Asian Americans are currently the fastest growing racial group in the United States (U.S. Census Bureau, 2017), and over 19% of Asian Americans living in the United States are Filipinos, making Filipinos the third-largest Asian group in the United States after the Chinese and Asian Indians (Lopez, Ruiz, & Patten, 2017). Historically, during the earlier waves of migration of Filipinos to the United States, Filipino American men outnumbered the women; however, over time, Filipino women have surpassed the number of Filipino men in the United States (Stoney & Batalova, 2013). The unprecedented growth of Filipino immigrant women to the U.S. offers an imperative to examine their experiences of migration, coping, and mental health issues related to acculturating into the U.S. dominant culture. In order to better understand Filipino immigrant women’s mental health and their resilient coping to stress associated with assimilating with the U.S. culture, it is necessary to examine the relationships between resilience, acculturative stress, and the influence of cultural family beliefs against the disclosure of mental health problems.
Purpose:
The present study aimed to examine the cultural factors affecting resilience among Filipino female immigrants living in the United States. More specifically, these cultural factors were acculturative stress and cultural family beliefs about disclosing mental health problems outside their families.
Methods:
After obtaining ethics approval to conduct the study from the institutional review board of the presenter’s affiliated university, recruitment of participants was initiated. This completed study used a convenience sampling method to recruit the community sample of Filipino immigrant women. Participants were mainly recruited in public locations where many Filipinos convened, such as community centers, parks, churches, and shopping centers. Participants were provided a quiet, comfortable space to complete the paper-and-pencil survey.
Data was collected from August 2017 to March 2018 from a final sample of Filipino immigrant women aged 18 years and above and residing in the United States (N=159). The questionnaire consisted of the following measures: the Connor-Davidson Resilience Scale-10 (CD-RISC-10, Campbell-Sills & Stein, 2007) to measure resilience; the Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale (SAFE, Mena, Padilla, & Maldonado, 1987) to assess the acculturative stress, and the family norms against disclosure of mental health problems (FNAD, Whealin et al., 2013; 2015) to measure cultural family beliefs about disclosing mental health problems outside their families. The measures used were reliable and valid as demonstrated by Cronbach’s alpha level of CD-RISC-10 and the SAFE ranging from .86 to .89 (Hébert, Parent, Simard, & Laverdière, 2018; Mena et al., 1987), and the content validity of FNAD evaluated by comparing responses with qualitative data of 40 veterans from different ethno-racial groups (Whealin et al., 2013).
Data analysis procedures included calculation of sum scores on the CD-RISC-10 and SAFE, and data for the FNAD was categorized ordinally by response across groups of interest. Total score statistics and overall Cronbach’s alpha reliability measures were also calculated for the CD-RISC-10 and SAFE instruments. Inferential statistical models were applied to determine correlations among variables. Mediation models were constructed, with indirect effects analyzed by way of bootstrap confidence intervals with 10,000 resamples (Hayes, 2018) in order to assess potential mediating effect of resilience on the relationship between acculturative stress and family norms against disclosure of mental health problems.
Results:
Results indicated that participants were highly resilient and had moderate levels of acculturative stress. Findings also showed that resilience was significantly, negatively correlated with acculturative stress and that resilience had a significant predictive effect on acculturative stress. Resilience and family norms against disclosure of mental health problems were significantly, negatively correlated. There was no mediating effect of resilience on the relationship between acculturative stress and family norms against disclosure of mental health problems.
Implications:
Our findings have implications to nursing science and patient outcomes. For example, our findings confirm the negative relationship between resilience and acculturative stress (Archuleta, 2015; Yoo et al., 2013; Yu et al., 2014). Our findings also demonstrate the protective nature of resilience among Asian immigrants against negative mental health outcomes such as depression brought about by acculturative stress (Yoo et al., 2013; Yu et al., 2014). The lack of mediating effect of resilience on the relationship between acculturative stress and family norms against disclosure of mental illness may be related to the lack of theoretical models and research regarding the role of resilience among Filipino immigrant women. Therefore, findings imply the need to further explore underlying mechanisms that explain the relationships between resilience, acculturative stress, and family norms against disclosing mental health problems outside the family.
Implications of our findings are also significant to nursing practice. Our study findings highlight the importance of developing nuanced cultural competence skills, particularly regarding nursing practices that promote resilient coping of immigrant women against the stress related to acculturation. Our study particularly offers foundational knowledge on the significance of Filipino immigrant women’s resilience on their acculturative stress and their cultural beliefs about disclosing mental health problems. In contrast, many studies aggregate the different Asian ethnic groups into one racial group, which overlooks the heterogeneity of various Asian subgroups such as Filipinos, Koreans, Vietnamese, Chinese, etc.). It is important to note that Filipino Americans, in particular, have a unique acculturation process as a result of the Philippines’ colonial history, which makes them markedly different from that of other Asian Americans (David & Nadal, 2013). Therefore, our study findings are critical to nursing practice, particularly to developing cultural competence skills among practicing nurses.
Study findings also imply significance to nursing education. Our findings highlight the significance of integrating strategies for promoting resilience in the context of cultural competence development. The significant findings of our study show the importance of incorporating the principles of resilience development into the nursing education curriculum that focuses on humanistic caring and cultural competence (Reyes, Andrusyszyn, Iwasiw, Forchuk, & Babenko-Mould, 2015).
Our study also include implications that are significant to nursing administration, leadership, and policy-making. The findings of the study confirm the need to develop resilience-based interventions and resources that ameliorate acculturative stress and promote an increase of the disclosure and reporting of mental health problems among Filipino immigrant women. Therefore, nursing leadership should focus on efforts of advocating and developing community-based interventions that are not only culturally relevant, but that programs should also be focused on facilitating healthy and positive coping among immigrant women.
Conclusions:
Our findings has global relevance, particularly with developing collaborations with nursing and, interdisciplinary colleagues and community stakeholders to improve global health outcomes. Philippines is one of the major contributors in the global “migration industry,” providing human resources across different industries in over 100 countries around the world (Polanco, 2017). Therefore, our study findings provide relevance to these Filipino women as migrant workers around the world because many of these women’s stress related to assimilating to the new country are complicated by poor working conditions and social inequities within the host country.
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