Qualitative Nursing Research on Haitians Essay
Qualitative Nursing Research on Haitians Essay
This paper is critical review of qualitative research on the influence of socio-cultural aspects on tuberculosis-related stigma among non-affected persons. The study is conducted with Haitians living in Florida, United States, and in Haiti. The paper provides a critical and analytical review of the purpose of the study, the study design, theory that guided the research, the methodology, instruments used and the data analysis procedures, limitations of the study and strengths of the research. The paper also reviews the implications of the findings of the study, applicability and the ethical considerations involved in this research.
Qualitative Nursing Research on Haitians
This paper is a review of qualitative research conducted on the Haitian population in two contexts; Haiti and South Florida in U.S.A. Qualitative Nursing Research on Haitians Essay. The paper provides a critical review of the purpose of the study, the study design, theory that guided the research, the methodology, instruments used and the data analysis procedures, limitations of the study and strengths of the research. The paper also reviews the implications of the findings of the study, its applicability and the ethical considerations.
The purpose of this study was to investigate how socio-cultural contexts influence perceived components of tuberculosis-related stigma in non-affected persons (Jeannine, ladys, Kelly, Michael, Yiliang, & Mitchell, 2010). The research adopted qualitative research design. Specifically, this research was comparative in nature since it involved comparison of tuberculosis-related stigma in two socio-cultural contexts. The study was two-phased and used the methods of cultural epidemiology.
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The research instruments that the study used included stigma scales which collected data on stigmatizing aspects of tuberculosis, focus group discussion guides which helped in directing discussions in the focus groups, and interview guides, which were used to collect data from the key informants (Jeannine et al, 2010). The methodology adopted was that of a comparative study or comparative analysis of the Haitians in the two socio-cultural contexts. Being a qualitative study, the researchers applied methods of cultural epidemiology collect ethnographic data on the cultural contexts and components of tuberculosis-related stigma. The theory that guided the study was ground theory.
The data analysis procedures that this study applied were guided, to large extent, by the nature of the design (Jeannine et al, 2010). Since this was a qualitative study, appropriate procedures for measuring qualitative data were necessary. Qualitative Nursing Research on Haitians Essay. The thematic analysis focused on tuberculosis stigma components that were expressed and captured in the interviews, focus group discussions. The use of observation revealed the distinctive emphases of tuberculosis stigma among Haitians in South Florida, U.S.A and in Haiti. Factor analysis was used to analyze the stigma scale scores and helped in confirming the thematic differences revealed by the analysis of and finding from the ethnographic data (Jeannine et al, 2010).
The findings of the study matched its objectives. The study results indicated that socio-cultural context of Haitians influenced the perceived tuberculosis-related stigma of non-affected persons. For example, the study found political and economic factors helped in shaping the meaning and the experiences of tuberculosis-related illnesses (Jeannine et al, 2010). The study also revealed that tuberculosis stigma among Haitians in South Florida integrated aspects of their identity as a negatively-stereotyped minority group with a larger, racially segregated society. The study thus confirmed that tuberculosis-associated stigma was influenced by socio-cultural aspects of the victims. These include politics, economic status, institutional policies, and structures for delivering health services (Juniarti and Evans, 2011). The tuberculosis stigma among the immigrant communities was also found to be compounded by the racial stereotypes and prejudicial perceptions immigrant communities by the natives.
In Haiti, tuberculosis stigma was significantly associated and compounded by poverty, malnutrition, and HIV/AIDS infections (Jeannine et al, 2010). The study thus confirmed that tuberculosis-associated stigma was influenced by socio-cultural aspects of the victims. These include politics, economic status, institutional policies, and structures for delivering health services (Juniarti and Evans, 2011). Qualitative Nursing Research on Haitians Essay.
This study was thus timely and instrumental in influencing and informing policy makers in the health service delivery to formulate policies that will be favorable to the already tuberculosis-stigmatized immigrant communities. Such policies should thus build structures for improved accessibility and effectiveness of healthcare services for the immigrant and minority communities. The ethical considerations included confidential treatment of the data collected from the participants. They were assured that the data will be used purely for the purposes of the study. Besides, all the participants were recruited after voluntary acceptance and informed consent was secured by the researchers. The study also informed the participants of the potential benefits of voluntary participation in the study. The researcher, therefore, explained to the participants that what the researchers were interested in was collection of data that can then be used to recommend policy legislations that will improve the welfare of the participants.
The strength of this study is in the way it accurately applied qualitative design in terms of data collection tools, data analysis and presentation of the findings. However, the weaknesses of this study are the limitations that are common with qualitative research and its design (Rahill, Rosa & Edwards, 2012; Thorne, 2011). This study can be biased since it does not allow for random sampling of the participants. Thus inferential analysis becomes challenging and thus external validity might be difficult to achieve (Polit & Beck, 2010).
This study was largely objective. Its limitations create room for further studies that apply both qualitative and quantitative designs so as to enhance triangulation and limitation of the weaknesses associated with qualitative research designs. Thus, more studies should be conducted, especially focusing on the context specific tuberculosis-related stigma and the possible interventions that are relevant to such specific contexts.
In conclusion, this study applied qualitative techniques that are relevant to any qualitative research. In the general evaluation, the study was able to meet its objectives through the methods proposed and used in the development and implementation of the planned study. Although there may be some limitations, the study displayed a significant operationalization of the of the conventional qualitative study methods.Qualitative Nursing Research on Haitians Essay. The strengths, by far surpasses the weaknesses that a critical analysis of the study can cite. The areas of weaknesses can thus be used for future research improvement.
References
Jeannine, C., ladys, M., Kelly, S.M., Michael, L., Yiliang, Z. & Mitchell, W. (2010).”Structural forces and the production of TB-related stigma among Haitians in two contexts”. Social Science and Medicine 71, (8):1409-1417.
Juniarti, N. and Evans, D. (2011). “A qualitative review: the stigma of tuberculosis”. Journal of Clinical Nursing, 20: 1961-1970.
Polit, D.F.& Beck, C.T. (2010). “Generalization in quantitative and qualitative research: Myths and strategies”. International Journal of Nursing Studies, 47 (11): 1451-1458
Rahill, G. J., Rosa, M. D., & Edwards, B. (2012). “Insights and Practical Strategies for Health Research Among Haitian Immigrants: Lessons Learned From the Miami-Dade Picuriste Study”. Journal of Immigrant & Refugee Studies, 10 (1): 1961-1970.
Thorne, S. (2011). “Toward methodological emancipation in applied health research”. Qualitative Health Research, 21(4): 443-453.
This 2009 qualitative study investigated Haitian women’s most pressing health needs, barriers to meeting those needs and proposed solutions, and how they thought the community and outside organizations should be involved in addressing their needs. The impetus for the study was to get community input into the development of a Family Health Centre in Leogane, Haiti. Individual interviews and focus group discussions were conducted with 52 adult women in six communities surrounding Leogane. The most pressing health needs named by the women were accessible, available and affordable health care, potable water, enough food to eat, improved economy, employment, sanitation and education, including health education. Qualitative Nursing Research on Haitians Essay. Institutional corruption, lack of infrastructure and social organization, the cost of health care, distance from services and lack of transport as barriers to care were also important themes. The involvement of foreign organizations and local community groups, including grassroots women’s groups who would work in the best interests of other women, were identified as the most effective solutions. Organizations seeking to improve women’s health care in Haiti should develop services and interventions that prioritize community partnership and leadership, foster partnerships with government, and focus on public health needs.
Haiti is the poorest country in the Western hemisphere. More than half its residents live on less than one US dollar per day, and accessible health care is not available for the majority of the population.1,2 There are only 25 physicians per 100,000 Haitians, and many serve only the upper class. Skilled birth attendants are present for just 26% of all deliveries. Indicators of reproductive health in Haiti are among the worst in the world. Infant and maternal mortality rates are 64 per 1,000 live births and 630 per 100,000 live births, respectively.3,4 Fifty-two percent of Haitian women have an unmet need for contraception.5
Poor health in Haiti cannot be understood outside the context of the country’s long history of political turmoil. Haiti became a prosperous but brutal French slave colony in 1697 after its indigenous population was decimated during Spanish occupation. In 1791, Haitian slaves won their independence in a bloody revolution. Qualitative Nursing Research on Haitians Essay.Since then, Haitians have weathered destructive Western interventions and occupations, internal governmental instability, and frequent episodes of violence. The brunt of these effects is felt by the large numbers living in poverty, who continue to be oppressed, under-educated and denied the fruits of millions of dollars of financial aid and donations, pocketed by their leaders.6–9 The mountainous terrain, ecological devastation, poor roads, natural disasters, and reliance on traditional healers present additional challenges to providing health care.
Leogane is a port town two hours drive from Port au Prince, Haiti’s capital, surrounded by mountainous rural communities and the site of frequent flooding. Much of the population sought health care at the local multidisciplinary charity hospital,10 but that hospital closed its inpatient services in January 2008. After this study, Leogane was the epicentre of the January 2010 earthquake, and indigent patients had to travel hours to Port-au-Prince, Petit Goave or Jacmel to receive hospital care, though outpatient services overseen by the Haitian Ministry of Health did continue to be provided. Additional health resources in Leogane include an expensive private hospital, several private clinics with varying levels of international support, a public maternity hospital in neighbouring Carrefour, a women’s health clinic through Family Health Ministries, a Filariasis research project, and a Children’s Nutritional Program.10 In the rural areas, several small clinics provide first aid and children’s nutrition, overseen by nurses and public health workers (Telesmanick K, Children’s Nutrition Program. Personal communication, 2009). Additional community resources include the university in Fondwa, a microloan agency in Leogane and Fondwa, and a peasant’s foundation in Fondwa.
Women in Leogane have long expressed a desire for a women and children’s health centre. Family Health Ministries, a US non-profit organization, is supporting this community initiative. Their vision is to focus on local priorities and complement existing health services. They carried out a community survey of existing health services in Leogane in 2007.10 However, more information was needed. Our goal was to gain this information from local women, using qualitative methods. Women from Leogane were asked to identify their most pressing health needs, barriers to meeting those needs, and how they thought the community and outside organizations should be involved in addressing those needs. Qualitative Nursing Research on Haitians Essay.
Methodology
A literature review was performed in PubMed, Web of Science, and Google Scholar using MeSH terms “Haiti” and “women’s health” or “pregnancy” or “maternal mortality”, “Haiti” and “corruption”, “Haiti” and “focus groups”. Key references were identified and their bibliographies searched for additional relevant publications. Multiple barriers to health care (financial, geographic and limited resources), reliance on alternative health practitioners (traditional birth attendants, herb doctors, spiritual practitioners), and attribution of disease to spiritual causes were identified as important issues. A brief individual interview script was prepared to collect demographic information, current access to care and important health needs.
A focus group discussion (FGD) script was developed to explore themes identified in the literature review and questions deemed important by those planning the Women’s Health Centre and Haitian field workers. The script encouraged women to list and prioritize their five most important health needs, explored barriers to care arising from the literature review, and asked them to propose health care solutions. The questions and informed consent documents were translated and back translated from English to Kreyol by local field staff. Qualitative Nursing Research on Haitians Essay.
We planned to recruit 6–12 women to each group from among women likely to seek health care in Leogane. Saturation of qualitative themes is usually reached after at least two FGDs with each group of interest.11 Six groups were planned: three in Leogane town and three in surrounding rural communities. Researchers modified the interview guide for later groups in order to incorporate knowledge gained from earlier sessions.
The inclusion criteria were: female, Haitian, 18 years and older to capture women’s experiences across all age groups, mother of at least one child, and Kreyol speaking. A local Voudou leader, who directed an educational non-profit, recruited the first urban group; the other two were recruited among women awaiting cervical cancer screening at a Family Health Ministries cervical cancer screening clinic. These two groups included women from Carrefour (7 out of 13) and Port au Prince (3 out of 13) who were seeking health care in Leogane. A nurse from a public health outpost* funded by the Children’s Nutritional Program recruited one rural group in Troinn, located one hour by bus, 30 minutes by motorcycle taxi or half a day’s walk from Leogane. A second rural group was from a Fondwa local peasant’s association women’s group, 90 minutes by bus and a one-mile mountain walk from Leogane. The third was from a Children’s Nutritional Program safe water education session, located in Darbonne, 30 minutes by bus from Leogane.
Bilingual research assistants from the community were employed and trained to conduct the individual interviews and focus group discussions using published curricula.12Individual interviews were conducted privately before the FGDs; the latter lasted 40–90 minutes and were audio-recorded.
Descriptive statistics for the demographic information (Table 1) were calculated using the SAS means, median and freq procedures (SAS Institute Inc). Qualitative Nursing Research on Haitians Essay.Responses regarding health needs were grouped in similar categories, and total numbers of responses in each category were calculated using the SAS freq procedure.
Table 1
Demographic characteristics of participants (n=52)
| Mean or Per cent (Range) | |
|---|---|
| Age (years) | 39.1 years (22–58) |
| Household size | 5.9 people (1–20) |
| Education years in school | 7.0 (0–19) |
| Median monthly income | US$IOO ($0–$1525) |
| Pregnancies | 3.6 (0–11) |
| Live births | 3.2 (0–11) |
| Live children | 3.0 (0–9) |
| Children in school | 2.6 (0–8) |
| Time to reach hospital | 84 minutes (5–240) |
| Married | 33.3% |
| Single | 21.6% |
| Living together | 35.3% |
| Widowed | 9.8% |
| Children vaccinated | 100% |
The interviews were read as they were transcribed, and common themes were noted. All transcriptions were read a second time while listening to the audio recording to verify accuracy. The data were analyzed on an ongoing, iterative basis to develop a summary of common themes.13 A list of themes for health needs, barriers to care and solutions was created after review of the transcripts. Final codes were decided upon by agreement between one author and two independent reviewers. Responses were aggregated using NVivo (QSR International) to create summary matrices. Health needs of women and their families, barriers in gaining access to health care, and proposed health care solutions were the primary focus.
Findings
Participant characteristics
Responses from 52 women were included in the analysis. One participant did not complete the individual interview but completed the focus group discussion. Another completed the individual interview but only part of the focus group discussion. The remaining 50 participants completed both. FGDs ranged in size from 6 to 13 women. All but one lasted 60–90 minutes; one was 40 minutes and was interrupted several times.
Demographic information is shown in Table 1. The mean age of participants was 39. The average household size (5.9) was slightly larger than the national average (4.6). The average number of pregnancies and living children was similar to the 2011 estimated total fertility rate in Haiti of 3.07. Marital status was also similar to national averages. Education levels were low; the majority of women had not completed primary education, consistent with national data (4% of Haitians complete high school and only 2% have any education beyond secondary school).14
Health needs
The five most important health needs named by the women individually are shown in Table 2. Nutritious food and drink were the most commonly mentioned (24%), and at least 15 of 38 mentions of food were directly related to not having enough to eat (more common among urban women). Other important needs were access to affordable and available medical care (17%), potable water (16%), education/training, enough work/improved economy, hygiene/bathing and improved sanitation (all 5–7%). Although “happiness” and “belief in God” may not reflect direct health needs, they represented 5% of the responses. Qualitative Nursing Research on Haitians Essay.
