İSVİÇRE’DE YAŞAYAN TÜRKİYE KÖKENLİ GÖÇMEN KADINLARIN KRONİK HASTALIK DENEYİMİ: NİTELİKSEL BİR ÇALIŞMA

Öz

İsviçre’de, Türkiye kökenli göçmen kadınların daha fazla kronik hastalık yüküne sahip oldukları ve yeterli bakımı almada dezavantajlı oldukları bilinmektedir. Fakat bu popülasyonun deneyimlerini derinlemesine inceleyen sınırlı sayıda çalışma yapılmıştır. Bu çalışmanın amacı, İsviçre’de yaşayan ve kronik hastalığı olan Türkiye kökenli kadınların İsviçre sağlık sistemi ile ilgili deneyimlerini derinlemesine incelemektir. Bern ve Cenevre şehirlerinde, maksimum varyasyon stratejisi kullanılarak, 18 yaşından büyük, kronik hastalığı olan Türkiye kökenli 12 ilk nesil göçmen kadınla derinlemesine görüşmeler yapılmıştır. Görüşmeler, kadın bir araştırıcı tarafından, Türkçe olarak gerçekleştirilmiş; biri hariç ses kaydı alınmış; ortalama 70 (45-103) dakika sürmüştür. Veriler Levesque’in sağlık hizmetlerine erişim modeli kullanılarak, tematik analiz ile değerlendirilmiştir. Görüşülen kişilerin yaş ortalaması 53,2 (42-71), İsviçre'de ortalama kalış süresi 23,5 yıldır (1,5-45). Çoğu (9/12) ilk veya ortaokul mezunudur; 11’inin çoklu kronik hastalığı bulunmaktadır (en sık kronik ağrı ve psikiyatrik bozukluklar). Kronik hastalığı olan Türkiye kökenli göçmen kadınların sağlık hizmetlerine erişimini etkileyen ana konular şöyle bulunmuştur: dil/kültür, toplumsal cinsiyet rolleri, damgalama/ayrımcılık; ve göçmenlik deneyimi/süresi. Türkiye kökenli göçmen kadınların, İsviçre sağlık sistemi ile ilgili deneyimlerinde, toplumsal cinsiyet eşitliğinin önemli ve olumlu bir tema olarak ortaya çıktığı görülmektedir. Öte yandan, olumsuz çalışma koşulları ve diğer sosyal faktörlerin kronik hastalığın ortaya çıkmasında belirleyici olduğu görünmektedir. Sağlık sorunlarının sağlık çalışanları tarafından sıkça sıla özlemi ile ilişkilendirilmesinin sağlık ihtiyaçlarının karşılanamamasına yol açtığı görünmektedir. Özellikle göçün ilk dönemlerinde dil bariyeri ve sisteme yabancılık nedeniyle sağlık sistemine erişimde önemli zorluklar yaşandığı görünmektedir. Bu nedenle, hem göçmen sağlığının korunması hem de hizmetlere erişimin iyileştirilmesi için yapılacak müdahalelerde, göçün ve hastalığın erken dönemleri öncelikli görünmektedir.

Anahtar Kelimeler

• Kronik hastalık
• göç
• göçmen kadın
• sağlık hizmetleri
• erişim

Destekleyen Kurum

İsviçre Ulusal Bilim Fonu (Swiss National Science Foundation)

Etik Beyan

Bu çalışma Bern Kantonu (İsviçre) Etik Kurulu tarafından 18.05.2017 tarihinde onaylanmıştır.

CHRONİC DİSEASE EXPERİENCE OF İMMİGRANT WOMEN OF TURKİSH ORİGİN İN SWİTZERLAND: A QUALİTATİVE STUDY

Öz

Immigrant women of Turkish origin in Switzerland face a higher burden of chronic diseases and encounter challenges in accessing appropriate healthcare. Despite this, there is a notable gap in studies investigating their healthcare experiences. This study aims to scrutinize the encounters of Turkish women with chronic diseases within the Swiss healthcare system. Twelve in-depth interviews, averaging 70 minutes, were carried out with first-generation migrant women of Turkish origin. The interviews were conducted in Turkish, and audio recorded. The gathered data underwent thematic analysis utilizing Levesque's model of health service access. The average age of the participants was 53.2 (42-71), and the average length of stay in Switzerland was 23.5 years (1.5-45). Most (9/12) were primary or secondary school graduates; and 11 experienced multiple chronic conditions (most commonly chronic pain and psychiatric disorders). The themes related to access were language/culture, gender roles, stigma/discrimination, and immigration experience/duration. Gender equality emerged as a significant and positive theme in the experiences of Turkish immigrant women within the Swiss healthcare system. Conversely, poor working conditions and various social factors contributed to the development of chronic diseases. Health professionals frequently attributing health issues to homesickness often resulted in unmet health needs. Particularly during the early stages of migration, significant challenges in accessing healthcare arose due to language barriers and unfamiliarity with the system. Therefore, interventions targeting early stages of migration and early stages of chronic illness seem crucial for protection and improvement of the health of immigrant women of Turkish origin in Switzerland.

Anahtar Kelimeler

• Chronic disease
• migration
• migrant women
• health services
• access

Kaynakça

1. World Health Organization. Global recommendations on physical activity for health. World Health Organization; 2010. 58 p. [cited 2024 May 16] Available from: https://www.who.int/publications/i/item/9789241599979
2. World Health Organization. The global burden of disease: 2004 update. World Health Organization; 2008. 146 p. [cited 2024 May 16] Available from: https://iris.who.int/bitstream/handle/10665/43942/9789241563710_eng.pdf
3. World Health Organization. Noncommunicable diseases country profiles 2014. World Health Organization; 2014. 210 p. [cited 2024 May 16] Available from: https://www.who.int/publications/i/item/9789241507509
4. Rosenberg P, Kano M, Ludford I, Prasad A, Thomson H. Global report on urban health: equitable, healthier cities for sustainable development. World Health Organization; 2016. 241 p. [cited 2024 May 16] Available from: https://www.who.int/publications/i/item/9789241565271
5. Davies AA, Basten A, Frattini C. Migration: a social determinant of the health of migrants. Eurohealth (Lond). 2009;16(1):10–2. 25 p. [cited 2024 May 16] Available from: https://migrationhealthresearch.iom.int/migration-social-determinant-health-migrants
6. De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, Wittenbecher F, Quentin W. Switzerland: Health System Review. Health Syst Transit. 2015;17(4):1-288, xix. PMID: 26766626. [cited 2024 May 16] Available from: https://iris.who.int/bitstream/handle/10665/330252/HiT-17-4-2015-eng.pdf?sequence=5&isAllowed=y
7. Guggisberg J, Gardiol L, Graf I, Oesch T, Künzi K, Volken T, Rüesch P, Abel T, Ackermann S, Müller C. Gesundheitsmonitoring der Migrationsbevölkerung (GMM) in der Schweiz: Schlussbericht. 106 p. [cited 2024 May 16] Available from: https://www.ssoar.info/ssoar/handle/document/36016
8. Guest G, Bunce A, Johnson L. How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field methods. 2006;18(1):59–82. doi:10.1177/1525822X05279903.

9. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12(1):18. doi:10.1186/1475-9276-12-18.
10. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):1–8. doi:10.1186/1471-2288-13-117.
11. Garrett CR, Treichel CJ, Ohmans P. Barriers to health care for immigrants and nonimmigrants: a comparative study. Minn Med [Internet]. 1998;81(4):52–5. Available from: https://pubmed.ncbi.nlm.nih.gov/9577539/
12. Scheppers E, Van Dongen E, Dekker J, Geertzen J, Dekker J. Potential barriers to the use of health services among ethnic minorities: a review. Family practice. 2006 Jun 1;23(3):325-48. doi:10.1093/fampra/cmi113.
13. Bayram T, Sakarya S. Oppression and internalized oppression as an emerging theme in accessing healthcare: findings from a qualitative study assessing first-language related barriers among the Kurds in Turkey. Int J Equity Health. 2023 Jan 7;22(1):6. doi:10.1186/s12939-022-01824-z.
14. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. The Milbank Quarterly. 2005 Dec;83(4):Online-only. doi:10.2307/3349613.
15. Hatfield B, Mohamad H, Rahim Z, Tanweer H. Mental health and the Asian communities: a local survey. The British Journal of Social Work. 1996;26(3):315–36. doi:10.1093/oxfordjournals.bjsw.a011098.
16. Jirojwong S, Manderson L. Physical health and preventive health behaviors among Thai women in Brisbane, Australia. Health Care Women Int. 2002;23(2). doi:10.1080/073993302753429068.
17. Sakarya S. Göç, Toplumsal Cinsiyet ve Sağlık [Internet]. 2021 [cited 2024 Jan 8]. Available from: https://kockam.ku.edu.tr/goc-toplumsal-cinsiyet-saglik-sibel-sakarya/
18. Ay P, Hayran O, Topuzoglu A, Hidiroglu S, Coskun A, Save D, et al. The influence of gender roles on health seeking behaviour during pregnancy in Turkey. The European Journal of Contraception & Reproductive Health Care. 2009;14(4):290–300. doi:10.1080/13625180902925211.
19. Morgan M. Prenatal care of African American women in selected USA urban and rural cultural contexts. Journal of Transcultural Nursing. 1996;7(2):3–9. doi:10.1177/104365969600700202.
20. OECD Better Life Index. Safety, Switzerland [Internet]. [cited 2024 Jan 8]. Available from: http://www.oecdbetterlifeindex.org/topics/safety/
21. Kadioglu A. The Impact of Migration on Gender Roles: Findings of Field Research in Turkey1. International Migration. 1994;32(4):533–60. doi:10.1111/j.1468-2435.1994.tb00170.x.
22. Azar M, Kroll T, Bradbury-Jones C. Lebanese women and sexuality: a qualitative inquiry. Sexual & Reproductive Healthcare. 2016;8:13–8. doi:10.1016/j.srhc.2016.01.001.
23. Panos PT, Panos AJ. A model for a culture-sensitive assessment of patients in health care settings. Soc Work Health Care. 2000;31(1):49–62. doi: 10.1300/J010v31n01_04.
24. Elliott SJ, Gillie J. Moving experiences: a qualitative analysis of health and migration. Health Place. 1998;4(4):327–39. doi: 10.1016/S1353-8292(98)00029-X.
25. Müller MJ, Koch E. Perceived discrimination in patients with psychiatric disorder and Turkish migration background in Germany. J Nerv Ment Dis. 2016;204(7):542–6. doi:10.1097/NMD.0000000000000535.
26. Shekunov J. Immigration and risk of psychiatric disorders: A review of existing literature. American Journal of Psychiatry Residents’ Journal. 2016;11(02):3–5. doi:10.1176/appi.ajp-rj.2016.110202.
27. Bhui K, Stansfeld S, Hull S, Priebe S, Mole F, Feder G. Ethnic variations in pathways to and use of specialist mental health services in the UK: systematic review. The British Journal of Psychiatry. 2003;182(2):105–16. doi:10.1192/bjp.182.2.105.
28. Manirankunda L, Loos J, Debackaere P, Nöstlinger C. “It is not easy”: challenges for provider-initiated HIV testing and counseling in Flanders, Belgium. AIDS Education and Prevention. 2012;24(5):456–68. doi:10.1521/aeap.2012.24.5.456.
29. Worth A, Irshad T, Bhopal R, Brown D, Lawton J, Grant E, et al. Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: prospective longitudinal qualitative study. Bmj. 2009;338. doi:10.1136/bmj.b183.
30. Egger M, Minder C, Smith G. Health inequalities and migrant workers in Switzerland. The Lancet. 1990;336(8718):816. doi:10.1016/0140-6736(90)93284-V.
31. Bollini P, Siem H. No real progress towards equity: health of migrants and ethnic minorities on the eve of the year 2000. Soc Sci Med. 1995;41(6):819–28. doi:10.1016/0277-9536(94)00386-8.
32. Mechali D. Pathologie des étrangers ou des migrants. Problèmes cliniques et thérapeutiques, enjeux de santé publique. Rev Eur Migr Int [Internet]. 1990;6(3):99–127. [cited 2024 May 16] Available from: https://www.persee.fr/doc/remi_0765-0752_1990_num_6_3_1263
33. Isacsson A, Hanson BS, Janzon L, Kugelberg G. The epidemiology of sick leave in an urban population in Malmö, Sweden. Scand J Soc Med. 1992;20(4):234–9. doi:10.1177/140349489202000408.
34. Parkin DM. Studies of cancer in migrant populations: methods and interpretation. Rev Epidemiol Sante Publique [Internet]. 1992;40(6):410–24. [cited 2024 May 16] Available from: https://europepmc.org/article/med/1287740
35. Havas K, Douglas C, Bonner A. Closing the loop in person-centered care: patient experiences of a chronic kidney disease self-management intervention. Patient Prefer Adherence. 2017;1963–73. doi:10.2147/PPA.S147831.
36. Kennedy I. Patients are experts in their own field: The interests of patients and healthcare professionals are intertwined. BMJ. 2003;326(7402):1276–7. doi:10.1136/bmj.326.7402.1276.
37. Knipscheer JW, Kleber RJ. Help-seeking attitudes and utilization patterns for mental health problems of Surinamese migrants in the Netherlands. J Couns Psychol. 2001;48(1):28. doi:10.1037/0022-0167.48.1.28.
38. Sonis J. Association between duration of residence and access to ambulatory care among Caribbean immigrant adolescents. Am J Public Health. 1998;88(6):964–6. doi:10.2105/AJPH.88.6.964.
39. Leclere FB, Jensen L, Biddlecom AE. Health care utilization, family context, and adaptation among immigrants to the United States. J Health Soc Behav. 1994;370–84. doi:10.2307/2137215.