Cultural beliefs and chronic disease management among immigrant women from Sub-Saharan Africa

¶ … Culture among Immigrant Women from Sub-Saharan Africa Diagnosed with Chronic Diseases, Living in Grande Prairie, Alberta

The concept culture is defined as learned beliefs revealing the method people interact with their physical and social environment generally shared among a large segment of the population and transmitted from one generation to the other. These beliefs can include body size, habit and food habit. This proposal discusses the impact culture among immigrant women from Sub-Saharan Africa diagnosed with chronic diseases, living in Grande Prairie, Alberta. The review of the literature and its outcomes reveal that SSA women in Canada still prefer using the traditional medicine rather than western medicine. Moreover, African women in Canada diagnosed with chronic disease continue indulging unhealthy lifestyle that includes overeating to gain body weight because of the cultural beliefs that overweight is associated with wealth and prestige. Moreover, many women from Sub-Saharan Africa still rely on traditional medicine to cure the ailments because culturally, large numbers of sub- Saharan African women believe in the traditional medicine than orthodox medicine. The culture of non-disclosure is among the cultural factors affecting sub-Saharan African women.

The proposal will collect and analyze data using the quantitative techniques. The tables, words and graphs will be used to present the research findings.

Introduction

In the history of Canada, immigration has played a critical role in the economic and socio-cultural development of the country. By 2016, one out of five Canadians is an immigrant and foreign born making their number reaching approximately 20.6% of the Canadian population and contributing to the 66% of the annual population growth of Canadian. Between 2006 and 2011, more than 145,700 African immigrants arrived in Canada, and an immigrant from SSA (Sub-Saharan African) consists of people from the African region situated below the Sahara desert. The SSA countries are 49 in number that includes Botswana, Ethiopia, Malawi, Niger and Uganda. Prior to 1960, the population of sub-Saharan African were very small, and almost unknown ethnic groups. However, between 1960 and 2007, the numbers of Sub-Saharan African immigrants have increased by more than 40-fold from 30,000 to 1.1 million. Typically, evidence has shown that immigrants from sub-Saharan African share common health behaviors, health beliefs, diets and disease experiences. The acculturation theory discusses the way in which SSA immigrants in Canada attach themselves to the African cultures. Many African women in Canada still believe in culture using the traditional method to treat ailments rather than using the modern medicine.

"Theory of Health Behavior Change (ITHBC)" (Ryan, 2009 p 161) will be integrated into the proposal to explore the SSA immigrants behavioral choices to manage their chronic disease.

Fig 1: ITHBC

Source: Ryan, (2009)

As being revealed in Fig 1, the ITHBC assists in exploring individual capability to adopt positive and effective health behaviors to enhance health interventions. The assumption of the ITHBC is to facilitate the behavioral changes to assist SSA in Grande Prairie, Alberta Canada to manage their diseases.

The objective of this proposal is to investigate "the Influence of Culture in Immigrant Women from Sub-Saharan Africa Diagnosed with Chronic Diseases, Living in Grande Prairie, Alberta.".

RESEARCH QUESTION

Are immigrant women from sub-Saharan Africa, 25 to 60 years old, who have lived in Grande Prairie, Alberta, Canada between 0-5 years at increased risk of complicated health issues due to unhealthy cultural practices?

HYPOTHESIS

Immigrant women from sub-Saharan Africa, 25 to 60 years old, who have lived in Grande Prairie, Alberta, Canada between 0-5 years are at increased risk of complicated health condition(s) due to the use of complementary and alternative medicine.

Rationale

The rationale for conducting this study is to provide the clinical understanding of the SSA immigrant in Alberta living with chronic disease. At present, there is a gap in the literature about the cultural influence of the SSA immigrant living Alberta and suffering from chronic disease. The study attempts to fill the gap and describe the theoretical perspectives on the management of chronic disease among SSA immigrant in Alberta. This study provides a unique perspective to enhance a greater understanding of the impact of cultural perspective on SSA immigrants in Alberta suffering from chronic disease.

Research Methods used and Data Collected

The proposal will use the quantitative technique to collect data from SSA immigrant women diagnosed with the chronic disease in Canada to enhance a greater understanding of their cultural attachment to alternative and complementary medicine. The sample population will consist of Sub-Saharan African women in Canada diagnosed with the chronic diseases aged between 25 to 60 years. Moreover, the researcher will collect data from medical practitioners in Alberta in Canada, and the proposal will use the stratified random sampling to select the subject population. Trochim, et al. (2016) argue that the stratified random sampling is a proportional sampling that assists in dividing the entire population in the homogenous subgroup and using a simple random sampling to represent the entire population. The benefit of stratified sampling is that it will assist in representing the key subgroup of the population. The survey method will be used to collect data from the sample population because the method is cost effective and it is a simpler method of collecting data. The data will be collected through survey method and sample questionnaire is in Appendix 1.

Analysis and Results

The researcher will also use the quantitative technique for the analysis and descriptive statistics will be used to summarize the data in a manageable form. The summary of the data will be presented using the Mean, Median and standard deviation. The study will also use the regression analysis and the ANOVA technique to test the hypothesis. Added the to the analysis, the researcher will integrate an ethical consideration to protect the private information of participants. To assist in analyzing the data without errors, the proposal will use the SPSS Version 21 or Microsoft Excel 2016 for the analysis. An application of the ethical consideration will also be used to protect the private information of the participants. To enhance the research validity and reliability, the ERB (Ethics Review Board) will evaluate the research to ensure that its outcome is consistency with health research guideline. The IRB (Institutional Review Board) will be allowed to evaluate the method of data collection using the consent form to seek for authorization from participants. The consent form is placed in appendix 2. The research findings will be presented in tables, graphs, and texts which will assist in answering the research questions and test the hypothesis. The sample finding is revealed in fig 1.

Fig 1: Number of SSA Women Disclosing their Ailments

Annotated Bibliography

Renzaho et al. (2012) in their research article argue that immigrant from sub-Saharan Africa have a high risk of obesity and cardiovascular disease. Renzaho et al. (2012) use the acculturation theory to explain the level the African immigrants still attach to their African health cultural beliefs. The cultural factor that underpins their body size is their continued attachment to a large body size. Many immigrant African women still adopt unhealthy behaviors by linking larger body size as a sign of prestige, wealth and healthy living. Renzaho et al. (2012) support the hypothesis by pointing out, Africa women still believe that

"slimness equated to sickness or ugliness. For example: "Thinness means [being] unwell, TB [tuberculosis] or AIDS. Thin means ugly. The beauty is not how you look, it is your size." Some women stressed that people who were slender were poor, had many problems, and did not have money to buy food or to welcome relatives and friends into their home." (Renzaho et al. (2012 p 784).

In this sense, the SSA immigrant in Canada does not engage in physical activity to maintain their large body size because they believe that slimness is associated with poverty and chronic illness.

Tulloch et al. (2012) in their article argue that the rate of HIV epidemic is high across SSA with the prevalence estimate to nearly 45%. The 2008 data reveal that HIV prevalence in SSA account to 75% of global HIV population. While Canadian authority medically screens SSA immigrants before being allowed to immigrate into Canada, nevertheless, some of the SSA immigrants contact HIV before boarding a flight to Canada thereby increasing the HIV population in Canada. The cultural factor responsible for the high prevalence of HIV in Alberta in Canada is associated with cultural attachment of marrying more than one wives. Many immigrant African men still believe in marrying multiple wives. While Canadian legal system does not allow marrying more than one wife, some immigrant African men in Canada have the habit of marrying a legal wife in Canada and at the same time marrying another wife in their country of origin. Thus, Tulloch et al. (2012) develop the "information-motivation-behavioral skills model (IMB)" (p 132) to explain the HIV preventive behavior. The model argues that fundamental behaviors reduce HIV include behavioral skills, motivation, and proper condom usage. However, some SSA women in Canada do not have a deep knowledge of HIV that can assist them to prevent a prevalence of HIV.

Scott (2013) in their research article reveals that the prevalence of obesity and overweight lifestyle among women in SSA is increasing. In essence, the prevalence of obesity is more than double in the West African region increased by more than 114% between 1995 and 2005. The authors point out that obesity and overweight are the risk factors for non-communicable diseases that include cancer, hypertension and heart disease. The major factor that leads to an increase in the rise of obesity in SSA is the sedentary lifestyle of Africa people. Thus, when African women immigrate to Canada, many of them continue their cultural attachment by indulging in the lifestyle that will make them gain weight.

Renzaho, A. (2004) in their research article argue that there has been an increase in the number of SSA immigrants into the advanced countries in the last few years. However, when they arrive in the advanced countries, they still attach to the same African cultural believe. For example, African women still believe that overweight is associated with wealth, good healthy living and prestige. While thinness is associated with poverty and sickness. When ladies are about to marry in many SSA countries, their parents will keep them in a house for more than a month overfeeding them to increase their body weight. Their cultural belief is that fat women will be more pleasing to their husbands than thin women. When these women immigrate to Canada, they continue indulging in the same cultural beliefs, and at the same time increasing their unhealthy lifestyle

Discussion

The study reveals that there has been an increase of SSA migrants in Canada because of the population displacement, chronic poverty, natural disaster, ethnic conflicts and high level of malnutrition.(Renzaho et al. 2004). When SSA immigrants move to Canada, they maintain their cultural attachment, and, many SSA women migrants still prefer large body size compared to the European counterparts. Moreover, African women diagnosed with the chronic disease still prefer using the traditional medicine because of their low trusts in modern medicine. The study collects data using the quantitative technique to collect analyze data, and the findings are presented in graphs, tables and words.

Reference

Agyemang, C., Stronks, C., Addo, J., Bhopal, R., de Graft Aikins, A., et al. (2009). Cardiovascular disease, diabetes and established risk factors among populations of sub-saharan african descent in europe: A literature review. Globalization and Health, 5, 7.

Arrey, A. E., Bilsen, J., Lacor, P., & Deschepper, R. (2015). "It's My Secret": Fear of Disclosure among Sub-Saharan African Migrant Women Living with HIV/AIDS in Belgium. Plos One, 10(3). doi:10.1371/journal.pone.0119653

Commodore-Mensah, Y.,Himmelfarb, C.D., Agyemang, C. et al. (2015). Cardiometabolic Health in African Immigrants to the United States: A Call to Re-examine Research on African-descent Populations. Ethnicity & Disease, 25(3), 373. doi:10.18865/ed.25.3.37.

Kesteman, T., Lapostolle, A., Costagliola, D., Massari, V., & Chauvin, P. (2015). Impact of migration origin on individual protection strategies against sexual transmission of HIV in paris metropolitan area, SIRS cohort study, france. BMC Public Health, 15(1), 807.

Mensah G.,A. (2008). Epidemiology of stroke and high blood pressure in Africa. Heart, 94:697-705.

Njomo, L. (2012). Satisfying the indigenous food needs of sub-saharan african immigrants in south africa: A food consumption behaviour model for south africa's leading supermarket chains. African Journal of Business Management, 6(25), 7557-7568.

Ryan, P ( 2009). Integrated Theory of Health Behavior Change, Clin Nurse Spec. 23(3): 161 -- 172.

Renzaho, A. (2004). Fat, rich and beautiful: Changing socio-cultural paradigms associated with obesity risk, nutritional status and refugee children from sub-saharan africa. Health and Place, 10(1), 105-113.

Scott, A., Ejikeme, C., Clottey, E., & Thomas, J. (2013). Obesity in sub-saharan africa: Development of an ecological theoretical framework. Health Promotion International, 28(1), 4-16.

Trochim, W. M., Arora, K., & Donnelly, J. P. (2016). Research methods: the essential knowledge base. Boston, MA: Cengage Learning.

Tulloch, H., Balfour, L., Kowal, J., Tasca, G., Angel, J., et al. (2012). HIV knowledge among Canadian-born and Sub-saharan african-born patients living with HIV. Journal of Immigrant and Minority Health, 14(1), 132-139.

Appendix 1

Sample Questionnaire

Strongly Disagree

Agree

Neutral

Agree

Strongly agree

Prefer traditional medicine than western medicine

My husband makes decision for me concerning my health disclosure

Prefer western medicine than traditional medicine

I disclose my ailment to healthcare provider

I consult my husband before disclosing my ailment to a healthcare provider

I increase my body size to please my husband

Prefer to continue attaching to my African culture than the Western culture

Will prefer using the medicine from Africa the medicine from Canada.

African medicine is more superior than western medicine.

I do not like to indulge in the physical activity.

Appendix 2: Consent Form

Statement of Consent:

I have read the stated information, and I consent to participate in the study.

Your Signature _ Date _

Your Name (printed) _

Your Signature _ Date _

Signature of person who obtains consent _ Date _

Printed name of person who obtains consent _ Date _

The researcher will keep this consent form for at least 3 years beyond the end of the study.