Nigerian Clergy and healthcare professionals’ perceptions of health-seeking behaviours among Nigerian immigrants in the UK

The diversity in patient populations due to immigration in the UK has implications for adequate understanding of a patients’ culture by the clinician as well as patient–clinician cultural matching for enhanced service use and outcome. This qualitative study investigated how Nigerian clergy and health professionals perceived health-seeking behaviours among Nigerians in the UK, while considering the impact of their own beliefs and values as care providers. Six participants were interviewed (clergy, n?=?2; health professionals, n?=?4). Data were analysed using Interpretative Phenomenological Analysis. Results showed that the clergy and health professionals themselves use religious/cultural cure and formal healthcare methods, and believed Nigerian immigrants as predominantly using religious/cultural methods which can affect healthcare utilisation, although differences between the professionals were reported. The potentials for integrating other cure methods into the formal healthcare services were considered, while highlighting the challenges that may arise from such collaborative effort.     

Common barriers to healthcare for transgender people in the U.S. Southeast

Abstract

Background: Transgender and non-binary people are more likely to face barriers to healthcare than their cisgender counterparts. The majority of work in this area centers on the experiences of transgender people in northern cities and urban enclaves, yet over 500,000 transgender people live in the U.S. Southeast.

Aims: The purpose of this study is to explore barriers to healthcare among transgender people in the U.S. Southeast.

Methods: The research team conducted four 120-minute focus groups (eligibility criteria: 18?years or older, self-identify as transgender, live in the U.S. Southeast). Participants completed a demographic questionnaire prior to the start of the focus group. Each focus group explored access to and experiences of receiving basic healthcare as a transgender person in the U.S. Southeast. Established qualitative methods were used to conduct the focus groups and data analysis.

Results: Participants (n?=?48) ranged in age from 19 to 65, with the majority identifying as trans women (43.8%) and non-binary (33.3%). The sample was racially diverse: White (50%), Black (37.5%), and Latinx or Multiracial (12.5%). Multiple barriers to care were identified: (1) fear and mistrust of providers; (2) inconsistency in access to healthcare; (3) disrespect from providers; and, (4) mistreatment due to intersecting experiences of gender, race, class, and location.

Discussion: Transgender Southerners face barriers to care at the structural, cultural, and interpersonal levels. The study results have implications for researchers, as well as providers, practices, and health care systems throughout the region.     

Mental health attitudes among Middle Eastern/North African individuals in the United States

ABSTRACT

Middle Eastern/North African (MENA) individuals may have heightened risk for developing mental health problems due to unique cultural stressors. However, traditional cultural and religious practices and beliefs socialised within the family environment may reduce the likelihood of seeking mental health services. This qualitative study aimed to better understand the intersection of cultural, religious, and mental health attitudes among MENA individuals. Semi-structured telephone interviews were conducted with MENA adults who had received therapy services (N?=?13) and were analysed for emergent themes. Respondents reported lack of understanding of mental illness within their communities, and prominent levels of perceived and self-stigma. Families and religious practices/beliefs played an important role in responding to mental illness. Results suggest that incorporating psychoeducation and community awareness campaigns alongside religious services may help to reduce barriers to receiving mental health treatment.     

Immigration and Psychosis: an Exploratory Study

This qualitative study aimed to explore views (and related experiences) of healthcare providers regarding immigration and its relation to psychosis, such as schizophrenia, particularly to identify support needs and challenges of immigrants with psychosis and related challenges and enablers of their mental health service providers. The objectives of this study were to identify (1) barriers and enablers of mental health and other services for Canadian immigrants with psychosis and (2) barriers and enablers for their mental health service providers. The study used a phenomenological approach to elicit views of 12 mental healthcare providers with experience in providing mental healthcare to immigrants with psychosis. Semi-structured individual interview data obtained were coded and thematically analyzed. Six themes in relation to the experience of service provision to immigrants with psychosis were found: the immigration process, service availability and accessibility, social determinants of health, cultural context, psychosocial stressors, and enablers and facilitators of recovery. The most prominent challenges/barriers were related to cultural context, language, social and health services, and support. Most mental healthcare providers believed that immigration process precipitates the first episode of psychosis in a majority of immigrants and that psychosis was undetected/non-present when in the country of origin. This study demonstrated system challenges and related opportunities for service provision for immigrants with psychosis. We identified important areas for intervention to reduce disparities for immigrants with psychosis in their use of social and health services. Future directions for research in relation to immigration of people with psychosis are discussed.     

“What Goes Around Comes Around”: Attitudes and Practices Regarding Ageing and Care for the Elderly Among Moroccan Muslim Women Living in Antwerp (Belgium)

The aim of this article is threefold. First, we seek to elicit the attitudes and practices of middle-aged and elderly Moroccan Muslim women towards ageing and care for the elderly. Second, we aim to identify possible differences between middle-aged and elderly women’s attitudes and practices. Third, we seek to explore which role religion plays in their attitudes and practices. Qualitative empirical research was conducted with a sample of middle-aged and elderly Moroccan Muslim women living in Antwerp (Belgium) (n = 30) and with experts in the field (n = 15). Our study unveils that ageing and care for the elderly are clearly understood from a religious framework. More specifically, theological and eschatological considerations take up a central position. Access to and utilization of professional elderly care is hampered by several barriers (e.g. religious, cultural and financial). We found a more open attitude towards professional elderly care among middle-aged women than among elderly women.

     

Perceived lack of training moderates relationship between healthcare providers’ personality and sense of efficacy in trauma-informed care

ABSTRACT

Background and Objectives: Medical patients often have trauma histories that are not routinely assessed, which can adversely affect health outcomes. Despite growing awareness of this issue, there is limited understanding of factors that influence provider competency in trauma-informed care (TIC). The study examined healthcare providers’ personality traits in relation to their sense of TIC efficacy, taking into account perceived barriers to TIC and professional quality of life.

Study Design: The study used cross-sectional survey methods to examine our central hypothesis that provider personality traits and perceived barriers to TIC would be associated with TIC-efficacy, and to explore interactions among study variables.

Methods: Survey data were collected from 172 healthcare providers examining TIC knowledge, TIC-efficacy, perceived barriers to TIC, personality traits, and professional quality of life.

Results: TIC-efficacy was positively correlated with “intellectence/openness” and inversely correlated with “neuroticism” and perceived lack of training as a barrier. “Intellectence/openness” interacted with perceived lack of training to predict TIC-efficacy, suggesting that providers with lower “intellectence/openness” report greater TIC-efficacy when lack of training is not perceived as a barrier.

Conclusions: Provider personality traits and perceived barriers to TIC appear related to providers’ TIC-efficacy. Implications for overcoming barriers to TIC through training and implementation are discussed.     

Strategies used by transmasculine and non-binary adults assigned female at birth to resist transgender stigma in healthcare

Abstract

Background: Transgender stigma is rampant within healthcare systems in the United States. Transgender adults assigned female at birth – including those identifying as transmasculine or non-binary – face unique barriers, such as stigma when accessing sexual and reproductive healthcare labeled as being for “women.” However, transgender and non-binary people are not passive victims to this stigma, and the medical community would benefit from understanding the actions this population takes to resist and reduce transgender stigma in healthcare. Yet, little research has attempted to understand such actions.

Aims: This qualitative study aims to explore how transmasculine and non-binary adults are actively resisting and reducing the impact of transgender stigma in healthcare.

Methods: In-depth semi-structured interviews were conducted with 25 transmasculine and non-binary adults assigned female at birth who were living in a metropolitan area in the mid-Atlantic United States. The research team analyzed qualitative interview data using content analysis.

Results: The 25 participants ranged in age from 21 to 57, with an average age of 33?years old. Six themes were identified related to resisting and reducing transgender stigma in healthcare: (a) using social support; (b) persistence to meet one’s own needs; (c) avoiding mainstream healthcare; (d) advocacy; (e) doing one’s own research; and (f) strategic disclosure of transgender/non-binary identity. We detail how privilege and intersectionality connect to the use of these strategies.

Discussion: Findings indicate there is value in using peer advocates and peer health literacy; in developing and nurturing support groups related to transgender/non-binary health; in developing “allies” employed within the healthcare system; in creating and maintaining lists of culturally responsive health providers and resources about navigating the healthcare system; and in offering trainings related to self-advocacy and health-related activism. These findings can be used to inform future health prevention and intervention efforts with transmasculine and non-binary adults.     

The Long Arm of Religion: Childhood Adversity,Religion, and Self‐perception Among Black Americans

Significant associations between childhood adversity and adult mental health have been documented in epidemiological and social science research. However, there is a dearth of research examining this relationship among black Americans, as well as into what cultural institutions and practices may help individuals in dealing with childhood adversity. This study suggests that religion may be an important resource for black Americans in the face of early‐life socioeconomic and health disadvantage. Using data from the National Survey of American Life, a nationally representative sample of both African Americans and black Caribbeans (n = 5,191), this study outlines a series of arguments linking childhood adversity, religiosity, and self‐perception among black Americans. The results suggest some support for religious involvement in moderating—or buffering—the harmful effects of childhood adversity on the self‐esteem and mastery among black Americans, specifically religious service attendance and religious coping. In addition, the results reveal that religion may also amplify the deleterious effects of childhood disadvantage on adult mental health. Study limitations are identified and several promising directions for future research are discussed.     

Improving Health Education for Women Who Carry an <Emphasis Type="Italic">FMR1</Emphasis> Premutation

Women who carry an FMR1 (i.e., fragile X) premutation have specific health risks over their lifetime. However, little is known about their experience understanding these risks and navigating their health needs. The aim of this study was to use qualitative analysis to uncover both barriers and facilitators to personal healthcare using a framework of the Health Belief Model. Five focus groups were conducted with a total of 20 women who carry the FMR1 premutation using a semi-structured discussion guide. All sessions were transcribed verbatim and independently coded by two researchers. The coders used a deductive – inductive approach to determine the prominent themes related to the participants’ experiences seeking healthcare for premutation-related conditions. Salient barriers to personal healthcare included difficult clinical translation of research findings, lack of knowledge among healthcare providers and among the women themselves, different priorities, and shortage of premutation-specific support and targeted educational materials. Facilitators included family members, national and community support organizations, research studies, compassionate physicians, and other premutation carriers. Addressing barriers to personal healthcare through up-to-date educational materials can help diminish misperceptions regarding health risks. Targeted educational materials will aid in information sharing and awareness for women who carry the FMR1 premutation and their physicians.     

Predicting attitudes towards seeking medical care among Nigerian immigrants in the UK

ABSTRACT

This study investigates the relationships between acculturation, religion, and coping styles; as well as their predictive potentials in relation to socio-demographic factors, on access to medical help among Nigerians in the UK. This is a cross-sectional study using questionnaires for data collection (N?=?297). Results revealed negative correlations between assimilative behaviours and religious behaviours and between religious behaviours, denial and religious coping. High levels of religiosity and coping through behavioural disengagement and self-blame predicted poor attitudes to medical help; but those who used instrumental support, emotional support, and active coping showed more positive attitudes to medical help-seeking. No gender differences in medical help-seeking were found, but older people sought medical help more than those who were younger; while affiliation to the Christian religion predicted positive attitudes towards medical help seeking. These findings have implications for policy development towards tailored interventions that can enhance healthcare utilisation among immigrants.     

Religion,Spirits, Human Agents and Healing: A Conceptual Understanding from a Sociocultural Study of Tehuledere Community,Northeastern Ethiopia

This paper explores the relationship among religion, spirits and healing in the Tehuledere community in the northeastern part of Ethiopia and focuses on how this knowledge can inform primary healthcare reform. The study employed qualitative ethnographic methods. Participatory observation, over a total of 5 months during the span of 1 year, was supplemented by focus group discussions (96 participants in 10 groups) and in-depth interviews (n = 20) conducted with key informants. Data were analyzed thematically using narrative strategies. The present study revealed that members of the study community perceive health, illness and healing as being given by God. Many of the Tehuledere people attribute illness to the wrath of supernatural forces. Healing is thought to be mitigated by divine assistance obtained through supplication and rituals and through the healing interventions of nature spirit actors. We found that the health, illnesses and healing were inextricably linked to religious and spiritual beliefs. Our findings suggest that religious and spiritual elements should be considered when drafting and implementing primary healthcare strategies for the study communities and similar environments and populations around the globe.

     

Referrals to chaplains: The role of religion and spirituality in healthcare settings

Given the increasing importance of understanding how healthcare workers interact with the principal person designated to meet patients’ spiritual needs— the chaplain— the current study provides an inter-disciplinary perspective of the role of chaplains (and spirituality) in patients’ emotional, physical, and spiritual health. The study surveyed a randomly selected national sample of hospital directors in four disciplines: medicine (n?=?278), nursing (n?=?230), social services (n?=?229), and pastoral care (n?=?470). Participants rated the importance of referring patients to chaplains for four different areas: pain/depression, anxiety/anger, treatment issues, and loss/death/meaning. Results revealed significant differences in referral patterns for type of hospital, professional discipline, the hospital's religious affiliation, and self-reported spirituality. Results are discussed in relation to historical views of spirituality and religion within the different disciplines.     

Mental health help‐seeking and refugee adolescents: Qualitative findings from a mixed‐methods investigation

There is general agreement in Australia and other Western resettlement countries that many refugee adolescents with social, behavioural, and mental health problems are not accessing mental health care. There is, however, a paucity of research on refugee adolescent mental health service utilisation and help‐seeking. Most research to date has centred on adolescents in the general population, and even then is still very limited. This paper presents the findings of 13 focus groups held with 85 refugee adolescents aged 13–17 years from Afghanistan, Bosnia, Iran, Iraq, Liberia, Serbia, and Sudan. The study was part of a wider investigation of mental health service utilisation by refugee parents of children aged 4–17 years, and by adolescents aged 13–17 years. With respect to adolescents, the focus group findings indicate that most are very reluctant to venture beyond their close friendship networks for help with their psychosocial problems due to a range of individual, cultural, and service‐related barriers. Implications for mental health policymakers, service planners, and service providers are discussed.     

Where,O death,is thy sting? The meaning-providing function of beliefs in literal immortality

Terror management theory suggests that humans invest in cultural worldviews that allay mortality-related anxiety by promising death transcendence. Many religious individuals adhere to belief in literal immortality – believing that one will live on after death. Across two studies (n?=?1137), we explored the terror management function of such beliefs by exploring whether these beliefs are associated with lower death anxiety and greater meaning among individuals of varying religiousness. In both Study 1 (n?=?236) and Study 2 (n?=?901), belief in literal immortality was related to lower death anxiety only among intrinsically religious participants. Moreover, meaning in life mediated the relationship between belief in literal immortality and death anxiety. Study 2 clarified that this mediational relationship was only present for intrinsically religious individuals. We discuss the importance of particular religious beliefs in the provision of meaning in order to manage existential concerns.     

Testing the Culture-Fit Hypothesis with religious beliefs: a multilevel analysis

This study tested the hypothesis that internalising cultural values that fit internalised Christian religious orientations would produce higher levels of well-being than internalising cultural values that are incongruous with one's religious orientation. Participants (n?=?409) completed self-report measures of cultural values (individualism and collectivism), religious orientation (quest and Christian orthodoxy) and well-being. A series of hierarchical regression analyses and hierarchical linear modelling revealed several Cultural Value X Religious Orientation interaction effects. Specifically, people whose cultural values did not cohere with their religious orientation experienced lower levels of well-being than those whose cultural values fit well with their religious orientation.     

Mental Health Collaboration: A Survey of Practicing School Psychologists

Schools have become the primary setting for mental health service among youth. However, school-based providers are sometimes limited by lack of time, training, and other resources. Furthermore, problem-solving models emphasize the importance of developing partnerships with other professionals and agencies. Thus, it is critical to engage in collaborative practice with non–school-based, community mental health providers (CMHPs). The purpose of this study was to survey practicing school psychologists about their experiences in communicating and collaborating with CMHPs. Participants (n = 194) indicated their frequency of communication and collaboration with CMHPs; although communication (i.e., release and receipt of information) was typical, fewer school psychologists reported engaging in ongoing collaboration. Benefits and barriers to collaboration were identified, and implications for practice are discussed.     

Untapped Potential: Psychologists Leading Research in Clinical Practice

Enhancing the capacity of allied health professionals to engage in research is central to improving healthcare delivery. Psychologists have research skills given their training focus that emphasises the scientist‐practitioner model. We aimed to investigate among psychologists the link between individual research capacity and their current level of research activity, how this compares with other allied health professions, and the role of team and organisation research capacity. Psychologists (n = 60) working in clinical roles in a large metropolitan public health setting completed an online survey consisting of the validated Research Capacity and Culture tool, and questions related to current research activities, barriers, and motivators. The results indicated that psychologists reported relatively high individual research capacity, higher than both team and organisation levels, and greater individual research capacity compared with studies of dietitians and a mixed group of allied health. Preliminary findings suggested that team research capacity mediated the link between individual research capacity and the level of current research activity. Finally, barriers and motivators to research activity were similar compared with studies of other allied health professions. Overall, a multi‐strategy approach that focuses on and facilitates practice‐based and interdisciplinary research, and enhances the leadership skills of psychologists in research, as well as broader efforts from an organisational perspective to build a strong and sustainable research culture, may contribute to the rapid use of research skills in clinical practice and improve health and healthcare delivery.     

Counsellor-delivered HIV risk reduction intervention addresses safer sex barriers of people living with HIV in KwaZulu-Natal,South Africa

This study developed an HIV risk reduction intervention for people living with HIV (PLWH) obtaining care at primary healthcare clinics in KwaZulu-Natal, South Africa by (1) conducting elicitation research to understand the dynamics of risk behaviour among PLWH, (2) modifying an existing HIV risk reduction intervention based on research findings and (3) conducting a pilot study to evaluate feasibility, acceptability and fidelity of the modified intervention implemented by trained lay counsellors at a rural clinic in KwaZulu-Natal. A total of 61 healthcare providers and 77 HIV+ patients from four primary healthcare clinics participated in 14 focus groups and 20 individual interviews to identify informational, motivational and behavioural skills (IMB) factors contributing to PLWH's sexual risk behaviour. Elicitation research findings were incorporated into a revised version of Options for Health, an evidence-based risk reduction intervention for PLWH in clinical care. In a 5-day training, lay counsellors learned strategies to address IMB barriers to safer sex identified in elicitation research. The revised intervention, which was implemented by six counsellors with 39 patients, was feasible to implement, acceptable to patients and counsellors, and implemented with good fidelity. This study makes an important contribution towards development of a theory-based HIV risk reduction intervention for PLWH linking prevention with treatment in South Africa.     

International Migration and Religious Selection

Migrants are selected by several characteristics (age, education, skill, health, and family migration experience). Often less examined is religious selection. Using Guatemalan data, this research note tests whether religious affiliation is significantly associated with migration to the United States, net of other competing factors. Results are robust, demonstrating that Protestants are more likely than other religious groups to migrate. Additionally, mediating factors (social networks, cultural norms, and ideological links) are tested to identify social mechanisms behind the Protestant effect. The research note concludes with implications of religious selection and how religious selection can be further examined in migration and religion studies.