Renegotiating formal and informal care while ageing abroad: Older Pakistani women's healthcare access, preferences and expectations in Norway

Sanjana Arora,Melanie Straiton,Astrid Bergland,Bernd Rechel,Jonas Debesay

doi:10.1016/j.jmh.2020.100002

Abstract

This study explores older Pakistani women's preferences and expectations of formal and informal care while ageing in Norway. Our study is based on qualitative interviews with older Pakistani women living in Oslo municipality, Norway. The participants were aged between 48 and 81 years and had been living in Norway for 26 to 46 years. Our analyses resulted in five themes: 1) renegotiating the expectations of informal care in light of the ‘nazaam’ (or social system and practices) of Norway, 2) fear of being left behind in residential care homes, 3) disloyalty and shame of being cared for by outsiders, 4) perceptions about the quality of formal care and 5) concerns about mixing with other cultures and genders. Our findings point to potential barriers beyond culture that influence older Pakistani women's preferences for, expectations of and access to formal care services. The study further highlights the structural barriers that older Pakistani women perceive and experience in accessing formal care services in a majority society.

Highlights

The proportion of older immigrants in Europe is relatively low today, it is expected to rise markedly in the future (Ruspini, 2009; Ciobanu et al, 2017)
The analyses resulted in five themes: 1) renegotiating expectations of informal care in light of the nazaam of Norway, 2) fear of being left behind in residential care homes, 3) disloyalty and shame of being cared for by outsiders, 4) perceptions about the quality of formal care and 5) concerns about mixing with other cultures and genders
This is consistent with previous research in Norway, which found that the willingness or ability of the son to care for the older family member was the basis for respect and honour among the Pakistani-Norwegian men’s community (Næss and Vabø, 2014).While culture could be construed as influencing the ability to seek formal care services, it highlights how the minority caregiving practices are organised and constructed in society by the minority members themselves

Summary

Introduction

The proportion of older immigrants in Europe is relatively low today, it is expected to rise markedly in the future (Ruspini, 2009; Ciobanu et al, 2017). Care for older immigrants is an important issue, for older immigrant women, since studies have shown that the intersections of gender, old age, ethnicity and socioeconomic factors have implications for health and access to care (Northwood et al, 2018; Småland Goth and Berg, 2011; Villatoro et al, 2018; Brenner and Clarke, 2018) Despite these trends, we have limited knowledge about immigrants’ needs and preferences for care as they age. Even if family-based care is more common and perceived as more desirable in immigrant populations, changes in the family structure, responsibilities and roles may make this difficult or sometimes impossible (Curtin et al, 2017), and caregiving by family as a norm is increasingly becoming difficult to uphold This is one of the reasons why the demand for formal care services for older immigrants is expected to increase in the future (Ingebretsen, 2011; Nergård, 2009). The ability of the Norwegian system to adapt to older immigrants’ needs is important for this population to effectively utilise care

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