Understanding Arab Americans’ Psychological Service Use Experiences

How might therapy services be made more accessible for Arab American users?

Context
I didn’t see my community reflected in psychological treatment models, though there was a need for mental health services- Middle Easterners are twice as likely to report serious psychological distress than Whites of European descent.¹
Problem
⅔ of Arab Americans are at risk of developing some type of depressive disorder² and are much less likely to seek out help for mental health problems than European Americans³ and even other minorities.⁴
Role
I was the lead investigator for this project, meaning I independently conceptualized the study design, generated the interview protocol, virtually recruited and interviewed 35 Arab Americans, analyzed qualitative data, generated 3 final research deliverables, and managed all findings communication.

References

¹ Dallo, F. J., Kindratt, T. B., & Snell, T. (2013). Serious psychological distress among non-Hispanic whites in the United States: the importance of nativity status and region of birth. Social psychiatry and psychiatric epidemiology, 48(12), 1923–1930. https://doi.org/10.1007/s00127-013-0703-1
² Baker, W., Howell, S., Jamal, A., Chih Lin, A., Shyrock, A., Stockton, R., et al. (2003). Preliminary Findings from the Detroit Arab American Study. The University of Michigan.³ Baker, W., Howell, S., Jamal, A., Chih Lin, A., Shyrock, A., Stockton, R., et al. (2003). Preliminary Findings from the Detroit Arab American Study. The University of Michigan.⁴ Lipson, S. K., Kern, A., Eisenberg, D., & Breland-Noble, A. M. (2018). Mental Health Disparities Among College Students of Color. Journal of Adolescent Health, 63(3), 348-356. doi:10.1016/j.jadohealth.2018.04.014

Defining the Approach  

I knew Arab Americans underused psychological services, now I wanted to know why.

  • 1

     To better understand Arab Americans’ therapy experiences

  • 2

    To identify user pain points

  • 3

    To propose opportunity areas to improve service access

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Structuring the Investigation

I decided to conduct a semi-structured interview study on Arab Americans’ mental health service use. Exploring user narratives would help service providers better understand this user population, and hopefully encourage the designing of services for and with this unique population.

Recruitment Process

Participants were eligible for the study if they were 18 years old or older and self-identified as Arab American, which I defined in the recruitment email as all people of Arab origin currently residing in America, regardless of citizenship or generational status.
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Since this was evaluative research focused on better understanding a harder-to-reach population (Arab Americans are legally classified by the Census as White), I decided on just 2 eligibility criteria.
Recruitment materials highlighted that the study sought to “welcome and aim to represent the diversity of the Arab American community” and encouraged Arab Americans of all nationalities and genders to apply.
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Leveraging Digital Communities

Email Lists

Most of my participants came from email lists (for the Arab Am.  associations of multiple universities and some Arab Am.  professional associations).

Twitter

I reached a smaller but still significant amount of participants through Twitter posts and sharing.

Instagram

I reached the second highest proportion of participants through Instagram messages with Arab Am. Student Association accounts as well as outreach to Arab Am. civic organizations' accounts and asking them to publicize the study recruitment on their respective platforms.

Survey Design

For the interviews, I generated an interview guide of 6 questions, which included:
If you start to notice that you are feeling mentally ill or unwell, what do you do first? [Probe: where or who are you most likely to turn towards for help?]
What are your general impressions about mental health services/therapy? [Probe: What would be some good reasons for someone to enter therapy?]
What do you think someone in your community would expect from therapy? Are there specific concerns or topics they’d want to avoid?

Interviewing

I interviewed 35 participants on Zoom on their service use experiences
Indexed transcripts using NVIVO, an analytic software which assisted with data visualization and analysis
Iterated a coding scheme to organize themes and the most prevalent user narratives

Coding

After re-reading all the interviews and noting down my initial ideas, I developed theoretically derived thematic codes, collating those codes into potential themes that provided a nuanced picture of user pain points and experiences.

I then reviewed and cross-checked these themes for their representativeness of the overall sample, using a tally system to indicate the frequency of each theme and subtheme.

I visualized my thinking in Google Sheets as shown above.

Findings

I found that the most common user complaints were:

Persona Profile

I created seven user personas, from which I've included one.

Malak's Persona

About Malak
Malak is a 26 year old engineer from Riverside who helps support her mother and two siblings. Her mother is from Lebanon and her father is from Palestine. She has never visited either country but hopes to. She grew up learning English as a second language. She's been to therapy twice, once in college and once after her father's passing. Both times, her therapist made racial comments about her hijab and gender experiences around oppression.
Malak
Mechanical Engineer, Eldest sister second-generation
Age: 26
Hometown: Riverside, CA
Occupation: Works at Deloitte
Interests
  • Folkloric dance
  • Community organizing
  • Game of Thrones
  • Diversifying engineering
  • Tennis
Pain Points
  • The process of getting referred to therapy felt laborious
  • Care provider made insensitive comments about her religion
  • Was difficult to justify the frequency of sessions to family
Therapy Satisfaction Ratings
  • Intake
  • Trust in Clinician
  • Clinician Effectiveness
  • Overall
Post-Treatment Influences
  • Felt treatment would've been better with an ethnic-matched clinician
  • Felt her treatment was not culturally competent
Post-Treatment Influences
  • Felt treatment would've been better with an ethnic-matched clinician
  • Felt her treatment was not culturally competent
"I can't discuss my extremely Arab problems with a White person."

Deliverables

I created 3 different deliverables for communication across cross-functional audiences.
I wrote a research manuscript outlining the project background, methods, findings, and actionable insights for both service providers and organizations.
I design a poster for presentation at three research conferences including practitioners, professors, and professionals.
I was commissioned by ACCESS to present my findings into a series of deliverables for social media sharing on multiple platforms.

Action

I was hired as a Research Consultant by ACCESS (the Arab Community Center for Economic and Social Services) to iterate and develop a series of community-accessible research deliverables based on my study for social media platforms as part of their Mental Health Department’s outreach initiative.  Beyond the deliverables I designed for publication on their social channels.

I applied my findings to streamline and improve organizational outreach to mental health service clients.

I also led cross-functional collaboration and developed data accessibility strategies across 4 teams and 3 time zones, communicating with site designers, researchers, and health practitioners to improve their outreach strategies.

Impact

ACCESS informed me my work has improved their success in reaching Arab American clients across backgrounds, especially in terms of improving the accessibility of their intake language.

My work has also informed the organization's efforts in deepening research on Arab American communities, particularly as it pertains to further substantiating their advocacy for an official MENA (Middle Eastern North African) category on the Census.

Learnings

This project taught me the ins and outs of the end-to-end research and study design process, especially deepening my skills in recruitment, user interviewing, data analysis, and findings communication.

Favorite Challenge

Because Arab Americans are legally categorized as White, participant recruitment was a particular challenge. My first recruitment email didn’t get any responses, but I decided to get creative and better research where I could reach my targeted user demographic. Reaching out to Arab Student Associations on social media and getting referrals to professional Arab American email lists helped a lot, and helped me recruit 35 participants - 15 more participants than my original target of 20!
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