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.     

The Role of Public Health in Addressing Racial and Ethnic Disparities in Mental Health and Mental Illness

Racial/ethnic minority populations are underserved in the American mental health care system. Disparity in treatment between whites and African Americans has increased substantially since the 1990s. Racial/ethnic minorities may be disproportionately affected by limited English proficiency, remote geographic settings, stigma, fragmented services, cost, comorbidity of mental illness and chronic diseases, cultural understanding of health care services, and incarceration. We present a model that illustrates how social determinants of health, interventions, and outcomes interact to affect mental health and mental illness. Public health approaches to these concerns include preventive strategies and federal agency collaborations that optimize the resilience of racial/ethnic minorities. We recommend strategies such as enhanced surveillance, research, evidence-based practice, and public policies that set standards for tracking and reducing disparities.     

Living a 'normal' life: young people coping with thalassaemia major or sickle cell disorder

This qualitative paper explores the strategies and resources young people use to cope with sickle cell disorder or thalassaemia major, two haemoglobin disorders with serious implications for health and survival. By focusing on coping strategies, we explore how young people attempt to take control over their lives. The respondents, largely of South Asian and African Caribbean origin, aged between 10 and 19 years, valued maintaining a normal' life and struggled to achieve this normalcy. Strategies were employed to minimise difference from peers but these strategies remained vulnerable. Coping occurred in a dynamic space, involving negotiation and engagement with both personal and structural factors. Threats to normalcy did not always reside in the condition; life transitions, changes in social relationships and racist. disablist or sexist marginalisation also threatened coping strategies.     

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.     

Dementia in People from Ethnic Minority Backgrounds: Disability,Functioning, and Pharmacotherapy at the Time of Diagnosis

ObjectivesIncreasingly, older populations in the United Kingdom and other well-resourced settings are ethnically diverse. Despite a concern that the prevalence of dementia is expected to rise, very little is known about the association of ethnicity and dementia among aging older adults. The current study aimed to compare ethnic group differences in symptom profile, functioning and pharmacotherapy at dementia diagnosis.DesignCross-sectional study of patient characteristics at the point of dementia diagnosis.Setting and ParticipantsIn total, 12,154 patients aged 65 years or older diagnosed with dementia in Southeast London between 2007 and 2015.MethodsData were extracted from the Clinical Record Interactive Search system, which provides anonymized access to the electronic health records of a large mental healthcare provider in Southeast London. Patients from ethnic minority backgrounds were compared with white British individuals on mental and physical well-being, functional scales and medications prescribed at dementia diagnosis, as well as subtype of dementia documented anywhere in the record.ResultsCompared with white British patients, Black African and Black Caribbean patients were more likely to present with psychotic symptoms and were less likely to have an antidepressant prescribed; white Irish patients had higher rates of substance/alcohol use and depressive symptoms were more prevalent in South Asian patients; all ethnic minority groups had higher odds of polypharmacy; and vascular dementia diagnoses were more common in Black and Irish ethnic minority groups.Conclusions and ImplicationsAt dementia diagnosis, there are substantial differences in noncognitive mental health symptoms and pharmacotherapy across ethnic minority groups and compared with the white British majority population. Some of these differences might reflect access/treatment inequalities or implicit unconscious bias related to ethnicity, influencing both. They need to be taken into consideration to optimize pathways into care and personalize assessment and management.     

Racial and Ethnic Discrimination,Medical Mistrust,and Satisfaction with Birth Control Services among Young Adult Latinas

Background

Racial/ethnic discrimination and medical mistrust contribute to disparities in use of and satisfaction with health care services. Previous work examining the influence of discrimination and medical mistrust on health care experiences has focused primarily on African Americans. Despite the finding that Latinas report lower rates of contraceptive use than White women, little is known about the influence of these factors on health care satisfaction, specifically satisfaction with contraceptive services, among Latina women.

Perceptions of schizophrenia in multi-cultural Britain

Objectives: The importance of perceptions of mental health problems from the perspectives of different ethnic populations is especially pertinent within a society such as Britain, which is culturally diverse, but employs a classification of psychopathology which is based upon western models. This study aimed to investigate differences in the lay perceptions of mental health problems, particularly schizophrenia, across different ethnic populations living in Britain. Further it aimed to look at the influence ethnic background had in relation to other variables such as age, gender, religion and contact with people with mental health problems. Design: 190 participants from five broad ethnic groups (Afro-Caribbean, Bangladeshi, Indian, Sub-Saharan African and White British) reported their perceptions of schizophrenia symptoms using the Perceptions of Mental Health Problems Questionnaire. Results: Differences were found across ethnic groups in participants' perceptions of schizophrenia symptoms. Differences were consistently shown across the specific symptoms of hallucinatory behaviour, suspiciousness, unusual thought content and alogia. In particular, in comparison with the white British group, Bangladeshi participants were less likely to view suspiciousness or hallucinatory behaviour as indicative of mental health problems, and the Afro-Caribbean participants were less likely to view unusual thought content as a symptom. As expected, differences in perceptions were also associated with religion, education, gender and contact with people with mental health problems. However, ethnicity was the best predictor of perceptions of schizophrenia symptoms. Conclusion: Ethnicity was found to be an important factor in influencing perceptions of schizophrenia. The specific differences found across ethnic groups are useful in beginning to understand more fully public perceptions of mental health problems in Britain today. The findings raise interesting discussion in relation to ethnic and cultural factors in planning services for people from ethnic minorities, and considering in more detail issues concerning diagnosis and engagement.     

The relationships among coping styles and fatigue in an ethnically diverse sample

The present study focused on coping strategies among African Americans, Latinos, and European Americans with chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). The coping strategies examined were measured by using the COPE Scales, which assess Seeking Emotional Social Support, Positive Reinterpretation and Growth, Acceptance, Denial, Turning to Religion, Behavioral Disengagement, and Focusing on and Venting Emotions. In addition, the four coping strategies specifically designed for people with CFS, including maintaining activity, accommodating to the illness, focusing on symptoms, and information-seeking, were used in this study. It was hypothesized that African Americans and Latinos in comparison to European Americans would be more likely to use religious coping, behavioral disengagement, and denial. As predicted, African Americans were significantly more likely to turn to religion than European Americans, and Latinos and African Americans used denial significantly more often than European Americans. An additional finding was that focusing on symptoms was associated with greater fatigue and more physical disability among African Americans. Within the Latino sample, acceptance was related to greater fatigue and less physical disability, and greater optimism predicted less mental disability. Among European American participants, maintaining activity was related to less mental disability, whereas accommodating to the illness predicted more physical disability. These results indicate that coping varies among various ethnic groups with CFS and ICF; however, denial is consistently related to less adaptive outcomes. Therefore, healthcare professionals should find ways to reduce patient use of denial and promote alternative strategies for managing life events.     

Perception of racial barriers to health care in the rural South

We assessed how commonly people in the rural South perceive racial barriers to care, the characteristics of the people among whom this perception is most common and whether this perception is associated with satisfaction with and use of health services. We analyzed telephone survey data collected in 2002-3, using weighted statistical techniques and multivariate logistic regression in analyses stratified by race. Fifty-four percent of African Americans and 23% of Whites reported that they perceive racial barriers to care in their communities. African Americans who were middle-aged or older, male, or who report being in good-to-excellent health were more likely to perceive racial barriers. Whites who were younger, less educated, and uninsured were more likely than other Whites to perceive racial barriers. For African Americans, perceptions of racial barriers were associated with lower likelihood of being satisfied with care, but not with use of preventive services. The perception of racial barriers to health care is prevalent in the rural South, especially among African Americans. The consequences of this perception may include mistrust and dissatisfaction with medical care.     

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.     

Perceptions of dementia and use of services in minority ethnic communities: a scoping exercise

Despite the rapidly ageing population and a predicted sevenfold increase in the prevalence of dementia in minority ethnic communities, people from these communities remain under‐represented in specialist dementia services. Leventhal's Model of Self‐Regulation suggests perceptions of illness facilitate help‐seeking behaviours such as the use of services. This scoping exercise makes use of the model to explore perceptions of dementia in British Indian, African and Caribbean, and East and Central European communities in the United Kingdom. Between August 2013 and April 2014, culturally specific dementia awareness roadshows were attended by people living with dementia, carers and members of the public. During the roadshows, 62 British Indian, 50 African and Caribbean, and 63 East and Central European attenders participated in discussion groups and a dementia knowledge quiz. Thematic and framework analysis were conducted on the discussion group data. Three main themes are presented: Perceptions of dementia, awareness of dementia in the wider family and community, and awareness and use of services. The findings suggest that although groups attributed a biological basis for memory loss, a number of misconceptions prevailed regarding the cause of dementia. Groups also made use of religion, as opposed to medical healthcare services, as a form of personal and treatment control. Seeking help from healthcare services was hindered by lack of awareness of services, and culturally specific barriers such as language. The findings have a number of implications for policy and practice including the development of public health interventions and the need to focus further on reducing barriers to accessing services.     

Fear,black people and mental illness: A vicious circle?

The relationships between black communities and the mental health (MH) services are fraught. Paradoxically, black communities receive the MH services they don't want, but not the ones they do or might want. Black people mistrust and often fear services, and staff are often wary of the black community, fearing criticism, and not knowing how to respond, are fearful of black people, in particular, young black men. The situation is fueled by prejudice, misunderstanding, misconceptions and sometimes racism. The present paper describes the findings of a study to explore the issues in greater depth. The study was premised on a belief that there are 'circles of fear' which lead to poorer treatment of black communities. A purposive sampling approach was used to seek out groups and individuals in whom the 'circles of fear' were likely to be evident. The findings suggest that there are fears which impact negatively on the interaction between black communities and MH services. Two major themes emerged in this study, i.e. the sources of fear and the consequences of fear. Sources of fear included perceptions of MH services, attitudes to mental illness and diagnosis, and experiences of hospital care. The impact of fear included limited trust, limited engagement and delayed help-seeking behaviour. The study concludes that these fears mar the interactions between these communities and MH services, affect help-seeking behaviour adversely, and lead to restrictive and punitive interventions. Progress will only be made in breaking the 'circles of fear' if there is a systematic change in the experience of black services users at each point in the care pathway.     

Barriers to mental health treatment services for low-income African American women whose children receive behavioral health services: an ethnographic investigation

Despite the prevalence of mental illness among low-income African American women, only a limited number seek and/or accept help from mental health service delivery systems. A qualitative analysis of 64 ethnographic interviews of low-income African American women whose children receive behavioral health services was completed to assess what barriers to care were reported for the women themselves. These African American women were interviewed as part of a larger study seeking to determine why mothers seek mental health treatment for their children, but not themselves, after many of the women (n = 32) met the baseline criteria for anxiety and/or depression. Our finding revealed that (1) the fear of losing their children, (2) economic stressors, (3) role strain, (4) perceptions of the system, and (5) violence and survival are key factors to consider when engaging low-income African American women in mental health treatment services. These factors have a negative influence on help seeking that should be considered for eliminating disparities in access to and utilization of mental health services.     

Health and use of health services: a comparison between Gypsies and Travellers and other ethnic groups

Objectives. To examine the health status of adults from black and minority ethnic groups and from a socio-economically mixed White population, all resident in England.

Design. A cross-sectional questionnaire survey using validated standardised health measures of a sample of Gypsies and Travellers, Pakistani Muslims, African Caribbean, and White adults living in five geographical locations. Health outcomes included general health, health in the past year, limiting long-term illness, anxiety, depression, respiratory symptoms and angina.

Results. Of the 520 recruited age–sex matched sample (260 Gypsies and Travellers matched with 260 Pakistani Muslims, African Caribbean, and White residents), 516 were included in this analysis (173 men, 343 women). There were no differences by age between the four groups but men were approximately four years older than women. There were significant statistical differences in smoking status and educational attendance with more Gypsies and Travellers being current smokers (58% (95% confidence interval (CI) 52, 64) versus 25% (14, 38) or lower in the other groups) and having poorer regular educational attendance (61% (54, 68) versus 89% (77, 96) or higher in the other groups). For all health outcomes examined, Gypsies and Travellers had significantly poorer outcomes (after adjustment for age, sex and smoking status) compared with the White population. The health status of the Pakistani Muslims and African Caribbeans was similar to that of the Gypsies and Travellers for health in the past year, asthma, and depression, but other outcomes (cough, sputum) were significantly less prevalent. There were also significant differences in specific outcomes between African Caribbean and Pakistani Muslim populations. Consultations with various health professionals and use of health services varied between the groups.

Conclusion. Being a Gypsy or Traveller is associated with even poorer health outcomes than those seen in two other ethnic minority groups resident in England, Pakistani Muslim and African Caribbean, and they in turn have poorer health outcomes than the White residents. More remains to be done to address the health and health service needs of such black and minority ethnic groups.     

Alcohol use by young people from different ethnic groups: consumption, intoxication and negative consequences

Objective. To investigate alcohol consumption among mid‐adolescents from different ethnic groups and explore overall and gender variations in drinking behaviours.

Methods. A survey of alcohol use by 609 14–16 year olds recruited from three schools in an ethnically diverse area of London. Approximately 70% of the sample was of White English, White Irish, Black Caribbean or Black African ethnic origin. Self‐report information was collected via a researcher‐administered structured interview.

Results. There was a significantly lower prevalence of lifetime alcohol use among Black African respondents than among the other three ethnic groups. Black African males and males and females from the two White ethnic groups reported drinking above levels recommended by the English Department of Health. Among the recent drinkers, over half of the White Irish and White English groups and over a quarter of Black Caribbean and Black African groups had been intoxicated in the 90 days before interview. Approximately three quarters of the White English and White Irish recent drinkers, but only a half of Black Caribbean and Black African recent drinkers had experienced a negative drinking‐related consequence during the last year.

Conclusions. The survey findings suggest that while young people of White English or White Irish ethnic origin from the populations studied are more likely to drink excessively and experience negative consequences from their drinking than Black African and Black Caribbean youth, a substantial minority of Black African and Black Caribbean youth also experience alcohol‐related problems.     

Ethnicity, nativity, and the health of American Blacks

There have been few empirical studies of ethnic differences in health within the American Black population. Logistic regressions were used to examine the relationships among ethnicity, nativity, depressive symptoms, and physical health in the two largest ethnic groups of American Blacks, African Americans and Caribbean Blacks. The data were from the National Survey of American Life, a national household survey representative of the non-institutionalized U.S. Black population. We found that African Americans, U.S.-born Caribbean Blacks, and Caribbean-born Blacks had significantly different self-ratings of their health and self-reports of being diagnosed with a chronic physical health condition: Caribbean-born Blacks had the best health outcomes and U.S.-born Caribbean Blacks had the worst. This finding remained significant even after considering self-reported depressive symptoms. This study highlights the importance of considering ethnic diversity, nativity and immigration as independent sources of variation in health status within the American Black population.     

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

African Caribbean women are under-represented within mental health services in the United Kingdom, despite sociocontextual vulnerabilities which may increase emotional distress. This qualitative study aimed to explore individual explanatory models of experiences of distress, coping and help-seeking choices, with a view to improving cultural relevance of services. Participants were recruited following their self-referral to self-help community wellbeing workshops. Interpretative phenomenological analysis was carried out following semi-structured interviews with seven African Caribbean women in central London, who reported previously experiencing emotional distress. The study was conducted during 2009. Five super-ordinate themes emerged from the data: explanations of distress, experiences of distress, managing distress, social and cultural influences and seeking help. Each super-ordinate theme consisted of several subthemes which described participants' experiences. Gender roles and a cultural legacy of being strong and hiding distress emerged as influential in participants' beliefs about managing personal difficulties. However, this was balanced with an acknowledgement that intergenerational differences highlighted an increasing acceptance amongst the community of talking about issues and seeking professional support. The findings offered support for the notion that understandings and responses to personal distress are subject to broad-ranging and interwoven influences. This complexity may be conceptualised as an 'exploratory map' where individuals make links between their current and newly encountered knowledge and experience to guide their personal route to coping and help-seeking. The study provides support for tailoring services to individual needs using a flexible approach which empowers individuals from black and minority ethnic groups by valuing explanatory models of distress alternative to the westernised medical model. Furthermore, findings emphasise the importance of readily available and accessible information about statutory and non-statutory community resources which use language relevant to the communities they are aimed at engaging.     

Multiple Roles,Multiple Lives: The Protective Effects of Role Responsibilities on the Health Functioning of African American Mothers

Using data from 747 rural African American mothers, this study incorporated role accumulation theory to test direct and indirect effects of stressors, coping behaviors, and role responsibilities on health functioning. Results indicated that demands emerging from financial strain were related to compromised mental health and decreases in mothers' use of effective coping strategies and role responsibility engagement. Conversely, mothers who effectively responded to stressors and fulfilled responsibilities to their children and communities experienced enhanced mental health, which in turn promoted optimal physical health. The results can inform research and intervention with African American women.     

The context of coping: a qualitative exploration of underlying inequalities that influence health services support for people living with long‐term conditions

Coping with chronic illness encapsulates both practical and emotional aspects of living life in relation to one's long‐term health condition(s). Dominant health psychology approaches for understanding coping, which underpin a more recent policy discourse on ‘self‐management’, focus sharply on the person affected by illness and potentially mask the influence of overarching social structure. In this paper we draw on qualitative interviews with 48 people living with long‐term conditions (LTCs), in order to highlight the role that structural configurations such as healthcare systems may play in either helping or hindering people's efforts to cope with chronic illness. We argue that coping is a social process in which health and related services, situated within their wider political‐economic contexts, play an active role in shaping people's attempts to live well with LTCs. More specifically, health systems are sites of social and cultural capital exchange that can differentially mobilise coping resources through access, continuity of care, and coordination across services. Whilst it is essential to recognise the personal agency of people living with chronic illness, it is also vital to acknowledge the underlying inequalities that affect the ways in which services can support such resourcefulness.