Levels of Depression in West Massachusetts Capstone Project

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Running head: DEPRESSION AMONG OLDER IMMIGRANTS DEPRESSION AMONG OLDER IMMIGRANTS 32Depression among Older Immigrant African Women in Metro West MassachusettsSection 1: Foundation of the Study and Literature ReviewIn West Massachusetts United States, the most common health disorders are anxiety and depression, which are prevalent in elderly immigrant women aged between 50 and 79 years (Agbemenu, 2016). Despite a variety of efficacious interventions for depression and anxiety, it is clear elderly immigrant women experience mental health care disparities in their access to mental health services and the quality of treatment they receive. Research indicates African American heterogeneity impacts access to depression and anxiety treatment. In addition, African Americans are becoming an increasingly visible minority within the United States especially in West Massachusetts and are often depicted as Blacks. The current study sought to understand the causes and prevalence of depression among older immigrant African American women in Metro West Massachusetts as well as how the older immigrants cope with depression. A total of 12 self-identified social workers were interviewed about their patient’s mental health problem symptoms and treatment experience, what they thought was the cause of their patient’s anxiety, stressors facing their patient’s life in West Massachusetts, their patient access to mental health services, and how patients coped with depression. Results indicated considerable variability across the two groups, with African American elderly immigrant women endorsing higher rates of depression and anxiety, as well as higher rates of treatment seeking, than the whites. Individual\'s gender, age, marital status, and origin played a major role in the endorsement of anxiety and depression for the immigrants. Finally, although the two groups differed in the extent to which they experienced stigma about mental health issues, stigma did not predict symptom endorsement or treatment-seeking behavior for any of the two groups. These findings underscore the importance of attending to both between-groups and within-group differences in the mental health and mental health treatment experiences of different ethnic groups.The data collection methodology that will be used for the research study will be discussed in this section. The methodology will be semi-structured interviews, which will give the researcher an opportunity to explore the participant’s responses further in order to provide clarification of an answer given. Semi-structured interviews make use of open-ended questions that require an explanation and not just a yes or no answer. Data collection will be done using interviews and the study participants will comprise of social workers working in Metro West Massachusetts. All the interviews will be conducted using internet services like GoToMeeting, skype, Zoom, or any other web-based service due to the current pandemic of Covid-19. Only 10 questions will be asked. The reason for using social workers is for the researcher to get information that is credible and to also be able to get varied insights as the social workers will be dealing with numerous clients. The study participants will be social workers who have been working in the area for a minimum of three years. The idea for this criterion is to ensure that the researcher only interviews social workers who have enough knowledge, and they have been attending to clients in the area for some time. The researcher anticipates to have at least 10-12 social workers taking part in the study. It is assumed that this number will be representative of the population and it is an easy number to work with. Having a large number of participants would result in a lot time spent conducting the interviews and data analysis, which may not offer any considerable difference in the results.The data analysis process will begin with transcription of the audio tapes.…

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…Runninghead:DEPRESSIONAMONGOLDERIMMIGRANTSDEPRESSIONAMONGOLDERIMMIGRANTS32DepressionamongOlderImmigrantAfricanWomeninMetroWestMassachusettsSection1:FoundationoftheStudyandLiteratureReviewInWestMassachusettsUnitedStates,themostcommonhealthdisordersareanxietyanddepression,whichareprevalentinelderlyimmigrantwomenagedbetween50and79years(Agbemenu,2016).Despiteavarietyofefficaciousinterventionsfordepressionandanxiety,itisclearelderlyimmigrantwomenexperiencementalhealthcaredisparitiesintheiraccesstomentalhealthservicesandthequalityoftreatmenttheyreceive.ResearchindicatesAfricanAmericanheterogeneityimpactsaccesstodepressionandanxietytreatment.Inaddition,AfricanAmericansarebecominganincreasinglyvisibleminoritywithintheUnitedStatesespeciallyinWestMassachusettsandareoftendepictedasBlacks.ThecurrentstudysoughttounderstandthecausesandprevalenceofdepressionamongolderimmigrantAfricanAmericanwomeninMetroWestMassachusettsaswellashowtheolderimmigrantscopewithdepression.Atotalof12self-identifiedsocialworkerswereinterviewedabouttheirpatient’smentalhealthproblemsymptomsandtreatmentexperience,whattheythoughtwasthecauseoftheirpatient’sanxiety,stressorsfacingtheirpatient’slifeinWestMassachusetts,theirpatientaccesstomentalhealthservices,andhowpatientscopedwithdepression.Resultsindicatedconsiderablevariabilityacrossthetwogroups,withAfricanAmericanelderlyimmigrantwomenendorsinghigherratesofdepressionandanxiety,aswellashigherratesoftreatmentseeking,thanthewhites.Individual\'sgender,age,maritalstatus,andoriginplayedamajorroleintheendorsementofanxietyanddepressionfortheimmigrants.Finally,althoughthetwogroupsdifferedintheextenttowhichtheyexperiencedstigmaaboutmentalhealthissues,stigmadidnotpredictsymptomendorsementortreatment-seekingbehaviorforanyofthetwogroups.Thesefindingsunderscoretheimportanceofattendingtobothbetween-groupsandwithin-groupdifferencesinthementalhealthandmentalhealthtreatmentexperiencesofdifferentethnicgroups.Thedatacollectionmethodologythatwillbeusedfortheresearchstudywillbediscussedinthissection.Themethodologywillbesemi-structuredinterviews,whichwillgivetheresearcheranopportunitytoexploretheparticipant’sresponsesfurtherinordertoprovideclarificationofananswergiven.Semi-structuredinterviewsmakeuseofopen-endedquestionsthatrequireanexplanationandnotjustayesornoanswer.DatacollectionwillbedoneusinginterviewsandthestudyparticipantswillcompriseofsocialworkersworkinginMetroWestMassachusetts.AlltheinterviewswillbeconductedusinginternetserviceslikeGoToMeeting,skype,Zoom,oranyotherweb-basedserviceduetothecurrentpandemicofCovid-19.Only10questionswillbeasked.Thereasonforusingsocialworkersisfortheresearchertogetinformationthatiscredibleandtoalsobeabletogetvariedinsightsasthesocialworkerswillbedealingwithnumerousclients.Thestudyparticipantswillbesocialworkerswhohavebeenworkingintheareaforaminimumofthreeyears.Theideaforthiscriterionistoensurethattheresearcheronlyinterviewssocialworkerswhohaveenoughknowledge,andtheyhavebeenattendingtoclientsintheareaforsometime.Theresearcheranticipatestohaveatleast10-12socialworkerstakingpartinthestudy.Itisassumedthatthisnumberwillberepresentativeofthepopulationanditisaneasynumbertoworkwith.Havingalargenumberofparticipantswouldresultinalottimespentconductingtheinterviewsanddataanalysis,whichmaynotofferanyconsiderabledifferenceintheresults.Thedataanalysisprocesswillbeginwithtranscriptionoftheaudiotapes.Theresearcheraimsatuncoveringpatternsandmakingcodesforuseinthethemesthattheywilldiscover.Theresearcherwilltrytoassigneachcodetoaparticularthemeifpossible.However,theresearcherisawaretherearesomecodestheywillnotbeusing.Thedataanalysisprocesswillcompriseoffamiliarizationwiththedata,assigningpreliminarycodesfordescribingthecontent,searchingforpatternsinthecodes,reviewingthemes,definingandnamingthemes,andproducingthereport.Thesestepswillbefollowedsystematicallytoensurethestudydoesnotmissoutonanythingvital.Thisresearcherhasanalyzedtheethicalproceduresthatwillbeusedtoensuretheysafeguardtheinterviewparticipants,andtheresearchstudyisethical.TheresearcherwillseekapprovaloftheIRBsincetheyareusinghumansubjectsinthisstudy.Thisisarequirementforallstudiesthatwillbeinvolvinghumansubjects.Oncetheygettheapproval,theresearcherwillneedtogetwrittenconsentfromthepotentialparticipantsbeforetheycanbegindatacollection.Duringtheconsentseekingprocess,theresearcherwilldiscusswiththeparticipantstheroletheywillplay,thepurposeofthestudy,thebenefits,risks,andalternativestoparticipation.Itisthedutyoftheresearchertoensurethepotentialsubjectsunderstandtheinformationgivenandtheparticipantscanaskquestionstoclarifyanythingtheydidnotunderstand.Whiletheresearchermightbetimepressed,theywillgivethepotentialsubjectsadequatetimetoreviewalltheinformationpresentedbeforetheysigntheconsentforms.Onlyaftertheyhavesignedcantheybeincludedinthestudy.Thestudyparticipantswillhavearighttowithdrawfromthestudyatanytimeandtheywillbeprovidedwithallthedatacollectedupuntilthepointoftheirwithdrawal.Thestudyparticipantsshallbeprovidedwithinformationontheirrighttowithdrawaspartoftheconsentseekingprocess.Allthedatacollectedinthestudywillbesecurelystoredtoprotectitfrompryingeyesandtheresearcherplanstostorethedataforatleastoneyearaftertheresultsarepublished.Accesstothedatawillberestrictedtoonlyauthorizedpersonnel.Allthedatawillbedestroyedafterthespecifiedperiodhaslapsed.ProblemStatementTheintentinthisstudyistoexploretheviewsofsocialworkersinrelationtodepressionamongolderimmigrantAfricanwomencurrentlylivinginwestMassachusetts.OlderimmigrantAfricanwomenreferstowomenwhoareover55yearsofageandtheyrelocatedfromanyAfricancountryafteracquiringpermanentresidencyintheUnitedStates.Depressionamongelderlyimmigrantwomenstandsoutasanimportantphenomenonforstudyinthecontextofsocialworktakingintoconsiderationtheextenttowhichtheconditionaffectsvulnerablepopulations.Derr(2017),pointedoutimmigrantstypicallyfacestressorsrelatingtomigrationexperiencewhichmaycauseorintensifymentalhealthproblems.Moreover,Derr(2017)alsodiscussedthatimmigrantstendtoaccessmentalhealthservicesatalowerrateascomparedtonon-immigrants.Subsequently,thissituationleavesimmigrantsatriskofuntreatedhealthconditionsleadingtoincreaseddiseaseburden(Lynch,Berg,Manna,andSchade(2016).Assuch,thisnegativehealthpredispositioncreatesgreaterneedformentalhealthservicesamongimmigrantswhoseemmoresusceptibletodevelopdepression.Thissituationmakesitimperativetoestablishtheviewsofsocialworkersaddressingthementalhealthneeds,especiallydepression,amongolderimmigrantAfricanwomeninMetroWestMassachusetts.Inturn,insightsgainedshouldplayacriticalroleinthedevelopmentofcomprehensivementalhealthprogramsaimedatimprovingtheimmigrants’healthoutcomes.Asnoted,migrationcanbechallenging,andmanyimmigrantwomenexperiencechallengesthataffecttheirmentalhealth(Fooetal.,2018).Forexample,thechangesinpractices,values,socialfactorsandculturalidentificationareconsideredasfactorscontributingtothepotentialriskofdevelopingmentalhealthissues(Alegría,Álvarez,&DiMarzio,2017).Similarly,Fooetal.(2018)assertedmigrationintoanewcountryleadstodrasticchangesinessentialaspectsofnormaldaylife.Here,theprocessofassimilatingtonewenvironmentsandculturescausesconsiderablelevelsofacculturativestress,whichresearchershavelinkedtotheoccurrenceofpsychiatricdisorders(Fooetal.,2018).Therefore,examiningstressorssurroundingthemigrantexperiencesfromthesocialworkperspectiveshouldofferinsightsintotheissuesfacedbythisvulnerablepopulation,especiallyforwomenaged50yearsandabove.Basedonthehighlightedproblem,itisimperativetodeterminetheviewsofsocialworkersfromWestMassachusettswhoworkwitholderimmigrantAfricanwomeninMetroWestMassachusettsaffectedbydepression(O’Donnelletal.,2016).Suchanundertakingmayrevealservicemodificationssuchasgivingpatientswithlanguagebarriersmoretimeneededtoenhanceaccesstoqualitymentalhealthservices(O’Donnelletal.,2016).Assuggestedbyresearchers,immigrationcancreateworry,whichmayincreasetherisksofexperiencingdepression,andthiscanbeexacerbatedbyculturalfactors,suchaslanguagebarrierswhichmaycausedifficultyindiagnosingandtreatingthisdisorderamongimmigrantpopulations(Landa,Skritskaya,Nicasio,Humensky,&Lewis-Fernández,2015).Failuretodetermineappropriatelytheviewsofsocialworkersondepressionwithinacertaincommunitytranslatestoneglectingsocialhealthandwelfare(Baldwin-Clark,OfahengaueVakalahi,&Anderson,2016).Inresponse,theintentofthisstudyistoobtaintheperspectiveofsocialworkersregardingdepressionwithintheselectedmigrantpopulationaswellasinsightsintothewaysinwhichprofessionalsinthehealthcaresectorcanhelpmeetemergingneeds.PurposeoftheStudyInthisstudy,theviewsofsocialworkersregardingdepressioninolderimmigrantAfricanwomeninMetroWestMassachusettswillbeobtained.Throughanalyzingtheseperspectives,insightscanbeprovidedintowaysthesocialworkerssectorcanassisttomeettheemergingneedsofthepopulation.ExpectedintheresultsofthisstudywillbeanyservicemodificationneededtomeettheneedsoftheimmigrantAfricanwomenlocatedinMetroWestMassachusetts(Takeuchi,2016).Thesefindingscanenhanceaccesstoqualitymentalhealthservicesandensurethewomenunderstandtheimplicationsofnotseekingmentalhealthservices.Havingexaminedthestressorsfacedbythemigrantwomen,insightswillbegainedintotheissuesthewomenfacewithinthepopulationandsolutionsdirectlytargetedtothepopulationcanbedeveloped(Agbemenu,2016).Socialworkerswillalsobenefitastheywillusethefindingsofthisstudytodeterminemethodstheycanusetoreachouttothepopulationunderstudy.ResearchQuestionsFocuseduponinthisstudywillbethefollowingresearchquestions:1.Fromthesocialworkperspective,whatfactorsinfluenceolderimmigrantAfricanwomen’sadaptivecapacityinMetroWestMassachusetts?2.Fromthesocialworkperspective,whatmentalhealthservicesdosocialworkersoffertoolderimmigrantAfricanwomeninMetroWestMassachusetts?3.Howdosocialworkersassesstheneedformentalhealthservicesfortheirclientele,particularlytoolderimmigrantAfricanwomeninMetroWestMassachusetts?4.WhatservicemodificationscansocialworkersintroduceinpracticetoenhancementalhealthservicedeliveryforolderimmigrantAfricanwomeninMetroWestMassachusetts?DefinitionofKeyTerms1.Culturallyinformed-Culturallyinformedisdefinedastheofferingofcarebyhealthcareprofessionalsthatrespects,acknowledges,andintegratesthepatient\'sculturalvalues,practices,andbeliefs.Inourstudy,cultureextendsbeyondidentifyingthepatientandfamilybyraceandethnicitytoincludevariableslikefaith,countryoforigin,educationlevel,socioeconomicstatus,andlevelofacculturation.Inthisstudyculturallyinformedreferstotheabilityofthesocialworkerstoofferservicesthatrecognize,affirm,andvaluetheworthoftheclients,theirfamilies,communities,andpreservesandprotectstheirdignity.1.OlderimmigrantAfricanwomen-OlderimmigrantAfricanwomenreferstowomenwhoareover55yearsofageandtheyrelocatedfromanyAfricancountrytotheUnitedStates.ThewomencouldhavecometotheUSlegallyorillegally.ThephrasealsoreferstowomenwhocametotheUSasrefugeesandtheyhaveremainedtheretilltheiradvancedage.Forthisstudy,thefocuswillbeonolderimmigrantAfricanwomenwholiveinWestMassachusettsandsufferfromdepression.1.Immigrant-AccordingtotheOxfordUniversityPress(n.d.-b),animmigrantisdefinedasapersonwhocomestopermanentlyliveinaforeigncountry.Therearefourtypesofimmigrationstatusnamelycitizens,residents,undocumented,andnon-immigrants.Inthispaperthefocuswillnotbeonthestatusoftheimmigrant,butweexpectthestatusoftheimmigranttocontributetohowtheimmigrantaccessmentalhealthservices.Therefore,thestudywillconsiderallimmigrantsprovidedtheyimmigratedfromAfricaandtheyhavebeenlivingintheselectedcommunity.1.Africanwomen-AfricanwomenreferstoanativeorinhabitantwomanofAfricaorawomanwhohasAfricanancestry.Inthisstudy,AfricanwomenreferstotheolderimmigrantAfricanwomenwhowerebornoutsideofUSinAfricaandtheyhadtomigratetotheUSeitherlegallyorillegallyandtheycurrentlyresideinWestMassachusetts.ThewomenwillhavelivedalmosthalftheirlifeinAfricabeforetheyimmigratedtotheUS.1.Copingmechanisms-Copingmechanismisdefinedas\"anadaptationtotheenvironmentalstressbasedontheconsciousandunconsciouschoiceandthatenhancescontroloverbehavior.\"Inthestudy,copingmechanismreferstothedifferentculturalstrategiesusedbythewomenandtodealwiththestressfulsituationstheyencounter.Themethodsthewomenwillusetoadjusttothestresstheyfaceandassistthemtomaintaintheiremotionalwell-being.1.Migration-Migrationisthemovementofpeopleoranimalsfromoneplacetoanother.Inthestudy,migrationreferstothemovementofpeoplefromanyAfricancountrytotheUnitedStates.ThefocuswillonlybeonthewomenwhohavemigratedfromAfricatotheUSeitheralone,withtheirfamily,orwitharelativeandtheyarecurrentlylivinginWestMassachusetts.Theprocessofthewomenmigratingwillnotbeamajorfocus,butitcanbereliedupontodetermineifitcontributestothewomenfailingtoaccessmentalhealthservices.1.Hostcountry-AccordingtotheOxfordUniversityPress(n.d.-a),ahostcountryisacountrythatholdsaculturaleventorsportingeventtowhichothersareinvited.Inthisstudy,hostcountryreferstothecountrythatisaccommodatingtheAfricanimmigrantsorwheretheimmigrantsareliving,whichistheUS.SignificanceoftheStudyThefindingsofthisstudywillcontributenewknowledgetoaddressthegapinresearchregardingdepressioninolderimmigrantAfricanwomenresidinginMetroWestMassachusetts.Findingswillofferinsightsintowayssocialworkerscanmeettheemergingneedsofthispopulation.ThestudyresultswillassistthecommunitysocialworkerstobetteraddresstheemergingneedsandchallengesolderimmigrantAfricanwomenfacewhenaccessingmentalhealthservices.Morespecifically,thestudywillfocusonhowthetargetpopulationisaffectedbydepressionwhentherearebarrierstothemreceivingsupport.FindingsinthestudywillequipsocialworkerswiththeknowledgetodevelopstrategiestheycanusetotreatdepressionandbringawarenesstotheuniqueneedsoftheolderimmigrantAfricanwomen.TheoreticalFrameworkThetheoreticalframeworkthatcanbeusedtoframethisprojectistheStructural-FunctionalTheory.SometheoristssuchasCassel(1995)andCobb(1976)expressedsocialsupportservesasaresistancefactor,andplaysanimportantroleinreducingadverseimpactofexposuretonegativelifeevents(Thoits,1985).ThistheoryshouldplayakeyroleinunderstandingtheonsetofdepressionamongolderimmigrantAfricanwomen,giventhevarioussocialdemandsassociatedwithbeingamigrant.Further,KinserandLyon(2014)emphasizedthatdepressingexperiencesmayincreaseaperson’spossibilitytosufferfromstressfulepisodes.Stressandvulnerabilityadduptothepossibilityofdevelopingdepression,wherechangesintheenvironment,lackofcopingmechanismsandlackofsupporthaveanadverseimpactonthementalhealthoutcomeofthisgroup(Alegríaetal.,2017).Culturalinfluencescanberevealedthatwillbevitalindeterminingthemethodsthatcanbeusedtotreatthispopulation.Tobecomeculturallycompetentwhendealingwiththispopulation,socialworkerswouldneedtobefamiliarwiththeStructural-FunctionalTheory.Explainedinthistheoryiswhysocietyfunctionsthewayitdoes,anditemphasizesontherelationshipsbetweenthedifferentsocialinstitutionsthatmakeupsociety(Emadpoor,Lavasani,&Shahcheraghi,2016).Someofthesesocialinstitutionsareeducation,law,government,religion,andculture.Thesocialworkershouldunderstandsocietyislikeasystemwhereallthepartswillworktogethertocreateawholesociety.Emadpooretal.(2016)positsocietieswillneedcultureforthemtofunction.Therefore,beingculturallyinformedisbeneficialtothesocialworkeranditwillallowthemtoreachouttothecommunitymembersandapproachtheminanacceptablemanner(Sabbionietal.,2018).ReviewofProfessionalandAcademicLiteratureFromthereviewconducted,alackofliteratureexistsinwhichtheprimaryfocuswasplacedonolderAfricanimmigrantwomen(Okudo&Ross,2016).ThisshortageisduetonumerousfactorsthatmostlyinvolvewiththeperceptionthatAfricanimmigrantshaveregardingdepression(Thomson,Chaze,George,&Guruge,2015).Mosttimes,depressedindividualsarestigmatized,andmostAfricancommunitiesbelievedepressioniscausedbybadspirits.Withthisnotionitbecomesdifficultforthewomentoseekprofessionalhealthservicesastheywouldbelabelledandjudgedbyothercommunitymembersharshly(Sánchezetal.,2014).Forthisstudy,searchwasconductedforpeer-reviewedpublicationsfocusingonmentalhealthamongolderAfricanimmigrantwomen,fromthefollowingsources,MEDLINE,PsycINFO,CINAHL,EBSCO,ResearchGate,ProQuest,SAGEJournals,andEMBASE.Thekeyword(s)usedtosearchfortheappropriateliteratureforthisstudywasolderAfricanAmericanwomen,olderimmigrantAfricanwomen,depressioninimmigrantAfricanwomen,depression,andolderimmigrantwomen.CulturalCompetenceOkudoandRoss(2016)offeredinformationonthevarioushealthchallengesthatAfricanImmigrantsfromdifferentpartsofAfricafacewhentheyrelocatetotheUSovertimeandtheexplorationofthehealthyimmigranteffect(HIE)WhenAfricanimmigrantsrelocatetotheUS,theyarehealthierthantheirAmericancounterpartsduetoHIE.However,astheimmigrantsacclimatizeintotheUSsystem,theywilladopttheunhealthylifestylesandbehaviorsoftheUS,whichleadstothemdevelopinglifestylediseasestheywouldnothavedevelopedhadtheynotrelocatedtotheUS.Thisarticleissignificantasitsupportsourstudybyofferinginsightsintothechangeimmigrantsundergoregardingtheirhealthandhowthispopulationisneglectedbyphysicians.WithoutunderstandingthepeculiaritiespertainingtotheAfricanimmigrantpopulation,physicianscannotofferculturallyusefulcaretotheimmigrants.ThesignificanceofthisarticleisthatwecanusetheinformationtodetermineifsocialworkersmakeuseofculturallyacceptablepracticeswhentreatingolderimmigrantAfricanwomen.Sánchezetal.(2014)identifiedthemostcommonlyoccurringmentalhealthdisordersaredepressionandanxiety.Theauthorsalsonotethereisdisparityinthequalityofcaregivenandintheiraccesstomentalhealthservices.Theroleofcultureandstigmatizationwasexploredinthestudy.Thisarticleindicatestherearementalhealthcaredisparitiesexperiencedbyimmigrantsduetoinsufficientmentalhealthservicesintheircommunities,lackofculturalcompetency,andmentalhealthstigmatization.WiththisinformationisbecomesclearastowhymanyAfricanimmigrantsdonotreceiveorseekmentalhealthservices.UnderstandinghowtoovercomesomeofthesebarrierswillassistinreducingthecasesofdepressionamongolderAfricanimmigrantwomeninthecommunity.AsnotedbyDelara(2016)thementalhealthofAfricanimmigrantwomenisaffectedbysocial,cultural,andthehealthcaresystemandthereisaneedtoembracedifferentmethodologiesforpromotingmentalhealthamongthewomen.AccordingtoDelara(2016)themerefactawomanisamigrantmakeshermorevulnerabletonegativeandpositivementaleffectsofmigration.Theeffectsfeltbythewomanwillbedependentontheirlegalstatus,stageofmigrationcycle,andmodeoftravel.TheauthorsnotetheimmigrationprocesscouldbetraumatizingformostwomenespeciallyifthewomenhadtoseekclandestinemeanstoarriveintheUS.Askingthesewomenrepetitivequestionsregardingtheirimmigrantvictimizationcouldbringaboutmentaldisorderslikedepression.Thewomencouldalsoavoidseekingmentalhealthservicesastheyfearbeingaskedquestionsabouttheirimmigrationexperience.OlderimmigrantAfricanwomenhavebeenfoundtoexperienceproblemsofisolation,language,abuse,culture,andmobility.Theseproblemshindertheiraccesstomentalhealthservices.Therelevanceofthisarticleisthatisshowstheproblemsolderimmigrantwomenfaceandthereasonswhytheyfailtoseekprofessionalmentalhealthservices.MentalHealthofImmigrantsRashidandGregory(2014)focusedontheexperiencesofAfricanImmigrantwomenwithafocusontheirlifebeforeandaftertheirrelocation.RashidandGregory(2014)havedemonstratedAfricanimmigrantwomenfacenumerouschallengeswhentheyrelocatetotheUS.However,therearewomenwhohavemanagedtoovercomethechallengesandwithstandtheadversitytheyfaced.ItisvitaltoknowwhysomeolderimmigrantAfricanwomenwillsufferfromdepressionwhileotherswillnot.Thisarticleoffersvitalinformationonhowsomeofthewomenmanagedtheirrelocationandavoideddevelopingdepression,whichcouldbeusedbyotherAfricanimmigrantwomenwhentheyrelocatetotheUS.Thomsonetal.(2015)therelocationprocesscanimpactthementalhealthofimmigrantsandwithoutinformationonmentalhealthandhelpfulservicesmanyimmigrantsaredeniedaccesstomentalhealthservices.Theauthorsnotedimmigrantsareunderrepresentedinthementalhealthcaresystemandtheyunderutilizementalhealthservices.BarrierstoserviceutilizationplayakeyroleinolderimmigrantAfricanwomen.Thisarticlenoteseconomichardshipsfacedbytheimmigrantsaffecttheirmentalhealthandaccesstomentalhealthservices.Forthisstudy,thisarticleisrelevantasitallowsustounderstandwhymostimmigrantsdonotaccessmentalhealthservicesandwhytheysufferfromdepression.Thethreemajorbarriersnotedbytheauthorsarebarriersintheuptakeofhealthinformationandservices,inadequacyoflinguisticallyandculturallyappropriateservices,andbarriersrelatedtothesettlementexperience.TheresearcherwantstodetermineifthesearethesamebarriersfacedbytheolderimmigrantAfricanwomeninWestMassachusetts.DepressionAmongOlderAfricanImmigrantWomenBaldwin-Clarketal.(2016)noteddepressionisamajorproblemamongolderAfricanimmigrantwomenandsincetheyareunderstudied,theirdepressionisrarelydiscussedorresearched.ThelackofrelevantresearchfocusingonolderimmigrantAfricanwomenisanindicationtheprevalenceratesofdepressionmightbehigherthanwhatisthought.ThefocusofmostdepressionstudieshasbeenWhiteolderadults.ItisraretofindAfricanimmigrantsmakinguseofhealthcare,socialservices,andlong-termcareandthereasonistheylackawarenessoftheresources,limitedfinancialresources,differencesintheinterpretationofmentalhealthissues,andmistrustofthesystems.ThisstudyisbeneficialtoourcurrentstudyasitfocusesonolderimmigrantAfricanwomen.Theauthorshavedemonstratedthereasonwhymentalhealthservicesarenotaccessedbythewomenandstrategiestousetoencouragethewomentoaccesstheservices.Understandingwhytheyfailtoaccesstheservicesisbeneficialtoourstudyasitwillassisttheresearchertoformulatequestionstothesocialworkersaimedatestablishingifthesearethesameissuesfacedbythepopulationunderstudy.Lazar-Neto,Louzada,deMoura,Calixto,andCastro(2018)assessedthefrequencyofdepressionamongimmigrantslivinginMassachusettstodeterminecorrelatesofdepression.Theauthorsdemonstratethatmostimmigrantsdosufferfromdepression.ByanalyzingBrazilianimmigrantswhohaverelocatedtoMassachusetts,theauthorsindicatethemigrantsencounterthesamebarriersasthosefacedbyolderimmigrantAfricanwomen.Therefore,theproblemofaccesstomentalhealthservicescouldbeduetosystemicissuesandnotthemigrantsthemselves.Understandingwhathindersmigrantsfromaccessingorseekingmentalhealthserviceswillbebeneficialtothecommunitiesasthoseproblemscanbeeliminated.Thisarticleenablestheresearchertodeterminetheaccessofmentalhealthservicesbydifferentmigrantswithinthesamestate.Whileitmightbeeasytostatethefailuretoaccessisduetoalackofknowledgebythemigrants,thereareotherissueslikeculturalpreferencesandlackofservices.ImmigrantsfromAfricaandBrazilfacethesamelanguagebarrierswheretheyarenotcompetentinEnglish,whichresultsinthemfailingtounderstandwhatphysiciansormentalhealthprofessionalsarerecommendingoradvising.Cultureplaysakeyroleinthetreatmentofmigrants.Therefore,culturalcompetencyshouldbeanalyzedtoestablishifthesocialworkersareculturallyawareoriftheyunderstandtheroleofculturewhenitcomestotreatingordealingwithimmigrants.ThesignificanceofthisarticleisthatimmigrantsseemtosharethesameexperienceswhenitcomestodepressiononcetheyrelocatetotheUS.Therefore,thereisaneedtoinvestigatetheissuessurroundingmentalhealthservicesinthecommunitiesandestablishthereasonsbehindthediscriminatoryaccesstotheservices.StressorsfacedbyOlderAfricanImmigrantWomenStressorsfacedbyAfricanimmigrantsandrefugeeswhentheyrelocatetotheUnitedStateswereanalyzedbyLi,Liddell,andNickerson(2016).Theauthorslinkthestressorstothedevelopmentofdepression.Manyimmigrantsfacesocialandinterpersonalchallengeswhentheymigratetoanewcountry.Someofthesocialandinterpersonaldifficultiesincludeseparationfromfamily,socialisolation,anddiscriminationinthehostcountry.AnotherdifficultypositedbyLietal.(2016)islossofsocialidentitytiedwiththeirformerculturalandcommunitygroups.ThesedifficultieswillleadtodepressionsymptomsintheolderimmigrantAfricanwomen.ThearticlebyLietal.(2016)increasestheknowledgeonthedevelopmentofdepressionamongimmigrantwomenandtheunderlyingcausesofthesymptoms.Theauthorshavegonefurthertodemonstratethestrategiesemployedbymostoftheimmigrantstoreducethesymptomsofdepression,whichwouldbesignificantforourstudyaswecanquestionifthesamestrategiescouldbeappliedtothepopulationunderstudy.Thepost-migrationfactorsaffectingmentalhealthinmigrantsshouldbecloselyanalyzed.Addingtothecurrentinformationwehaveregardingthestressorsandissuesfacedbyimmigrants,theauthorshavedemonstratedthereisneedtonotonlyconsiderthepre-migrationfactors,butthepost-migrationfactorsaswell.Post-migrationfactorshavebeenfoundtobehighcontributorstotheimmigrantsdevelopingdepressivesymptomsandfailingtoseekmentalhealthservices.Fooetal.(2018)wasanalyzingtheextentofdepressionamongimmigrantsandexploredthevariationsonprevalencebasedondemographicandeducationalfactors.WhenolderimmigrantAfricanwomenhavetoassimilatetonewculturalpracticesandsurroundings,theydevelopacculturativestress,whichleadstothedevelopmentofdepression.Theauthorswantedtoexaminethelinkbetweenmigrationanddevelopmentofdepression.Thearticlehasnotedthattheearlypost-migrationphaseishighlyattributedwithincreasedlevelsofacculturativestress,whichtendtoreduceastheimmigrantsettlesdowninthehostcountry.Theincreasedlevelsofacculturativestresscouldleadtoincreasementaldistressandifnotproperlytreatedcouldresultindepressionlateroninlife.However,theauthorshavenotedthereisnorelationbetweenmigrationanddevelopmentofdepressionsinceoncetheimmigrantiswellacclimatizedwiththenewenvironmenttheywilladaptandsettledowntothenewculture.Theadjustmentperiodinvolvesadjustmentofculturalvaluesandsocialnetworks,whichleadstoconfusionanddevelopmentofdepression.Thelackofsocialsupportisshownasahugecontributortowardsthedevelopmentofdepressionlateroninlifeastheolderimmigrantwillbelonely,andshewillnothavethesocialsupportshewouldhaveinherhomecountry.EkwemalorandEzeobele(2020)exploredtheportrayalofdepressionamongNigerian-bornimmigrantwomenwhowerelivingintheUnitedStates.Whenmovingfromapatriarchalculturetoamoredemocraticonecanbechallengingforimmigrants.Withlimitedknowledgeofwhatservicesareavailabletotheimmigrantsandthecultureofbeingsecretivedeniesmostmigrantstheopportunitytoreceiveassistancewithmentalhealthproblems.DisruptionofthetraditionalfamilystructureisoneoftheeffectsofmigratingtotheUS.FamilystructureasitisknownbackinAfricanisnotthesameandthiscausesdistresstothewomenwhoareusedtosocializationbetweentheextendedfamilymembers.WhenNigerianmigrantsarefacedwithstressfulsituationstheycanbeguardedintheirinteractionsandtheywillnotdivulgeinformation.Therefore,thereisneedforculturalcompetenceonthepartofthesocialworkers.Withoutculturalcompetence,thesocialworkerswillnotgetthroughtotheimmigrantsandtheywillcontinuesufferinginsilence.Culturalexpectationsplayakeyrolewhenitcomestomentalhealthproblemslikedepression.Thebeliefstheyhadbackhomewillbeharboredinthehostcountryandthewomenwillnotwanttoheartheyhavebeendiagnosedwithdepression.Inthestudyconductedby EkwemalorandEzeobele(2020),theresearchersestablishedthatmostNigerianWomenwhohaveimmigratedtotheU.S.labeldepressionascrazinessormadness.Oneparticipantstatedthat‘YoupeopleintheU.S.callitdepression;wecallitmadnessinNigeria.’ThisshowsthelevelofstigmathatonewouldhaveiftheyweretobediagnosedwithdepressionandtheyhappentocomefromNigeria.TheauthorshaveproposedtheuseofconversationalstyleofinterviewtoassistinrelaxingtheNigerianimmigrantswhentheyareundergoingtheirhealthassessment.Usingconversationalstyleinterviewswillbreaktheculturalshieldanallowthewomentodisclosetheirhealthconditions.SummaryTheprofessionalandacademicliteratureindicateolderimmigrantAfricanwomendonotreceiveadequatementalhealthservices.Therearesystemicandculturalbarrierspromotingthelackofaccesstomentalhealthservices,whichshouldbeinvestigatedfurther.Identifyingthemissinglinksonlyisnotenoughandthereshouldbeinvestigationonhowtoovercomethebarriersandmakeiteasierforthewomentoaccessmentalhealthservices.Thestudiesunderreviewhaveallconfirmedthereisadiscrepancywhenitcomestoaccessandusageofmentalhealthservicesamongtheelderlywomen.MostimmigrantswillcometotheUSAhealthyandtheywillonlybegindevelopingtheselifestylediseasesduetothechallengestheyfaceafterrelocation.Socialworkersinteractcloselywiththeimmigrantsandtheycanoffervitalinsightstohowtheimmigrantsmakeuseoftheavailablementalhealthservices.Thelackofservicescanalsobeconfirmedbythesocialworkersastheyarechargedwithofferingtheavailableservicestothepopulation.Thekeypointtothereviewoftheliteratureisthegenuinelackoffocusonthesocialworkers.MostresearchershavepointedouttheimpactofimmigrationandhowAfricanimmigrantsbegindevelopingdepressionandothermentalhealthissues.However,thelackofinformationonaccesstomentalhealthservicesisagaptheresearcherwouldliketofillbyconductingthepresentstudy.Section2:ResearchDesignandDataCollectionResearchDesignNatureoftheStudyThiswillbeanexploratorystudywiththeaimofuncoveringtheviewsofsocialworkerswhoworkwithimmigrantAfricanwomenlocatedinMetroWestMassachusetts.ThefocusofthestudyistogaininsightsintothebarriersolderimmigrantAfricanwomenfaceinaccessingmentalhealthresources,whichwillalsoincludeananalysisoftheavailabilityofthoseresources.Duetotheirunderstandingofandinteractionwiththispopulation,theviewsofthesocialworkerswillbeexaminedtoensuretheinformationbeingpresentedisreliable.Socialworkersareresponsibleforaddressingthehealthchallengesthatthiscommunityfaces.Withthisinmind,vitalinsightscanberevealedbyinterviewingandgainingtheirperspectiveregardingthecurrentsituation.TheviewsexpressedbythesocialworkersshouldbeanalyzedtodeterminetheeffectofdepressionamongolderimmigrantAfricanwomen.Thesourceofinformationforthisstudywillcomefromtheresponsesobtainedfromtheindividualinterviewswitheachsocialworker.Secondarydatawillcomefromdocumentsandarchivaldata.TheepistemologyofthisstudywillfocusonexploringtheexperiencesofsocialworkersworkingwitholderAfricanimmigrantwomenlivinginMetroWestMassachusetts.Socialworkersworkinginthecommunityfor3ormoreyears,aregraduatelevelsocialworkersorhigher,female,andareover30yearsofagewillbeusedforthisstudy.ExclusionswillincludesocialworkerswhomeettheabovecriteriabuthavenotworkedwitholderAfricanimmigrants.Thisinclusionprocesswillensureexperiencedsocialworkersareprovidinginformationrelevanttothestudy.Theinterviewswillbeaudiorecordedandtheinterviewerwillbetakingnotesastheinterviewprogresses.Transcriptionwillbethefirststepofdataanalysiswhereallaudiorecordedinterviewswillbewrittendownandtypedintoaworddocument.Thisresearcherwillusetranscriptiontodevelopcodestousebeforethedataisenteredintothesystem.Forthisstudy,theresearcherwillmakeuseofSPSSStatisticssoftwaretoanalyzethedata.Dataanalysiswillbeconductedbyindependentanalystswhowillnotbeprivytotheparticipantinformation(Scheider,Ostermann,&Adams,2017).Theanalysiswillbeusedtoverifythedatacollectedfromsocialworkersbyidentifyingdifferencesandsimilaritiesfromtheviewsexpressedbythesocialworkers.MethodologyDataTypesandSourcesofInformationThedatatypesofthestudywillbequalitativeastheresearcherswillrelyoninterviewswiththesocialworkersusinginternetserviceslikeGoToMeeting,skype,Zoom,oranyotherweb-basedservice.Experiencedsocialworkershavetheabilitytounderstandtheirclientsandtheycaneducateusontheimpactofcultureonthewomen\'sdepression.Toconducttheresearch,sampleswillbeselectedfromsocialworkerswhoarecurrentlyservingtheMetroWestMAregion,apriorplaceofemployment.Thisresearcherwillpostflyersaroundmentalhealthoffices,retirementhomes,andhospitalsinvitingsocialworkerstoparticipateinthestudy.Additionalmethodwillbehandingoutflyerstosocialworkersattendingconventions,trainings,andprogramswithinthearea.Thesocialworkerswillalsoberequestedtoanswercertainquestionsabouttheroletheyplayinensuringtheavailabilityofmentalhealthservicestothepopulationaswellasservicemodificationsthatcanhelpimprovehealthdelivery.Forexample,howdoyouensureelderlyAfricanimmigrantwomenareabletoaccessmentalhealthservices?ThedatacollectionprocesswillrelyoninternetserviceslikeGoToMeeting,skype,Zoom,oranyotherweb-basedservicetoconducttheinterviews,where10questionsaredevelopedtoprobeforrelevantinformationfrom10-12socialworkersworkingwithelderlyimmigrantsinWestMassachusetts.Asisthecaseinotherstudiesweforeseetheremightbesomesocialworkerswhowillleavethestudyearlyormightnotbeinterviewedduetotimeconstraints.TheGoToMeeting,skype,orZoominterviewwilllastapproximately45minutestoonehour.Toensuretheintervieweeswillbecomfortableduringtheinterviewprocess,thisresearcherwillproposeconductingtheinterviewsinthesocialworker\'sofficeduringtheirlunchbreakoranotheragreeduponspacewhereallinformationobtainedcouldbekeptconfidential.Thisstudywillmakeuseofquotasampling,becausewehaveidentifiedthecharacteristicsofparticipantstobeincludedinthestudy.Quotasamplingissimilartopurposivesamplingwiththeonlydifferencebeingthatinquotasamplingtheresearcherdecidesonthenumberofparticipantsandthecharacteristicstheyarelookingforintheparticipants.Inpurposivesampling,theparticipantsaregroupedtoapreselectedcriterion.Thesamplesizesarenotfixedonpurposivesamplingastheyareinquotasampling.Thecharacteristicsusedinquotasamplingareage,gender,class,residence,profession,experience,ormaritalstatus.Byusingthequotasamplingstrategy,thisresearcherwillfocusonthesocialworkerswhowouldbemostlikelytohaveexperienceworkingwitholderAfricanimmigrants,knowaboutdepressioninthecommunity,andhavevitalinsightsintotheresearchtopic.Theresearcherchosequotasamplingastheresearcherhasaspecificcriterionoftheparticipantshewouldliketohaveforthestudy.Socialworkersoperateonadailybasisinteractingwithdifferentpeopleinthecommunity.Theyhandlenumerouscases,andtheyareattheforefrontofthecommunityinitiativesregardinghealthcare.Thismakesthemthebestcandidatesforourstudyastheydealwithdifferentclientsandtheyhandlecasesofdepression.Interviewingthesocialworkerswilloffertheresearcherinformationontheprevalenceofdepressionandunderstandwhyitisnothighlyreported.Byunderstandingtheimpactofculture,thesocialworkerscantreatthewomenwithoutthemrealizingtheyarebeingtreatedfordepression.Socialworkerswillalsooffervitalinsightsandgivedepthtoourstudyastheywillbewillingtodiscussdepressioninthecommunityascomparedtothewomenthemselves.Socialworkersareinastrategicpositiontointeractevenwithpeoplewhohadnotcometotheirfacilityfordepression.Beingabletospotanissuegivesthemtheedgetoinitiateconversationwithawomanwholooksdepressed.Socialworkersarechargedwithvisitingthemembersofthecommunityintheirhouseholds,whichgivesthemanadvantageastheycancheckupontheolderwomenanddiscusswiththemabouthowtheyarefeeling.Makingthesevisits,thesocialworkercandiscovercasesofdepressionthatremainundiagnosed.Theprojectednumberofstudyparticipantsis10-12socialworkerswhohavebeenworkingintheMetroWestMassachusettsareaforaminimumofthreeyears.Theresearcherhasdeterminedthatworkingwiththisnumberofsocialworkerswouldberepresentativeofthepopulationunderstudyastherearearound120socialworkersinthearea.Withalargesamplesize,theresearcherwillspendtoomuchtimeconductingtheinterviewsandperformingdataanalysis(Okudo&Ross,2016).Itwouldbeunethicaltoselectalargesamplesizebecausetheresearchermightendupbeingunabletointerviewalltheparticipants.Also,thereisapossibilitythatthisresearcherwillbepressedfortimeandopttoshortentheinterviewtimeline.Thiswillresultinunclearanswersandtheresearchstudywouldbeaffected.DataAnalysisAlltheinterviewswillbeaudiorecordedandtranscribedverbatim.Thiswillprotectagainstbiasandwillprovideapermanentrecordofwhattheinterviewersaid.Theintervieweewillmakefieldnotesduringtheinterviewindicatingtheobservationstheyhavenoted,thoughts,andopinionabouttheinterview.Observationslikebodylanguageandgeneralcomposureoftheintervieweeisvitalasitgivesapictureofhowtheinterviewprocesswasconducted.Allthisinformationcanbehelpfulinthedataanalysisprocess.Dataanalysiscomesafteralltheinterviewshavebeencompleted.Itispossiblethattheinterviewermightfeeltheyhaveafairlygoodideaaboutwhatpeoplehavetoldthemandonemightbeeagertobeginimplementingtheinsightstheyhavegained.However,thereisneedtodoaproperanalysistoensurethereisvalidityoftheresults.Theinterviewermighthavepreconceivedassumptionsofwhattheyexpecttouncoverfromtheinterviewees.Withaproperanalysis,thesebiasesareeliminatedandthereisasystematicandthoroughanalysisconducted.Dataanalysisgivesothersawayofunderstandingexactlyhowtheresearcherreachedtheirvariousconclusionsandmakestheresultsmuchmoretrustworthy.Sincetheresearcherwillbeconductingsemi-structuredinterviews,hewillmakeuseofthematicanalysisofthedata.Thematicanalysisisflexibleandcanbeusedforexplorativestudieswheretherearenoclearpatternsbeingsearchedfor.Thestepsforathematicanalysisarefamiliarizationwiththedata,assigningpreliminarycodesfordescribingthecontent,searchingforpatternsinthecodes,reviewingthemes,defining,andnamingthemes,andproducingthereport.Atthispoint,transcriptionisdoneoftheaudiorecordingsthatwillallowfortheresearchertoworkwiththedata.Theresearcherwillthengothroughallthedatafromtheentireinterviewprocessandbegintakingnotes.Itisatthispointthattheresearcherwillbeginmakingpreliminaryideasforcodestheycandescribefromthecontent.Theamountofdatathatistranscribedwilldependonwhattheresearcherislookingfor.Thesecondstepwillbegeneratingtheinitialcodesfromthedatacollected.Acodeisabriefdescriptionofwhattheintervieweesaidduringtheinterview.So,everytimesomethinginterestingisnoted,theresearcherwillwritedownacode.Acodeisadescriptionnotaninterpretation.Itwillbetheresearcher’swayoforganizingthedataintomeaningfulgroups.Thisstudywillbeexploratory,whichmeansthecodeswilldependonthedata.Initially,theresearcherwillhavetocodeforasmanyinterestingthemesashepossiblycan,toensurethathedoesnotlosetoomuchofthecontext.Inthethirdphasetheresearcherwillbegintosortthecodesintothemes.Themeswillinvolveactiveinterpretationofthedataandcodes.Theresearcherwillbeginbylookingatthelistofcodesandtheassociatedextracts.Thenhewillcollatethecodesintobroaderthemesthatwillsaysomethinginterestingregardingthedata.Theprocessofsearchingforthemesisaniterativeprocesswheretheresearcherwillbemovingbackandforthtotryandformdifferentthemes.Therearesomecodesthatwillseemredundant,whichcanbeplacedinatemporarymixedtheme.Codesthatdonotfitanywhereshouldnotbethrownawayatthispoint,theymightbeofinterestlater.Phase4willinvolvethereviewingofthemes.Thethemestheresearcheridentifiedinphase3willbereviewed.Thiswillbedonethroughthereadingofalltheextractsthatarerelatedtothecodestoexploreiftheysupportthetheme.Theresearcherwillalsoaimatdeterminingifthereareanycontradictionsandthemeoverlap.Ifathemeistoobroad,itwillbesplitintoseparatethemes.Theresearchermightalsohavetomovesomeofthecodesintoexistingthemeswheretheyarebettersuited.Thisprocesswillbedoneuntiltheresearcherfeelshehasasetofthemesthataredistinctiveandcoherent.Theresearcherwillhavetodothesameprocessfortheentiredataset.Thisisdonetoensurethestudyhasthemesthatadequatelyrepresenttheinterestingthemesfromtheinterviews.Atthisphase,theresearchermightdiscovernewthemesthathadbeenmissedbefore.Sincethisisaniterativeprocess,theresearcherwillkeepgoingbackandforthbetweenthemesperfectingthethemesendlessly.Whentheresearchercannolongeraddanythingsignificanttotheanalysis,theycannowfinishreviewingthethemes.Phasefiveinvolvesdefiningandnamingofthethemesweidentifiedintheprevioussteps.Thenameofthethemesshouldbedescriptiveanditifpossibleengaging.Whentheresearcherwillbegivingthethemedescription,hewillnotonlydescribewhatthethemeisabout,buthewillalsodescribewhatisinterestingaboutthetheme.Thestorythateachthemetellswillbeuncoveredandhowthestoryrelatestotheotherthemesandtotheoverallresearchquestion.Whentheresearchergetstothispoint,heshouldbeabletotellacoherentstoryaboutatheme.Iftheresearcherfindsthatathemeistoocomplextotellacoherentstory,hemighthavetorevisitphase4toreworkthetheme.Thefinalphaseisreportproduction.Whenwritingthefinalreport,theresearcherwillstrivetoensurethereisenoughinformationregardingthestudyandprocessforthereadertoevaluatethequalityoftheresearch.Toachievethis,theresearcherwillhavetowriteupaclearaccountofwhatwasdonewhentheywerecarryingouttheresearchandtheanalysis.Theresearcherwillaimtousequotesofwhatsomeoftheparticipantssaidtodemonstratethefindings.Thejobwillbetomaketheparticipantsfeelrealtothepeoplereadingthefindings,whileatthesametimerespectingtheparticipantsrighttoprivacy.Asdiscussedinpreviouschapters,itisvitaltoensurethatthestudyisreliableandvalid.Towardsthis,theresearcherwillmakesureduringthedataanalysisprocess,theywillconducttheanalysisbyfollowingalltherequiredstepsofanalysisandtomaintainahighlevelofobjectivity.theresearchermighthavehis/herpreconceivedassumptionsregardingthestudyandthesehaveawayofcreepinguponthemastheyperformthedataanalysis.Byadheringtothestepslaiddownforthematicanalysis,theresearcherwilleliminatethepreconceivedassumptionstheymightbeharboring,whichwillgivethestudythevalidityitneeds.Also,bydocumentingtheprocessesthattheresearcherhasundertakenfordataanalysisandcollectiontheycanmanagetodemonstratetothereaderthattheyremainedobjectiveinthedatacollectionandanalysis.Givingastep-by-steprepresentationofwhatwillbedoneensuresthereadercanfollowtheresearcherthroughthejourneyandtheywillfeelconfidenttheresearcherhasconductedthestudywiththeutmostcredibility.Theresearcherintendstoofferalltheinformationregardingthestudyincludingthenumberofsocialworkers,theselectioncriteria,andquestionsaskedduringtheinterview.Thisinformationwillgivethestudythereliabilityandvalidityneeded.Inthefinalreporttheresearcherwillprovideinformationonhowtheanalysiswascarriedout,whichwillallowapersontoreplicatethestudyandconfirmitsvalidity.Theresearcheriscertainwiththeinformationtheywillofferitispossibleforthesameresultstobeachievedifaresearcherwastomakeuseofthesamemethodsunderthesameconditions.Theresearcherwillhaveanoutsideresearchertoconductaninquiryauditforourstudy.Theindependentresearcherwillhavealookattheprocessofdatacollection,dataanalysis,andresultsofourstudytodeterminetheaccuracyofourfindings.Byusinganexternalaudit,theresearcherwillgivethisstudythedependabilitythatitneeds.Itwillalsoconfirmthefindingsofthestudyareconsistentandrepeatable.Theresearcherwouldbeinvolvinganexternalauditortoensurethatifotherresearchersweretolookoverthedatatheywouldarriveatthesameconclusions.Theexternalresearcherwillalsopointoutsomethingtheresearchermighthavemissedinthestudy.Theexternalresearcherwillchallenge,explore,andexaminehowdataanalysisandinterpretationtookplace.Trustworthinessofastudyisdeterminedbycredibility,transferability,confirmability,anddependability.Credibilityreferstohowconfidenttheresearcherisinthetruthofthestudyfindings.Theresearcherwillusetriangulationtodemonstratethestudyfindingsarecredible.Transferabilitydetermineshowtheresearcherdemonstratesthefindingsofthestudytobeapplicabletoothercontexts.Theresearcherwillusethickdescriptiontodemonstratethestudyfindingscanbeappliedtoothercontexts,situations,andcircumstances.Confirmabilityisthedegreeneutralityinthestudyfindings.Thisindicatesthestudyfindingsarebasedontheresponsesfromtheparticipantsandnotfromanypotentialbiasoftheresearcher.Toestablishconfirmability,theresearcherwillprovideanaudittrailthatwillhighlighteverystepofdataanalysisthattheymadetoprovidearationaleforthedecisionsmade.Dependabilityistheextenttowhichthestudycanberepeatedbyothersandtheywillfindthesameresults.Theresearcherwillgiveoutenoughinformationfromthestudyforotherresearcherswhoareinterestedinreplicatingthestudytobeabletodoso.Toensuredependabilitytheresearcherwillmakeuseofinquiryaudit.EthicalProceduresAnyresearchthatinvolveshumansubjects,hasinteractionorinterventionthatinvolveshumansubjects,orinvolvestheaccesstoidentifiableprivateinformationshouldundergoanInstitutionalReviewBoard(IRB)reviewandapproval(Wolf,Clayton,&Lawrenz,2018).Forthisstudy,theresearcherplansoninterviewingsocialworkers,whichindicatesthattheresearcherwillbeinvolvinghumansubjectsinthestudy.Therefore,theresearcherisrequiredtoundertakeanIRBreviewandcannotbeginthestudybeforereceivingtheIRBapprovalnumber.TheIRBApprovalisafederalrequirementputinplacetosafeguardhumansubjectswhoareinvolvedinanyresearchstudy.TheTuskegeeSyphilisstudywastheunderlyingreasonwhytherewasrequirementthatbeforehumansubjectsareinvolvedinanyresearchstudy,theresearchersmustseekapprovalfromtheboardtoensurethattheyhaveputinplacemeasuresforsafeguardingtheinterestsoftheparticipants.TheTuskegeeSyphilisstudyhadnumerousethicalviolationsthatnecessitatedfortheinvolvementofanindependentboardtooverseeresearchstudiesthatinvolvehumansubjects.Anyresearchstudythatinvolveshumansubjectsmustseekinformedconsentfromthestudyparticipantsbeforethestudybegins(Wolfetal.,2018).Thereshouldbebothawrittenandverbalconsentforparticipationintheresearch.Asresearchers,wearechargedwitheducatingandinformingthepotentialstudyparticipantsabouttheresearchstudyandtheroletheywillplayinthestudy.Weunderstandthattheinformationwewillsharewiththeparticipantsmightbecomplexordistressfulandtheparticipantsmightneedsometimetoabsorballtheinformation(Biros,2018).Towardsthistheresearcherwillgivetheparticipantsatleast48hourstoreviewtheinformationprovidedbeforetheycansignoffonparticipation.Theresearcherwillavailhimselftothepotentialresearchparticipantstoansweranyquestionstheymighthave.Ensuringthestudyparticipantsreceivealltheassistanceandsupporttheyneedbeforetheyappendtheirsignaturesontheconsentform.VerbalconsentcanonlybeallowedwiththeapprovaloftheIRB(Biros,2018).Inthiscasetheresearcherwillnotberequiredtohavesignedconsentformsfromthestudyparticipants.Theprocessforverbalconsenthasthreesteps.Thefirststepinvolvestheresearcherexplainingtothepotentialstudysubjectsverballyinformationpertainingtostudypurpose,procedures,benefits,risks,andalternativestoparticipation.Theresearcherisrequiredtogivethepotentialsubjectsampletimetoprocesstheinformationandaskquestion.Thepotentialsubjectsshouldbeencouragedtoaskquestiontoensurethattheyhaveunderstoodwhatthestudypertains.Thesecondstepiswherethepotentialsubjectisgivenastudyinformationsheet.Thepotentialstudysubjectsaregivenampletimetoconsideriftheyarewillingtoparticipateornot.Thetimelinecanrangefromminutestohours.Thetimegivendependsonhowmuchoneconsiderstobereasonabletimeforthepotentialsubjectstoevaluatetheprocedures,benefits,risks,andalternatives.Thefinalstepiswheretheresearcherwillansweranyfurtherquestionsthatthepotentialsubjectsmighthaveandonce,theyaresatisfiedtheycanoffertheirverbalagreementtoparticipateinthestudy.Writtenconsentisnotjustaboutreceivingasignaturefromtheparticipant.Theprocessissimilartotheoneforverbalconsent.However,forwrittenconsent,theresearchermustprovidetheconsentdocumenttothepotentialsubjectsbeforetheybeginthediscussion.Theconsentdocumentwillbeaguidefortheresearchertoexplaintothepotentialsubjectsallinformationpertainingtotheresearchstudy.Theinformedconsentprocessinvolvesgivingthesubjectadequatetimetoreviewtheinformationgivenandthepotentialsubjectisgivenadequatetimetoconsideralloptions.Theresearcherisrequiredtoanswerallthequestionsposedbythepotentialsubjecttoclarifyanythingthatisnotclear.Itisvitalthattheresearcherensuresthepotentialsubjectcomprehendsalltheinformation.Thereshouldbeampletimegivenfortheresearcherandthesubjecttoexchangeinformationandaskquestions.Oncethepotentialsubjectiscertainabouttheinformationtheymightbegivenfurthertimetoreviewtheinformationbeforetheyareallowedtosigntheconsentform(Liu,Zeng,Deng,&Zhou,2018).Writtenconsentinvolvesthreestepsastheonesforverbalconsent.Theonlydifferenceisthatforthewrittenconsentthepotentialsubjectisgivenawrittenconsentform.Oncethesubjectiscertaintheyarewillingtoparticipatetheywillsigntheformandhanditbacktotheresearcher.SummaryThedatacollectionwillbedoneusingonlineinterviewsthroughinternetserviceslikeGoToMeeting,skype,Zoom,oranyotherweb-basedservice,andthestudyparticipantswillcompriseof10-12socialworkersworkinginMetroWestMassachusetts.Theideaistoonlyinterviewsocialworkersastheywilloffervitalinsightsintotheinformation,weseeklikeservicesavailable,culturalcompetenceofthesocialworkers,andaccesstotheservicesbythewomen.Alltheinterviewswillberecordedtoaidintranscriptionduringthedataanalysisprocess.Theresearcheraimstouncoverpatternsandmakecodesforuseinthethemestobediscovered.Duringthedataanalysisprocess,theresearcherwillfamiliarizehimselfwiththedata,assignpreliminarycodesfordescribingthecontent,searchforpatternsinthecodes,reviewthethemes,defineandnamethemes,andproducethereport.Thesestepswillflowsystemicallyensuringtheresearcherdoesnotmissanythingvital.Oncethedataanalysisprocessiscompleted,theresearcherwillmovetothepresentationofhisfindings.Inthisstagetheresearcherwilldescribethefindingsuncoveredandreportontheinterestingthingstheydiscoveredfromthedata.Limitations,Challenges,and/orBarriersRecruitingofthesocialworkerswillbeahugechallengeforthisresearchmainlyduetohavingnopriorrelationshipwithprospectiveparticipants.Gettingthemtotrusttheresearcherwillbeanuphilltaskasthenatureoftheirworkissensitiveandtheirdiscomfortsharingpatientinformation.Anotherchallengeistimelimitation,asthesocialworkersmightbeunavailablefortheinterviews.Anotherchallengethatmightoccurissomesocialworkersmighthaveanemergencyand,asaresult,mighthavetocanceltheirinterview.Thiswillresultinattritionandreducethenumberofstudyparticipants.Thisresearcherestimateshewillhaveanattritionoflessthan5%,whichwillnothaveahugeimpactonthestudyresults.However,iftheresearchernoticestheattritionishigherthan6%thenthereisapossibilityofattritionbias.Toreduceoreliminateattritionbias,theresearcherproposestofollow-upwiththestudyparticipantswhocancelledtheirinterviewsandencouragethemtorescheduletheinterview.Face-to-faceinterviewsmaynotbefeasibleduetoCOVID19.ToovercomethischallengetheresearcherproposestomakeuseofinternetserviceslikeGoToMeeting,skype,Zoom,oranyotherweb-basedservice.Somesocialworkersmaynotbefamiliarwiththesetechnologies.SummaryAccordingtoSaeidimehr,Geravandi,Izadmehr,andMohammadi(2016),reducingthecausesofdepressionisbeneficialtosocietyduetoareducednumberofpeoplewhoneedmentalhealthservicesorarelivingwithmentalconditions.Resultsfromthisinvestigationcanbenefitthesocialworkersastheywillgetinsightsintostrategies,theycanusetoassistolderimmigrantAfricanwomenwhoaresufferingwithdepressiontogetmentalhealthservices.Thisstudyaimstouncovertheculturalinfluencesfacedbysocialworkerswhenworkingwiththispopulation.Byunderstandingtheimpactculturehasonthecommunity,socialworkerscandevelopstrategiestheywillusetobecomeculturallycompetent.Section3:PresentationoftheFindingsThestudyaimstogettheviewsofsocialworkersregardingdepressioninolderimmigrantAfricanwomeninMetroWestMassachusetts.Theperspectivesofthesocialworkerswillofferinsightsintowaystheolderimmigrantwomencanbeassisted.Thestudyresultscanofferservicemodificationsuggestionsandenhanceaccesstoqualitymentalhealthservices.TheresearchquestionsfocusonthefactorsthatinfluenceolderimmigrantAfricanwomenadaptivecapacity,thementalhealthservicesofferedbythesocialworkerstotheolderimmigrantwomen,howsocialworkersassessthementalhealthservicesneedsfortheolderimmigrantwomen,andservicemodificationssocialworkerscanintroducetotheirpracticetoenhanceservicedelivery.Dataforthisstudywillbecollectedusinginterviewswiththesocialworkers.AllinterviewswillbeconductedusinginternetserviceslikeGoToMeeting,Skype,Zoom,oranyotherweb-basedserviceduetothecurrentCovid-19pandemic.Thesocialworkerswereaskedtenquestionsprobingthemforrelevantinformation,andthestudypopulationcomprised11socialworkersworkingwithelderlyimmigrantsinWestMassachusetts.Theresearcherwillstartbydescribingthedataanalysistechniquesusedinthestudyandthenpresentthestudy\'sfindings.DataAnalysisTechniquesThesocialworkers\'schedulesdiffered,andthisresearcherhastoworkaroundthesocialworker\'sschedules.Therefore,thetimeframefordatacollectionwasinitiallysettotwoweeks.However,therewasapossibilityofextendingthistimeframetoaccommodatethoseparticipantswhomighthavemissedtheirinitialtimeslots.Thesocialworkers\'recruitmentwasconductedusingflierspostedaroundmentalhealthoffices,hospitals,andretirementhomes,invitingsocialworkerstoparticipateinthestudy.Anothermethodusedtorecruitparticipantswashandingoutflyerstosocialworkersattendingtraining,conventions,andprogramsaroundMetroWestMassachusetts.Itisestimatedtheremightbeahighnumberofinterestedstudyparticipants,andthisresearcherwillhavetoreviewallthestudyparticipantstodeterminethosewhoarequalifiedormeetthecriteriaofthestudy.OnlysocialworkerswhohaveexperienceworkingwitholderAfricanimmigrants,knowaboutdepressioninthecommunity,andhavevitalinsightsintotheresearchtopicwillbeconsideredforparticipationinthestudy.Quotasamplingwillbeusedastheresearcherhasaspecificcriterionoftheparticipantshewouldliketohaveforthestudy(Etikan&Bala,2017).Socialworkerswhoshowinterestinthestudywillberequestedtoprovideinformationregardingthenumberofyearsworkedinthearea,theclienteletheyworkwiththemost,andthevitalinsightstheymightbringtothestudy.Theresearcherwillhavetoreducethenumberofstudyparticipantstoensurehewillhaveadequatetimetointerviewtheproposednumberandgetadequatesocialworkers\'information.Sincequotasamplingwillbeused,theresearcherwillselecttheparticipantsbasedonthecharacteristicsheislookingforfromthesocialworkers.Samplesizesarefixedinquotasampling,andthereisnoroomforincreasingthenumberofparticipants.Theprojectednumberofstudyparticipantsisbetween10-12socialworkers.Theresearcherhasdeterminedthisisarepresentativenumberasabout120socialworkersareworkinginthearea.Duetotimerestrictions,itisnotpossibletohavemorethan12socialworkers.Thetimetakentocodeandperformdataanalysiswouldprolongthestudydurationandresultinunclearanswers.Interviewingtheparticipantswilltakethebulkoftime,andschedulinginterviewswithmorethan12participantscanresultintheresearcherfailingtointerviewthem.AlltheinterviewswillbeconductedusinginternetserviceslikeGoToMeeting,Skype,Zoom,oranyotherweb-basedserviceandrecorded.Aftereachinterview,theresearcherwilltranscribetheinterviewverbatim,whichwillprotectagainstbiasandprovideapermanentrecordofwhattheintervieweesaid.Theinterviewerwillbemakingfieldnotesastheinterviewprogresses,notingtheinterviewee\'sbodylanguage,thoughts,andopinionsregardingtheinterview.Bodylanguageisvitalasitoffersapictureofhowtheinterviewprocesswasconductedandtheinterviewee\'sfeelings,whichisvitalindataanalysis(Farooq&DeVilliers,2017).Thestudywillusesemi-structuredinterviews,andtheresearchercanusethematicanalysisofthedata.Therearenoclearpatternsexpectedoridentifiedbeforethestudycommenced.Therefore,usingthematicanalysis,theresearchercanuncoverthemestheycanusefortheirstudy(Castleberry&Nolen,2018).Tobegintheanalysis,theresearcherwillfamiliarizethemselfwiththedata.Familiarizationinvolvestranscribingtheaudio,readingthetextandtakingnotes,andgenerallylookingthroughthedata.Withoutfamiliarization,theresearcherwillfindithardtounderstandthedataandstruggletoperformtheanalysis.Thesecondstepiscoding,wheretheresearcherhighlightssectionsofthetexttheyfindinterestingorjumpsoutfromtheinterview.Theresearcherwillcreateshorthandlabels(codes)describingthehighlightedphrasesorsentences(Castleberry&Nolen,2018).Theresearcherhastogothrougheachinterviewtranscriptandhighlightallthosephrasesorsentencesthatseeminterestingorrelevanttothestudy.Theresearchercankeeponaddingnewcodesastheygothroughthetext.Allthedatawillbecollatedintogroupsbasedontheidentifiedcodes.Thethirdstepisgeneratingthemes.Duringthisphase,theresearcherwillgoovertheidentifiedcodes,identifypatterns,andbegingeneratingthemes.Themeswillcompriseseveralcodes.Someoftheidentifiedcodescanbediscardediftheyaredeemedvagueornotrelevantenough.Somecodesmightbeconvertedintothemes.Thethemesidentifiedwilloffermoreinformationaboutthedatafortheresearch.Next,wereviewthemestoensuretheyaccuratelyrepresentthedata.Theresearcherwillreturntothedatasetandcomparetheidentifiedthemesagainstthedataset.Theobjectiveistoensurenothingismissingandallthevitalinformationhasbeencaptured.Theresearcherhastoensurethethemesrepresentthedata.Themescanbemodified,discarded,orcombined,ensuringtheyarevaluableandaccurate.Theidentifiedthemeswillthenbedefined.Defininginvolvesformulatingwhateachthememeansanddetermininghowitassiststheresearcherinunderstandingthedata.Afterthedefinitionisdoneforthethemes,eachthemewillbegivenasuccinctnameandcanbeeasilyunderstood.Finally,theresearcherwillwriteuptheirreportontheanalysisofdata.Theresearcherwillmakeuseofpeerde-briefersorpeerdebriefingtoestablishthevalidityofthestudy(Chengetal.,2017).Usingpeerdebriefing,thisresearcherwillensuretheycollectedvalidinformation.Theresearcherwillworkwithoneofhiscolleagueswhoisnotinvolvedinthestudyandholdsimpartialviewsregardingthestudy.Thepeerwillexaminethestudytranscripts,generalmethodology,andfinalreport.Theywillthenofferfeedbacktotheresearcher,enhancingvalidityandcredibility(Chengetal.,2017).Thepeercandetectoveremphasizedpoints,underemphasizedpoints,vaguedescriptions,biasesmadebytheresearcher,andgeneraldataerrors.Thepeerde-briefercanassisttheresearcherinbecomingawareofhisviewsonthedata.Theresearcherwilldeterminethedebriefingschedule,andthebestschedulewillinvolvesharingofinformationregularlyaftervitaltaskshavebeenachieved.DuetotheCovid-19pandemic,theresearcherwasforcedtouseinternetservicestoconducttheinterviews.WithinternetserviceslikeGoToMeeting,Skype,orZoom,technicalchallengescouldoccurlikelossofinternetconnectionorcomputerproblems.Theresearcherhastoperseverethroughthem,andintheworstcases,theinterviewscouldberescheduledtoalaterdateortime.Itisnoteasytogaugebodylanguagewhenconductinganinterviewonline.Themainareatheinterviewerwillseeistheface,andthismightnotoffermuchinformationaswouldhavebeenpossibleiftheinterviewwasconductedface-to-face(Farooq&DeVilliers,2017).Anotherchallengewasthelackofpersonaltouchavailablewhenconductinganinterviewface-to-face.Therewasageneraldisconnectbetweentheinterviewerandtheinterviewee,whichcouldaffectthestudyresults.Thesocialworkerscouldfindithardtoconcentrateontheonlineinterviewssincetheyarenotusedtothem,andthenatureoftheirworkrequiresthemtohaveaphysicalpresencewhendealingwithaclient.FindingsTheresearcherwilllookoutforpatternsandcharacteristicsinthedatasets.Theresearcherwillmakeinvestigationsonthedatatodiscoveranomaliesandcheckforassumptionswiththehelpofgraphicalrepresentations.Theyarelookingoutforcommonpatternswithinthesocialworkers\'responsestoachievetheresearchobjectivesandaims.Allcollecteddatawillbekeyedintoacomputerprogram,andforthisstudy,theresearcherwilluseSPSSsoftwaretoanalyzethedata.Sincetheresearchershallbeusingonlineinterviews,alltheinterviewanswerswillbeconvertedintocodesbeforeenteringintothesystem.Dataanalysiswillthenbeconductedbyindependentanalystswhowillnotbeprivytotheparticipantinformation.Theresearcheraimstouncoverthedifferencesandsimilaritiesinthedatacollectedfromtheinterviewsconducted.Thestudyresultswillbepresentedintablesandfiguresforeaseofreadingandpresentation.Theresultswillanswertheresearchquestionsproposed,andvitalinsightswillbegainedfromthedata.Section4:ApplicationtoProfessionalPracticeandImplicationsforSocialChangeThestudywasconductedtouncoversocialworkers\'viewsregardingdepressioninolderimmigrantAfricanwomeninMetroWestMassachusetts.Socialworkersofferedinsightsonhowtheydelivermentalhealthservicesandtheresponsestheygetfromthewomen.Theresultsofthestudywillassistinservicemodificationsandenhancingaccesstoqualitymentalhealthservices.ThestudywascarriedoutsincetherearedisparitiesinmentalhealthaccessbyolderimmigrantAfricanwomen.Therearementalhealthdisparitiesamongthewomen,andmoststruggletoreceiveassistanceandacceptamentalhealthdiagnosis.Socialworkershavehadissueswhenitcomestodiscussingmentalhealthproblemslikedepressionandanxietywithwomen,mainlyduetoculture.Thesocialworkershavetobeculturallyawareandapproachthewomenbasedontheirculture.Therefore,culturalawarenessplaysacrucialroleinthetreatmentofwomen.Socialworkpracticehasbeenmodifiedinthislocationassocialworkershavetolearndifferentculturesandunderstandhoweachcultureapproachestheissueofmentalhealthcare.Reducingthecausesofdepressionisbeneficialtosocietyastherewillbefewerpeoplewhoneedmentalhealthservicesorarelivingwithmentalconditions.ThestudywillbenefitthecommunitybyreducingcasesofdepressionamongsttheolderimmigrantAfricanwomencausedbytheirmigrationexperience.Thisstudy\'sresultscanbeusedbyothersocialworkerswhoaredealingwithasimilarpopulation.Basedonthisstudy\'sresults,othersocialworkerswillbenefitfromfindingoutthestrategiestheycanemploytoreachouttosuchapopulationandthestrategiestheyshouldavoid.Culturalinfluenceshavebeenuncoveredthatwillbevitalindeterminingthemethodsthatcanbeusedtotreatthispopulation.Beingculturallyinformedisbeneficialtothesocialworker,anditwillallowthemtoreachouttothecommunitymembersandapproachtheminamannerthatwillbeacceptable.SocialworkwillbenefitthemostsincetheresultswillsuggeststrategiessocialworkerscanusewhendealingwitholderimmigrantAfricanwomen.Consideringthewomenwillhavedifferentculturesbasedontheircountryoforigin,itwillbevitalthatasocialworkerfirstunderstandstheculturebeforeheorshecanbeginofferingtreatmentorcounselingtotheindividual.ApplicationforProfessionalEthicsinSocialWorkPracticeThesocialworkproblemhighlightedinthisstudyrelatescloselytothesetwoprinciplesoftheNationalAssociationofSocialWorkers(NASW)CodeofEthics,culturalawareness,andsocialdiversityandcompetenceofthesocialworker(NationalAssociationofSocialWorkers,1996).Asocialworkershouldunderstandthecultureofthepopulationtheyareservingandtherolecultureplaysinhumanbehaviorandsociety.Withoutunderstandingculture,asocialworkerwillstruggletointeractwiththeclients,andthiswillcreateariftbetweentheclientsandthesocialworkerresultingintheclientnotreceivingadequateservice.Theservicesofferedbyasocialworkershouldbesensitivetotheclient\'sculture.Culturalsensitivityallowsthesocialworkertounderstandtheclient\'scultureandofferservicesthatareinlinewiththeclient\'sculture.Beingculturallysensitiveensuresthesocialworkercanofferservicesthatwillbeacceptabletotheclient.Asocialworkermustunderstandthenatureofsocialdiversityandoppressionastheyrelatetorace,nationalorigin,ethnicity,sex,sexualorientation,color,age,maritalstatus,religion,immigration,andmentalhealth(NationalAssociationofSocialWorkers,1996).Thestudyconfirmstheimportanceofbeingculturallysensitiveasthereisevidencetosupportthisprinciple.SocialworkerswhoarenotculturallysensitivehavehadahardtimetreatingolderimmigrantAfricanwomen,whichhasmainlybeenduetofailuretounderstandtheirculture.Competenceisthesecondprinciplefocuseduponinthisstudy.Asocialworkershouldaccepttheresponsibilitybasedontheirexistingcompetence.ForasocialworkertoworkwitholderimmigrantAfricanwomen,theyneedtohavethecompetenceneededtoassistadiversepopulationorclientele.Therefore,asocialworkerwhohasnoexperienceordesiretogainexperienceworkingwithadiversecommunityshouldnotacceptemploymentinsuchanarea.Acceptingemploymentandfailingtogetthenecessarycompetencewouldbeadisservicetothewomenastheywillnotreceivethecaretheyneed.ThestudyincreasesthecurrentknowledgeregardingthediscrepancyinaccesstomentalhealthbytheolderimmigrantAfricanwomen,andothersocialworkerswouldusetheresultsofthisstudytoincreasetheirknowledge.Understandingthebarrierswomenandsocialworkersfaceregardingmentalhealthaccesswillallowsocialworkerstomodifytheircurrentpracticemodelstobemoreaccommodating.Socialworkershavetoreviewtheavailableliteraturetodeterminenewmodelsandadvancesinpracticetheycanimplementintheirpractice.Thecurrentstudyshouldbeusedaspartofthiscontinuedknowledgeacquisition.TheNASWcodeofethicsisclearintermsofhowasocialworkershouldhandleculturalissues,andtherequirementofbeingculturallycompetentisvital(NationalAssociationofSocialWorkers,1996).Asocialworkershouldnotacceptemploymentinanareawithadiversepopulationiftheyarenotpreparedtolearnaboutthedifferentculturespresentintheirworkarea.Withoutculturalcompetence,thesocialworkerwilldiscourageclientsfromseekingmentalhealthservices,whichleadstofurtheralienationofthepopulationunderstudy.Already,thewomenarefindingithardtoaccessmentalhealthservices,andthesituationshouldnotbeaggravatedfurtherbyemployingsocialworkerswhoarenotculturallyawareorwillingtolearn.Socialworkershavetounderstanddiversityandoppression,whichallowsthemtoworkwithdifferentclientsandoffereffectiveserviceswithoutdiscrimination.Competenceinsocialworkmandatesthesocialworkerstohaveampleknowledgeinanareabeforeofferingtheirservices.Therefore,socialworkerswhoarenotculturallycompetentshouldnotattempttooffertheirservicestoaclientfromadifferentculture.Familiarizationwiththedifferentculturesatthebaseoftheirclient\'sareaisvitalandshowsthesocialworker\'scompetence.RecommendationsforSocialWorkPracticeThefindingshaverevealedservicemodificationslikegivingtheclientsmoretimesincetherearelanguagebarriers.Theadditionaltimewillensuretheclientcanexpressherselffullyandnotfeelthesocialworkerisrushingthem.Toenhancequalitymentalhealthservices,itisvitaltoensureclientsarenotlimitedtoagiventimeframeandthesocialworkerisnotrushedtofinishwitheachclient.Theadditionaltimeallowstheclienttohaveenoughtimetoexpressherselftothesocialworker,andthesocialworkerbenefitsbyhavingattendedfullytoaclient\'sneeds.Increasedtimeframeforthesocialworkerwillgivethesocialworkerampletimetodiagnoseandtreattheclient.Culturalbarrierscanbeovercomethroughincreasedtimespentwithaclient.Themoretimespentasocialworkerspendswithaclient,theclientwillfeelcomfortable,andtheywillbegintotrustthesocialworker,whichwillencouragetheclienttospeakfreelywiththesocialworkerandexpresswhatisbotheringher.Itiswellknownthatthemoretimeapersonspendswithanother,themorelikelytheyaretotrusttheperson.Therefore,theincreaseintimeshouldbeapolicyconsiderationforsocialworkersworkinginculturallydiverseareasorareaswheretherearelanguagebarriers.Thesecondactionstepwouldbestrategiessocialworkerscanusetoreachouttothepopulationunderstudy.Currently,socialworkersinteractprimarilywiththewomenwhovisitthesocialworkfacilities.However,otherwomenoptnottovisitthesefacilitiesduetocultureorfear.Reachingouttothesewomenwouldbevitalasitwouldreducementalhealthcaseswithinthecommunity.Womencanbeencouragedtovisitthefacilitiestoreceiveassistancewithanyunderlyingissuetheymighthave.Takingservicestothecommunityremovesthestigmaassociatedwithmentalhealthservices,andmorewomencanstartappreciatingtheservicesofthesocialworkers.Servicemodificationtohavesocialworkersvisitingthecommunitywillmakethesocialworkersfamiliarwiththewomen,andwithtimethewomenwillstartembracingtheservicesoffered.Reducingcasesofdepressionandanxietyinthecommunityisthemainagenda,andsocialworkersshouldensuretheycanreachouttothecommunityindifferentways.Thesestudyfindingscanbetransferabletootherpopulationsdealingwitholderimmigrantwomenfromotherpartsoftheworld.TheissuesfacedbyAfricanimmigrantsmightbesimilartootherimmigrantsmakingthefindingstransferable.Theimportanceofculturalcompetencecomestotheforefromthestudyresults.Socialworkershavedemonstratedhowvitalitistohaveculturalcompetence,whichisaskillthatcanbeusedfordifferentcommunitiesandindifferentsettings.Thereshouldbeapushtoincreaseculturalcompetencetraininginschooltohavemoresocialworkersunderstandinghowtohandleadiversepopulation.Thestudyresultshavedemonstratedthatinformationismissingsincemostsocialworkershaveexpressedthattheystruggledtohandlethepopulation.Therefore,theywererecommendingformoretrainingregardingcultures.Policyconsiderationsandchangescanbeimplementedbasedontheresultsofthisstudy.Therearedifferentaspectstolookforwithinacommunity,andinmostcases,socialworkersfindithardtomanageanewcommunitysincetheylacktheappropriateskills.Immigrantsfacedifferentchallenges,andunderstandingthesechallengescanhelpasocialworkertreattheclient.Furtherresearchisneededtouncovermoreinformationthatmighthavebeenmissedorapplicableforotherraces.Thispresentstudy\'sfocuswasonolderAfricanimmigrantwomen,whichmighthavelimitedtheresultsasmoreinformationisneededtodetermineifthemenalsofacethesamechallengesasthewomen.Africanimmigrantsmighthavedifferentexperiencesthanimmigrantsfromothercontinents.Therefore,amoreinclusivestudycanbeconductedtodetermineifthestudyresultscanbeusedforothercommunities.Themajorlimitationofthisstudyisthefactweusedasmallsamplesize.Withonly12socialworkers,peoplemightfeelthestudypopulationisnotrepresentativeandmightnotbegeneralizabletothepopulation.Thestudy\'sfocuswasonolderAfricanimmigrantwomen,whichlimitsthestudyresultstoonlythispopulation.Thestudy\'sgeneralizabilitycanbeproblematicassomeoftheproposedpracticechangescanonlybeusedforAfricanimmigrants.Thelackoffocusonothercommunitieswillaffecthowthestudyisinterpreted.Whilewecanpushtohavethestudyapplicabletoothersocialworkersworkingwithadifferentpopulation,thereareaspectslikeexperienceandculturethatwillbedifferentandimpactitsusefulness.Onlineinterviewshavethelimitationofnotbeingabletofullygaugetheparticipant\'sbodylanguagesincetherearepartsoftheparticipant\'sbodythatwillnotbevisible.Therefore,theinterviewer\'snotesarelimitedtoonlyfacialexpressionsandhandgestureswhenvisible.Furtherresearchisneededtoincludemoresocialworkersandalsocoverotherimmigrants.FocusingsolelyonAfricanimmigrantslimitsthestudy\'sgeneralizability,makingithardtodetermineifthesameresultswouldbefoundifthepopulationunderstudywasdifferent.Expansionofthestudytoincludeimmigrantsfromothercontinentswillincreasethestudy\'strustworthinessandcanbeusedtogeneralizethepopulation.Thesamplesizeusedwassmallduetoalackofampletime.Futurestudiesshouldconsiderincreasingthenumberofsocialworkers.Withalargesample,thesocialworkers\'viewscanbedeterminedbetterandcanbeusedtoinformpracticechanges.ImplicationsforSocialChangeIthasbeennotedthereisanincreaseinmentalhealthcaseswithinthecommunity,andthesameisnotreplicatedinmentalhealthinstitutions.Thenumberofwomenseekingmentalhealthisasmallportionofthepopulationanddeterminingthereasonbehindthissmallnumberisvital.Thereisanopportunitytopushforchangesbyusingthisstudy\'sresultstodemonstratetheneedformentalhealthservicesinthecommunity.Thechallengessocialworkershavenotedcanbeusedtochangepractice,likeincreasingeachclient\'sallocatedtime.Languagebarrierswillmakeithardforaclienttoexpressthemselffullywithinashortduration.However,withanincreaseintheallocatedtime,theclientwillhaveampletimetostatetheirissuewithoutfeelingpressurized.Socialworkerscanalsomodifytheirapproachtowardsimmigrantsandencouragethewomentoseekassistance.Theolderimmigrantwomenmightnotbereceptivetothesocialworkersinitially,butwithtimethewomenwillembracesocialworkers,whichwillincreaseaccesstomentalhealthservicesinthecommunity.SummaryThestudyaimstoreducethecasesofmentalhealthproblemsfacedbyAfricanimmigrantwomenlocatedinMetroWestMassachusetts.Reducingthecausesofdepressionisbeneficialtosocietyastherewillbefewerpeoplewhoneedmentalhealthservicesorarelivingwithmentalconditions.ThestudywillbenefitthecommunitybyreducingcasesofdepressionamongsttheAfricanimmigrantwomencausedbytheirmigrationexperience.Thisstudy\'sresultscanbeusedbyothersocialworkerswhoaredealingwithasimilarpopulation.Basedonthisstudy\'sresults,othersocialworkerswillbenefitinthattheywillfindoutthestrategiesthatcanbeemployedtoreachouttosuchapopulationandthestrategiesthattheyshouldavoid.Culturalinfluencescanbeuncoveredtodeterminethemethodsthatcanbeusedtotreatthispopulation.Beingculturallyinformedisbeneficialtothesocialworker,anditwillallowthemtoreachouttothecommunitymembersandapproachtheminamannerthatwillbeacceptable.SocialworkwillbenefitthemostsincetheresultswillhavesuggestionsthatothersocialworkerscanusewhendealingwithAfricanimmigrantwomen.Consideringthatthewomenwillhavedifferentculturesbasedontheircountryoforigin,itwillbevitalthatasocialworkerfirstunderstandstheculturebeforeheorshecanbeginofferingtreatmentorcounselingtotheindividual.

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