Help-seeking Process Research Articles

Professionals’ critical positionings of women as help-seekers: Finnish women’s narratives of help-seeking during post-separation stalking

The study explores how women victims of post-separation stalking perceive the positions ascribed to them in the help-seeking process by social workers and other professionals. Applying positioning theory, the research identifies ‘critical’ positionings, namely, those hindering the women in seeking help. The ultimate aim of the inquiry is to inform professional practices by identifying how professionals position victims of stalking and the risks of misinterpretation this process entails. The data comprise narratives of 15 Finnish female victims of stalking, who were interviewed either individually or together with a professional (social worker, shelter worker or therapist) who had worked with them. A total of five such professionals participated in conducting the interviews. The analysis of the women’s perceptions posits four critical positionings: Professionals viewed them as (1) alienating parents, (2) unprotective mothers, (3) overcautious women and/or (4) implausible victims. These determinations are seen as rooted in considerations of morality, accountability, rationality and agency. The findings indicate that the complex nature of stalking, women’s reactions to it and the ambivalent appearance of their strategies for dealing with stalking may pose obstacles to professionals in positioning them as help-seekers. This in turn may hinder women in their efforts to receive adequate help or even victimise them further. The study highlights that client–professional interaction in the context of post-separation stalking needs to be more victim-sensitive. It suggests that when analysing women’s situations and providing help, professionals should be more mindful of women’s own understandings and valorise their sensitive experiences.

Canına kıymak – ‘crushing life energy’: a qualitative study on lay and professional understandings of suicide and help-seeking among Turkish migrants in the UK and in the Netherlands

ABSTRACT: Currently, little is known about the views that Turkish migrants hold towards suicide, which may differ from the narratives held by native inhabitants of their host countries. Central to improving the provision of mental health services, furthering our knowledge of these views is important. The aim of this research was to explore Turkish cultural understandings on suicide and help-seeking for suicide. A qualitative study included data from 6 focus groups and 7 individual interviews with 38 Turkish-speaking lay people and 4 key informants living in the Netherlands or the UK during the year 2014/2015. Through the analysis of participants’ stories and narratives, the following key themes emerged in relation to suicide: suicide as an escape from failure and as a failure in itself; acculturation orientation; parenting style; and shame and stigma. There were more similarities than differences between the themes among laypersons and key informants from two countries. Canina kiymak (crushing life energy) was a strong metaphor for personal distress. Suicide was perceived as a failing of responsibilities towards the family and community. Future research should aim to give voice to all ethnocultural groups to further the present understanding of suicide and help-seeking processes in these communities.

Selection of Treatment Strategies among Patients with Type 2 Diabetes Mellitus in Malaysia: A Grounded Theory Approach.

BackgroundDiabetes Mellitus is a multifaceted chronic illness and its life-long treatment process requires patients to continuously engage with the healthcare system. The understanding of how patients manoeuvre through the healthcare system for treatment is crucial in assisting them to optimise their disease management. This study aims to explore issues determining patients’ treatment strategies and the process of patients manoeuvring through the current healthcare system in selecting their choice of treatment for T2DM.MethodsThe Grounded Theory methodology was used. Twelve patients with Type 2 Diabetes Mellitus, nine family members and five healthcare providers from the primary care clinics were interviewed using a semi-structured interview guide. Three focus group discussions were conducted among thirteen healthcare providers from public primary care clinics. Both purposive and theoretical samplings were used for data collection. The interviews were audio-taped and transcribed verbatim, followed by line-by-line coding and constant comparison to identify the categories and core category.ResultsThe concept of “experimentation” was observed in patients’ help-seeking behaviour. The “experimentation” process required triggers, followed by information seeking related to treatment characteristics from trusted family members, friends and healthcare providers to enable decisions to be made on the choice of treatment modalities. The whole process was dynamic and iterative through interaction with the healthcare system. The decision-making process in choosing the types of treatment was complex with an element of trial-and-error. The anchor of this process was the desire to fulfil the patient’s expected outcome.ConclusionPatients with Type 2 Diabetes Mellitus continuously used “experimentation” in their treatment strategies and help-seeking process. The “experimentation” process was experiential, with continuous evaluation, information seeking and decision-making tinged with the element of trial-and-error. The theoretical model generated from this study is abstract, is believed to have a broad applicability to other diseases, may be applied at varying stages of disease development and is non-context specific.

Cross-National Comparisons of Teachers’ Knowledge and Misconceptions of ADHD

Attention-deficit/hyperactivity disorder (ADHD) is among the most prevalent disorders of childhood and adolescence worldwide. Teachers are likely to play an important role in multiple stages of the help-seeking process (e.g., problem recognition) for children with ADHD. This study examined the relationship of prior exposure and ADHD training with teachers’ knowledge and misconceptions of the disorder in a multinational sample. Teachers ( N = 2,307) from 9 countries (Czech Republic, Germany, Greece, Iraq, the Republic of Korea, Saudi Arabia, South Africa, United States, and Vietnam) completed measures of ADHD knowledge, prior exposure, and education or training related to ADHD. There was considerable variability in overall levels of knowledge and specific misconceptions across the countries sampled. Although the predictors of ADHD knowledge varied considerably across countries, some form of professional training and prior exposure to ADHD was associated with greater knowledge in the majority of countries. Implications for teacher training and the role teachers can play in the help-seeking process are discussed.

Health Promotion and Health Service/Program Use on an Urban Campus in the U.S.

The purpose of the present study was to find the main predictors for the utilization of campus health-related services in order to figure out the help-seeking process of urban graduate students seeking a healthy life. Of 2,400 students, 536 were randomly selected (response rate: 22%) and recruited. ...

Reasons and pathways of first-time consultations at child and adolescent mental health services in Italy: an observational study.

BackgroundAn increasing number of young people have made contact with the Child and Adolescent Mental Health Services (CAMHS). However, only a small proportion of the population with emotional problems, actually seek specialized care. Research concerning the help-seeking process and pathways to care of a clinical sample could help to develop effective health policies to facilitate access to specialized care.AimTo analyze the access pattern for CAMHS, reasons of contact and care pathways of a consecutive sample of first-time patients. Our aim was to analyze the association between source of referral, socio-demographic and clinical variables.MethodsStandardized assessment instruments and information concerning access patterns and care pathways were collected from 399 patients at first-time contact with CAMHS in a Northern Italian Region.ResultsMost patients were referred to CAMHS by school teachers (36 %) or health professionals (32 %), while only 17 % of the parents sought help by themselves. School issues (50 %) and emotional problems (17 %) were the most frequent reasons for contact. The proportion of first-time contacts with no diagnosis of mental disorder at their first consultation did not differ by source of referral. Parents of children who did not receive a clinical diagnosis of mental disorders described them as “psychosocially impaired” and their condition as “clinically severe” likewise parents of patients who received a psychiatric diagnosis. Patients with externalizing problems were more frequently referred by the parents themselves, while youth with internalizing problems were more often referred through health professionals. Families with non-traditional structures (adoptive, foster care, mono-parental) were more likely to consult CAMHS directly, while immigrant youth were more often referred by teachers.ConclusionSocio-demographic and clinical characteristics can affect pathways to care. To improve early access to care for children and adolescents with ongoing mental disorders, a plan for proper action addressed to teachers and health professionals may well be important. This would improve their ability to recognize emotional and behavioral problems and use proper referral pathways, while informative intervention addressed to non-Italian families should inform them about the functioning and the mission of CAMHS.

Social Influences of Help-Seeking Behaviour Among Patients With Type 2 Diabetes Mellitus in Malaysia.

This qualitative study aimed to explore the influence of social networks such as family members, friends, peers, and health care providers toward the help-seeking behaviour (HSB) of patients with type 2 diabetes mellitus in the public and private primary care settings. In-depth interviews of 12 patients, 9 family members, and 5 health care providers, as well as 3 focus groups among 13 health care providers were conducted. All interviews were audio-taped and transcribed verbatim for qualitative analysis. Social influences play a significant role in the help-seeking process; once diagnosed, patients source information from people around them to make decisions. This significant influence depends on the relationship between patients and social networks or the level of trust, support, and comforting feeling. Thus, the impacts on patients' help-seeking behavior are varied. However, the help-seeking process is not solely an individual's concern but a dynamic process interacting with the social networks within the health care system.

Pathways to help: adolescent sexual assault victims' disclosure and help-seeking experiences.

In this study, we conducted semistructured interviews with N = 20 adolescent sexual assault victims who sought postassault help from the medical and legal system to understand young survivors' disclosure and help-seeking processes. Results revealed three distinct disclosure patterns and pathways to help-seeking. First, in the voluntary disclosure group, victims told their friends, who encouraged them to tell an adult, who then encouraged--and assisted--the survivors in seeking help. Throughout this process, the survivors' disclosures at each step were within their control and reflected their choices for how to proceed. Second, in the involuntary disclosure pattern, victims also first disclosed to friends, but then those friends told adults about the assault, against the survivors' wishes; the adults made the victims seek help, which was also against the survivors' preferences. Third, in situational disclosures, the survivors were unconscious at the time of the assault, and their friends disclosed and sought help on their behalf. We also examined how these initial disclosure patterns related to victims' continued engagement with these systems.

Help-seeking trajectory in patients with rheumatoid arthritis.

Early diagnosis and treatment of rheumatoid arthritis (RA) depends on the degree of fit between the characteristics of the patients and those of the health services. Ensuring timely assessment and treatment is the ideal medical care of RA. The reasons that underlay delays and the help-seeking trajectories are contextually determined. This study aims to identify the empirical evidence related to the help-seeking process and delay in RA in Latin America and to create a comprehensive model integrating the RA medical care processes of help-seeking and delay in a mixed health care system with variable accessibility. Non-systematic literature review of studies with both quantitative and qualitative methodology was conducted. Most of the research about delay and its associated variables have been undertaken in European countries and with White population and cannot be translated to the Latin America context where this research is almost inexistent. These countries have a completely different social context, and for most of the population, the health services are insufficient, inaccessible, fragmented, limited, and inequitable. Our results also show that in RA medical care utilization research, the theories and measurements of the constructs of illness trajectories, help-seeking, and accessibility are not integrated. We offer a conceptual framework that integrates help-seeking trajectories, delay, and accessibility of RA medical health services. If research on RA service utilization is to be undertaken in these countries, there is a need for a comprehensive framework than can enable researchers to integrate and contextualize the study of the problems within broad theoretical and methodological perspectives.

Correlates in the Endorsement of Psychotic Symptoms and Services Use: Findings from the Collaborative Psychiatric Epidemiology Surveys.

Endorsement of psychotic symptoms serves as an indicator of significant health issues and interpersonal distress. Seeking services is the ultimate recourse for many individuals, yet few studies have assessed the help-seeking process in a nationally representative sample. This study, guided by Lewis-Fernández et al.'s (J Nerv Ment Dis 197(5):337-347, 2009) analyses, examined the association of lifetime endorsement of psychotic symptoms with demographic, clinical and support system variables and types of services received. Based on nationally weighted epidemiological data, 11.6% of adults reported one or more psychotic symptoms. Psychotic symptoms were associated with poor physical and mental health, specifically depressive, anxiety, and substance use disorders. Respondents were more likely to receive services from both informal and mental health providers and were more likely to be hospitalized than those not endorsing psychotic symptoms. Study findings inform community efforts to develop comprehensive services for individuals experiencing psychotic symptoms.

Symptomatic presentation with cervical cancer in Uganda: a qualitative study assessing the pathways to diagnosis in a low-income country.

BackgroundSymptomatic cervical cancer patients in low- and middle-income countries usually present with late stage disease and have poor survival. We explored the views of cervical cancer patients on their symptom appraisal and interpretations, and their help-seeking including lay consultations.MethodsWe conducted an in-depth interview study in two northern Ugandan hospitals. Theoretical models underpinned the study guide for data collection and analysis. We used thematic analysis techniques, informed by the theoretical concepts in the Model of Pathways to Treatment. Sub-themes and themes were identified through consensus among investigators.ResultsEighteen women aged 35–56 years, recently diagnosed with cervical cancer were interviewed. Their first symptoms included abnormal vaginal bleeding, offensive vaginal discharge and lower abdominal pain. Most participants did not perceive themselves to be at risk for cervical cancer and they usually attributed the initial symptoms to normal bodily changes or common illnesses such as sexually transmitted diseases. Lay consultations with husbands, relatives and friends were common and often influenced decisions and timing for seeking care. Prompt help-seeking was frequently triggered by perceived life threatening symptoms such as heavy vaginal bleeding or lower abdominal pain; symptom burden sufficient to interfere with patients’ work routines; and persistence of symptoms in spite of home-based treatments. Participants did not promptly seek care when they perceived symptoms as mild; interpreted symptoms as due to normal bodily changes e.g. menopause; and attributed symptoms to common illnesses they could self-manage. Their cancer diagnosis was often further delayed by long help-seeking processes including repeated consultations. Some healthcare professionals at private clinics and lower level health facilities failed to recognize symptoms of cervical cancer promptly therefore delayed referring women to the tertiary hospitals for diagnosis and treatment.ConclusionUgandan patients with symptomatic cervical cancer often misattribute their gynaecological symptoms, and experience long appraisal and help-seeking intervals. These findings can inform targeted interventions including community awareness campaigns about cervical cancer symptoms, and promote prompt help-seeking in Uganda and other low- and middle-income countries with high incidence and mortality from cervical cancer.

Psychological Help-Seeking among Latin American Immigrants in Canada: Testing a Culturally-Expanded Model of the Theory of Reasoned Action Using Path Analysis

The current study investigated the psychosocial and cultural predictors of psychological help-seeking based on the Theory of Reasoned Action (TRA: Ajzen and Fishbein 1980) in a sample of 223 adult Latin American immigrants living in Canada. Using path analysis, the results provided empirical support for the TRA, as both help-seeking attitudes and subjective norms were found to influence participants’ help-seeking intentions. Moreover, the re-specified culturally-expanded model showed a good fit to the data and revealed the direct and indirect effects that bi-directional acculturation (Latino and Canadian Cultural orientations), familism, and collective coping had on help-seeking intentions. The results point to the integral roles familism and subjective norms of social referents (e.g., parents, siblings) play in the help-seeking decision process among Latin Americans. Limitations, future research directions and clinical implications are considered and discussed.

Mental Health, Self-Stigma, and Help-Seeking Intentions Among Emerging Adults

Many college students experience common mental health concerns, such as anxiety and depression, but do not seek psychological help. The present study proposed an attachment theory–driven model interrelating adult attachment, mental health concerns, and self-stigma in predicting intentions to seek counseling with a college student sample ( N = 1,682). Structural equation modeling revealed that attachment anxiety, but not attachment avoidance, directly and positively predicted intentions to seek counseling. However, mediation analyses indicated that attachment anxiety was also indirectly and negatively linked to help-seeking intentions through self-stigma. Specifically, higher levels of attachment anxiety, or the combination of attachment anxiety and mental health concerns, predicted greater levels of self-stigma, which in turn predicted weaker intentions to seek counseling. The findings point to the importance of considering the combined contributions of individual differences in attachment dimensions, levels of mental health concerns, self-stigma, and help-seeking intentions in understanding the help-seeking process.

Social work interventions on intimate partner violence against women in China

Summary Intimate Partner Violence (IPV) affects approximately one-fifth of women during their lifetime in China. However, limited studies have been conducted in China among women and service providers on IPV. The study reported in this article used an Ecological Model and the Capabilities Perspective integrated with the Advocacy Intervention Model as the theoretical framework for guiding the research and data analysis. This study was part of a participatory project to develop appropriate social work interventions in Guangzhou, China. Findings Twenty-one women who experienced IPV and 30 service providers were interviewed for their views on barriers to help-seeking processes, needs and concerns of this population, and recommendations for any changes. The results of this study clearly suggest that gender inequality is the root cause of IPV against women and prevents women from leaving a violent relationship. Applications The results suggest a number of needed changes at micro, meso, exo, and macro levels and the ways in which social workers can act as advocates for the changes in the context of Guangzhou.

Help seeking by parents in military families on behalf of their young children.

Over the past decade, many children have experienced a parental deployment, increasing their risk for emotional and behavioral problems. Research in the general population has shown that while many services are available for families with children experiencing problems, the rate of service utilization is low. This study examined help-seeking processes in military families in relation to children's problems. We collected data on emotional and behavioral problems from a sample of military parents with children ranging in age from zero to 10 years. While prevalence of children with problems was similar to prior research, results in this study suggested that military parents were alert to problems. Although military parents' help-seeking processes were similar to those documented in civilian studies in many respects, we did not find a significant gender difference in the recognition of problems. Furthermore, we found that children's experiences of deployment were related to use of services. Families who used services most often relied on primary care providers. These findings suggest military families are mindful of the possibility of their children having problems. In addition, many families utilize civilian services. Therefore, it is important to ensure that front-line civilian providers fully understand the context of military family issues.

Parents' help-seeking processes for early childhood mental health problems.

Mental health problems affect up to one in five children and adolescents. Yet less than one quarter will access the appropriate professional help. This study explored parents' help-seeking processes for young children with mental health problems. The present study followed up 442 6-year-old children of an original 733 infants (60% retention) who had been recruited from routine universal maternal and child health well-child appointments. An adapted help-seeking model was applied to a subsample of 84 children with mental health problems. Less than one third of parents whose child had a mental health problem accessed any type of professional service for their child's mental health. The majority of parents had highly positive help-seeking intentions, however, only one third of parents whose child had a mental health problem recognised their child's behavioural difficulties. Parents with more positive help-seeking intentions were more likely to access professional care for their child in need than parents who felt ambivalent about seeking help. Parent recognition that their child's behaviour was more difficult than average was a key barrier to accessing professional help when their child had a mental health problem. While most parents have positive help-seeking intentions, professionals aiding parent recognition of their young child's mental health difficulties could facilitate early intervention for children's mental health.

The Healing Journey

Help seeking is known to be a complex and difficult journey for people who self-injure. In this article, we explore the process of help seeking from the perspective of a group of people living in Northern Ireland with a history of self-injury. We conducted 10 semistructured interviews and employed a grounded theory approach to data analysis. We created two major categories from the interview transcript data: (a) "involution of feeling," which depicts participants' perspectives on barriers to help seeking; and (b) "to be treated like a person," in which participants communicate their experiences of help seeking. The findings pose important implications for policy, practice, theory, and future research, including the need to increase the uptake of follow-up care among people who arrive at hospitals as a result of self-injury, self-harm, or suicidal behaviors.

Migrating Diseases

Understanding qualitative inquiry as a global endeavor and using it in a globalizing context leads to several challenges. Differences in concepts of what qualitative research is may become visible. Methods like interviews may have a different connotation in other cultures, where our interviewees come from. We may have to conduct and analyze interviews differently. These challenges are discussed here on the background of an ongoing project focused on migrants from former Soviet Union states living in Germany with drugs and alcohol addiction problems. For understanding how the help-seeking processes in this context work and what makes them more complicated, episodic interviews with the clients were conducted in German or Russian and triangulated with expert interviews with service providers.

Health care barriers on the pathways of patients with anxiety and depressive disorders - a qualitative interview study

Which health care barriers do patients with anxiety and depressive disorders experience on their clinical pathways? Semi-structured interviews were conducted among 30 patients with anxiety and depressive disorders. Interviews were audio-taped, transcribed, coded and content-analysed. Following barriers perceived by patients were extracted: a lack of early diagnosis, communication and coordination problems between different services and providers, little information about their illness and its adequate treatment, as well as intrapersonal barriers. Patients perceive barriers on the individual, provider and system level. Especially barriers on the system and provider level indicate a need for more information, early recognition and support especially during the help-seeking process.

Mexican immigrant women reaching out: the role of informal networks in the process of seeking help for intimate partner violence.

More inquiry is needed into how Mexican immigrant survivors of intimate partner violence (IPV) are seeking help, to improve interventions designed to reach this isolated and vulnerable population. This grounded theory study, using a sample of 29 Mexican immigrant survivors of IPV and 15 key informants, examines the help-seeking process. Findings indicate that informal networks, particularly family and female friends, play a critical role in providing assistance and linking women to formal services. These findings have implications for the delivery of formal domestic violence services to this community as well as the response of police and other formal service systems.