Faculty of health sciences Departm ent of health and care sciences The construction of Sami identity, health, and old age in policy documents and life stories A discourse analysis and a narrative study — Bodil Hansen Blix A dissertation for the degree of Philosophiae Doctor – October 2013 I've looked at life from both sides now From win and lose and still somehow It's life's illusions I recall I really don't know life at all I've looked at life from both sides now From up and down, and still somehow It's life's illusions I recall I really don't know life at all (Joni Mitchell: Both sides now (1969))1 To Alfred, Signe, and Bendik 1 Mitchell, J. (1969). Both sides now. Retrieved 2013-08-06, from http://jonimitchell.com/music/song.cfm?id=83. Front page photo: Jakob Bredrup 1930-tallet © Arkiv: Finnmark fylkesbibliotek/Finmarksbiblioteket. Contents Acknowledgements ....................................................................................................................................... iii English Abstract ............................................................................................................................................. v Sami Abstract - čoahkkáigeassu ................................................................................................................... vii Norwegian Abstract – sammendrag .............................................................................................................. ix 1.0 Introduction ............................................................................................................................................. 1 1.1 Outline of the thesis ....................................................................................................................... 3 1.2 Project changes during the course of the study ................................................................................... 3 2.0 Background ............................................................................................................................................. 5 2.1 The Sami – a historical account........................................................................................................... 5 2.2 Culture and healthcare ......................................................................................................................... 8 2.3 Literature review ............................................................................................................................... 10 2.3.1 Health, healthcare and the Sami population ............................................................................... 10 2.3.2 Cultural competence and healthcare ........................................................................................... 13 2.3.3 Sami elderly and healthcare ........................................................................................................ 14 3.0 Aims ...................................................................................................................................................... 17 4.0 Theoretical framework .......................................................................................................................... 20 4.1 Discourse ........................................................................................................................................... 20 4.2 Narrative, life story, and public narratives ........................................................................................ 22 4.3 Narrative identity ............................................................................................................................... 29 4.4 Aging and narrative gerontology ....................................................................................................... 31 4.5 Health ................................................................................................................................................ 32 4.6 The notion of culture from a critical cultural perspective and post-colonial theorizing.................... 33 i 5.0 Methods ................................................................................................................................................. 35 5.1 Discourse analysis of policy documents regarding care services for elderly Sami ........................... 35 5.1.1 Choosing policy documents for analysis .................................................................................... 36 5.1.2 Conducting the discourse analysis .............................................................................................. 38 5.2 Dialogical narrative analysis of life stories related in the context of qualitative research interviews 39 5.2.1 Choosing municipalities ............................................................................................................. 39 5.2.2 Participants and recruitment ....................................................................................................... 39 5.2.3 Interviews ................................................................................................................................... 43 5.2.4 Dialogical narrative analysis ...................................................................................................... 45 5.2.5 Ethical considerations ................................................................................................................. 49 6.0 Results ................................................................................................................................................... 51 6.1 Article 1 ............................................................................................................................................. 51 6.2 Article 2 ............................................................................................................................................. 52 6.3 Article 3 ............................................................................................................................................. 53 7.0 Discussion ............................................................................................................................................. 55 7.1 Discussion of methods ....................................................................................................................... 55 7.2 Discussion of results .......................................................................................................................... 64 7.2.1 “Sami identity” ........................................................................................................................... 66 7.2.2 “Sami health” ............................................................................................................................. 71 7.2.3 “Sami old age” ............................................................................................................................ 76 7.2.4 Narrative and post-colonial theory: a possible escape from the culturalist quagmire? .............. 79 7.2.5 Implications ................................................................................................................................ 81 8.0 Concluding remarks .............................................................................................................................. 83 References ................................................................................................................................................... 86 ii Acknowledgements First, I would like to express my tremendous gratitude to the elderly Sami who generously shared their stories with me. Your stories opened my mind, and I sincerely hope that others will learn from them, as I am still learning. Thank you! I would also like to thank the managers of local nursing homes and home care services who were so willing to help me contact the elderly Sami. Further, I would like to thank the senior associations that allowed me to attend to their meetings to describe my study. I am deeply indebted to my supervisors Professor Hans Ketil Normann and Professor Torunn Hamran. You gave me the trust and the benefit of the doubt to conduct this project the way I wanted to. Both of you have been great inspirations for me throughout this process. Your critical questions and our discussions always drove me further. Additionally, you have always made me feel confident. I have always left our meetings in higher spirits and with renewed trust in my own abilities. Thank you Torunn and Ketil – I will always owe you! The Department of Health and Care Sciences, Centre for Care Research Northern Norway, and the Nursing Program at UiT The Arctic University of Norway deserve warm thanks for allowing me this opportunity. Thanks to my understanding leaders and colleagues I have had the privilege of immersing myself in studies for several years. I am well aware that my privileges came at the cost of an increased workload for my colleagues. This project would not have been a reality without financial support. I am thankful for the assistance of the Research Council of Norway, which funded the study. I would also like to thank Centre for Sami Studies, UiT, who granted me the funds that allowed me to travel to Canada and translated the informational letters and the summary of the thesis to the Sami language. Thanks to Professor Annette Browne at School of Nursing, University of British Columbia, I had the opportunity to spend