Graduation Year

2018

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Social Work

Major Professor

Guitele J. Rahill, Ph.D.

Committee Member

Manisha Joshi, Ph.D.

Committee Member

Celia Lescano, Ph.D.

Committee Member

Nan Sook Park, Ph.D.

Keywords

Sexual Health Communication, Health Disparities, HIV/AIDS, Constructivist Grounded Theory

Abstract

This exploratory study examined links between health communication and other constructs affecting health promotion and disease prevention among Haitian mother-daughter dyads living in West Central Florida, and the risk or protective factors for HIV. Risky sexual behaviors can be reduced with accurate and effective information provided through parent-adolescent communication (Coetzee et al, 2014; Ogle, Glasier & Riley, 2008; Hadley et al., 2009). In Haiti, a country that bears a disproportionate burden of HIV/AIDS, women are the most vulnerable (UNAIDS, 2016a); In the United States (U.S.), foreign-born Haitian women in the state of Florida experience health disparities in many areas and bear a disproportionate burden of HIV/AIDS relative to their non-Haitian peers but little is known about (Florida Department of Health [FLDOH], 2017; U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion [ODPHP], 2017). Indeed, the state of Florida recently reported that newly diagnosed cases of HIV increased for foreign-born Haitian women and in 2016, the latter represented 3.64% of all cases (Florida Department of Health, Bureau of Communicable Diseases, HIV/AIDS Section, 2017a). Recognizing that Haitian mothers traditionally bear the primary responsibility for transmitting traditional norms, values, health beliefs and practices, a concept referred to as poto mitan, this qualitative study examined risks and protective factors for HIV that may emerge in health and sexual health communication among Haitian mothers and daughters.

This study comprised a two-phase process in which purposive sampling was first used to recruit and interview a focus group of seven health care providers and Haitian-descendant community leaders who engage Haitian-descendant clients in West Central Florida, after which findings from the focus group were used to strengthen a semi-structured interview guide that would be used to interview 10 Haitian mother/daughter dyads in the area. This study addressed a gap in the scientific literature related to health and sexual health promotion and disease prevention communication among Haitian immigrant women in the U.S., particularly surrounding HIV risk. Specifically, it sought to discover what constitutes specific methods that Haitian mothers use to communicate health and sexual health and the contents of such conversations, as well as the intention of daughters to transmit information that they received from their mothers, even here in the U.S.

This study applied a constructivist grounded theory approach, in which Symbolic Interactionism (SI) and the Information-Motivation-Behavioral Skills Model (IMB) were triangulated as a framework. ATLAS.ti® 7.0, a software that supports analysis of textual data, was used to analyze transcripts from the focus group and from the interviews.

Findings indicate that (a) Haitian mothers intentionally transmit specific and valued traditional knowledge about health and sexual health to their daughters, specifically in the areas of vaginal health, post-partum rituals, and abstinence as the acceptable mode of HIV prevention; (b) Haitian mothers in the study sample lack adequate and accurate knowledge about HIV/AIDS as well as the time to learn more that they can share with daughters; (c) Haitian mothers in the study sample do engage in direct communication about HIV prevention, taking advantage of teachable moments, using popular music and television programs; (d) there is a strong reliance on religious leaders and school systems to address health and sexual health instruction; (e) Haitian mothers in the sample reported and daughters confirmed that there is extremely limited conversation between the mothers and daughters surrounding sex, HIV risk reduction methods outside of abstinence. (f) Symbolic Interactionism is a useful framework for understanding the process of communication between Haitian mothers and daughters in this study; (g) IMB is useful to understand that the information being provided by Haitian mothers in this sample is at times insufficient and inaccurate, thereby limiting the ability of daughters to effectively and intentionally engage in conduct that protects their sexual health and reduces HIV risk.

This study has several implications for social work education, research, practice, and policy. First, social work students must be taught to conduct comprehensive assessments of Haitian women in the context of valued Haitian family dynamics, and to engage in life-long learning regarding protective as well as risk factors for Haitian mothers and daughters. Second, Haitian and non-Haitian health providers who serve Haitian clientele could be surveyed regarding knowledge of health beliefs and practices and its potential impact on the health of their constituents. their Haitian patients. Third, researchers may use this study’s findings as a foundation for developing interventions that enhance strategies aimed at establishing rapport with Haitian clients and for assessing potential interactions between hidden health practices and prescribed medications. Fourth, findings suggest the need to develop interventions that empower trusted religious leaders to gain accurate HIV knowledge and to deliver empowering information effectively to their congregants. Fifth, findings suggest a need to develop outreach programs aimed at heightening HIV awareness and increasing HIV testing for Haitian women who are similar to this study’s sample. Sixth, social workers engaging Haitian female clients can make intentional efforts to include Haitian mothers in treatment. Seventh, this study’s findings underscore a need for social workers to advocate on behalf of Haitian immigrants’ efforts to be properly counted in the census, and to be counted as a culturally distinct group in other surveillance data.

Social workers can benefit from understanding the strengths of relationships between Haitian mothers and daughters and to enhance their awareness of the heterogeneity among Haitians in general when working with Haitian clients. To work effectively with Haitian immigrant females overall requires cultural humility to mitigate the likelihood of bias towards them based on known or hidden traditional health beliefs and practices and gender roles.

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