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A Focused Ethnography of Iranian Canadian Women’s Experiences of Diabetes

  • Author / Creator
    Komeilian, Zahra
  • Living with diabetes is challenging. Achieving optimal blood sugar balance involves major lifestyle choices and changes that can be difficult to sustain over time. When a woman with diabetes immigrates to a new country with very different social and cultural customs, religion, values, norms, and expectations, effective diabetes self-care becomes even more complex. Despite a growing number of Iranian immigrants in Canada, there is a paucity of empirical research on how Iranian Canadian women integrate their diabetes with their original and new cultural and social habits. The purpose of this qualitative focused ethnography study was to explore the experiences of Iranian Canadian women living with type II diabetes. Transition Theory and Shifting Perspective Model formed the study’s conceptual framework to explore and understand the nature, conditions, and processes of these women’s health-illness transitions associated with diabetes and how immigration influenced their diabetes transitions. 15 women were recruited using purposive and snowball sampling at a local Iranian community center in a large Western Canadian city. Most women were aged 42 to 48 years and were diagnosed 3–17 years prior to my study, the majority being diagnosed with diabetes in Iran. They arrived in Canada 3-25 years ago. Four women were fluent in English and the rest understood English to some degree. Data collection consisted of 21 individual semi-structured interviews conducted in Farsi. Interviews explored their life journeys in learning to live with diabetes and how their culture, social context, religion and immigration experiences influenced this journey. Six participants were interviewed twice to verify the researcher’s emerging analysis. Data analysis occurred concurrently with data collection. The analytic approach employed constant comparison, including open and in vivo coding, categorizing, identifying themes and writing memos. Verification strategies built into the inquiry process ensured research strategies adhered to principles of inductive qualitative inquiry and the results were trustworthy. Experiences of having diabetes are contextualized by aspects of illness identity, socio-cultural and religious commitments and practices and immigration journeys for the women in my study. Iranian culture was intertwined with Islamic beliefs that impact diabetes self-care management directly and indirectly as women selectively chose which cultural and social customs to retain or adopt. Each woman had a unique transition trajectory in diabetes, but there were some common phases: 1) “Dark days of diagnosis” started with the reactions to diagnosis and included a search for meaning and cause; 2) “Struggling to live with diabetes” reflected each woman’s personal journey as she learned how to integrate diabetes into daily life and was faced with challenges and choices to attend to diabetes or adhere to transitional cultural, social, family norms and expectations; and 3) “Recognizing their life road with diabetes” which included two sub themes of experiencing diabetes as “Life as a bumpy road” and “Life as an uphill battle.” These phases were not linear, but cyclical and often repetitive. Some women were stuck in experiencing life as an uphill battle and they struggled to meet their diabetes needs within their current roles and commitments. Their socio-cultural and religious backgrounds and immigration journeys strongly shaped how they experienced their diabetes journey, lifestyle behavior options, relationships with others, their perceptions, interpretations, and self-management behaviors. For some women their beliefs led to more passive behaviors, while for others they were a source of power and motivation. Traditional roles within the family and the Iranian immigrant community were important in either supporting their self-care or functioning as a justification for being unable to manage their diabetes effectively. This study provides significant insight into the realities of a largely hidden diabetic population. Clinically, religious, cultural and social norms and values must be considered in self-care planning. Involving family and individual socio-cultural and religious commitments in education and support strategies will enhance the quality of care and the interaction and trust between Iranian Canadian immigrants and the health care system. The findings also have implications for interventions incorporating a role for the support group within the diabetes clinic and Iranian community. This role would not only address issues of socio-cultural and religious support in diabetes self-care, but would also serve as a means to educate individuals with diabetes, their families, and the community about improving diabetes management.

  • Subjects / Keywords
  • Graduation date
    2016-06
  • Type of Item
    Thesis
  • Degree
    Doctor of Philosophy
  • DOI
    https://doi.org/10.7939/R3BZ61K4V
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Doctoral
  • Department
    • Faculty of Nursing
  • Supervisor / co-supervisor and their department(s)
    • Marion, Allen (Faculty of Nursing)
    • Jude, Spiers (Faculty of Nursing)
  • Examining committee members and their departments
    • Messias, DeAnne K Hilfinger (University of South Carolina)
    • Paul, Pauline (Faculty of Nursing)
    • Duggleby, Wendy (Faculty of Nursing)
    • Mayan, Maria (Faculty of Extension)
    • Richter, Solina (Faculty of Nursing)