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Living with diabetes within the framework of Swedish primary health care : Somalian and professional perspectivesWallin, Anne-Marie January 2009 (has links)
The overall aim of this thesis was to provide knowledge on the one handSomalian-born immigrants´ experiences of living with diabetes mellitus (DM)in a new cultural environment, on the other hand their encounter with Swedishdiabetic care – this from both their own point of view and that of the health-care professionals. There was an endeavour to describe methodological aspectsof the interpreter´s role in respect of the trustworthiness of research performedin multicultural societies. A descriptive design was used, involving threequalitative interview studies with an interpreter (Studies II-IV) and onesystematic literature review (Study I). The latter served as a foundation forconducting the interviews with an interpreter and the Matrix Method was used.The same 19 patients with diabetes of Somalian origin participated in StudiesII-IV, joined by five health-care professionals in Study IV. The interviews weresubjected to qualitative content analysis in the case of Studies II and III, and to phenomenograpic analysis in the case of Study IV. In Study I, 13 empirical cross-cultural interview studies with aninterpreter involved were scrutinized. The findings showed that the interpreter’srole in the research process was given little attention. There was usually noaccount either of the style of interpreting, the interpreter’s previous experienceor the seating arrangements for the interviews. On the other hand most of thestudies offered direct or indirect information about the interpreter’s knowledgeof the aim of the research or participation in the transcription of the text or data analysis. The most frequent techniques used to established trustworthiness were prolonged engagement and member checks. A prominent problem for the participants in Study II was to give uptraditional eating habits. Difficulty in managing everyday life was mentionedespecially by women in connection with the need to keep to the diet regimebecause of a lack of understanding and support from family and friends. Tochanging lifestyle was considered as a hard work and a number of barriers wasmentioned especially when it comes to eating habits. The findings showed avariation how the participants managed the fasting month of Ramadan. Thosewho fasted did not see the diabetes as an obstacle, others did so and indicated that fasting was not compulsory for a sick person. In study III the findings showed that women used more supernaturalbeliefs than men when they described their experiences in connection with thediagnosis and their health beliefs. Most of the experiences of receiving thediagnosis consisted of ways of managing this information. Commonlymentioned by the participants, irrespective of gender, when they receiving thediagnosis was a attempt to find some advantages, or positive comparison. Other participants tried to repress the diagnosis and doubted it. Most of theparticipants, irrespective of gender, did not immediately respond with shock orother strong emotion when they received the diagnosis. In study IV the patients conceived the diabetes care as being of highquality but they also conceived limitation with the care. They conceived unmetneeds such as too long waiting times for appointments, not encountering thesame physician every time, lack of contact with specialists and failure toculturally adapt dietary advice. Health-care professionals conceived severalcultural challenges in the encounter such as managing language barriers,illiteracy and traditions such as fasting during Ramadan. In conclusion, this thesis generate knowledge which can serve as afoundation to securing the quality of diabetes care for this patient group andcontribute to working out local diabetic programmes for patients with anotherbackground than the Swedish. In addition the thesis can contribute to makingimprovements when it comes to working with an interpreter in qualitativeinterview studies as well as in clinical settings.
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Understanding barriers to small business growth from the perspective of owner-managers in RussiaDoern, Rachel R. January 2008 (has links)
Small businesses, particularly growing small businesses, are regarded by policy makers and academics alike as being important sources of wealth creation, employment generation and innovation. Yet, few small businesses grow. One potential way of explaining why so many businesses do not grow is through the notion of 'barriers'. Previous studies on barriers typically identify and predict what kinds of barriers affect business growth, rather than attempt to explain how or why this is the case, if indeed it is the case at all. This thesis aims to elaborate on our understanding of barriers to small business growth. Two qualitative inductive interview-based studies were conducted in St. Petersburg Russia; the first was conducted in 2003, the second in 2005. Using semi-structured interviews in the second study (the main study), 27 owner-managers of small businesses in Russia were asked if they had intentions to grow the business, how they grew their businesses or intended to do so, and what, if anything, interfered with this process. The purpose of the study was two-fold: first, its purpose was to examine barriers from the perspective of individual owner-managers, with an emphasis on the meaning of barriers and the context in which they are perceived, and second to explore and examine how or the ways in which perceived barriers may influence owner-managersâ growth intentions and behaviours. Data were analysed using template analysis mainly, drawing on interpretive phenomenological analysis and matrix analysis. Based on the accounts of owner-managers, barriers were found to work in different ways to shape intentions to grow or not to grow, and as well to shape intention realization. How this occurred depended partly on owner-managersâ perceptions of the institutional environment. Findings suggest that the relationship between barriers and small business growth is complex. It is, nevertheless, a relationship which purports to be a fruitful area of study, one in which future research might further our understanding of small business growth from a continuing examination of barriers, particularly in relation to intentions, in relation to how meaningful barriers are perceived to be, and in relation to the context in which they are perceived.
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