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Article
Publication date: 10 December 2020

Fahimeh Mianji, Jann Tomaro and Laurence J. Kirmayer

In light of the growing number of refugees and immigrants in Canada, this paper aims to identify barriers to mental health services for newcomer immigrants and refugees in Quebec…

Abstract

Purpose

In light of the growing number of refugees and immigrants in Canada, this paper aims to identify barriers to mental health services for newcomer immigrants and refugees in Quebec and to examine how mental health services can be improved for these populations.

Design/methodology/approach

In this qualitative study, semi-structured individual interviews with Farsi-speaking health professionals and focus group interviews with participants from community organizations in Quebec were conducted.

Findings

Participants, both health-care professionals and community members, reported that mental health services are not readily accessible to Farsi-speaking immigrants and refugees. Structural barriers, language barriers, cultural safety and stigma were identified as obstacles to accessing care. Recommended strategies for improving access to mental health care are discussed.

Originality/value

Multiple studies have found that language and cultural barriers are associated with health inequalities and under-utilization of mental health services among linguistic and ethnic minorities. However, there are limited data on many groups and contexts, and a need to better understand how language barriers affect health outcomes, service utilization, patient satisfaction or overall costs to the health system or to society. In response to this gap, the present study explores how access to mental health services for Farsi-speaking newcomers may be limited by structural and linguistic barriers and cultural differences and as well as to identify strategies that can reduce the identified barriers.

Abstrait

Objet

Compte tenu du nombre croissant de réfugiés et d'immigrants au Canada, cette étude vise à identifier les obstacles aux services de santé mentale pour les nouveaux arrivants immigrants et réfugiés au Québec et à examiner comment les services de santé mentale peuvent être améliorés pour ces populations.

Conception/méthodologie/approche

Dans cette étude qualitative, des entretiens individuels semi-structurés avec professionnels de la santé parlant le Farsi et entretiens avec des participants des organisations communautaires au Québec ont été menées.

Résultats

Les participants, tant des professionnels de la santé que des membres de la communauté, ont déclaré que les services de santé mentale sont inaccessibles aux immigrants et réfugiés parlant le Farsi. Obstacles structurels, les barrières linguistiques, la sécurité culturelle et la stigmatisation ont été identifiées comme des obstacles à l'accès aux soins. Les stratégies recommandées pour améliorer l'accès aux soins de santé mentale sont discutées.

Originalité/valeur

De nombreuses études ont montré que les barrières linguistiques et culturelles sont associées à les inégalités en matière de santé et la sous-utilisation des services de santé mentale chez les minorités linguistiques et ethniques. Cependant, les données sont limitées sur de nombreux groupes et contextes, et il est nécessaire de mieux comprendre comment les barrières linguistiques ont une incidence sur les résultats de santé, l'utilisation des services, la satisfaction des patients ou les coûts globaux pour le système de santé ou à la société. En réponse à cet écarte, la présente étude examine comment l'accès aux services de santé mentale pour les nouveaux arrivants parlant le farsi peuvent être limités par des barrières structurelles et linguistiques et des différences culturelles, ainsi que d'identifier les stratégies de réduire les obstacles identifiés.

Article
Publication date: 15 September 2020

Mahan Mobashery, Ulrike von Lersner, Kerem Böge, Lukas Fuchs, Georg Schomerus, Miriam Franke, Matthias Claus Angermeyer and Eric Hahn

An increasing number of migrants and refugees seeking asylum in Germany is challenging psychiatrists and psychotherapists in multiple ways. Different cultural belief systems on…

Abstract

Purpose

An increasing number of migrants and refugees seeking asylum in Germany is challenging psychiatrists and psychotherapists in multiple ways. Different cultural belief systems on the causes of mental illness and their treatment have to be taken into consideration. The purpose of this study is to explore perceived causes of depression among Farsi-speaking migrants and refugees from Afghanistan and Iran, which represent two groups with a shared cultural heritage, but originating from very different regimes of mobility. Both are among the largest migrant groups coming to Germany over the past decade.

Design/methodology/approach

In total, 50 Iranian and 50 Afghan migrants and refugees, who arrived in Germany in the past 10 years were interviewed, using an unlabeled vignette presenting signs and symptoms of depression. The answers were then coded through inductive content analysis.

Findings

Among Iranians, there was a more significant number of causal attribution to Western psychiatric concepts, whereas Afghans attributed depression more often to the experience of being a refugee without referring to psychological concepts. These differences in attribution did, however, not affect the desire for a social distance toward depressed people. Nonetheless, a higher number of years spent in Germany was associated with less desire for social distance toward persons with depression among Afghans, but not among Iranians.

Originality/value

To the best of the knowledge, this is the first study examining perceived causes of depression with Farsi-speaking migrants in Germany and contributes to understanding tendencies in the perception of depression in non-Western migrant groups.

Details

International Journal of Migration, Health and Social Care, vol. 16 no. 3
Type: Research Article
ISSN: 1747-9894

Keywords

Article
Publication date: 1 September 2006

Nadia Robb and Trisha Greenhalgh

This article explores issues of trust in narratives of interpreted consultations in primary health care.

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Abstract

Purpose

This article explores issues of trust in narratives of interpreted consultations in primary health care.

Design/methodology/approach

The paper is based on empirical data from a qualitative study of accounts of interpreted consultations in UK primary care, undertaken in three north London boroughs. In a total of 69 individual interviews and two focus groups, narratives of interpreted consultations were sought from 18 service users, 17 professional interpreters, nine family member interpreters, 13 general practitioners, 15 nurses, eight receptionists, and three practice managers. The study collected and analysed these using a grounded theory approach and taking the story as the main unit of analysis. It applies a theoretical model that draws on three key concepts: Greener's taxonomy of trust based on the different “faces” of power in medical consultations; Weber's notion of bureaucratic vs traditional social roles; and Habermas' distinction between communicative and strategic action.

Findings

Trust was a prominent theme in almost all the narratives. The triadic nature of interpreted consultations creates six linked trust relationships (patient‐interpreter, patient‐clinician, interpreter‐patient, interpreter‐clinician, clinician‐patient and clinician‐interpreter). Three different types of trust are evident in these different relationships – voluntary trust (based on either kinship‐like bonds and continuity of the interpersonal relationship over time, or on confidence in the institution and professional role that the individual represents), coercive trust (where one person effectively has no choice but to trust the other, as when a health problem requires expert knowledge that the patient does not have and cannot get) and hegemonic trust (where a person's propensity to trust, and awareness of alternatives, is shaped and constrained by the system so that people trust without knowing there is an alternative). These different types of trust had important implications for the nature of communication in the consultation and on patients' subsequent action.

Research limitations/implications

The methodological and analytic approach, potentially, has wider applications in the study of other trust relationships in health and social care.

Practical implications

Quality in the interpreted consultation cannot be judged purely in terms of accuracy of translation. The critical importance of voluntary trust for open and effective communication, and the dependence of the latter on a positive interpersonal relationship and continuity of care, should be acknowledged in the design and funding of interpreting services and in the training of both clinicians, interpreters and administrative staff.

Originality/value

This is the first study in which interpreted consultations have been analysed from a perspective of critical sociology with a particular focus on trust and power relations.

Details

Journal of Health Organization and Management, vol. 20 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 16 March 2015

Maureen Mayhew, Karen J. Grant, Lorena Mota, Setareh Rouhani, Michael C. Klein and Arminée Kazanjian

The purpose of this paper is to describe the patient level characteristics of government-assisted refugees (GARs) who had acquired family doctors after leaving specialized refugee…

Abstract

Purpose

The purpose of this paper is to describe the patient level characteristics of government-assisted refugees (GARs) who had acquired family doctors after leaving specialized refugee clinics (RC).

Design/methodology/approach

A cross-sectional telephone survey of GARs households, three to six years after arrival to British Columbia, that used logistic regression to identify GAR characteristics associated with having a family doctor compared to having no family doctor or remaining at a RC.

Findings

Contact rate was 52 percent. Of 177 interviewed GARs who spoke 24 languages, only 61 percent had secured a family doctor. Only 57 percent were educated; 46 percent spoke English and 40 percent worked consistently. Central Asian or African origin was associated with having a family doctor (OR 10.6 (95 percent CI 3.1-36.8) for RC; OR 10.3 (95 percent CI 2.2-47.8) for no family doctor). Other significant characteristics in the comparison with GARs at a RC included English proficiency (OR 15.6 (95 percent CI 4.3-56.9)), and female sex (OR 4.0 (95 percent CI 1.4-1.1)). When compared to those with no family doctor, additional significant characteristics included Health Authority A compared to B (OR 8.9, 95 percent CI 1.4-55.6) and having recently visited a doctor (OR 7.7 (95 percent CI 1.9-30.7)).

Research limitations/implications

The results of this study are limited to a specific environment and the low contact rate may have resulted in bias.

Originality/value

This study described characteristics of GARs who had successfully transitioned to a family doctor and those who had not. This population is rarely captured in studies because they are difficult to contact, ethnically diverse and not proficient in English.

Details

International Journal of Migration, Health and Social Care, vol. 11 no. 1
Type: Research Article
ISSN: 1747-9894

Keywords

Article
Publication date: 30 March 2010

Beverley Costa

Many people accessing services, including counselling services, do not speak the official language of the country in which they find themselves. This paper first considers, in…

Abstract

Many people accessing services, including counselling services, do not speak the official language of the country in which they find themselves. This paper first considers, in general terms, the way that language is used to negotiate relationships and to structure and provide meaning for our experiences, needs, feelings and ideas. This is then related to the use of native language in therapeutic work and the practical issues that this can present for services.The paper then reports on a small‐scale informal piece of research that was conducted in 2009 by Mothertongue multi‐ethnic counselling and listening service with six bilingual and multilingual counsellors, none of whom were native English speakers. The aim was to explore what might be learned from their experience of living with more than one language and then to apply this to the task of communicating in English with non‐English speakers in the therapeutic relationship.Some practical observations and suggestions are included in this paper. These incorporate the themes that emerged from the research such as: attending to clients' linguistic history; the way in which emotions are expressed in different languages; how speaking more than one language impacts on identity formation and the ability to understand across languages and culture; how we convey and construe significance and meaning; how we relate to people's experiences of learning a language. The author of this paper hopes that these findings and observations will stimulate further conversations on this topic.

Details

Ethnicity and Inequalities in Health and Social Care, vol. 3 no. 1
Type: Research Article
ISSN: 1757-0980

Keywords

Book part
Publication date: 2 July 2010

Kristian Berg Harpviken

For over three decades, Afghanistan has been a battleground in which many of the states of the wider neighbourhood have been involved. The importance of fostering a concerted…

Abstract

For over three decades, Afghanistan has been a battleground in which many of the states of the wider neighbourhood have been involved. The importance of fostering a concerted effort for Afghan peace and stability is widely agreed upon, yet such a process remains difficult to bring about. Some analysts emphasize states and their security relationships, seeing Afghanistan as an ‘insulator’ caught between different regional state systems, each with a strong dynamic of its own. Other analysts emphasize various transnational networks and see Afghanistan as the ‘core’ of a larger conflict formation. This chapter takes as its starting point the former perspective, which has been codified by Barry Buzan and Ole Wæver (2003) as the regional security complex (RSC) approach. The chapter examines the security dynamics of each of the regions surrounding Afghanistan – South Asia, the Persian Gulf and South Asia – adopting a comparative and historical perspective, with an emphasis on the period since the late 1970s. It concludes that each of Afghanistan's three surrounding regions is characterized by deep security concerns of its own. These concerns nonetheless inform the engagement of neighbouring countries in Afghanistan, which then comes to reflect conflicts and cleavages specific to the respective regions. One central implication is that a more promising strategy for Afghanistan might be to seek a unilateral non-offensive or neutral status, rather than full security integration with its neighbours. Although such a strategy would necessitate the creation of a forum for Afghanistan's neighbours to foster understanding for the Afghan position, it represents a dramatic departure from mainstream policy proposals with their emphasis on an integrated regional approach.

Details

Troubled Regions and Failing States: The Clustering and Contagion of Armed Conflicts
Type: Book
ISBN: 978-0-85724-102-3

Book part
Publication date: 22 December 2006

Milton J. Esman

What were the functions of public administration within this paradigm? Because of the expanding role of the state in promoting and guiding development and because of the…

Abstract

What were the functions of public administration within this paradigm? Because of the expanding role of the state in promoting and guiding development and because of the increasing complexity of modern economies, good public management was obviously necessary. The capabilities of the state and of its administrative organs would have to be increased, and rapidly, in order to cope with new requirements both from the productive sectors and from the “nation building” and welfare services instituted by post-colonial governments to legitimatize new regimes. This explosive expansion of the state and its heavy dependency on public administration implied the need for rationalization of government services, in effect Weberianization of the structures and procedures of the burgeoning public bureaucracies.

Details

Comparative Public Administration
Type: Book
ISBN: 978-1-84950-453-9

Article
Publication date: 19 August 2021

Martin Joseph Gannon, Babak Taheri and Ross Croall

Heritage management is underpinned by preservation, sustainability and generativity; concerns of obvious interest to domestic audiences. However, domestic tourists are not…

Abstract

Purpose

Heritage management is underpinned by preservation, sustainability and generativity; concerns of obvious interest to domestic audiences. However, domestic tourists are not homogenous and can be differentiated by various characteristics, including proximity to the sites they visit. Drawing upon the consumer-based model of authenticity, this study investigates whether the influence of authenticity, self-connection and serious leisure hold over experience memorability differs for distinct domestic visitor groups.

Design/methodology/approach

To investigate perceptual differences between “local” and “non-local” domestic visitors, the authors developed and tested a conceptual model using a sample of 320 heritage site visitors within Tabriz, Iran, investigating the effects of self-connection, serious leisure and perceived authenticity on memorable tourism experiences (MTEs) for both groups.

Findings

Significant inter-group differences regarding the influence of serious leisure and self-connection on visitors' perceptions of authenticity emerged. Similarly, the extent to which serious leisure, self-connection and authenticity influenced MTEs also differed. The effect sizes for all proposed relationships were larger for local visitors.

Originality/value

Hospitality and tourism literature often focuses on the boon that inbound international and non-local domestic tourism can bring to local sites and attractions. However, the findings encourage heritage tourism managers to focus greater attention on attracting custom from “closer to home”. With local visitors demonstrating strong pre-, during and post-visit outcomes, the findings suggest local domestic visitors are a market ripe for greater investigation given ongoing international travel restrictions and Iran's historically-limited international appeal.

Details

Journal of Hospitality and Tourism Insights, vol. 5 no. 5
Type: Research Article
ISSN: 2514-9792

Keywords

Article
Publication date: 11 April 2008

Jacques Richardson

The purpose of this paper is to demonstrate how admonitions to apply forethought in planning and execution may trap, deceive or discourage even the most circumspect of experienced

Abstract

Purpose

The purpose of this paper is to demonstrate how admonitions to apply forethought in planning and execution may trap, deceive or discourage even the most circumspect of experienced managers and leaders.

Design/methodology/approach

A series of real‐life experiences are cited, in most of which foresight, evoked and encouraged by personalities of recognized authority, largely failed to hold its promise.

Findings

With determined intentions behind their conception, design and materialization, some processes and creations do not fulfil their promise because of human or other failing.

Research limitations/ implications

Space available is the limiting factor here for the presentation of case examples.

Practical implications

The instances cited are expressly concrete failures in applied foresight. Avoiding such pitfalls should be the best way of profiting from the instances used as illustrations.

Originality/value

Planners, strategists and designers should be able to take advantage of the illustrations used – especially in those cases when foresight goes completely wrong

Details

Foresight, vol. 10 no. 2
Type: Research Article
ISSN: 1463-6689

Keywords

Article
Publication date: 30 July 2019

Ron Berger, Ram Herstein, Daniel McCarthy and Sheila Puffer

The purpose of this paper is to analyze the role of Wasta, a culturally based system of social networks of exchange among in-group members in the Arab world, as exemplified by…

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Abstract

Purpose

The purpose of this paper is to analyze the role of Wasta, a culturally based system of social networks of exchange among in-group members in the Arab world, as exemplified by three groups of Arabs in the Palestinian Authority, and then compares it to Guanxi (China), Sviazi (Russia) and JaanPechaan (India). The use of social networks is a common business model around the world to accomplish business objectives and is especially relied upon in emerging economies where formal institutions are weak. It is important to understand the commonalities and differences in the use of reciprocity in various cultural contexts in order to conduct business effectively. The aim of the paper is to illustrate the structure of Wasta and how it is perceived and constructed among three Arab social groups, and then compare and contrast it with social business models in three other high context cultures.

Design/methodology/approach

Qualitative approach based on interviews to better understand the relationships involved.

Findings

The findings provide the foundation for a number of critical insights for non-Arab managers seeking to do business in the Arab world. For international managers to conduct business successfully, it is essential to understand how Wasta works, and establish relationships with members of influential social networks by building trust over time such that they create Wasta for themselves and indirectly for their firms. Using Wasta in the Arab world, as noted above, is similar to doing business successfully in other emerging economies such as using Sviazi in Russia (McCarthy and Puffer, 2008; Berger et al., 2017), Guanxi in China (Yen et al., 2011) and Jaan–Pechaan in India (Bhattacharjee and Zhang, 2011). The authors feel more confident in stating this view after comparing Wasta with these other three concepts, and noting that all four are built upon the same fundamental constructs.

Research limitations/implications

The authors recognize that the study is limited in terms of the geographical sample since it does not include any non-Palestinians, although the managers the authors sampled came from various regions in the Palestinian authority. Additionally, Palestinian managers are highly educated and mobile, and can be found in many other Arab countries working in managerial positions (Zineldin, 2002), thus potentially broadening the generalizability of the findings. Nonetheless, the samples would be called ones of convenience rather than randomly drawn from the three groups, since the latter would be extremely difficult to execute not only in the Palestinian Authority but in most of the Arab world due to the culturally based reluctance to provide sensitive information to those outside one’s network. Despite the difficulties that might be involved in exploring such culturally sensitive issues as the authors did in this study, the benefits in knowledge gained can be of significant importance to the study of international business in emerging and transition economies.

Originality/value

Little research has focused on the use of Wasta in the Arab world, a gap which this paper addresses. The authors do so by analyzing the views of Wasta held by three important groups – leaders, business people and students. While each type of reciprocity has its own unique characteristics, the authors focus on three interrelated constructs that have been found to underlie the use of reciprocity in various cultures. In the Arab world, these are Hamola, which incorporates reciprocity; Somah, that incorporates trust; and Mojamala, which incorporates empathy through social business networks.

Details

International Journal of Emerging Markets, vol. 14 no. 5
Type: Research Article
ISSN: 1746-8809

Keywords

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