Dr Andrea Martinez PhD

Abstract

Purpose

This pilot study of a culturally adapted online mental health literacy (MHL) program called ‘Tara, Usap Tayo!’ (C’mon, Let’s Talk) aims to assess the acceptability, appropriateness, feasibility, and potential effectiveness in improving the help-seeking behavior of Filipino migrant domestic workers in the United Kingdom (UK).

Methods

Using mixed methods, we conducted a non-randomized single-group study of the online MHL program with 21 participants. The development of this intervention was guided by the Medical Research Council Framework for developing complex interventions and utilized Heim & Kohrt’s (2019) framework for cultural adaptation. Content materials from the WHO Mental Health Gap Action Program (mhGAP), WHO Problem Management Plus (PM +) and Adult Improving Access to Psychological Therapies (IAPT) were modified and translated into the Filipino language. The MHL program was delivered online in three sessions for two hours each session. Data were collected at three time points: (T1) pretest; (T2) posttest; and (3) follow-up test. Quantitative data on participants’ attitudes towards help-seeking and level of mental health literacy as outcome measures of potential intervention effectiveness were collected at T1, T2 and T3, while focus group discussions (FGDs) to assess participants’ feedback on the acceptability, feasibility, and appropriateness of the online MHL program were conducted immediately at T2. Data analysis was done using a thematic approach for qualitative data from the FGDs and descriptive statistics and repeated-measures ANOVA were used to assess the difference in the T1, T2, and T3 tests. Both quantitative and qualitative results were then integrated and triangulated to answer the research questions.

Results

The online MHL program is generally acceptable, appropriate, and feasible for use among Filipino migrant domestic workers. Preliminary findings lend support for its possible effectiveness in improving mental health literacy and help-seeking propensity. The cultural adaptation made in the content, form, and delivery methods of the intervention was acceptable and feasible for this target subcultural group.

Conclusion

By improving their mental health literacy and help-seeking propensity, this online MHL program has the potential to provide support to the mental health and well-being of Filipino migrant domestic workers in the UK. Further feasibility study or large-scale randomized controlled trial is needed to confirm the preliminary findings of this study.

An estimated 10 million overseas Filipino workers (OFWs), or 10% of the Philippine population, are dispersed worldwide (Oxford Business Group, 2018). In the UK alone, roughly 250,000 Filipinos have immigrated since the 1980s and one-third of them are concentrated in the Greater London area (UK Foreign and Commonwealth Office, 2014). The majority of OFWs end up in service and domestic work, production work, professional and technical jobs, or healthcare and nursing in different parts of the world (Philippine Overseas Employment Agency, 2010). In the UK, the majority of Filipino migrants are nurses, carers, or domestic workers.

The purpose of this qualitative study among Filipino domestic workers in the UK was to investigate their access and utilization of mental health services. In particular, it explored their views and experience of mental health and illness, their patterns of psychological help-seeking and other coping strategies, their perceived barriers and facilitators in help-seeking, and the sense of meaning they attached to their experience of help-seeking for mental health.

Filipino domestic workers in the UK view mental ill-health as a stigmatized condition caused by difficult experiences in life which require the use of various coping strategies such as positive reframing and seeking informal help from friends, selected family members, or charity organisations. Professional assistance is sought only as a last resort when problems have physical manifestations and are disrupting their work. Their patterns of help-seeking reveal a three-stage approach in which help is initially sought from informal networks of friends who then refer them to charity or community-based organisations that provide them with psychosocial assistance. Before they are referred to a GP or a mental health specialist. The most notable barriers from seeking specialist services are stigma, lack of familiarity with the structure of the services, and a sense of self-reliance. General dissatisfaction with mental health services was also noted.

Abstract

Objectives

Although there are disparities in both risk of developing dementia and accessibility of dementia services for certain minority ethnic groups in the United States and United Kingdom, disparities in survival after a dementia diagnosis are less well-studied. Our objective was to systematically review the literature to investigate racial/ethnic differences in survival and mortality in dementia.

Methods

We searched Embase, Ovid MEDLINE, Global Health and PsycINFO from inception to November 2018 for studies comparing survival or mortality over time in at least two race/ethnicity groups. Studies from any country were included but analysed separately. We used narrative synthesis and random-effects meta-analysis to synthesise findings. The Newcastle–Ottawa Scale was used to assess quality and risk of bias in individual studies.

Results

We identified 22 articles, most from the United States (n = 17), as well as the United Kingdom (n = 3) and the Netherlands (n = 1). In a meta-analysis of US studies, hazard of mortality was lower in Black/African American groups (Pooled Hazard Ratio = 0.86, 95% CI = 0.82–0.91, I2 = 17%, from four studies) and Hispanic/Latino groups (Pooled HR = 0.65, 95% CI = 0.50–0.84, I2 = 86%, from four studies) versus comparison groups. However, study quality was mixed, and in particular, quality of reporting of race/ethnicity was inconsistent.

Conclusion

Literature indicates that Black/African American and Hispanic/Latino groups may experience lower mortality in dementia versus comparison groups in the United States, but further research, using clearer and more and consistent reporting of race/ethnicity, is necessary to understand what drives these patterns and their implications for policy and practice.

Abstract

Purpose

This systematic review aims to synthesise the evidence on behavioural and attitudinal patterns as well as barriers and enablers in Filipino formal help-seeking.

Methods

Using PRISMA framework, 15 studies conducted in 7 countries on Filipino help-seeking were appraised through narrative synthesis.

Results

Filipinos across the world have general reluctance and unfavourable attitude towards formal help-seeking despite high rates of psychological distress. They prefer seeking help from close family and friends. Barriers cited by Filipinos living in the Philippines include financial constraints and inaccessibility of services, whereas overseas Filipinos were hampered by immigration status, lack of health insurance, language difficulty, experience of discrimination and lack of acculturation to host culture. Both groups were hindered by self and social stigma attached to mental disorder, and by concern for loss of face, sense of shame, and adherence to Asian values of conformity to norms where mental illness is considered unacceptable. Filipinos are also prevented from seeking help by their sense of resilience and self-reliance, but this is explored only in qualitative studies. They utilize special mental health care only as the last resort or when problems become severe. Other prominent facilitators include perception of distress, influence of social support, financial capacity and previous positive experience in formal help.

Conclusion

We confirmed the low utilization of mental health services among Filipinos regardless of their locations, with mental health stigma as primary barrier, while resilience and self-reliance as coping strategies were cited in qualitative studies. Social support and problem severity were cited as prominent facilitators.

This study focused on the drivers of online child sexual exploitation and abuse (OCSEA) among Filipino children and youth, with emphasis on community norms. An ethnographic qualitative study was conducted in two communities in MetroManila that are considered “hotspots” for child sexual abuse. One hundred and forty-four (144) males and females from various age groups served as key informants. Political officials, Internet shop managers, professionals and police officers were also interviewed. Non-participant observations and mapping were used to provide context regarding OCSEA in the communities.The results revealed that OCSEA was committed online by heterosexual and same sex attracted men in their 40s–50s. The usual victims were girls aged 13–17 years, although boys were also noted. The victims came from poor families and were out-of-school. The various forms of online activities leading to OCSEA included sexual chatting, showing of child sex photos and live videos as well as sextortion. The online transactions were usually initiated by the peer group and some enablers. In general, online sexual activities were perceived as “normal” among young people, although regarded as “disgusting”. Online sex activities had become a source of “easy money” for the child and family. They were perceived as not harmful because of anonymity and the absence of any actual physical contact. People in the community tolerate these online practices and do not report the incidence to authorities. The effects on children and youth were predominantly social and psychological, albeit perceived as economically beneficial. Some preventive and mitigating actions were recommended to curb the incidence of OCSEA in the communities.