Chronic back pain, Community and Indian culture

Abstract

The main aim of this thesis was to gain a better understanding of cultural influences on pain-related beliefs among Australian Indian migrants. This was achieved through a series of studies. First, existing community-based approaches to, and outcomes of, chronic musculoskeletal health conditions were examined in a systematic review. Although the quality of the evidence was low, there was some support for the effectiveness of education and exercise in the management of chronic musculoskeletal health conditions for rural and remote populations and use of community engagement strategies to ensure treatment success. The second study involved cross-cultural adaptation and validation of two beliefs questionnaires, Back Beliefs Questionnaire (BBQ) and Pain Self-Efficacy Questionnaire (PSEQ) in the Indian language of Marathi. This addressed the need for assessment tools that evaluate beliefs about pain to be adapted to the language and culture of Indian communities. Beliefs were examined in a cross-sectional questionnaire study among 386 Indian migrants living in Sydney using the BBQ. It was found that beliefs relating to back pain had subtle cultural elements, which warranted further investigation. These subtle cultural elements were further explored using focus groups in which Indian migrants living in Sydney provided a deeper understanding of the cultural beliefs relating to chronic back pain. Participants (n=26) in the focus group discussions identified a core cultural belief in ‘the philosophy of Karma’, and cultural values of collectivism-contribution, gendered roles, and mind-body wellness, as central to the experience of pain. The findings can be used to guide delivery of current approaches to back pain management using a Karmic lens, aligning with the beliefs held by Indian migrant communities. Collectively, these studies provide greater insight into the Indian cultural influences on pain-related beliefs.