Factors affecting the adjustment to disability for new immigrants.(Ethics in Practice)

Factors such as self-esteem, social support, and perceived social discrimination are associated with the acceptance of disability. A new immigrant may face unique barriers to health care, including cultural differences between the patient and provider, language/communication issues, and discrimination. However, little research is available that identifies barriers specific to new immigrants relating to disability. This is an exploratory descriptive pilot study using a phenomenological approach. The investigator interviewed two "new" immigrants with an acquired disability. A "new" immigrant is defined as an individual who was born outside of the United States, whose parents were born outside of the United States, and who relocated across international borders to live in this country. The participants reported on perceived barriers to the adjustment to a disability. Strategies to consider in the care of the immigrant patient are described. Key words: barriers, culture, disability, immigrant, rehabilitation

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When an individual experiences an injury or an illness resulting in a disability, the adjustment process can be a difficult one. The physical changes resulting from the disability may affect basic function, familial and social relationships, occupational duties, and societal roles. Factors such as self-esteem, social support, and perceived social discrimination are associated with one's acceptance of the disability. (1) As health care providers in rehabilitation, we intervene therapeutically and educationally to facilitate this adjustment and to enhance the individual's quality of fife. To intervene effectively, providers must identify the individual's motivating factors, behavior, social support, personality, and cultural beliefs.

When the individual is a new immigrant, he or she is faced with unique barriers that may hinder the positive adjustment to a new disability. As a physical therapist in a large urban rehabilitation center, 1 work with a very diverse patient population. Although each patient's situation is unique, I became interested in the particular barriers faced by immigrant patients. Such barriers may include cultural or religious differences, language/communication issues, economic factors, and immigrant health care policies. In addition, I come from a family of immigrants who moved to the United States during the period of 1968-1994. My observations of the clinical encounters between my family members and US health care providers highlighted these challenges and frustrations from the patient perspective. As a result, I began a pilot study to investigate this topic and to answer the following questions: What are the unique barriers faced by immigrant patients undergoing rehabilitation that negatively affect their adjustment to a disability? Can health care providers address these barriers during the rehabilitation process to positively affect immigrants' adjustment to a disability?

In this article, I will discuss the common factors affecting the adjustment of immigrants to a new society and to a new disability, barriers to health care for ethnic minorities as identified in the literature, and the methodology and preliminary findings of my pilot research project.

Common Factors Affecting Adjustment of Immigrants to a New Society and to a New Disability

A new immigrant is defined as an individual who was born outside of the United States, whose parents were born outside of the United States, and who relocated across international borders to live in this country When a new immigrant relocates, many factors affect his or her adjustment to a new society. Akhtar (2) outlined these factors as shown in the box titled, "Factors That Affect Adjustment." As seen in that box, the factors for the new immigrant can be compared with the factors that affect adjustment to a new disability as described by Li and Moore. (1)

Reason for migration/cause of disability

The reasons for leaving the country of origin may vary between immigrant groups. Akhtar (2) separates groups into immigrant and exile groups. Immigrant groups left their country of origin voluntarily The reasons for leaving may include a hope for better educational, professional, or financial opportunities in the new country; reunion with family members; or simply personal preference/choice. Often these immigrants have time to prepare to leave the country of origin, and the events preceding the departure are not traumatic. In addition, these immigrants may have the option of returning home temporarily or permanently The countries of origin are usually …