Influence of culture and discrimination on care-seeking behavior of elderly African Americans: a qualitative study

'I'm still here, I'm alive and breathing': The experience of Black Americans with long COVID

AIMS AND OBJECTIVES

In this study, we aimed to characterize the impact of long COVID on quality of life and approaches to symptom management among Black American adults.

BACKGROUND

As a novel condition, qualitative evidence concerning long COVID symptoms and their impact on quality of life can inform the refinement of diagnostic criteria and care plans. However, the underrepresentation of Black Americans in long COVID research is a barrier to achieving equitable care for all long COVID patients.

DESIGN

We employed an interpretive description study design.

METHODS

We recruited a convenience sample of 15 Black American adults with long COVID. We analysed the anonymized transcripts from race-concordant, semi-structured interviews using an inductive, thematic analysis approach. We followed the SRQR reporting guidelines.

RESULTS

We identified four themes: (1) The impact of long COVID symptoms on personal identity and pre-existing conditions; (2) Self-management strategies for long COVID symptoms; (3) Social determinants of health and symptom management; and (4) Effects on interpersonal relationships.

CONCLUSION

Findings demonstrate the comprehensive ramifications of long COVID on the lives of Black American adults. Results also articulate how pre-existing conditions, social risk factors, distrust due to systemic racism, and the nature of interpersonal relationships can complicate symptom management.

RELEVANCE TO CLINICAL PRACTICE

Care approaches that support access to and implementation of integrative therapies may be best suited to meet the needs of long COVID patients. Clinicians should also prioritize eliminating patient exposure to discrimination, implicit bias, and microaggressions. This is of particular concern for long COVID patients who have symptoms that are difficult to objectively quantify, such as pain and fatigue.

NO PATIENT OR PUBLIC CONTRIBUTION

While patient perspectives and experiences were the focus of this study, patients were not involved with the design or conduct of the study, data analysis or interpretation, or writing the manuscript.

Nurses' experiences of discrimination in health care: A qualitative study in Iran

BACKGROUND

Justice in health is one of the main concerns of health organizations, and discrimination in health care is one of the negative outcomes to achieving this goal. Hence, a full understanding of the phenomenon of discrimination in health care and adopting strategies to eliminate it is necessary. The present study was conducted to explore and describe the experiences of nurses of discrimination in health care.

MATERIALS AND METHODS

The present qualitative content analysis study was conducted between 2019 and 2020. Data were collected through semi-structured interviews with 18 participants (two physicians, three nursing supervisors, two head nurses, four clinical nurses, two nursing assistants, and three hospitalized patients) in one public and one private hospital in the city of Tehran. The participants were selected by purposive sampling, which continued until saturation of data. Data obtained were analyzed using the Graneheim and Lundman method.

RESULTS

Four main categories and 14 subcategories were extracted from data analysis: 1) habitual discrimination (everyday discrimination in health centers, ignoring patient rights, low levels of trust in medical staff); 2) interpersonal relationships (expectations of associates, respect for colleagues and friends, the possibility of the occurrence of similar situations, reciprocating people's favors); 3) shortage of health-care resources (shortage of medical equipment, heavy workload, infrastructure of medical centers, lack of access to physicians); and 4) favoritism (ethnicity, favoritism as a common method, and favoritism as the ultimate solution to treatment problems).

CONCLUSION

The present study revealed certain dimensions of discrimination in health care that remain hidden in many quantitative studies. It appears that health system managers will be able to move toward eliminating discrimination in health care. Thus, designing effective models to reduce discrimination in health care based on the underlying concepts of this study is recommended.

Justice and unintentional discrimination in health care: A qualitative content analysis

BACKGROUND:

Discrimination in health care is a common phenomenon whose complete understanding has always been a major concern of health-care systems to control and reduce it. This study aimed to explore the experiences of unintentional discrimination and related factors in health-care providers.

MATERIALS AND METHODS:

This qualitative study was conducted with a content analysis approach in 2019. Data were collected through semi-structured interviews with 13 health-care providers including two physicians, three nursing supervisors, two head nurses, four staff nurses, and two nurse aides in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling. The obtained data were analyzed by Graneheim and Lundman method.

RESULTS:

Three main categories and eight subcategories were obtained from the data analysis: (1) forced discrimination (superiors' pressures and executive orders, occupational concerns, and fear of the superiors); (2) guided discrimination (professional challenges, managers' policymaking, and lack of medical ethics knowledge); and (3) lack of resources (workforce shortage and lack of medical equipment).

CONCLUSION:

The results of this study suggest that health-care providers such as doctors and nurses are unintentionally forced to provide discriminatory care on some occasions. Knowing and managing these unwanted factors can partly counteract unintentional discrimination. Thus, preventing the factors that lead to superiors' pressures and occupational forces and improving the medical ethics knowledge should be considered by health-care managers.

"All I know is that there is a lot of discrimination": Older African immigrants' experiences of discrimination in the United States

Discrimination is implicated in the disproportionate burden of disease and health disparities in racial/ethnic minorities. This qualitative descriptive study explored the experiences of discrimination and its impact on the health of older African immigrants. Semi-structured interviews were conducted with 15 participants. Three main themes and six sub-themes were identified. These included: (1) types of discrimination which were: (a) accent-based, (b) unfair treatment during routine activities, (c) experience with systems; (2) consequences of discrimination; and (3) surviving and thriving with discrimination: (a) "blind eye to it", (b) reacting to it, (c) avoiding it. These themes described common experiences of discrimination, current strategies used to deal with discrimination, and the impact of discrimination on this sample. Health care providers should be aware of discrimination experiences, how to assess for it, and identify when to refer patients to appropriate community resources that include mental health, employment, cultural groups and legal services.

Finding Paradise Within: How Spirituality Protects Palliative Care Clients and Caregivers From Depression

The aims of this article are to explore the experience of depression among palliative care clients and caregivers, describe the strategies they use in coping with depression, and clarify the role of spirituality in preventing and/or overcoming depression. This article discusses an aspect of the findings of a larger doctoral study that explored the nature of spirituality and spiritual engagement from the viewpoint of individuals with life-limiting conditions and their caregivers. van Manen’s phenomenology was used in the study. The data generated from the doctoral study were subjected to secondary analysis to uncover the experience of depression. The methodology underpinning the secondary analysis was phenomenology also by van Manen. Fourteen clients and caregivers from across regional and rural South Australia informed the study. Data collection involved in-depth nonstructured home-based interviews that were audiotaped and transcribed verbatim. The findings highlighted relate to participants succumbing to depression, but having spiritual beliefs and practices helped them cope. One of the most insightful understanding was the role spirituality played in protecting individuals from depression, encapsulated in the theme “finding paradise within.” Spirituality, understood from a religious or secular perspective, must be embedded in palliative care as it assisted in preventing and overcoming depression.

Chronic Pain in Older African American Grandparent Caregivers

African American grandparent caregiving is increasing, and evidence shows that grandparent caregiving influences health and its management. As older adults age, their potential of experiencing chronic pain increases, and this is profound given that physiological research shows that African Americans, aside from aging, may have a predisposition for developing chronic pain. Research shows older African Americans experience significant chronic pain, but few have discussed the implications of managing chronic pain in older African Americans who have added parental responsibility. Many older African Americans receive home healthcare services and there is a unique role for home healthcare clinicians in caring for this vulnerable population. This article discusses the impact of pain on caregiving, challenges in pain management, and practice and policy implications to assist home healthcare clinicians maintain the safety and protection of both the older grandparent and grandchildren.

The Mutual Relationship Between Immigrants' Disrupted Everyday Activities and Their Health: A Grounded Theory of Experiences of Korean Immigrants Settling in New Zealand

For Asian immigrants, immigration has the potential to disrupt all familiar routines. That is a threat to their health and well-being. This grounded theory study explored how immigrants adjust to a new environment by analyzing the experiences of 25 Korean immigrants in New Zealand. The findings suggest that immigration is a stress-inducing phenomenon that requires adjustment of valued activities and adversely affects their health. In response, participants worked on regaining control over disrupted activities by opting for two world perspectives. The study helps social workers to develop effective interventions and services for immigrants to better handle health problems.

Examining the public policy perspective of CSR implementation in Sub-Saharan Africa

Purpose

– The purpose of this paper is to examine the public policy perspective of corporate social responsibility (CSR) implementation in Sub-Saharan Africa. There has been an increase in the number of countries adopting a national policy for CSR practice, particularly in the Western society. Despite the growing awareness about the role of government in CSR promotion, governments in Sub-Saharan Africa are yet to evolve policies that could help promote CSR in the region. As drivers of CSR, governments hold resources, like access to regulated parts of society that makes the inclusion of CSR opportunities relevant to strategic and operational management. From the extant literature, the role of government in defining and shaping the field of CSR is gaining wider acceptability.

Design/methodology/approach

– Using a qualitative research approach, this paper examines the current status of CSR implementation, particularly from the public policy perspective in selected Sub-Saharan African countries. Semi-structured interviews were conducted with policymakers and policy implementers. The study adopted a thematic analysis and developed a rigorous phenomenological design to reveal the insights to CSR policy-making.

Findings

– The findings established that the status of CSR implementation in Sub-Saharan Africa is influenced by absence of national CSR policy, CSR being mainstreamed in government constitution and CSR being a company initiative action to comply with international code of business conduct.

Practical implications

– The results of this study could have policy implications for both executive and MPs of national governments for CSR regulatory policies.

Originality/value

– In most developing countries, including Sub-Saharan African countries, the aforementioned institutional conditions are often an exception. There are both no legal and regulatory frameworks for Multinational Corporation activities and their socio-ecological impact, or such regulations may exist but are not adequately enforced (Rwabizambuga, 2007). This situation, unfortunately, has created a huge reporting gap between what organisations do and what they report regarding CSR. Hence, this original study adds to the body of knowledge for this region by revealing the central issues around the phenomenon.

Understanding inequities in home health care outcomes: staff views on agency and system factors

Results regarding staff perspectives on contributing factors to racial/ethnic disparities in home health care outcomes are discussed. Focus group interviews were conducted with home health care staff (N = 23) who represented various agencies from three Northeastern states. Participants identified agency and system factors that contribute to disparities, including: (a) administrative staff bias/discretion, (b) communication challenges, (c) patient/staff cultural discordance, (d) cost control, and (e) poor access to community resources. Participants reported that bias can influence staff at all levels and is expressed via poor coverage of predominantly minority service areas, resulting in reduced intensity and continuity of service for minority patients.

African Americans’ Perceptions of Pain and Pain Management

Purpose: The purpose of this systematic review is to explore the perceptions of acute, persistent, and disease-specific pain and treatment options held by adult African Americans. Underassessment and undermanagement of pain in African Americans has been well documented; however, the cultural continuum of pain perceptions and their influence on pain assessment and management has not been synthesized. Design: Electronic database searches of the Cumulative Index for Nursing and Allied Health Literature and PubMed, Web-based searches of the pain-specific journals plus a manual search of reference lists identified 41 relevant articles addressing perceptions of pain and/or pain management. Findings: Analysis of the literature revealed six themes: (a) meaning of pain, (b) description of pain, (c) coping with pain, (d) impact of pain, (e) patient–provider relationship, and (f) treatment approaches. Conclusion: These findings warrant further research and indicate the need for more precise evaluation of pain in African Americans, highlighting an imperative to incorporate cultural patterns into pain management practice and education.

Racial differences in coping strategies among individuals with epilepsy

PURPOSE

The purpose of this study was to determine whether racial differences exist in the coping styles of individuals with epilepsy.

METHODS

This study utilized a survey of patients with epilepsy, including the Brief-COPE.

RESULTS

One hundred thirteen Caucasians and 70 African-Americans comprised the study population. On univariate analysis, annual household income (p<0.01), receiving disability benefits (p<0.01), and number of AEDs being currently used (p=0.04) significantly distinguished Caucasians from African-Americans. African-Americans reported higher utilization of religion (p<0.01), denial (p<0.01), emotional support (p=0.02), positive reframing (p<0.01), and planning (p<0.01) as coping reactions compared to Caucasians. Using ordinal logistic regression, the association between being African-American and the higher utilization of religion, positive reframing, planning, and denial as coping strategies remained statistically significant.

CONCLUSION

Among individuals with epilepsy, African-Americans appear to utilize more engagement-type coping reactions when compared to Caucasians but also utilize more denial.

STRUCTURAL AND HIDDEN BARRIERS TO A LOCAL PRIMARY HEALTH CARE INFRASTRUCTURE: AUTONOMY, DECISIONS ABOUT PRIMARY HEALTH CARE, AND THE CENTRALITY AND SIGNIFICANCE OF POWER

PURPOSE

To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States.

METHODOLOGY/APPROACH

Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach.

FINDINGS

Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers.

RESEARCH LIMITATIONS/IMPLICATIONS

Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power.

ORIGINALITY/VALUE

This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

The Impact of John Henryism on Self-Reported Health Behaviors in African American Men

Purpose: African American men have poorer health and higher disease-related mortality as compared to non–African American men. John Henryism refers to the predisposition to engage in active high-effort coping with environmental stressors. Little is known about relationships between John Henryism and personal health behaviors in African American men. The study purposes were to examine predictive relationships among John Henryism, marital status, age, education years, and health insurance on health behaviors in African American men. Design: Cross-sectional descriptive study. Method: The convenience sample included 60 African American men (mean age 54.8 + 10.13) recruited from a large urban area in the Midwestern United States. Findings: John Henryism significantly predicted self-reported health behaviors accounting for 12% of the multiple regression model variance. Discussion and Conclusions: Results suggest that John Henryism could have benefits for African American men’s engagement in health behaviors. Implications for Practice: Findings provide early evidence to consider in the design of interventions aimed at promoting healthy behaviors in African American men.

Blood donation practices, motivations and beliefs in Montreal's Black communities: the modern gift under a new light

OBJECTIVES

Through the conceptual lens of the archaic and modern gift, this study aims to examine perceived limitations and facilitators to increasing blood donations within Black communities in Montreal, Canada. The overall objective is to support blood agencies, such as Héma-Québec, in understanding the challenges and opportunities they face in promoting blood donation among Black communities in pluralistic societies.

DESIGN

Thirty-three semi-structured qualitative interviews were conducted with donors and leaders of ethnocultural groups in Montreal: of these, 6 were Héma-Québec employees; 3 were Caribbean blood drive organizers; 14 were leaders of African, Caribbean or Black multiethnic churches and community groups; and finally, 10 were donors, including 2 African, 4 French-speaking Haitian and 4 English-speaking Caribbean.

RESULTS

The existence of multiple Black communities in Montreal reflects the various facilitators and obstacles facing Héma-Québec. Caribbean and African communities have their own experiences with regard to blood donation as well as different relationships with the broader Quebec society, both of which have great impact on how they perceive the cause. Questions of trust, of giving to the family and to the community, as well as perceived social exclusion appear to be fundamental issues for our informants. The current participation of groups interested in bettering the lives of those affected by sickle cell anaemia combined with the fact that leaders felt more comfortable donating to someone close to the community suggests that the promotion of blood donation through this angle would be well received.

CONCLUSION

Trust issues, perceived discrimination and social exclusion have structural and historical roots that can only be partly overcome with long-term efforts to increase awareness, develop collaborative partnerships and increase institutional efforts to adapt to the challenges of blood donation from Black citizens.

Patient Satisfaction Influenced by interpersonal treatment and communication for African American men: the North Carolina-Louisiana Prostate Cancer Project (PCaP)

The purpose of this study was to determine if a particular set of health behaviors of health care providers and African American men (AAM) influence patient satisfaction from the AAM's perspective. This descriptive, correlational study consisted of 505 AAM in North Carolina diagnosed with prostate cancer and enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP). Analyses consisted of bivariate analyses and multiple regression. Patient-to-provider communication, interpersonal treatment, and provider-to-patient communication accounted for 45% (p ≤ .0001) of the variability in patient satisfaction. Interpersonal treatment (provider focusing on the patient) explained the greatest amount (F = 313.53, R² = .39) of patient satisfaction. Since interpersonal treatment focuses on the patient and demonstrated to be the strongest predictor in patient satisfaction, it is noteworthy to consider the emphasis that should be placed on patient-centered care. In addition, knowing important variables positively affecting patient satisfaction provides useful information for developing appropriate interventions to improve AAM health care experiences.

Self-care recommendations of middle-aged and older adults with sickle cell disease

Self-care management is an important part of living with a chronic illness. Sickle cell disease (SCD) is a chronic disease with acute, painful exacerbations that often results in a shortened life expectancy. Some middle-aged and older adults with SCD lived with the disease prior to having a diagnosis and without modern advances. The purpose of this study is to share the self-care recommendations of middle-aged and older adults with SCD. Using descriptive qualitative methods, data were gathered through semistructured interviews from 11 individuals living with SCD, including 6 women and 5 men. Self-care recommendations themes included physiological, psychological, and provider-related. The self-care recommendations may be seen as an additional resource or "words of wisdom" for younger adults with SCD who can use the recommendations to better manage their own disease. Additionally, providers may be able to use these recommendations to inform their practice.

A prospective population-based study of differences in elder self-neglect and mortality between black and white older adults

BACKGROUND

Self-neglect is the behavior of an elderly person that threatens his or her own health and safety, and it is associated with increased morbidity and mortality. Although report of self-neglect is more common among black older adults, the racial/ethnic differences in mortality remain unclear.

METHODS

The Chicago Healthy Aging Project is a population-based cohort study conducted from 1993 to 2005. A subset of these participants were suspected to self-neglect and were reported to a social services agency. Mortality was ascertained during follow-up and from the National Death Index. Cox proportional hazards models were used to assess the mortality risk.

RESULTS

In the total cohort, there were 5,963 black and 3,475 white older adults, and of these, 1,479 were reported for self-neglect (21.7% in black and 5.3% in white older adults). In multivariable analyses with extensive adjustments, the interaction term indicated that impact of self-neglect on mortality was significantly stronger in black than in white older adults (parameter estimate, 0.54, SE, 0.14, p < .001). This difference persisted over time. In race/ethnicity-stratified analyses, at 6 months after report of self-neglect, the hazard ratio for black older adults was 5.00 (95% confidence interval, 4.47-5.59) and for white older adults was 2.75 (95% confidence interval, 2.19-3.44). At 3 years after report, the hazard ratios were 2.61 (95% confidence interval, 2.25-3.04) and 1.47 (95% confidence interval, 1.10-1.96) for black older adults and white older adults, respectively.

CONCLUSIONS

Future studies are needed to qualify the casual mechanisms between self-neglect and mortality in black and white older adults in order to devise targeted prevention and intervention strategies.

Health disparities: a primer for public health social workers

In 2001, the U.S. Department of Health and Human Services published Healthy People 2010, which identified objectives to guide health promotion and to eliminate health disparities. Since 2001, much research has been published documenting racial and ethnic disparities in healthcare. Although progress has been made in eliminating the disparities, ongoing work by public health social workers, researchers, and policy analysts is needed. This paper focuses on racial and ethnic health disparities, why they exist, where they can be found, and some of the key health/medical conditions identified by the U.S. Department of Health and Human Services to receive attention. Finally, there is a discussion of what policy, professional and community education, and research can to do to eliminate racial and ethnic disparities in healthcare.