LIMITED UNDERSTANDING OF THE PERCEPTION OF AFRICAN WOMEN IMMIGRANTS IN THE UK AS THE RESULT TO THE CURRENT TREND OF INADEQUATE CLINICAL INTERVENTION FOR POSTNATAL DEPRESSION PATIENTS
Limited understanding of the perception of African Women Immigrants in the UK the Cause of the Current trend of inadequate Clinical Intervention
Over the recent decades, the number of immigrants settling in the UK has grown exponentially to give the country a new outlook on cultural diversity. With these social changes, new demands have been imposed on the healthcare sector to provide health services in ways that promote social justice. According to the World Health Organization (WHO), mental health is central to health and overall social wellbeing. The organization’s concept of mental health includes interventions to promoting mental well-being, prevention and the rehabilitation of patients with mental diseases (Haro et al., 2006, p.119). There exists a large body of research that recognizes the vulnerability of refugees, immigrants and minority groups in relation to poor mental health. Health statistics indicate that among the illnesses in the category of mental diseases, depression accounts for the greatest burden of disease that affects nearly twice as many women during childbearing than men.
Postnatal depression, also known as postpartum depression is one of the most prevalent mental conditions in the UK, where reports indicate that of all the known 6 million cases of this disease, only 4% of this population access therapy. It's with great concern that a significant number of African women immigrants account for the remaining 2 million cases of victims not receiving treatment for this condition (Kutz et al., 2010, p.175). These statistics are particularly frustrating considering the efforts and dedication the government is putting to realize a holistic approach to public health intervention. Given the sharp contrast of the trends recorded by the African women group of immigrants in the UK compared to the national average and their native counterparts, there is need to understand the influences behind these trends.
With the understanding that culture is a critical determinant of health and related perceptions, it can be argued that the trends reflected by the African women migrants in the UK are a result of cultural and ethnic factors. In this case, the cause of the high number of this group of immigrants is to some extent be related to the inability of practitioners to detect and diagnose the condition. In other words, the better a healthcare provider understands their patient’s culture and perceptions to the disease, the better they can give them appropriate care. As observed in many past studies, it is often hard to capture a clear picture of the experiences of minority groups and their unique mental health needs using national samples. Against that background, the research paper will set out to argue that limited understanding of the perceptions of prenatal depression by African women immigrants in the UK is the cause of the current disparities in diagnosis and treatment between natives and these immigrants and the resultant insignificant clinical intervention observed for this group.
Postpartum depression (PPD) is a clinical depression that may be experienced by both sexes after childbirth. Clinical manifestation of the disease occurs in symptoms that may include, low energy, changes in eating and sleeping patterns, anxiety, irritability and reduced desire for sex among others. Available literature acknowledges the fact that may difference in the expression of the different contractions of mental health illnesses. The current research, therefore, promotes the view that there are various ways through which mental illness are expressed and handled. For instance, in their literature review titled “The mental health status of the South Asian women,” Aradhana and Cochrane reflect on the cultural specific manifestation of mental health issues among minority groups from Asia. In their review, the author comment on the mental issues unique to people of Asian origin called the “sinking heart.” As explained, this mental condition results from feelings of social failure, excessive heat worry or exhaustion (Aradhana & Cochrane, 2005, p. 5).
In complement of the concept that mental illness are perceived differently and thus handled differently in a broad range of different contexts, one his research on postpartum depression among African American women, Linda Amankwaa established that women of African descent in the US managed and described their depression in particular and culturally specific ways. Such ways included keeping the depression as family secrets, seeking solace in religious beliefs and seeking advice from other members of the family. Testimonies collected from through his research also revealed that African women immigrants believed they couldn’t suffer from the condition as the disease did not only satisfy as a legitimate illness but was also a sign of weakness (Amankwaa, 2003,p. 312). Other studies have gone forward to show that there is a close link between the role of such factors as attitudes and perceptions towards depression cases in varying cultures which goes as far as influencing assistance seeking behaviors, expression of symptoms and getting access to treatment (Jones, 1994, P.56).
In his view, Vertovec (2007p.1025) the level of diversification women migrants have to go through before they can settle in the UK are among the factors that limit the ability to give assistance to these migrants. These levels which he terms as spheres include women migrants having clear through long formal processes, different immigration status among other challenging physiological experiences that involves settling in a new country, in the long run, makes it hard for policymakers and service providers to assist such groups. In this case, through going through a set of diversification changes to adapt to the new challenges, a new round of challenges is created for commissioners and healthcare providers who deliver services in relatively traditionally conceptualized aspects of diversity, often considered through the lens of race or ethnicity (Vertovec, 2007,p. 125). In this case, the author observes that it is hard to collect any significantly meaningful information through generalized and traditional contexts that did not necessarily consider the unique cultural aspects of a variety of minority groups.
Close examination of the available literature reveals a significant gap in the understanding and the scale of the impact of ethnic and cultural factors on maternal mental conditions (Bina, 2008, p.123; Higginbottom et al., 2013 p. 67). Most scholars have maintained focus on the impact of health care practices where most have heavily borrowed from western concepts of culture which discuss ways through which women immigrants use a range of mental health care services. Other studies have examined in depth the social support preferences of migrant women and the various barriers they face; many include recommendations based on the migrant’s perspectives (Kurtz et al., 2008 p.364; Ganann et al., 2012 p. 127). O’Mahony and Donnelly (2010) focus on the various limitations encountered by women immigrants in the UK where they highlight issues such as stigma-related concerns, language and discrimination (O’Mahony and Donnelly, 2010 p.321).
As if to offer an explanation for the prevalence of high cases of postnatal depression in migrant women in the UK, some studies have argued that the current mental health approaches may fail to deliver appropriate assistance to women immigrant in the UK (Sword et al., 2006; Kurtz., 2008 p.64). According to these studies, the tools often use to diagnose maternal mental health diseases are initially designed to identify the needs of populations from western culture and significantly require patients to self-report their symptoms to formulate a diagnosis. For instance, Zubaran et al. (2010), finds it inappropriate for practitioners to use the Edinburg Postnatal Depression Scale (EPDS) for screening PND as it may lack cultural congruence for a range of ethnocultural groups. The author also adds that in cultures with relatively low or no awareness of mental health issues related to maternity, patients are likely to find it hard to identify the symptoms. In other circumstances, while such women may be able to understand the symptoms but lack the ability to express or even recognize them (Yoshida et al., 1997, p.23). Such studies relate the concept of limited understanding of the problem to straining the process of delivering assistance.
There is, however, some small-scale studies that have been carried out in the past and identified symptoms of postnatal depression in African women immigrants in the UK (see Edge,2004, 2007 et al p. 45; Husain et al., 2012 p. 324). Nevertheless, adequate evidence to explain why Western diagnostic tools are sensitive to detecting postnatal depress in migrant groups from some communities but not in others. However, while the three mentioned studies that yielded positive results with samples of African women immigrants pointed that the tools could work to some extent, all studies has one unique limitation that could have far-reaching implications. The limitation of all these studies lay in the fact that all the researchers used samples of minority groups which were established in the UK for some time instead of using samples of African women migrants who had recently arrived in the UK. With that in mind, it can be argued that the diagnosis results can have been subject to the influence of acculturation (Husain et al., 2012 p.76). Nevertheless, accurate results on the impact of such factors are hard to come by because of a limited evidence base.
In their qualitative and systematic review of the barriers to help-seeking for postpartum depression and maternal treatment preferences, Denis and Chung-Lee argue that the way people understand and perceive their health is a result of progressive subjective cultural experiences encountered in one’s society(Dennis & Chung-Lee, 2006, p. 23). This view implies that the same postpartum depression symptoms are likely to be expressed in a range of different ways by people from various cultures. With that in mind, African women immigrants are also likely to present theirs in relatively different approaches as well. Given that healthcare provider from the UK and African women immigrants come from two sharply contrasting cultural backgrounds, there is a high likelihood that the patients may not display the expected symptoms to the physician or rather the physician may not accurately receive what they supposed to complete a comprehensive diagnosis.
Kleinman and Good (1985) insist that to deliver appropriate care to female African immigrants in the UK, such factors as they are a group that shares a particular system of thought, language, religion and the experience of being Immigrants must be put into consideration. The authors also emphasize the need for developing a comprehensive understanding of the backgrounds of this group of women was critical in the delivery of healthcare services. In additional contribution, Kleinman and Good comments on the value of understanding how African women immigrants communicate as an approach to overcoming intercultural communication barriers that characterize most multicultural societies (Kleinman & Good 1985, p.78).
Bashiri and Spielvogel (1999,p. 38) observe international cross-cultural studies on postnatal depression to present non-western women to have a higher tendency of presenting physical symptoms of their depression. According to the two authors, exhibiting the physical symptoms of their condition may be as a result of lack of knowledge of psychological distress and the impact of cultural stigma often attached to mental health symptoms. Given that the tooled used for diagnosing this group of minorities leave out somatisation related questions, Bashiri and Spielvogel (1999) dismiss the current tools as ineffective is comprehensively detecting depressive symptoms in non-western culture. Similarly, according to Babatunde and MorenoLeguizamon (2012), postnatal depression was stigmatized back in African women migrant’s home countries and to some extent in the UK.
Consequently, in fear of stigmatization female migrants decline to disclose what they felt to practitioners. As established by Gilbert et al. (2004), the underlying attitudes towards the mental health of women were highly deregulatory. As a result, most African women immigrants subscribed to the belief that they would fall as victims of ridicule if the public knew they had mental health problems. To this effect, migrant African women disclosed petite if not nothing that could help practitioners give them appropriate care services. Also, empirical studies have in the past established that the influence of cultural factors on postnatal disorders was far reaching and could even affect how the symptoms are manifested. For instance, studies show that mothers from different backgrounds may display cultural specific actions and responses when suffering from the impact of depression (Lazarus & Folkman, 1984, p.318). With that in mind, it can be argued that the current shallow base of understanding of the perceptions of African women immigrant’s perceptions of postnatal depression explains the observed inadequate clinical intervention for patients among this minority group. The research will therefore seek to collect sufficient evidence to support this claim and positively impact of the efforts of delivering holistic care for all citizens of the UK.
Aims and Objectives
The research seeks to trace and explain the factors resulting in the current disparities in diagnosis and treatment of postpartum depression among African women immigrants in the UK as compared to white counterparts. In this study, the focus will be placed on the role of cultural diversity and differing perspective on the disease as a result of cultural influence. The study, therefore, aims to use qualitative data to show that limited understanding of the perceptions of African women immigrants limits significant clinical intervention by practitioners.
1. How appropriate are the tools used to diagnose postnatal depression in African women immigrants?
2. How do African women migrants perceive postpartum depression?
3. What are the factors that shape the perceptions of African Women immigrants towards postpartum depression?
Research Design and Methodology
The research will set out to collect data from participants of focus groups. In these focus groups, participants will discuss in-depth, open-ended issues relating to the topic of research. To maximize of productive use of time, the issues of discussion will have predefined limits. With this approach, the research will target to initiate collective testimonies while as the same time serve as the platform that will validate the statements. In the course of the testimonies, the researchers will be keen to collect various cultural values that may be expressed by the participants.
As a group, the participants will feel relatively comfortable with the knowledge that they are not alone with people they do not know and therefore participate maximally in giving the testimonies.
During the exercise, some of the expected limitations include non-corporative participants and others that are afraid to open up completely. Other challenges may include straining to remain attentive while at the same time recording feedback through constant manipulation of data collection instruments.
The study will also rely on search engines and databases to generate complementary information in support of the research insights.
List of Databases
In this search, 35 studies were retrieved; however, most of the retrieved studies and collections of literature were carried out in the US while others represented larger groups of samples representing national figures. The objective of using the databases is to ensure that gathered information not also accurate and in context but also a representation of the most recent knowledge.
The study will set out to enlist 24 women of African background for the study aged between the age of 16to 45. This age group was selected as this age represents the range of years where women are productive and may have given birth recently. The participants will be purposely picked through hospitals visitors list and be contacted to gain their consent to participate in the study. All female participants must have migrated to the UK recently so as to collected data from a group of people who are most reflective of the target social group. There will be no participants over the age of 45 years as the age is above the reproductive range while ages below 18 won’t be considered because of the sensitivity revolving around the study.
Information about the participant’s marital status will be obtained and the network of support received by all participants. This information will be considered as such factors are known to predispose people to conditions of depression. Also, information about employment or educational backgrounds will also be obtained and documented as such factors may influence the participant’s perceptions of postnatal depression. Lastly, after the research acquires ethical permissions, all stakeholders will be served with participation invitation letters. Such people will include the homeless liaison team, the clinical psychologist team among other visiting teams whose participation will be deemed essential to adding to the validity of the study.
The study will seek approval from the south London research and ethics committee before the process of recruiting participants is commenced. In this case, the study will seek permissions by sending a letter through the integrated research application system after it passes the review of the panel of the school ethics committee.
This process will commence after all women participants have been issued and signed their consent forms. A schedule of a focus group will be planned whereby the activity of data collection will set out to capture the feeling participants experienced when and after they became pregnant and gave birth. All participants will be issued with codes, and all conversations during the activity will be recorded through the media of a tape recorder. After data collection, transcripts will be read several times to make sure that all collected data is clearly understood. The study will use and develop codes that will characteristically capture the descriptive languages of the participants. After coding, data will be listed in groups of themes where data will be thoroughly reviewed to ensure comprehensive coverage of all themes. In an attempt to improve the aspects of validity and reliability of the study the method of triangulation will be employed to analyze the data. Data collected through interviews and field notes will be reexamined and matched with tape records to eliminate any erroneous presentation of data.
Invitation to take part in the study
You are hereby invited to participate in our research project. Before agreeing to participate in the study, you are requested to familiarize yourself with information about what is the purpose of the study.
What is the purpose of the study?
The research aims to trace and explain the factors resulting in the current disparities in diagnosis and treatment of postpartum depression among African women immigrants in the UK as compared to white counterparts. In this study, a focus will be placed on the role of cultural diversity and differing perspective on the disease as a result of cultural influence. The study, therefore, aims to use qualitative data to show that limited understanding of the perceptions of African women immigrants limits significant clinical intervention by practitioners.
Why have I been requested to participate in the study?
You are a member of the focus group the study seeks to investigate. You also have a living child you gave birth to within the last one year. All members with these qualifications are being invited to participate.
Is it a must that I take part?
Participants of the research are voluntary, and you can always opt out at will. However, while you may decide to opt out at will, you are requested to remain in the study until completion to save the project a lot of inconveniences.
What is my role when I take part?
You will be grouped in a focus group of 28 women African women immigrants as yourself which will discuss topics relating to the research topics. You will also be allowed to share your perception on postnatal depression and listen to others as well. In the research, you will be asked to share information relating to your network support. It should be noted that the data collected will not have the names of participants and it would therefore to identify names of the participants in the future.
What are the risks involved in participating in the study
There are currently no anticipations on the risks that may be involved in the study. However, any disclosure of sensitive personal information may result negative emotional feeling may rise due to unforeseen circumstances. This is adequately prepared for in the event that arises in the sense that various intervention strategies are already planned for. There will also be a follow-up for all participants to ensure they retain if not add to their overall social well-being even after the research is completed.
What can I possibly gain from participating from in the study?
Based on the nature of the study, you are likely to benefit from being relieved from a range of mental health issues that may have been a burden in your life. You will also get a chance to contribute to the efforts of implementing holistic healthcare services for your social group and elevate many victims of postnatal depression from their suffering.
Please tick the box
I hereby confirm that I have gone through and understood with clarity, the information paper for the above-titled research project. I find the information written therein as clear and answers to my concerns satisfactory.
I agree to participate with the understanding that my attendance is voluntary and I am allowed to withdraw at any time without explanation. In the event that I leave, I will not face any consequences on both my legal and medical care.
I agree that the information I give is going to be collected as data and may be presented to relevant third parties who may be involved in data analysis.
I agree to take part in the above titled study.
In closing, as observed in the proposal’s discussion, the study will employ a range of approaches to conduct a comprehensive qualitative study to get insights into the extent to which the current lack of understanding of the perceptions of African women Immigrants in the UK on Postnatal depression results in limited clinical intervention. Through the research design, methods and the sampling techniques discussed herein, the research aims to present conclusive findings and help in developing a lasting solution for victims of depression who do not have access to care on account of cultural ethnic and practical limitations. In an attempt to present accurate findings, the research will use the most recent knowledge from a broad range of databases and follow very strict research ethics considerations.
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