Hmong Older Adults’ End-of-Life Care Preferences: Physical, Psychosocial, Cultural, Religious, and Spiritual

As the Hmong community continues to grow and age in the United States (US), mainstream healthcare providers may encounter Hmong older adults who prefer their cultural end-of-life (EOL) care. The challenge for these providers is to offer culturally sensitive EOL care to Hmong older adults within the realm of the Western healthcare system. One factor contributing to this challenge may be the lack of knowledge regarding Hmong older adults’ EOL care preferences. Another is Hmong EOL care is interwoven with care from domains such as culture, religion, and spirituality. The purpose of this study is to garner an understanding of the care preferences of Hmong older adults during the dying process. A qualitative study using inductive content analysis was conducted. Thirty Hmong older adults who reside in Wisconsin participated in semi-structured interviews that were audio recorded and transcribed. Data was analyzed using inductive content analysis by Elo & Kyngäs (2008). The findings revealed that participants preferred care at EOL in the domains: physical, psychosocial, cultural, religious, and spiritual. Physical care included ADL’s while psychosocial care related to communication and companionship. Cultural care included children as caregivers and decision-makers. Religious and spiritual care surrounded Animism and Christian beliefs such as soul calling and prayers. Findings also suggest Hmong older adults’ care preferences as heterogenous and holistic. The findings have implications for the Hmong community and formal care services to collaborate on how culturally sensitive care can be provided to Hmong older adults at end of life.

Implementing a digital system for contact tracing and case investigation during COVID-19 pandemic in San Francisco: a qualitative study

Lay summary During the COVID-19 pandemic, many health departments implemented digital systems to collect, store, and share data for case investigation and contact tracing (CICT). In San Francisco, much of the contact tracing workforce was entirely remote and had little to no public health experience. Given this unique situation, we wanted to understand their experience with the digital system to inform future implementation of digital systems for public health responses. This case study describes how CICT workers in San Francisco experienced and used the digital system and how it could be improved. We conducted semi-structured 90-minute interviews and a short survey with a sample of 37 CICT workers, and found that, overall, the digital system was easy to learn and improved workers’ experience of data management during the pandemic. The digital system was also important in fostering a supportive and collaborative work environment. We found that the system could be improved to better support culturally sensitive care and highlight the importance of digital systems in ensuring equitable public health responses.

The Pregnancy Experiences and Antenatal Care Services of Chinese Migrants in Switzerland: A Qualitative Study

Background: Differences in reproductive health outcomes according to the mother's origins have been reported in Switzerland, for example, women from European countries and non-European countries. The Swiss Federal Office of Public Health has therefore called for specific Swiss-wide studies on migrant populations. This study explores the pregnancy and antenatal care experiences of Chinese migrants in Switzerland, intending to clarify their maternity care needs.Methods: In-depth interviews of 14 Chinese mothers and 13 family members were conducted in Chinese or English and audio recorded. All audio-recordingswere transcribed verbatim. All Chinese transcripts were translated into English.Thematic analysis was performed with the assistance of the qualitative dataanalysis software, MAXQDA Analytics Pro 2020.Results: Five themes were extracted from the transcripts: (1) Motivations andconcerns about having children, (2) The merits of the Swiss maternity caresystem, (3) The inconvenience and barriers of accessing Swiss maternity careservices, (4) Strategies to deal with the inconveniences of the Swiss maternitycare system, and (5) The need for culturally sensitive care.Conclusions: The results of our study provide new knowledge and understandingof pregnancy experiences and antenatal care services of Chinese mothers andtheir families in Switzerland. Their unique positive experiences included: familyplanning, the continuity of maternity services, humane care with the privacyrespected, personalized sensitive care needs, preferences for female obstetriciansand obstetricians of Asian origin. Several barriers were highlighted, suchasinformation seeking difficulties, communication difficulties, and a rigidappointment system. Reducing barriers enabling access to maternity care serviceswithin the Swiss healthcare system is necessary to provide equal qualitymaternitycare for individuals, irrespective of their origins.

Understanding transnational healthcare use in immigrant communities from a cultural systems perspective: a qualitative study of Dutch residents with a Turkish background

ObjectivesTransnational utilisation of healthcare by people with an immigrant background carries risks, including medicalisation and adverse iatrogenic outcomes. We investigated the drivers behind such transnational healthcare use from a cultural perspective on health systems.DesignQualitative interview study (2018).SettingTwo primary care practices in Amsterdam, the Netherlands.ParticipantsThirteen Dutch patients of Turkish background, who had obtained healthcare in Turkey, and who in general visited the primary care practice more than once a month.ResultsIn the respondents’ stories, we observed how: (1) cross-border healthcare use was encouraged by cultural mismatches between expected and provided services and by differing explanatory models of illness upheld by patients and Dutch providers; (2) both transnationalism in patients and entitlements to insurance reimbursement facilitated the use of Turkish health services to bypass perceived barriers in the Dutch system; (3) cultural mismatches were reinforced during general practitioner consultations after the patients’ return to the Netherlands, thereby inducing further service use abroad.ConclusionsAlthough cultural system influences are difficult to bridge, measures to reduce the unwelcome consequences of transnational healthcare use may include (1) strengthening the provision of culturally sensitive care in the country of residence and (2) restricting the reimbursement of care in the country of origin while maintaining the option to obtain care abroad.