Ethnic Minority Clients Research Articles

Decolonising integrative practice with Black queer men who experienced trauma: A thematic analysis

AbstractAimBlack queer men in the UK are increasingly at risk of mental health problems related to anxiety and depression, often triggered by traumatic experiences. This study explored the efficacy of integrative practice with Black queer men who experienced trauma from a decolonised, intersectional and queer‐affirming perspective.MethodOne‐to‐one semi‐structured interviews with nine integrative practitioners were completed. Data collected from these interviews were analysed using Braun and Clarke's six stages of reflexive thematic analysis (RTA).FindingsRTA identified four subordinate themes: (1) understanding the experience of Black queer men, (2) developing the working alliance and use of self in practice, (3) effective integrative practice and (4) intersectional differences and considerations. Findings discussed the varying forms of trauma Black queer male clients experienced that impacted their mental health and how developing a strong working alliance with Black queer men was crucial when supporting them to recover from trauma. Additionally, the participants described a breadth of trauma‐informed integrative counselling and coaching practice. A decolonised approach utilising the intersection of race, gender and sexuality of Black queer men was successfully integrated into the approach used by practitioners in this study.ConclusionOverall, this study evidenced that a decolonised perspective to integrative practice effectively supports Black queer men to recover from trauma. Future research should focus on an integrated approach with Black queer men and other gender and sexual ethnic minority clients who experienced trauma.

Cultural Competency: A Cardinal Force in Social Work Practice and Service-A Cultural Practice Guide for Human Services and the Helping Professions

Culture is a significant factor in human development, sustainability, and societal cohesion. It is greatly cherished and holds universal significance to individuals, groups, families, communities, societies, and nations. Culture affects how a victim, survivor, client, or family responds to life altering experiences such as domestic violence, child abuse and neglect, sexual abuse, and trauma. It also influences how a client or family deals with loss and grief, resilience, and recovery. Hence, understanding different cultures and cultural practices, symbols, artifacts, the meaning they hold, and respecting and operating within the confines of a set culture is very important. Cultural competency is a key medium through which this need can be addressed. Cultural competency is a core principle that should undergird a social worker’s service/practice with clients as enshrined in the Code of Ethics of the National Association of Social Workers. Failure to execute cultural competency is detrimental to the delivery of appropriate and effective services to clients, and a digression from the code of ethics and professional standard of practice within the profession of social work. The execution of cultural competency in social work practice fosters a positive and enduring therapeutic relationship between the social worker and client, and lays the foundation for productive engagement, interaction, and intervention. From this perspective, this article embodies a review of the research literature on the topic of culture and culturally competent practice from different disciplines. The review and analysis include a study this author conducted in Ghana-Africa that examined the significance of culture and its impact on individuals and their perceptions as well as behaviors within a cultural context. Specifically, the study focused on the cultural effects on learning and the transfer of knowledge, and this paper relates its significant implications for understanding culture and responsiveness to cultural practices within professional practice. The findings from this original study revealed that culture impacts an individual’s perception and behavior significantly. The implications for culturally effective social work practice were discussed and recommendations for cultural competence, responsive, and responsible practices including anti-oppressive intervention strategies at the micro, mezzo and macro levels were put forward. In addition, a cultural conceptual practice model called GACIE was proposed for use in assessing and intervening with culturally diverse ethnic minority clients.

The development of the Broaching Assessment Scale: A client-rated measure of therapists’ broaching behaviour in clinical counselling*

Objective: Addressing ethnic-cultural topics during the process of psychotherapy, i.e. broaching, is considered highly important for ethnic minority clients who consult mental health care services. Surprisingly little is known, however, about clients’ perception of a therapist’s broaching qualities, and how clients’ mental construction of broaching translates into behavioural broaching acts a therapist may display. Method: Based on previous work and nine in-depth interviews with ethnic minority clients, a client-rated measure of therapists’ broaching behaviour was developed and psychometrically evaluated in two samples. Sample 1 (N = 252 UK ethnic minority clients) was used to empirically delineate the factor structure of an initial item set. Participants were then resolicited to complete a revised item pool. Results: The empirical structure resulted in a final 25-item broaching instrument with five subscales probing into therapists’ broaching behaviour. This Broaching Assessment Scale (BrAS) was validated in Sample 2 (N = 239 US ethnic minority clients). Strict measurement invariance of the factor structure was observed across the two samples and distinctive correlational patterns with therapeutic process measures were found. Conclusion: The BrAS provides new insights on how sensitivity to ethnic-cultural topics can be targeted along its concrete features, and is a promising tool for conceptualizing culturally sensitive mental healthcare assessment.

Cultural adaptation of CBT as a human rights issue: A UK study

Cognitive behaviour therapies have been used widely across the world and have been recommended as the first line of psychotherapeutic treatment for multiple mental health disorders. However, such blanket guidelines for use of Western-generated psychotherapies discount the socio-cultural determinants and aspects of mental health when recommended unadapted across ethnicities, eventually creating disparities in thequalityof care available to different populations. Examining the cultural relevance of these therapies for ethnic minority groups has therefore become an important avenue of inquiry.Recent decades have brought a revolution of cultural competency and adaptation research for such psychotherapies. Despite recent advances in cultural competency and adaptation research, the available body of literature in this domain remains limited and heterogenous. Furthermore, the lack of mandatory cultural competence training and the ineffectiveness of existing programmes increase the obvious discrepancy in the provision of mental healthcare services for certain minority groups, jeopardising equitable access and raising concerns about human rights protection.AimsThis study aimed to explore UK-based CBT therapists’ use of adaptations in their own practice, and understand what elements they tend to adapt, the impact and feasibility of their approaches, and the challenges faced by those who adapt and those who do not. The larger intention was to be able to gather information to recommend basic direction for policy and research to create plans for the benefit of ethnic minority groups for whom access to quality, tailored healthcare is currently largely overlooked.MethodThe study involved developing a survey informed by existing literature and distributing it to UK-based CBT therapists.ResultsThis study found that CBT therapists and their clients value cultural competency. It also found that therapists tend to believe that adapting CBT techniques and implementation and using culturally significant idioms and stories are impactful for their clients and practical to achieve as therapists. It further found that current barriers to adapting CBT for ethnic minority clients involves a lack of resources to study the efficacy of adaptations as well as a lack of well-established evidence-based adaptations in existing literature.ConclusionThe authors recommend that policymakers and service managers prioritise the regulation of cultural competence in psychotherapy and afford resources and incentive to researchers and clinicians that would eventually help to improve the effectiveness of their approaches and enhance mental health outcomes for ethnic minority groups. Future research could build on this study using qualitative methods or creating more robust surveys, using random sampling, and drawing larger sample sizes.

Research and engagement considerations for alcohol use telehealth services within HIV care: a qualitative exploration in federally qualified health centers

ABSTRACT The prevalence of alcohol misuse is high among people with HIV (PWH); however, access to and utilization of evidence-based alcohol misuse interventions remain limited. Telehealth is one treatment approach with the potential for enhancing substance use disorder treatment utilization for PWH served by Federally Qualified Health Centers (FQHCs). However, questions remain regarding barriers to alcohol-focused telehealth service integration and telehealth research in FQHCs. This study employed qualitative methods, guided by the Dynamic Sustainability Framework, to evaluate barriers and cultural factors impacting FQHC telehealth integration. Eighteen qualitative interviews were completed with staff and leaders across four FQHCs. Interviews were analyzed using directed content analysis, and codes were organized into a priori and emergent themes. Key themes included the presence of common workflows for referring clients to substance use disorder treatment; existing research workflows and preferences for active project staff involvement; telehealth barriers including exacerbation of healthcare disparities and high provider turnover; and the importance of cultural humility and telehealth adaptations for sexual, gender, racial and ethnic minority clients. Findings from this study will inform the development of an alcohol-focused telehealth implementation strategy for a Hybrid Type 1 implementation effectiveness trial to enhance FQHC substance use disorder treatment. Trial registration: ClinicalTrials.gov identifier: NCT02563574..

Addressing cultural topics during psychotherapy: Evidence-based do’s and don’ts from an ethnic minority perspective*

Objective: Broaching—i.e., a counsellor’s effort to install meaningful conversations in psychotherapy concerning one’s cultural identity—is a strong predictor of positive treatment outcomes and client satisfaction, especially for minority-identified clients. Despite this understanding, the broaching literature has struggled to translate broaching principles into practical recommendations for specific behaviours and skills. The current study therefore explores the effects of broaching approaches by the therapist (i.e., direct, indirect and avoidant approach) about cultural topics including ethnicity, religion, gender expression and socioeconomic status on clients’ perception of (1) the multicultural orientation of the therapist and (2) the frequency of microaggressions during therapy. Method: These research questions were investigated in a sample of ethnic minority clients (N = 231) who followed at least one session of mental healthcare counselling during the last 12 months. Results: Findings show that indirect broaching is the overall most favourable approach, whilst avoidant broaching is consistently negatively associated with all therapy-related outcome measures. Conclusion: The results lay the basis for practical guidelines for broaching in psychotherapy, and provide counsellors with a foundation for having cultural conversations in an effective and respectful manner.

Practitioners’ Understanding Of Sociological And Medical Models Of Mental Illness When Working With Ethnic Minority Victims/Survivors Of Child Sexual Abuse (CSA)

Being unaware of the pros and cons of a sociological versus medical approach to the treatment of mental illness as a result of child sexual abuse (CSA) risks abuse of gendered power in the clinical setting and disengagement from ethnic minority clients who already traverse steep barriers to help-seeking. To address this, an education/training program was developed, delivered, and evaluated in Australia over six months using mixed-methods (T1 n=112, T2 n=44). At T1 and T2, hardly any participants thought a sociological approach – which squarely names sexism – was not useful or effective. However, they were mostly social workers and counsellors, and therefore centrally aware of social justice issues. Replication with medical practitioners is required to see how findings compare. The results also speak of ethnic minority practitioners becoming feminists against highly valued traditional gender roles in collectivist cultures, and of Anglo practitioners not judging highly patriarchal societies to demonstrate respect for difference. The results contribute new and innovative data, including about practitioners’ commitment to social justice when faced with forced choice questions about it. This study provides a platform for future participatory research with victims/survivors and medicos, so patriarchy outside the clinical context is held to professional account and not repeated within it.

Ethnic Minority and Majority Social Workers Working with Ethnic Minority Clients: Culture-Bound Professional Interventions and Burnout among Arab and Jewish Israeli Social Workers

Purpose This study tests a new bicultural model of social work with ethnic minority clients. We examined how often social workers applied professional interventions rooted in the minority and majority cultures and how the choice of interventions affected the social workers' burnout. Methods: The study was conducted in Israel, and the research samples included Arab ( n = 300) and Jewish ( n = 210) social workers. Results: We found that Arab and Jewish social workers more often used interventions rooted in the minority than in the majority culture. More frequent application of both types of interventions was associated with a higher level of personal accomplishment in both groups of social workers. However, the connection between interventions rooted in the majority culture and burnout was positive among Jewish and negative among Arab social workers. Discussion: The implementation of the obtained results in social work practice with ethnic minorities is discussed.

Midwives’ perceived barriers in communicating about depression with ethnic minority clients

ObjectiveThis study aimed to assess the most influential barriers midwives perceive in communicating about depression-related symptoms with ethnic minority clients. MethodsIn-depth interviews were held with midwives (N = 8) and Moroccan-Dutch women (N = 6) suffering from perinatal depression to identify the most salient communication barriers. Subsequently, an online survey among midwives (N = 60) assessing their perceived barriers and the occurrence of these barriers in practice was administered. Composite scores using the QUOTE methodology were calculated to determine influential barriers. ResultsThree types of barriers emerged from the interviews. Educational-related barriers, client-related barriers and midwife-related barriers. Results of the survey showed that the most influential barriers were educational-related barriers (e.g. lack of culturally sensitive depression screening instruments) and client-related barriers (e.g. cultural taboo about talking about depression). ConclusionCulturally sensitive screening instruments for depression and patient education materials should be developed to mitigate the educational-related barriers to communicating about depression. Patient education materials should also target the clients’ social environment (e.g. husbands) to help break the cultural taboo about depression. Practice implicationsBased on this study’s results, communication strategies to empower both midwives and ethnic minority clients with depression can be developed in a collaborative approach.

Acculturation Orientations, Professional Interventions and Burnout amongst Ethnic Minority Social Workers Working with Ethnic Minority Clients: A Case of Arab Citizens of Israel

Abstract In this article, we formulate a new bicultural model of social work with ethnic minorities. The suggested model connects acculturation orientations, professional interventions and burnout amongst social workers working with ethnic minority clients. We tested this model in a sample of Arab Israeli social workers (n = 299). The study results confirmed that ethnic minority social workers working with ethnic minority clients used interventions that may be classified as either rooted in the minority or the majority culture. Arab Israeli social workers used slightly more often interventions rooted in the minority than the majority culture; however, the two types of intervention were complementary rather than contradictory. Acculturation orientations of Arab Israeli social workers were connected to their choice of professional interventions. Specifically, a higher preference for separation was associated with more frequent use of professional interventions rooted in the minority culture. In contrast, a higher preference for integration was associated with more frequent use of interventions rooted in both minority and majority cultures. More frequent use of interventions rooted in the majority culture was associated with a lower level of burnout and a higher level of personal accomplishment, whilst more frequent use of interventions rooted in the minority culture was associated with a higher level of burnout. Based on the obtained results, an integrative approach to education and training of social workers and social work practice with ethnic minorities is advocated.

Consultation rate and chlamydia positivity among ethnic minority clients at STI clinics in the Netherlands.

Although ethnic minority clients (EMs) from STI endemic countries have a higher risk for STI, little is known about their STI clinic consultation rate proportionality. The aim of this study was to assess consultation and chlamydia positivity rates among different EMs visiting STI clinics in the Netherlands. We calculated consultation rates in EM groups by dividing the number of STI consultations by the total number of inhabitants in the region belonging to an EM, then compared the EM rates to native Dutch rates. Factors associated with chlamydia positivity were analysed using multivariate regression analysis. A total of 23,841 clients visiting an eastern Netherlands STI clinic between 2011 and 2013 were included in the analysis, of which 7% were EMs. The consultation rate of native Dutch clients was 22.5 per 1000, compared to 8.5 per 1000 among EMs. Consultation rates in all EMs were lower than in Dutch clients, except for Antillean or Aruban EMs and Latin American EMs. The chlamydia positivity rate among all clients was 15.5%, and Antillean or Aruban ethnicity (27.1%) EMs had the highest rates. Multivariate analysis identified the following factors associated with chlamydia positivity: Eastern or Northern European EM, African EM, Antillean or Aruban EM, STI related symptoms, heterosexual preference, partner in a risk group, receiving a partner notification, and having had three or more partners in the past six months. On a population level, most EMs visit STI clinics less often than native Dutch clients, but they have a higher rate of positive chlamydia diagnoses. STI clinics should increase outreach activities for EM clients because they are insufficiently reached by current practices, but contribute substantially to chlamydia incidence rates.

The Black Lives Matter Movement: A Call to Action for Couple and Family Therapists.

The frequent police killings during the COVID-19 pandemic forced a reckoning among Americans from all backgrounds and propelled the Black Lives Matter movement into a global force. This manuscript addresses major issues to aid practitioners in the effective treatment of African Americans via the lens of Critical Race Theory and the Bioecological Model. We place the impacts of racism on Black families in historical context and outline the sources of Black family resilience. We critique structural racism embedded in all aspects of psychology and allied fields. We provide an overview of racial socialization and related issues affecting the parenting decisions in Black families, as well as a detailed overview of impacts of structural racism on couple dynamics. Recommendations are made for engaging racial issues in therapy, providing emotional support and validation to couples and families experiencing discrimination and racial trauma, and using Black cultural strengths as therapeutic resources.

The Experiences of Couple/Marriage and Family Therapists of color: A Survey Analysis.

The family therapy literature documenting the experiences of couple/marriage and family therapists (C/MFTs) of color as a group is limited. The purpose of this study was to assess the status of C/MFTs of color in their clinical training programs, clinical work, and related areas of professional challenges and opportunities. Participants (N=113) completed a one-time, anonymous electronic survey on SurveyMonkey consisting of demographic questions, closed- and open-ended questions about their experiences. Key findings are reported related to C/MFTs of color experiences in training programs, areas of professional need, and working with racial and/or ethnic minority clients. These findings shed light on how social justice principles and practices upheld in our field are experienced from the emic perspectives of C/MFTs of color. These voices help to broaden our understanding of how we might move forward in advocating for and advancing a more culturally responsive agenda within our profession.

Implementation of Dialectical Behavior Therapy with Suicidal and Self-Harming Adolescents in a Community Clinic

The object of this research was to examine the feasibility and effectiveness of Dialectical Behavior Therapy (DBT) with suicidal and self-harming adolescents treated in a community clinic. A group of 24 adolescents at high risk for suicide were enrolled in 6 months of comprehensive DBT, provided by therapists and trainees at a county-run outpatient mental health clinic serving disadvantaged, ethnic minority clients. Results showed significant pre/post-treatment decreases in suicide attempts, non-suicidal self-injury behaviors (NSSI), and suicidal ideation. Results also showed significant decreases in other suicide risk factors, including emotion dysregulation, depression, impulsivity, BPD symptoms, psychopathology, PTSD symptoms, and substance use, as well as increases in family expressiveness and reasons for living. Treatment retention and satisfaction rates were high. As many youth at risk for suicide will be treated in community settings, findings showing that receiving DBT in a community clinic resulted in significant improvements across a range of suicide risk factors are an important contribution to the adolescent suicide prevention literature.

State of the art in U.S. multicultural social work practice: Client expectations and provider challenges

ABSTRACTTo obtain a comprehensive view of the level of knowledge and development achieved in multicultural social work practice, I conducted a scoping review of U.S. empirical literature for the 10-year period from 2007 through 2016. The review revealed that across the board racial and ethnic minority clients continue to experience marginalization and report low satisfaction with services. Conversely, providers are subject to some tensions and biases toward multicultural practice exacerbated by employers’ lack of emphasis on cultural competence. The problematic findings from the review suggest that our current approaches to cultural competence may need to be reexamined.

Reported factors for practitioners working with diverse ethnic minority clients to support positive therapeutic outcomes: An Interpretative Phenomenological Analysis

Background:It is an ethical imperative that practitioners recognise and understand the different factors that may contribute to our work with ethnic minority clients (BPS, 2018; HCPC, 2016). Previous research provided conflicting views regarding the key factors for practitioners working with people from ethnically diverse minorities to support Positive Therapeutic Outcomes (PTO). This study aimed to explore the experiences of counselling psychologists in the UK working with people from ethnic minorities, and to find the strengths and limitations the practitioners encounter when working with ethnically diverse clients.Method:Semi-structured interviews were conducted with five participants, and data was analysed using Interpretative Phenomenological Analysis (IPA).Results:One superordinate and three subordinate themes emerged: reported limitations and ways to overcome them (institutional disparities; lack of multicultural training; multicultural awareness)Conclusion:Findings suggest the presence of common elements that contribute to PTO with people from ethnic minorities. Consistent with previous research the study shows that participants experience barriers to their practice which might affect the efficacy of therapeutic outcomes with ethnic minorities.Keywords:ethnic minority; diversity; therapeutic outcomes; IPA.

Punishment on the Frontlines of Public Service Delivery

In the wake of neoliberal public policy reforms, public welfare programs have become more directive in setting behavioral expectations for clients and more punitive in responding to client noncompliance. Many public welfare programs give public employees discretionary authority to dispense sanctions when clients do not follow or comply with the policies and procedures required to receive the welfare benefits. At the same time, research shows that public employees’ use of discretion in decision-making that affects clients can occasionally be marked by nontrivial racial biases and disparities. Combining these insights and drawing on the Racial Classification Model (RCM) for a theoretical model, this article examines how public employees’ decisions to sanction clients are shaped by client ethnicity in the Scandinavian welfare state of Denmark. With Danish employment agencies as our empirical setting, we present findings from two complimentary studies that expand our understanding of the scope conditions of the RCM. In Study 1, we present survey experimental evidence that municipal employment caseworkers are more likely to recommend sanctions for clients of ethnic minority (Middle-Eastern origin) than for clients of the ethnic majority (Danish origin). In Study 2, we triangulate the findings from Study 1 with analyses of agency-level administrative data from the national employment program. Demonstrating how client ethnicity shapes caseworkers’ decisions to sanction in a non-U.S. context adds important knowledge about the generalizability of both the RCM and extant empirical research on racial disparity in public employee decision-making to different subjects and settings. Moreover, we use the survey experiment to investigate how three caseworker characteristics–gender, ethnicity, and work experience–condition the relationship between client ethnicity and caseworkers’ decision to sanction clients. While previous research has extended the RCM with insights on the moderating effects of client characteristics, we thus contribute with new knowledge about the moderating effects of caseworker characteristics. We find no moderation effects for caseworker gender or ethnicity, but work experience appears to diminish the influence of client ethnicity on the caseworkers’ sanctioning decision. Overall, our studies offer support that ethnic minority clients (clients of Middle-Eastern origin) are more likely to be punished for infraction of policy than ethnic majority clients (clients of Danish origin)–and that caseworker work experience mitigates part of this bias. We discuss the implications of these findings for future public administration research and policy.

Barriers to continuity in the pathway toward occupational engagement among ethnic minorities with mental illness

Ethnic minorities have particular needs and difficulties in terms of support for meaningful occupations, lack of access to and use of occupation-based rehabilitation services. They are not established in the labour market and are seldom in paid employment. This study aimed to investigate how mentally ill ethnic minority clients experience, feel and think about participation in occupation-based rehabilitation, and potential barriers they might encounter. Nine participants experiencing mental illness and receiving occupation-based rehabilitation were interviewed. Grounded theory methods were used in order to collect and analyze data. One core category, “barriers for a continuous path towards enriched and meaningful occupation” described the participants’ experiences of a variety of barriers related to personal, occupational and system factors that hindered participation in occupation-based rehabilitation and influenced their need for occupational development and growth. The core category was composed of; personal-related barriers, occupational-related barriers, and system-related barriers as well as six related sub-categories. These barriers interacted continually across time and space in ways that increased the participants’ sense of occupational deprivation and alienation. The findings also suggested that the issues of paid employment for ethnic minorities with mental illness should feature on the agenda of local, regional and state politicians and professionals involved in occupational rehabilitation.

Psychotherapists' outcomes with White and racial/ethnic minority clients: First, the good news.

The purposes of this study were to (a) investigate whether psychotherapists differ in their effectiveness with clients, (b) determine whether disparities exist within therapists' caseloads in their outcomes with White and racial and ethnic minority (REM) clients, (c) explore therapist factors that might contribute to observed therapist effects, and (d) identify whether treatment outcomes varied for REM and White clients. A sample of 3,825 clients seen by 251 therapists at 45 college counseling centers completed the Counseling Center Assessment of Psychological Symptoms at the beginning and end of individual psychotherapy. Therapists differed in their effectiveness at reducing general distress across clients, and evidence was found for disparities within therapists' caseloads in their effectiveness with REM and White clients. Effect sizes were small. Disparities within therapists' caseloads were not a function of any therapist variable that was studied. Therapy outcomes were similar for White and REM clients. Therapist multicultural competence can, and should, be considered in terms of measurable outcomes across client racial/ethnic groups. It is possible to identify multiculturally expert therapists who evidence competence with both REM and White clients and who might serve as models from whom the field could learn.

Caught in the middle? How women deal with conflicting pregnancy-advice from health professionals and their social networks

Objectiveto investigate how pregnant women deal with conflicting advice from their social networks and their caregivers and how this influenced their pregnancy-related behaviours. Design and methodsa qualitative study based on face-to-face interviews and focus-groups. We applied an inductive analysis technique closely following the ‘Gioia method’. Settingimpoverished neighbourhoods in Rotterdam, the Netherlands. Participants40 women who were pregnant, or had given birth within the last 12 months. 12 women were Native Dutch, 16 had a Moroccan background, and 12 had a Turkish background. Findingsall women faced a misalignment of advice by health professionals and social networks. For the native Dutch respondents, this misalignment did not seem to present a challenge. They had a strongly articulated preference for the advice of health professionals, and did not fear any social consequences for openly following their advice. For the women with a Turkish/Moroccan background, however, this discrepancy in advice presented a dilemma. Following one piece of advice seemed to exclude also following the other one, which would possibly entail social consequences. These women employed one of the three strategies to deal with this dilemma: a) avoiding the dilemma (secretly not following the advice of one side), b) embracing the dilemma (combining conflicting advice), and c) resolving the dilemma (communicating between both sides). Key conclusions and implications for practicewe argue that the currently popular interventions geared towards increasing the health literacy of non-Western ethnic minority pregnant women and improving communication between ethnic minority clients and caregivers are not sufficient, and might even exacerbate the dilemma some pregnant women face. As an alternative, we recommend involving not only caregivers but also women׳s social network in intervention efforts. Interventions could aim to increase the negotiation capacity of the target group, but also to increase the health literacy of the members of their social network to enable the circulation of ‘new’ information within a rather homogeneous, tight-knit network.