Describing Determinants of Negotiation and Bargaining to Access and Utilize Resource Including Health among Immigrant Pakistani Women in U.S

摘要

The objective of this study was to explore the domestic negotiation process around Pakistani homes in Houston. It centers on bargaining as a strategy used by Pakistani immigrant women in the US in negotiating power within and outside the household. I explored the gendered differences in negotiations and various bargaining strategies employed in order to utilize or access various resources including modern healthcare or to deal with an illness episode.;Overall aim: The purpose of this study was to describe the determinants of women bargaining power to access resources including health and to explore various methods employed by Pakistani women in Houston to manage ill health.;Methods: Qualitative research methods were used to accomplish the objectives of the study, including participant observation, in-depth interviews and key informant interviews. Nineteen face-to-face, semi structured, in-depth interviews were conducted with participants, between ages of 25 to 39 years, married, residing in US for less than 10 years. In addition, five key informant interviews with senior women of the community were also carried out between January to August 2016. Human subjects' approval was obtained from the University of Texas Health Science Centre, Houston and Institutional Review Boards (IRB). Data was analyzed using narrative and thematic content analysis.;Results: The first paper presents the determinants of Pakistani women bargaining power and how women and men manage and negotiate couple, family, and intergenerational dynamics around healthcare as well as other needs. It revealed how Pakistani women mange to fulfill their needs, take care of their health, how they discuss their health needs and what strategies they use to access resources. In the second paper, I explored around the participant's illness experiences, how ill-health is managed, who decides, bicultural negotiations, what type of provider is approached, folk healing, spirituality and eventual health outcome. The final paper describes the diverse system of self-managing practices including self-medication among participant women when they are confronted with ill-health as well as to maintain health.;Conclusion: In our first paper, we observed that women's education and employment, have significant positive effect on wife's negotiation and decision-making power. This was followed by two other chief determinants that act as a catalyst in wife's bargaining power and autonomy namely, strong natal family and wife sponsored permanent residency. The second paper revealed that the practice of traditional medicine/remedies among Pakistani immigrants are still alive and thriving. The results derived from this paper can help to provide a framework for educational programs that will create knowledge about the risk of delaying treatment and worsening of health condition. Finally, the third paper observed some serious gaps in knowledge and perceptions regarding self-medication especially antibiotic use among this community, that in-turn boost the importation of antibiotics into the US. Knowledge of these practices could be used by authorities to enhance health provision to this minority population.