Blix Bodil Hansen, Hamran Torunn
a Centre for Care Research, north, Department of Health and Care Sciences , UiT The Arctic University of Norway , Tromso , Norway.
Int J Circumpolar Health. 2017;76(1):1328962. doi: 10.1080/22423982.2017.1328962.
Norwegian government white papers have stated that the Sami population is reluctant to seek help from healthcare services and has traditions of self-help and the use of local networks.
In this article we explore healthcare professionals' discursive constructions of Sami persons with dementia and their families' reluctance to seek and accept help from healthcare services.
The article is based on an analysis of focus group interviews with healthcare professionals (n = 18) in four municipalities in Northern Norway with multiethnic populations. A narrative context analysis, which involved an examination of sequences of discourse, was employed.
Reluctance to seek and accept help among Sami service users and assumptions about self-support were recurring themes in the focus groups. The reluctance was attributed to macro contexts, such as socio-historical processes and cultural norms, and to micro contexts, such as individual and interpersonal factors including the healthcare professionals' cultural backgrounds and language competence. The healthcare professionals' positioning as insiders or outsiders (Sami or non-Sami) affected their attributions.
Local healthcare professionals are at the front line for providing and assessing service users' needs for healthcare services. Consequently, their perceptions of service users' needs are pivotal for achieving equity in healthcare. The established opinion that Sami "take care of their own" and are reluctant to seek and accept help may lead to omissions or neglect. Healthcare professionals' awareness about how present encounters in healthcare settings are framed and shaped by the service users' previous and prevailing experiences of marginalisation and subordination is crucial to avoid omissions or neglect resulting from assumptions about cultural preferences. Discursively shaped boundaries and differences between groups may create the impression that the distance between the groups is too wide to traverse, which in turn may lead to further marginalisation of service users in healthcare encounters.
挪威政府白皮书指出，萨米族民众不愿寻求医疗服务的帮助，且有自助和利用当地网络的传统。
在本文中，我们探讨医疗保健专业人员对患有痴呆症的萨米人及其家庭不愿寻求并接受医疗服务帮助的话语建构。
本文基于对挪威北部四个多民族自治市的医疗保健专业人员（n = 18）进行的焦点小组访谈分析。采用了叙事语境分析，其中涉及对话语序列的考察。
萨米族服务使用者不愿寻求和接受帮助以及关于自我支持的假设是焦点小组中反复出现的主题。这种不愿被归因于宏观背景，如社会历史进程和文化规范，以及微观背景，如个人和人际因素，包括医疗保健专业人员的文化背景和语言能力。医疗保健专业人员作为内部人或外部人（萨米人或非萨米人）的定位影响了他们的归因。
当地医疗保健专业人员处于提供和评估服务使用者医疗服务需求的第一线。因此，他们对服务使用者需求的认知对于实现医疗保健公平至关重要。萨米人“自己照顾自己”且不愿寻求和接受帮助这一既定观点可能导致疏漏或忽视。医疗保健专业人员意识到医疗环境中的当前接触是如何由服务使用者先前和普遍的边缘化及从属经历所构建和塑造的，对于避免因文化偏好假设导致的疏漏或忽视至关重要。话语塑造的群体间界限和差异可能造成群体间距离过大难以跨越的印象，这进而可能导致服务使用者在医疗接触中进一步被边缘化。
