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“Then, It Doesn't Matter Where They Come From”

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“Then, It Doesn't Matter Where They Come From” “Then, it doesn’t matter where they come from” Cultural Competence and its Construction among Public Health Nurses and Students in Maternal and Child Health Clinics in the Province of Eastern Finland Satu Leppälä Master’s Thesis, 30 credits Master Programme in International Health IMCH (International Maternal and Child Health) Department of Women’s and Children’s Health Uppsala University Spring 2015 Word Count: 12 173 2 LIST OF ABBREVIATIONS FGM Female Genital Mutilation FGD Focus Group Discussion MCH Maternal and Child Health PHN Public Health Nurse QCA Qualitative Content Analysis RN Registered Nurse RQ Research Question 3 ABSTRACT BACKGROUND Public Health Nurses (PHNs) in the Province of Eastern Finland are facing a new situation when the families attending maternal and child health (MCH) services represent increasingly diverting cultural backgrounds. Cultural competency is a part of PHNs’ qualification demands in Finland, however little is known on the phenomenon in the study area at the moment. AIM This study aims to describe how cultural competence is understood and constructed among PHNs and PHN students working and training in the MCH clinics in the Province of Eastern Finland. METHODS Qualitative design was employed. Data were collected in five semi-structured individual interviews and two focus group discussions conducted in Finnish by author. Data were audio-recorder, transcribed and analysed through qualitative content analysis (QCA). Translation to English took place during the QCA process. The total number of participants was 15. FINDINGS The participants perceived culture as a multi-dimensional phenomenon, and that specific skills are needed when meeting clients from different cultures. Cultural competence in this sample refers to a four-staged process which is highly affected by social processes and interaction between the PHNs, students, clients and other stakeholders in MCH care and community. CONCLUSION This study can serve as an explanatory material to fill the knowledge-gap between the previously published theoretical studies on cultural competence and the grass- root level MCH work. The findings represent perceptions and experiences of highly educated, native Finnish sample working in a relatively rural province, and thus their transferability should be viewed with criticism. 4 ACKNOWLEDGEMENTS I sincerely thank Dr Beth Maina Ahlberg, Dr Pia Olsson and Dr Carina Källestål for guiding me through this exciting journey with their constructive criticism and friendly supportiveness. A big thank you belongs also to my Finnish supervisor, lecturer MNSc Raija Lappalainen who believed in my idea and made this project possible with her encouraging advises. My student colleagues at IMCH, thank you for providing me with your honest feedback and cheerful peer support, and most importantly, for always recognising which one was needed the most. IMCH Degree Course Administration, thank you for making the practical matters smooth and easy for us students in the department. Thank you, Sanni Heikkinen, for being an amazing focus group discussion research assistant in addition to being an amazing friend. Emmi Särkkä and Vesa, thank you for hosting me during the data collection and letting me to turn your home into a temporary research office. My dear family and friends, thank you for your endless support in and outside of this project. And darling Arttu, thank you for reminding me of the simple joys of life in the days when this project felt overwhelming. Lastly, I would like to thank the public health nurses working in maternal and child health clinics in the Province of Eastern Finland for inspiring this research project. This thesis is written for you. 5 Table of Contents LIST OF ABBREVIATIONS ........................................................................................................................ 2 ABSTRACT .................................................................................................................................................... 3 ACKNOWLEDGEMENTS ........................................................................................................................... 4 INTRODUCTION .......................................................................................................................................... 8 A Brief Review of the Literature ............................................................................................................. 10 THEORETICAL FRAMEWORK .............................................................................................................. 12 Macro Theory: Social Constructionism .................................................................................................. 13 Middle Range Theory: Model on Cultural Competence by Papadopoulos, Tilki and Taylor ............ 13 AIM AND RESEARCH QUESTION ......................................................................................................... 14 METHODS ................................................................................................................................................... 15 Setting ........................................................................................................................................................ 15 Sampling ................................................................................................................................................... 17 Participant Characteristics ...................................................................................................................... 18 Individual Semi-structured Interviews ................................................................................................... 18 Focus Group Discussions ......................................................................................................................... 19 Qualitative Content Analysis ................................................................................................................... 22 ETHICAL CONSIDERATIONS ................................................................................................................ 24 Confidentiality and Potential Risks......................................................................................................... 25 Reflexivity ................................................................................................................................................. 25 FINDINGS .................................................................................................................................................... 26 Section I: Operational Context ................................................................................................................ 27 Area-Specific Features in Understanding of the Cultural Competence ............................................... 27 Perceived Determinants of Culture ......................................................................................................... 28 Section II: Development Process of Cultural Competence and Social Processes Involved in it ......... 29 Everyone is a cultural being – Forming Cultural Awareness through Social Encounters ................... 30 Kind curiosity – Gaining Cultural Knowledge in MCH Work .............................................................. 31 What goes around, comes around – Developing Culturally Sensitive Working Methods .................... 34 Then, it doesn’t matter where they come from – Reaching Cultural Competence in MCH Work ....... 38 DISCUSSION ............................................................................................................................................... 39 Discussion on Findings ............................................................................................................................. 40 Forming Cultural Awareness through Social Encounters ..................................................................... 41 Gaining Cultural Knowledge in MCH Work ......................................................................................... 41 Developing Culturally Sensitive Working Methods ............................................................................... 42 6 Reaching Cultural Competence in MCH Work ..................................................................................... 43 Methodological Strengths and Limitations............................................................................................. 43 Beneficence and Contribution to the Existing Literature...................................................................... 44 Conclusion ................................................................................................................................................. 45 REFERENCE ............................................................................................................................................... 46 Annex 1: Interview Guide ............................................................................................................................ 51 Annex 2: FGD Guide .................................................................................................................................... 52 Annex 3: Informed Consent • PHNs ........................................................................................................... 54 Annex 4: Informed Consent form • PHN students ....................................................................................
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