I need 2 assignments: 1 Quantitative & another Qualitative (I attached both chosen articles for the papers)
Research Critique Assignment (Individual) (15% each/30% total)
One Quantitative
One Qualitative
APA Style 6th Edition format for both
Choose one qualitative and one quantitative article that interest you from CINAHL, MEDLINE, EBSCO, GoogleScholar, or pubMed.
You will select a quantitative and a qualitative nursing research article. Each studys main components should be summarized. A critique also contains comments about the positive and negative aspects of the study and the report of the study. The critique should be written as concisely as possible, no longer than five pages, typewritten, double-spaced. The paper should address all parts of the report equally, with strengths and weaknesses outlined where appropriate. Where possible, include suggestions for improvement. A copy of the research discussed must be submitted with the assignment. At least one of the lead authors on each article must be a nurse. Use the research critique guide provided by your professor to complete this assignment.
2020 Indian Journal of Palliative Care | Published by Wolters Kluwer MedknowS58
Abstract
Original Article
IntroductIon
A disaster situation such as the COVID19 crisis highlights
the specific challenges faced by patients and their caregivers
on palliative care. An analysis of 95 peerreviewed and gray
literature documents reveal a scarcity of data on palliative
care needs and interventions provided in crises, challenges
of care provision, particularly due to inadequate pain relief
resources and guidelines, a lack of consensus on the ethics of
providing or limiting palliative care as part of humanitarian
healthcare response, and the importance of contextually
appropriate care.[1] This article aims to address some of
these gaps.
Context
The Cipla Palliative Care and Training Centre (CPC), Pune,
Maharashtra, offers inpatient, outpatient, and home care to
people living with cancer and opting for palliative care services.
Aim: The aim of this article is to describe the range of challenges faced by both patients and caregivers during the lockdown due to the COVID19
pandemic. It also seeks to describe the nature of interventions provided by the social work team to address these challenges. In addition, it aims
to highlight the lessons that can be learnt in supporting families on palliative care in such unique disaster situations. Methods: This exploratory
study uses a qualitative approach and analyses the perceptions of patients, their caregivers, and the staff in providing care. Out of 30 patients
worked with during the lockdown period, a total of nine families were selected that had received services during this time. The challenges
faced and the interventions provided were analyzed using Framework analysis. We then used this framework to develop the themes that have
been presented in the article. Results: The analysis indicates that the range of challenges faced by patients included physical distress due lack
of availability of medicines and nursing care; emotional distress due to the interruption of cancer treatment; financial and social distress about
loss of incomes, isolation; and spiritual distress due to the uncertainty of last rites as well as fulfilment of last wishes. The concerns outlined by
caregivers included: living with guilt due to the inability to ease their relatives distress; the stress of constant care giving; lack of information
about available services and confidence to ask for help from others as well as the dealing with the grief of a dying relative. These families
were supported through telephone calls and home visits for critical patients with the social work team providing active listening, reassurance,
empathy, and networking to assist patients and families at this time. Conclusion: Palliative care is an essential component, especially in a
disasterrelated situation such as the COVID pandemic as patients and caregivers are left more vulnerable at this time. Telephonic and video
calls play an important role in supporting patients and caregivers and in the most critical cases. However, it is also important to find the ways
to provide direct homebased support to patients and families at this time so that they feel less alone, cope better, and experience meaningful
support to build their resilience.
Keywords: Challenges, COVID 19, palliative care, response interventions, social work
Address for correspondence: Ms. Prajakta Dhavale,
Cipla Palliative Care Centre, 118/1, MumbaiBangalore Road, Warje, Opp.
Popular Nagar, Pune411058, Maharashtra, India.
Email: [emailprotected]
Access this article online
Quick Response Code:
Website:
www.jpalliativecare.com
DOI:
10.4103/IJPC.IJPC_149_20
This is an open access journal, and articles are distributed under the terms of the Creative
Commons AttributionNonCommercialShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work noncommercially, as long as appropriate credit
is given and the new creations are licensed under the identical terms.
For reprints contact: [emailprotected]
How to cite this article: Dhavale P, Koparkar A, Fernandes P. Palliative
care interventions from a social work perspective and the challenges
faced by patients and caregivers during COVID19. Indian J Palliat Care
2020;26:S5862.
Palliative Care Interventions from a Social Work Perspective
and the Challenges Faced by Patients and Caregivers during
COVID19
Prajakta Dhavale, Akhila Koparkar, Prakash Fernandes1
Department of Social Work, Cipla Palliative Care and Training Centre, Warje, Pune, 1Department of Palliative Care Partnerships, Cipla Foundation, Mumbai, Maharastra, India
Submitted: 20May20 Accepted: 21May20
Published: 30Jun20
Dhavale, et al.: Patient and caregiver challenges during COVID19
Indian Journal of Palliative Care Volume 26 | Supplement 1 | June 2020 S59
It is staffed by a multidisciplinary team of doctors, including
pain specialists, physiotherapists, dieticians, nurses, and social
workers. During this lockdown period, the inpatient care
and homecare services for critical patients continued while
the outpatient clinics in external hospitals were suspended.
The social work team consists of seven members who were
involved in supporting patients and families during this time.
Aim of this paper
As COVID19 has thrown up special challenges, especially
in facetoface contact and communication with patients and
families. This article aims to:
Describe the challenges faced by patients and caregivers at
this time
In regular times patients and caregivers face numerous
challenges.[2,3] However, in situations such as the COVID
lockdown, these challenges may be exacerbated. This study,
therefore, aims to understand the specific challenges faced by
the patients and caregivers due to the pandemic.
Outline the interventions possible by the social work team
The COVID situation has changed the communication pattern
of the social work team from being face to face to largely on
the phone. This article aims to outline the support provided to
families during this time and the reflections of the social work
team in providing this support.
methodology
The case notes of all the thirty families that the social work
team intervened (n = 30) from the announcement of lockdown
on the March 22 to May 15 were reviewed. From these nine
families were chosen who were (a) at various stages in their
cancer trajectory (b) of different ages (from 17 to 68 years)
and (c) were either inpatient or on home care receiving
palliative care. The data from these nine families were analyzed
using the Framework approach,[4] and the key findings are
presented in this article.
Findings
The findings have been divided into three categories:
challenges faced by patients during the lockdown period; stress
faced by caregivers during this period, and finally, the types of
support and interventions provided to families.
Challenges faced by patients during this time of COVID
The key challenges faced by the patients during this time
included:
Unavailability of medicines
Patients living with cancer already go through a lot of anxiety
and stress. The uncertainty of the availability of medicines
made them more anxious. Patients had several limitations
to travel to CPC or any other hospital as there were lot of
formalities to be completed in terms of obtaining a police pass
for travel as well as arranging transport. Patients living in more
rural areas were even more disadvantaged. For example, one
patient on home care has been stable on morphine for almost
1 year, but his morphine supply was now running low. As he
was staying far away from CPC, it was not possible from him
or his relative to travel due to lockdown. In addition, when we
were able to locate an oncologist closer to the patient who could
provide morphine, there was reluctance from the oncologists
side to do as he had not previously intervened with the patient.
Fear of treatment being incomplete
Patients expressed a lot of worries about the delay to their
treatment due to the postponement to all elective procedures/
treatment during the lockdown period. The hospitals which
were declared as COVID19 hospitals were not very keen
to admit cancer patients so as not to put them at risk due
to their comprised immunity. Patients were anxious that
this postponement in their treatment may result in them
experiencing increased level of pain and that they would suffer
with some other side effects.
Inadequate nursing care
Patients also complained about a lack of nursing care that was
available as either they were living alone or family members
were unable to provide this level of care. Also, dressing
material was not easily available during lock down period
which resulted on the lack of wound management in people
staying at home. Patients especially with cervical cancer and
oral cancer faced problems of getting diapers and dressing
materials which resulted in incomplete dressings. Patients
expressed that their wounds were resulting in a foul smell and
also that they had started developing bedsores.
Worries about other family members
Patients who were admitted in the inpatient facility at CPC
were worried about their family members who were staying in
containment zones. They were worried about family members
being infected by COVID. As the lockdown progressed,
patients were increasingly worried about the uncertainty of
employment for their in family members. As relative visits
to CPC were also restricted due to lockdown, this resulted in
increased irritability among patients.
Sense of isolation
Patients also spoke about how alone they were feeling even
at home. One patient spoke about how as he had a cough and
mild fever which he considered to be normal during his cancer
treatment, several members from the community stopped
visiting him as they feared he was suffering from COVID.
Caregivers in some cases were also reluctant to go near their
patient and do the dressing as they were worried that their
patient was suffering from COVID. This made the patient feel
leftalone and he spoke to the social worker that this is terrible
life he is living where in his own family is not supporting him
at the endoflife.
Unable to complete last wishes
Patients who are close to the end of life expressed their
frustration at being unable to fulfil their last wishes. Patients
wished to stay with family during last moments of life and
Dhavale, et al.: Patient and caregiver challenges during COVID19
Indian Journal of Palliative Care Volume 26 | Supplement 1 | June 2020S60
this seemed to not be possible due to travel restriction and
social isolation norms. One patient was anxious that as he was
nearing endoflife, he wanted to make his will to divide his
assets equally among the daughtersbut this was not possible
due to unavailability of services.
Stress faced by caregivers at this time
The key stressors identified by caregivers at this time included:
Helplessness and guilt caused by the inability to care for
patient properly
Few patients had travelled from their hometown to CPC to
avail services. Once the lockdown started, the patients were
unable to receive help from the relatives. This resulted in
helplessness and guilt from the caregivers of not providing care
to patient. Also several caregivers spoke about their uncertain
employment situation during this time which diverted they
attention from caring for their relative. For some caregivers,
this financial strain hampered their ability to meet the basic
needs of the patients like arranging ambulance travel or
nutritious food to meet the patients diet, getting dressing
material, which resulted in more guilt among them.
Lack of information with caregivers, lack of confidence to
ask for help
Caregivers expressed that they were anxious that they were
unable to find clear information about COVID and its impact on
daily life. Many expressed a fear of having to ask for help from
the police or IO8 ambulance services to travel to Pune. Caregivers
also shared their lack of confidence to travel alone to receive the
medicine for patients from CPC and felt frustrated that they were
unable to arrange medicines from any facility closer to them.
Caregivers own physical health deterioration
Caregivers spoke about the issues with their own health as
they cared for their patient. One of the caregiver had been
complaining of the rash on her skin but was not able to visit
doctor and also was unwilling to do the regular investigation.
She shared she did not want to put additional financial stress
on the family.
Worries about death certificate
Caregivers whose patients were at the end of life shared
additional worries. The caregiver whose patient was in the
inpatient facility of CPC shared they would prefer not to get
a discharge even though it was the wish of their patient to
spend their final days at home. This was because they feared
that if their relative died at home, then the local physician may
refuse to visit their home which may result in inability to get
the death certificate.
Frustration about incomplete last rituals and no proper
ending/grief
Caregivers whose patients died during this time spoke about
their loss and additional grief at their relative not being able to
have a proper funeral. This was because some family members
and members from the community refused to attend the last
rituals of patient or some key relatives such as a daughter was
unavailable to travel from Delhi to Pune due to lockdown. The
caregiver felt helpless and frustrated as nobody was willing to
support him during this time making them feel more isolated
and guilty that their patient did not have a proper ending in life.
Interventions from the social work team perspective
As highlighted in the previous sections, patients and caregivers
faced several challenges and stress points during the COVID
lockdown. During the period of the COVID lockdown that
continues till the time of writing (end March to 1st week of
May 2020), the social work team actively intervened with 30
families affected by cancer through phone calls, video chats
and liaising with the CPC home care team that were visiting
patients in critical conditions to ensure continuity of care.
The team supported the caregivers and patients and made
them comfortable through phone calls, oneonone session
and started home care visits. CPC also designed guidelines
to follow during the lockdown that focused on hand hygiene,
caregiving at home and at the canteen. The social work team
was instrumental in explaining and dialoguing with the
patients and caregivers to implement these guidelines and
understanding any barriers they faced.
The kinds of support provided to patients and families are
outlined in Table 1. This support included:
Counselling patients on the disease progression
The social work team members are generally used to breaking
news face to face. However in these circumstances as it was not
possible, counselling had to be done over the phone. Example:
patient A was aware about the diagnosis but was unaware
about the progression and prognosis. Due to lockdown it was
difficult to reach CPC. The patient was very anxious about the
symptoms related to disease progression and complained that
the pain was also very severe. The social worker intervened and
Table 1: Types of support availed by all families during
the lock down period
Total number of patients supported n=30
Food coupon 3
Financial help 3
Ambulance 4
Transportation 4
Medical equipment 4
EOLC wish 4
Connect with local GP 5
Dressing material 6
Medicines 6
Grocery 8
NGO networking 8
Caregivers counselled 30
Patients counselled 30
Telephonic calls 120
Some families received multiple types of support. GP: General
practitioner, EOLC: End of life care, NGO: Nongovernmental
organization
Dhavale, et al.: Patient and caregiver challenges during COVID19
Indian Journal of Palliative Care Volume 26 | Supplement 1 | June 2020 S61
with a regular calls tried to relieve her anxiety. For individual
counselling initially the family was not comfortable but with
regular intervention the social worker convinced them about
the need of counselling and making the patient aware about her
progression. The family agreed and the social worker spoke to
the patient reported feeling less anxious. Later the family also
supported the patient by talking to her about the prognosis.
End of life wishes
A key task for the palliative social work team is to assist in
helping patients identify their wishes in their final months to
help improve their quality of life. This was hampered due to
the lockdown situation. For example: one patient at the end
of life care wished to meet her children. Due to lockdown it
was difficult for CPC to allow children to enter in premises.
Also, the children were facing difficulties to reach centre
as they were unable to obtain an e pass. Initially the social
worker intervened to do the video call with the children, but
that didnt suffice the purpose and patient was not happy
with the call. She continuously emphasized on meeting them
physically and talking to them face to face. With the advice
of the multidisciplinary team, the social workers could take
the decision to call the children to the Centre. With all the
precautions (wearing PPE kit) we took the patient at the gate
and the meeting happened with the patient and their children.
It was very emotional moment for all those who were present
there. She was very satisfied after meeting her children and
passed away peacefully after 2 days at the centre.
Nongovernmental organization networking
The task of nongovernmental organization (NGO) networking
was intensified during the COVID period as several NGOs
were not operational themselves. The social work team
therefore had to identify these NGOs that were able to support
patients at this time. For example, one patient who was not
from Pune and had visited CPC for palliative care service faced
financial issues and was not able to meet basic needs. CPC
networked with few organisations and provided the patient
with grocery and financial support. Also, they were provided
with medical essentials from NGO as well as CPC.
Connect with local general practitioner
The social work team realised the importance of having a strong
network of general practitioners (GPs) who were locally available
to patients in any emergency situation. For example, a patient who
wished to spend his last days with his family had to travel to his
home town. There the GP was not so convinced about the need to
visit the patient. The family was therefore not sure of getting the
death certificate if the patient passed away at home. CPC team,
after several calls with the concerned GP could convince him
to visit the patient if required, bringing much reassurance to the
caregiver and the patient. In another case, the social work team
actively followed up with the GP to visit the home of a patient
who had died to give the family a death certificate.
In summary, the specific nature of support provided by the
social work included:
Support to patients and caregivers who were staying at
the inpatient facility of CPC
Oneonone sessions with patients helped them to vent out
their feelings and helped in releasing their stress. Sessions and
activities helped caregivers to be motivated and support patient
with intense care. These sessions included group activities
maintaining social distancing but involved communication
and aimed to leave the caregiver feeling energised and relaxed.
Support to patients and caregivers who were being
discharged from the Centre to go back home
The CPC team was continuously engaged in coordinating
services for patients who wanted to go back home. This
included arranging ambulance services, arranging for rations
to start off the family provisions when they get back home
and preparing both the patient and caregiver for care at home.
The social work team called families once they reached back
home to follow up on any of their concerns.
Support to patients and caregivers who were at home
Coordinating and liaising with different organisation focused
on providing basic needs like grocery and financial help to
patients. This resulted in building the confidence among
patients and caregivers and the feeling of being supported
Additional support includedcoordinating with relatives to
support during last rituals and arranging transport for family
to come to take medicine.
Also support in getting epass from the police. Continuous
follow up during end of life care and bereavement support
helped caregivers to grieve Home care visits helped in wound
management and resulted in managing the smell which had
hampered the comfort of family members staying with patient
The social work team received positive feedback from several
of these families through their verbal and written feedback.
The key aspects in this feedback to the team was that they
felt the CPC team had helped them cope better in this crisis
situation; helping fullfill last wishes; making them feel less
alone and giving them hope making it possible to cope with
the situation.
dIscussIon
This analysis highlights the additional stress and challenges
faced by patients and families who are receiving palliative
care. This group is generally most neglected during a crisis
situation as their needs are considered low priority.[5] However
the stress and challenges shared by patients and caregivers
reveal how the lack of services to this group impacts their
physical, social and emotional health.[6] It demonstrates that in
the absence of any services for palliative care during a crisis,
patient and caregiver needs would go unaddressedleaving
patients in pain and caregivers in guilt, affecting their grieving
process significantly.
The social work team at CPC has also reflected on the
importance of keeping in contact with families and patients
Dhavale, et al.: Patient and caregiver challenges during COVID19
Indian Journal of Palliative Care Volume 26 | Supplement 1 | June 2020S62
over the telephone, to be available for them, listen to
their worries and plan together with them to reduce their
suffering.[7] The team learnt that it is essential to strengthen
the networking among different palliative care organizations
as well as with local GPs, so that patients on palliative care
can access services more locally. Bereavement support
should also be strengthened in such lockdown situation. In
addition, a group of volunteers should be trained to support
the families who face the problem conducting the last rituals
for the patient.
conclusIon
A crisis situation such as the COVID pandemic has illustrated
the scope of palliative care services to integrate the physical,
emotional, and social aspects of care and highlighted the
importance of the interrelationship of all these dimensions.
As we slowly will move back to new normalcy in life, it
would be important to ensure that we continue to focus on
identifying and responding to patients on palliative care who
are struggling to meet their basic needs; ensure our plans of
care for patients and families are designed based on their
inputs and suggestions; and that continue to offer regular
telephonic support in addition to facetoface support to
patients and families.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
references
1. Nouvet E, Sivaram M, Bezanson K, Krishnaraj G, Hunt M, de Laat S,
et al. Palliative care in humanitarian crises: A review of the literature. Int
J Humanitarian Action 2018;3:5.
2. LloydWilliams M. Psychosocial Issues in Palliative Care. New York:
Oxford University Press; 2008.
3. Hanks G, Cherny NI, Christakis NA, Kaasa S. Oxford Textbook of
Palliative Medicine. USA: Oxford University Press; 2011.
4. Ritchie J, Lewis J. Qualitative Research Practice: A Guide for Social
Science Students and Researchers. London: Sage; 2003.
5. Krakauer EL, Daubman BR, Aloudat T. Integrating palliative care
and symptom relief into responses to humanitarian crises. Med J Aust
2019;211:2013.e1.
6. Oechsle K. Current advances in palliative & hospice care: Problems and
needs of relatives and family caregivers during palliative and hospice
care An overview of current literature. Med Sci (Basel) 2019;7:43.
7. Ragesh G, Zacharias L, Thomas PT. Palliative care social work in India:
Current status and future directions. Indian J Palliat Care 2017;23:939.
Copyright of Indian Journal of Palliative Care is the property of Wolters Kluwer India Pvt Ltd
and its content may not be copied or emailed to multiple sites or posted to a listserv without
the copyright holder’s express written permission. However, users may print, download, or
email articles for individual use. A comparison of Israeli Jewish and Arab women’s birth perceptions
Ofra Halperin, RN, PhD (Senior Lecturer)a,n, O. Sarid, PhD (Senior Lecturer)b, J. Cwikel, PhD
(Professor)b
a Emek Izrael College, Nursing Department, Israel
b Department of Social Work, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
a r t i c l e i n f o
Article history:
Received 10 April 2013
Received in revised form
6 November 2013
Accepted 10 November 2013
Keywords:
Childbirth experience
Trauma
Transcultural nursing
a b s t r a c t
Background: birth is a normal physiological process, but can also be experienced as a traumatic event.
Israeli Jewish and Arab women share Israeli residency, citizenship, and universal access to the Israeli
medical system. However, language, religion, values, customs, symbols, and lifestyle differ between the
groups.
Objectives: to examine Israeli Arab and Jewish women’s perceptions of their birth experience, and to
assess the extent to which childbirth details and perceptions predict satisfaction with the birth
experience and the extent of assessing the childbirth as traumatic.
Methods: this study was conducted in two post partum units of two major public hospitals in the
northern part of Israel. The sample included 171 respondents, including 115 Jewish Israeli and 56 Arab
Israeli women who gave birth to their first (33%) or second (67%) child. Respondents described their
childbirth experiences using a self-report questionnaire 2448 hours after childbirth.
Findings: the Arab women were much less likely to attend childbirth preparation classes than the Jewish
women (5% versus 24%). Forty-three per cent of the respondents reported feeling helpless, and 68%
reported feeling lack of control during childbirth. Twenty per cent of the women rated their childbirth
experience as traumatic, a rate much lower than the rate of medical indicators of traumatic birth (39%).
The rate of self-reported traumatic birth was significantly higher among the Arab women than among
the Jewish women (32% versus 14%). A higher percentage of the Arab women reported being afraid
during labour (24.97, po .05), expressed fear for their newborn’s safety (212.44, po .001), and
reported that the level of medical intervention was excessive in their opinion, as compared to the Jewish
women (25.09, po .05; 27.33, po .01). However, both the Arab and Jewish women reported similar
numbers of medical interventions and levels of satisfaction with their medical treatment.
Conclusions: despite universal access to the Israeli health care system, Arab Israeli women use fewer
perinatal medical resources and subjectively report more birth trauma than Jewish Israeli women. Yet,
they give birth in the same hospitals with the same practitioners and report similarly high levels of
satisfaction with the medical services. Taking into account the fact that perceptions of the birth
experience differ between ethno-cultural groups will enable professionals to better tailor intervention
and support throughout childbirth in order to increase satisfaction and minimise trauma from the
experience.
& 2013 Elsevier Ltd. All rights reserved.
Introduction and literature review
Israeli Jewish and Arab women share Israeli residency, citizenship
and access to the Israeli medical system. However, language, religion,
values, customs, symbols, and lifestyle differ between the two groups
(Klug et al., 2009). Israel is not a melting-pot society, but rather more
of a mosaic made up of different population groups coexisting within
the framework of a single democratic state. As a multi-ethnic,
multicultural, multireligious, and multilingual society, Israel has a
high level of informal segregation patterns. Although groups are
not separated by official policy, a number of different sectors within
the society have chosen to lead a segregated lifestyle, maintaining
their strong cultural, religious, ideological, and/or ethnic identity
(Jabareen, 2006).
The vast majority of Arab Israelis have chosen to maintain their
distinct identity and not assimilate. The community’s separate
existence is facilitated through the use of Arabic, Israel’s second
official language; a separate school system; literature, theatre, and
mass media; and the maintenance of independent Muslim denomi-
national court, which adjudicates matters of personal status.
Although the development of inter-group relations between Israel’s
Contents lists available at ScienceDirect
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Midwifery
0266-6138/$ – see front matter & 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.midw.2013.11.003
n Correspondence to: Nursing Faculty, The Max Stern Academic College
Emek-Yezreel, P.O. Box 105, Givat Ela 36570, Israel.
E-mail address: [emailprotected] (O. Halperin).
Midwifery 30 (2014) 853861
www.sciencedirect.com/science/journal/02666138
www.elsevier.com/midw
http://dx.doi.org/10.1016/j.midw.2013.11.003
http://dx.doi.org/10.1016/j.midw.2013.11.003
http://dx.doi.org/10.1016/j.midw.2013.11.003
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http://crossmark.crossref.org/dialog/?doi=10.1016/j.midw.2013.11.003&domain=pdf
mailto:[emailprotected]
http://dx.doi.org/10.1016/j.midw.2013.11.003
Arabs and Jews has been hindered by deeply rooted differences in
religion, values, and political beliefs, the future of the Israeli Arab
sector is closely tied to that of the State of Israel. Although they
coexist as two self-segregated communities, over the years
Jewish and Arab Israelis have come to accept each other, acknowl-
edging the uniqueness and aspirations of each community and
participating in a growing number of joint endeavours (Bard and
Berman, 2012).
Health indicators in Israel present a picture of poorer health
along with lower socio-economic levels in the Arab population as
compared with the Jewish population (Israel Center for Disease
Control, 2005). For example, life expectancy in 2002 was about
three years less for Arab Israelis than for their Jewish counterparts
(Central Bureau of Statistics, 2004). In 1995, a National Health
Insurance Law (NHIL) was enacted, providing health care services
for all Israeli residents (Shvarts, 1998). The aim of the law was to
provide equal health care services for all, with the expectation that
adequate use would decrease the differences in health status
between the two population groups in Israel
