Introduction
Statement of the Problem
Is the phenomenon of interest clearly identified?
The phenomenon of interest is clearly identified. The phenomena being studied is the mental health care experiences of women who are immigrants and refugees talks about how experience of immigrant and refugee women with mental illnesses with regards to support and coping mechanisms.
Is the problem stated unambiguously, and is it easy to identify
The problem is unambiguously stated, and this problem is that as a result of the migration process, women suffer from a variety of mental illnesses.
Does the problem have significance for nursing?
The problem has significance for nursing because these women are an increasing segment of the people that nurses will come across in their practice.
Is there a good match between the research problem and the paradigm and methods used?
Is a qualitative approach appropriate?
The study involves interviewing immigrant women, and there is a good match between the research problem and the paradigm and methods used, because what is better than learning about the experience of the patient then asking her in person? Furthermore, interviews allow researchers to understand the variety of complicated issues that influence the choice of interventions the individual uses as coping strategies to deal with her mental illness.
Literature Review
Does the report summarize the existing body of knowledge related to the problem or to the phenomenon of interest?
The report begins with an overview of the rates of mental illness all over the world and narrows down to Canada, and then among the immigrants and refugees. It also identifies that mental disorders such as depression, schizophrenia, posttraumatic stress disorder (PTSD), suicide, and psychosis have been associated with immigrants and refugees. The literature review goes ahead to identify the barriers, which influence the immigrants and refugees mental health care such as socioeconomic status, unemployment and underemployment, discrimination, gender issues, language barriers, discrimination, cultural differences, social stigma, and lack of awareness on mental healthcare services in Canada. While defining the terms ‘immigrant’ and ‘refugee,’ the paper also explains the caregivers’ perspective of the barriers to access of mental health care among the aforementioned populations.
Is the literature review adequate?
The literature review provides the necessary information about the problem under study. Different perspectives of the immigrant and refugee mental health care problems are identified. The literature review is inclusive of sufficient information to develop a research hypothesis.
Does the literature review lay a solid basis for the new study?
The literature review provides a perfect information background for the new study since it identifies most of the issues faced by the immigrant and refugee population in accessing mental health care services.
Conceptual underpinnings
Are key concepts adequately defined conceptually?
The key concepts including the terms “immigrants” and “refugees” are clearly defined in the Canadian context, which is the study environment. Other concepts such as barriers to access of mental health care and health care provider-perspectives are also addressed conceptually. Other areas addressed in the paper include cultural beliefs, values, patterns of relationship and communication, and social, political, and historical processes that impact health care behaviour.
Is the philosophical basis, underlying tradition, conceptual framework, or ideological orientation made explicit, and is it appropriate for the problem?
Research Questions
Are research questions explicitly stated? If not, is their absence justified?
The research questions cover the different perspectives of the research problem. While investigating how the immigrant and refugee women access health care services in Canada as well as the social support networks to assist them in coping with mental health problems, the research questions also delve into the perception of barriers for these populations in accessing health care services.
Are the research questions consistent with the study’s philosophical basis, underlying traditions, conceptual framework, or ideological orientation?
The research questions cover the relationships between the immigrants and refugees, culture and beliefs, and ideologies such as inequality and professionalism through the investigation of the barriers.
Method
Research Design and Research Tradition
Is the identified research tradition (if any) congruent with the methods used to collect and analyze data?
The identified research tradition used in this research study is ethnography, which has been defined in different perspectives including the art and science that describes a culture or a group, especially a minority such as a tribal community in a given society. In this research study, the immigrants are a minority community in Canada. The research tradition is congruent with the sampling procedure used to recruit the participants. The interviews used were also adequate to collect the data from these participants. The fact that the participants dictated the location and time of day for the interview ensured that the data gathered is appropriate for the study. The data coding, analysis, and interpretation done manually also provided the best results. The principal investigator alongside the other two qualified staffs was up to the analysis task.
Was an adequate amount of time spent in the field or with the study participants?
The researchers spent between the researchers and every participant was between 1.5 and 2 hours. The number of participants interviewed were ten (5 Chinese origin and 5 Sudanese origin), which implies that about 20 hours were spent on interviewing all the participants. The time was adequate to gather all the relevant information.
Did the design unfold in the field, allowing researchers to capitalize on early understandings?
The descriptive research design unfolded in the field and the researchers sought information through interviews from the immigrant and refugee women population in Canada using female interviewers with foreign ethno-cultural backgrounds in order to increase the understanding of immigrant experience.
Was there evidence of reflexivity in the design?
The researchers opted to use female interviewers in order to ensure that the participants were free to express their views and experiences as well as cultural perspectives on treatment and access to medical services as minority group.
Were there an adequate number of contacts with study participants?
The researchers exercised the maximum utility of their time with the research participants by ensuring that they retrieved valuable information from these participants. The time spent was neither too long to inconvenience the participants nor too short to gather the information
Population and Sample
Was the group or population of interest adequately described? Were the setting and sample described in sufficient detail?
The population sample represented the Sudan and Chinese immigrant populations, which are the two large groups of immigrant and refugee women in Canada. However, the sample size was small considering the number of Chinese and Sudanese immigrants and refugees. Nevertheless, the researchers indicated that there were barriers such as reasons for departing home countries and stigma.
Was the approach used to gain access to the site or to recruit participants appropriate?
The method used to recruit the participants was appropriate since it ensured that the participants understood the purpose of the study as well as its relevance. They were informed that they were participating in the study without coercion and were free to withdraw at any stage without any implications on them. This encouraged participation based on free will.
Was the best possible method of sampling used to enhance information richness and address the needs of the study?
A maximum variation purposive sampling procedure was used to select a heterogeneous sample of the population. The sampling method ensured that the researchers observed the commonalities in the experiences of the sample and the total population.
Was the sample size adequate? Was saturation achieved?
The sample size was small considering the total immigrant and refugee population. However, saturation was achieved with a balance in representation of the Sudanese and Chinese immigrants and refugees in the sample.
Data Collection and Measurement
Were the methods of gathering data appropriate? Were data gathered through two or more methods to achieve triangulation?
The interviews used to gather the data was appropriate for the study’s purposes. The data collection method used was only one. However, it gave accurate results. The interviewers also completed the field notes.
Did the researcher ask the right questions or make the right observations, and were they recorded in an appropriate fashion?
The participants were asked question concerning the factors affecting their methods of seeking mental illness help, the things that motivate or prevents them from seeking mental health solutions, and the sustainability and accessibility of the available mental health services. They also investigated mental health attitudes, knowledge, practices, beliefs, and care as well as the perceptions of the immigrants and refugees on the health care services and programs. The interviews were video tapped for recording. This provided adequate data for reference during analysis.
Was a sufficient amount of data gathered? Was the data of sufficient depth and richness?
The data collected in this research study was adequate to prove the hypothesis of the study. The researchers established the cultural, social, economic, and the psychosocial data related to mental health services received by the participants
Procedures
Were data collection and recording procedures adequately described, and do they appear appropriate?
Data collection and recording procedures including participant awareness creation, preparation, site selection, and actual data collection were adequately described. The interviewers were qualified to collect and record the data as well as create a good relationship with the participants.
Were data collected in a manner that minimized bias or behavioural distortions? Were data collection staff members appropriately trained?
The data were collected by the first author of the research paper. She is a graduate research assistant, which implies that she has adequate knowledge and experience as well as the training to collect the data. Behavioural distortions and bias were minimized by ensuring that the interviewer and the participants are of the same sex and have the immigrant and refugee experiences.
Were appropriate procedures used to safeguard the rights of the study participants?
The names used in the research study for the participants were pseudonyms. This was meant to reduce the stigma barriers to the research and that the participants were sure that the information they give will not be used for victimization or any other purposes apart from those of the research study.
Enhancement of Rigour
Were methods used to enhance the trustworthiness of the data (and analysis), and was the description of those methods adequate?
The video tapping provided adequate information for the trustworthiness of the data since the information was recorded as is, without any transcription errors
Were the methods used to enhance credibility appropriate and sufficient?
In order to enhance credibility, the participants were informed about the purpose of the study.
Did the researcher document research procedures and decision processes sufficiently that findings are auditable and confirmable?
The findings are appropriately documented in notes and are auditable through the videos.
Results
Data Analysis
Were the data management (e.g., coding) and data analysis methods sufficiently described?
The principal investigator and other trained graduate students (a master and a doctoral degree student), who were the research assistants, conducted the data coding, analysis, and interpretation. The data was thoroughly read and the comments recorded in the transcript margin, which refined, identified, and categorized emerging concepts, ideas, and themes. The research team members compared different personal aspects of the research such as comments, themes and ideas to achieve a unanimous result.
Was the data analysis strategy compatible with the research tradition and with the nature and type of data gathered?
The descriptive research tradition is consistent with the data analysis strategy used in the research study because it involves proper analysis of different responses from the participants.
Did the analysis yield an appropriate “product” (e.g., a theory, taxonomy, or thematic pattern)?
The analysis yielded a thematic pattern of finding the balance between the factors affecting the immigrants and refugees’ access to mental health care services through the in-depth analysis of the team.
Did the analytic procedures suggest the possibility of biases?
Findings
Were the finding effectively summarized, with good use of excerpts?
There three findings of the data analysis. The immigrant and refugee’s personal experiences with biomedicine as well as lack of information on mental health issues affect their mental health service accessibility. Secondly, the system level factors bar them from accessing these services. Finally, informal support practices and systems, and self-care strategies have been used in coping with mental illness among the participant population and their related problems.
Do the themes adequately capture the meaning of the data? Does it appear that the researcher satisfactorily conceptualized the themes or patterns in the data?
The findings adequately explain the meaning of the data. The thematic patterns indicate that the immigrants and the refugee women in Canada go through certain barriers, which hinder their access to mental health services. These barriers are either self or society generated.
Did the analysis yield an insightful, provocative, and meaningful picture of the phenomenon under investigation?
The immigrants and refugee experience with biomedicine, lack of awareness, and fear, system barriers, and care practices provided insightful information on the barriers to accessing quality mental health care among this population
Theoretical Integration
Are the themes or patterns logically connected to each other to form a convincing and integrated whole?
The interconnection between these barriers indicate that the immigrant and refugee women society in Canada experience problems in accessing mental health care services. They combine to form a general implication of inequality between the local community and the participants of the study.
Were figures, maps, or models used effectively to summarize conceptualization?
This research study did not use much of the figures apart from the inferences from the literature review. However, the qualitative presentation of facts effectively summarized the phenomenon of the study and indicated how different factors are interrelated in determining access to health care services.
If a conceptual framework or ideological orientation guided the study, are the themes or patterns linked in a cogent manner?
The Themes indicate are related from the historical and current situation revealed by the literature review to the investigations found in the interview section.
Discussion
Interpretation of the Findings
Are the findings interpreted within an appropriate social or cultural context?
The findings of this research study are discussed in different social and cultural contexts, which answer the research questions based on the access to mental health services and what these populations perceive as barriers, based on socio-cultural, psycho-social, and cultural contexts.
Are major findings interpreted and discussed within the context of prior studies?
The research findings of this research study are discussed in relation to the literature review. The discussion reveals significant similarities between the current research results and the previous research studies, which were investigated some years ago. Therefore, this implies that these conditions have been persistent among the populations for a significant period.
Are the interpretations consistent with study’s limitations? Does the report deal with the transferability of the findings?
Some of the limitations to this research study include the participants’ unwillingness to participate in the research based on the circumstances surrounding their departure from their homes such as historical and political processes. The interpretation of the findings also indicate that the participants’ population have problems associated with being a minority and reluctance to seek mental health information
Implications/Recommendations
Do the researchers discuss the implications of the study for clinical practice or further inquiry--and are those implications reasonable?
The researchers acknowledge the existence of disparities of access to mental health services by the marginalized communities of immigrants and refugees in their host societies. Therefore, it recommends that future research studies should delve into the subcultures of the aforementioned populations. This research study also proposes that, the active engagement with the marginalized immigrants and refugees is important for the development of health policies, which are sensitive of cultural diversities of the immigrant and refugee women in their host societies.
The article significantly identifies the roles played by cultural differences as well as social components of the society in shaping the access to mental health services. This can be translated to the whole implications of the diversities in opportunities in the society. The article uses the representative sample to indicate that the data are relevantly collected from people with the experiences of being a refugee or immigrant woman.
