Search

Background Diabetes type 2 is more prevalent in people from ethnic minorities in the Netherlands, and outcomes of care are worse compared with other Dutch people. Dieticians experience difficulties in managing these groups in self-management and adherence to dietary advice. The aim of this study was to explore the views regarding a healthy diet and dietetic care among ethnic minority type 2 diabetes patients. Methods Semi-structured interviews were held with 12 migrants with diabetes from Turkey, Morocco, Iraq and Curacao, who visited a dietician. Inclusion went on until saturation was reached. The interview guide was based on the Attitudes, Social influence and self-Efficacy (ASE) model and Kleinman's explanatory model of illness. Interviews were held in the language preferred by the respondent. Transcripts were coded and thematically analyzed. Results Several respondents expected a more rigorous, directive and technical approach of the dietician. All respondents acknowledged the importance of a healthy diet. What they considered healthy was determined by culturally influenced ideas about health benefits of specific foods. Important hindrances for dietary change were lack of self-efficacy and social support. Social influences were experienced both as supportive and a hindrance. Conclusions Migrant diabetic patients' opinions about healthy food are determined by culturally influenced ideas rather than by dietary guidelines. Dutch dietary care is not tailored to the needs of these patients and should take into account migrants' expectations, cultural differences in dietary habits and specifically address the role of family. [ABSTRACT FROM AUTHOR]

Background: Research has shown that ethnic minority groups are less likely to participate in colorectal cancer (CRC) screening than the majority population and hence less likely to be diagnosed at an early stage when treatment is potentially more successful. Objective: To explore knowledge, attitudes and beliefs regarding CRC and CRC screening among ethnic minority groups in the Netherlands. Design: We conducted qualitative interviews with 30 first‐generation immigrants born in Turkey, Morocco and Surinam. We based the topic guide on the health belief model. Framework analysis was used to analyse our data. Results: Although knowledge of CRC and CRC screening was limited, all respondents felt susceptible to CRC. CRC screening was perceived to mainly benefit those individuals with poor health and symptoms. Although most respondents had a positive attitude towards CRC screening, knowledge about its potential harms was limited and self‐efficacy to participate was low. Adult children acted as important mediators in providing access to information. The language barrier and low literacy formed serious barriers to informed participation in CRC screening. Conclusion: To ensure that all eligible individuals, including ethnic minority groups, have equal opportunities to informed participation in screening, targeted communication strategies should be developed, such as oral and visual channels, and face‐to‐face communication in the mother tongue. This will help ethnic minority groups to make an informed decision about participation in CRC screening. [ABSTRACT FROM AUTHOR]

Background: Problematic interethnic relationships, expressed by feelings of discrimination, may contribute to ethnic variations in health and health care utilization. The impact of daily perceived discrimination on (mental) health has been shown. Less is known about the effect of everyday discrimination on the health care utilization. We examined the relationship between perceived discrimination of Turkish and Moroccan patients on GP health care utilization in the Netherlands and on health services use in the home country. Methods: Cohort study within the second Dutch National Survey of General Practice (2001). Interviews were conducted with 416 Turkish and 381 Moroccan respondents, and repeated in 2005 among respectively 118 and 102 participants. Linear, logistic and zero-inflated binomial regression models were used for the analyses. Results: Perceived discrimination was associated with non-attendance to the GP. Perceived quality of GP care was not a mediator in this relationship. No evidence was found for substitution of health care utilization in the home country to health care in the host country. GP attenders had higher odds of using health care in the home country than non-attenders. Over time, a lasting discrimination feeling was related to persistent non-attendance at the GP practice. Conclusion: Ethnic minority patients who feel discriminated may avoid GP health care. Further research is warranted on magnitude and health effects of such potential underutilization. Information on perceived discrimination within health care settings would increase insight into the profile of non-attenders, and on possible measures to better target interventions at a group at risk of underutilization. [ABSTRACT FROM AUTHOR]

Background: Dutch residents of Turkish origin frequently utilize healthcare in Turkey., Methods: To investigate their motives for doing so, we conducted a qualitative study among these healthcare users using semi-structured interviews. We complemented this with informal conversations with Turkish healthcare providers and observations at the registration offices and waiting rooms of outpatient clinics in several Turkish hospitals., Results: Respondents believed their perceived needs for referral to specialist care and diagnostic assessments to quantify their health were not being met in the Netherlands., Conclusions: These mismatches in expectations of what constitutes "good care" led to dissatisfaction with Dutch primary care. Consequently, respondents utilized healthcare in Turkey if the opportunity arose, and were encouraged in this by their social networks. Establishing cross-border communication between healthcare providers is necessary, because there is currently no continuity of care for cross-border patients.

Background: Studies from the USA, New Zealand and Denmark suggest that many ethnic minority citizens obtain healthcare in their country of origin. Their reasons for doing so and the possible consequences remain unclear., Methods: We used data from the Healthy Life in an Urban Setting study to investigate the magnitude, types, self-reported reasons and determinants of past-year healthcare consumption in the country of origin by ethnic minority people living in the Netherlands. Individuals of African Surinamese (n = 2059), South-Asian Surinamese (n = 1915), Ghanaian (n = 1426), Moroccan (n = 1516) and Turkish (n = 2245) origin were included (recruited 2011-2013). We performed descriptive and stepwise logistic regression analyses., Results: Respondents of Turkish origin reported the highest healthcare utilization in the country of origin (21.3%) compared with Moroccan (9.8%), Ghanaian (6.6%), African Surinamese (4.8%) and South-Asian Surinamese (3.0%) respondents. The main services used were outpatient clinics, pharmacies and health centres. The chief reported motivations were healthcare for illness, dissatisfaction with care in the residence country and seeking second opinions. Physical health status, cultural distance to the Dutch healthcare system and Turkish origin were all independently associated with healthcare use in countries of origin., Conclusion: Both health status and attitudes towards services in the countries of residence and origin are significantly associated with cross-border healthcare use. Further research is needed to clarify the reasons for the relatively high rates shown by Turkish respondents and to explore the consequences for health and for healthcare utilization in the country of residence., (© The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objective: To examine the ethnic differences in the uptake of professional maternity care assistance (MCA) in the Netherlands, and the factors that may explain these differences. Additionally the effect of MCA on health risk behaviour around infants is examined., Design: Questionnaire survey., Method: Questionnaire data from 3967 mothers from the ABCD study (Amsterdam Born Children and their Development) included during pregnancy in 2003-2004, were used. We examined the explanatory role of ethnicity, age, socioeconomic status, mastery of the Dutch language, parity, housing situation and place of giving birth on MCA uptake, and the effect of MCA uptake on health risk behaviour around infants, such as smoking indoors, infant sleep behaviour, infant nutrition, and response to infant crying., Results: Mothers of non-Western origin less often used MCA than Dutch mothers (Ghanaian: 70%; Turkish: 75%; Moroccan: 79%; Surinamese: 81%; Dutch Caribbean: 85% vs. Dutch: 95%). Higher educational level, better mastery of the Dutch language, having a paid job and home delivery were all independently associated with the uptake of MCA, and also partially explained ethnic differences in the uptake of MCA. Mothers who received MCA more often breastfed, more often gave vitamin K when not breastfeeding, and more often lived in smoke-free homes. The protective effect of MCA was stronger for non-Western mothers than for Dutch mothers., Conclusion: Mothers of non-Western origin make less use of professional MCA. Given that the use of MCA is associated with a less risk behaviour around infants, efforts should be made to improve the accessibility of professional MCA for mothers of non-Western origin.

Background: The aim of this study was to assess ethnic variations in informed decision-making about prenatal screening for Down's syndrome and to examine the contribution of background and decision-making variables., Methods: Pregnant women of Dutch, Turkish and Surinamese origin were recruited between 2006 and 2008 from community midwifery or obstetrical practices in The Netherlands. Each woman was personally interviewed 3 weeks (mean) after booking for prenatal care. Knowledge, attitude and participation in prenatal screening were assessed following the 'Multidimensional Measure of Informed Choice' that has been developed and applied in the UK., Results: In total, 71% of the Dutch women were classified as informed decision-makers, compared with 5% of the Turkish and 26% of the Surinamese women. Differences between Surinamese and Dutch women could largely be attributed to differences in educational level and age. Differences between Dutch and Turkish women could mainly be attributed to differences in language skills and gender emancipation., Conclusion: Women from ethnic minority groups less often made an informed decision whether or not to participate in prenatal screening. Interventions to decrease these ethnic differences should first of all be aimed at overcoming language barriers and increasing comprehension among women with a low education level. To further develop diversity-sensitive strategies for counselling, it should be investigated how women from different ethnic backgrounds value informed decision-making in prenatal screening, what decision-relevant knowledge they need and what they take into account when considering participation in prenatal screening.

Objective: To evaluate ethnic differences in considerations whether or not to participate in prenatal screening for Down syndrome and to relate these to differences in participation., Method: The study population consisted of 270 pregnant women from Dutch, Turkish and Surinamese (African and South Asian) ethnic origin, attending midwifery or obstetrical practices in the Netherlands. Women were interviewed after booking for prenatal care. Considerations were assessed by one open-ended question and 18 statements that were derived from focus group interviews. Actual participation was assessed several months later., Results: Women from ethnic minorities were less likely to participate in prenatal screening, which could be attributed to differences in age and religious identity. They more often reported acceptance of 'what God gives', low risk of having a child with Down syndrome and costs of screening as considerations not to participate in prenatal screening. They also reported many considerations in favour of participation, which did not differ from those of Dutch women but were less often consistent with actual participation in screening., Conclusions: Women from ethnic minorities should not be stereotyped as being uninterested in prenatal screening, but should be better informed about the consequences of prenatal screening and Down syndrome., (Copyright (c) 2009 John Wiley & Sons, Ltd.)

Objective: To evaluate the provision of information about prenatal screening for Down syndrome to women of Dutch, Turkish and Surinamese origins, and to examine the effects of this provision on ethnic differences in knowledge about Down syndrome and prenatal screening., Methods: The study population consisted of 105 Dutch, 100 Turkish and 65 Surinamese pregnant women attending midwifery or obstetrical practices in The Netherlands. Each woman was personally interviewed for 3 weeks (mean) after booking for prenatal care., Results: Most women reported to have received oral and/or written information about prenatal screening by their midwife or obstetrician at booking for prenatal care. Turkish and Surinamese women less often read the information than Dutch women, more often reported difficulties in understanding the information, and had less knowledge about Down syndrome, prenatal screening and amniocentesis. Language skills and educational level contributed most to the explanation of these ethnic variations., Conclusion: Although most Dutch, Turkish and Surinamese women reported to have received information from their midwife or obstetrician, ethnic differences in knowledge about Down syndrome and prenatal screening are substantial., Practice Implications: Interventions to improve the provision of information to women from ethnic minority groups should especially be aimed at overcoming language barriers, and targeting information to the women's abilities to comprehend the information about prenatal screening for Down syndrome.