This qualitative study examines the meanings that African Canadians living in Nova Scotia, Canada, ascribe to their experiences with cancer, family caregiving, and their use of complementary and alternative medicine (CAM) at end of life.
Case study methodology using in-depth interviews were used to examine the experiences of caregivers of decedents who died from cancer in three families.
For many African Canadians end of life is characterized by care provided by family and friends in the home setting, community involvement, a focus on spirituality, and an avoidance of institutionalized health services. Caregivers and their families experience multiple challenges (and multiple demands). There is evidence to suggest that the use of CAM and home remedies at end of life are common.
The delivery of palliative care to African Canadian families should consider and support their preference to provide end-of-life care in the home setting.
Depression is a topic that is often avoided in discussions among Black women for a myriad of reasons. The purpose of this study was to investigate the midlife health of Black women living in the province of Nova Scotia, Canada. This paper will present one of the key findings of this research; midlife depression. It will examine the factors associated with depression among mid-life African Canadian women and how these women deal with depression. A triangulation of qualitative and quantitative methods guided by the principles of participatory action research (PAR) was used in the study. Data collection methods included 50 in-depth interviews of mid-life African Canadian women aged 40-65, focus groups, and workshops as well as the CES-D structured instrument. Purposive sampling method was the primary recruitment strategy and 113 people participated in the study. Although the women rarely openly discussed depression, they described depression as emotional feelings that range from "feeling blue" to being clinically depressed. Women viewed midlife depression as the consequence of a complex set of circumstances and stressors that they face. At midlife, Black women frequently recognize the importance of greater self-care and the need to pay more attention to their health, but they are reluctant to do so because they have to be "strong" in order to deal with their daily experiences of racism. Racism, among other things, leads to accumulated stress and undermines Black women's ability to cope and make healthy life choices. This signifies the implications of these research findings for clinical practice.
The On the Margins project investigated health status, health-care delivery, and use of health services among African-Canadian women residing in rural and remote regions of the province of Nova Scotia. A participatory action research approach provided a framework for the study. Triangulation of data-collection methods--interviews, focus groups, and questionnaires--formed the basis of data generation. A total of 237 in-depth one-on-one interviews were conducted and coded verbatim. Atlas-ti data-management software was used to facilitate coding and analysis. Six themes emerged from the data: Black women's multiple roles, perceptions of health, experiences with the health-care system, factors affecting health, strategies for managing health, and envisioning solutions. The authors focus on 1 of these themes, factors affecting Black women's health, and discuss 3 subthemes: race and racism, poverty and unemployment, and access to health care.
Although breast and prostate cancer are those most frequently diagnosed in Canada, information about the ways in which gender, class, race, culture, and other social determinants impact the experience of African Canadians living with cancer is lacking. This study began to address this gap by exploring cultured and gendered dimensions of African Nova Scotians' experiences of these two cancers. Using a participatory action research approach, data were collected in two phases of focus group discussions in five African Nova Scotian communities from a total of 57 people, including those with breast or prostate cancer and their families and associates. Findings provide insight into how gender and meanings of masculinity and femininity in the African Nova Scotian community unavoidably interact with other social structures such as race and class to affect women and men's perceptions and experiences of these two cancers. These insights point to the need for culturally appropriate and meaningful health interventions. As a prerequisite, health care professionals need to have an understanding of the overlapping and contextualized nature of gender, class, and race and be willing and able to work in partnership with African Nova Scotian communities to identify and develop strategies that reflect the realities of peoples' lives.
The social determinants of health (SDH) are recognized as important indicators of health and well-being. Health-care services (primary, secondary, tertiary care) have not until recently been considered an SDH. Inequities in access to health care are changing this view. These inequities include barriers faced by certain population groups at point of care, such as the lack of cultural competence of health-care providers. The authors show how a social justice perspective can help nurses understand how to link inequities in access to poorer health outcomes, and they call on nurses to break the cycle of oppression that contributes to these inequities.
Occupational therapy has increasingly explored the impact of cultural differences on occupations but has not yet begun to explore the impact of racism on human occupation.
This study with 50 African Canadian women used mixed methods to explore the effects of racism on their occupational experiences.
Women aged 40-65 were interviewed in-depth about everyday experiences with racism and overall well-being. Three standardized instruments assessed frequency and stressfulness of race-related experiences.
Everyday racism had subtle, almost intangible, impacts, shaping women's engagement with and the meaning of leisure, productive, and caring occupations.
As occupational therapy increasingly attends to issues of cultural difference, it is critical to also attend to racism. This means learning to ask thoughtful questions about how racism may shape clients' occupations. Attention to this aspect of the social environment will enhance practice with African-heritage clients and clients from other racial minority groups.