{"paper_id":"e7a2d2a2-084c-439a-8612-2c8ea3914e62","body_text":"Dismissed and unheard: Arab immigrant women’s experiences seeking pelvic pain care in Norway\nAbstract\nObjective:\nMethods:\nResults:\nConclusion:\nPlain language summary\nIntroduction\nMaterials and methods\nStudy design\nData sampling\n| Code | Age range | Years resident in Norway | Educational level | Marital status | Urban or rural |\n|---|---|---|---|---|---|\n| Participant A | 30–40 | 11 | Primary school | Married, children | Rural |\n| Participant B | 20–30 | 10 | High school | Married, children | Rural |\n| Participant C | 30–40 | 7 | University | Married, children | Urban |\n| Participant D | 30–40 | 9 | High school | Unmarried, child | Rural |\n| Participant E | 40–50 | 20 | University | Married, children | Urban |\n| Participant F | 40–50 | 9 | Primary school | Married, children | Urban |\n| Participant G | 30–40 | 14 | University | Married, children | Urban |\n| Participant H | 50–60 | 13 | University | Married, children | Urban |\n| Participant I | 20–30 | 13 | University | Married, no children | Urban |\nData collection and analysis\n| Superordinate theme | Subtheme | Experiential statement | Linguistic elements | Supportive quotes | Interpretative notes |\n|---|---|---|---|---|---|\n| Cultural and Communication Barriers in Patient-Provider Trust | Trust and Credibility | Feeling dismissed and invalidated | Use of passive voice, emotional language | The doctor didn’t take me seriously . . . (P-B) | Reflects power dynamics in health care relationships |\n| Barriers to changing providers | Expression of helplessness | I wanted to change my GP, but . . . it was embarrassing. (P-C) | Reflects power dynamics in health care relationships | ||\n| Cultural Communication | Impact of language barrier | Direct reporting of challenges | My GP speaks Arabic, so I don’t have any problems. (P-A) | Language as facilitator or barrier to care | |\n| The Intersection of Pain, Identity, and Daily Life | Physical Limitations | Restricted mobility and function | Detailed description of limitations | I can’t work now; I can’t vacuum either. . . (P-D) | Impact on independence and self-sufficiency |\n| Social Isolation | Withdrawal from social activities | Use of absolute terms | I have no social life; I have cut contact with everyone. (P-F) | Social consequences of pelvic pain conditions | |\n| Navigating Healthcare Systems and Treatment Journey | Treatment Approaches | Comparing health care systems | Comparative language | Here in Norway, they are careful with medication, the opposite of [the system in] my home country. (P-H) | Cultural expectations influence treatment perception |\n| Patient Education | Unmet information needs | Expression of uncertainty | When you don’t get enough information . . . you become less motivated . . . (P-I) | Impact of communication on treatment adherence |\nEthics approval and consent to participate\nResults\nSymptom dismissal and erosion of trust in health care\nSince the health personnel said it was normal, I just have to endure it.\nThe doctor didn’t take me seriously; he said I just think I have problems, but actually I don’t. (Participant B)\nShe [her GP] refused to examine me, was dismissive, and I was suppressed. I wanted to change my GP, but I had a male contact person in the municipality, and it was embarrassing to talk about my challenges [the pain during intercourse]. (Participant C)\nCultural stereotyping and communication challenges\nThe doctor said to me that my uterus is down due to childbirth [referring to uterine prolapse] . . . it is uncomfortable, especially during menstruation. (Participant G)\nA doctor told me ‘. . . you have difficulties [during childbirth] because you who come from the Middle East are shorter than us [‘white’ Europeans], therefore you don’t have enough space for the baby’. (Participant G)\nThey [healthcare personnel] say the disease is sleeping [sic; the intended medical meaning was ‘in remission’] . . . is the disease ‘sleeping’?! I have never heard of that, yet I have all these symptoms. (Participant H)\nI feel a bit uncertain. I got medical help, but an explanation or sufficient information was not quite there. When you don’t get enough information, you become less motivated to engage with the healthcare process. (Participant I)\nYes, but you can get an interpreter who can help. My GP speaks Arabic, so I don’t have any problems communicating with him. (Participant A)\nThe intersection of pain, identity, and daily life\nI can’t do anything when I get these pains. One day my daughter had an appointment at the health clinic, and suddenly the pains came. I couldn’t go to the appointment. (Participant E)\nIt’s in the joints and nerves. I can’t work now; I can’t vacuum either. The condition [an autoinflammatory disease] has really developed. I can’t hold the phone for more than 10 minutes, and I can’t drive for more than an hour. Showering is the biggest challenge, especially one week before menstruation starts . . . (Participant D)\nI have no social life, I cut contact with everyone. My quality of life has become very poor after I came to Norway, due to the pain in my body. (Participant F)\nNavigating health care systems and treatment pathways\nHere in Norway, they are careful with medication, the opposite of my home country. In Norway, you either die or get better [she said with a smile] while waiting for the appointment. What’s not good is the long waiting time. (Participant E)\nIn my home country, I used to take medicines, and I didn’t have any adverse reactions to them. I developed them [side-effects from medication] after my last operation in Norway. (Participant F)\nDiscussion\nStrengths and limitations\nConclusion\nAcknowledgments\nEthical considerations\nConsent to participate\nConsent for publication\nDeclaration of conflicting interests\nFunding\nORCID iDs\nFootnote\nData availability statement\nReferences\nSupplementary Material\nPlease find the following supplemental material available below.\nFor Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.\nFor non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.\nCite\nCite\nCite\nDownload to reference manager\nIf you have citation software installed, you can download citation data to the citation manager of your choice\nInformation, rights and permissions\nInformation\nPublished In\nKeywords\nData availability statement\nAuthors\nAuthor contributions\nMetrics and citations\nMetrics\nPublication usage*\nTotal views and downloads: 112\n*Publication usage tracking started in December 2016\nPublications citing this one\nReceive email alerts when this publication is cited\nWeb of Science: 0\nCrossref:\nThere are no citing articles to show.\nFigures and tables\nFigures & Media\nTables\nView Options\nView options\nPDF/EPUB\nView PDF/EPUBAccess options\nIf you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:\nloading institutional access options\nAlternatively, view purchase options below:\nPurchase 24 hour online access to view and download content.\nAccess journal content via a DeepDyve subscription or find out more about this option.","source_license":"CC0","license_restricted":false}