Witnessed Incivility and Perceptions of Patients and Visitors in Hospitals.

Research has examined instances of incivility witnessed by physicians, nurses, or employees in hospitals. Although patients and visitors are members in hospitals, witnessed incivility from their perspective has rarely been empirically investigated. The aims of the current study are 2-fold: (1) to investigate the forms of incivility patients/visitors witness in hospitals and (2) to examine whether these patients/visitors believe these incivilities impact the target's sense of perceived control. An integration of interpretative phenomenological analysis and thematic analysis was used to code qualitative data (N = 77). Eight themes of witnessed incivility and 3 themes for impact on perceived control were identified. The results illuminate patterns of incivility targeted at marginalized groups, historically underrepresented in hospital-focused incivility research (eg, homeless individuals, incarcerated individuals, the elderly individuals). The majority of witnesses believed the incident of incivility would negatively impact the target's perception of control, possibly affecting their experience and health. The current study demonstrates that empirically investigating witnessed incivility from the patient/visitor perspective provides critical information about the unique patterns of mistreatment occurring within hospital contexts.

Capturing women's voices: lived experiences of incivility during childbirth in the United States.

Increasing research has improved global awareness of mistreatment during childbirth. However, research primarily focuses on "higher-intensity" mistreatment during childbirth, and largely focuses on women outside the United States (U.S.). We address these gaps by exploring the phenomenology of incivility, a "lower-intensity" mistreatment, experienced by women during childbirth in the U.S. We used a combination of interpretative phenomenological analysis (IPA) and thematic analysis to analyze the qualitative responses (N = 200) of experiences of incivility during childbirth. We identified nine primary themes of incivility: lack of empathy, denial/minimization, ignoring, pressure, privacy issues, breastfeeding/formula issues, identity-based, uncomfortable physical interactions, and silencing. Results demonstrate incivility is critical to consider as a form of mistreatment in childbirth because it violates respect. The results help nuance the understanding of how mistreatment is experienced in childbirth. Results also demonstrate unique manifestations of incivility were shaped by the sociopolitical context of the U.S. Implications for policy development and health outcomes are discussed.

Discrimination, perceived control, and psychological health among African Americans with hypertension.

Hypertensive individuals represent a "vulnerable" population regarding psychological health. While African Americans are disproportionally burdened with hypertension, pathways predicting their psychological health remain understudied. We examine if discrimination is associated with psychological health, through an indirect effect of perceived control within a sample of African American individuals with prevalent hypertension (n = 990). Discrimination was significantly associated with an increase psychological distress and a decrease in psychological well-being through a reduction in perceived control, supporting Minority Stress Theory. Cardiovascular disease risk factor management implications are discussed.

Experiences of Patient Incivility: A Qualitative Study.

BACKGROUND: Incivility is one of the most prevalent forms of interpersonal mistreatment. Although studies have examined the full range of experiences of incivility against nurses and other hospital personnel, very few studies examined the forms of incivility that patients face in a hospital. OBJECTIVE: To empirically investigate the range of uncivil experiences targeted against patients. Our study furthers our understanding of the phenomenology of incivility from the patients' perspective. METHOD: We used interpretative phenomenological analysis to analyze participant's (n = 173) experiences of incivility in a hospital. RESULTS: We identified 6 major themes of incivility, namely Insensitivity, Identity Stigma, Gaslighting, Infantilization, Poor Communication, and Ignored. CONCLUSION: The findings highlight that instances of incivility are present in almost all aspects of the patient experience and take on unique forms, given the patient's role in the hospital. Implications for health consequences are discussed.

Perceptions of control and improved psychological, physical, and social functioning in postmenopausal women.

Throughout life, social messages about women's bodies put them at greater risk of specific psychological health conditions than men; yet little is known about what psychological factors can help promote mental health in older women. In this study, we examine how perceptions of control relate to perceptions of psychological health, in addition to physical health, and social functioning in a sample of postmenopausal women. Results suggest that increased perceptions of control relate to improved perceptions of health via a reduction in negative affect. Implications for promoting health and reducing gendered mental health disparities are discussed.

Theoretical, methodological, and ethical challenges to the study of immigrants: perils and possibilities.

Research on immigrant communities has often been reductionist, stereotypical, and simplistic, and even the most well-intentioned researchers are susceptible to using cultural deficit models. This chapter critically evaluates some of the dominant tensions and problem areas with respect to researching immigrant communities. Specifically, we analyze three primary challenges that researchers encounter: the heterogeneity of immigrant lives, adequate representations of immigrant communities, and researcher privilege. In addition to identifying these unique theoretical, methodological, and ethical concerns, we draw from critical theory, feminist scholarship, and cultural psychology to provide an interdisciplinary solution. For researchers investigating immigrant communities, we advocate the following: (a) grounding of intersectional frameworks; (b) reliance on a risk and resilience framework; (c) phenomenological understanding of immigrants' everyday lives; (d) inclusion of immigrant participants' voices; and (e) cultivation of negative capability. Finally, we briefly review selected studies that address three recurring challenges that researchers face and heed our five recommendations.

A multiple-group path analysis of the role of everyday discrimination on self-rated physical health among Latina/os in the USA.

BACKGROUND: Few studies have examined the psychosocial mechanisms through which self-reported discrimination may influence the health status of Latinos. PURPOSE: This study examined the mediating role of subjective social status in the USA and psychological distress on the relation between everyday discrimination and self-rated physical health, and the moderating role of gender and ethnicity. METHODS: A US population-based sample of Latinos (N = 2,554) was drawn from the National Latino and Asian American Study. Respondents completed measures of everyday discrimination, subjective social status, psychological distress, and self-rated physical health. RESULTS: Path analysis revealed that among the total sample, subjective social status and psychological distress sequentially mediated the effect of everyday discrimination on self-rated physical health. Psychological distress was a more consistent mediator across Latino subgroups. Gender and ethnicity moderated the mediation model. CONCLUSIONS: This study provides a systematic examination of how psychosocial mechanisms may operate differently or similarly across Latino subgroups.

The idealized cultural identities model on help-seeking and child sexual abuse: a conceptual model for contextualizing perceptions and experiences of South Asian Americans.

In this paper, we propose an interdisciplinary framework to study perceptions of child sexual abuse and help-seeking among South Asians living in the United States. We integrate research on social marginality, intersectionality, and cultural psychology to understand how marginalized social experience accentuates South Asian immigrants' desire to construct a positive self-identity. Using model minority ideology as an example of such a construction, we highlight its role in silencing the topic of child sexual abuse within this immigrant community as well as its impact on attitudes towards professional mental health services. We contend that our framework, the idealized cultural identities model on help-seeking and child sexual abuse, provides a unique analytical model for clinicians and researchers to understand how South Asian Americans process, experience, and react to child sexual abuse.

Idealized cultural beliefs about gender: implications for mental health.

BACKGROUND: In this paper, we examined the relationship between culture-specific ideals (chastity, masculinity, caste beliefs) and self-esteem, shame and depression using an idealized cultural model proposed by Mahalingam (2006, In: Mahalingam R (ed) Cultural psychology of immigrants. Lawrence Erlbaum, Mahwah, NJ, pp 1-14). METHODS: Participants were from communities with a history of extreme male-biased sex ratios in Tamilnadu, India (N = 785). RESULTS: We hypothesized a dual-process model of self-appraisals suggesting that achieving idealized cultural identities would increase both self-esteem and shame, with the latter leading to depression, even after controlling for key covariates. We tested this using structural equation modeling. The proposed idealized cultural identities model had an excellent fit (CFI = 0.99); the effect of idealized identities on self-esteem, shame and depression differed by gender. CONCLUSIONS: Idealized beliefs about gender relate to psychological well-being in gender specific ways in extreme son preference communities. We discuss implications of these findings for future research and community-based interventions.

John Henryism, self-reported physical health indicators, and the mediating role of perceived stress among high socio-economic status Asian immigrants.

This study examined the relationship between John Henryism (a strong behavioral predisposition to engage in high effort coping with difficult barriers to success) and self-reported physical health among high socio-economic (SES) status Asian immigrants to the USA. Cross-sectional data were collected from a community sample of 318 self-identified Chinese and Indian immigrants aged 18-73, averaging 10.2 yr lived in the US. In addition to the John Henryism Active Coping Scale, health status was measured using ordinal ratings of global self-rated health, somatic symptoms and physical health functioning. We also evaluated whether perceived stress would explain the relationship between John Henryism and health. Controlling for demographic factors, regression analyses showed that higher John Henryism significantly predicted better self-rated health and physical functioning, and fewer somatic symptoms. These relationships were significantly and fully mediated (for physical functioning and somatic symptoms) or partially mediated (for self-rated health) by lower perceived stress. Results suggest that John Henryism relates to better health among high SES Asian immigrants in part by reducing perceived stress. To better understand and improve health in all racial/ethnic groups, especially racial minorities and immigrants, more research is needed on John Henryism and perceived stress as important psychosocial mechanisms intervening between environmental exposures and health outcomes.

Essentialism and the cultural psychology of gender in extreme son preference communities in India.

Using a cultural ecological framework, the authors examined key psychological antecedents of a pressing public health problem in Tamilnadu, India: the persistence of extreme forms of female neglect including female infanticide and feticide. Community-based respondents (N = 798) were recruited from Tamilnadu, a south Indian state, from villages with highly male biased sex ratios. Study 1 examined beliefs about behavioral gender transgressions in the villages that are identified as having extremely male-biased sex ratios. Study 2 examined the same participants several weeks later, investigating beliefs about biological gender essentialism and attitudes toward violence. Although behavioral and biological aspects of gender were essentialized differently, a regression analysis controlling for SES and marital status found that the more men essentialized female identity, the more they endorsed violence against women and the less anxiety they felt. The authors conclude by discussing the cultural psychological implications of this asymmetry in the essentialist beliefs about gender.

Perceived congruence between expectations and outcomes: implications for mental health among Caribbean immigrants.

Previous research on the psychological adjustment of immigrants has cited the perceived congruence between premigratory expectations and postmigratory realities as a primary determinant of psychological well-being. Using a sample of 137 first-generation Caribbean immigrants, a measure of the perceived congruence between expectations and outcomes was developed to examine the relationship between perceived congruence in various life domains, and indexes of psychological well being, such as anxiety, depression, and life satisfaction. Overall, perceived congruence was positively associated with life satisfaction and negatively associated with depression. Factor analyses revealed the presence of two reliable domains (social and professional) in the congruence measure. Perceived congruence in both domains was positively associated with life satisfaction, and perceived congruence in the professional domain was negatively associated with depression symptoms. Implications of the findings are discussed.

Transnational ties and mental health of Caribbean immigrants.

Immigration scholars have demonstrated the increasing importance of transnational activities among contemporary immigrants. While much of the previous research has emphasized social and economic outcomes, very little attention has been paid to psychological well-being or mental health. Using a community sample of West Indian immigrants, we developed an empirical measure of the nature and frequency of transnational practices. The resulting Transnationalism Scale is examined for psychometric properties using an exploratory principal components factor analysis, and bivariate correlations with pre-existing measures of psychological well-being, perceived social support, and ethnic identity. Results reveal five factors, some of which are significantly correlated with measures of psychological well-being, social support, and ethnic identity. Findings suggest that transnationalism, as a construct, is a valid measure for this population. We argue that transnational ties shape various aspects of immigrants' lives.

"We're not speaking any more": a cross-cultural study of intergenerational cut-offs.

This study of individuals in the U.S. and Tamil Nadu, India, examines the reasons given for voluntary limitations on contact between adult children and their parents ("cut-offs"). We examine the possibly that these breeches occur as a solution to the problem of negative social relationships by looking at the different cultural contexts of the U.S. and India. We challenge Bowen's (1978) assertion that intergenerational cut-offs always occur in the vain attempt to promote differentiation and propose a system for categorizing the reasons given for cut-offs, and explore the research and practice implications of the findings. Although based on a limited sample, this paper provides an important contribution to this understudied aspect of interpersonal relationships.