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Nurs Health Sci. 2014 Jun;16(2):186-92. doi: 10.1111/nhs.12084. Epub 2013 Aug 29.

Cultural responses to pain in UK children of primary school age: a mixed-methods study.

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Sulaimanea Polytechnic University, Sulaimenea, Iraq; Faculty of Health, Education & Society, Plymouth University, Plymouth, UK.


Pain-measurement tools are often criticized for not addressing the influence of culture and ethnicity on pain. This study examined how children who speak English as a primary or additional language discuss pain. Two methods were used in six focus group interviews with 34 children aged 4-7 years: (i) use of drawings from the Pediatric Pain Inventory to capture the language used by children to describe pain; and (ii) observation of the children's placing of pain drawings on red/amber/green paper to denote perceived severity of pain. The findings demonstrated that children with English as an additional language used less elaborate language when talking about pain, but tended to talk about the pictures prior to deciding where they should be placed. For these children, there was a positive significant relationship between language, age, and length of stay in the UK. The children's placement of pain drawings varied according to language background, sex, and age. The findings emphasize the need for sufficient time to assess pain adequately in children who do not speak English as a first language.


English as an additional language; Pediatric Pain Inventory; children; language; narrative analysis; pain; pain measurement

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