Counter-narratives against hardships among Syrian refugee youth and parents.

The conventional literature and popular media describe the challenges of (Syrian) refugees in terms of their being victims who need to deal with the traumatic events they experienced before and during their flight. Their lack of seeking professional psychosocial help to improve their mental wellbeing is often explained by migrants' supposed fear of stigmatization. Using in-depth interviews with 10 Syrian refugees in the Netherlands, we show that their main struggle concerns their identity fragmentation as a result of both their displacement and the stereotypical discourses of Muslim/Syrian people as victims or terrorists. In this article, we explore how Syrian refugee youths use strategic forgetting and remembering of both positive and negative memories to reconstruct their (collective) identity. Our finding that Syrian refugee youths use counter-narratives of being strong and competent to deal with their experience of identity fragmentation offers an alternative explanation for refugees not seeking professional help in dealing with their hardships.

"They don't do anything" contextual factors influencing Turkish-Dutch individuals' perceptions of general practitioners and medical specialists in the Netherlands and Turkey.

OBJECTIVE: Intercultural difficulties between GPs and patients are important contributors to health disparities. Framed in an interpretivist paradigm, this paper's thematic analysis examined how Turkish-Dutch patients' expectations of Dutch GPs may result in intercultural communication difficulties. METHODS: Five focus group discussions were conducted with 21 participants of Turkish-Dutch background. Participants were asked to discuss perceived differences between GP-patient encounters in the Netherlands and Turkey. RESULTS: Our study revealed that Turkish-Dutch patients regularly expect Dutch GPs to show other behavior than they perceive to obtain on two themes, 1) dealing with patients' symptoms and 2) communication. In general, Turkish-Dutch patients expect Dutch GPs to show faster, more decisive and informative behavior in diagnostics and treatment. These expectations seem based on their experiences with practitioners in Turkey and on differences between health care systems. CONCLUSIONS: GP-patient difficulties appear primarily the result of underlying frustrations rather than clashes resulting from differences in explanatory models of illness or cultural values. PRACTICE IMPLICATIONS: Whereas systemic differences are more difficult to alter, difficulties in the communication are more readily amenable to change. Patient-centered communication and information about the reasons for being restrictive in diagnosing and treating on symptoms could alleviate these frustrations.

Refugees' Agency: On Resistance, Resilience, and Resources.

This study set out to answer the question 'Which kinds of agency do refugees perform when dealing with mental health problems of themselves and their children?'. Aiming to gain more insight in why it seems harder for refugee parents and minors than for the native population to talk to health professionals about their mental health and wellbeing, we combined two theoretical notions of agency to investigate a broad spectrum of informants' behaviour. We conducted 25 interviews with 30 refugees from 8 countries (Syria, Yemen, Iran, Afghanistan, Armenia, Eritrea, Turkish Kurdistan, Vietnam), whose Dutch residence permit varied from 26 years to less than one year. Data were analysed through open and axial coding, followed by pattern analyses. Although sometimes refugees seek (mental) healthcare, at other times they show agency by doing 'nothing' or by deliberately using distracting activities to deal with severe stress. Making use of resources available to them, oftentimes refugees show agency in ways that are less visible to healthcare professionals, by surviving, showing resilience, and suffering. In these cases, we think healthcare for refugees should intervene in a non-medical way, e.g., by supporting them to obtain resources that help refugees to (re)gain agency.

Dealing with disability: challenges in Dutch health care of parents with a non-Western migration background and a child with a developmental disability.

PURPOSE: Parents of children with developmental disabilities who have a non-western migration background often experience unique challenges in foreign health care systems. This study aimed to describe these experiences to better understand these challenges and thereby improve health care provision. METHOD: Twelve parents were interviewed using in-depth, semi-structured interviews. Our data was analysed, and themes were identified using open, selective, and axial coding. RESULTS: Multiple parents in our study had a different perception of what constitutes a "handicap", may regard it as something that is very severe and highly stigmatized and will be less aware of the complex system of care professionals that aim to support them in the care for their child. Additionally, communication with care professionals may be complicated because of language differences and expectations about the division of roles and responsibilities between parents and professionals. This may result in lower involvement in health care. CONCLUSION: As a result of cultural differences in the meaning, information and interaction about disabilities, non-western migrant parents will have a harder time coping with the diagnosis of their child's disability and will experience more challenges with their involvement in health care.1Implications for RehabilitationTo be aware that non-western parents who are told their child has a disability are likely to experience more shame, fear of stigma and may have other definitions of disability than western parents.To pay specific attention to explain as much as possible about the causes, meaning and medical as well as societal future expectations for children with a disability to parents with another cultural background.To explore which knowledge parents have about their child's disability and the Dutch health care system, so that information and support can be personalized.To make sure there are translators present who can not only translate in the correct language but who can also explain commonly used terms for disabilities and other medical concepts, diagnostic procedures, and other specificities of the health care system of the host country to migrant parents.To psycho-educate parents with a migrant background that they are expected to be actively involved in the professional care for their child with a disability without this having negative consequences for the care of their child.

Early Identification of Social, Emotional, and Behavioral Difficulties by School Staff: A Qualitative Examination of Dutch Primary School Practices.

About 16% of Dutch children are reported to have social, emotional, and behavioral difficulties (SEBDs). SEBDs generate distress and pose risks for various negative outcomes; thus, their timely identification is deemed important to respond appropriately to children's needs and avoid such negative outcomes. Primary schools are considered convenient places to implement early SEBD identification, but the ways in which schools achieve this in practice may be inadequate, although the issue remains under-researched. Although there are several systematic school-based early identification methods (e.g., universal or selective screening), primary schools predominantly rely on school staff to recognize children at risk for, or experiencing, SEBDs. As differences in identification practices could impact whether and when (signs of) SEBDs are identified, this study aimed to increase our understanding of differences in identification practices used by school staff and their potential implications for early identification effectiveness. Thirty-four educational and clinical professionals working at nine primary schools participated in in-depth semi-structured interviews. We used MAXQDA to thematically code and analyze the data. Our analysis of these interviews illustrated that schools' identification practices differed on three elements: the frequency of observations, maintaining a four-eyes principle, and the utilization of specialist knowledge. We argue that differences in these elements have potential consequences for the timeliness and quality of SEBD identification.

Cultural competence in lifelong care and support for individuals with intellectual disabilities.

Objectives: Although an extensive amount of research has been devoted to models defining cultural competence of healthcare professionals in short-term care, there is unclarity about the cultural competencies that professionals providing lifelong care and support should have. The current study aimed to explore which cultural competencies are used by these healthcare professionals, and whether these competencies enabled them to make cultural adaptations to their regular care practices.Design: To investigate cultural competencies and cultural adaptations, semi-structured in-depth interviews were conducted with eight professionals who provide lifelong care and support to individuals with intellectual disabilities. Five cultural competencies were explored: awareness, knowledge, skills, motivation, and encounters.Results: A thematic analysis of the interviews revealed that professionals providing lifelong care and support used all cultural competencies in their care practices. Moreover, our analysis suggested that these competencies could be categorized as either practical or analytical cultural competencies. Although these competencies were conditional in order to make cultural adaptations to care practices, the presence of cultural competencies did not automatically lead to these cultural adaptations.Conclusions: All five cultural competencies were used by professionals in lifelong care and support. Our analysis revealed that both practical and analytical cultural competencies were essential in providing culturally sensitive lifelong care and support. We additionally suggest that the cultural competence of professionals is necessary, but not sufficient, for making cultural adaptations to lifelong care and support for individuals with intellectual disabilities. In many cases, other factors also played a role in a professional's final decision to adapt their care practices.

Beyond the talking imperative: The value of silence on sexuality in youth-parent relations in Bangladesh.

Research conducted in various parts of the globe suggests that young people who can openly communicate with their parents about sexuality benefit in many ways. Correspondingly, in Bangladesh, the lack of an open communication on sexuality in the youth-parent relationship is considered a barrier to ensuring young people's sexual and reproductive health and overall well-being. Taking 'silence' as a core concept, this paper investigates what silence on sexuality means to Bangladeshi young people in their relationship with parents. It draws on findings from an ethnographic study conducted among 72 middle-class boys and girls aged between 15 and 19 years and 18 parents living in Dhaka over a year between 2016 and 2017. The findings suggest that silence is not always perceived as problematic by young people, and this is particularly true for topics related to sexual pleasure. This paper challenges the monolithic understanding that silence is necessarily bad and hinders young people from getting what they need. It offers an additional conceptual understanding to silence for studying sexuality among youths and designing interventions for their sexual and reproductive well-being.

Providers' perspectives on factors complicating the culturally sensitive care of individuals with intellectual disabilities.

BACKGROUND: Culturally sensitive care is essential for improving healthcare for ethnic minorities with intellectual disabilities (ID), who require intensive, sometimes lifelong, care and support. AIMS: The present study aimed to uncover factors that may complicate the delivery of culturally sensitive care for ethnic minorities with ID, which have not previously been studied for this group. METHODS AND PROCEDURES: By means of in-depth interviews with care professionals we identified these factors at the care receiver, professional, and institutional levels. OUTCOMES AND RESULTS: Eight factors were found to complicate the delivery of culturally sensitive care: abilities of the individuals with ID, communication with the family of the care receiver, cultural competency of the professional, personal attitude and experience of the professional, job position and responsibilities of the professional, resources, legislation and protocols, and the team of colleagues. The factors at the care receiver level were specific for the delivery of culturally sensitive care to individuals with ID. CONCLUSIONS AND IMPLICATIONS: In addition to the complicating factors previously identified for other forms of culturally sensitive healthcare, we identified novel complicating factors for the care of individuals with ID. Future research should investigate how these complicating factors could be overcome.

Perceived realism moderates the relation between sexualized media consumption and permissive sexual attitudes in Dutch adolescents.

This study examined whether the development of sexualized media consumption and permissive sexual attitudes would be more strongly interrelated when adolescents perceived sexualized media images as highly realistic. We used data from a three-wave longitudinal sample of 444 Dutch adolescents aged 13-16 years at baseline. Results from parallel process latent growth modeling multigroup analyses showed that higher initial levels of sexualized media consumption were associated with higher initial level of permissive sexual attitudes. Moreover, increases of sexualized media consumption over time were associated with increases of permissive sexual attitudes over time. Considering the moderation by perceived realism, we found these effects only for those who perceived sexualized media as more realistic. Findings for male and female adolescents were similar except for the relations between initial levels and subsequent development. Among male adolescents who perceived sexualized media images to be realistic, higher initial levels of permissive sexual attitudes were related to subsequent less rapid development of sexualized media consumption. For male adolescents who perceived sexualized media to be less realistic, higher initial levels of sexualized media consumption were related to a subsequent less rapid development of permissive sexual attitudes. These relations were not found for female adolescents. Overall, our results suggest that, in male and female adolescents, those with a high level of perceived realism showed a correlated development of sexualized media consumption and permissive sexual attitudes. These findings point to a need for extended information on how to guide adolescents in interpreting and handling sexualized media in everyday life.

From the wizard to the doubter: prototypes of scientists and engineers in fiction and non-fiction media aimed at Dutch children and teenagers.

The aim of this paper is to gain insight into the prototypical scientists as they appear in fiction and non-fiction media consumed by children and teenagers in The Netherlands. A qualitative-interpretive content analysis is used to identify seven prototypes and the associated characteristics in a systematic way. The results show that the element of risk is given more attention in fiction than in non-fiction. Also, eccentric scientists appear more often in fiction. In non-fiction, the dimension useful/useless is more important. Furthermore, fictional scientists are loners, although in practice scientists more often work in a team. In both fiction and non-fiction, the final product of the scientific process gets more attention than the process itself. The prototype of the doubter is introduced as an alternative to the dominant representations because it represents scientists and engineers in a more nuanced way.

The significance of reciprocal and unilateral friendships for peer victimization in adolescence.

The present study examined to what extent the number of friends and their social and personal characteristics were related to peer victimization in adolescence. Participants were 2,180 adolescents (1,143 girls), aged 11-18 (M = 14.2), who were classified as victims, bully-victims, or non-involved (i.e., adolescents who neither bullied others nor were victimized by others). Three types of friends were distinguished: reciprocal friends, desired friends (who were unilaterally nominated by a target adolescent) and choosing friends (who unilaterally nominated a target adolescent). Between-group comparisons of the three types of friends showed that victims had fewer reciprocal and choosing friends than non-involved adolescents. Compared to bully-victims and non-involved adolescents, victims had reciprocal friends who were socially less well adjusted. No differences existed with respect to the characteristics of the desired friends. In general, victims' choosing friends scored less positive on the personal characteristics than bully-victims' and non-involved adolescents' choosing friends. Within-group comparisons revealed that victims' reciprocal friends showed lower adjustment than victims' desired friends, but higher adjustment than their choosing friends. For bully-victims and non-involved adolescents, such differences between their three types of friends were largely absent. Our findings seem to suggest that victims' reciprocal friendships may not be totally default associations and that out of all possible friends, victims might tend to select those who score most positive on personal or social factors.