Exploring acculturation beliefs towards therapy for the UK and Zimbabwean communities

Title

A Qualitative Study: Exploring acculturation beliefs towards therapy for the UK and Zimbabwean communities.

LITERATURE REVIEW

Introduction

There is an alarming rate of mental health disorders across the globe. Due to the high prevalence rate, the World Health Organization has implored member countries to use whatever resources, including indigenous healers, to fight the disease burden (Annelisa, 2014). Following how Zimbabweans have been displaced, with the majority of them living through hardships as they moved to South Africa and the United Kingdom, they can be viewed as vulnerable groups (Deslandes et al.2022). Zimbabwe is known to be one of Africa's countries with the most producer of migrants. Political repression, hunger, and economic collapse are significant contributors to the mass exodus.

Zimbabwean communities, families, and individuals were substantially affected by economic challenges, including homelessness, unemployment, and poverty (Mapuranga, 2017). Moreover, they have gone through multiple complex factors which operate at the structural and institutional levels. In a nutshell, stressors like political instability, wars, and civil unrest have been recorded as contributors to immigration.

Acculturation

Acculturation is considered the progressive assimilation of foreign cultures through ideas, behavior, norms, and values. It involves a shift in one's thinking pattern together with social behavior and activities. Usually, the migrant changes their behavior and attitude in favor of those from the host community (Phillimore, 2011). Different multidimensional models can be used to understand the relationship between mental health and acculturation. Several people have undergone mental challenges in their life through to long-term conditions.

According to research studies, there are four different stages of acculturation where one can change their worldview, systems of thinking, self-identity, preferences of languages, and communication (Annelisa, 2014). Language is usually the visible expression of culture that is most available. During the initial acculturation stages, one may be faced with euphoria and excitement. The next is culture shock due to a lack of effective communication during the initial acculturation stages (Deslandes et al.2022). The third stage is usually marked with thoughts of rejecting or accepting behaviors posed by the new culture. The last stage can culminate in either considered reputation of the adaption or assimilation.

Regarding Berry's acculturation model, there exist two independent dimensions: cultural maintenance and intercultural contact (Mapuranga, 2017). Multiple studies on immigrants' mental health depend on an un-dimensional scale to measure acculturation. Another parameter that can be used to gauge acculturation is the period of stay in the host country (Phillimore, 2011). Usually, people lose several aspects of self-identify when shifting from one culture to the other. The self-identity is modified to enable one to suit the host's cultures and values (Annelisa, 2014). When the length of stay is used as the only variable to gauge acculturation, it means that a more extended stay within the host's cultural society would translate to a greater level of acculturation.

Different models of mental health among the immigrants

Several current works of literature on the acculturation of immigrants concentrate on Hispanics and Asians living in North America, New Zealand, and Australia. There is limited literature on African Immigrant studies. This review has established only two research studies of the experience of the Zimbabwean migrants. One involves the Zimbabwean migrants in New Zealand; another is on the migration challenges among Zimbabwean migrants during, before, and post-arrival in South Africa (Deslandes et al.2022). While the last one focuses on” the influence of familial and schooling experiences on the acculturation of immigrant children from Zimbabwe.”

The economic and social challenges Zimbabweans faced during acculturation could result in mental health illnesses. Studies have found that well-integrated migrants undergo less stress compared to marginalized and separated migrants (Adams, 2017). For instance, displaced people like refugees and asylum seekers experience more acculturative stress than economic migrants who plan their travel and are also psychologically prepared (Phillimore, 2011). Several studies have associated several outcomes and symptoms of mental health challenges with cultural change and acculturation (Annelisa, 2014). Moreover, Earlier studies have also established a positive relationship between mental health and acculturation. People with greater acculturation indicated good mental health outcomes compared to those with lower levels of acculturation. Such findings imply that good health, minimal psychological problems, and fewer mental health are supported by better acculturation.

Besides, pieces of literature have hinted that adjusting to the host's culture was very stressful and hectic for the migrants. The adjustments included challenges in accessing medical treatment, communication barriers, housing challenges, and the educational system (Deslandes et al.2022). The current research studies have indicated that immigrants' health, more particularly mental health seems to be much poor compared to the host's population health. However, even if several research studies have reported a positive relationship between mental health and acculturation, some pieces of literature have also reported contradicting findings (Phillimore, 2011). According to studies by Bhugra (2004), higher levels of acculturation is liked to greater depression levels, psychiatric disorder, and substance use. Research findings by Koch et al. (2004) also reported that acculturation contributes very little to mental health; however, it indicated a substantial relationship between mental health and socioeconomic and socio-demographic factors (Mapuranga, 2017). Conflicting findings may mean an individual's differential impact based on circumstances around their migration culture and experience. Further findings by Rogler et al. (1991) on Hispanics in the United States indicated a positive, non-significant, and negative relationship between mental health and acculturation. Other research studies on a diverse population, including Latinos, Asians, and other ethnicities, also gave the same findings.

Mental Health and Biosocial Spiritual Model

The mental challenge is pervasive in almost all cultures; as a result, different people from different cultures have adopted ways and mechanisms to deal with them (Phillimore, 2011). For instance, the western medical model in charge of diagnosing and offering mental health medication and the pharmacological industry founded on it became successful in propagating its influence across the globe, regardless of proof of effectiveness (Deslandes et al.2022). Similar to the United Kingdom, where stigma is still embedded in mental challenges, those experiencing identifiable mental issues in Zimbabwe are equally stigmatized (Annelisa, 2014). According to the populace, mental health challenge is considered a taboo that no one wants to associate with.

Nonetheless, some differences exist between Zimbabweans and UK citizens. Amongst the Zimbabweans, it was until recently, after acquiring some level of education, that people have started to change their perception of the mental health challenge as a common health issue that can befall anyone in society (Mapuranga, 2017). Previously, mental health was associated with evil spirits, thus, making it a challenging subject to handle, more so whenever it was a child suffering from mental health challenges. However, in the United Kingdom, parents were ready and willing to diagnose their children with mental health (Phillimore, 2011). The sharp difference in cultural perception between the UK and Zimbabweans created a massive shock for those Zimbabweans who came from one extreme side of view towards mental health to another extreme side.

Consequently, successful efforts have been made to destigmatize mental health challenges and psychiatric diagnoses in the west, more so about the most common and mild learning challenges affecting young people (Mapuranga, 2017). These include Dyslexia and Asperger’s Syndrome, attention deficit disorder, and attention-deficit/hyperactivity disorder (Adams, 2017). Also, most parents got motivated to take their children for mental health diagnosis since whenever one was found with some mental challenge conditions, they would be accorded some privileges and necessary support during the examination (Phillimore, 2011). As a result of the transition into modernity as well as the development and appearance of psychology and psychiatry, and more so with the pharmaceutical industry establishment and growth, several behaviors that would be attended to through religious frameworks, amongst other ways in traditional society, are now treated as medical conditions (Mapuranga, 2017). Regardless of limited success, the medical model is slowly making its way through the world, including Zimbabwe, and cultural view toward mental health is set to change in due time.

On the other hand, regarding legislation, Zimbabweans have established several policies on mental health that protects the rights of patients with mental challenges (Deslandes et al.2022). Nevertheless, the legislation application is more limited and emphasizes institutionalizing those diagnosed pf mental challenges. While from the UK, institutionalization is not allowed per the least restrictive practice. According to research findings, in 2016, only five clinical psychologists were found to be working in the public sector, while psychiatry was also not popular among the medical specialties (Phillimore, 2011). This means that mental health has not been of interest to Zimbabweans, likely due to stigmatization associated with mental illness and fears that it can be 'contagious.'

Moreover, according to Pitorak et al. (2012), faith healers and traditional healers are usually contacted and consulted in Zimbabwe whenever an individual has a mental health problem. Most of the population believed that mental health challenge is, as a result, a punishment for some immoral acts one committed (Mapuranga, 2017). For instance, maybe one took another’s wife or his parents, hence, being punished by traditional gods for the act (Deslandes et al.2022). Therefore, this explains why the social or medical model for treating mental illness was not widely accepted in Zimbabwe (Phillimore, 2011). It also substantiates why people with mental illness were referred to traditional faith healers for treatment. Such findings clarify the differences in mental illness cultural views between the United Kingdom and Zimbabwe, together with the challenges Zimbabwean social workers in the United Kingdom are likely to experience in adjusting to their new local context.

Biopsychosocial spiritual models

Mental health is a substantial predictor of quality of life and physical health. As a result, international public health agencies have recognized mental health improvement as an area of international concern for all the countries. Within low-income countries, mental illness is a great epidemic (Phillimore, 2011). However, in most cases, mental health is given minor consideration and attention due to competing health challenges like malaria, HIV/AIDS, or clean water that gets the most significant chunk of the national health budget (Deslandes et al.2022). Further, the stigma due to belief of spiritual origin and misinformation on mental problems propagates a lack of medical treatment (Adams, 2017). Immigrants usually indicate strange mental health needs instigated by migration to a new culture, acculturative sensors, and life challenges that come with previous trauma and resettlement experiences.

In the United Kingdom, whenever there is a need for a psychiatrist, Zimbabwean immigrants are usually referred to mental health services provided by the Refugee/Immigrant Council's Therapeutic casework unit or the General Practitioners. However, regardless of their presence, obtaining their services is complicated and confusing, with a lot of bureaucracy and language barriers. Another challenge towards providing mental health services to this minority group (Zimbabweans) is provider bias, where most Zimbabweans risk receiving low attention and quality care from the providers.

Another contention is whether it is proper to use diagnostic categories established in the United Kingdom under the western psychiatric system like post-traumatic disorder and depression to a particular population that are war-affected (Phillimore, 2011). Consequently, the challenge of evaluating the most effective way to integrate mental health treatment into the general support provided to these minority groups originates not just from legal and social pressures facing this group but also from the helplessness of mental care providers in supporting the minority groups.

Cultural, mental health

Like other immigrant groups, African immigrants, particularly the Zimbabwean immigrants, embrace cultural norms, values, and beliefs that are usually distinct from the host nation. In general, the Zimbabweans' attitudes toward mental problems are strongly influenced by their traditional beliefs in supernatural remedies and causes (Deslandes et al.2022). In most instances, individuals with mental illnesses are considered mad or being molested by some spiritual spirits. Generally, Africans, more so the Zimbabwean migrants, believe that mental and physical conditions originate from external causes like ancestral spirits, punishment by the gods, or demonic possession.

Besides, even amongst other perceived more westernized African countries like South Africa, the majority still believe that mental illness results from causes. As a result, individuals with mental disorders seek treatment from traditional healers (Phillimore, 2011). Another aspect that plays a role in mental health within African culture is religion. Even though Christianity and Islam are the most dominant religious faiths, most African Zimbabweans included practice variations of African Traditional Religion, which encompasses the concepts of God, divine spirits, and ancestral cult (Deslandes et al.2022). A common belief developed from the African Traditional Religion of mental illness explanation. According to African Traditional Religion, mental problems are caused by spiritual possession, which is best treated only through traditional healers. Such beliefs linger in the minds of Zimbabweans migrants even as they become acculturated in the United Kingdom, emphasizing their habit toward biculturalism as they hold on to their ancestral beliefs.

In another qualitative study of the Somali immigrants of female gender in the United States, the mental problem was recorded as a worrying concern and illustrated as having spiritual causes (Adams, 2017). Also, multiple research studies have shown that immigrants' attitudes towards mental health may not be similar based on acculturation after immigration and country of origin.

METHODOLOGY

Introduction

This study will adopt the qualitative research approach to focus on and obtain data through informal and open-ended communication. This method would allow gathering what people think and why they think so (Maxwell, 2012). Therefore, it will enable an in-depth probe of the respondents depending on their responses, while at the same time, the interviewer would be in a position to gauge their feelings.

The benefits of using qualitative research in this study: the research framework is based on the available incoming data (Janesick, 1994). The data collected in qualitative research contains predictive quality in it. Qualitative research upholds respect for different groups of people. Qualitative research unveils perceptions, attitudes, and feelings of a given discussion. Through the collaboration of researchers, the data collected is usually precise and reliable.

Research Design

The approach of qualitative research unveils a detailed description of the respondents' feelings, experiences, and opinions and the interpretation of the actions meaning (Janesick, 1994). This study intends to understand the relationship between acculturation and therapy for the Zimbabweans living in the United Kingdom.

Besides, interviews are considered the most effective tool in qualitative research because they help the researcher explore and understand the respondent's phenomenon, experiences, behavior, and opinions better. This study proposes to adopt the use of semi-structured interviews due to the flexibility in the approach (Maxwell, 2012). A semi-structured interview is when the interviewer asks open-ended questions other than following a formal list of questions strictly. The benefits of using a semi-structured interview format include that it promotes two-way communication between the researcher and the respondent (Janesick, 1994). The respondent and the interviewer can raise questions, allowing comprehensive and detailed discussion of pertinent topics.

Further, a semi-structured interview allows the interviewer to ask follow-up questions on various responses provided to ensure clarity while at the same time enabling the respondent an opportunity for verbal expression (Maxwell, 2012). In addition, the adoption of semi-structured interviews in qualitative research presumes that the respondents can interpret and recognize the subjectivity of the world in their particular ways (Janesick, 1994). Moreover, due to an excellent conversational tone, the respondents are likely to feel more comfortable expressing detailed experiences and techniques regarding the interview questions.

Target population

The target population for this study will be Zimbabwean immigrants working in the United Kingdom, trauma units, and health professionals working in hospitals within the United Kingdom. The study will, in particular, target those Zimbabweans who arrived in the United Kingdom in the last five years and have significant experience in the country. This target population will be able to give bets illustration of their experience on the relationship between acculturation and seeking therapy and how the experience has impacted their mental health and behavior. On the other hand, the health workers in trauma units will help the study get their experience with immigrants who visited for treatment and cases which immigrants take to their attention during such visitation in hospitals.

Study Sample

This study will involve 30 respondents as the population representation. The sample number is chosen because it is easily manageable. Among them, 20 will be Zimbabwean immigrants working in the United Kingdom, while ten will include health professionals from the trauma units within the country. The samples must also be adults of 18 years and above able to speak and understand English. People below 18 and non-Zimbabweans, except health professionals, will be excluded from the study. This number is manageable; hence, it will give the researcher ample time to probe the interviewees.

Sampling Techniques

The study will use purposive sampling to select samples for the study. It will be based upon the /researcher's decision regarding the features of a representative sample (Campbell et al. 2020). The method will also eliminate inappropriate respondents; it is also time and cost-effective.

Data Collection Procedure

The researcher will invite interested respondents through social media platforms like Twitter, Facebook, Instagram, and WhatsApp. Respondents willing to participate in the research will respond to the advert by sending in their names and email details.

After that, the researcher will email every interested participant a qualifying form to evaluate whether the participants meet the minimum requirement to be engaged as a sample. For instance, whether one is of Zimbabwean origin for non-mental health workers, if one can understand and speak English, and also above 18.

In the form, the respondents will be provided detailed information on the research, ethical considerations, data protection, and the right to withdraw from the study at any point.

Upon receipt of qualifying forms, the researcher will screen them and notify those who have met the minimum qualification required to participate in the study. After that, they can sign a consent form and choose an appropriate date and time for the interview through Zoom.

During the interview, the interviewer will be able to record the respondents, and major themes from their responses noted. This will enable the study to use thematic analysis in analyzing the data obtained.

Data Analysis and Presentation

According to Bless et al. (2006), the data analysis process follows once the data collection is complete. An analysis is carried out to allow the researcher to identify any consistent or inconsistent pattern within the data. In addition, the process allows the researcher to generalize research outcomes from the sample used to represent the larger population.