An interpretative phenomenological analysis of African Caribbean women's experiences and management of emotional distress

Exploring black women's experiences of mental health services: a literature review

The prevalence of mental health issues among black women is high, but they are underrepresented among mental health service users. This article details a systematised review of the literature that explored black women's perceptions and experiences of, and barriers to, engaging with mental health services. A total of 16 articles from the UK and North America were included in the review. Four main themes were identified as presenting barriers to black women's engagement with services: mistrust; sociocultural factors; lack of awareness; and practical barriers. The intersection of gender and race was evident in the 'strong black woman' ideal, which may have hindered their recognition and disclosure of mental health conditions, as well as in practical barriers such as costs and caring responsibilities. Historical and cultural perceptions of mental health issues and healthcare services, alongside their previous negative experiences of services, may prevent many black women from accessing essential support. Nurses and other healthcare professionals have an important role in engendering trust, challenging racism and promoting positive mental health.

The perceived effects of migration on the mental health of Afro-Caribbean immigrants: A narrative synthesis of qualitative studies

WHAT IS KNOWN ON THE SUBJECT?: Economic and educational opportunities are usually the principal driving forces for migration. There is a large body of quantitative research studies, mainly from the U.K., supporting the high prevalence of psychiatric disorders, mainly psychotic disorders, in Afro-Caribbean immigrants which increases across generations. The process of migration and acculturation can present significant risk factors for psychiatric disorders in immigrants. Research involving members of the Black community is generally conducted with the perception that Blacks are a homogenous group, ignoring the cultural and ethnic differences among the subgroups. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: It provides a broadened understanding of the experiences, thoughts and feelings of Afro-Caribbean immigrants, and the factors within the processes of migration and acculturation that negatively impacts their mental health. It provides context to the volume of quantitative studies indicating a high prevalence of psychiatric disorders, particularly psychotic disorders, in Afro-Caribbean immigrants and their offspring. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses conducting mental health evaluations and assessments for members of the Black community should be culturally competent. Cultural competence entails an understanding of cultural beliefs, race, ethnicity and values. Additionally, knowledge of the effects of migration and acculturation as mental health risks is also important to improve mental health outcomes. Cultural competence will help reduce health disparities by increasing trust in the health care system and providers, not only for Afro-Caribbean immigrants, but all immigrant groups.

ABSTRACT

INTRODUCTION: There is evidence to support migration as a significant risk factor for psychiatric disorders in immigrants. Unfortunately, as an immigrant group, little is known about the mental health of Afro-Caribbean immigrants and the factors that threaten their mental health.

AIM

To explore the perceived effects of migration on the mental health of Afro-Caribbean immigrants.

METHODS

A qualitative narrative synthesis was employed to interpretively integrate 13 primary qualitative research findings. Eleven of the primary studies were conducted in the U.K., one in the U.S. and one in Canada.

RESULTS

The themes gleaned: (1) experiences of racism, (2) generational conflicts, (3) feelings of powerlessness, (4) limited socioeconomic resources, (5) unfulfilled expectations, (6) fragmented family and community and (7) ignoring cultural/ethnic identity.

DISCUSSION

The findings broadened the understanding and experiences of Afro-Caribbean immigrants and their mental health vulnerabilities as they navigate through migration and acculturation.

IMPLICATIONS FOR PRACTICE

Addressing the mental health of Afro-Caribbeans will require health care providers to: (1) be cognizant of their immigrant status; (2) understand how migration and acculturation influence the mental health of immigrants; (3) be aware of the ethnocultural differences among Black subgroups.

Decision-making on colorectal cancer screening in Curaçao - interviews with the target population

BACKGROUND

During the first year of the population based colorectal cancer (CRC) screening program on Curaçao, about 20% of invitees participated. This study explored the target population's perceptions and awareness on CRC (screening), beliefs on the program provision, their preferences and information needs for informed decision-making.

METHODS

Semi-structured interviews with 23 individuals, who were not yet invited for CRC screening, were recorded, transcribed, coded and analyzed.

RESULTS

CRC (screening) was discussed in the context of personal health, where own responsibility and food were important. Cancer was perceived as an unpredictable disease that causes suffering and leads to death and was also associated with fear. Despite being aware of the program, most respondents were not familiar with the screening procedure. Provision of the screening program was regarded positively and as an opportunity to contribute to health improvement. This seemed related to the expressed trust in the Caribbean Prevention Center (program organizer). Respondents preferred to make independent decisions about CRC screening participation. A personal approach, visual aids and media were the preferred sources of information.

CONCLUSION

The results of our interviews suggest that it may be beneficial to provide information on CRC screening in Curaçao within the context of personal health. While including sensitivity to fears and respect for the autonomy of the target population. Finally, electronic media maybe useful in supporting informed decision-making.

A meta-ethnography investigating relational influences on mental health and cancer-related health care interventions for racially minoritised people in the UK

OBJECTIVE

Despite calls to increase the 'cultural competence' of health care providers, racially minoritised people continue to experience a range of problems when it comes to health care, including discrimination. While relevant qualitative meta-syntheses have suggested better ways forward for health care for racialised minorities, many have lacked conceptual depth, and none have specifically investigated the relational dimensions involved in care. We set out to investigate the social and cultural influences on health care interventions, focusing on psychological approaches and/or cancer care to inform the trial of a new psychological therapy for those living with or beyond cancer.

METHOD

A meta-ethnography approach was used to examine the relevant qualitative studies, following Noblit and Hare, and guided by patient involvement throughout. Papers were analysed between September 2018 and February 2023, with some interruptions caused by the Covid pandemic. The following databases were searched: Ovid MEDLINE, EBSCO CINAHL, Ovid Embase, EBSCO PsycINFO, Proquest Sociology Collection (including Applied Social Sciences Index & Abstracts (ASSIA), Sociological Abstracts and Sociology Database), EBSCO SocINDEX, Ovid AMED, and Web of Science. The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42018107695), and reporting follows the eMERGe Reporting Guidance for meta-ethnographies (France et al. 2019).

RESULTS

Twenty-nine journal papers were included in the final review. Themes (third-order constructs) developed in the paper include the centrality of the patient-practitioner relationship; how participants give meaning to their illness in connection to others; how families (rather than individuals) may make health decisions; how links with a higher power and spiritual/religious others can play a role in coping; and the ways in which a hierarchy of help-seeking develops, frequently with the first port of call being the resources of oneself. Participants in studies had a need to avoid being 'othered' in their care, valuing practitioners that connected with them, and who were able to recognise them as whole and complex (sometimes described in relational languages like 'love'). Complex family-based health decision-making and/or the importance of relations with non-human interactants (e.g. God, spiritual beings) were frequently uncovered, not to mention the profoundly emergent nature of stigma, whereby families could be relatively safe havens for containing and dealing with health challenges. A conceptual framework of 'animated via (frequently hidden) affective relationality' emerged in the final synthesis, bringing all themes together, and drawing attention to the emergent nature of the salient issues facing minoritised patients in health care interactions.

CONCLUSION

Our analysis is important because it sheds light on the hitherto buried relational forces animating and producing the specific issues facing racially minoritised patients, which study participants thought were largely overlooked, but to which professionals can readily relate (given the universal nature of human relations). Thus, training around the affective relationality of consultations could be a fruitful avenue to explore to improve care of diverse patients.

Coping and Protective Factors of Mental Health: An Examination of African American and US Caribbean Black Women Exposed to IPV from a Nationally Representative Sample

Existing research continues to highlight the harm that intimate partner violence (IPV) can pose to health and well-being. However, little is done to understand the effectiveness of coping and protective mechanisms in helping women manage under adverse circumstances. The current study addresses the mental health of US Black women and the role of coping and protective moderators. An analysis of data from the National Survey of American Life (2001-2003), the most comprehensive survey on the health of US Blacks, was conducted. The association between severe physical intimate partner violence and mental health outcomes were confirmed. Resilience moderated the relationship between severe intimate partner violence and mood disorder among US Black women, but this differed between African American and Caribbean Blacks. Resilience, emotional family support, and spirituality reduced the likelihood of having a mental health condition for some African American and Caribbean Black women, while the opposite was found for religiosity. Demographic factors were also associated with mental health conditions and behaviors. The study draws our attention to potential coping and protective mechanisms that could be incorporated into counseling and intervention practices while recognizing factors that may be harmful to the mental health of individuals.

How Can We Actually Change Help-Seeking Behaviour for Mental Health Problems among the General Public? Development of the 'PLACES' Model

Good treatment uptake is essential for clinically effective interventions to be fully utilised. Numerous studies have examined barriers to help-seeking for mental health treatment and to a lesser extent, facilitators. However, much of the current research focuses on changing help-seeking attitudes, which often do not lead to changes in behaviour. There is a clear gap in the literature for interventions that successfully change help-seeking behaviour among the general public. This gap is particularly relevant for early intervention. Here we describe the development of a new model which combines facilitators to treatment and an engaging, acceptable intervention for the general public. It is called the 'PLACES' (Publicity, Lay, Acceptable, Convenient, Effective, Self-referral) model of treatment engagement. It is based on theoretical work, as well as empirical research on a low intensity psychoeducational cognitive behavioural therapy (CBT) intervention: one-day workshops for stress and depression. In this paper, we describe the development of the model and the results of its use among four different clinical groups (adults experiencing stress, adults experiencing depression, adolescents (age 16-18) experiencing stress, and mothers with postnatal depression). We recorded high rates of uptake by people who have previously not sought help and by racial and ethnic minority groups across all four of these clinical groups. The clinical and research implications and applications of this model are discussed.

How people of African Caribbean or Irish ethnicity cope with long-term health conditions in UK community settings: A systematic review of qualitative, quantitative and mixed method studies

Living with a chronic or mental health condition can be challenging and requires considerable adjustment. As ways of coping are culturally influenced, it is important to understand how minority ethnic populations cope, to inform appropriate services. This review aimed to explore the coping strategies used by UK residents from an African Caribbean or Irish background between 1960 and 2020. A systematic literature search on strategies used to cope with chronic health conditions in both populations living in the United Kingdom identified 26 relevant studies. Data were extracted, quality of papers was appraised and critical interpretive synthesis was applied. Two major foci of the studies were coping strategies and barriers to coping. The main coping strategies were denial/scepticism, self-management, spirituality and religion. Within each population, there was variation in ways of coping. The review highlights the complex role of religion in influencing coping strategies. It demonstrates how personal and minority ethnic populations' experiences of service use are connected with stigma, fear and mistrust, which also act as barriers to seeking help and to coping. Coping with a chronic or mental health condition in the Irish and African Caribbean populations is under-researched. Stigma, fear and mistrust in services act as key barriers to help-seeking and religion is a prominent coping strategy. However, few detailed examples were given on how it was used to assist individuals when managing a chronic or mental health condition. Also due to a lack of research, firm conclusions cannot be drawn for the Irish population.

Staying strong: Exploring experiences of managing emotional distress for African Caribbean women living in the UK

The “strong Black woman” (SBW) is a Western cultural stereotype that depicts African-heritage women as strong, self-reliant, independent, yet nurturing and self-sacrificing. US research indicates that this stereotype negatively impacts the emotional wellbeing of African-heritage women, while also allowing them to survive in a racist society. UK research has documented the significance of this stereotype in relation to African Caribbean women’s experience of depression around the time of childbirth and “attachment separation and loss”. However, research is yet to explore how UK African Caribbean women make sense of and negotiate the SBW stereotype in relation to their emotional wellbeing more broadly. Using five focus groups, with a total of 18 women, this research explored how these women experienced and managed emotional distress in relation to the SBW stereotype. The importance of “being strong” consistently underpinned the participants’ narratives. However, this requirement for strength often negatively impacted their ability to cope effectively with their distress, leading them to manage it in ways that did little to alleviate it and sometimes increased it. This study offers important implications for understanding the experiences of emotional distress for UK African Caribbean women.

Developing Culturally Sensitive mHealth Apps for Caribbean Immigrant Women to Use During Pregnancy: Focus Group Study

Background

A valuable addition to the mobile health (mHealth) space is an exploration of the context of minorities in developed countries. The transition period postmigration, culture, and socioeconomic uniqueness of migratory groups can shed light on the problems with existing prenatal mHealth apps.

Objective

The objectives of this study were to (1) use the theoretical concept of pregnancy ecology to understand the emotional, physical, information, and social challenges affecting low-income Caribbean immigrant women’s prenatal well-being practices and (2) develop a deep understanding of challenges worthy of consideration in mHealth design for these women.

Methods

This qualitative interpretive approach using analytical induction presents the findings of 3 focus group sessions with 12 Caribbean immigrant women living in South Florida in the United States. The study took place from April to September 2015.

Results

The participants revealed problematic tiers and support needs within the pregnancy ecology including emotional stressors caused by family separation, physical challenges, information gaps, and longing for social support.

Conclusions

mHealth interventions for low-income Caribbean immigrant women must be designed beyond the conventional way of focusing on the events surrounding the unborn child. It can be tailored to the needs of the expecting mother. Pregnancy information should be customized on the basis of the variability of lifestyle, cultural practices, socioeconomic status, and social ties while still being able to deliver appropriate guidelines and clear cultural misconceptions.

"It has not occurred to me to see a doctor for that kind of feeling": a qualitative study of Filipina immigrants' perceptions of help seeking for mental health problems

BACKGROUND

Immigrant women face greater barriers to health care, especially mental health care, than non-immigrant women. However, immigrants are a heterogeneous group and bring with them a range of different personal, social, cultural and economic factors, which impact both mental health and access to care. In this study, we explored factors that influence Filipina immigrants' perceptions of help seeking from a general practitioner for mental health problems in Norway.

METHOD

Using data from semi-structured interviews, we applied a post-colonial feminist perspective to identify factors that affect perceptions of help seeking.

RESULTS

Findings indicated that a combination of the women's beliefs and values, stigma, experiences with healthcare services in Norway and familiarity with mental health services influence perceptions of help seeking. Some factors represented structural barriers to healthcare seeking in general, while others related to mental healthcare seeking in particular. The significance of each factor varied depending on the women's backgrounds.

CONCLUSIONS

Socioeconomic status, educational background, familiarity with health services and experience of mental health can influence immigrant women's perceptions of, and barriers for, help seeking for mental health problems. There are a number of barriers to address at a structural level to improve both the propensity to seek healthcare in general, as well as mental healthcare in particular. Efforts to increase awareness of primary mental healthcare services may also help change the perception that professional help is only appropriate for serious mental health disorders.

Social Interaction Needs and Entertainment Approaches to Pregnancy Well-Being in mHealth Technology Design for Low-Income Transmigrant Women: Qualitative Codesign Study

Background

Low-income Caribbean transmigrant women face unique health challenges during pregnancy that set forth multidimensional implications for the design of mobile health (mHealth). Acknowledgment of the unique health needs of low-income Caribbean immigrant women in the United States and what that entails regarding technology design remains rarely examined in the literature of mHealth technologies.

Objective

The goal of this study was to reveal the needs and gaps in mHealth interventions for pregnant immigrant women not yet realized in this field. These understandings reveal design opportunities for mHealth.

Methods

The use of the qualitative participatory action research approach of codesign workshops in this study resulted in design solutions by the participants after reflecting on their earlier focus group discussions. The highlights are not the resulting designs per se but rather the inferences derived from the researcher reflecting on these designs.

Results

The designs exposed two themes relevant to this paper. First, the participants desired the inclusion and rebuilding of social and organizational relationships in mHealth. The resulting designs formulate an understanding of the women’s health-related social support needs and how technology can facilitate them. Second, the participants wanted entertainment with an element of social participation incorporated in mHealth pregnancy management interventions. This brings attention to the role entertainment can add to the impact mHealth can deliver for pregnancy well-being.

Conclusions

The study concluded with an examination of social and entertainment design implications that reveal pregnant immigrant women’s virtual health-related sharing habits, choice of sharing interaction scenarios during pregnancy (eg, local, long distance, one-way, two-way, and many-many), and choice of sharing media (eg, text, voice, and video). Additionally, the study revealed exclusions to social sharing capabilities in health technologies for these women.

Rethinking Strength

In this qualitative study, we examined perceptions of the strong Black woman (SBW) or superwoman role in a sample of 30 Black women. We found that participants conceptualized the SBW/superwoman role through five characteristics: independent, taking care of family and others, hardworking and high achieving, overcoming adversity, and emotionally contained. Most participants were ambivalent about their relationship with this role, given historical accounts and familial examples of Black women. Many participants appropriated the SBW/superwoman role by redefining it in ways that were more empowering and freeing. Several participants were critical of and rejected the SBW/superwoman role, focusing on its problematic and rigid view of strength. All of these perspectives underscore the importance of increasing awareness of restrictive gendered and racialized role expectations as well as the desire to maintain connections to the cultural legacy of Black women. Several important contextual factors (e.g., social status, family relationships) emerged that are relevant to the identified themes. Results from this study highlight how the discourse of strength and familiarity with the SBW/superwoman role are pervasive among Black women. Our findings underscore the need for practitioners to understand the complexity in how Black women make meaning of this role relative to help seeking for physical and mental health. Online slides for instructors who want to use this article for teaching are available on PWQ 's website at http://pwq.sagepub.com/supplemental

Stuttering and work life: an interpretative phenomenological analysis

PURPOSE

The experiential claims of nine people who stuttered were examined with the purpose of determining the impact of stuttering on their work lives and to further examine what meaning they derive from these experiences.

METHOD

Six male and three female participants aged 29-61 years (mean age, 41.4) who stuttered were interviewed and verbatim interview transcripts were analyzed using interpretative phenomenological analysis. Credibility was established by way of member checking, researcher comparison with only consensual themes and interpretations presented in the final analysis.

RESULTS

Four Superordinate themes, "stuttering is always there; stuttering at work reveals a problem; stuttering limits communication; and stuttering limits occupational progression" were distilled by descriptive and interpretative treatment of the interview transcripts. The interpretative level of analysis identified self-stigma as central to the meaning derived from these experiences. Participants' expectation of stigmatizing public attitudes, together with their own self-validation of such attitudes perpetuated diminished feelings about self-esteem and self-efficacy. Fear of negative evaluation may be heightened in the work context and might mediate feelings of self-stigma in this context.

CONCLUSIONS

Superordinate themes and their subthemes indicate that stuttering is problematic at work by way of perpetuating in the PWS an expectation of negative evaluation by others. Findings implicate issues of self-stigma as generating feelings of self-doubt and self-reproach in PWS in the workplace. The development and effects of self-stigma in PWS have broader implications than the workplace context alone and further examination of the issues of self-stigma in stuttering is recommended.

EDUCATIONAL OBJECTIVES

At the end of this activity the reader will be able to: (a) describe how stuttering might affect workplace experiences; (b) describe the impact of stuttering on communication in the work context; (c) describe how qualitative methods can provide insights into the impact of stuttering in the work context; (d) describe the impact of self and public stigma on wellbeing in the work context.