Factors Influencing the Perception and Management of Chronic Pain for Immigrant Women in Saskatchewan: An Exploratory Qualitative Study

Introduction: Chronic pain is a complex concept affected by biological, physiological, psychological, environmental, and social factors. Research has found that immigrant women are a vulnerable group because they are likely to experience higher pain intensity than non-immigrants and immigrant men due to gender roles. However, there is little qualitative research about how immigrant women perceive and manage chronic pain and the factors that aggravate their pain. An understanding of how immigrant women experience and manage their chronic pain is, therefore, important for improving healthcare outcomes for this patient group. Purpose: The study aims to explore immigrant women's experiences with chronic pain in Saskatchewan, Canada. The following objectives guiding the study are to 1) describe the perception of chronic pain among immigrant women in Saskatchewan’s context, 2) identify factors that aggravate the immigrant women’s experiences of chronic pain, and 3) explore the overall management of chronic pain among immigrant women in Saskatchewan’s context. Methodology: Exploratory qualitative study design was used to explore the factors influencing the perception and management of chronic pain among immigrant women in Saskatoon, Saskatchewan, Canada. Semi-structured individual interviews were conducted with 15 participants recruited using a purposive theoretical sampling strategy. The research followed the six phases of thematic analysis. Findings: A total of 15 participants from China, Egypt, Pakistan, Bangladesh and Nigeria were interviewed in this study. All but one experienced chronic pain before immigrating to Canada. More than half of the participants reported chronic pain in multiple areas of their bodies. The study yielded three major themes: 1) culturally-shaped perception of chronic pain, 2) immigration-related experiences of chronic pain, 3) strategies for managing chronic pain, and 4) healthcare utilization for chronic pain. Participants report different perceptions of chronic pain, regarding how they verbalize and understand chronic pain. Most of our participants reported worsened chronic pain after immigrating to Canada and post-immigration experiences, including changes in socioeconomic status and the weather conditions, were responsible for aggravating the pain. To control their pain, participants used self-management, including adjusting lifestyles (behavioural, dietary, and psychological changes) and seeking help from social support. When self-management failed, they sought healthcare services both in their home countries and in Canada. Discussion： Immigrant perceptions and perspectives of chronic pain, informed by sociocultural factors, can impact how participants make sense of their chronic pain and further impact their choice of interventions to address chronic pain. Participants experience economic stress, associated with working in physically exhausting jobs and change in weather conditions, which increase chronic pain sensitivity. Hence, it undermined their ability to cope with chronic pain. Self-management strategies were the first option to control minor pain because they are less expensive. When these strategies failed, they sought medical care to manage the pain. However, the multiple barriers they experienced such as language and cultural differences between providers and the participants, made their care experience ineffective, leading to disappointment, frustration, helplessness, and mistrust of the Canadian healthcare system. Conclusion: Our study findings indicate how immigrant women from diverse cultural groups perceive and manage chronic pain differently. They experienced underutilization of healthcare care in Canada. Two challenges arose during the virtual data collection: the impact of COVID-19 on the conduction of qualitative research and the virtual recruitment challenge of participant diversification. The study findings provide some implications for policymakers, researchers, immigrant-serving organizations and healthcare providers about the complexity of chronic pain recognition and management among immigrant women