Chronic Disease and Women

¶ … 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. Literature Review Arrey, et al. (2015) argue that cultural background affects the disclosure of their diseases to the healthcare providers because some of them still believe that their ailments are their secret. The of non-disclosure is affecting the health outcomes of sub-Saharan African women living in Alberta in Canada.

For example, the cultural background affects the disclosure decision of sub-Saharan African women affected with HIV in Canada. Moreover, some women do not have the ability to make a decision on their own because they believe that it is their husbands who should make the decision for the entire families. Culturally, in Sub-Saharan African, it is men who are the head of the household and they are responsible for making decisions including health decision for the entire households.

When they immigrate to Canada, sub-Saharan African women continue with the same cultural belief. Thus, when the health issues affect sub-Saharan African women, it is men who will make decisions whether the women should use the traditional medicine or accept the western medicine. Thus, cultural believe as the men the head of the family and men are responsible for making health decision for women is affecting the health status of Sub-Saharan African women living in Canada.

Their continuing attachment to the culture of their countries of origin makes women immigrant from sub-Saharan Africa to face the risk of chronic diseases such as cardiovascular disease. For example, some African immigrants immigrate with high cholesterol, diabetes, and heart disease. Agyemang et al. (2009) argue that CVD (Cardiovascular Disease) is one of the chronic disease and a leading cause of death among SSA immigrant in Canada. Compared with European descendants, African population in Canada have a higher rate of hypertension, diabetes and increased risk of stroke.

Moreover, obesity is prevalent among SSA women immigrants that consequently lead to chronic diseases such as diabetes, and CVD. An increased risk of hypertension and CVD mortality is increasing among SSA immigrant women. Mensah (2008) identifies the major factor that leads to the high prevalence of hypertension among SSA immigrants, which includes a culture of physical inactivity, overweight and obese body style. Among African society, obese and overweight are associated with happiness, good health living, and prestige especially among women.

Thus, SSA women immigrants in Canada still hold these perceptions and many of them indulge in physical inactivity to gain weight. (Renzaho, et al. (2012) Moreover, the cultural barriers prevent them from access quality care. When SSA women immigrants are diagnosed with the chronic diseases, they prefer the traditional medicine to treat the ailments because of their low trust in western medical practitioners. The cultural attachment to the use of alternative and complementary medicine make the immigrant women be at high risks of complicated health condition. (Kesteman, et al. (2015).

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.