title: A lonely life--A qualitative study of immigrant women on long-term sick leave in Norway.
abstract: BACKGROUND
  This study focuses on the everyday life of immigrant women with chronic pain on long-term sick leave in Norway. Research has shown that rehabilitation of immigrant women with chronic pain might be challenging both due to their lack of linguistic competence, due to lack of sufficient confidence/trust in their employers and in health personnel and lack of knowledge/skills among health care personnel in meeting immigrants' special needs.
  
  
  OBJECTIVE
  The objective of the study was to explore how immigrant women on long-term sick leave in Norway due to chronic pain experience their illness and their relationships at work and in the family.
  
  
  METHODS
  This article has a qualitative design, using participant observation and in-depth interviews.
  
  
  METHODS
  Participant observations were carried out in an outpatient clinic and qualitative interviews were conducted after the rehabilitation period. A hermeneutic approach was used to understand the meaning of the narrated text. All the authors participated in the discussion of the findings, and consensus was obtained for each identified theme.
  
  
  METHODS
  The research was conducted at an outpatient clinic at a rehabilitation hospital in the southern part of Norway. The clinic offers wide-ranging, specialized, multidisciplinary patient evaluations that last between 24 and 48h, followed by advice and/or treatment either individually or in a group, i.e. in a rehabilitation course.
  
  
  METHODS
  Participants (immigrant women) who had been referred to the outpatient clinic and to a rehabilitation course were recruited. Fourteen African and Asian women were observed in two rehabilitation courses, and eleven of them agreed to be interviewed once or twice (3).
  
  
  RESULTS
  The interpretation revealed the following two main themes: 'Shut inside the home' and 'Rejected at the workplace'. Based on the women's experiences, a new understanding emerged of how being excluded or not feeling sufficiently needed, wanted or valued by colleagues, employers or even by family members rendered their daily lives humiliating and lonely.
  
  
  CONCLUSIONS
  The immigrant women on long-term sick leave live in triple jeopardy: being ill and being lonesome both at home and at the workplace. This can be described as a vicious circle where the humiliating domestic and workplace-rejection might reinforce both the women's experience of shame and avoidance of telling anybody about their illness/symptoms, which then results in more days on sick leave during which they are again isolated and lonesome. There is a need for more research on multidisciplinary rehabilitation approaches designed to cater for immigrants' special needs.
authors.affiliation: Oslo & Akershus University College of Applied Sciences, Institute of Nursing, Faculty of Health Science, Oslo, Norway. Electronic address: line.nortvedt@hioa.no.
authors.forename: Line
authors.initials: L
authors.lastname: Nortvedt
authors.affiliation: Oslo & Akershus University College of Applied Sciences, Institute of Nursing, Faculty of Health Science, Oslo, Norway.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Lohne
authors.affiliation: Oslo University Hospital, Norwegian Center for Minority Health Research, Oslo, Norway; University of Oslo, Faculty of Medicine, Institute of Health and Society, Oslo, Norway.
authors.forename: Bernadette Nirmal
authors.initials: BN
authors.lastname: Kumar
authors.affiliation: University of Southern Denmark, Institute of Public Health, Odense, Denmark.
authors.forename: Helle Ploug
authors.initials: HP
authors.lastname: Hansen
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000523:psychology; D003144:Communication Barriers; D054242:Emigrants and Immigrants / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008132:Loneliness / Q000523:psychology*; D008875:Middle Aged; D009664:Norway; D011369:Professional-Patient Relations; D018582:Sick Leave
keywords: Chronic pain; Humiliation; Immigrants; Loneliness; Qualitative; Shame; Sick leave; Women; Work