Unveiling Co-cultural Communicative Practices

We are now featuring the article by Cassie Wardlaw, PhD, MSW, PMHNP-BC; Donna Shambley-Ebron, PhD, RN, CTN-As titled “Co-cultural Communicative Practices of African American Women Seeking Depression Care.” In this article, the author’s report the outcome of their study, and in addition offer a model using two critical theories that can inform future research. Please share your comments and ideas related to the issues addressed in this article. Here is a message Dr. Wardlaw sent for ANS readers about this work:

Dr. Donna Shambley-Ebron hooding Dr. Cassie Wardlaw during graduation in April 2018

We are so honored to have our research study, “Co-cultural Communicative Practices of African American Women Seeking Depression Care” published in the current ANS issue featuring the topic of Culture, Race and Discrimination. This publication emanated from my PhD dissertation at the University of Cincinnati where I was a Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellow. I had the privilege of presenting the preliminary findings of this study at the Transcultural Nursing Society annual meeting in 2017.  Moreover, for my dissertation work, I received the Outstanding PhD Student Award from the UC College of Nursing.

As a Psychiatric-Mental Health Nurse Practitioner, I was aware of data which indicate higher depression symptom severity and chronicity among African Americans.  I also understood that women of color face many challenges when seeking health care.  This led me to want to discover more about their experiences in the mental health care system, in order to improve care delivery for this population.  Moreover, I recognized that communication is a key factor in navigating within systems of care when attempting to achieve desired outcomes.  Dr. Mark Orbe’s theory, Co-Cultural Theory of Communication, explains the practices that people from traditionally marginalized groups use when communicating in dominant societal structures, which includes the health care system. This theory, in addition to Collins’ seminal work on Black Feminist Thought provided the theoretical underpinnings to support this study.

Dr. Wardlaw discussing the use of the frameworks used in the study at the University of Cincinnati

Dr. Donna Shambley-Ebron, my dissertation chair, mentor and co-author on this publication, is a certified Advanced Transcultural Nurse and a Transcultural Scholar. Her background in studying health issues facing African American women in addition to her experience in conducting ethnographies helped ensure the quality and integrity of this study.

African American women face unique challenges when seeking care, often related to past experiences with racism and subsequent distrust of providers. From the findings of this study which included interviews of 19 women who were receiving care for depression in community mental health agencies, we were able to develop a beginning theory about the influences that impact their communication practices. They were: intersectionality, system and structural impact, establishing trust, preserving self, and practice selection.  These findings demonstrated that African American women did indeed alter their communication in the mental health care setting. This was consistent with Orbe’s work. The implications of this study point to the need for nursing to move beyond basic assessment related to culture and examine the greater overarching issues related to power and dominant societal structures. Overall, we realize that the communicative practices of African American women who seek care for depression are complex and cannot be fully explained by the findings of this study. However, we believe that this study is an essential starting point in theory development regarding how African American women navigate the mental health care system.