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. 2020 Dec 22;15(12):e0243803. doi: 10.1371/journal.pone.0243803

Table 1. Example of the analytical process.

1. Self-understanding “It is obvious that those immigrants that are here (nursing home) are the most isolated… they have no one to talk to often, and just sit there without being able to communicate
“It often happens, when there are frustrations, when they are not able to understand the language (anymore) […], or when they are not able to speak Norwegian, then it develops into aggression … acting-out”
2. Critical common-sense understanding Not being able to communicate causing isolation and frustration: Respondents told how not being able to talk in the majority language or another shared language seemed to represent a source of isolation, loneliness, aggression/agitation among patients; thus also a challenge for health personnel in providing good care. Several mentioned that some of the patients with immigrant background did not have relatives/social network; thus being particularly vulnerable in relation to becoming isolated.
3. Abstracted/theoretical understanding Studies on communication across linguistic and cultural diversity show that residents who do not speak the majority language tend to have less communication with the staff compared to people representing the majority group (38, 39) and tend to sit more alone (37). The relationship between agitation and people with dementia who do not speak the majority language is also thematised (43); patients having the majority language as the second language are associated with significantly higher agitation level. Such a position can be seen in the light of intersectionality theory (54) as lack of exposure to the majority language and culture; including a lack of social network are likely to be interlinked with migration history; ethnicity; level of education; job opportunities/experience; gender roles; thus creating differences in the possibility of accessing adjusted care.