“There's an art to it” - Exploring Sami Health Culture and Empowering Communication through an E-health Application

Abstract

Studies have shown that the Sami culture of communicating about health can often be indirect and reliant on implications and hints rather than clear unambiguous statements. The style is described as “roundabout”, circling around a topic before closing in on it. Modern medicine typically values directness and unambiguousness in its mission of effective anamnesis and diagnosis. Due to these differing styles of communication, there can arise a clash of cultures in health care settings with Sami patients, where the patient may feel uncomfortable and suddenly confronted with personal questions. The SAMINOR studies have shown a high prevalence of type 2 diabetes within the Sami community. Diabetes is a disease that requires daily awareness and permanent lifestyle changes in order to not cause severe complications such as heart disease, poorly healing wounds, worsening eyesight and sexual dysfunction. Close cooperation and good communication with a primary care physician is important to achieve the best health outcomes. This thesis aims to explore if a mobile application can be created to empower and encourage Sami diabetes patients to discuss their health concerns and treatment options confidently and openly with their primary care physician. To assess how such an app could be tailored to a Sami audience, a literature review was performed on the Sami culture of communication about health. Interviews with health care workers on the same topic were also conducted. A mobile application was created which implements a novel chat-like functionality that users may employ to prepare for a routine visit with their doctor. The chat will ask the user questions that are likely to come up during the visit, offering the user a safe space to consider these questions in a non-stressful environment before the consultation. The questions are based the guidelines for yearly diabetes control sessions, created by the Norwegian Directorate of Health. The user may also track their blood glucose level and bodyweight using the app, and the registered data will influence the questions that appear in the chat. The application avoids confrontational language, offers explanations and supplementary information to questions, and starts the questioning with more general topics before asking ii about sensitive issues. The northern Sami language was used for the applications user interface and contents. The application was tested by Sami individuals with type 2 diabetes. The application was well received, and all test participants were of the opinion that the application would be a useful tool in preparing for a consultation with their doctor.