title: 'A chronic disease is a disease which keeps coming back…it is like the flu': chronic disease risk perception and explanatory models among French- and Swahili-speaking African migrants.
abstract: BACKGROUND
  African migrants to the West are at increased risk of hypertensive related diseases and certain cancers compared with other ethnic groups. Little is known about their awareness of this risk or knowledge of associated risk factors.
  
  
  OBJECTIVE
  To explore African migrants' perceptions of chronic disease risk, risk factors and underlying explanatory models.
  
  
  METHODS
  In-depth interviews with 19 Africans from French- or Swahili-speaking countries living in Glasgow were conducted. Interviews were transcribed and 10 translated (3 Swahili and 7 French). Analysis was informed by a grounded theory approach.
  
  
  RESULTS
  Narratives suggested low awareness of chronic disease risk among participants. Africans reported a positive outlook on life that discouraged thought about future sickness. Infectious diseases were considered the dominant health threat for African migrants, mainly HIV but also TB and 'flu'. Chronic diseases were sometimes described as contagious. Explanatory models of chronic disease included bodily/dietary imbalance, stress/exertion, heredity/predisposition and food contamination. Cancer was feared but not considered a major threat. Cancer was considered more common in Europe than Africa and attributed to chemical contamination from fertilisers, food preservatives and industrial pollution. Evidence cited for these chemicals was rapid livestock/vegetable production, large size of livestock (e.g., fish), softness of meat and flavourless food. Chemicals were reported to circulate silently inside the body and cancer to form in the part where they deposit, sometimes years later. Cardiovascular diseases were described in terms of acute symptoms that required short-term medication. Confidentiality concerns were reported to prevent discussion of chronic disease between Africans.
  
  
  CONCLUSIONS
  This study suggests a need to improve chronic disease health literacy among African migrants to promote engagement with preventive behaviours. This should build on not only participants' existing knowledge of disease causation and risk factors but also their self-reliance in the pursuit of a healthy lifestyle and desire to retain cultural knowledge and practice.
authors.affiliation: General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. m.cooper@bsms.ac.uk
authors.forename: Maxwell
authors.initials: M
authors.lastname: Cooper
authors.forename: Seeromanie
authors.initials: S
authors.lastname: Harding
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mullen
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Donnell
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000368:Aged; D002908:Chronic Disease / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology*; D005247:Feeding Behavior / Q000208:ethnology / Q000502:physiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology; D009765:Obesity / Q000208:ethnology / Q000517:prevention & control / Q000523:psychology; D036301:Qualitative Research; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D057185:Sedentary Behavior / Q000208:ethnology; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult