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Intercultural Pediatrics Unit (UPI)

Socio-cultural Factors of Protection and Vulnerability in the Appearance and Development of Intestinal Function Disorders: Perspectives of the Child and Its Family and Their Recourse to Services

1- Issues

Defined by recurrent symptoms that organic anomalies cannot explain, intestinal function disorders (IFD) are very frequent in pediatrics. More than 15% of school-age children suffer from abdominal pain secondary to IFD. The physiopathological mechanisms underlying these disorders have not been fully elucidated. A biopsychosocial model, however, makes it possible to shed some light on the problem. The onset of symptoms and sustained abdominal pain are reported to be due to the association, to varying degrees, of an anomaly of visceral sensitivity to psychological disorders (anxiety or depression) under the influence of the response of the parents, family, traditions, culture, school, etc. Nevertheless, the cultural dimensions inherent to these disorders and the responses brought to them remain unexplored. Fifty per cent (50%) of the patients seen for the first time at the specialized gastro-enterology clinic of the CHUSJ present symptoms related to an intestinal function disorder. At this clinic, most of the children who present a function disorder are Quebeckers of French-Canadian origin. This over-representation is striking in so far as: (1) a study conducted at the CHUSJ in 2002 indicated that more than 40% of the families that visited the hospital are of immigrant origin; and (2) intestinal function disorders are noted in all of the countries in Asia, Africa and the Americas where their prevalence was evaluated. No study, to our knowledge, allows us to understand and explain the quasi-absence of children of immigrant origin who consult for this type of disorder at the CHUSJ. We propose that a study of the socio-cultural factors of protection and fragilization of the health of children, based on the accounts of the children and their parents outside the health departments and integrating families from various cultural groups, is likely to shed light on this issue in an innovative way.

2- Hypotheses and Objectives

Our hypotheses are the following:

  1. In response to the onset of symptoms related to intestinal function disorders, replacement solutions are adopted by the family and the child to relieve the child’s symptoms and avoid the chronic development of symptoms and recourse to pediatric services;
  2. The symptoms are not interpreted by the child’s family and close contacts as being pathological or serious enough to require a medical consultation;
  3. These symptoms can be understood but neglected because of communication problems (ability of the parents to express themselves in the language used by the healthcare services), not being accustomed to have recourse to healthcare services, inflexible work conditions (making consultation difficult) or even limited economic resources that hinder consultation efforts (in terms of the availability of time and money).

Our general objective is to isolate the socio-cultural factors of protection and risk concerning pediatric function disorders and the perceived “need” to turn to healthcare services to respond to these disorders. Our operational objectives are:

  1. To explore the signs, i.e., the perception and expression of the symptoms related to disorders from the point of view of the child and its parents;
  2. To recognize the meaning attributed to the symptoms as well as the explanation models introduced by the various actors (children and parents);
  3. To examine the reactions and actions associated with the disorders in children, their parents and close contacts (e.g., extended family, friends, educators, religious figures), particularly in terms of the treatment of symptoms and looking for help.

3- Methodology

We have adopted an anthropologically-based approach that focuses on accounts given by children and their parents. The study population, made up of 50 children 10 to 12 years old and their parents, will be divided into 5 membership groups: 1) Caribbean; 2) Atikamekw; 3) East Asian; 4) French-Canadian Quebecker. A control group will be made up of children monitored at the CHUSJ Gastroenterology Clinic. An adapted version of the Pain Questionnaire (Perquin et al. 2000) will be administered to pupils in twenty classes spread among the schools selected according to the language of schooling (French), the ethnic makeup of their territories and the similarity of their respective socioeconomic backgrounds. The study subjects will be selected using this questionnaire and the following inclusion criteria: (1) presence of chronic abdominal pains and (2) absence of recourse to a medical consultation for this reason. The children in the control group will be comparable with those in the community groups in terms of symptomatology, but they will have recourse to healthcare services. The qualitative data (accounts) will be collected from children and their parents through ethnographically-based semi-structured interviews. These data will be submitted to comparative-, vertical- and transversal-type analyses in order to allow similarities and differences to emerge among the accounts and socio-cultural groups at the following three levels: clinical manifestations (signs), meaning given to these manifestations and actions taken (or not taken) in relation to the general progression of the disorder. The challenge with these analyses will be to measure socio-cultural factors of protection and fragilization involved in intestinal function disorders in terms of signs, meanings and actions that shape the experience of the children and families.

4- Pertinence and Benefits

As gastrointestinal function disorders have become increasingly prevalent and medical interventions in this field in North America are of limited efficacy, it has become urgent that we renew our conceptions and approaches. This project is part of a plan aimed at understanding the study phenomenon by isolating the constituent elements of a new analysis paradigm of function disorders based on elements of socio-cultural nature anchored in the experience of children and families. By providing keys that allow us to shed light on the factors at issue in the appearance and progression of function disorders, the results of this study should result in a clear identification of the socio-cultural factors of protection and risk related to function disorders. Our study will allow us to better understand the intercultural variations of the relation with healthcare services and shed light on the over-representation of Quebeckers of French-Canadian origin in the Gastroenterology Clinic of the CHUSJ. Our findings will add to the knowledge of the mechanisms that underlie gastrointestinal function disorders and have a major impact on the response of clinicians to children and families who consult for this type of problem. They will be made public in journals that specialize in the field of pediatrics, gastroenterology and medical anthropology within the framework of national and international scientific symposia as well as available to caregivers in various clinical settings through seminars and workshops. Based on the thorough analysis of clinical cases and a focus on the improvement of knowledge regarding socio-cultural factors of protection and risk associated with function disorders in children, such activities will be made available to caregivers to apply within their practice. They will help in the search for solutions aimed at responding adequately to the day-to-day difficulties experienced by the families concerned.

 

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Updated on 10/14/2014
Created on 10/10/2014
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