University of Macau / Faculty of Education

University of Macau / Faculty of Social Sciences and Humanities / Department of Psychology

This qualitative research used the Long Interview method to study cultural and gender influences on mental health, health beliefs, health behaviour, help-seeking and treatment expectations for mental health problems in newcomers to Canada who are members of an ethnocultural, visible minority population - the Sri Lankan Tamils. The study employed a comparative design and analyzed data from interviews with Tamil men (N=8) and Tamil women (N=8) who self-identified as having been diagnosed with depression, and service providers (N=8) who provide frontline mental health and related services to the Sri Lankan Tamil community. The objectives were to a) understand cultural and gender factors inherent in the Sri Lankan Tamil community; b) investigate how these cultural and gender factors impact mental health and influence the trajectory of help-seeking and treatment for depression in the Sri Lankan Tamil community; c) explore the intersection of culture and gender as it relates to health behaviour; and d) explore service providers’ perceptions of the influence of culture and gender in relation to help-seeking for mental health problems and the application of this understanding to service delivery. The study found that the respondents equated social function with health and that this concept informed help-seeking and treatment expectations. Socially appropriate functioning was seen as an indicator of health, and this differed by gender. Gender-differentiated social stressors contributed to depression. Women played a role as enablers of care, both for family members and acquaintances. Men were more resistant to help-seeking and tended to disengage from care. There was a distinct preference for service providers who understood the culture and spoke Tamil. Religious groups served a social support function. Family physicians and Tamil service providers in the social service sectors were identified as key players in the pathways to care. Service providers did not appear to understand the community’s holistic view of health; however, they did use their knowledge of the community to make adaptations to practice. Recommendations that result from these findings include health promotion and prevention strategies beyond the traditional health care system, targeted culture and gender-informed interventions, and the need for multisectoral collaborations.

This qualitative research used the Long Interview method to study cultural and gender influences on mental health, health beliefs, health behaviour, help-seeking and treatment expectations for mental health problems in newcomers to Canada who are members of an ethnocultural, visible minority population - the Sri Lankan Tamils. The study employed a comparative design and analyzed data from interviews with Tamil men (N=8) and Tamil women (N=8) who self-identified as having been diagnosed with depression, and service providers (N=8) who provide frontline mental health and related services to the Sri Lankan Tamil community. The objectives were to a) understand cultural and gender factors inherent in the Sri Lankan Tamil community; b) investigate how these cultural and gender factors impact mental health and influence the trajectory of help-seeking and treatment for depression in the Sri Lankan Tamil community; c) explore the intersection of culture and gender as it relates to health behaviour; and d) explore service providers’ perceptions of the influence of culture and gender in relation to help-seeking for mental health problems and the application of this understanding to service delivery. The study found that the respondents equated social function with health and that this concept informed help-seeking and treatment expectations. Socially appropriate functioning was seen as an indicator of health, and this differed by gender. Gender-differentiated social stressors contributed to depression. Women played a role as enablers of care, both for family members and acquaintances. Men were more resistant to help-seeking and tended to disengage from care. There was a distinct preference for service providers who understood the culture and spoke Tamil. Religious groups served a social support function. Family physicians and Tamil service providers in the social service sectors were identified as key players in the pathways to care. Service providers did not appear to understand the community’s holistic view of health; however, they did use their knowledge of the community to make adaptations to practice. Recommendations that result from these findings include health promotion and prevention strategies beyond the traditional health care system, targeted culture and gender-informed interventions, and the need for multisectoral collaborations.

The main purpose of the present study was to examine the effect of perceived social support, psychological distress, prior help-seeking experience, and gender on attitudes toward seeking psychological help of university students. In addition to the main purpose / gender, faculty, living arrangement, and year of study differences in attitudes toward seeking psychological help and students&rsquo / knowledge about the psychological counseling services of the METU Health and Guidance Center were investigated. The sample consisted of 417 (223 female, 194 male) undergraduate students of Middle East Technical University. The data was gathered using the scale of Attitudes Toward Seeking Psychological Help-Shortened (ASPH-S), the Multidimensional Scale of Perceived Social Support (MSPSS), General Health Questionnaire (GHQ-12) and a demographic information form. It was found that nearly half of the participants (47%) had knowledge about the psychological counseling services of the METU Health and Guidance Center. Friends were the most frequently stated sources of help (59%) in times of need for personal problems. Females had more positive attitudes toward seeking psychological help than males. Students of the Faculty of the Arts and Sciences, and students of the Faculty of the Education were found to have more favorable attitudes than of the Faculty of Engineering students. Finally, hierarchical regression analysis showed that perceived social support, prior help-seeking experience, and gender significantly predicted attitudes toward seeking psychological help. However, psychological distress was not associated with help-seeking attitudes.

Acute Coronary Syndrome (ACS) is common and associated with high mortality. Effective treatments are available but require prompt administration. Studies have consistently demonstrated that delays to treatment are common, with patient decision time accounting for most delay. Interventions aimed at reducing delay have had little success. Evidence suggests that psychological factors, in particular illness representations (Leventhal’s Commonsense Model of Self-Regulation (CS-SRM)) might be important in relation to patient decision time. This thesis describes a two-stage investigation, undertaken within NHS 24, exploring the content and timing of people’s initial presentations with possible symptoms of ACS. The first stage comprised a CS-SRM-guided content analysis of peoples’ initial symptom presentations. The second stage utilised the Illness Perception Questionnaire-revised (IPQ-R) to explore how illness representations relate to patient decision time. Results show that the components of illness representations accounted for 95% of participants’ initial presentations. The components most related to behaviour and outcome were volunteered least (cause, consequences, cure/control and coherence). Decision time for most participants (89%) was out-with the ideal and appraisal time accounted for most of the delay. Appraisal delay was shorter for those with fewer symptoms and high emotion. Illness delay was longer where the person making the call reported high treatment control. Interventions may need to raise awareness of the range of possible presentations and of the consequences associated with delay. Interventions should also provide guidance as to an appropriate time-limit for self-care. Individuals may benefit from being informed about how to respond to strong emotional responses. Interventions aimed at bystanders may need to differ from those for patients. People at high risk of ACS should be informed about how and when to access healthcare out-of-hours.

This study explored the patterns of help-seeking of 64 urban high school adolescents in Grades 10 and 11 in two South African provinces, KwaZulu-Natal and Limpopo. The type of problems faced by these adolescents such as interpersonal relationships, family and peer pressure, and whether or not they sought help for these problems was explored. Adolescents' preference for different sources of help for different problems is also discussed. Of concern was what mediated whether and where help was sought. This study also examined the role that the Life Orientation Programme and Guidance Programme played in the help-seeking behaviours of these adolescents. Data was collected using focus groups and individual interviews and analysed using a thematic method of data analysis. Adolescents across the two provinces seemed to have common problems and dealt with them in a similar manner. The adolescents' problems included peer pressure, family, academic anxiety and drug usage. To solve those problems adolescents seemed to prefer informal to formal sources to confide in. The Life Orientation Programme (LOP) seemed to play no significant role at this stage to the adolescents concerned. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2004.

À ce jour, peu d’études ont été conduites pour mieux comprendre le phénomène de la demande d’aide auprès d’hommes dans le contexte du cancer. Les études consultées suscitaient de nombreuses questions et hypothèses sur la signification que pouvaient accorder ces hommes à la demande d’aide. C’est pourquoi l’étudiante chercheuse a réalisé cette étude phénoménologique auprès d’hommes atteints d’un cancer de la sphère otorhinolaryngologique, afin de mieux comprendre ce phénomène. Huit hommes ont accepté de participer à l’étude. Suite aux entrevues semi-structurées, l’analyse des données, assistée par la méthode proposée par Giorgi (1997), a fait ressortir les thèmes centraux suivants : 1) Se sentir capables de faire face seuls aux diverses adversités; 2) Bénéficier du soutien des proches et de l’équipe de soins; et 3) Utiliser des stratégies cognitives. Les résultats ont révélé que la signification accordée à la demande d’aide est intimement liée à la construction sociale du genre, c’est-à-dire aux normes d’identité masculine acquises culturellement. Les valeurs accordées à l’autonomie, à l’estime de soi et à « l’égo masculin » expliqueraient en partie pourquoi les hommes interviewés demandent peu d’aide. Par ailleurs, la présence constante de la conjointe et le soutien de l’équipe professionnelle de santé semblent avoir grandement modulé les comportements de demande d’aide des participants en anticipant leurs besoins avant même qu’ils puissent les exprimer; ce qui invite à une réflexion sur l’empowerment, stratégie d’intervention fondée sur la responsabilisation individuelle. Des recommandations pour la pratique et la recherche infirmières sont formulées afin d’optimiser le soin et le développement du savoir infirmier dans ce domaine d’intérêt. / To date, few studies have been conducted to better understand the phenomenon of help seeking of men in the context of cancer. The reviewed studies elicited many questions and hypotheses about men’s understanding of help seeking in the context of cancer. Therefore, the research student has conducted a phenomenological study to describe this phenomenon in men with otorhinolaryngological cancer. Eight men have agreed to participate in the study. Following semi-structured interviews, the data analysis, assisted by the method proposed by Giorgi (1997), highlighted the following key themes: 1) Feeling able to cope alone with the various adversities, 2) Having the support of the family and the care team, and 3) Using cognitive strategies. The results showed that the lived experience of help seeking is closely linked to the social construction of gender, that is to say to the culturally acquired male norms. Values of autonomy, self-esteem and “male ego” explain in part why most of the participants did not ask for help. Moreover, the constant presence of the spouse and the support of the professional health care team appear to have greatly modulated participants’ help seeking behaviors by anticipating their needs, before they could even express them; this issue invites us to a reflection on the phenomenon of empowerment, intervention strategy based on the individual responsabilisation. Recommendations for practice and nursing research are formulated to optimize nursing care and to insure the pursuit of the development of nursing knowledge in this area of interest.

While previous research has explored women’s experiences of intimate partner violence (IPV), their help-seeking experiences and the barriers they encounter when seeking support, little research has explored the perspectives of women with disabilities regarding helpful IPV prevention, intervention and healing strategies. My qualitative research project sought to address two research questions: what have women with disabilities experienced when accessing support (from family, friends, and services) for IPV; and what do women with disabilities say would be helpful in the prevention or intervention of intimate partner violence. I undertook a secondary analysis of six interviews of women with disabilities who had been interviewed as part of a larger research study. My thematic analysis revealed many themes including experiences with sources of support—such as family, friends, counselling, and shelters—and strategies for prevention, including education and awareness; support system; affordable childcare and transportation; and self-care, spirituality, community, and social change. Barriers to support I identified include lack of education and awareness, lack of resources, lack of services, community size and dynamics, and potentially exclusive admission criteria. My intersectional analysis revealed the ways in which women’s social locations—such as their gender, cultural background, socio-economic situation, religion, disability and relationship status—influenced and shaped their help-seeking behaviours and their access to support systems. Several recommendations to address gaps in service provision are provided.

Untreated substance use disorders are a major public health concern that has costly consequences at both the societal and individual level. Identifying the characteristics and resources of those who seek help for substance abuse problems in order to inform more effective intervention and treatment techniques is therefore an important research objective. Using the Network Episode Model (NEM) as a theoretical framework, this dissertation examines both substance abuse help-seeking (i.e. inpatient/outpatient treatment and 12-Step meeting attendance) and patterns of drug use over time among low-income African American women, with a special focus on the role of the social network system in shaping these outcomes. Drawing on social network theory, critical race theory, and health service utilization research, this test of the Network Episode Model addresses the relative absence of work examining the connections between network characteristics and help-seeking in multiply marginalized groups. The core relationships proposed by the NEM are systematically tested using longitudinal data gathered for the Black Women in the Study of Epidemics Project (N=643). Findings of multilevel models indicate strong support for the Network Episode Model. Specifically, measures of social influence, social control, and social integration significantly predict both patterns of drug use and help-seeking. Importantly, having contact with and receiving health advice from a physician emerged as a significant predictor of a number of positive outcomes, including quitting or abstaining from illicit drug use during the study and attending 12-Step meetings. Results also reveal that experiences specifically related to low-income African American women’s multiply marginalized status – such as experiencing gendered racism – significantly predict patterns of drug use over the study timeframe and may be an important risk factor for substance abuse. In all, this research reveals the important contributions of both traditional predictors and social network predictors on substance abuse help-seeking and patterns of drug use over time. Conclusions suggest that given the limited financial and material resources of multiply marginalized groups, learning how to mobilize or effectively build upon available social network resources to encourage substance abuse treatment may be a particularly fruitful strategy to explore.