Dismissed and unheard: Arab immigrant women’s experiences seeking pelvic pain care in Norway

Miroslava Tokovska, Simen Christensen Grøgaard, Merete Kolberg Tennfjord
In: Women's Health · 2026 · vol. 22 , pp. 17455057261444190 · doi:10.1177/17455057261444190 · PMID:42041063 · W7156133688
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This study used interpretative phenomenological analysis to explore how nine Arab immigrant women in Norway experienced and navigated seeking care for pelvic pain, revealing challenges in symptom dismissal, cultural stereotyping, and healthcare system navigation.

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Abstract

OBJECTIVE: Immigrant women face unique challenges accessing appropriate gynaecological health care. This study investigates how Arabic-speaking women perceive and respond to pelvic pain while navigating Norwegian health care. METHODS: Interpretative Phenomenological Analysis (IPA) was employed to examine the lived experiences of nine Arab women through interviews conducted in Arabic, facilitating both in-depth individual case analysis and cross-case comparative examination. RESULTS: Four themes emerged: (1) Symptom Dismissal and Erosion of Trust in Healthcare; (2) Cultural Stereotyping and Communication Challenges; (3) The Intersection of Pain, Identity, and Daily Life; and (4) Navigating Healthcare Systems and Treatment. These themes reveal challenges in provider relationships, impacts on daily functioning, and complexities of cross-cultural health care experiences. CONCLUSION: Findings highlight the need for improved cultural competency and better recognition of immigrant women's health concerns. Health care providers should consider cultural backgrounds and previous health care experiences when treating Arab immigrant women, ensuring more effective and culturally sensitive care delivery.
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Abstract

Objective:

Methods

Results:

Conclusion

Plain language summary

Introduction

Materials and methods Study design Data sampling | Code | Age range | Years resident in Norway | Educational level | Marital status | Urban or rural | |---|---|---|---|---|---| | Participant A | 30–40 | 11 | Primary school | Married, children | Rural | | Participant B | 20–30 | 10 | High school | Married, children | Rural | | Participant C | 30–40 | 7 | University | Married, children | Urban | | Participant D | 30–40 | 9 | High school | Unmarried, child | Rural | | Participant E | 40–50 | 20 | University | Married, children | Urban | | Participant F | 40–50 | 9 | Primary school | Married, children | Urban | | Participant G | 30–40 | 14 | University | Married, children | Urban | | Participant H | 50–60 | 13 | University | Married, children | Urban | | Participant I | 20–30 | 13 | University | Married, no children | Urban | Data collection and analysis | Superordinate theme | Subtheme | Experiential statement | Linguistic elements | Supportive quotes | Interpretative notes | |---|---|---|---|---|---| | 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 | | 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 | || | 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 | | | 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 | | 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 | | | 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 | | 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 | Ethics approval and consent to participate

Results

Symptom dismissal and erosion of trust in health care Since the health personnel said it was normal, I just have to endure it. The doctor didn’t take me seriously; he said I just think I have problems, but actually I don’t. (Participant B) She [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) Cultural stereotyping and communication challenges The doctor said to me that my uterus is down due to childbirth [referring to uterine prolapse] . . . it is uncomfortable, especially during menstruation. (Participant G) A 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) They [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) I 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) Yes, 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) The intersection of pain, identity, and daily life I 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) It’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) I 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) Navigating health care systems and treatment pathways Here 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) In 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)

Discussion

Strengths and limitations

Conclusion

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