Voices of immigrant South Asian women: expressions of health concerns.

Abstract

392 Brief communication VOICES OF IMMIGRANT SOUTH ASIAN WOMEN: EXPRESSIONS OF HEALTH CONCERNS Health care concerns, health issues, and illness are defined within a social, cultural, political, and economic context.1 When health care practitioners and patients share a common culture, it is not always necessary to negotiate an understanding of the health problem. The distinctive ways that health problems are discussed and treated are often taken for granted when cultures are shared.2 Immigrants to North America may bring a set of beliefs and expectations to health care interactions that differ from those held by Western health care providers trained in biomedicine. Differences in explanatory models between professionals and their patients have the potential to create mismatches that can lead to problems, including misunderstandings and unmet expectations and needs. Explicating explanatory models in health care interactions can provide an effective device for identifying the sources of clinical miscommunications and misrecognitions.3 The concept of explanatory models is based on a distinction between illness (the patient's perceptions of symptoms and disability) and disease (the biomedical practitioner's perspective). While authors such as Kleinman have extensively explored the nature of these explanatory models, Kleinman has cautioned that they are easily misapplied when a patient's perceptions and beliefs are treated as distinct entities to be identified and recorded.4 There is evidence that immigrant groups, including South Asian women, have experienced difficulties accessing health care services and, in particular, communicating with health care providers.5,6 Ardener7 suggests that marginal groups become "muted" in interactions with the dominant order. There have been some efforts to describe health concerns and customs of South Asian women who immigrate to Western cultures. Practitioners have often used a process of patient "typification" in an effort to enhance their ability to respond to the needs of particular minority groups such as South Asian women.8 Typification involves creating an overly generalized profile about the characteristics of certain groups, including the kind of problems they have. The diversity among group members is obscured by the use of these stereotypical profiles and has been recognized as racist. South Asian women, for example, have reported that they encounter racism when they receive differential treatment on the basis of their ethnicity. Such treatment is often based on false assumptions and is often insensitive to individual women.9 Received April 17,2000; revised June 26,2000; accepted June 6,2001. Journal ofHealth Care for the Poor and Underserved · Vol. 12, No. 4 · 2001 Bottorffet al. 393 In an effort to improve health services for South Asian women, research has been conducted regarding their perceived health needs and concerns. Many of the health concerns reported by South Asian women are similar to those of other women (e.g., breast screening, psychological well-being, choice in childbirth ).10,11 Despite these similarities, South Asian women in the Canadian context have expressed a desire to be treated differently, for example, to have special health services or clinics. Bowes and Domokos10 argue that this desire is not necessarily related to cultural beliefs or values but rather is related to women's desire to avoid mainstream clinics where they are patronized or judged or where they experience discrimination. In contrast, other researchers have found some evidence that South Asian women's health problems may differ from those of mainstream women in important ways. Reporting on a study of Canadian Sikh women, George12 notes that in her conversations with study participants, there was a notable lack of discussion regarding what are viewed as traditional symptoms of menopause. She explains that menopause is not "isolated, identified, and labeled within the Punjabi language as an entity in and of itself" (p. 302).12 Rather than seeing menopause as a negative life event necessitating medical advice, Punjabi women view it as a natural completion of their duty to bear children. Other South Asian women view menopause with some relief because activities such as cooking or involvement in religious ceremonies no longer need to be avoided during menstruation.12 While many of the health concerns of South Asian women may be similar to those of mainstream women, the way these concerns are expressed, organized , and experienced sometimes differs.10,13...