Opvattingen over lage rugklachten en zoekgedrag naar zorg in een Kalinya Inheemse gemeenschap in Suriname

Low back pain (LBP) is a common musculoskeletal condition that affects millions of people worldwide. While it is not a disease in itself, LBP is a symptom with a wide range of potential causes. An estimated 85% of adults will experience LBP during their lifetime, and most are diagnosed with nonspecific LBP due to the absence of a clearly identifiable pathoanatomical cause. The complexity of LBP is best understood through a biopsychosocial lens, recognizing that biological, psychological, and social factors all influence how pain is experienced and how disability is expressed. Comorbidities, cognitive and emotional states, and social conditions play a significant role in shaping the course and impact of LBP, making it a challenging condition to treat effectively. LBP is particularly prevalent among Indigenous Peoples, and social determinants of health—including marginalization, poverty, and historical trauma—likely contribute to this higher burden. In Suriname, the Community Oriented Program for Control of Rheumatic Diseases study was conducted to obtain preliminary insights into musculoskeletal complaints, including LBP. The study also included Indigenous populations in both urban and rural areas, providing valuable data on a group often underrepresented in health research. The study found a point prevalence of 14% for LBP among Indigenous participants. However, it also revealed that Indigenous individuals were more likely to hold negative beliefs about LBP and showed higher rates of treatment-seeking behavior. To truly understand the experience and management of LBP, it is essential to explore the broader sociocultural setting and barriers to healthcare access faced by Indigenous Peoples. This doctoral research aims to provide a more in-depth understanding of the beliefs surrounding LBP, its impact, and related care-seeking behavior among Indigenous Peoples in Suriname. The research comprises of four interrelated studies. The first study is a topical review of the existing literature on LBP in Indigenous populations. This study revealed that LBP is a burden amongst Indigenous Peoples, impacting different aspects of their lives including their cultural identity.. Obtaining Western healthcare presents unique challenges for Indigenous Peoples. The Western healthcare system often falls short in meeting their needs due to inadequate communication by healthcare practitioners (HCPs), ignorance of their patient's culture, racism, and discriminations. The second study used qualitative methods to explore the lived experiences of LBP among Kalinya Indigenous residents in the village of Galibi. Participants described LBP as having a profound impact on both physical functioning and emotional well-being. Many continued their daily activities, despite pain, due to economic necessity. Feelings of anxiety, financial stress, and uncertainty about the cause and future of their condition were common. Participants reported using both traditional and Western treatments, although encounters with Western HCPs were often marked by logistical difficulties and negative experiences, further discouraging formal care-seeking. The third study, a quantitative investigation, assessed the prevalence of LBP among Indigenous Peoples in Galibi. The findings revealed that 12.4% of respondents reported current LBP, while 52.3% had experienced LBP at some point in their lives—figures consistent with those reported in other rural Indigenous communities worldwide. The study also examined demographic and clinical characteristics of individuals affected by LBP. Approximately two-thirds of the population was classified as overweight, with significant gender differences observed (p < 0.001); women were more likely to be overweight than men (73.0% vs. 64.1%). Notably, the Galibi Indigenous Peoples, particularly men, demonstrate high levels of physical activity. Study 4 built upon the findings of the second study by validating and triangulating data related to the perceived causes, impact, and care-seeking behaviors associated with LBP post COVID-19. The study confirmed that physically demanding labor—integral to the Indigenous way of life—was widely recognized as a primary contributing factor to LBP. Although stress and alcohol misuse were also reported, their connection to LBP was less acknowledged within the community. Significant barriers to healthcare access were identified, including geographic isolation, financial constraints, and the COVID-19 pandemic. Additionally, ineffective communication and a lack of cultural understanding by HCPs further impeded appropriate management of LBP. This doctoral thesis c concludes that LBP has a significant impact on physical, emotional, and cultural aspects of Indigenous Peoples worldwide as well as in the Kalinya Indigenous community of Galibi in Suriname. Indigenous Peoples face unique barriers when accessing Western healthcare, including geographical, logistical, and financial challenges. Even when these are overcome, they often encounter discrimination and a lack of culturally competent HCPs, leading to miscommunication and negative healthcare experiences. The thesis calls for culturally adapted healthcare that reflect Indigenous values. Addressing these gaps is vital for improving care, promoting equity, and supporting the health and cultural integrity of Indigenous communities. findings consistently demonstrated that Indigenous Peoples face numerous and intersecting barriers to accessing equitable and respectful healthcare. Even when services are available, the absence of culturally safe care remains a critical challenge. The research highlights the need for a holistic framework that incorporates cultural competence and community engagement into healthcare delivery and policy, with the aim of reducing the burden of LBP and improving health outcomes in Indigenous communities.