Perception of Pain Expression Among Surgical Patients and Families from Three Ethnic Groups of a Nation: A Multicenter Qualitative Study

Abstract

Background

Despite its universal nature; perception, coping, responses, treatment options, and overall experiences of pain are influenced by biopsychosocial factors to various extents. Pain perception, expression, and control are progressively learned behaviors among members of a society and are culture-specific. Effects of ethnicity-related culture (ethnoculture) on pain experience in a broader context have increasingly been reported. However, evidence from ethnoculturally diverse groups of a nation, particularly based on surgical patients, is limited. Therefore, as a qualitative research effort of a broader project aimed at assessing ethnocultural determinants of surgical pain management, this study explored the perception of ethnoculturally diverse patients and families about expressing surgical disease-related pain.

Methods

This study follows subjectivist-interpretivist philosophical assumptions as an underpinning research paradigm. We purposively selected 11 patients for in-depth interviews and 12 patients’ family members for focus group discussions in three hospitals of ethnic-based regions of Ethiopia. In the phenomenological frame, thematic analysis was employed.

Finding

Ethnocultural background influences how individuals express and respond to pain according to emergent themes of finding— Pain and overlooked cultural influence, Pain expressiveness in cultural context, Stereotypes of pain expressiveness, and Bravehood through stoic response. Pain feelings are commonly hidden where the domestic culture values stoic response to pain compared to ethnoculture where pain expressiveness is encouraged.

Conclusion

Individuals can express and respond to pain differently due to ethnocultural diversity within a nation. Researchers and clinicians should consider cultural context while applying the prevailing one-size-fits-all pain assessment tools among surgical patients of a nation with ethnocultural diversity.

Keywords:

• surgical pain
• pain and culture
• pain expression
• pain behavior
• pain response
• stoic response

Data Sharing Statement

Data supporting our finding is available from the corresponding author, GAH, upon reasonable request.

Ethical Approval

The principles of the Helsinki Declaration for medical research involving human subjects and the guidelines of the local institutional review board were followed throughout the study. Ethical approval was obtained from two institutions, Hawassa University Institutional Review Board with reference numbers HUCMHS-IRB 039/14 and HUCMHS-IRB 333/15 (twice due to mandatory periodic renewal of initial vote) and LMU ethical committee vote with the registered project number of 23-0479. The anonymity and privacy of the study participants were maintained throughout the study as it had been promised before data collection.

Acknowledgment

We would like to thank Hawassa University for financially supporting part of the study through a university-wide thematic research fund. We are also grateful for our research assistants and interpreters who helped us during data collection, especially, Mirkat Tsegaye, Ejamo Eyamo, Roba Hirpo, and Abdi Shehicho. We also would like to extend our gratitude to the three hospitals for allowing us to collect data, and to patients and their families for willingly participating in the study. Finally, our heartfelt thanks go to the Center for International Health at LMU (CIH^LMU) for supporting the first author through CIH.AMEAR scholarship program which covered travel expenses and subsistence during Ph.D. Module Block-II.

Author Contributions

All authors significantly contributed to the work reported; they contributed to various extents during conception, study design, data collection, analysis, interpretation, manuscript drafting, and critically reviewing the article. All authors also agreed on the selected journal, approved all versions of article before submission/decision, and agreed to take responsibilities and be accountable for the contents of the article.

Disclosure

GAH and SJ have received grants for a thematic research project titled “Assessment of Sidama Traditional Medicine” from the Hawassa University Vice President for Research and Technology Transfer, and part of the fund was used for data collection of the current study.

Additional information

Funding

Please refer to the details in the “Conflict of Interest and Source of Funding” section above.