Amanda Stromberg and Dr. Jane Lassetter, Nursing
The world in which we now live is a global community where people of many origins and their respective cultures cross paths on a daily basis. We are a mobile society in many respects, including geographically, as people are no longer bound to their native lands and now migrate further from home, with more ease, than ever before. Though health concerns have always accompanied migrants, attitudes have shifted as research has uncovered both the positive and negative impacts of migration on the health and well-being of migrants (Hull, 1979). Changes have been attributed to a variety of factors including stress, changes in climate, separation from family members, and exposure to different cultural surroundings (Elliott & Gillie, 1998; Frisbie, Cho, & Hummer, 2001). It is the goal of all healthcare professionals, and nurses in particular, to reduce negative impacts on migrants’ health, however, it is difficult to do so without a clear understanding of a migrant group’s definition of health. This is due to the fact that the definition of good health can influence a number of decisions, such as if and when people access healthcare. In addition, little or no progress can be made towards the goal of ‘good health’ unless health care professionals understand the goals and health definitions of patients. With increased understanding of a migrant population’s perceptions and definitions of good health, healthcare professionals will be better able to care for that population.
The primary qualitative study was conducted using in-depth, audio-taped interviews that lasted approximately an hour and a half. The interviews consisted of semi-structured, open-ended questions regarding the impact of migration on the health and well-being on the participant, access to health-care, and changes in cultural health practices since migration. The initial step of analysis was transcribing the recorded interviews verbatim. Following transcription, the principle researcher used NVivo7 to categorize and code pertinent data into groupings of similar topics. My secondary analysis involved such a topic from the primary data collected, specifically ‘definitions of good health.’ I read the data collected on this topic from all interviews multiple times to sort data and identify similar trends between the various interviews. As general trends emerged, several definitions that embodied the bulk of the data analyzed were developed.
My hypothesis as I began this research was that one general definition of good health would emerge from the interviews. As I worked through the data, however, I found that nearly all of the participants’ responses fell into the categories of physical, mental, or spiritual components of good health. As I examined these three components, I discovered that many participants included several in their definitions of good health.
Physical components were most frequently mentioned, followed by mental and spiritual components, respectively. When participants were initially asked to describe their definition of good health, 20 first identified physical components, six identified mental components, and one identified spiritual components. As the conversation continued, many participants included a second component of good health, four of which were physical components, 12 of which were mental components, and four of which were spiritual components. In addition, six participants noted a third component to good health.
The most frequent response, physical components to good health, included core concepts such as diet and exercise. Diet was a primary response for many individuals, and many participants understood the direct relationship between altering diet and improving overall physical health. For many participants, a diet that leads to good health involved eating healthy goods. Other participants, however, discussed how the quantity, not quality, of foods affects good health. Exercise was also very important; many participants indicated that regular exercise was essential to avoiding poor health. Other physical components included taking vitamins, drinking enough water, understanding the body, getting adequate sleep, and seeing a doctor regularly.
Mental components of good health involved ways to stay happy, such as doing good for others. For some, the mental component of good health was closely tied to the Aloha Spirit that was found in Hawaii. This optimistic attitude was an important part of the participants’ lives in Hawaii and many expressed making conscious efforts to bring that Spirit with them to Las Vegas. Nearly all of the participants that mentioned a mental component to health talked about the importance of decreasing stress in their lives in order to maintain good health. There was a large variety of response as to how to best avoid stress, most of which directly correlated with the individual challenges of each participant. Financial instability, which brought many participants to Las Vegas, still remained a battle and therefore a cause of stress and poor health.
The spiritual components mentioned included having hope in order to remain healthy. Some found this hope through prayer and active participation in their religion. Other participants found the hole they needed to keep going from a higher power or from their heritage and history.
In October 2008, I was able to present my findings at the 2008 Nursing Research Conference, which was co-sponsored by Intermountain Healthcare and the Brigham Young University College of Nursing. This was especially valuable as it was a wonderful opportunity for me to practice presenting in a professional setting among others in my field.
The main problem I encountered during my project was the fact that I was performing a secondary analysis and I could not personally talk to the participants or ask follow-up questions. In the future it would love to be more involved in the research so that my analysis could be more complete.
As I prepare to graduate and enter the work force as a nurse, maintaining and restoring patients’ health will be my number one priority. It is my hope that by better understanding the definition of good health of Native Hawaiians who have migrated to the mainland, I will be better prepared to provide culturally competent care to this and other populations. In addition, I have come to have an increased understanding of the importance of performing research within my field and I now hope to continue to participate in research throughout my career.
- Elliott, S. J., & Gillie, J. (1998). Moving experiences: A qualitative analysis of health and migration. Health & Place, 4(4), 327-339.
- Frisbie, W. P., Cho, Y., & Hummer, R. A. (2001). Immigration and the health of Asian and Pacific Islander adults in the United States. American Journal of Epidemiology, 153(4), 372-380.
- Hull, D. (1979). Migration, adaptation, and illness: A review. Social Science and Medicine, 13A, 25-36.