5 Results
5.2 Interview findings
5.2.2 Theme 2: Health behavior among migrant women
This theme identified the health behaviors of the participants, the action they take when they do become ill. Three sub-themes were identified under this theme as reporting of symptoms, where do the sample of migrant women seek help when they get ill, and health-related decision-making among the sample.
Sub-theme 1: Healthy lifestyle
This sub-theme examines how conscious of health the samples are and the actions they take to stay healthy. The actions identified include a healthy diet, exercise, and physical activity,
maintaining emotional health, and good sleeping habits. The methods for maintaining emotional health described varied and included stress control, studying, performing Yoga, and socializing.
Over half of the participants mentioned healthy eating and exercise as being important to them and others expressed sleep as one of the important activities necessary for health. For instance, one stated that:
“Well, myself I take good care of my diet, exercising, or avoiding new sources of disease.
Regarding the mental or psychological part, I kick myself socializing with others. I like social coherence with others, talking to my family, friends, those who support me when I am feeling down” (P9).
“...Yoga like 15 minutes in morning and 15 minutes evening. In my family, we are doing yoga since the last 25 years. since we are child, we have taught yoga that about the best way. Luckily in our family, we do not have a such chronic disease. Still, I have both my grandparents”.
P8 also said that, “I usually doing follow up, but also that I try to follow balanced diet that
nowadays, I walk for 40 minutes in the evening regularly at least six days in a week. I tried” (P12).
Sub-theme 2: Help-seeking activity
The majority of the participants focused on self-help or traditional treatments when they have any symptoms, except for participants who had a specific health condition that required them to seek hospital care or visit a doctor with some regularity.
“First, I will do some kind of home remedies. Let us say like, I will drink hot water, or I will make some herbs like ginger and turmeric and honey in that one, and I drink that first. And then like, if the pain does not subside, then I go for painkillers” (P2).
“Actually, I will tolerate it a little bit at first, and then I'll go to the doctor if it takes a few days. The first few days I try to ignore it and don’t think about it or to do self-treatment” (P1).
“Well, it depends on the severity of pain or illness, if it is like, some flu things, so I just take the home remedy and rest. And if it is some something severe out of hand, I immediately seek a doctor advice or the nurse” (P11).
Sub-theme 3: Health-related decision-making
In terms of whom they relied on for decision making, some said they relied on themselves who were health care professionals; others relied on self initially and then consulted a doctor later when the condition is severe; some relied on self in addition to family and friends, while few participants count on friends or only depend on family. In terms of relying on self, being a worker also influenced independent decision-making.
“Self- No, actually because like, obviously the elder in my family is my parents and my brothers and sisters. But as myself, I am health professional, they leave everything up on me. Because they believe that I know better than them. And in our family, gender it doesn't matter anything”
(P2).
One participant reported relying on self for health-related decision-making. She stated that:
“It is only me because I'm also an expert so I know what I am doing and the decisions that I'm taking but I have to tell that I also trust like giving the decision for someone else that my brother
is also a …, he has quite good knowledge. So, I trust his consultation he never makes a decision”
(P9).
Noting that one participant was independent in making decisions but will consult family and workers.
“Actually, I am completely independent, and I cannot say that the family has to decide for me, they do not say anything, but I consult them myself because I am basically a person who consults a lot, like, what do we do now? Either we come up with a result or before that, I will consult my friends who are doctors, and then I will tell my family that this happen to me and I decided to do this treatment” (P1).
The above statements indicated that participants who consulted health care workers did so formally when there was a severe condition while some consulted health care workers informally as friends.
5.2.3 Theme 3: Impact of culture on the use of health care services
This theme coalesces the data on how cultural factors affect access and use by migrant women.
The sub-themes that emerged under this theme are the role of language and communication, and the influence of cultural traditions.
Sub-theme 1: Role of language/communication
The majority of the participants reported that language was not a barrier to their utilization of health services, even though for some of them it did create a challenge. It was challenging to explain their symptoms and their health histories where the nurses and doctors were not very good at English and interpreters were not provided. However, this challenge did not constitute a barrier to use. Few of the sample considered language to be a barrier such that they feel
discouraged from going to use health care services. Some of the participants communicated in both English and Finnish to help them navigate the communication challenge.
“Finnish? Actually, I do not know that well, but sometimes when I go to health care professionals, like let say to the nurses, some nurses like they are quite uncomfortable in speaking English language..., so they so I tell them that you can use both like because I have some ideas in Finnish words as well” (P2).
“Some of them don't have good English language skill, to tell you the truth ...if I know my sickness is difficult to make them understand, I'll get help from my friend who's a doctor to tell me a medical terminology ...or we'll google the point and make them understand and help each other” (P1).
Representing an example of a participant who does not perceive language to be a barrier, one woman stated that, “I had a bit of medical background like I'm a pharmacist, so I used to like, understand what they want to say. I used to make it easier to communicate like by giving them the word like "is it this you want to tell me?", or "is it so you want to ask me?" so it went okay”
(P11).
However, one person proffered that language is a barrier, stating that:
“I try to get an interpreter because I don't speak Finnish and my English is not good, and some places with sign and gesture that you are in pain or not?... it's very difficult for me and people like me who emigrated because we don't know the language and we say, it's okay we go to the
doctor later when we get better in language” (P10).
One even suggested that migrants wait to learn the language before going to access health services. Similarly, another person described language as a barrier to health services use:
“…Very difficult. That might be another reason I am not even going to hospitals. That also possible. for example, I have this lower back pain problem...I went, many times but then, not many times couple of times maybe. But then, it did not work out and then I honestly feel like there is not good much effort from the hospital side, so I stopped going” (P13).
Sub-theme 2: Influence of cultural traditions
Most of the participants did not identify any cultural barriers to their use of health services. They did not identify any cultural taboos that hinder their use of health services. Their statements
indicated a mixture of not following traditions as well as acceptance of the setting as a place where taboos do not apply too deeply. This attitude may be explained by the fact that most of the participants were holding high education levels while more than half of the samples were health professionals. Some participants stated their preferences for female doctors for certain procedures, but there was also a willingness to receive services from male doctors.
“Culture wise I think it is fine, because when we are going to doctor is hardly matters the gender, because they are expert, and they are taking it is fine for me. Does not makes a difference nowadays...Yeah that is right I am vegetarian, but I think most of the time we have. I have eaten eggs also and some like tablets of fish oil tablets, but it is acceptable by my family also and cultural so there's not a problem” (P13).
Some participants mentioned the gender of the care provider to be an issue when receiving certain procedures.
“Yes, well, because of Islamic culture, many women are for these issues, and they prefer to do this with the woman, especially the check-up that concerns the women, but it depends again on the person, but for the ladies, it is very important” (P4).
“...for girls we prefer the lady doctor or lady nurse because the physical touch... Because it is a physical because if she wants to show some private area so she would prefer a lady nurse than, a male doctor so in my country it is there. They are so first they will, especially for the pregnant ladies. They prefer to work with the lady doctor” (P6).
None of the participants identified diet as a barrier to health service use. While some described the dietary taboos in their cultures, it was not connected in any way to their use of health care services. For example, one participant said:
“We don't eat some meat in our culture, so it is understood, we don't eat horse meat, we don't eat pork, like we don't eat frog meat, maybe they eat in other countries...”. However, these statements were not linked to use of health services.
Also, one woman said she would put aside personal preferences regarding food if the doctor told her, it was the only option for healing. She stated:
“I don't prefer having Pork, but like as I said if something is like I am in condition that is the only cure I have, if it is, I don't believe it is like that. Like, if I take pork, it will cure me the doctor says that it will benefit. I have and it is only the last option left for me” (P7).
Some participants also said that even if they refuse eating certain foods, it was based on personal reasons, not cultural reasons.
5.2.4 Theme 4: Experiences of cultural competency in the Finnish health care service
This theme combined the information regarding the experiences of the participants as it relates to cultural competency demonstrated by health care providers.
Sub-theme 1: Comparative views on health care services in Finland and home country
The participants described differences between the health care services in their country and Finnish health care facilities. A common description of the health care services in Finland was that it was better organized.
“To be honest, their respectful behavior and their patience, it was very strange to me because in my home country we don't have this. And that a lot of things are organized, I take time online and, on the phone, to see my doctor, and I see my doctor on a certain time, and sometimes Ido not need to see the doctor at all, and the nurse can do it, these things are very different from the system of my home country” (P1).
A common experience among participants was also the lengthy process associated with receiving care. Participants described that not only did they require appointments to get care, but the process of getting specialist care was also long and slow.
“Yeah, because like in my country, it is not like, because obviously, the system in Finland is much more better than what is in my country. But like in my country, we don't have to wait for the appointment if we have to go to the doctor. Because if you have money, then you can go and
have all that treatment, but here like you have to wait for the appropriate time... first they will send you to the nurse and then after that a nurse can come and go to the doctor” (P2).
“Yeah, seeking the medical specialist doctor is really hard in Finland. I even now I don't like it. I'm surprised for it. They just linger you on the General Practitioner (GP) for a long, long time. And the specialist is like cut-off person that you have to pass so many reserves of the GP to reach to the specialist, that they take hell of time” (P11).
Sub-theme 2: Response to cultural needs
The majority of the participants reported no problems concerning response to their cultural needs, primarily because they had no cultural needs on their minds, and they had no
expectations that they would be singled out for a different kind of treatment because of their home cultures. Two participants reported issues regarding culture, one was concerning difficulty describing emotional distress and cause of the depression to a psychologist, while the other was regarding a request to avoid a certain invasive procedure (Transvaginal Ultrasound for
unmarried women).
“…that specialist doctor to call me and maybe I didn't understand, but they didn't follow up.
Because we had cultural problem, I was telling them I cannot do internal Sonography and they were telling, we don’t know other way and they were not ready listen to me” (P1).
Sub-theme 3: What works well in the Finnish health care system
The participants listed many aspects of care they received that were exceptional. A participant stated that received free tests:
“Yeah, cheaper, and then, like, if I had to get some kind of blood tests or something like this laboratory tests, then it was also free” (P2).
“working well, many things. The nurses are well trained. The doctors are good as well. They listen to you, they spoke to you, they obviously, explain you well whenever ask, and especially when you are at a specialist chamber they deal very well” (P1).
Other responses included the demonstration of equity in health care and support from the social insurance institution for persons who cannot pay for care and methodological approach to diagnosis, patient assessment, and service delivery.
Sub-theme 4: Cultural awareness and culture sensitivity among nurses
There were no complaints from participants regarding nurses’ demonstration of cultural competency, primarily because the participants did not expect to be single out for a different kind of treatment based on being foreigners. They expected to be treated like any other patient.
“Honestly, I don’t think so, and it also I feel it is not their job like we cannot learn culture along with medicine, I don’t think so they know” (P13).
“I am not sure they are familiar because they didn't ask, they have not involved. They didn't interact that much with my culture, but with me yes because they asked about all my details personally how what about my health and everything but not about culture” (P12).
Many participants noted that the nurses did not ask them anything about their cultures;
however, the participants themselves also did not expect to be asked anything about their cultures.
Sub-theme 5: Diverse experiences encountered while receiving care
The participants described having good experiences while receiving care, irrespective of challenges that may have occurred such as language barriers. Most of the terms used in describing participant's experiences were “positive”, “overall good”, “good”, “I have no complaints”.
“It is positive, but then can be improved because of language barrier or cultural barrier, if that is removed then it can be the most perfect one. Yes, my experience is positive, some of the thing which I feel I should get used to it then is going to be fine for me, I mean it is not a complain, what I feel actually. So, if slowly I get used to that culture over here, then it is not going to be problem anymore” (P13).
6 Discussion
The result section presented the findings from the data analysis process. This section focuses on the meaning and applicability of these findings. The discussion is presented based on answers to the research questions. New information generated from this work is also presented.
6.1 Experiences of migrant women with the Finnish health care services
This study found Migrant women were able to access the health services they needed both primary care and specialist care. This finding is in line with the Finnish government actions which guarantees medical, social, and health services for all citizens by the constitution of the country.
The government is responsible for social welfare and financing, with the Ministry of Social Affairs and Health being responsible for social welfare and health care. (Keskimaki et al.,2019.) In our study migrant women claimed that were also able to access both primary and specialized care including psychological conditions, chronic conditions, and gynecology care. As shown in the literature, Finnish service is divided into specialized medical and primary providing diverse types of care including preventive services, occupational health, rehabilitation, medical care, mental health, and substance abuse services. Immigrants who are residents in the country are entitled to the same health services and benefits as provided to citizens of the country. (Shrestha, 2017.)
The ability of the migrant women to access care according to participant's statements and study of their demographic data suggests that they had the legal status and documentation to access the services. The study found Migrant women were able to access free health services such as free tests and support from the institution responsible for social welfare. This indicates that the Finland authorities have a social safety net such that persons of low income, specifically
migrants, in this case, can access the care they need.
6.2 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.
combinations of environmental, genetics, personal responsibility to curses and spiritual factors.