South Asian women,psychological distress and self-harm: lessons for primary care trusts

The present paper reports an investigation of the self-reported needs of South Asian women suffering distress and mental health problems which may lead to self-harm and suicide, and uses the data to define indicators of good practice for primary care. The design was a qualitative study using focus group discussion. Four focus groups of South Asian women (using existing women's groups in Manchester, UK) formed the setting for this study. Each focus group was facilitated by one of the authors, and the discussions occurred in Urdu, English and Punjabi. An interview guide was used, although the direction of the discussions followed the women's agenda. Notes were taken during the focus group discussions. Analysis of notes to define themes and emergence of framework was carried out. The data were analysed according to the principles of framework analysis. A range of systemic issues were described by respondents including: social, political and economic pressures; domestic violence; poverty; language problems; family and children's issues; and health. These experiences were reinforced by an extremely efficient community grapevine and were evident in described experiences such as: racism and stereotyping of Asian women; Asian communities and Islam; and the concept of izzat (honour) in Asian family life, which was seen as a major influence in the lives of Asian women. These experiences were thought to result in mental distress, which was described in a variety of ways by the women. The women saw self-harm as a usable coping strategy to deal with their distress. Perceived barriers to services were described by the women. Services tended to be accessed only at a point of desperation, rather than prior to crisis points. This indicated the need for services to be able to respond rapidly when Asian women did ask for help. Whilst the present paper describes a local study, thus limiting its generalisability, the use of such work in commissioning local health and social services is outlined. A number of indicators for good practice were drawn up in relation to addressing systemic issues in service provision using these findings. Such indicators will be of use by primary care trusts in developing, commissioning and monitoring services for this patient group.     

Comparison of Cardiac Risk Scores among the East Mediterranean and South Asian Population

BackgroundCardiovascular disease (CVD) is a global burden particularly in developing countries necessitates the periodical monitoring for these vulnerable population. This study aimed to compare four tools to measure the CVD risk between the East Mediterranean and South Asian population.MethodsThis retrospective analysis included 139 patients from East Mediterranean (n=90) and South Asians (n=49) ethnicity who were admitted during the one-year period in a multi-specialty tertiary care hospital located in Tabuk, Saudi Arabia. Four different tools currently in use across the world were used to analyses the CVD risk.ResultsAtherosclerotic Cardiovascular Disease (ASCVD) from American College of Cardiology/American Heart Association (ACC/AHA) was found to be significant (P=0.0000) than World Health Organization/International Society of Hypertension (WHO/ISH) and Framingham Risk Score (FRS) European SCORE (Systematic Coronary Risk Evaluation) memo card from European Society of Cardiology risk prediction charts. Meanwhile, FRS looks equally good as it detects 44.89% of South Asian study population with >10% CVD risk while ACC/AHA detects 46.93%.ConclusionThe present study recommends ACC/AHA cardiac risk estimator to identify the CVD risk in East Mediterranean population. However, the South Asian population needed a population-based tool to assess the accurate CVD risk.     

Healthy changes? Observations on a decade of dietary change in a sample of Glaswegian South Asian migrant women

Dietary intake amongst South Asian people (i.e. those from the Indian sub-continent including Pakistan and Bangladesh) living in the UK is of particular interest because of the high rates of coronary heart disease in this ethnic minority. However, few studies have described in detail the social context within which food is consumed in this group and the nutritional composition of that food. In this study the BMIs, food habits and nutrient intake of a group of South Asian women were examined prospectively, using the 7 day weighed food record method and compared with data collected 10 years previously in the same women. Results showed that changes in food selection and nutrient intake were consistent with current dietary recommendations for health.     

Contextualising experiences of depression in women from South Asian communities: a discursive approach

The aim of this paper is to present an interpretation of the accounts of depression provided by women from South Asian communities. The paper presents the findings from a qualitative study, conducted in the UK, which explored women from South Asian communities and their experiences of depression. It is argued here, through examples of women's accounts of their experiences, that depression is 'embodied', that is, grounded in the materiality of the body which is also immersed in subjective experiences and in the social context of women's lives. Qualitative data were collected from four focus groups and ten individual interviews with women. The analysis involved a discursive approach. Analysis revealed how women made strategic choices in how they presented their symptoms as legitimate and for gaining access to what they perceived to be appropriate healthcare. This is not to argue that this is a culturally specific phenomenon but one which is a feature of all healthcare negotiations.     

慢性职业中毒患者心理需要问卷的编制与信效度检验

目的 编制信效度较好的慢性职业病患者心理需要测评问卷,为慢性职业中毒患者心理需要的满足程度评估和实施心理治疗及心理护理提供依据。方法 本文对100例研究对象依据马斯洛需要理论,编制慢性职业中毒患者心理需要测评问卷的45个条目,分别按年龄、性别、总体及各子维度进行测量内在一致性信度的系数,并对该问卷量表的单个条目和总量表内容效度指数值进行评估。结果 通过对100例慢性职业中毒患者的45个条目心理需要测评问卷进行信效度系数测量,结果表明,按年龄、性别、总体案例分别测定该问卷量表的总体及各子维度内在一致性信度的系数值均在0.75以上,该问卷量表的单个条目内容效度系数(I-CVI)均在0.78及以上,总量表内容效度指数(S-CVI)为0.934。结论 本文编制的慢性职业中毒患者心理需要测评问卷具有较好的信效度,可为慢性职业中毒患者心理需要及心理治疗满足程度评估提供依据。     

Reproducibility and validity of an interviewer-administered semi-quantitative food frequency questionnaire to assess dietary intake of urban adults in southern India

We report on the reproducibility and validity of a food frequency questionnaire (FFQ) developed for southern India. One hundred and two adult subjects aged ≥20 years drawn from the Chennai Urban Rural Epidemiology Study participated. The FFQ was developed based on local foods and habits, and was administered three times at 0, 6 and 12 month periods (called FFQ1, FFQ2 and FFQ3) to assess the reproducibility. To test the validity of the FFQ, multiple 24-h recalls collected at 2-monthly intervals for a period of 1 year and the estimated energy intake/basal metabolic rate (EI/BMR) ratio were used. The ‘EpiNu’ in-house food and nutrient database was used to compile dietary intakes, which were analyzed for statistical analysis. The intraclass correlation coefficient for all three FFQs ranged from 0.72 for carbohydrates to 0.45 for folate. The de-attenuated Pearson correlation for the energy adjusted nutrients between FFQ3 and 24-h recalls ranged from 0.73 for carbohydrates to 0.35 for calcium. Bland and Altman plots for energy intake between the two methods showed the limits of agreement ranged from 768 to ?1358 calories/day (±2 standard deviations). Misclassification was low for most of the nutrients. Under-reporting of the energy intake (EI/BMR ratio<1.2) was higher in females than males. This FFQ appears to be a robust tool to measure dietary intakes in southern India.     

Determining aspects of ethnicity amongst persons of South Asian origin: the use of a surname-classification programme (Nam Pehchan)

OBJECTIVE: Name-based classification systems are potentially useful in identifying study samples based on probable ethnic minority group. The aim of the current study was to assess the validity of the Nam Pehchan name classification programme of religion and language against subject self-report. STUDY DESIGN AND SETTING: A population-based cross-sectional survey conducted in areas of the North-West and West Midland regions of England with a relatively high density of South Asian ethnic minority groups. The sampling frame was age-sex registers of selected general practices and subjects were classified according to language and religion using the Nam Pehchan programme. These were compared with responses by subjects on a self-complete postal questionnaire. RESULTS: One thousand nine hundred and forty-nine subjects who participated, classified themselves as South Asian. Sensitivity in identifying religion was high amongst Muslims (92%) and Sikhs (86%), and somewhat lower in Hindus (62%). Specificity exceeded 95% for all ethnic groups. The vast majority of subjects assigned Punjabi or Gujarati as their main South Asian language indicated that they did in fact speak these languages (97% and 94%, respectively). Subjects assigned Urdu or Bengali, however, were less likely to do so (61% and 35%, respectively). CONCLUSIONS: The name-based classification system Nam Pehchan has demonstrated high levels of accuracy in some sub-groups of the South Asian population in determining subjects likely language spoken and religion-and is likely to be a useful additional tool when information on ethnicity is not already available.     

Reliability and relative validity of a quantitative food-frequency questionnaire for use among adults in Italian population

Our objective was to assess the reliability and relative validity of a food frequency questionnaire (FFQ) among adult people. In a cross-sectional study carried out in northern Italy, 112 adults were recruited. A total of 189 food and drink items were selected according to those typically consumed by Italians. FFQ reliability was assessed by two repeated administrations at 6 weeks. The FFQ was validated using four 24-h recalls repeated in the same period of time. For the validation study, classification into quartiles from the two methods and Bland–Altman plot were also performed. The reliability study showed a good correlation between the two methods. Bland–Altman plots showed that the two methods are very likely to agree for individual energy and macronutrient intakes. The reliability and relative validity of this FFQ was good, supporting its use in assessing dietary intakes of Italians in nutritional surveillance programs and in epidemiological dietary surveys.     

Development of a childhood obesity prevention programme with a focus on UK South Asian communities

Objective

We report the development of a childhood obesity prevention intervention for UK South Asian primary school-aged children, guided by the UK Medical Research Council (MRC) framework for complex intervention development and evaluation.

Methods

We combined information gained from a literature review, stakeholder focus groups, an expert group, review of local resources and mapping to the Analysis Grid for Environments Linked to Obesity (ANGELO framework) in an intervention development process. The study took place in 2007 in Birmingham, UK.

Results

Contextual information from the stakeholder focus groups was essential for informing intervention development. The expert group defined guiding principles for the intervention. Informing intervention design by assessing existing local resources addressed intervention sustainability. The use of the ANGELO framework ensured a comprehensive environmental approach to intervention development. The intervention consisted of two broad processes; increasing children's physical activity levels through school, and increasing skills of families through activity-based learning. The developed intervention is being evaluated in a major study.

Conclusions

The intervention development process has resulted in a tailored intervention programme to prevent childhood obesity in UK South Asian communities, but also intervention processes that could be applied to other communities and tailored to local context.     

Validation of an asthma questionnaire for use in healthcare workers

Background

Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group.

Aims

To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers.

Methods

An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk‐through surveys and review of material safety data sheets. A cross‐sectional validation study was conducted in 118 non‐smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens.

Results

The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test–retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach''s α ⩾ 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self‐reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals.

Conclusions

Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross‐validation in a larger healthcare worker population is in progress. The need for development of more reliable occupational exposure assessment methods that go beyond self‐report is underscored.     

Beliefs related to breast health practices: the perceptions of South Asian women living in Canada

Breast cancer is becoming a major concern for many South Asian women. Clinical observations of women from a South Asian community living in Canada revealed an under use of early detection strategies. The purpose of this qualitative ethnoscience study was to examine breast health practices from the perspective of South Asian women to provide a foundation for the development of culturally suitable breast health services for this group. Open-ended interviews were conducted with a convenience sample of 50 South Asian women over the age of 30 who had not been diagnosed with breast cancer. Adequate representation of the main religious groups (i.e. Sikh, Hindu, Muslim and Christian) was ensured through sampling techniques. Analysis of translated interviews involved identification of themes and the development of a taxonomy to represent relationships among emerging cultural themes and domains. Four central domains of beliefs related to breast health practices were identified: beliefs about a woman's calling, beliefs about cancer, beliefs about taking care of your breasts and beliefs about accessing services. These beliefs hold important implications for how health promotion strategies should be structured and offered, In particular, attention must be paid to the language that is used to talk about breast cancer, the importance of the role of the family in women's health decisions and traditions related to using narratives to share information and advice.     

高血压心身问卷编制及评价

目的初步编制高血压心身问卷,评价其信度和效度。方法在查阅相关文献、专题小组讨论和问卷调查的基础上初步形成高血压心身问卷的理论结构,运用项目分析、探索性因素分析、主成分分析和信效度检验方法对广东省403例高血压患者的心理行为特征及躯体症状进行分析,验证该问卷理论结构的合理性。结果通过项目分析、探索性因素分析和主成分分析,确定高血压心身问卷由心理功能、社会功能、躯体功能和生活习惯4个维度共36个条目组成,累积贡献率为45.568%;4个维度和总问卷的Cronbach's α系数分别为0.834、0.846、0.771、0.662和0.921,分半信度均为0.904,重测信度分别为0.762、0.739、0.792、0.660和0.786;各维度与总问卷的相关系数分别为0.678、0.739、0.784、0.690(均P<0.01),表明该问卷具有较好的信度和效度。结论初步完成高血压心身问卷的编制,验证性分析证明该问卷具有较好的信度和效度。     

Perceptions of community participation and health gain in a community project for the South Asian population: a qualitative study

BACKGROUND: The new public health rejects old individualist attempts at improving health and embraces community-based approaches in reducing health inequalities. Primary Care Trusts in England face the challenge of converting community participation in health into reality. This study explores differences in perception of participation between lay and professional stakeholders of a community health project for a South Asian population in Greater Manchester. METHODS: In-depth interviews and focus groups were used to explore the views of professional and lay stakeholders. All data were audio-taped, transcribed and analysed for emerging themes using a qualitative framework. RESULTS: Professionals talked of working in partnership with the community but lay stakeholders did not feel that they had control over the project. There were problems in engaging the community and local health professionals in the project. Lack of cultural awareness hampered participation in the project. There was agreement that the project improved the self-confidence of participants and created a more informed population. However, there was little support for claims of improvements in social cohesion and changes in lifestyle directly as a result of the project. CONCLUSION: Converting the rhetoric of community participation in health into reality is a greater challenge than was envisaged by policy makers. Marginalized communities may not be willing participants and issues of language and cultural sensitivity are important. Project outcomes need to be agreed to ensure projects are evaluated appropriately. Projects with South Asian communities should not be seen to be dealing with all 'ethnic health' issues without addressing changes in statutory organizations and other wider social determinants of health.     

Combining food records with in-depth probing interviews improves quality of dietary intake reporting in a group of South Asian women

Objective: To investigate if the addition of an in‐depth interview focused on cultural dietary practices could improve the quality of dietary data from food records among South Asian women in New Zealand. Methods: Cross‐sectional data were collected from 134 South Asian women (≥20 years), living in Auckland. Dietary data were collected using four‐day food records. Nutritional analysis revealed 33.6% under‐reporting of energy intakes. All women were recalled for an in‐depth probing interview focused on culture‐specific foods and dietary practices. Results: The interview revealed extensive use of dairy products and plant oils. The nutrient content of the food record alone and the food record plus interview were compared; median energy intakes were 6,852 kJ vs 7,246 kJ (p<0.001); under‐reporting decreased by 14.2%, and total fat and protein intakes (g/day) increased (p<0.001). Estimates of poly‐ and mono‐unsaturated fatty acids increased significantly (p<0.001) due to greater use of plant oils due to greater use of plant oils replacing saturated fatty acid‐rich fats in food preparation. A significant increase (17%) (p<0.001) in calcium intake reflects the higher dairy intake identified with the interview. Conclusion: The addition of an in‐depth probing interview to a four‐day food record enhanced food intake reporting. Self‐reported dietary assessments in immigrant population groups require quality control for accuracy. Implications: Methods to ensure high‐quality dietary data are essential to assess health outcomes and to inform public health interventions, especially in immigrant populations.     

Exploring reasons for ethnic disparities in diet- and lifestyle-related chronic disease for Asian sub-groups in New Zealand: a scoping exercise

Objectives: The current study aimed to explore if the impact of various risk factors for chronic disease differed for people of Chinese, Indian and New Zealand European and Other (NZEO) ethnicities.

Design: Data analysed for this paper was extracted from the 2003–04 and the 2006–07 NZ Health surveys for adults aged 25–70 which used a cross-sectional survey design. Data from both the survey waves were combined and all statistical analysis was done using SAS version 9.2 or 9.3. Ethnicity of participants was coded using a priority-based classification system as (1) Indian, (2) Chinese, (3) Other Asian, (4) NZEO, (5) Maori and (6) Pacific. Only data for Indians, Chinese and NZEO were used for the current study. Prevalence estimates and 95% confidence intervals for chronic disease and the associated risk factors were generated to describe the sample. Logistic regression analysis was used to examine whether the difference in the change in risk of chronic disease with different exposures was different according to ethnicity.

Results: Higher deprivation resulted in increased risk of chronic disease in Indian and Chinese males but not in NZEO males (p =?.03). There was a weak evidence for a differing effect of physical activity (p?=?.10) on chronic disease with the protective effect not seen in Indian or Chinese participants.

Conclusion: The results of the current study indicate that some factors such as socio-economic deprivation and physical activity may impact differently on the prevalence of chronic disease according to ethnicity. The authors recommend further investigation of these factors using improved and innovative methodology and high-quality ethnicity data to better understand the factors underpinning ethnic disparities in disease prevalence among Asian sub-groups.     

Repeatability and validity of an upper limb and neck discomfort questionnaire: the utility of the standardized Nordic questionnaire

The repeatability and validity of a questionnaire for upper limb and neck complaints were assessed in a population of 105 hospital outpatients with a range of upper limb and neck disorders (including cervical spondylosis, adhesive capsulitis, lateral epicondylitis, carpal tunnel syndrome and Raynaud's phenomenon). Subjects were asked to complete a modified Nordic-style upper limb and neck discomfort questionnaire on two occasions closely spaced in time. The repeatability of their responses was assessed by calculating a kappa coefficient (kappa), and the sensitivity and specificity of component items in the questionnaire were determined for specific diagnostic categories of upper limb and neck disorder. Symptom reports for pain in the upper limb and neck, pain interfering with physical activities, neurological symptoms and blanching were all found to be highly repeatable (kappa = 0.63-0.90). A number of regional pain reports proved to be very sensitive in relation to specific upper limb disorders, but, with the exception of reported finger blanching in patients with Raynaud's phenomenon, none proved to have a good specificity (range = 0.33-0.38). We conclude that a modified Nordic-style questionnaire is repeatable and sensitive, and is likely to have a high utility in screening and surveillance. However a complementary examination schedule of adequate specificity and repeatability is essential to establish a clinical diagnosis.