Josephine Etowa

McMaster University, Hamilton, Ontario, Canada

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Publications (17)5.39 Total impact

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    ABSTRACT: Nurses are knowledgeable about issues that affect quality and equity of care and are well qualified to inform policy, yet their expertise is seldom acknowledged and their input infrequently invited. In 2007, a large multidisciplinary team of researchers and decision-makers from Canada and five low- and middle-income countries (Barbados, Jamaica, Uganda, Kenya, and South Africa) received funding to implement a participatory action research (PAR) program entitled “Strengthening Nurses’ Capacity for HIV Policy Development in sub-Saharan Africa and the Caribbean.” The goal of the research program was to explore and promote nurses’ involvement in HIV policy development and to improve nursing practice in countries with a high HIV disease burden. A core element of the PAR program was the enhancement of the research capacity, and particularly qualitative capacity, of nurses through the use of mentorship, role-modeling, and the enhancement of institutional support. In this article we: (a) describe the PAR program and research team; (b) situate the research program by discussing attitudes to qualitative research in the study countries; (c) highlight the incremental formal and informal qualitative research capacity building initiatives undertaken as part of this PAR program; (d) describe the approaches used to maintain rigor while implementing a complex research program; and (e) identify strategies to ensure that capacity building was locally-owned. We conclude with a discussion of challenges and opportunities and provide an informal analysis of the research capacity that was developed within our international team using a PAR approach.
    International Journal of Qualitative Methods. 05/2014; 13:151.
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    ABSTRACT: Nurses account for a significant proportion of the health care workforce in most countries. In the African continent, it is estimated that nurses constitute about 80% of the health care professionals; however they are marginally represented in health research investigations and policy/decision making roles. A descriptive research design was used to obtain data from 120 registered nurses in Calabar municipality, Nigeria. The study aimed at assessing the extent of nurses' involvement in research and policy development. The findings revealed that only 30 (25.0%) of the respondents indicated that they had been involved in research activity. Majority 74 (61.7%) utilized research findings and perceived research as a tool to enhance development of nursing, 93 (77.5%) respondents were not aware of any financial support for research and only 4(3.3%) had ever received research grant to support research activities. The results also revealed minimal 8(6.7%) involvement of nurses in health care policy development. A significant relationship (P<0.05) existed between nursing educational qualification and involvement in research activities after school. These findings therefore suggest the building of supportive research environments and strengthening nurses' research capacity for effective participation of nurses in health care policy decisions in low and middle income countries (LMICs) and global health priorities.
    Journal of Applied Medical Sciences. 12/2013; 2(4):35-51.
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    ABSTRACT: Richter M.S., Mill J., Muller C.E., Kahwa E., Etowa J., Dawkins P. & Hepburn C. (2013) Nurses' engagement in AIDS policy development. International Nursing Review60, 52-58 Background: A multidisciplinary team of 20 researchers and research users from six countries - Canada, Jamaica, Barbados, Kenya, Uganda and South Africa - are collaborating on a 5-year (2007-12) program of research and capacity building project. This program of research situates nurses as leaders in building capacity and promotes collaborative action with other health professionals and decision-makers to improve health systems for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) nursing care. One of the projects within this program of research focused on the influence of workplace policies on nursing care for individuals and families living with HIV. Nurses are at the forefront of HIV prevention and AIDS care in these countries but have limited involvement in related policy decisions and development. In this paper, we present findings related to the barriers and facilitators for nurses' engagement in policymaking. Methods: A participatory action research design guided the program of research. Purposive sampling was used to recruit 51 nurses (unit managers, clinic and healthcare managers, and senior nurse officers) for interviews. Findings: Participants expressed the urgent need to develop policies related to AIDS care. The need to raise awareness and to 'protect' not only the workers but also the patients were critical reason to develop policies. Nurses in all of the participating countries commented on their lack of involvement in policy development. Lack of communication from the top down and lack of information sharing were mentioned as barriers to participation in policy development. Resources were often not available to implement the policy requirement. Strong support from the management team is necessary to facilitate nurses involvement in policy development. Conclusions: The findings of this study clearly express the need for nurses and all other stakeholders to mobilize nurses' involvement in policy development. Long-term and sustained actions are needed to address gaps on the education, research and practice level.
    International Nursing Review 03/2013; 60(1):52-8. · 0.94 Impact Factor
  • Stephanie Premji, Josephine B Etowa
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    ABSTRACT: premji s. & etowa j.b. (2012) Journal of Nursing Management Workforce utilization of visible and linguistic minorities in Canadian nursing Aim This study seeks to develop a diversity profile of the nursing workforce in Canada and its major cities. Background There is ample evidence of ethnic and linguistic segregation in the Canadian labour market. However, it is unknown if there is equitable representation of visible and linguistic minorities in nursing professions. Methods We cross-tabulated aggregate data from Statistics Canada's 2006 Census. Analyses examined the distribution of visible and linguistic minorities, including visible minority sub-groups, among health managers, head nurses, registered nurses, licensed nurses and nurse aides for Canada and major cities as well as by gender. Results In Canada and its major cities, a pyramidal structure was found whereby visible and linguistic minorities, women in particular, were under-represented in managerial positions and over-represented in lower ranking positions. Blacks and Filipinos were generally well represented across nursing professions; however, other visible minority sub-groups lacked representation. Conclusions Diversity initiatives at all levels can play a role in promoting better access to and quality of care for minority populations through the increased cultural and linguistic competence of care providers and organizations. Implications for Nursing Management Efforts to increase diversity in nursing need to be accompanied by commitment and resources to effectively manage diversity within organizations.
    Journal of Nursing Management 07/2012; · 1.45 Impact Factor
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    ABSTRACT: This mixed-methods study explored the racism-related experiences of 50 mid-life African-heritage women living in Nova Scotia, Canada, along with their use of spirituality as a coping strategy for dealing with racism-related stress. Four standardised instruments, along with qualitative in-depth interviews, were used to examine women's experiences of racism, depression, stress, and spirituality. Spirituality provided a key coping mechanism for racism-related stress, providing church community, spiritual community, faith, guidance, a personal relationship with God, and a source of meaning-making. For some women, spiritual belief provided a means of cognitive reinterpretation, allowing them to make sense of racism and other life challenges, recasting these as tests and trials which they were capable of surmounting with God's blessing and protection. Implications for mental health practitioners include working with spiritual and religious venues to help lessen stigma against mental health problems.
    Mental Health Religion & Culture 02/2012; Religion & Culture(Vol. 15):103-120.
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    ABSTRACT: Purpose. Indigenous Peoples are underrepresented in the health professions. This paper examines indigenous identity and the quality and nature of nursing work-life. The knowledge generated should enhance strategies to increase representation of indigenous peoples in nursing to reduce health inequities. Design. Community-based participatory research employing Grounded Theory as the method was the design for this study. Theoretical sampling and constant comparison guided the data collection and analysis, and a number of validation strategies including member checks were employed to ensure rigor of the research process. Sample. Twenty-two Aboriginal nurses in Atlantic Canada. Findings. Six major themes emerged from the study: Cultural Context of Work-life, Becoming a Nurse, Navigating Nursing, Race Racism and Nursing, Socio-Political Context of Aboriginal Nursing, and Way Forward. Race and racism in nursing and related subthemes are the focus of this paper. Implications. The experiences of Aboriginal nurses as described in this paper illuminate the need to understand the interplay of race and racism in the health care system. Our paper concludes with Aboriginal nurses' suggestions for systemic change at various levels.
    ISRN nursing. 01/2012; 2012:196437.
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    Brenda L. Beagan PhD, Josephine B. Etowa
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    ABSTRACT: This article explores the meanings and functions of spiritually-related occupations for 50 African Canadian women in Nova Scotia, Canada. All but two women were affiliated with a Christian church. Using qualitative in-depth interviews, several spiritual occupations were identified by participants: prayer, Bible study, reading other sacred texts, private devotion, singing spiritual songs, and church-related activities such as committees, community ministry, choir, and leading Sunday school. These occupations were part of a holistic conception of health, and helped to protect against the psychological effects of racism. They connected women with church and spiritual communities, including ancestors. These communities and personal relationships with God gave women moral guidance for living according to their values and principles. Spiritual occupations were central to meaning-making, helping women reinterpret suffering as challenges accompanied by God's blessing, and providing hope through transcendence. For these women, spiritual occupations were part of surviving in the context of racism.
    Journal of Occupational Science 08/2011; 18(3):277-290.
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    ABSTRACT: This qualitative study examines the meanings that African Canadians living in Nova Scotia, Canada, ascribe to their experiences with cancer, family caregiving, and their use of complementary and alternative medicine (CAM) at end of life. Case study methodology using in-depth interviews were used to examine the experiences of caregivers of decedents who died from cancer in three families. For many African Canadians end of life is characterized by care provided by family and friends in the home setting, community involvement, a focus on spirituality, and an avoidance of institutionalized health services. Caregivers and their families experience multiple challenges (and multiple demands). There is evidence to suggest that the use of CAM and home remedies at end of life are common. The delivery of palliative care to African Canadian families should consider and support their preference to provide end-of-life care in the home setting.
    Journal of Transcultural Nursing 04/2010; 21(2):114-22. · 0.51 Impact Factor
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    Brenda L Beagan, Josephine Etowa
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    ABSTRACT: Occupational therapy has increasingly explored the impact of cultural differences on occupations but has not yet begun to explore the impact of racism on human occupation. This study with 50 African Canadian women used mixed methods to explore the effects of racism on their occupational experiences. Women aged 40-65 were interviewed in-depth about everyday experiences with racism and overall well-being. Three standardized instruments assessed frequency and stressfulness of race-related experiences. Everyday racism had subtle, almost intangible, impacts, shaping women's engagement with and the meaning of leisure, productive, and caring occupations. As occupational therapy increasingly attends to issues of cultural difference, it is critical to also attend to racism. This means learning to ask thoughtful questions about how racism may shape clients' occupations. Attention to this aspect of the social environment will enhance practice with African-heritage clients and clients from other racial minority groups.
    Canadian Journal of Occupational Therapy 10/2009; 76(4):285-93. · 0.69 Impact Factor
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    ABSTRACT: Women are among the most disadvantaged members of any community, and they tend to be at greatest risk of illness. Black women are particularly vulnerable and more prone than White women to illnesses associated with social and economic deprivation, including heart disease and diabetes. They utilize preventive health services less often, and when they fall ill, the health of their families and communities typically suffers as well. This article discusses the process of doing innovative participatory action research (PAR) in southwest Nova Scotia Black communities. The effort resulted in the generation of a database, community action, and interdisciplinary analysis of the intersecting inequities that compromise the health and health care of African Canadian women, their families, and their communities. This particular research effort serves as a case study for explicating the key tenets of PAR and the barriers to and contradictions in implementing PAR in a community-academic collaborative research project.
    Journal of Transcultural Nursing 11/2007; 18(4):349-57. · 0.51 Impact Factor
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    ABSTRACT: The On the Margins project investigated health status, health-care delivery, and use of health services among African-Canadian women residing in rural and remote regions of the province of Nova Scotia. A participatory action research approach provided a framework for the study. Triangulation of data-collection methods--interviews, focus groups, and questionnaires--formed the basis of data generation. A total of 237 in-depth one-on-one interviews were conducted and coded verbatim. Atlas-ti data-management software was used to facilitate coding and analysis. Six themes emerged from the data: Black women's multiple roles, perceptions of health, experiences with the health-care system, factors affecting health, strategies for managing health, and envisioning solutions. The authors focus on 1 of these themes, factors affecting Black women's health, and discuss 3 subthemes: race and racism, poverty and unemployment, and access to health care.
    The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 10/2007; 39(3):56-76.
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    ABSTRACT: The On the Margins project investigated health status, health-care delivery, and use of health services among African-Canadian women residing in rural and remote regions of the province of Nova Scotia. A participatory action research approach provided a framework for the study. Triangulation of data-collection methods — interviews, focus groups, and questionnaires — formed the basis of data generation. A total of 237 in-depth one-on-one interviews were conducted and coded verbatim. Atlas-ti data-management software was used to facilitate coding and analysis. Six themes emerged from the data: Black women's multiple roles, perceptions of health, experiences with the health-care system, factors affecting health, strategies for managing health, and envisioning solutions. The authors focus on 1 of these themes, factors affecting Black women's health, and discuss 3 subthemes: race and racism, poverty and unemployment, and access to health care.
    The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 08/2007; 39(3):56-76.
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    ABSTRACT: Depression is a topic that is often avoided in discussions among Black women for a myriad of reasons. The purpose of this study was to investigate the midlife health of Black women living in the province of Nova Scotia, Canada. This paper will present one of the key findings of this research; midlife depression. It will examine the factors associated with depression among mid-life African Canadian women and how these women deal with depression. A triangulation of qualitative and quantitative methods guided by the principles of participatory action research (PAR) was used in the study. Data collection methods included 50 in-depth interviews of mid-life African Canadian women aged 40-65, focus groups, and workshops as well as the CES-D structured instrument. Purposive sampling method was the primary recruitment strategy and 113 people participated in the study. Although the women rarely openly discussed depression, they described depression as emotional feelings that range from "feeling blue" to being clinically depressed. Women viewed midlife depression as the consequence of a complex set of circumstances and stressors that they face. At midlife, Black women frequently recognize the importance of greater self-care and the need to pay more attention to their health, but they are reluctant to do so because they have to be "strong" in order to deal with their daily experiences of racism. Racism, among other things, leads to accumulated stress and undermines Black women's ability to cope and make healthy life choices. This signifies the implications of these research findings for clinical practice.
    International journal of mental health nursing 07/2007; 16(3):203-13. · 1.29 Impact Factor
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    ABSTRACT: A culturally diverse nursing workforce is essential to meet the health needs of an increasingly diverse Canadian population. The recruitment and retention of nursing students representing diverse backgrounds are vital to the building of this diversified work force. Studies have shown that diversity within the student body benefits everyone. For example, students who study and work within a diverse environment are better able to understand and consider multiple perspectives and to appreciate the benefits inherent in diversity. This paper describes one school of nursing's project on the Recruitment and Retention of Black students into their Bachelor of Science Nursing (BScN) Program. The project goals are to increase diversity, foster student learning, and ultimately improve health care for the Black community. Presented in this paper are the project background, implementation process, challenges and outcomes. This may provide learned lessons and future directions for similar initiatives in other institutions.
    International Journal of Nursing Education Scholarship 02/2005; 2:Article 13.
  • Brenda Beagan, Josephine Etowa
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    ABSTRACT: While cultural differences clearly influence occupational participation and meaning, it is equally important to examine how the hierarchical ordering of social and cultural groups may also affect occupation. This paper explores the impact of racism. The theory of everyday racism (Essed, 1991) suggests that racism is manifest in minute, even trivial, everyday interactions which constitute instantiations (enactments) of existing social relations of power. In other words, an individual incident is given its meaning and destructive power precisely because it encapsulates historical and current social relations. In addition, racist encounters gain their meaning not just from individual experiences but also from the experiences of the collective. Drawing on qualitative interviews and standardized measures with 50 African Canadian women, this paper explores how everyday racism has shaped their participation in occupations and the meaning of occupations. Paid work, schooling, leisure, parenting and spirituality are all directed affected by racism. Paid work and leisure may become episodes of endurance, infused with the need for hyper-vigilance, guardedness against hurtful messages. This experience of occupational participation inevitably alters occupational meaning. When schooling becomes an occupation that demands negotiating for your own dignity – with classmates as well as administration – how does that affect occupational performance? Occupational participation? Meaning? When parenting necessarily takes on added dimensions concerning teaching children survival skills, how can the occupational meaning be understood without taking racism into account? Finally, the meaning of spirituality as a core coping mechanism for surviving racism highlights the political meanings of spiritually-oriented occupations for this population. Taken together, the results suggest valuable way to think about the ‘social environment’ and its effects on occupation.
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    ABSTRACT: This paper forms the foundation for the promotion of mental health with rural Mi'kmaq youth through a community based participatory research project. Western understandings of mental health and illness are compared and contrasted with Aboriginal understandings. Mainstream mental health services that accommodate cultural differences do not speak to the total-ity of Aboriginal understandings of mental health or to self-determination and self-reliance of Aboriginal peoples. The paper comprises three sections. Differences in the major understandings of mental health and illness are examined in the first section and common understandings associated with these concepts are addressed in the second section. Within the third section an analysis of three exemplar models of Aboriginal mental health and illness services is conducted. These models illustrate similarities and differences, and provide evidence of the effectiveness of health promotion that is inclu-sive of difference. The paper concludes that research to address Mi'kmaq youth mental health must be conducted with an awareness of how Western and Traditional systems of health and healing operate: in isolation of each other; in parallel directions; and in collaboration with each other. Aboriginal youth can benefit from the knowledge and wisdom of both understandings of mental health and illness.
  • Josephine B Etowa, Swarna Weerasinghe, Felicia Eghan
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    ABSTRACT: Historically, immigration has had a significant impact on the changing demographic of the Canadian society. Each year more newcomers enter the country. There are more than 45 ethno-cultural associations and more than 100 different ethno-cultural groups residing in Nova Scotia. In the recent past, social science researchers are becoming increasingly involved in identifying ways of effectively addressing the social and health needs of this culturally diverse Canadian population. There is very limited literature on the Nova Scotian experiences of immigrant women especially those of African descent. For the government to develop public policy that ensures the inclusion of vulnerable and high-risk populations in our society such as recent immigrants and black people, their perspectives should be considered. Some steps are being taken by individual researchers to illuminate these perspectives. The paper will discuss the findings of a project that examined the health care experiences of immigrant women in a Canadian province with a goal of illuminating health care needs of recent immigrant women and facilitating community capacity building to create positive change for more accessible health care. The data collection method was primarily focused group meetings and workshops held with the individual immigrant communities. Although the project was conducted with immigrants from five regions of the world, this paper will focus on the experiences of first generation immigrant women of African descent with emphasis on their perspectives on the process mothering in a multicultural society. The paper will discuss their childrearing needs and their attempt to address these needs within the spaces of multiculturalism, the two predominant ones being the Canadian culture and that of their countries of origin. The paper will conclude with some suggestions for change at both the practitioner and policy level in order to effectively address the social and welfare needs of this population.