“It is difficult for us to treat their pain”. Health professionals’ perceptions of Somali pastoralists in the context of pain management: a conceptual model

Abstract

Pain is one of the most neglected areas of care in sub-Saharan Africa. Access to adequate pain management is important, especially in marginalised populations, such as pastoralists. Little is known about health professionals’ perceptions of pain-related care for Somali pastoralists. This study seeks to understand health professionals’ perceptions of Somali pastoralists in the context of pain management in Eastern Ethiopia. Within the scope of this qualitative multicentre study, we conducted semi-structured interviews with 17 health professionals (mainly nurses) experienced in treating Somali pastoralists with pain. Data analysis was based on the coding paradigm proposed by Strauss and Corbin within Grounded Theory methodology and resulted in a conceptual model of pastoralist-specific pain management. We gave voice to pastoralists in the study design, for example, through focus group discussions conducted prior to this study. Our study is part of a larger ongoing research project involving health professionals and pastoralist communities. The perspective of pastoralists is explored in a consecutive study. ‘Patient-professional relationship’ was the core category we identified within the conceptual model. This category was closely linked with issues of ‘(mis)trust’ and ‘communication (barriers)’. ‘Patient-related conditions’ (eg, (under)-reporting of pain, care preferences and beliefs) and ‘health professional-related’ conditions’ (eg, insufficient training, (under)exposure to local culture) had an influence on the core category. Contextual factors proved to be relevant as well, such as age and gender. The study highlights the complexity of pain management among marginalised communities, such as pastoralists. Health professionals perceive Somali pastoralists to have distinct illness beliefs and pain concepts influencing their health-seeking behaviour. The study highlights the importance of reaching this patient group with culturally acceptable and comprehensive pain management strategies.

“I could not bear it”: Perceptions of chronic pain among Somali pastoralists in Ethiopia. A qualitative study

“…This approach contributed to the culture-specific understanding of a sickness episode. The findings from the focus group discussions and the workshop informed us that pain was a challenging concept to speak about [ 26 ]. We found no specific term for pain in the Somali language, as described in other research [ 46 ].…”

“…Common reasons among pastoralists for not visiting health facilities are the far distance of health institutions from the place of residence or cultural beliefs that health services lack efficacy for certain health problems [ 21 ]. In addition, the necessary resources especially for treating pain, such as pain medication, are often not available in health care facilities [ 26 ]. This diminishes the degree of acceptability for pastoralists.…”

“…Pastoralists commonly also seek aid from traditional healers or prefer self-treatment when experiencing illness symptoms [ 22 , 27 ]. In such contexts, pain can lack prioritization as a serious health problem–on the part of pastoralists themselves and also on the part of health professionals [ 11 , 21 , 26 ]. However, Carruth argued that seeking biomedical aid is ever-changing in this population as pastoralists alter their views about healthcare and adapt to new environments [ 19 ].…”