Exploring the Systemic Structures That Affect Access to Physical Therapist Services for Non-Indigenous Black People in Australia

OBJECTIVE

Physical therapy is generally considered to be a white profession in Western nations. Australia's increasingly diverse population, driven largely by growth in immigration, invites Australian health systems to be responsive to factors that may impact on non-white Australian population's access to health care. Here, the authors sought to explore non-Indigenous Black people's perspectives of physical therapy in Australia.

METHODS

Eligible participants (n = 12) took part in semistructured, in-depth interviews and were prompted to discuss their experiences and perceptions of physical therapy. Interview data were analyzed using critical discourse analysis, underpinned by critical race theory.

RESULTS

Participants were on average 29.4 years (SD = 12.9) from diverse cultural and linguistic backgrounds. Participants described mostly positive experiences with physical therapists, but they noted that it was not widely accessed by their communities, with 2 key discourses underpinning these discussions. Discourse 1, "physiotherapy is a solution for white people," established physical therapy as primarily accessed by and welcoming of white people. "Whiteness" and the perpetuation of Western norms in physical therapy resulted in little consideration of other cultural practices. Participants' discussions also pointed to the intersections of systemic racism and social inequities such as low income and language barriers, impacting Black people's engagement with physical therapy. Discourse 2, "physiotherapists are white," was mostly concerned with how the perceived "whiteness" of professionals and lack of Black physical therapists impacts cultural safety and comfort when accessing physical therapy.

CONCLUSION

Our results suggest that Westernization and whiteness persist among discourses surrounding physical therapy. Such discourses are likely to inform Black people's perceptions and experiences of physical therapy. Our analyses suggest avenues to enhance the cultural diversity of the profession and improve physical therapy accessibility for Black people in Australia by providing culturally appropriate material, including critical reflexivity, epistemic and cultural humility in the curricula, recruiting staff from diverse backgrounds, and providing outreach services to underserved populations.

IMPACT

These findings highlight the need for increased cultural safety and diversity within the physical therapy profession to improve equity.

"Don't you care about the well-being of your race?": African American couples discuss racial differences involving criticisms of other Black people

African American couples have unique racial stress and high relationship instability, although few studies have examined the role of racial stressors in their relationships. This qualitative study used grounded theory to examine 10 African American couples' disagreements about criticisms of other Black people. Each couple completed a standard couple problem-solving task modified to focus solely on racial differences between the partners. Two models of couple relationships framed the approach; the general vulnerability-stress-adaptation model (Karney & Bradbury, Psychol. Bull., 118, 1995, 3) was combined with a comprehensive race-focused model (Bryant et al., J. Fam. Theory Rev., 2, 2010, 157). The goal was to understand racial stress faced by African Americans, including its context, how and why it is stressful, how they cope, and its consequences in their relationship. A tentative model emerged, suggesting that some African Americans have early race-related experiences that make them vulnerable to concerns about how Black people are seen by others. This may result in a unique minority status stressor that appears indicative of internalized stereotypes and may often include gendered criticisms of their partners. Partners seem to adapt by looking to other African Americans to take personal responsibility for their behavior and defending their racial group. Black male-female gender role issues appear to emerge as a consequence of racial stress that also seems salient across all aspects of the model. Future studies can further examine culturally specific models involving African Americans' criticisms of other Black people and identify successful couple-level strategies to overcome internalized oppression.

A Narrative Review of Mental Illness Stigma Reduction Interventions Among African Americans in The United States

Among African Americans, the chronicity and severity of mental illness correlates with worse health outcomes and widens health disparities. Stigma related to mental illness compounds mental health disparities by creating barriers to help-seeking behavior. We examine the current tools designed to reduce mental illness stigma and promote improved mental health outcomes among African Americans. The authors reviewed the current evidence in the literature for such stigma reduction interventions. The review team developed a focused search across four databases: PubMed, Embase, Scopus, and APA PsycINFO. Initial searches identified 120 articles, from which six studies were included as reporting on mental illness stigma reduction interventions among African Americans. We describe these four quantitative and two qualitative studies. There have been various interventions used among African Americans to reduce mental illness stigma, and the level of efficacy and effectiveness is not well studied. Our review demonstrated a need for more robust studies to yield strong evidence on effectiveness among stigma reduction interventions in this target population. The evidence does support tailoring intervention studies to this population. Effectively engaging and partnering with key stakeholders, including schools, community organizations, and faith-based institutions enhances the acceptance and delivery of stigma reduction interventions.