Cultural issues in the primary care of South Asians

One of the fastest growing immigrant groups in the United States is from the Indian subcontinent of South Asia. Included in this group are people from India, Sri Lanka, Bangladesh, and Pakistan. Although there is considerable heterogeneity within and between the populations of these countries, cultural similarities contribute to common challenges when South Asian immigrants are seen in primary care settings in the United States. This article describes aspects of the South Asian culture and of the acculturation process relevant to establishing rapport and providing competent biopsychosocial care to individuals and families from this region. We discuss the differing needs of recent immigrants, second-generation Americans from South Asia, and individuals temporarily in the United States for study or employment. We discuss linguistic and interpersonal style concerns in regard to the relationship between health care professionals and immigrant patients and use case material to illustrate cultural issues. We conclude with suggestions for culturally sensitive health care of South Asians.     

Immigration and HIV/AIDS in the New York Metropolitan Area

Because the HIV pandemic undergoes continual change in its locations and affected populations, it is crucial to study HIV risk behaviors among mobile and immigrant groups within and across borders. The impact of cross-cultural migrations and the importance of studying that impact in terms of demographic characteristics as well as cultural and environmental factors has not received adequate attention in public health research. This collaborative analysis utilizes data from three studies of immigrant groups in New York to describe and compare these factors that provide the context for risk and prevention of HIVAIDS and other health challenges. Data discussed were obtained utilizing multi-method approaches to identify and describe HIV risks among both new and more established immigrant populations within the urban settings of North America, with NYC as a central focus. Demographic and epidemiological data situate the analysis within the larger contexts of US migration and the HIV/AIDS epidemic in NYC. The authors identify risk and protective factors embedded to varying degrees in immigrants' multiple cultures and sub-cultures. The three populations studied include: 1) new Hispanic immigrants from the Dominican Republic, Mexico and Central America; 2) West Indian (Caribbean) immigrants from Jamaica, Trinidad/Tobago and other anglophone Caribbean nations; and 3) South Asian immigrants from India (Indian Americans). The paper seeks differences and commonalities, focusing on the social, attitudinal and behavioral factors that contribute to increased HIV/AIDS vulnerability among these populations. The data presented also identify some of the attitudes and behaviors of individuals and groups, as well as other facilitators and obstacles to transmission for immigrants as they adapt to new environments. Topics addressed include factors affecting HIV/AIDS vulnerability of immigrant groups, goals and expectations, health and mental heath issues, gender role change, sexual risk, alcohol and other drug use, perception of HIV/AIDS risk and implications for prevention.     

Acculturation Strategies Among South Asian Immigrants: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

In the past, epidemiologic research on acculturation and health has been criticized for its conceptual ambiguity and simplistic measurement approaches. This study applied a widely-used theoretical framework from cross-cultural psychology to identify acculturation strategies among South Asian immigrants in the US and to examine sociodemographic correlates of acculturation strategies. Data were from the Mediators of Atherosclerosis in South Asians Living in America study. We used latent class analysis to identify groups of individuals that were similar based on cultural attitudes and behaviors. We used latent class regression analysis to examine sociodemographic correlates of acculturation strategies. We found that South Asian immigrants employed three acculturation strategies, including separation (characterized by a relatively high degree of preference for South Asian culture over US culture), assimilation (characterized by a relatively high degree of preference for US culture over South Asian culture), and integration (characterized by a similar level of preference for South Asian and US cultures). Respondents with no religious affiliation, those with higher levels of income, those who lived a greater percentage of their lives in the US, and those who spoke English well or very well were less likely to use the separation strategy than the assimilation or integration strategies. Using epidemiologic cohort data, this study illustrated a conceptual and methodological approach that addresses limitations of previous research on acculturation and health. More work is needed to understand how the acculturation strategies identified in this study affect the health of South Asian immigrants in the US.     

Practice of and attitudes towards family planning among South Asian American immigrants

Background

Previous studies performed outside of the US that examined contraceptive knowledge and beliefs in South Asian women identified significant barriers. Our study aimed to further understand these practices in this population residing in the US.

Methods

This cross-sectional study surveyed women of all ethnicities receiving health care from either of two ambulatory practices in New Jersey from October 2011 to November 2012. Using chi-squared testing, the frequencies of contraceptive outcomes between South Asians and non-South Asians were compared.

Study Design

There were 42 South Asian respondents and 143 non-South Asian respondents. Our results show that South Asians are statistically significantly less likely to routinely use contraception and that gaps in contraceptive knowledge appear to stem from multiple barriers, including family opposition and pressure from spouse or in-laws to have children, cultural prohibitions, fear of side effects and misinformation, lack of education/knowledge about contraceptives and difficulty in accessing contraception. These gaps in contraceptive knowledge were also found to be multigenerational, despite higher levels of education generally seen in the South Asian population.

Conclusions

Clinicians caring for South Asian women should acknowledge both the barriers and the lack of contraceptive knowledge in this population and provide culturally competent family planning information to them during all women's health encounters.     

Health care seeking for HIV/AIDS among South Asians in the United States

Health-related behavior is a function of the sociocultural and environmental contexts in which it occurs. With South Asian immigrants, a comprehensive approach that focuses on community and individual factors may be more effective than an individualistic one. This article explores the factors that may influence HIV/AIDS-related health care seeking by South Asian immigrants to the United States. It focuses on South Asians from Bangladesh, India, and Pakistan. The need to involve the community in any intervention process is discussed. An understanding of the determinants of HIV-related health care seeking and behavioral change factors can help social work practitioners develop effective interventions for and with South Asian immigrants.     

Cultural Perceptions and Negotiations Surrounding Sexual and Reproductive Health Among Migrant and Non-migrant Indigenous Mexican Women from Yucatán,Mexico

Information regarding sexual and reproductive health of indigenous women from Mexican sending and US receiving communities is limited. This research aims to explore the perceptions of indigenous women from US migrant receiving and Mexican migrant sending communities regarding their sexual health experiences and reproductive health practices. From January to March 2012, two key informant interviews and 31 in-depth, semi-structured interviews were conducted among women ages 18–55 in Tunkás, Yucatán and Anaheim and Inglewood, California. Women reported challenges to obtaining routine reproductive clinical care, including access to care barriers and lack of perceived power over their own sexual health. This was further compounded by migration processes and deficiencies in health care delivery systems. Socio-cultural beliefs and gendered power dynamics influence sexual and reproductive health decisions and behaviors of migrant and non-migrant women. Findings underscore existing gender-based reproductive health norms and serve to inform future transnational research and public health education to improve the health of indigenous migrant and non-migrant women in the US and Mexico.     

Social change, migration and sexual health: Chilean women in Chile and Australia

Cultural beliefs, norms and values regarding sexuality and gender roles forge people's sexual behaviour and understanding of sexual health risk. Acknowledging a person's cultural background is a key challenge for the promotion of sexual health programs and strategies for the prevention of sexually transmitted diseases (STDs) and HIV/AIDS. This challenge acquires larger dimensions when health promotion programs are directed towards migrant communities. This article examines narratives about past and present life experiences of Chilean women living in Australia and Chilean women in Chile. We inquire about social changes and exposure to education women experienced in their own country and in Australia and the ways in which migrant women define and articulate their experiences in relation to sexual health prevention. In comparing these experiences, we raise a number of questions about sexual health promotion and programs, including the prevention of STDs and HIV/AIDS targeted to specific migrant communities in Australia. Very few sexual health policies and strategies in Australia take into account the impact that the social and cultural background of migrants, social changes and the 'settlement process' has on the cultural construction of gender identity of migrants in the new country. We propose that these cultural constructs are key in the formulation of migrants' beliefs and attitudes towards sexuality and sexual health. We suggest that there is a need to build effective and culturally appropriate sexual health promotion and prevention strategies that build upon the social and cultural background and the present and past life experiences of migrant women and men.     

A Qualitative Study to Understand Positive and Negative Child Feeding Behaviors of Immigrant Asian Indian Mothers in the US

To understand current practice of child feeding behaviors, and underlying factors influencing these practices in Asian Indian mothers, qualitative in-depth interviews were conducted with 27 immigrant Asian Indian mothers of children ages 5–10 years. Using the theory of planned behavior as a guiding framework, child feeding behaviors employed, beliefs about the outcomes of feeding behaviors, perceived ease or difficultly in practicing feeding behaviors, and social norms were explored during the interviews. Thematic analysis was conducted using coding and display matrices. Mothers were motivated by nutrition outcomes when practicing positive and negative controlling feeding behaviors. Outcomes related to preservation of Indian culture and values also influenced feeding behaviors. Pressuring to eat was often practiced despite the perception of ineffectiveness. Use of food rewards was found, and use of TV to control children’s food intake despite the clear understanding of undesirable nutrition outcomes was a unique finding. Asian Indian mothers need effective child feeding strategies that are culturally appropriate. Integrating cultural beliefs in nutrition education could help support existing motivation and behavior modification.     

Teachers’ conflicting cultural schemas of teaching comprehensive school-based sexuality education in Kampala,Uganda

Teachers can feel uncomfortable teaching sexuality education when the content conflicts with their cultural values and beliefs. However, more research is required to understand how to resolve conflicts between teachers’ values and beliefs and those implicit in comprehensive approaches to sexuality education. This study uses cultural schema theory to identify teachers’ cultural schemas of teaching sexuality education and the internal conflicts arising between them. In-depth interviews were conducted with 40 secondary school teachers in Kampala, the capital city of Uganda. Embedded in a context of morality, conflicting cultural schemas of sexuality education and young people’s sexual citizenship in traditional and present-day Ugandan society were found: young people are both innocent and sexually active; sexuality education both encourages and prevents sexual activity; and teachers need to teach sexuality education, but it is considered immoral for them to do so. In countries such as Uganda, supportive school regulations and a mandate from society could help teachers feel more comfortable adopting comprehensive approaches to sexuality education.     

Premarital Sexual Behavior among male college students of Kathmandu, Nepal

Background  

In Nepal, as in other Asian countries, the issue of sexuality still remains a taboo. Despite this fact, an increasing number of sexual activities is being reported by Nepalese students. This trend warrants serious and timely attention. Due to the sensitivity of the topic of premarital sexuality, youth receive inadequate education, guidance and services on reproductive health. The main objectives of this paper are to explore the sexual behavior especially focusing on prevalence of premarital sex among college men and to investigate the factors surrounding premarital sexual behavior.     

Sexual Behavior of Married Young Women: A Preliminary Study from North India

Background:

There are significant gaps in the scientific literature concerning female sexual behavior and attitudes surrounding sexuality, which have definitive implications on public health and clinical work.

Aim:

To study the sexual behavior of young married Indian women.

Materials and Methods:

The study group comprised 100 consecutive women attending the Department of Pediatrics for the care of noncritical children in a multispecialty, tertiary care teaching hospital setting in North India. Current levels of sexual functioning and satisfaction were assessed by using the Brief Index of Sexual Functioning for Women (BISF-W). All participants were also administered a translated and culturally adapted instrument called Sex Knowledge and Attitude Questionnaire-II (SKAQ-II).

Results:

Peno-vaginal sex continues to be considered the most desired and actually performed sexual activity for arousal and orgasm, followed by kissing and foreplay. Difficulties while performing sexual activity, in the form of physical problems, were faced by 17% of the participants. The participants displayed adequate sexual knowledge and favorable attitude towards sexuality as measured by SKAQ-II.

Conclusion:

The present study is a preliminary effort to understand the contemporary female sexual behavior, knowledge and attitude by employing standard instruments. Still further studies are required in this area.     

A successful guide in understanding Latino immigrant patients: an aid for health care professionals

The recent growth of Latino immigrants in the United States has presented great challenges to the health care system, particularly in "emerging Latino states." An educational DVD was developed to aid professionals in providing culturally competent care to Latino immigrants and better understand their expectations when seeking care, as well as common cultural beliefs and practices. Knowledge and confidence was assessed through pre- and posttest measurements among 515 health care professionals nationwide. Results indicated significant increase (P < .001) in overall knowledge/confidence in Latino cultural beliefs as they relate to health care seeking, differences in health care systems between the United States and Latin America, and barriers to health care. Such multimedia training may be a promising approach to improving health care with Latino immigrants in the United States.     

Sexuality education: our current status, and an agenda for 2010

Three articles are presented that record changes in American public schools sexuality education during the last decade of the 20th century. These articles include "Adolescent Views," which reports major shifts in the prevalence and content of school-based reproductive health education over 1988-95. Instruction is focused on HIV/AIDS prevention, contraceptive education, how to say no to sex, and condoms. In "Changing Emphases," teachers of grades 7-12 testify to a marked shift from a more balanced treatment of abstinence and protection in 1988 to a heavier reliance on abstinence in 1999. The last article, "Grades 5-6," shows that sexuality education is much less common at these grade levels than in grades 7-12. Where programs exist, they mainly cover such topics as puberty, HIV/AIDS, sexuality, sexually transmitted diseases, sexual abuse, and abstinence, while the discussion of contraceptive methods is relatively rare. Views presented in these articles will help formulate research and advocacy agendas for 2010.     

Midwives¿ views on factors that contribute to health care inequalities among immigrants in Sweden: A qualitative study

ABSTRACT: INTRODUCTION: Ethnic and socioeconomic inequalities in the Swedish health care system have increased. Most indicators suggest that immigrants have significantly poorer health than native Swedes. The purpose of this study was to explore the views of midwives on the factors that contribute to health care inequality among immigrants. METHODS: Data were collected via semi-structured interviews with ten midwives. These were transcribed and related categories identified through content analysis. RESULTS: The interview data were divided into three main categories and seven subcategories. The category "Communication" was divided into subcategories "The meeting", "Cultural diversity and language barriers" and "Trust and confidence". The category "Potential barriers to the use of health care services" contained two subcategories, "Seeking health care" and "Receiving equal treatment". Finally, the category "Transcultural health care" had subcategories "Education on transcultural health care" and "The concept". CONCLUSIONS: This study suggests that midwives believe that health care inequality among immigrants can be the result of miscommunication which may arise due to a shortage of meeting time, language barriers, different systems of cultural beliefs and practices and limited patient-caregiver trust. Midwives emphasized that education level, country of origin and length of stay in Sweden play a role when an immigrant seeks health care. Immigrants face more difficulties when seeking health care and in receiving adequate levels of care. However, different views among the midwives were also observed. Some midwives were sensitive to individual and intra-group differences, while some others viewed immigrants as a group of "others". Midwives' beliefs about subgroup-specific health services vs. integrating immigrants' health care into mainstream health care services should be investigated further. Patients' perspective should also be considered.     

Health behaviors, chronic disease prevalence and self-rated health of older Asian Indian immigrants in the U.S

The purpose of this study was to examine the correlates of healthy behaviors and self-rated health in middle-aged and older Asian Indian immigrants in the U.S. Asian Indian men (n = 162) and women (n = 64), 50 years of age or older completed a telephone survey which collected information regarding demographics, behavioral risk factors, acculturation, perceived control, quality of social support, depression, body mass index, chronic disease prevalence, and self-rated health. Participants average length of residence in the U.S. was 25 years, 52% were normal weight, 41% were vegetarians, 55% incorporated aerobic activity into daily lifestyle, and only 5% smoked. Hypertension and diabetes were most common chronic diseases (31 and 18%, respectively). Younger age, longer length of residence and a bicultural or more American ethnic identity were associated with greater participation in physical activity. Likewise, higher income, a bicultural or more American ethnic identity and depression were associated with higher fat intake. Poor self-rated health was associated with older age, female gender, BMI > 25, satisfaction with social support, and greater number of chronic disease conditions. A multitude of factors influence the practice of healthy behaviors and the perceived health of Asian Indian immigrants, which should be addressed when developing culturally appropriate health promotion interventions.     

Meaning and knowledge of health among older adult immigrants from Russia: a phenomenological study

This qualitative study examined the meaning and knowledge of health among older adult Russians who have immigrated to the US. Prior studies have shown that this group has a high rate of chronic disease and low compliance with preventative health behaviors. However, little is known about the knowledge and beliefs about health among Russian immigrants that may be driving their low participation in health behaviors. The goal of the present study was to use a phenomenological approach to gain a deeper understanding of the experience of health in this population. Twelve older adults were recruited through English language classes, and interviewed in focus groups about their experience with health and health care. Qualitative analysis using the phenomenological approach revealed a number of important health themes: participants (1) define health as the absence of disease, (2) feel distrust toward media information about health, (3) experience alienation from their current health care system, and (4) experience a sense of stress and helplessness in the US because they do not understand the English language or the US health care system. These themes may underlie the immigrants' lack of participation in health practices and in seeking out information about health. Information about the Russian immigrants' knowledge about health behavior is also reported. This study represents a first step toward better understanding the barriers facing older adult Russian immigrants in learning about and practicing health behaviors. The study also draws attention to the ways in which beliefs about health may impact health behavior.     

Health Behaviors,Chronic Disease Prevalence and Self-Rated Health of Older Asian Indian Immigrants in the U.S.

The purpose of this study was to examine the correlates of healthy behaviors and self-rated health in middle-aged and older Asian Indian immigrants in the U.S. Asian Indian men (n = 162) and women (n = 64), 50 years of age or older completed a telephone survey which collected information regarding demographics, behavioral risk factors, acculturation, perceived control, quality of social support, depression, body mass index, chronic disease prevalence, and self-rated health. Participants’ average length of residence in the U.S. was 25 years, 52% were normal weight, 41% were vegetarians, 55% incorporated aerobic activity into daily lifestyle, and only 5% smoked. Hypertension and diabetes were most common chronic diseases (31 and 18%, respectively). Younger age, longer length of residence and a bicultural or more American ethnic identity were associated with greater participation in physical activity. Likewise, higher income, a bicultural or more American ethnic identity and depression were associated with higher fat intake. Poor self-rated health was associated with older age, female gender, BMI > 25, satisfaction with social support, and greater number of chronic disease conditions. A multitude of factors influence the practice of healthy behaviors and the perceived health of Asian Indian immigrants, which should be addressed when developing culturally appropriate health promotion interventions.     

West African Immigrant Families from Mauritania and Senegal in Cincinnati: A Cultural Primer on Children’s Health

Similar to many cities in the US, the Greater Cincinnati area has recently had an increase in immigrants from other countries. In particular, there is a small but growing population of West African immigrants especially from Senegal and Mauritania. In order to better understand children’s health of West African families in the Cincinnati area, in-depth, in-home narrative interviews were conducted with ten West African immigrant parents from Senegal and Mauritania. Four salient themes about cultural information related to children’s health were derived from the qualitative analysis: (1) health care practice and expectations including barriers; (2) cultural values and identity; (3) health beliefs and traditions/customs; and (4) quality of life. It is essential that health care providers understand the nuances of working with West African immigrants including cultural differences, strengths, challenges and perceptions in order to provide these individuals with the most effective health care services.     

Sexuality Education Curriculum Content for Malaysian Students with Learning Disabilities

Sexuality education for students with learning disabilities has not been formally established in Malaysia. This study aimed to identify special education teachers’ acceptance of sexuality education content for secondary school students with learning disabilities. A nation-wide survey was conducted with 314 heads of the integrated program for students with learning disabilities. They rated the appropriateness of 42 sexuality education topics for students with learning disabilities. A principal component analysis revealed three distinct dimensions: human development and interpersonal skills; sexual behavior; and, social-sexual health, society and culture. Topics in the human development and interpersonal skills as well as the sexual health, society and culture dimensions were rated higher than topics in the sexual behavior dimension. This empirical finding was reflective of typical beliefs about sexuality in a conservative society. The practitioners perceived sexuality education for students with learning disabilities from a socialized biological perspective, with medical and social-based topics clustered under similar dimensions. Results also did not differ across gender. In conclusion, cultural context contributed to the acceptability of sexuality education content. We advocate that teachers be provided with more exposure and support to teach topics deemed more sensitive in a conservative society.