Cultural barriers to health utilization for migrant women

The study explored the cultural health beliefs of migrant women as a necessary factor in understanding their utilization and experiences. Accordingly, the findings from this study regarding the healthy lifestyles, health beliefs, language, and health-seeking behaviors of

migrant women provided valuable information from which the experiences of migrant women in accessing health services can be understood.

In this study, migrant women held the condition of being healthy to be defined by physical, mental, and social aspects. This definition in turn guided their health behaviors as they sought to achieve health on those aspects. Beliefs regarding the causes of illness varied from

combinations of environmental, genetics, personal responsibility to curses and spiritual factors.

These findings align with the definition of culture and its influence in the literature. Culture is noted to shapes how people perceive the world and their experiences, and therefore, how both care providers and patients view health and illness (Mayhew, 2018).

As noted in the literature, cultural health beliefs are how people perceive illness, explain pain, define quality care, and select their caregiver. Cultural factors include health beliefs, acceptance of health services, and language proficiency. Also, as noted in the literature, health-seeking behaviors are a precursor to actual health care utilization, although the concepts being closely related. (Ejike, 2017.)

In tandem with the beliefs about the dimensions of being healthy and illness, migrants require and value care for both physical and mental health conditions. However, the current study found both care-seeking behavior and utilization of care among migrant women to be influenced by culture in several areas. First, there is a high reliance on traditional treatment modalities as self-care and the primary line of treatment for various ailments among migrant women. Treatment from the health care system was sought only for severe chronic health conditions. This finding is related to the culture of the migrant women as they were all from eastern cultures, with the majority being from Indian and Oriental cultures where there is high use of traditional medicine.

This finding is also reported in the literature: some cultures rely on western medicine primarily while other cultures rely on traditional medicines as a primary system of treatment; health-seeking behavior of people will therefore vary depending on the belief they hold regarding each system of medicine (Mayhew, 2018).

Expression of illness among migrant women was influenced by culture. There was the frequent demonstration of stoicism (tolerance) in the case of pain or illness. In our findings, migrant women’s acceptance was sometimes their understanding of health and shaped by cultural forces as they were practiced. therefore, they considered certain kinds of care were requested or

rejected based on cultural beliefs. These findings are supported by the literature on the impact of culture on health. According to Mayhew (2018), culture influences how people perceive and express ill-health such as how people express pain; in some cultures, stoicism, or tolerance in the face of great pain, while in other cultures such symptoms would have been expressed, investigated, and treated. Culture also influences decisions about and what diagnosis and treatments are accepted (Ejike, 2017; Mayhew, 2018).

This study found that migrant women found it challenging to communicate clearly and to describe their symptoms and requests where they did not speak Finnish/Swedish or did not speak it well enough to express themselves clearly. The official languages being spoken in Finland are Finnish and Swedish; 86.9% of the population speak Finnish while 5.2% speak Swedish (Statistics Finland, 2020), with these languages being used predominantly in the health care sector. A similar result was found where patients who are not proficient in the language of

the host country may not be able to explain their health problems clearly and or to understand the information, they receive from providers (Fernandez et al., 2011). Language barriers also served as the factor that discouraged some migrants from attempting to seek help even in the absence of other barriers. This is again supported by previous studies that found that

immigrants with limited language proficiency and who resided in the host country for less than ten years had lower access and lower rates of health care utilization (Leburn,2012). Another important finding of this study was that some providers are also not proficient in English, compounding communication difficulties for migrant women. This factor has also been identified in the literature as a contributor to barriers to migrant health care access (Karanja, 2013).

Environmental contexts such as the geophysical, spiritual, socio-political, ecological, expectation of using modern or traditional care, financial resources, knowledge regarding care options, and technologic factors, located within migrant contexts, are described as being closely related to cultural contexts. Such factors are described in the literature as having the capacity to serve as a barrier of a facilitator for health-seeking and health care outcomes (Ejike, 2017; McFarland &

Wehbe-Alamah, 2019). The current study found that spiritual belief while occurring in the health beliefs and behaviors of migrant women, did not necessarily affect their decisions about

utilization. Care knowledge affected their decisions positively, housing contexts did not affect their health care decisions, and expectations for modern care only affected their health care utilization in the sense that they used to care for chronic conditions and severe conditions while using traditional care and self-help techniques for minor illnesses. The perception of what constitutes minor illness is also influenced by culture as migrant women are more tolerant.

The literature describes structural factors that affect health care utilization as factors such as affordability (lack of financial resources), accessibility (lack of knowledge, lack of transportation, or lack of insurance), and availability of services (Ejike, 2018). Some of these factors are

important from the perspective of access to care for migrant women. The study found that migrant women were able to access the full scope of services they need. Although the study did not seek to investigate the legal status of participants, from their demographic data such as

employment and education history, these migrant women had the legal status that afforded them access to health services. As noted in the literature, legal status is the most important factor directly affecting health and social services access for migrants and refugees. In Finland, only documented migrants have access to the same care and resources as citizens of the country. (Chiarenza et al., 2019.)

The current study did not identify discrimination as a barrier to health care utilization among the participants. There were no experiences of discrimination based on race. While this study

participants intentionally were migrant women from Eastern countries, these findings may not represent other migrant women’s opinions on that. Discrimination is described in the literature as unjust or prejudicial treatment based on diversity factors such as race, age, or sex (Cambridge Dictionary, 2021). Discrimination, where it exists, can be a deterrent to health care utilization (Shrestha, 2017).

This study findings suggest that migrant women who are working and well-positioned to access health care services are not affected by socio-economic forces as a barrier to health care

utilization. Social and economic factors are, therefore, important as barriers depending on the economic and social profile of the migrant, rather than being a general factor that affects health care utilization. For example, language barriers would be the same for all migrants who do not speak the Finnish language irrespective of their level of income. Research evidence shows that socioeconomic factors affect how migrant’s access to care and their level of health care

utilization (Ejike, 2017; Shrestha, 2017).