TRADITIONAL HEALTH-RELATED PRACTICES OF RUSSIAN-SPEAKING IMMIGRANTS RESIDING IN THE UNITED STATES by POLINA AMBURG A Dissertation submitted to the Graduate School-Newark Rutgers, The State University of New Jersey In partial fulfillment of the requirements For the degree of Doctor of Philosophy Nursing Written under the direction of Dr. T. Lindgren and approved by ___________________________________ ___________________________________ ___________________________________ ___________________________________ Newark, New Jersey January 2019 @2019 Polina Amburg All Rights Reserved ABSTRACT OF THE DISSERTATION Traditional Health-Related Practices of Russian-Speaking Immigrants Residing In The United States By POLINA AMBURG Dissertation Director: Dr. Teri Lindgren The population of Russian-speaking immigrants is growing in the United States. Like many other immigrants, Russian-speakers (born in the former USSR) present with a number of health concerns. Many of the health conditions pertinent to this population are highly manageable and/or preventable. Empirical literature indicates low engagement in health-promotion, health maintenance, and screening behaviors in this group of immigrants. There is also an indication of a gap in research addressing culturally-based beliefs and behaviors of Russian-speakers in the US. To address a gap in empirical literature, a qualitative ethnographic study was conducted on the East coast of the United States. Twenty participants ages 36 to 83 years were interviewed along with participant observation at community events and analysis of documents (visual and print media). Data analysis revealed perceptions of health and illness to be influenced by perception of healthcare, and these findings subsequently guide health-related practices of Russian-speaking immigrants. The study also identified transnational socio-cultural ii connections to influence beliefs and practices of the immigrants who came to the United States after the USSR dissolution. Further research is recommended to examine the factor of transnational socio- cultural connections in greater details, and to explore diverse groups of Russian-speaking immigrants residing in various areas of the US. iii ACKNOWLEDGEMENTS Thanks to my committee members: Dr. K. D’Alonzo, Dr. S. Chase, and Dr. L. Ivanov for their hard work and guidance of my proposal defense. Especial thanks to my Dissertation Chair Dr. T. Lindgren for her ongoing support and unconditional patience. Thanks to: Dr. E. Toughill for encouraging me to go for my PhD and Mr. J. Ferraro for “yelling” at me for not finishing the PhD sooner. Thanks to my wonderful colleagues at Monmouth University. Thanks to Beata Trogan, BBA, CPA, JD, Sofia Shutan, and their family for guiding me to the path of nursing, and continuous support throughout my carrier and education. Thanks to my family for being there when I needed you the most: Aleksander Vaks and Maya Goldman, Lyubov Yuzefovskaya and Viktor Yuniver, Vladimir Kravtsov, and Lance and Royce Amburg iv TABLE OF CONTENTS ABSTRACT---------------------------------------------------------------------------------------- ii ACKNOWLEDGEMENTS --------------------------------------------------------------------- iv LIST OF TABLES-------------------------------------------------------------------------------- x LIST OF FIGURES------------------------------------------------------------------------------- xi CHAPTER 1. INTRODUCTION AND PURPOSE-------------------------------------------------- 1 1.1. Introduction -------------------------------------------------------------------------- 1 1.2. Population of Interest---------------------------------------------------------------- 3 1.3. The concern to be addressed------------------------------------------------------- 6 1.4. The phenomenon of Interest ------------------------------------------------------ 8 1.5. Foundational Assumptions-------------------------------------------------------- 9 1.6. The significance of the study------------------------------------------------------ 10 2. REVIEW OF THE LITERATURE----------------------------------------------------- 13 2.1.Background of the phenomenon of health-related practices-------------------- 15 2.2. Related phenomenon: Culture------------------------------------------------------16 2.3. Literature review--------------------------------------------------------------------- 18 2.3.1. Historical content of USSR-----------------------------------------------21 2.3.1.1.Healthcare system in USSR---------------------------------------------22 2.3.2. Health status and issues of current residents of the former USSR-26 v 2.3.2.1.Life expectancy indicators-----------------------------------------------27 2.3.2.2.Health-related behaviors and practices---------------------------------28 2.3.2.3.Health-seeking practices-------------------------------------------------29 2.3.3. Russian-speaking immigrants from the USSR in the United States and other non-USSR countries-------------------------------------------30 2.3.3.1. Emigration---------------------------------------------------------------- 31 2.3.3.2.Common health issues of Russian-speaking immigrants in non- USSR countries-----------------------------------------------------------32 2.3.3.3.Russian-speaking immigrants in the United States------------------ 34 2.3.3.4.Transnational connection------------------------------------------------37 2.4. Summary of the literature search and need for further research----------------39 3. METHODOLOGY----------------------------------------------------------------------- 42 3.1.Methodology-------------------------------------------------------------------------- 42 3.1.1. The study--------------------------------------------------------------------47 3.1.2. The sample------------------------------------------------------------------48 3.1.3. Inclusion criteria-----------------------------------------------------------52 3.1.4. Exclusion criteria----------------------------------------------------------52 3.1.5. Protection of human subjects-------------------------------------------- 52 3.1.6. Recruitment procedure--------------------------------------------------- 53 3.1.7. Setting-----------------------------------------------------------------------56 3.1.8. Data collection--------------------------------------------------------------57 3.1.8.1.Interviews------------------------------------------------------------------57 3.1.8.2. Participant observation--------------------------------------------------59 vi 3.1.8.3.Collection and analysis of documents----------------------------------59 3.1.9. Field notes and reflective journal----------------------------------------60 3.1.10. Data analysis and validation----------------------------------------------60 3.1.11. Rigor-------------------------------------------------------------------------66 4. DATA ANALYSIS 4.1. Data analysis--------------------------------------------------------------------------68 4.2. The description of the sample-------------------------------------------------------69 4.3.Themes, Cores, and Categories------------------------------------------------------69 4.3.1. Core1. Established views based on previous experiences----------- 71 4.3.1.1.Theme 1. Perception of Health----------------------------------------- 72 4.3.1.1.1. Stimulus to stay healthy-----------------------------------------73 4.3.1.1.1.1.Role of the family in being healthy--------------------- 73 4.3.1.2.Theme 2. Perception of Illness----------------------------------------- 77 4.3.1.2.1. What to do when sick? ----------------------------------------- 79 4.3.1.2.1.1 Remedies to illness-----------------------------------------80 4.3.2. Core 2. Modifying views and factors------------------------------------87 4.3.2.1.Theme 3. Perception of Healthcare-------------------------------------87 4.3.2.1.1. Perception of the healthcare system in the former USSR--88 4.3.2.1.2. Perception of the healthcare system in the United States-- 91 4.3.2.1.3. Expectations of healthcare providers--------------------------95 4.3.3. Core 3. Behavioral outcomes---------------------------------------------99 4.3.3.1. Theme 4. Health-related practices------------------------------------- 99 4.3.3.1.1. Health-related activities in the former USSR-------------- 100 vii 4.3.3.1.2. Health-related activities in the United States---------------101 4.3.3.1.2.1.Diet--------------------------------------------------------- 102 4.3.3.1.2.2.. Exercise---------------------------------------------------105 4.3.3.2. Underpinning Theme 5. Transnational socio-cultural connections (transnational connections)---------------------------------------------106 5. DISCUSSION OF FINDINGS---------------------------------------------------------117 5.1. Discussion of findings--------------------------------------------------------------117 5.1.1. The study------------------------------------------------------------------ 118 5.1.2. Results of the study and Analysis of findings------------------------118 5.1.3. Application of results to Pender’s Health Promotion Model-------120 5.1.3.1.Transnational socio-cultural connections theme in relation to the HPM-----------------------------------------------------------------------121 5.1.4. Core 1. Perceptions of Health and Illness themes--------------------126 5.1.4.1.Perception of Health and Illness in relation to the HPM-----------131 5.1.5. Core 2. Modifying views and factors--------------------------------- 133 5.1.5.1.Perception of the