For a list of all new publications from the first quarter of 2017, click here
At the closure of this new quarter we have tried to trace the articles published by members and non-members again. The sheer number of articles identified alone already testify to the relevance of our topic of interest. In this post about the last quarter, I again highlight two articles that discuss related topics. The first is an article published by, among others, fellow AAGE member Lynette Leidy Seivert about the experience of hot flashes among Mayan and non-Mayan women in Campeche state, Mexico (Huicochea-Gómez et al. 2017). The second concerns an article published by Kaitrin M. Jacklin and co-authors (Jacklin et al. 2016) about the experiences of indigenous people with Diabetes type II with Canadian health care.
First author Huicochea-Gómez together with our AAGE member Leidy Seivert researched 85 women through open-ended interviews about the menopausal transition to understand which aspects of a woman’s life shapes her hot flash experience. About half of the women interviewed described experiencing hot flashes that were associated with menopause. The authors found that the terms calores and bochornes were most often used, but they also found these terms were also used for other experiences, such as climate depending on the living location of the women. For instance, women in the city of Campeche working in a government office described menopausal hot flashes as calor but flashes caused by ambient temperature were also called calor. The researchers used the qualitative data to verify the meaning in context.
They also found through quantitative analyses that the frequency of reporting menopausal hot flashes depended on the proximity to the city of Campeche. However, the qualitative data analyses further detailed that in fact, this seemed more related to the level of medicalization of the community. The women in the rural community of Cristóbal Colón reported similar frequencies of hot flashes as the office workers in the city of Campeche and used similar biomedical framing to discuss menopausal hot flashes, probably due to the mobile health centers that regularly came to their community. This is in contrast to rural and semi-urban locations of Ich Ek and Xmabén that might see mobile health centers only every two or three years. Women in these locations also referred much less to a biomedical framing of hot flashes, and there were differences in support, e.g. rural women were more likely to discuss hot flashes with their husband than urban women and there were differences in marital and occupational situation and stress. The authors show “the importance of identifying the words and ideas that women use to describe their experiences of hot flashes” (p. 61) and integrated these findings in a quantitative survey they developed afterwards.
The second article, by Kristen Jacklin and colleagues, discusses the findings of five sequential focus groups and three in-depth interviews. The analyses of the experiences of indigenous patients with type II diabetes were categorized into four themes: the colonial legacy of health care, the perpetuation of inequities, structural barriers to care and the role of health care relations in mitigating harm. The authors find that indigenous people experiences of “interactions and engagement with health services are influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care” (p. E111). Among these experiences are traumatic interactions with Canadian health care in the past, for instance being denied care, or being forced care or experiencing an authoritarian attitude of healthcare staff. Also important were racist, stereotypical or discriminatory structures of care and contact with Canadian health care staff. This has resulted in mistrust in the health care system and the health care providers and this, the authors argue, may lead to nondisclosure. They found that the harm done by these historic and current experiences could be mitigated through positive interactions with physicians and adaptive communication styles. For instance, physicians who took effort to involve family members, or who showed interest in indigenous practices, or who would phone patients at home were appreciated by the participants and restored some of the trust in the health care system. In essence, the findings clearly indicate that showing interest in the lifeworld of indigenous patients can increase the perceived effectiveness of clinical encounters. Given these findings, Jacklin and colleagues recommend to take a patient-centered, trauma-informed approach to clinical encounters with indigenous people.
Two strengths in both these articles, besides others, stand out. First the articles succeed very well in translating their findings to the medical practice and doing this in such a way that clinicians will be able to take their advice to their offices. Jacklin et al. and Huicochea-Gómez bring their results closer to everyday clinical practice eloquently by integrating relevant quotations and short case histories. A second strength is the multi-method approach they use, integrating qualitative and quantitative data, therewith also clearly showing the added value and importance of qualitative research. Both of these articles emphasize the great value anthropological fieldwork and qualitative research can have to ensure that healthcare comes closer to the lifeworld of patients.
On a more critical note, some anthropologists may feel that the complexity of their findings may never be fully done justice by the translational approach that is – at current – at least often necessary for clinicians to integrate their findings. Although it may be true, indeed, that our findings may be too complex to be fully integrated in clinical practice, even the tiniest shred that brings our understanding to the better of these patients is worth a shot.
Huicochea-Gómez, Laura, Lynnette Leidy Sievert, Diana Cahuich-Campos, and Daniel E. Brown
2017 An Investigation of Life Circumstances Associated with the Experience of Hot Flashes in Campeche, Mexico: Menopause 24(1): 52–63. accessed January 6, 2017.
Jacklin, K., A. Ly, B. Calam, et al.
2016 An Innovative Sequential Focus Group Method for Investigating Diabetes Care Experiences With Indigenous Peoples in Canada. International Journal of Qualitative Methods 15(1). accessed January 6, 2017.
For a list of all new publications from the first quarter of 2017, click here
For last quarter of 2016 publications, click here
