P. Rajan1, C. Hiller1, A. Leaver1, S. Dennis1,2,3, K. Refshauge1, B. Brady1,2
1The University of Sydney, Sydney School of Health Sciences, Faculty of Medicine and Health, Sydney, Australia, 2South West Sydney Local Health District, Liverpool, Australia, 3Ingham Institute of Applied Medical Research, Liverpool, Australia

Background: Back pain is a highly disabling prevalent health condition, largely due to the complexity and individuality of the pain experience. Current guidelines for back pain management recommend assessment of patient beliefs. Despite this recommendation, little is known about the cultural-specific beliefs of culturally diverse communities. Understanding the cultural influences on patient beliefs and the experience of pain is critical if burden of back pain is to be reduced, especially within multicultural societies such as Australia. This is particularly important for prominent and under-researched migrant communities such as the Indian community, which is the largest migrant community in the world with 17.5 million people.

Purpose: The purpose was to investigate the beliefs of back pain among Indian migrants living in Sydney. 

Methods: A qualitative study using five focus groups was conducted with 26 Indian migrants living with chronic back pain in Sydney, using a semi-structured interview guide exploring beliefs about low back pain. Participants completed a demographic survey, standardised pain questionnaires [Roland Morris Disability Questionnaire (RMDQ), Pain Self Efficacy Questionnaire (PSEQ) and Back Beliefs Questionnaire (BBQ)] and participated in one of five focus group discussions. Discussions canvassed participants’ beliefs, coping strategies, expectations and approaches to pain management. Inductive thematic analysis was used to analyse the transcripts.

Results: Overall there were similar numbers of men and women and the majority of the participants identified with the Hinduism religion. The standardised pain assessments revealed the sample was representative of a range of pain durations and severity; however, the overall sample displayed low levels of disability (RMDQ 5.04±3.2), high self-efficacy (PSEQ 44.6±8.75) and relatively positive beliefs about back pain (BBQ 28.6±4.4). Three categories of interconnected beliefs emerged from the focus groups: causative, treatment/coping-related, and prognostic beliefs, underpinned by a core cultural belief in ‘the philosophy of Karma’. This guiding philosophy manifested in how participants framed back pain as a natural consequence of living, which could be influenced by the direct actions of the individual. Within this core philosophy three cultural values emerged as central to the experience of pain and the construction of pain-related beliefs: collectivism and contribution, gendered roles, and mind-body-spirit wellness. The Indian belief system encouraged active coping and self-management strategies, despite higher pain intensities and health burden.

Conclusion(s): Indian migrants’ beliefs and health expectations are influenced by culture. Family and community strongly influence the coping strategies and management. An understanding of core Indian cultural beliefs may help healthcare providers understand the context behind positive beliefs and where relevant help align treatment towards such beliefs using holistic approaches to back pain management.

Implications: Health care providers should ensure sensitivity to cultural underpinnings and adapt current back pain guidelines to ensure cultural acceptance. The insights into Karma, traditional Indian system of medicine, meditation and yogic approaches to chronic back pain allow a greater appreciation of the need of holistic approach among Indian migrants. Awareness of these cultural beliefs will ensure that clinicians align treatment options with these beliefs, to ensure better acceptance, and potentially better outcomes and self-management strategies among Indian migrants.

Funding, acknowledgements: Pavithra Rajan has received The University of Sydney International Scholarship.

Keywords: Culture, Indian migrants, back pain

Topic: Musculoskeletal

Did this work require ethics approval? Yes
Institution: South West Sydney Local Health District
Committee: Human Research Ethics Committee
Ethics number: HREC/18/LPOOL/471

All authors, affiliations and abstracts have been published as submitted.

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