Understanding Family, Social and Health Experience Patterns in British Bangladeshi Families: Are People As Diverse As They Seem?
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Primary Health Care Research & Development 2007; 8: 333–344 doi: 10.1017/S1463423607000369 Understanding family, social and health experience patterns in British Bangladeshi families: are people as diverse as they seem? Kamila Hawthorne and Rosin Pill Department of General Practice, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK, Jasmin Chowdhury Barefoot Health Workers Project, Cardiff Local Health Board, Cardiff, UK and Lindsay Prior Department of Sociology and Social Policy, Queen’s University, Belfast, UK Aim: An exploratory study of the Cardiff Bangladeshi community in a primary care setting, prior to the development of culturally appropriate diabetes health edu- cation. Background: British Bangladeshis are one of the most economically deprived communities in Britain, with high morbidity and mortality rates from chronic illness. Access and use of their services is perceived by Primary Health Care Teams (PHCTs) to be difficult, due to communication and cultural barriers. Methods: One-to-one tape- recorded interviews were held in Sylheti, Bengali or English with an age-stratified sample from the community registered with a practice in central Cardiff. The N*DIST package was used to analyse data, with ongoing discussion of emerging themes. The topics explored in these interviews were family structure and decision making within families, meal patterns, health beliefs, experiences of primary care and barriers to engaging with the outside world. Findings: Family structure and social patterns had many similarities with those of the local community, and dietary and health beliefs also followed ‘Western’ concepts. People were anxious to be healthy, but often did not know about core primary care services. The community places value on the opinion and support of primary care professionals. However, a major cross-cutting theme was difficulty in accessing health care (especially for women), and reasons for this are discussed in the paper. With this information, the PHCT can now consider adapting itself to improve access and communication. We suggest that our methodological approach is both relevant and achievable for those working in primary care settings in our increasingly multi-cultural, ethnically mixed communities, and is not purely the province of sociologists or academics (important learning points have been identified and highlighted). Keywords: British Bangladeshi; primary care; health and social care patterns Received: June 2005; accepted: July 2007 Introduction develop heart disease (Balarajan, 1995; Nazroo, 1997). Its status as one of Britain’s most National data suggest that Bangladeshis in Britain socio-economically deprived communities (Atri are three to four times more likely to suffer et al., 1996; Modood and Berthoud, 1997) is from ill health than the general population thought to be an important factor in this picture of (2001 Census), five times more likely to get ill health (Roper et al., 2001) (Box 1). Within the Type 2 diabetes mellitus and 50% more likely to age group of 50–74 years, Bangladeshis are the most likely to describe their health as poor and visit general practitioners (GPs) twice as fre- Address for correspondence: Kamila Hawthorne, Department of General Practice, Cardiff University, 3rd Floor, Neuadd quently as the average UK citizen (Gillam et al., Meirionnydd, Heath Park, Cardiff CF14 4XN, UK. Email: 1989; Rashid and Jagger, 1992; Nazroo, 1997; 2001 [email protected] Census). r 2007 Cambridge University Press Downloaded from https://www.cambridge.org/core. IP address: 170.106.34.90, on 29 Sep 2021 at 20:50:42, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1463423607000369 334 Kamila Hawthorne et al. Box 1 Background to the Bangladeshi community in Britain Young men from Bangladesh (then East Pakistan) first started settling in Britain in the mid-1950s, mainly from the poor rural district of Sylhet. They were often seamen, who took jobs as kitchen workers in London hotels. The temporary nature of their stay, together with difficulties in competing with indigenous workers who had the benefits of education and language, resulted in poorly paid jobs and a low standard of living. Wives and children joined in the early 1980s, once it was recognised that it would not be practicable to move back to Bangladesh permanently. These families came with no knowledge of English. Basic schooling and integration into mainstream British life has been a tremendous struggle for many. The Bangladeshi community makes up 0.5% of the total population of the UK. There are approximately 8000 people in the Bangladeshi community in Cardiff, mainly employed in the restaurant trade (2001 Census data). The practice used to approach patients for this study had 311 adult patients registered from the Bangladeshi community, from a total list size of 5000 patients. Bangladeshis report dissatisfaction with GPs, Participants and methods and there is evidence that the health promotion advice given to them should be delivered in Design of the methodology was informed by ways that are more accessible and culturally recommendations from seminal papers on qualita- appropriate (Hoare et al., 1992; Naish et al., tive research within minority ethnic communities 1994; National Surveys of NHS patients, 1998; (Currer and Stacey, 1986; Hennings et al., 1996; Leedham, 2000). Professionals cite communi- Hillier and Rahman, 1996; Greenhalgh et al., 1998), cation and cultural barriers, lack of understanding and by the grounding of the study in a primary care of the system and unrealistic demands by patients, setting, with practical implications for resources and resulting in inappropriate use (Hawthorne et al., approach. It was based on qualitative one-to-one 2003). In planning cross-cultural health educa- interviews with participants, and needed to include tion, the need for prior systematic cultural asses- aspects that valued the culture and beliefs of the sment has been stressed in order to ensure its community. As part of this approach, community relevance and acceptability, and increase the leaders from the local Bangladeshi community likelihood of positive outcomes (Nolde and were invited to give their advice and opinions on Smillie, 1987). Even where culturally tailored the acceptability of the study. They stressed the health education programmes are introduced, if importance of finding a credible interviewer who there has not been evaluation of the target com- would be culturally acceptable (for example, a munity, the outcomes can be mixed, with poor female interviewer for female participants) and be attendance and marginal effects on health status able to speak Sylheti fluently (the dialect spoken by (Griffiths et al., 2005). most living in this community). They also helped in This study aimed to explore the barriers to the recruitment and appointment of a graduate engaging with the outside world from the point of Sylheti-speaking researcher (JC). view of the Bangladeshi community in Cardiff, An age-stratified sample (n 5 20) from the and to identify the important decision makers of Cardiff Bangladeshi community, registered with a health in these families. It was part of the scope group practice, was invited to participate in semi- for a larger project to design culturally appro- structured one-to-one interviews. Consent to priate diabetes health education and advocacy for participate in the study and allow the interviews the community, and so particular interest was to be audiotaped was obtained by our researcher taken in the meal patterns and contents of meals (JC) with initial approaches being made by the taken by families. The approach taken here, practice health visitor (HV) or one of the GPs although informed by social anthropology and who spoke Bengali. The sampling followed a qualitative methods, is a practical and pragmatic sequence, beginning with eight mothers with example of what is possible within a primary care young children, identified by the HV. Young setting and by a practice-based team. mothers were visited at home by the HV and JC Primary Health Care Research & Development 2007; 8: 333–344 Downloaded from https://www.cambridge.org/core. IP address: 170.106.34.90, on 29 Sep 2021 at 20:50:42, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1463423607000369 Understanding family, social and health experiences in British Bangladeshi families 335 together, to explain the purpose of the study. emerging themes as identified by KH and JC. They were also given an information letter in Early interview transcripts were read for these Bengali and English, so that they could discuss it themes and new ideas raised by participants were with their families (Sylheti has no written form). introduced into subsequent interviews for con- Further interviews were conducted with four firmation or otherwise (iterative process). They young fathers, four ‘older’ women and four ‘older’ were also read by LP and RP to look for over- men. We defined ‘older’ as meaning men and arching themes and connections. Initial meetings women with married children (and young grand- of the researchers discussed the coding strategy, children) living in Cardiff. The practice did not the detailed description of the data and further follow a personal list system, so participating ways the data could be explored to bring out patients could have previously seen any of the more themes. Later meetings covered the con- four GPs in the practice. Six of the participants nections between themes, and discussions of had Type 2 diabetes, but they were not specifically explanations why certain findings predicted diffi- chosen for this. culties in using the current primary care services Not everyone was literate enough to give as they stood. signed consent, but in these cases JC made The study was submitted to Bro Taf Local verbally sure the participant understood the pur- Research Ethics Committee (LREC) and poses of the study and was willing to take part approved. The researchers were very aware of the (Hennings et al., 1996).