ABSTRACT
This paper reports and critically discusses, against the literature on culturally sensitive
and cultural competency practices, the findings of a qualitative study which explored the
needs and expectations of older people and their carers from eight different migrant
communities and the white British majority. The study investigated the accessibility and
acceptability of care and support services in Bradford, UK, a city with a large migrant
population. A total of 167 study participants were recruited from February 2008 to
October 2008; of these 134 were older people and 33 carers. The age ranged from 25 to 90
years. The study found that older migrants and their carers described expectations of
services as complex constructions of ‘abstract expectations’, the study participants’ general
beliefs regarding what services should be about, and ‘pragmatic expectations’, their
specific views about how they would like to receive care and access services. All groups,
irrespective of their ethnic background, expressed three ‘abstract expectations’: high
standards of good practice; cultural understanding; and responsiveness to individual
expectations. This similarity did not imply a similarity in their preferences for how
services should provide for their ‘abstract expectations’. Dignity was a central expectation
for all older people in the care of their bodies. However, a number of culturally specific
‘pragmatic expectations’ emerged in the practices that older people and carers associated
with maintaining dignity in older age. Nevertheless, differences could not always be
explained as an outcome of different cultural backgrounds, but were rather linked to
individual characteristics and life experiences. This study indicates that whether and how
older migrants’ knowledge systems inform their expectations of care and support should
be objects of investigation rather than taken for granted, as implied in some literature on
culturally sensitive practices. Exploration of older migrants’ knowledge systems may help
us to understand if older migrants’ expectations differ with regard to what they expect to
receive from a certain service, their ‘abstract expectations’, and/or how they expect to
receive it, their ‘pragmatic expectations’. This information should help to identify if
different communities require different culturally competent interventions and of what
type: interventions at the organisational level, at the structural level or at the clinical
level.
