The AIMS of this study are to: (1) Explore the perceptions and experiences of diabetes consultations from the perspectives of Pakistani patients, health professionals and interpreters (when one was involved). (2) Identify the processes and mechanisms which hinder or foster effective communication between healthcare professionals and their patients. (3) Provide recommendations for ways in which communication can be improved between healthcare professionals and their Pakistani patients STUDY DESIGN: A prospective qualitative study was developed, comprising three sequential components; namely: In-depth interviews with patients prior to a diabetes consultation; observation of the consultation; and, in-depth interviews with patients, health professionals and interpreters (when one was involved) following the consultation. Data were collected in the form of 10 detailed case studies. Each case study involved a Pakistani patient with type 2 diabetes mellitus (T2DM), their practitioner (s) involved in the consultation and an interpreter (if one was used). SAMPLE: Five male and five female Pakistani with T2DM (aged 41-80 years), 12 practitioners (some patients consulted with two people) and three interpreters (two professional and one lay) were recruited through health services and personal contacts within Edinburgh’s Pakistani community. Individual case studies were thematically analysed before all the case studies were compared/contrasted to identify cross-cutting themes. FINDINGS: Alongside language, a range of barriers and issues were identified which impacted upon communication between patients and health professionals in the consultations observed. Because of previous experiences of attending consultations in the UK and also in Pakistan, patients tended to come to their diabetes consultations with limited expectations; namely, to have their medication reviewed and receive test results. Consequently, patients tended not to raise health concerns and other issues unless they perceived these to be directly relevant to the consultation. In some cases, this resulted in patients not disclosing important information relating to their diabetes management and led to health professionals making inappropriate treatment recommendations. The routine and predictable nature of these diabetes review consultations meant that patients could be passive, offer very little information and ‘get by’ in their consultations; for instance, by offering responses after guessing what the professional was asking. As a result, some health professionals were unaware of patients’ poor English and of how little they had understood during the consultation. Health professionals found it difficult to establish understanding and rapport with patients who adopted a passive role in their consultations. This hindered them from identifying, and appropriately addressing, gaps in patients’ diabetes knowledge and any concerns they may have had. Interpreters did not always address the language barrier and edited and misinterpreted information. This is partly because they struggled to interpret medical terminology. However, this research also revealed how interpreters can experience dilemmas and role conflicts by virtue of being members of the same closely-knit Pakistani community as the patients they interpret for. Some of the barriers identified during this study also arose because patients tended to see different professionals at every visit which discouraged patient-provider relationships from being established. CONCLUSION: Patients would benefit from receiving ‘continuity in care’ and education and training on how to use their consultations more effectively. Providers would also benefit from education and training on more effective ways to communicate with these patients.

Pakistani women in the UK have high levels of mental illness, alongside low levels of outpatient mental health service use, compared with women of other ethnic groups. Further, previous studies have suggested that Pakistani women have particularly low levels of social support, and high levels of social isolation which may reduce their chances of coming into contact with mental health services. However, to date, there has been little empirical evidence to support this. This thesis investigated the mental health service use, social networks' structure and function, and the relationship between the two, for Pakistani women compared with women of other ethnic groups. This was done using a systematic review of the relevant literature, and statistical modelling using two large nationally representative datasets from the UK. The first dataset, Understanding Society, was used to formulate latent classes of support networks, subsequently used in regression models to compare the support available in Pakistani women's networks with women of other ethnic groups. The second dataset, Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC), was used to ascertain the influence of social networks (perceived social support, contact with relatives and friends, network composition, and size) on the use of outpatient mental health services, using logistic regression modelling. These data were also used to build a structural equation model to test the direct and indirect effects of social networks on outpatient mental health service usage, via their impact on mental illness. Pakistani women (along with Bangladeshi women) had the lowest rate of mental health service use, compared with women in other ethnic groups. Further Pakistani women were more likely to be socially isolated than White majority women, but there were largely no differences between Pakistani women and other ethnic minority women in the structure and function of social networks. Finally, there was evidence to suggest that social networks indirectly reduced mental health service use via their impact on mental illness. There were only small ethnic differences in the indirect effect of social networks on mental health service use, and these differences did not explain Pakistani women's under-use of mental health services.

Two hundred non-insulin dependent diabetic patients, predominantly from three health facilities in Lahore, Pakistan were assessed for metabolic control, weight status, diabetes knowledge, and six areas of diabetes self-care activities as well as dietary intake. A questionnaire was administered in an interview format followed by a 24-hour recall of dietary intake. Glycosylated haemoglobin status were determined on ninety subjects. The care levels appear to be inadequate for satisfactory diabetes control. Only 5 subjects had HbA1c levels within the normal range, while 21 showed extremely high levels. Complications and associated medical conditions were present in more than half of the sample. Diabetes knowledge averaged 4 correct responses out of a total of 11. Considerable variation was noted in the reported care regimens including the dietary regimen. Analysis revealed a number of areas of concern including high fat intake and a low intake of leafy vegetables, pulses and fruit which along with nutrient analysis results suggests a low fibre intake. The data points towards the need for improved diabetes education at all levels and identifies several areas of concern to be address / Master of Science (Hons)

Seven women that identify as Muslim, Pakistani and Canadian in varying capacities participated in this qualitative research to discuss how their cultural and/or religious norms shaped their educational and career aspirations and overall decision-making. Areas of discussion included identity formation, understandings of culture and religion, familial influences on educational and career pursuits and overall experiences and interactions with faculty, peers and student service providers. This research brings together Chickering and Reisser’s (1993) Theory of Identity Development and feminist critical understandings of intersectionality (Collins, 1990; Knudson, 2005) and Orientalism (Said, 1978) in order to theoretically frame the students’ experiences. The research constitutes a major contribution from the Canadian perspective in terms of theory development as well as practical implications for faculty and campus services to ensure that students experience a learning environment that is supportive and inclusive.

Seven women that identify as Muslim, Pakistani and Canadian in varying capacities participated in this qualitative research to discuss how their cultural and/or religious norms shaped their educational and career aspirations and overall decision-making. Areas of discussion included identity formation, understandings of culture and religion, familial influences on educational and career pursuits and overall experiences and interactions with faculty, peers and student service providers. This research brings together Chickering and Reisser’s (1993) Theory of Identity Development and feminist critical understandings of intersectionality (Collins, 1990; Knudson, 2005) and Orientalism (Said, 1978) in order to theoretically frame the students’ experiences. The research constitutes a major contribution from the Canadian perspective in terms of theory development as well as practical implications for faculty and campus services to ensure that students experience a learning environment that is supportive and inclusive.

Thesis (M.L.E.)--Trinity Western Seminary, Langley, B.C., 1998. / Abstract and vita. Includes bibliographical references (leaves 166-168).

My research explores the tension between being and becoming modern and moral for British-born Muslim Pakistani women in Sheffield through an investigation into the judgements that surround beauty, beautification, and beauty work. Through ethnography I unpack the raced and classed regimes in which my interlocutors are embedded, arguing that global Islam and Asian are affiliations that are realised in relation to the English (White British) community. Through comparisons to White British women (referred to as ‘English’ amongst my informants), the young Pakistani women I met negotiate an understanding of themselves and others within a schema of British multiculturalism, in which English are the standard for which to aim. Over the last 10 years, the number of young, British-born Pakistani women in Sheffield who are establishing Ladies Only beauty salons and training as Asian Bridal Make-Up Artists has increased rapidly. These specialised services, catering for Muslim and Asian women respectively, appear at first glance to be conflictual with the notion of piety. In my thesis, I demonstrate how these two narratives overlap and are brought together by the idiom of ‘good intention’, a trope which centres on a discussion of self-esteem and female empowerment. In the everyday, beauty and beautification are judged through perceptions of ‘naturalness’ and ‘balance’, a narrative that gives way to one of beauty-as-effort during celebratory occasions. Whereas everyday beautification is directly linked to the superior beauty and beautification of White English women through discussions of ‘natural’ fair skin and good taste, I suggest that the perception of Asian beauty-as-effort is also compared to perceptions of White English beauty. Although Asian beauty-as-effort and transformation are considered superior to the mere improvement undertaken by White English women during celebratory occasions, forms of beautification thought of as Asian, are used as a measure of the ‘progression’ of the Pakistani community as a whole along a continuum on which the White English community is thought of as the furthest progressed. The popularity of beauty work amongst my informants is due to the perception that such work has high earning potential as well as offering job flexibility and the possibility of being one’s own boss. These positive attributes are troubled, however, by a perception of beauty work as being specifically related to Pakistani women, low-skilled, and potentially immoral. In my thesis, I explore how beauty workers negotiate the negative connotations of beauty work through contemplation of their Islamic faith, kinship relations, and the notion that beauty work is just a hobby or a stepping stone to ‘proper’ work within a graduate profession.

La thèse s’appuie sur une comparaison approfondie entre la peinture pakistanaise et la peinture occidentale. Cette dernière se caractérise le plus souvent par des genres (portraits, paysages…) des motifs, souvent exécutés à l’huile à la manière européenne classique. Dans la peinture occidentale (principalement la production française, anglaise et américaine à partir du XIXe siècle) la thèse explore une véritable sémantique du ciel.Notre propre production picturale se situant de manière complexe à mi-chemin entre les deux cultures, définit ainsi une sorte de jeu dans un entre-deux riche de sens.Il s’agit donc de décrire cet interstice avec précision, de développer les rapports poétiques et philosophiques que nous entretenons avec le ciel par notre propre pratique de la peinture et d’évaluer la nature exacte des paradigmes culturels qui sont désormais les nôtres.Bien entendu, s’agissant d’une thèse en arts plastiques, sont étroitement mêlées, réflexions historiques, critiques, esthétiques, la création proprement dite d’œuvres picturales ainsi que leur interprétation. / This thesis is based on a deep comparative study between Pakistani paintings and the Western paintings. The paintings in Pakistan are often characterized by genres (portraits, landscapes...), patterns, executed in oil in resemblance with classical European style. In Western paintings (mostly French productions, American and English from the nineteenth century), the thesis explores a true semantics of the sky in paintings.Our own pictorial production, located in a halfway between the two cultures, defines a kind of game in a wide sense.It is therefore to describe this interstice with precision, and develop our poetic and philosophical relationship by our own practice of paintings, relating to the subject of sky. We evaluate the exact nature of the cultural paradigms, which are now ours.Of course, as it is the thesis in the domain of fine-arts, it is intertwined, with historical reflections, criticism, and aesthetics, with addition to the actual creation of painting work and their interpretations which is also a part of this research work.

No / Lecturers Fiona Meddings and Jan Porter of the division of midwifery and women’s health at the School of Health Studies at the University of Bradford detail the difficulties faced by UK Pakistani women in making informed choices on breastfeeding.

Yes / Pregnant British Pakistani women have disproportionately poorer health than the wider population. Bradford has a strong Pakistani presence and a wide range of public health problems including high levels of gestational diabetes, high obesity rates and a high infant mortality rate, which is highest for babies of Pakistani origin. For women to be healthy, we need to know what concerns they have about their health so they can be addressed appropriately. The aim of this study, therefore, was to explore the health concerns of pregnant British Pakistani women living in deprived areas. Methods Semi-structured qualitative interviews were conducted with 21 pregnant Pakistani women in a hospital setting. Data were analysed using thematic analysis. Results Pakistani women identified safety issues, barriers to undertaking physical activity in the areas where they live, concerns surrounding exercising during pregnancy and cultural and religious constraints that prevented them from engaging in physical activity. They reported issues around food, concerns around a lack of culturally appropriate diet information, the cost of unhealthy food locally, and the lack of healthy food options in their residences. Women were unsure on where to obtain health promotion information and reported a lack of access in obtaining that information. Language barriers in accessing health promotion information were further reported as a concern. Discussion Researchers, midwives, health providers, local authority and policy makers interested in improving the health of pregnant Pakistani women may use these findings to develop further research and interventions to improve the poor health of this population. / National Institute for Health Research (NIHR) under its Applied Research Collaboration (ARC) Yorkshire and Humber [NIHR200166]; UK Prevention Research Partnership (UKPRP) [MR/S037527/1], the NIHR Clinical Research Network; and NIHR ARC Yorkshire and Humber