Intersections between culture, sociodemographic change and caring: a qualitative study of current and prospective family caregivers in mainland China.

Aim: As the ageing population in China increases, support required from family caregivers for older relatives living with long-term health conditions also increases. This being so, this thesis explored the experiences and perceptions of current and prospective family caregivers, under the culture of Xiao (孝; filial piety). Design and Methods: Phase 1 was conducted with 19 Chinese students using 3 focus groups to gain greater familiarity with the culture and inform the main study (Phase 2). Adopting a social constructivist philosophical position, data for Phase 2 were obtained from three generational sub-samples: only-children affected by the One-Child Policy (OCP), parents affected by OCP, and family caregivers in the workforce, totaling 23 participants through virtual in-depth interviews with participants in mainland China. Interviews were translated, transcribed, and analysed using reflective thematic analysis. Findings and Conclusion: Phase 1 confirmed the centrality of the concept of Xiao to attitudes and beliefs around future caregiving for parents. Phase 2 findings’ overarching theme was ‘Competing pressures’, which comprised of three inextricably linked themes: (i) Caregiving beliefs, (ii) Contextual factors, and (iii) Caregiving conditions. Participants expressed meaningful desires to fulfil obligations, reflecting value-based convictions, stemming from their socio-cultural environment. Stressors experienced reveals structural and personal barriers to seeking support. Ultimately, extensive demands and limited coping strategies could diminish meaning in caregiving. This thesis makes a novel contribution on perceptions and experiences of family caregivers of older relatives within China as a collectivist society. Findings have implications for research, policy, and practice, highlighting the need for culturally attuned services to build resilience

Indigenous mental healthcare and human rights abuses in Nigeria: The role of cultural syntonicity and stigmatization

BackgroundIndigenous mental healthcare using traditional non-western methods termed “unorthodox approaches” has been observed in Nigeria historically. This has been largely due to a cultural preference for spiritual or mystical rather than biomedical formulations of mental disorder. Yet, there have been recent concerns about human rights abuses within such treatment settings as well as their tendency to perpetuate stigmatization.AimThe aim of this review was to examine the cultural framework for indigenous mental healthcare in Nigeria, the role of stigmatization in its utilization and interrogate the issues of human rights abuses within a public mental health context.MethodsThis is a non-systematic narrative review of published literature on mental disorders, mental health service utilization, cultural issues, stigma, and indigenous mental healthcare. Media and advocacy reports related to human rights abuses in indigenous mental health treatment settings were also examined. International conventions on human rights and torture, national criminal legislation, constitutional provisions on fundamental rights and medical ethics guidelines relevant to patient care within the country were examined in order to highlight provisions regarding human rights abuses within the context of care.ResultsIndigenous mental healthcare in Nigeria is culturally syntonic, has a complex interaction with stigmatization and is associated with incidents of human rights abuses especially torture of different variants. Three systemic responses to indigenous mental healthcare in Nigeria include: orthodox dichotomization, interactive dimensionalization, and collaborative shared care. Conclusions: Indigenous mental healthcare is endemic in Nigeria. Orthodox dichotomization is unlikely to produce a meaningful care response. Interactive dimensionalization provides a realistic psychosocial explanation for the utilization of indigenous mental healthcare. Collaborative shared care involving measured collaboration between orthodox mental health practitioners and indigenous mental health systems offers an effective as well as cost-effective intervention strategy. It reduces harmful effects of indigenous mental healthcare including human rights abuses and offers patients a culturally appropriate response to their problems</jats:sec

Obstetric fistula and related factors: assessing pattern and quality of life among women in Southwest Nigeria

Background: Obstetric fistula remains major contributor to maternal morbidity in low resource countries. Study examined quality of life and related factors among women with obstetric fistula in Southwest Nigeria. Methods: A cross-sectional study, involving 159 purposively selected women receiving care at the fistula centre, Wesley Guild Hospital, Ilesa, Southwest Nigeria. An adopted interviewer-administered World Health Organization Quality of Life Scale, WHOQOL-BREF was employed to examine quality of life. Data was processed and analyzed using IBM statistical product and service solutions (SPSS) software version 25. Analysis was done at univariate, bivariate and multivariate levels. Fisher’s exact, Analysis of Variance, Independent t-test and Regression analysis examined association and significance, p&lt;0.05. Results: Findings shows that 64.20% of the women had vesicovaginal fistula, 17.60% had rectovaginal fistula, 10.70% had uterovaginal fistula while 7.5% had ureterovaginal fistula. The mean scores for physical, psychological, social relationship and environmental health domains were 48.92 ±14.89, 39.91±17.42, 68.71±30.85, 42.75±18.60 respectively. Overall quality of life had mean score of 19.89 ±26.51 while 82.4% of the women had low quality of life, 2.5% had moderate and 15.1% had high quality of life overall. Regression analysis shows significant association between low quality of life and primipara (p=0.002, RRR=32.55, CI=3.73-284.19), multipara (p&lt;0.001, RRR=23.20, CI=5.12-105.13), middle socio-economic status (p=0.02, RRR=4.62, CI=1.29-16.59). Conclusions: Significant proportion of the women studied had low quality of life. Parity and socio-economic status were main predictors of quality of life. Holistic management of obstetric fistula should take cognizance of these variables for optimal outcomes

Intersections between the culture of Xiao (孝) and caring for older relatives in China: perspectives of United Kingdom-based Chinese students on future care for their parents

Emphasis placed on Xiao (孝; filial piety) in Chinese culture highlights parents' investment in their children with the expectation of being cared for when older. An increasing number of Chinese students come to the United Kingdom (UK) to study, with the majority returning home and likely to become future care-givers for their parents. Little attention has been paid to the implications of transnational mobility of Chinese students on the reciprocal aspects of future care responsibility. With the uniquely changing family structure due to consequences of the One-Child Policy, we conducted proactive research on the opportunities and challenges that Chinese transnational students anticipate they may face in future care-giving for elderly parents. Hence, this study's aim was to make a novel contribution to knowledge through exploration of the perspectives of Chinese students in England on intergenerational ties and filial obligations. Adopting a social constructivist philosophical position, we conducted three focus groups with 19 UK-based Chinese students, using a semi-structured topic guide with informed consent. Interviews were translated, transcribed and analysed using reflective thematic analysis, capturing semantic and latent meanings, and employed a descriptive and interpretative approach. Six themes were discovered, revealing a ‘culture of duty’ where familial obligation and societal expectations were prominent. Prospective care-givers anticipated a future dilemma between balancing work commitments and providing care as mandated by Xiao. Furthermore, it appeared that lack of preparedness might further exacerbate barriers faced when accessing support. We surmised that the changing demographics and absence of formal support could compound stressors over time, especially if cognitive dissonance arises as realities of life do not fit with societal expectations. Our findings imply that policy makers, practitioners and the government will need to adequately support prospective family care-givers who are returnees in caring for older generations

Exploration of meaning, motivation, and preparedness to care amongst the One‐Child Policy generation in China

Objectives: In China there is a cultural expectation (Xiao, 孝- filial piety) that offspring should provide care for their parents. However, the sustainability of this is threatened by the impact of the One-Child Policy (1979-2015), which has resulted in a diminution in numbers of children available to care, rapid urbanisation and increase in the number of women in employment. In this context, the objective was to explore the motivations, meaning, and preparedness for future caregiving of offspring affected by the OCP. Design and Methods: We adopted a constructivist position using a hermeneutic phenomenology approach and interviewed eight current and prospective caregivers aged 20-35 years about future caregiving responsibilities. Data were obtained through in-depth interviews, analysed using reflective Thematic Analysis. Results and conclusion(s): Three prominent themes: (i) Caregiving beliefs, (ii) Caregiving conditions and (iii) Contextual factors were identified under an overarching theme “Competing pressures- meanings, motivation and preparedness”. Despite the inherent stress, participants envisaged providing or organising care in the future to fulfil Xiao, and most viewed long-term care settings as unviable. Ultimately, the findings suggested that the actual performance of caregiving would not always measure up to ideal expectations, resulting in ‘filial discrepancy’ i.e., a gap between societal expectations for caregiving to older relatives and actual caregiving performance. This could adversely impact the caregivers and quality of care provided. The findings highlighted the urgent need to develop culturally attuned services, including education and training for family caregivers, health and social care professionals

Exploration of meaning, motivation, and preparedness to care amongst the one-child policy generation in China

YesIn China there is a cultural expectation (Xiao, -filial piety) that offspring should provide care for their parents. However, the sustainability of this is threatened by the impact of the One-Child Policy (OCP) (1979-2015), which has resulted in a diminution in numbers of children available to care, rapid urbanisation and increase in the number of women in employment. In this context, the objective was to explore the motivations, meaning, and preparedness for future caregiving of offspring affected by the OCP. We adopted a constructivist position using a hermeneutic phenomenology approach and interviewed eight current and prospective caregivers aged 20-35 years about future caregiving responsibilities. Data were obtained through in-depth interviews, analysed using reflective Thematic Analysis. Three prominent themes: (i) Caregiving beliefs, (ii) Caregiving conditions and (iii) Contextual factors were identified under an overarching theme "Competing pressures-meanings, motivation and preparedness". Despite the inherent stress, participants envisaged providing or organising care in the future to fulfil Xiao, and most viewed long-term care settings as unviable. Ultimately, the findings suggested that the actual performance of caregiving would not always measure up to ideal expectations, resulting in 'filial discrepancy' that is, a gap between societal expectations for caregiving to older relatives and actual caregiving performance. This could adversely impact the caregivers and quality of care provided. The findings highlighted the urgent need to develop culturally attuned services, including education and training for family caregivers, health and social care professionals.This work was supported by Research England: Quality Related Global Challenge Research Fund; University of Bradford

Stressors and coping mechanisms of family care-givers of older relatives living with long-term conditions in mainland China: a scoping review of the evidence

As the ageing population in China continues to grow, more people will be living with long-term health conditions and require support from family care-givers. This scoping review therefore aims to explore sources of stress and coping mechanisms adopted by care-givers of older relatives living with long-term conditions in mainland China. Literature searches were conducted in English (CINAHL, EMBASE, MEDLINE, PsycINFO and SCOPUS) and Chinese (CNKI, WANFANG DATA, CQVIP and CBM) databases between October and November 2019. The searches focused on the stressors and coping mechanisms utilised by family care-givers residing in the community. Narrative synthesis was used to identify themes within the data. Forty-six papers were included: 20 papers from English and 26 from Chinese databases. Six themes captured stressors: care-giving time (N = 22), financial resources (N = 17), role and personal strains (N = 42), preparedness (N = 4), social roles (N = 10) and lack of adequate formal support (N = 22); and one theme captured coping (N = 14). Unmet needs of care-givers of older relatives in mainland China were found to be extensive. Only a few studies had attempted to explore the causal link between stressors, coping and the influence of culture. Findings underscore the significance of adequately capturing intricacies around care-givers' unmet needs, rather than generalising on the basis of culture. Qualitative studies are critical to providing a better understanding of the relationship between stressors, coping and resources afforded to care-givers by their cultural environment. Having such understanding is crucial to inform the development of competent care, which promotes self-efficacy and self-actualisation in care-givers in mainland China

Consultations With Muslims From Minoritised Ethnic Communities Living in Deprived Areas: Identifying Inequities in Mental Health Care and Support

Background Limited research concerning existing inequities in mental health care and support services in the United Kingdom captures perceptions and lived experiences of the significantly underrepresented Muslim population. Methods Underpinned by social constructivist theory, we used consultation to facilitate public and patient involvement and engagement (PPIE) to identify inequities in mental health care and support experienced by Muslims from minoritised ethnic communities living in deprived areas in Liverpool, UK. The rationale was to (a) better inform standards and policies in healthcare and (b) provide a psychologically safe space to members of the Muslim community to share perceptions and experiences of mental health care and support services. To ensure trustworthiness of the data, member checking was adopted. This paper describes the procedure to achieving this consultation, including our recruitment strategy, data collection and analysis as well as key findings. Findings Twenty-seven consultees attended the women's consultation and eight consultees attended the men's consultation. Consultees were from Yemeni, Somali, Sudanese, Egyptian, Algerian, Pakistani and Moroccan communities and share the Islamic faith. Four key interlinked themes were identified from consultees' narratives: (1) broken cycle of trust; (2) an overmedicalised model of care; (3) community mental health prevention initiatives; and (4) culturally conscious training and education. Conclusions The Muslim population has identified numerous barriers to accessing mental health support and there is a need to resource activities that would aid deeper understanding of mental health support needs through continuous and meaningful community initiatives. This would afford mental health practitioners and organisations opportunities for developing realistic anti-racism strategies, effectively adopting social prescription, strengthening partnerships and collaborations aimed at supporting delivery of evidence-based mental health care provisions to tackle mental health inequities. Patient and public involvement This paper reports on the involvement and engagement of Muslims from minoritised ethnic communities living in the Liverpool city region

Standards of proficiency for registered nurses—To what end? A critical analysis of contemporary mental health nursing within the United Kingdom context

Against the backdrop of cultural and political ideals, this article highlights both the significance of mental health nursing in meeting population needs and the regulatory barriers that may be impeding its ability to adequately do so. Specifically, we consider how ambiguous notions of ‘proficiency’ in nurse education—prescribed by the regulator—impact the development of future mental health nurses and their mental health nursing identity. A key tension in mental health practice is the ethical-legal challenges posed by sanctioned powers to restrict patients' freedom at the same time as the desire (and obligation) to promote patients' self-determined recovery. The genericism of the UK's Future Nurse Standards do little to prepare mental health nurses to navigate the tensions that ensue. This has consequences for nurses and patients alike, as both risk experiencing the distress and dissonance that attends giving or receiving poor care. We argue that more needs to be done to enable mental health nurses to define and articulate the nuances of the profession as part of becoming critical, thoughtful and confident practitioners. Educators can contribute to this mission by aligning curriculum, pedagogy and assessment to create meaningful opportunities for mental health nursing students to engage with the complexities of mental health nursing practice. Without this, the credibility of the profession will continue to be questioned; its future uncertain

Interpretable machine learning with tree-based shapley additive explanations: Application to metabolomics datasets for binary classification.

Machine learning (ML) models are used in clinical metabolomics studies most notably for biomarker discoveries, to identify metabolites that discriminate between a case and control group. To improve understanding of the underlying biomedical problem and to bolster confidence in these discoveries, model interpretability is germane. In metabolomics, partial least square discriminant analysis (PLS-DA) and its variants are widely used, partly due to the model's interpretability with the Variable Influence in Projection (VIP) scores, a global interpretable method. Herein, Tree-based Shapley Additive explanations (SHAP), an interpretable ML method grounded in game theory, was used to explain ML models with local explanation properties. In this study, ML experiments (binary classification) were conducted for three published metabolomics datasets using PLS-DA, random forests, gradient boosting, and extreme gradient boosting (XGBoost). Using one of the datasets, PLS-DA model was explained using VIP scores, while one of the best-performing models, a random forest model, was interpreted using Tree SHAP. The results show that SHAP has a more explanation depth than PLS-DA's VIP, making it a powerful method for rationalizing machine learning predictions from metabolomics studies