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.     

Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower Hamlets

OBJECTIVE: The purpose of this study was to explore first-generation Bangladeshi women's understandings and experiences of postnatal distress, and to describe coping strategies during the postnatal period. METHODS: This was a qualitative study using focus groups. Subjects were drawn from three existing community groups in Tower Hamlets, a multiethnic, socially deprived borough in east London. Thematic content analysis was used to explore and present the data. RESULTS: Many women received little practical or emotional support once home from hospital with a new baby, because of the lack of extended family networks; this contrasts with the 40 day rest period common in Bangladesh. These women understood emotional distress as separate from physical symptoms or illness, and recognized that one may influence or cause the other. Distinctive language was used to describe these thoughts and feelings. The roles of health visitors, midwives and GPs were understood solely in terms of physical care. Accordingly, they did not access professionals for emotional or psychological problems. Lack of language support services contributed to the women not seeking help. CONCLUSIONS: Information about services, and professional roles in the postnatal period should be extended to include key family members such as husbands and mothers-in-law. Dialogue with Bangladeshi women may ensure that women understand the extended roles of GPs, health visitors and midwives in providing help for emotional distress, alongside their role in physical health care. More language support and advocacy is needed if women are to access the full range of health services.     

Factors Influencing Medical Information Seeking Among African American Cancer Patients

Qualitative research methods were used to explore factors that may affect medical information seeking, treatment engagement, and emotional adjustment among African American cancer patients. Focus group findings suggest that an array of cultural and socioeconomic factors plays important roles in the behavior of African American cancer patients. Participants described a number of important barriers and facilitators of medical information seeking and treatment participation. Factors linked to the health care-related behaviors and adjustment of African American cancer patients included limited knowledge and misinformation about cancer, mistrust of the medical community, concerns about privacy, lack of insurance, religious beliefs, and emotional issues such as fear and stigma associated with seeking emotional support. Recommendations are made that may assist mental and physical health providers in improving patient information and mental and physical health outcomes of African American cancer patients.     

Factors influencing medical information seeking among African American cancer patients

Qualitative research methods were used to explore factors that may affect medical information seeking, treatment engagement, and emotional adjustment among African American cancer patients. Focus group findings suggest that an array of cultural and socioeconomic factors plays important roles in the behavior of African American cancer patients. Participants described a number of important barriers and facilitators of medical information seeking and treatment participation. Factors linked to the health care-related behaviors and adjustment of African American cancer patients included limited knowledge and misinformation about cancer, mistrust of the medical community, concerns about privacy, lack of insurance, religious beliefs, and emotional issues such as fear and stigma associated with seeking emotional support. Recommendations are made that may assist mental and physical health providers in improving patient information and mental and physical health outcomes of African American cancer patients.     

Dealing with it: Black Caribbean women's response to adversity and psychological distress associated with pregnancy, childbirth, and early motherhood

This paper focuses on Black Caribbean women's ideas about perinatal depression and the ways in which these are linked to coping with personal adversity. An epidemiological survey found that despite higher levels of social risk among Black Caribbean women living in the UK, they were no more likely than White British women to record above-threshold depression scores postnatally and were significantly less likely to have done so during pregnancy. In-depth interviews were undertaken to illuminate the models, experiences, and meaning of perinatal depression held by Black Caribbean women. Women's narratives suggested that they rejected 'postnatal depression' as a central construct for understanding responses to psychological distress associated childbirth and early motherhood. Rejection of depression as illness was associated with imperatives to normalise distress and a self-concept which stressed the importance of being 'Strong-Black-Women' for maintaining psychological well-being. This identity served to reinforce notions of resilience, empowerment, and coping strategies characterised by the need to problem-solve practically, assertively, and materially. The study questions the utility of attaching psychiatric labels to the emotional and psychological distress experienced by Black Caribbean women around the perinatal period.     

Correlates of African American sexual assault survivors’ medical care seeking

ABSTRACT

African American women are at higher risk for sexual assault than other racial/ethnic groups and have an overall high prevalence of lifetime sexual assault. Despite elevated risk and prevalence, African American survivors are often reluctant to use services in the aftermath of sexual assault. Yet, little research has focused exclusively on African American women’s sexual assault experiences including their experiences of medical care seeking. A mail survey study was conducted in Chicago (2010–2011) to understand better African American women’s sexual assault experiences in relationship to post-assault medical care seeking in a large community sample (N = 836). Multivariable regression analyses examined whether demographics, assault characteristics, trauma history, and post-assault psychosocial factors were related to medical care seeking. Results revealed unique correlates of immediate and long-term help-seeking from a variety of medical/health sources. Being of older age and lower income, perceived life threat, and delayed disclosure were related to less medical care seeking. Survivors who were assaulted by strangers, experienced interpersonal and contextual traumas, and who received tangible aid and mixed social reactions were related to medical care seeking. Implications for research and clinical practice with this population are provided.     

Balancing between normality and social death: Black, rural, South African women coping with HIV/AIDS

The millions of people living with HIV/AIDS are in urgent need of effective care and support interventions. Such interventions should take people's reported needs, coping strategies, and context into account. Usually, active problem-focused coping strategies have been encouraged because they are considered to be more beneficial than passive emotion-focused strategies. However, this may not be the case in the South African context. This study was based on in-depth interviews with Black, rural, South African women about their coping strategies. The overriding aim of coping was to solve the tasks of physical, psychological, and social survival. Strategies involving avoidance of, escaping from, or minimizing HIV/AIDS and its accompanying emotional distress were predominant. We argue that such strategies could be adaptive in a society with scarce resources and marked by gender inequalities. Our findings suggest that care and support interventions should be sensitive to culture and context, should be holistic and participatory, and should include income generation and child care services.     

Cultural Background and Socioeconomic Influence of Immigrant and Refugee Women Coping with Postpartum Depression

Postpartum depression is a serious condition that can have long lasting traumatic effects on women and their families. Until recently postpartum depression research has focused more on the population as a whole rather than refugee and immigrant women. Informed by Kleinman’s explanatory model and the postcolonial feminist perspective, 30 immigrant and refugee women were interviewed to find out what factors influenced them in seeking postpartum care and what strategies would be helpful in prevention and treatment of postpartum depression. We found that the immigrant and refugee women in our sample: (a) were influenced by both cultural background and socioeconomic factors in seeking support and treatment; (b) were influenced by cultural differences and social stigma when making decisions about health care practices; and (c) employed numerous coping strategies to deal with postpartum depression. Recommendations are provided for more culturally appropriate and equitable mental health care services for immigrant and refugee women living in Canada.     

A model of mother-child coping and adjustment to HIV

An increasing proportion of newly diagnosed AIDS cases is being reported among African American urban women. Recent research regarding the psychosocial and behavioral impact of a mother's HIV status on her uninfected children as well as a growing body of clinical evidence suggest that these children are extremely vulnerable and at risk for problems in psychosocial adjustment. The present paper reports the results of research designed to examine the pathways by which a mother's HIV-positive status affects the psychosocial adjustment of her uninfected school-age child. The principal predictor variables of the model are family sociodemographic characteristics, social support available to mother and child, HIV-related symptom distress in the mother, coping strategies of both mother and child, emotional distress of the mother, and quality of the parent-child relationship. The dependent variable is the psychosocial adjustment of the child. Data were collected on 147 mother-child dyads using standardized questionnaires and personal interviews. Eighty-six percent of the mothers were African American and over 96% were on public assistance. Structural equation modeling was used to test the proposed model of mother-child coping and adjustment. After adding three paths, the model had a good fit to the data (comparative fit index=0.94; root mean square estimate of error=0.06). Five model constructs accounted for 36% of the variance in child adjustment. The constructs in order of importance were maternal HIV-associated stressors, maternal emotional distress, child social support, child coping, and quality of parent-child relationship.     

Acculturation phenomena experienced by the spouses of Korean international students in the United States

I explored the ways in which Korean international students' spouses perceived and coped with the challenges associated with the adaptation process. I used in-depth interviews to examine how they dealt with life challenges, barriers, and coping strategies associated with acculturative stress. Three themes were identified: challenging life experiences and barriers as immigrants, the experience of emotional and psychological distress and stress, and new identified family structures. Two coping strategies used with acculturative stress were addressed: the recognition of personal strength and involvement in meaningful activities. I found that purposeful and meaningful activities associated with volunteerism, as well as cultural values and beliefs, played important roles in coping with stress. Further investigation into the role of meaningful activities for immigrants is necessary to have a better understanding of the phenomenon.     

Race,social support,and coping strategies among HIV‐positive gay and bisexual men

Few studies have examined the relation between race, social support, and coping, particularly among HIV‐infected individuals. We examined the relation of race and social support to coping with HIV infection in a sample of 121 gay and bisexual men (64 African American, 57 White). Compared to White participants, African Americans reported higher use of multiple coping strategies. High levels of perceived social support were related to greater use of positive coping and seeking support; lower levels of social support were related to greater use of self‐destructive coping. There were no race‐related differences in social support, and no race by social support interactions. Possible explanations for observed cultural differences and coping challenges of African American gay and bisexual men with HIV are discussed.     

Race, social support, and coping strategies among HIV-positive gay and bisexual men

Few studies have examined the relation between race, social support, and coping, particularly among HIV-infected individuals. We examined the relation of race and social support to coping with HIV infection in a sample of 121 gay and bisexual men (64 African American, 57 White). Compared to White participants, African Americans reported higher use of multiple coping strategies. High levels of perceived social support were related to greater use of positive coping and seeking support; lower levels of social support were related to greater use of self-destructive coping. There were no race-related differences in social support, and no race by social support interactions. Possible explanations for observed cultural differences and coping challenges of African American gay and bisexual men with HIV are discussed.     

Life after Stroke: Coping mechanisms among African Caribbean Women

In the UK, stroke is the third most common cause of death for women and the incidence in African Caribbean women is higher than that in the general population. Stroke burden has major consequences for the physical, mental and social health of African Caribbean women. In order to adjust to life after stroke, individuals affected employ a range of strategies which may include personal, religious (church) or spiritual support (i.e. prayer), individual motivation or resignation to life with a disability. This study explored these areas through the coping mechanisms that African Caribbean women utilised post stroke in the context of stroke recovery and lifestyle modification efforts needed to promote healthy living post stroke. A qualitative approach using interpretative phenomenological analysis was adopted. Seven women were recruited into the study. Semi‐structured, in‐depth interviews were audio recorded and were transcribed verbatim. Data were analysed using a four‐stage framework: familiarisation, sense making, developing themes, and data refinement and analysis. Three main themes on coping emerged: the need to follow medical rules to manage stroke, strength and determination, and the use of religion and faith to cope with life after stroke. These findings illustrate both a tension between religious beliefs and the medical approach to stroke and highlight the potential benefits that religion and the church can play in stroke recovery. Implications for practice include acknowledgement and inclusion of religion‐ and church‐based health promotion in post‐stroke recovery.     

Silent endurance and profound loneliness: socioemotional suffering in African Americans living with HIV in the rural south

We explored how community responses to HIV contribute to distress in African Americans living with HIV in the rural South of the United States. We listened to the voices of community members through focus groups and African Americans with HIV through interviews. Community avoidance of HIV, negative views of HIV, and discriminatory behavior powerfully affected the distress of people living with HIV (PLWH). Ongoing distress, coupled with limited support, led to a life in which many PLWH endured their pain in silence and experienced profound loneliness. We conceptualized their experiences as socioemotional suffering--the hidden emotional burden and inner distress of not only living with HIV, a complex serious illness, but also with the societal attitudes and behaviors that are imposed on the illness and on PLWH. To improve the quality of life and health of PLWH, we cannot focus solely on the individual, but must also focus on the local community and society as a whole.     

“Why doesn't she seek help for partner abuse?” An exploratory study with South Asian immigrant women

This study explores why South Asian immigrant women with experiences of partner abuse delay seeking help from professionals. Three focus groups were conducted in Hindi language with South Asian immigrant women in Toronto. Twenty-two women participated with a mean age of 46 years (range 29–68 years). Thematic analysis was conducted on the transcribed data using constant comparison techniques within and across the groups. We found that three major themes emerged from the discussions: reasons for delayed help-seeking, turning points and talking to professionals. Women expressed delaying help-seeking to the point when “Pani sar se guzar jata he” (water crosses over your head). Their dominant reasons for delayed help-seeking were social stigma, rigid gender roles, marriage obligations, expected silence, loss of social support after migration and limited knowledge about available resources and myths about partner abuse. Women usually turned for help only after experiencing pronounced mental and physical health problems.     

Acceptance and experience of treatment for postnatal depression in a community mental health setting

Our objective in this qualitative study was to investigate the acceptance and experience of treatment for postnatal depression (PND). Fifteen women who had received treatment and support from the community mental health service for PND were interviewed. Interviews were transcribed verbatim and then analyzed using the modified analytic induction method. The majority of women interviewed had reached "crisis point" before they sought and received treatment. The stigma attached to an inability to cope and being a "bad mother" emerged as the main barrier to seeking help earlier. In addition, women were unable to differentiate between "normal" levels of postpartum distress and depressive symptoms that might require intervention. Talking about their distress and experiences, both with health professionals and other mothers, was regarded as of primary importance in the recovery process.     

Acceptance and Experience of Treatment for Postnatal Depression in a Community Mental Health Setting

Our objective in this qualitative study was to investigate the acceptance and experience of treatment for postnatal depression (PND). Fifteen women who had received treatment and support from the community mental health service for PND were interviewed. Interviews were transcribed verbatim and then analyzed using the modified analytic induction method. The majority of women interviewed had reached “crisis point” before they sought and received treatment. The stigma attached to an inability to cope and being a “bad mother” emerged as the main barrier to seeking help earlier. In addition, women were unable to differentiate between “normal” levels of postpartum distress and depressive symptoms that might require intervention. Talking about their distress and experiences, both with health professionals and other mothers, was regarded as of primary importance in the recovery process.     

Mental health advocacy and African and Caribbean men: good practice principles and organizational models for delivery

Background Advocacy has a critical role to play in addressing concerns about access to appropriate mental health care and treatment for African and Caribbean men. Aim To investigate good practice principles and organizational models for mental health advocacy provision for African and Caribbean men. Study design The study consisted of: (i) A systematic literature review. Bibliographic and internet searching was undertaken from 1994 to 2006. The inclusion criteria related to mental health, advocacy provision for African and Caribbean men. (ii) Four focus groups with African and Caribbean men to explore needs for and experiences of mental health advocacy. (iii) An investigation into current advocacy provision through a survey of advocacy provision in England, Wales and Northern Ireland. (iv) Twenty‐two qualitative stakeholder interviews to investigate the operation of mental health advocacy for this client group. The study was undertaken in partnership with two service user‐led organizations and an African Caribbean mental health service. Results Primary research in this area is scant. Mainstream mental health advocacy services are often poor at providing appropriate services. Services developed by the Black Community and voluntary sector are grounded in different conceptualizations of advocacy and sharper understanding of the needs of African and Caribbean men. The lack of sustainable funding for these organizations is a major barrier to the development of high‐quality advocacy for this group, reflecting a lack of understanding about their distinctive role. Conclusions The commissioning and provision of mental health advocacy needs to recognize the distinct experiences of African and Caribbean men and develop capacity in the range of organizations to ensure equitable access.     

Barriers to detection,help-seeking,and service use for children with ADHD symptoms

This study describes 4 help-seeking steps among children at high risk for attention deficit hyperactivity disorder (ADHD), and identifies barriers to ADHD symptom detection and treatment. Using a district-wide stratified random sample of 1615 elementary school students screened for ADHD risk, predictors of 4 help-seeking steps among a high-risk group (n=389) and parent-identified barriers to care among children with unmet need for ADHD care (n=91) were assessed. Study findings indicate that although 88% of children were recognized as having a problem, only 39% had been evaluated, 32% received an ADHD diagnosis, and 23% received current treatment. Older children and those with more severe behavior problems were more likely to be perceived by their parents as having a problem. Additionally, gender and ethnic disparities in the subsequent help-seeking process emerged. Boys had over 5 times the odds than girls of receiving an evaluation, an ADHD diagnosis, and treatment. Compared to African American youth, Caucasian children had twice the odds of taking these help-seeking steps. For those children with unmet need for ADHD care, poverty predicted lower treatment rates and was associated with the most pervasive barriers. The gap between parental problem recognition and seeking services suggests that thresholds for parental recognition of a child behavior problem and for seeking ADHD services may be different. Future research examining the help-seeking process for ADHD should include a qualitative component to explore the potential mechanisms for gender and ethnic differences.