self-identified heterosexual men (N = 14) in Toronto and London, a focus group with community-based health promotion practitioners who provide HIV-related services to Black communities in Ontario (N = 6), and one-on-one interviews with four researchers distinguished for their scholarship with/among Black communities in Toronto. Participants in the men's focus group were recruited discretely through word-of-mouth. Focus groups were audiotaped and transcribed verbatim. Team members independently read the transcripts, and then met to identify, discuss and agree on the emerging themes. Results: We demonstrate that iSpeak participants (a) engage their personal and interpersonal vulnerabilities creatively and strategically, (b) complicate and challenge familiar interpretations of Black men's allegedly transgressive masculinity through their emotional and practical investment in their health, and (c) demonstrate a form of resourceful masculinity that ambiguously aligns with patriarchy. Conclusion: We conclude with a range of actionable recommendations to strengthen the discursive framework for understanding heterosexual Black men in relation to HIV and health, and substantively engaging them in community responses to HIV. [ABSTRACT FROM AUTHOR]

Introduction: Jamaican culture is considered 'fat-loving,' and thus less likely to foster obesity stigma. However, the importance of tourism to Jamaica's economy, global trends toward a thinness aesthetic and extant ethos' of both bodily self-acceptance and status-based bodily critique suggest that obesity stigma may exist in Jamaica – particularly in the context of class status aspiration. Objective: This pilot study examined the relationship between upward mobility and fat stigma in Kingston, Jamaica in two samples. Design: The first sample – nineteen college-enrolled 18–25 year olds – completed an online survey. Responses were grouped by perceived wealth status. Results: No relationship was found between wealth status and obesity stigma. There was no association between wealth group and body ideal – whether slender or curvaceous. However, responses to questions concerning the value of having an ideal body differed by wealth grouping. Those with lower perceived wealth tended to cite 'fitting in to society' as a benefit of having an ideal body. Half (5 of 10) the lower wealth group ranked having an ideal body 'very important;' one person in the higher wealth group did so. Findings from twenty ethnographic interviews conducted in Kingston's public spaces with 18–25 year olds confirmed the obesity stigma/social aspiration relationship. Having an ideal body was associated with greater economic and social opportunity and a sense of 'fitting in.' Conclusion: These findings suggest that though (1) there seems to be no singular, size-related aesthetic in Jamaica; (2) obesity stigma does exist; and (3) experience of stigma may be affected by socio-economic status and socio-economic aspiration. [ABSTRACT FROM AUTHOR]

Objective: Identify health perspectives among Asian Indians in greater Houston area, to guide a tailored community wide survey. Design: Four focus groups of different ages, gender, and nativity were conducted at which participants were asked for their opinions about specific health topics. Key informant interviews were conducted with ten community leaders to validate focus group responses. Recordings from focus groups and key informant interviews were transcribed and analyzed. Results: Diabetes, cancer, and hypertension were primary health concerns. Common themes were sedentary lifestyle and poor health literacy. Older participants were more accepting of having familial hypertension and high cholesterol. Women were more concerned about health of family members and dietary habits. Perspectives differed on eating habits, physical activity, use of Western medicine, and smoking based on nativity. Responses from key informant interviews validated focus group findings. Conclusion: Perspectives on health may differ among Asian Indians depending on gender, age, and nativity. [ABSTRACT FROM AUTHOR]

Objectives: Despite the disproportionately high rates of heterosexually transmitted HIV infection among US Blacks and ongoing need for effective inexpensive behavioral interventions, the use of sermons as an HIV prevention tool in Black churches has received little research attention. The Black church plays an important role in Black communities and is a potential ally in development and delivery of sexual risk prevention messages. The objective of this study was to examine Black pastors' thoughts about whether sermons should address issues related to heterosexual relationships – and the barriers and facilitators to discussing these topics in a sermon setting. Design: We conducted in-depth semi-structured, individual interviews among 39 pastors of Black churches in North Carolina and analyzed the interview data using thematic analysis strategies based on grounded theory. Results: Pastors expressed widely ranging opinions, especially about discussion of condom use, but generally agreed that sermons should discuss marriage, abstinence, monogamy, dating, and infidelity – behaviors that impact sexual networks and HIV transmission. The major barriers to incorporation of these subjects into sermons include the extent to which a concept undermines their religious beliefs and uncertainty about how to incorporate it. However, scriptural support for a prevention message and the pastor's perception that the message is relevant to the congregation facilitate incorporation of related topics into sermons. Conclusions: These findings have implications for the potential utility of sermons as an HIV prevention tool and suggest that it is possible for public health professionals and pastors of Black churches to form partnerships to develop messages that are consonant with pastors' religious convictions as well as public health recommendations. [ABSTRACT FROM AUTHOR]

Objective: Hispanic immigrants represent the largest and fastest growing ethnic minority within the US, justifying increased attention to identify factors that influence declining immigrant health across generations. This study investigates the range of psychosocial stress exposures and coping mechanisms of Mexican immigrant mothers, and implications for the health of their US-born children. Design: We conducted 10 focus groups with 1st generation Mexican-born immigrant mothers (n = 32 women) in Nashville, TN, in the summer of 2014. Focus groups elicited challenges and benefits of life as an immigrant mother. Data were analyzed using a modified grounded theory approach. Results: We identified four themes that indicate how maternal stressors could impact children's health: (1) work-family tradeoff, (2) limited freedom/mobility, (3) reduction of social networks, and (4) transmission of anxiety and fears to children. Women in our study also engage in a range of coping mechanisms, including the creation of new social networks, seeking support in religion, and seeking help from community resources. Conclusion: These results highlight the importance of developing new questionnaires to elicit stress exposures for Mexican immigrant mothers. Findings also suggest the value of intervention strategies and social policies that would ultimately improve maternal and child health in this marginalized population. [ABSTRACT FROM AUTHOR]

Objectives: Social stigma is commonly experienced by parents of children with autism. Our aim was to understand the nature of stigma experienced by Somali parents of children with autism in the United Kingdom (UK), and to consider how they coped with or resisted such stigma. Design: We used a community-based participatory research approach, collaborating with a community organisation of Somali parents. In-depth interviews with simultaneous translation were conducted with 15 Somali parents of children with autism living in Bristol, UK, in 2015. Parents were sampled purposively to capture diversity in children’s age, severity of autism and time since diagnosis. Directed thematic analysis used Link and Phelan’s model of stigma. Results: Of the 15 participants, 12 were mothers (mean age 36). The 17 children with autism they cared for were 4-13 years’ old, and five were girls. Two main themes with sub-themes were identified: the nature of stigma (labelling and stereotyping; separation; emotional reactions, discrimination and power), and coping and resistance (the power of language; faith as a resource; learning, peer support and community relationships). Children with autism were labelled and stereotyped (e.g. as ‘sick’, ‘naughty’, ‘different’) and parents blamed for not controlling them, leading to social rejection and isolation. Stigma was associated with a poor understanding of autism, a lack of vocabulary related to autism in the Somali community, and prejudice against mental illness and disability. There was evidence of enacted and felt stigma and examples of discrimination. Finding their own language to describe their child’s condition and drawing on faith, learning and peer support were important resources in resisting stigma. Conclusions: Findings inform support for this community, highlighting the need to raise awareness of autism, enable parents to speak openly, and ensure appropriate professional services and interventions are available. [ABSTRACT FROM AUTHOR]

Objective: To explore anti-diabetic medication taking behaviour in Nepalese patients with type 2 diabetes and investigate the factors impacting medication taking in this population. Design: Face-to-face interviews (n = 48) were conducted with Nepalese patients with type 2 diabetes in Sydney (Australia) and Kathmandu (Nepal). All interviews were audio-recorded, transcribed verbatim and thematically analysed. Participants’ medication adherence was also assessed quantitatively using the summary of diabetes self-care activity (SDSCA) questionnaire. Results: The medication taking behaviour of Nepalese participants aligned with the Stages of Change Model, with some notable patterns of behaviour. Most participants initiated and implemented anti-diabetic medications soon after obtaining their prescription. However, a few, delayed initiation and/or ceased medications after initiation to recommence later. Nonetheless, upon recommencement, participants persisted fairly well with their medications. The self-reported medication adherence was high (97.3%). Although some participants expressed adherence as a challenge at the start of therapy, medication taking on a day-to-day basis was not reported as difficult. Factors such as participants’ reluctance towards using medications and preference for natural methods of treatment, together with inadequate understanding about diabetes and treatment resulted in the delay in initiating therapy, and contributed to cessation of therapy. On the other hand, ooccasional non-adherence in daily medication taking was mostly related to inconsistency in meal practices and forgetfulness. Encouragement from doctors and increased awareness about the disease and treatment facilitated medication adherence, including initiation of therapy. Conclusion: This study demonstrates that Nepalese patients are likely to delay or cease anti-diabetic medications until they fully accept and acknowledge the benefits and necessity of medications for effective diabetes management. Thus, educating patients about the need for medications, as well as implementing strategies to address patients’ psychological resistance towards medications will be essential for effective medication management. [ABSTRACT FROM AUTHOR]

Objective: To understand the perspectives of healthcare professionals and interpreters in relation to working with and caring for non-English speaking families accessing National Health Service paediatric tertiary health care services. Design: Focus group and interview methods were used to elicit the views of healthcare professionals and interpreters at one tertiary paediatric hospital in the United Kingdom. Data were subjected to framework analysis. Results: Participants identified a number of factors affecting communication and their interaction with non-English speaking families in this setting, including time, role uncertainty, and interlinked dimensions of culture and gender. They also described how the nature of this communication could impact on both the delivery of care and the patient and family experience. These findings highlight gaps in services, training, and support for families, staff and interpreters. These need to be recognised and addressed by those in practice to improve care delivery and help tackle health inequalities. Conclusion: Our data show how significant the impact of language barriers can be, and the need to consider not only how communication can be improved, but also how this is situated in the specific context of tertiary paediatric care as well as a wider social context of inequity. [ABSTRACT FROM AUTHOR]

Objectives: Within their local realities, people experience and interpret disease in diverse ways that do not necessarily correlate or converge with Western biomedical interventions. In the high cervical cancer burden setting of Papua New Guinea, understanding how people experience and interpret cervical cancer is necessary for effective intervention. Drawing on work by Street on the production of unstable biomedical knowledge, we explored how ambiguity and uncertainty, coupled with cultural taboos and linguistic limitations, affect what and how people ‘know’ about women’s reproductive organs and their associated disease. Design: A qualitative research approach was used to explore and understand how people in PNG articulate matters of health and disease as they relate to cervical cancer and HPV infection. Specifically, how unstable biomedical knowledge is produced and sustained. We employed a mixed-methods approach in collecting data from 208 (147 women) participants between 2011 and 2012 across 3 provinces in PNG. Results: We found that knowledge and awareness about cervical cancer were poor. Five thematic areas emerged in our analysis, which included the gendered knowledge of women’s reproductive health, the burden of cervical cancer in the community and the role (or limitation) of language. We further identified four ways in which ambiguity and uncertainty operate on both sociocultural and biological levels, and in the intersection between to produce unstable biomedical knowledge. These included poor knowledge of where the cervix is located and the uncertainty or unreliability of (lay) diagnoses of disease. Conclusion: Local understandings of cervical cancer reflected the limitations of Tok Pisin as a lingua franca as well as the wider uncertain biomedical environment where diagnoses are assembled and shared. There is a clear need to improve understanding of the female reproductive organs in order that people, women in particular, can be better informed about cervical cancer and ultimately better receptive to intervention strategies. [ABSTRACT FROM AUTHOR]

Objectives:To explore whether gaps exist between caretakers from different ethno-cultural groups (Israeli-born Jews [Sabras], Israeli Arabs [Arabs], and migrants from Russia [Russians]) regarding their perceptions of autonomy and human dignity of patients with dementia. Design:A mixed-methods research scheme was used, comprised of qualitative and quantitative methods, utilizing semi-structured interviews and self-reported questionnaires. Twenty formal caretakers participated in the qualitative portion, and approximately 200 caretakers were included in the quantitative portion. All participants were recruited from three nursing homes and one hospital in the Galilee region (Israel). Results:The qualitative portion of the study yielded eight themes encapsulated in the concept of autonomy and ten themes entailed within human dignity, in the context of care for patients with dementia. By utilizing these themes in the quantitative portion, substantial differences in nursing homes were found in the attitudes to autonomy and dignity of patients with dementia between Russian and Arab as well as Sabra caretakers (index score for autonomy: 2.97, 4.07, and 4, respectively; index score for dignity: 3.17, 4.1, and 4.07). A multi-variable regression, focusing on caretakers from nursing homes, showed the most significant influencing variables on the indexes of autonomy and dignity were ethno-culture Arab/Russian (0.84, 0.62) and the patient’s family (0.29, 0.30). Regarding the autonomy index, being a female caretaker also had a significant influence (0.24). In the hospital, no influence emerged for the ethno-culture variables, and neither type of institution showed any influence of religion or religiousness as well as societal or community norms. Conclusions:Contrary to past research, in nursing homes, significant differences were found between certain ethno-cultural groups (Arabs and Russians) regarding their stance toward the dignity and autonomy of patients with dementia. Arab caretakers’ fostering of more encompassing conceptions of dignity and autonomy, irrespective of institutional setting, provides better grounds for person-centered care. [ABSTRACT FROM PUBLISHER]

Objective: Australian Indigenous children experience some of the most substantial health inequalities globally. In this context, research regarding their health and well-being has overemphasised physical illnesses with limited exploration of a diverse range of dimensions and determinants, particularly those based on Indigenous holistic understandings of health and well-being. This deficit-based approach has thus missed many strengths and assets of Indigenous children. This research aimed to gain insight into the perspectives of Indigenous children about their health and wellbeing in an urban setting in Australia. It joins a limited international literature examining views and experiences of non-majority children. Design: Participatory and qualitative child-friendly research methods were utilised. The project was developed in partnership with Indigenous community organisations and members. Photoelicitation activities and focus groups were conducted with 31 Indigenous children aged 8-12 years. Qualitative data were analysed thematically, combining focus group and interview data. Results: It was evident an urban Indigenous child perspective of health and well-being includes rich understandings of the interconnectedness of physical, social-emotional and cultural dimensions of holism, as well as the integral importance of family and community relationships. The study also found that specific worries regarding loss of loved ones and racism were highly salient in Indigenous children's lives. Conclusion: The overwhelming conclusion to be drawn from this research is that Indigenous children in urban areas need ongoing recognition of both their agency and resilience in the face of adversity, within a wider context of historical and contemporary racialisation and racism. [ABSTRACT FROM AUTHOR]

Objectives: Latina women are disproportionately affected by HIV in the US, and account for 30% of all HIV infections in Miami-Dade County, Florida. The main risk for Latina women is heterosexual contact. Little is known about the relational and cultural factors that may impact women’s HIV risk perception. This study aims to describe Latina women’s perception of their HIV risk within a relational, cultural, and linguistic context.Design: Eight focus groups of Latina women (n = 28), four English speaking groups and four Spanish speaking groups, were conducted between December 2013 and May 2014. Women were recruited from a diversion program for criminal justice clients and by word of mouth. Eligibility criteria included the following: self-identify as Hispanic/Latino, 18–49 years of age, and self-identify as heterosexual. A two-level open coding analytic approach was conducted to identify themes across groups.Results: Most participants were foreign-born (61%) and represented the following countries: Cuba (47%), Honduras (17.5%), Mexico (12%), as well as Nicaragua, Puerto Rico, Colombia, and Venezuela (15%). Participant ages ranged between 18 and 49, with a mean age of 32 years. Relationship factors were important in perceiving HIV risk including male infidelity, women’s trust in their male partners, relationship type, and getting caught up in the heat of the moment. For women in the English speaking groups, drug use and trading sex for drugs were also reasons cited for putting them at risk for HIV. English speaking women also reported that women should take more responsibility regarding condom use.Conclusion: Findings emphasize the importance of taking relational and cultural context into account when developing HIV prevention programs for Latina women. Interventions targeting English speaking Latina women should focus on women being more proactive in their sexual health; interventions focused on Spanish speaking women might target their prevention messages to either men or couples. [ABSTRACT FROM PUBLISHER]

Objective. We sought to document pathways between under/unemployment and health among racialized immigrant women in Toronto while exploring the ways in which gender, class, migration and racialization, as interlocking systems of social relations, structure these relationships. Design. We conducted 30 interviews with racialized immigrant women who were struggling to get stable employment that matched their education and/or experience. Participants were recruited through flyers, partner agencies and peer researcher networks. Most interviews (21) were conducted in a language other than English. Interviews were transcribed, translated as appropriate and analyzed using NVivo software. The project followed a community-based participatory action research model. Results. Under/unemployment negatively impacted the physical and mental health of participants and their families. It did so directly, for example through social isolation, as well as indirectly through representation in poor quality jobs. Under/unemployment additionally led to the intensification of job search strategies and of the household/caregiving workload which also negatively impacted health. Health problems, in turn, contributed to pushing participants into long-term substandard employment trajectories. Participants’ experiences were heavily structured by their social location as low income racialized immigrant women. Conclusions. Our study provides needed qualitative evidence on the gendered and racialized dimensions of under/unemployment, and adverse health impacts resulting from this. Drawing on intersectional analysis, we unpack the role that social location plays in creating highly uneven patterns of under/unemployment and negative health pathways for racialized immigrant women. We discuss equity informed strategies to help racialized immigrant women overcome barriers to stable work that match their education and/or experience. [ABSTRACT FROM PUBLISHER]

Objective.To explore lay understandings of sickle cell disease (SCD) among Jamaicans living with the illness. There is no qualitative research on this subject in Jamaica, where SCD is the most common genetic disorder. Design.Thirty in-depth semi-structured interviews (50% males, 50% urban residence) were conducted with adult patients attending the Sickle Cell Unit in Jamaica. Transcribed data were analysed using thematic analysis. Results.Patients' narratives focused on two main themes: lay understandings of how SCD works (using ideas of attack and fortification, and blockage and flow); and what causes the illness (lay ideas of inheritance). The most common description of SCD was that their white blood cells were ‘eating/sucking out/feeding on’ their red blood cells. Hence, treatment required ‘building up’ their blood, while a key to good health was ensuring an unimpeded flow of blood. Most participants believed SCD was hereditary, but there were various understandings of the mechanism and probability of its transmission. Belief in the possibility of transmitting SCD was not always a barrier to reproduction, nor did participants always insist on their partner or child being tested. Conclusions.Participants engaged in medical pluralism, a dynamic combination of folk and biomedical beliefs. Their concerns, experiences and interpretations were powerful motivators of reproductive and screening behaviour. Their narratives of SCD transcend the individual to express social, societal and cultural realities. Health care professionals and policy-makers should communicate clearly to ensure understanding, and recognize and engage with their patients’ sociocultural context. [ABSTRACT FROM PUBLISHER]

Objectives.The participation rate in the Danish National Health Survey (DNHS) 2010 was significantly lower among ethnic minorities than ethnic Danes. The purpose was to characterize nonresponse among ethnic minorities in DNHS, analyze variations in item nonresponse, and investigate barriers and incentives to participation. Design.This was a mixed-method study. Logistic regression was used to analyze nonresponse using data from DNHS (N= 177,639 and chi-square tests in item nonresponse analyses. We explored barriers and incentives regarding participation through focus groups and cognitive interviews. Informants included immigrants and their descendants of both sexes, with and without higher education. Results.The highest nonresponse rate was for non-Western descendants (80.0%) and immigrants 25 (72.3%) with basic education. Immigrants and descendants had higher odds ratios (OR = 3.07 and OR = 3.35, respectively) for nonresponse than ethnic Danes when adjusted for sex, age, marital status, and education. Non-Western immigrants had higher item nonresponse in several question categories. Barriers to non-participation related to the content, language, format, and layout of both the questionnaire and the cover letter. The sender and setting in which to receive the questionnaire also influenced answering incentives. We observed differences in barriers and incentives between immigrants and descendants. Conclusions.Nonresponse appears related to linguistic and/or educational limitations, to alienation generated by the questions' focus on disease and cultural assumptions, or mistrust regarding anonymity. Ethnic minorities seem particularly affected by such barriers. To increase survey participation, questions could be sensitized to reflect multicultural traditions, and the impact of sender and setting considered. [ABSTRACT FROM PUBLISHER]

Objectives.Provision for ethnic minority groups has been acknowledged as integral to good maternity care in England and ethnicity has been highlighted as an indicator of both poorer clinical outcomes and poorer experiences. Improving outcomes and services is dependent on understanding women's interaction with both service delivery and provision. The aim of this study was to explore Black and minority ethnic (BME) women's experiences of contemporary maternity care in England. Design.A UK-wide survey which investigated core aspects of maternity care sought the views of BME women about their experiences. A random sample of women were selected by the Office for National Statistics from birth registration in England and invited to complete a questionnaire three months after the birth. In a secondary analysis, text responses to open-ended questions about their maternity care were analysed using thematic analysis. Results.Sixty per cent of the 368 women who self-identified as BME responded with open text. Themes that emerged related to ‘feeling cared for,’ with subthemes of ‘expectations of care’ and ‘policies, rules and organisational pressures’; ‘staff attitudes and communication’ with sub-themes of ‘please believe me,’ ‘hospital as a safe place,’ ‘choices denied’ and ‘being sensitive and supportive would help,’ and ‘ethnicity and culture’ with sub-themes of ‘stereotyping’ and ‘improving the quality of care.’ Conclusion.The findings highlight issues affecting the quality of maternity care that BME women in England receive. Many issues are not unique to BME women; however, the findings reflect some seemingly enduring issues and coherence with other wider international findings, particularly in relation to post-natal care and staff attitudes. Actually being cared for and supported across their child-bearing experience are needs that women themselves identified as critical for care providers to recognise and respond to. The failures of care provision described should inform the development of services. [ABSTRACT FROM PUBLISHER]

Objectives. To explore early experiences of sickle cell disorder (SCD) in families with a young affected child, and the way these experiences influence relations within families. To consider ways in which stigma could be counteracted in health and research programmes in sub Saharan Africa. Design. A qualitative study was conducted in a rural area of coastal Kenya including in-depth interviews with 13 families affected by SCD and 12 staff of a local biomedical research progamme. Purposive selection aimed to maximize diversity in socioeconomic and educational status, religion, severity of illness burden and religion amongst families and draw on relevant experience for staffs. Interviews were recorded, transcribed and analysed using the constant comparative method for family interviews and a thematic framework approach for staff data. Results. Low initial recognition of SCD and its cause were associated with lay practices of surveillance within affected families, contributing to stigmatisation that occurred independently of genetic knowledge. Blame was often placed on mothers, including a risk of blame for misaligned paternity. Mothers are often particularly affected by SCD through the loss of independent livelihoods and their limited options in coping with this chronic condition. Conclusions. Mothers of children with SCD were particularly vulnerable to stigmatisation within families, with underlying structural influences that suggest these findings may apply to other similar settings in Africa, and have relevance for other genetic conditions. The potential, nature and form of stigmatisation point to the role of effective communication and SCD management in addressing for blame and discriminative effects of having a child with SCD. The findings highlight the importance of broader social programmes targeting underlying gender and economic inequalities. [ABSTRACT FROM AUTHOR]