Authors: Ebru Bakir, Parveen Ali Azam
Pain is a universal phenomenon and one of the most common reasons that children visit hospitals. However, it is very subjective and individual experience, because pain perception is affected by combination of several components such as cultural variations. As health workers, it is important to distinguish, how the cultural factors influence pain expression, behaviours and coping methods of children, because paediatric pain assessment and management require a comprehensive understanding of self report of children. The purpose of this systematic review was to determine cross-cultural similarities and differences in pain expression, behaviours and coping methods of children aged between 3 and 18 years old during paediatric pain procedures. Methods: The following major databases were searched; Medline; Cumulative Index to Nursing and Allied Health Literature (CINAHL); Cochrane Central Register of Controlled Trials (CENTRAL); The University of Sheffield Library; The nursing library; Google Scholar; The relevant reference lists. Included studies were written in English and Turkish between 1984 and 2014. Results: Ten studies were identified that examined pain expression, behaviours and coping strategies as well as pain description, colour and language of Palestinian, Jordanian, Lebanese, Egyptian, Syrian, African-American, European-American, Saudi Arabian, Thai, Taiwanese, Asian-American (Chinese-American), Canadian Mi’kmaq (Aboriginal), English, Kurdish, American and Arabic children during paediatric medical, experimental, recurrent, or chronic pain procedures. Findings were categorised into two themes; first, cultural influences on pain expression and behaviours of children due to both topics involved similar contents; second, cultural influences on pain coping strategies of children. Methodologically, included studies were analysed and six qualitative, three quantitative and one mixed methods studies were identified. Conclusion: Examined studies showed that pain expression, behaviours and coping strategies of children were different based on cultural factors, importantly there are significant differences between Asian and Western children. Studies showed that health care workers, particularly in multi-cultural societies, have commonly trained based on Western education systems and they had limited knowledge about pain expression and behaviours of children from different cultures. Furthermore, more cross cultural studies should have been done to understand how children are influenced by cultural factors during painful procedures, particularly for non-Western children.
Keywords: Paediatric pain assessment; Cross cultural; Pain expression; Pain behaviour; Pain coping method; Systematic review