Mahnoor Ayub
Detroit, Michigan, United States
According to the Kaiser Family Foundation,1 1 in 4 children in the US has an immigrant parent. South Asian (SA) countries are one of the main sources of international migration.2 The SA immigrant population in the US is heterogeneous and includes people from countries such as Pakistan, India, Nepal, Bhutan, Bangladesh, and Sri Lanka.3 Yet, despite geographic, religious, and linguistic differences, immigrants from SA countries may share cultural norms and social values that influence their healthcare beliefs and practices.3
Much of the SA diaspora is rooted in multi-generational households, where family is the emotional center. Family-based caregivers typically hold round-the-clock responsibilities for emotional, social, spiritual, and financial support.4,5 Caregivers often accompany patients to physician appointments and hospital visits and assist with decision-making. In SA populations, caregivers are typically adult children, but extended family members such as grandchildren may also assume responsibilities as directed by the primary family caregiver. In bicultural households, family caregivers and aging immigrant adults may find themselves trying to reconcile different values, cultural responsibilities, shifts in identity, and health challenges. Physicians may also find themselves at the center of this dynamic as they address treatment and prevention within this cultural context.
When there are linguistic barriers, there may be an even greater reliance on caregivers in the healthcare setting, who often translate and assume responsibility for adherence to medical regimens, exercise requirements, and dietary needs. Although there has been an increase in awareness of the struggles experienced by caregivers, there is little discourse on how cultural conceptions of caregiving differ in immigrant populations. In medical education, these narratives merit attention, as effective physicians must be cognizant and supportive of patient-caregiver dynamics to facilitate optimal health outcomes. Culturally competent interventions by a healthcare professional can establish rapport and limit communication barriers. An understanding of the centrality of family can assist care recipients in making sense of their need for care, the caregiving relationship, and, ultimately, their sense of self.
In medical education, a focus on family care helps future physicians understand diverse patient populations, especially in the context of multi-generational geographic mobility. Caregiving relationships in SA immigrant households can be viewed as growing, evolving partnerships, rather than fixed, static arrangements.4 As chronic health conditions become more prevalent in the aging immigrant population, healthcare providers will increasingly be called upon to understand and help navigate caregiving relationships. The diversity of religious, cultural, and spiritual beliefs and preferences in immigrant populations such as the SA community warrants further exploration in physician training. An educational grounding in the complexities of intergenerational, cultural, and family-based care has important implications for both healthcare policy and clinical practice.
References
- Nambi Ndugga (2022) Immigrants in the US continue to face health care challenges, KFF. Available at: https://www.kff.org/racial-equity-and-health-policy/slide/immigrants-in-the-u-s-continue-to-face-health-care-challenges/ (Accessed: March 15, 2023).
- Batra, Mehak, Sabrina Gupta, and Bircan Erbas. “Oral health beliefs, attitudes, and practices of South Asian migrants: A systematic review.” International journal of environmental research and public health 16, no. 11 (2019): 1952.
- Sudarsan, Indu, Karen Hoare, Nicolette Sheridan, and Jennifer Roberts. “South Asian immigrants’ and their family carers’ beliefs, practices and experiences of childhood long‐term conditions: An integrative review.” Journal of Advanced Nursing 78, no. 7 (2022): 1897-1908.
- Andruske, Cynthia Lee, and Deborah O’Connor. “Family care across diverse cultures: Re-envisioning using a transnational lens.” Journal of aging studies 55 (2020): 100892.
- Nugraheni, Suryadewi E., and Julia F. Hastings. “Family-based caregiving: Does lumping Asian Americans together do more harm than good?.” Journal of Social, Behavioral, and Health Sciences 15, no. 1 (2021): 87-102.
- Butler, Mary, Robert L. Kane, Donna McAlpine, Roger G. Kathol, Steven S. Fu, Hildi Hagedorn, and Timothy J. Wilt. “Integration of mental health/substance abuse and primary care.” Database of abstracts of reviews of effects (DARE): quality-assessed reviews [Internet] (2008).
- Chan, Angelique, and David B. Matchar. “Demographic and structural determinants of successful aging in Singapore.” Successful aging: Asian perspectives (2015): 65-79.
- Crosnoe, Robert. “Two-Generation Strategies and Involving Immigrant Parents in Children’s Education.” Urban Institute (NJ1) (2010).
- Ng, Reuben, and Nicole Indran. “Societal narratives on caregivers in Asia.” International Journal of Environmental Research and Public Health 18, no. 21 (2021): 11241.
- Asare, A. O., Stagg, B. C., Sharareh, N., Stipelman, C., Del Fiol, G., & Smith, J. D. (2024). Vision Loss in Children from Immigrant and Nonimmigrant Households: Evidence from the National Survey of Children’s Health 2018–2020. Journal of Immigrant and Minority Health, 1-10.
- Wilson, F. A., Wang, Y., Stimpson, J. P., Kessler, A. S., Do, D. V., & Britigan, D. H. (2014). Disparities in visual impairment by immigrant status in the United States. American journal of ophthalmology, 158(4), 800-807.
- Copado, I. A., Hallaj, S., Saseendrakumar, B. R., & Baxter, S. L. (2024). Disparities in Eye Care Utilization Among Refugee and Migrant Populations. Translational Vision Science & Technology, 13(2), 14-14.
- Juniat, V., Bourkiza, R., Das, A., Das-Bhaumik, R., Founti, P., Yeo, C., & Okhravi, N. (2019). Understanding visual impairment and its impact on patients: a simulation-based training in undergraduate medical education. Journal of medical education and curricular development, 6, 2382120519843854.
- Zagar, M., & Baggarly, S. (2010). Low vision simulator goggles in pharmacy education. American journal of pharmaceutical education, 74(5), 83.
MAHNOOR S. AYUB, BS, MS, is a fourth-year medical student at Wayne State University School of Medicine. Her research has explored the neuroendocrine basis of behavior in invertebrate models and cell biology of the retina in mouse models. She advocates for patient empowerment through accessible health journalism and is an editor for The Detroit Pulse.
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