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Objective: This study aimed to identify and classify the needs of caregivers of children with disabilities living in resource-limited settings and develop a framework for need assessment.Participants and Methods: This study was conducted in the Maha Sarakham Province, Thailand, with 15 caregivers caring for children with disabilities recruited from hospitals, the Association for the Disabled, and primary health centers. Semi-structured interviews were conducted in local dialects, recorded, transcribed, converted into standard Thai, and then into English for thematic analysis. Meaning units corresponding to caregivers’ needs were extracted, interpreted, coded, and hierarchically organized into subcategories by comparing similarities and differences among the extracted codes. The subcategories were further grouped and abstracted into categories, and then domains of caregivers’ needs were formed.Results: Nineteen categories were identified across five domains of caregivers’ needs: health and medical, welfare, educational, social, and informational. Although basic medical treatment was covered, specific support, such as referral to a specialist, rehabilitation, or psychological support, was limited. Financial support and relief from the care burden are the main welfare needs. Educational needs were identified to provide knowledge to children and to offer respite to their caregivers. Social needs revealed ethical problems that arose because of strong rural community ties, making it difficult to maintain privacy. Informational needs were intertwined with the other four domains. In rural areas, where parents of children with disabilities migrate to cities to find work, the special needs of grandparents who were primary caregivers of the children needed to be addressed.Conclusion: This study provides a conceptual framework for comprehensive needs assessment and policy development for caregivers of children with disabilities living in resource-limited settings.
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Objectives To clarify the transition process of Brazilian mothers of children with developmental disorders residing in Japan from “mothers raising healthy children” to “mothers raising children with developmental disorders within the Japanese healthcare and welfare system.”Methods We conducted semi-structured interviews of 11 Brazilian mothers who raised their children for at least 1 year after the children were diagnosed having developmental disabilities.According to an interview guide we prepared, the mothers were requested to talk regarding raising their children and treatment and education after they suspected that their children had developmental disabilities and regarding the changes in their views about the same. The interviews were analyzed using a modified Grounded Theory Approach (M-GTA).Results and discussions The average age of the research participants was 37.4 years. The children’s age ranged between 2 to 8 years. All the children had an autism spectrum disorder. Mothers began «suspecting» that their children exhibited developmental problems around the age of 1.5 years. Some mothers experienced a sense of «diving into turmoil» when diagnosis of autism was given. Since before the diagnosis, mothers experienced a persistent and «ongoing emotional pain due to their children’s disorder». Meeting people they can trust «provided them with the support to become stronger», and were ready to do anything for their children; in other words, they became akin to [superwomen for their children]. This process was similar to that observed in a previous study involving Japanese mothers. A short time between the initial suspicion of their children’s development and the first clinical examination and taking actions toward a diagnosis, in other words, “impatience,” were characteristics of Brazilians mothers.Conclusions The transition process of Brazilians mothers was similar to that of Japanese mothers, with some distinct characteristics. Managing impatience, providing intervention after a diagnosis, and seeking support from others will promote this transition.
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<b>Objectives</b><BR> This study aimed to compare accessibility to the health services in Brazilian CSHCN (children with special health care needs) with non-CSHCN living in Japan and the parenting stresses of the parents of both groups of children, as well as to examine if the children’s being CSHCN is a factor of increasing the parenting stresses of their mothers. <BR><b>Methods</b><BR> A questionnaire was administered to 130 Brazilian mothers in Japan of children between 3-6 years of age living in Aichi Prefecture, and analyzed the valid answers of 73.The questionnaire was constructed with background information, CSHCN Screener<sup>©</sup>, children’s health care service needs, and PSI/SF (Parenting Stress Index Short Form). We evaluated the differences between CSHCN and non-CSHCN, and conducted a multiple linear regression analysis on the parenting stress scores. <BR><b>Results</b><BR> Nine out of 73 children were identified as CSHCN including four with asthma, three with autism, one with chronic bronchitis, and one with cardiac hypertrophy. Although all CSHCN had family doctors, their mothers had unmet needs for specific health care services, especially dental care, rehabilitation and consultation of specialists. There were three mothers of non-CSHCN who had delayed or forgone care.<BR> The average score of PSI in all mothers was: TS (Total Stress)＝60.2, PD(Parental Distress)＝22.0, P-CDI(Parent-Child Dysfunctional Interaction)＝16.9, DC(Difficult Child)＝21.7. DC score was significantly higher in CSHCN than in non-CSHCN. Three determinants of elevated TS score were having CSHCN or children with chronic diseases, experiencing severe economic difficulties, and having a husband who did not speak Japanese.<BR><b>Conclusions</b><BR> The study revealed that Brazilian mothers with CSHCN in Japan were not disadvantaged in terms of access to health services, but had unmet needs in some specific areas. Although the mothers of CSHCN showed relatively low levels of total parenting stress, they had significantly higher levels of stress on the difficult child characteristics. Attention for the stress of the mothers of CSHCN is required.
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<B>Introduction</B><BR>The objective of this study was to explore experiences of immigrant medical interpreters working in Japanese hospitals and their view on how to improve medical interpreting services.<BR><B>Methods</B><BR>We conducted semi-structured interviews to five Brazilian and Argentinean interpreters working at two hospitals in Aichi Prefecture. The interviews explore their experiences since they started working as an interpreter focusing on difficulties and strategies to overcome them. We also asked how they saw medical interpreter system in Japan and how it can be improved. The interviews were recorded and transcribed. Descriptions related to difficulties and overcoming strategies were extracted from the transcription, coded and summarized into subcategories, then, to categories.<BR><B>Results</B><BR>Forty subcategories were extracted concerning difficulties and strategies immigrant medical interpreters experienced. They were integrated into eight categories. Their experiences were described as follows (« »shows categories). Immigrant medical interpreters started their career with«Groping due to lack of relevant experiences and training», therefore, they experienced«Initial difficulties and hardship». They devised various«Initial strategies to overcome difficulties»and improved their skills. Then they faced«Bafflement and dilemma as experienced». They struggle to bring«Change and contrivance as experienced»to themselves and to their colleagues. As they overcame serious difficulties, they gradually equipped with«Concern and consideration as a medical interpreter». Through experiences as an interpreter, they found out«Meaning of being an interpreter», and started«Taking on a new role»beyond what were assigned to them.<BR><B>Conclusion</B><BR>This study portrayed immigrant medical interpreters’ experiences on difficulties they faced as well as strategies to overcome them. It is important to enhance social recognition of medical interpreters and establish medical interpreter system in order to improve access of immigrants to health care.
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<B>Objectives:</B> In developing countries, measuring household income is difficult. The Wealth Index is an alternative to household income; however, it contains too many items making its use in a healt-related study difficult. Thus, we developed a shorter version of the index appropriate for rural areas in Cambodia and analyzed the relationship between economic status and maternal health knowledge and behavior using the index.<BR><B>Methods:</B> We conducted the study in four health center areas in Kampong Cham Province. We administered structured questionnaires to 640 women who had delivered babies within a year prior to the study. The development of the Cambodian Wealth Index-Rural version (CWI-R) followed the procedures of the Demographic and Health Survey (DHS) Wealth Index. Out of 69 items in the Cambodian DHS, we selected 18 items by assessing the distribution and correlation between the items and then performed principal component analysis. Those items that had principal component scores (PCS) below 0.4 were removed. As a result, we created an 11-item wealth index weighted by PCS; Cronbach’s <I>α</I> was 0.81. We tabulated economic status using quintiles and calculated health behavior and the women’s healt-related knowledge for each quintile.<BR><B>Results:</B> The mean age (SD) of the women was 27.0 (6.4) years. The rate of antenatal and postnatal care and skilled birth attendant increased as economic status improved. Knowledge of risk factors during pregnancy and delivery varied according to item. For prolonged labor and edema, knowledge increased as economic status improved; however, we observed no significant differences for vaginal bleeding. More women who had a higher economic status knew the benefits of Vitamin A and the causes of intestinal parasitic infections.<BR><B>Conclusion:</B> The pattern of maternal knowledge and behavior analyzed with the CWI-R was parallel to the original wealth index, indicating its usefulness as an alternative to the original wealth index.
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<B>Objectives</B><br>The study aims to clarify the difficulties of pregnancy, delivery, and child raising for immigrant women in Japan and their strategies for overcoming them.<br><B>Methods</B><br>The semi-structured interviews were conducted with 18 immigrant women who have experience of delivery or child raising in Japan. The participants were asked about their experiences and difficulties faced during pregnancy, delivery, and child raising, and how they overcame them. The data were analyzed in a qualitative and descriptive manner.<br><B>Results</B><br>Seven core categories of difficulties were extracted:«anxiety about child raising»,«problems with relationships with others»,«socio-economic problems»,«anxiety about pregnancy, delivery, and diseases»,«problems caused by illiteracy»,«lack of understanding about Japanese health system»,«choice of the delivery country». Women's«making efforts to manage»is supported by family members and it leads to«use of the Japanese health system». Getting support from friends and neighbors, and the use of an interpreter also leads to this. Some women try to overcome the difficulties by«using a non- Japanese health system»or«doing nothing».<br><B>Conclusions</B><br>When foreigners access health services, not only literacy but also health literacy, such as understanding medical terms or health systems are necessary. Many immigrant women got support from family and friends to overcome the difficulties. However, some women could not get such support and it is necessary for them to make a support network. Foreign women who take negative strategies and use non-Japanese health systems may be in the process of adjusting to Japanese society. Health providers should not deny such strategies, but understand them as a way of decreasing anxiety.