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Cited by 0Gender, Health, and Social InequalityParticipatory Visual Research MethodsCommunity Health and Development

Guyanese Women's Experiences of Invisibility in Health Care in England

Open access
Mitchell, Helena Ann·2020·Frontiers in Sociology
DOI 10.3389/fsoc.2020.00023PMC PMC8022778
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Abstract

This article explores the opportunities for strengthening participatory action research (PAR) through an intersectionality framework. In 2015, I completed a Ph.D. study into the lived experiences of migrant Guyanese women, living in England, when seeking diagnoses and treatment for Type 2 diabetes. Group storytelling acted as a lens for the women to talk about how they tried to obtain a diagnosis, in addition to their migratory experiences. Both PAR and intersectionality encourage participant collaboration and community engagement of oppressed groups. The article concludes that the PAR study would have been enhanced by overlaying it with an intersectionality framework. The argument is presented that by doing so the women's accounts in the research study would have been privileged more and activism encouraged in bringing about change to current practices and avoiding perpetuating existing oppressions. The Ph.D. study methodology was based on Koch's interpretation of PAR. In this, PAR is used where the focus is on participation of all stakeholders toward reform and change. It is seen as a social, practical and collaborative process where building relationships with participants is crucial. Intersectionality acknowledges the potential for "black" and other women of color to not remain on the margins but to challenge the traditional biomedical model of health care delivery. Implementing an intersectional approach to the data generation and analysis would have acknowledged power dynamics (i.e., privilege and oppression) and help to identify potential gaps in diabetic provision which are currently invisible or inequitable due to interventions designed to meet the needs of a homogeneous White middle class society.

AI snapshot

Written from the paper’s full text.

TL;DR

This article reflects on a 2010–2015 participatory action research (PAR) study with older migrant Guyanese women in England who struggled to obtain a Type 2 diabetes diagnosis, arguing that overlaying intersectionality would have strengthened the study. It concludes that intersectionality would have better privileged the women’s accounts, exposed power dynamics and health inequities, and encouraged activism to change diabetes services.

Key findings

  • The women were unaware they had Type 2 diabetes despite having accessed health care services on several occasions; delayed diagnosis resulted in many acquiring diabetes complications, and the women felt confused, lonely, ignored, marginalized, and powerless. They wondered whether the delay was due to discrimination or being “Black.”
  • PAR storytelling interviews and focus groups gave the women voice and reportedly led to lifestyle changes, including modified diets, more regular exercise, regular glucose checks, increased knowledge about portion sizes, and greater assertiveness with health care practitioners.
  • The paper argues that an intersectionality framework would have enhanced the PAR study by treating socioeconomic class, race, ethnicity, and migration background as interacting factors, acknowledging privilege and oppression, and identifying gaps in diabetic provision designed for a homogeneous White middle class society.
  • The discussion cites that Type 2 diabetes is five times more likely in Pakistani women and at least three times more likely in Bangladeshi and Black Caribbean women compared with women in the general population (Diabetes UK, 2012; Tillin et al., 2012).

Methods

  • This is a reflective/conceptual article revisiting the author’s 2015 Ph.D. PAR study (2010–2015) with Guyanese women born and raised in Guyana who had lived for an average of 40 years in England and had Type 2 diabetes.
  • The original PAR study used storytelling interviews, focus groups, and a research journal; analysis followed Koch’s “looking, thinking, and acting” cyclical process, with ethical approval from the University of Surrey (EC/2010/08/FHMS).
  • The article retrospectively proposes how an intersectionality framework could have been overlaid on the PAR study’s data generation and analysis; it does not conduct a new formal intersectional analysis.

Limitations

  • Stated: intersectionality is relatively new in UK health care research, has been criticized as poorly defined and inadequately operationalised, and language itself is limited in explaining the concept.
  • Stated: the original PAR study did not fully address how the health care system undermined the women’s quality of life and possibly glossed over discrimination and race; intersectionality was not integrated at the time.
  • Evident from the text: no sample size or detailed participant demographics are reported in this article, and the claims about what intersectionality “would have” added are retrospective rather than empirically tested here.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fsoc.2020.00023

Cites

30 of 30 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

3 of 11 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    The women's experiences, as evidenced in the PAR data, show a complexity of intersecting variables in terms of race, class and identity as they tried to cope with a debilitating chronic illness.

    “When the women's experiences are dissected, as evidenced in the PAR data, it is astounding to see the complexity of the intersecting variables in terms of race, class and identity as they tried to cope with a debilitating chronic illness (Hankivsky et al., 2010).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Hankivsky et al., 2010 source

      The Women's Employability and Health Project section (page unavailable) reports data showing complex interrelationships among gender, culture, poverty, race and geography in women's lives. It does not describe those women as coping with a debilitating chronic illness; its account instead mentions chronic stress, depression and worry associated with their living conditions. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Findingown data

    The women in the study felt marginalized and powerless despite attempts to seek a diagnosis.

    “Despite attempts to seek a diagnosis for their condition the women in this study felt marginalized and powerless.”
    Quote in the paperSubstantial claim
  • Findingown data

    The women developed knowledge and understanding that their preferred diet may not be appropriate to their needs.

    “The women developed knowledge and understanding that their preferred diet may not be appropriate to their needs.”
    Quote in the paperSubstantial claim
  • Findingnone given

    As the women engaged in the PAR process, they felt listened to during the story telling interviews as they reflected on their lives.

    “As the women engaged in the PAR process, they felt listened to during the story telling interviews as they reflected on their lives.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The women identified that the kind of diabetic service preferable was consultative with a holistic approach to care and treatment.

    “The women had identified in the study the kind of diabetic service that was preferable, one that was consultative with a holistic approach to the care and treatment.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 22
  • May combine two claims. 12

  • Classified as probably not a substantial claim.

    Findingcitation

    PAR as a methodological approach gave voice to the women.

    “Whilst PAR as a methodological approach (Dick, 2004; Baum et al., 2006; Bradbury, 2015) gave voice to the women”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Dick, 2004 source
    • cites Baum et al., 2006 source
    • cites Bradbury, 2015 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Type 2 diabetes is five times more likely in Pakistani women, at least three times more likely in Bangladeshi and Black Caribbean women compared with women in the general population.

    “Type 2 Diabetes is on the increase (Diabetes UK, 2015) but when compared with women in the general population, diabetes is five times more likely in Pakistani women, at least three times more likely in Bangladeshi and Black Caribbean women (Diabetes UK, 2012; Tillin et al., 2012).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Diabetes UK, 2012

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Tillin et al., 2012 source

      In “What has it found?” (Table 3; page not provided), diabetes by WHO criteria is reported in 20% of African Caribbean women versus 4% of European women, supporting the claim of at least a threefold difference for Black Caribbean women. The table groups South Asian women as “Indian Asian”; it does not report separate rates for Pakistani or Bangladeshi women. European women in this cohort are also not identified as women in the general population. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Racism, sexism, social and health inequalities exist in the UK for Black and minority ethnic (BME) communities.

    “It acts as reminder that racism, sexism, social and health inequalities exist in the UK for Black and minority ethnic (BME) communities.”
    • Also stated in: § Conclusions · hedged
      “The women in this study have provided some evidence for this.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The women believed the "one size fits all model" currently provided for all individuals with Type 2 diabetes was not culturally appropriate for those with specific beliefs and needs because it did not address cultural variations, underlying motivations, preferences and behaviors.

    “They believed the “one size fits all model” currently provided for all individuals with Type 2 diabetes was not culturally appropriate for those with specific beliefs and needs because it did not address cultural variations, underlying motivations, preferences and behaviors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    There was an impetus for the women to change their lifestyles, recognize the physical complications of diabetes and become more assertive when engaging with health care practitioners.

    “There was an impetus to change their lifestyles, recognize the physical complications of diabetes and become more assertive when engaging with health care practitioners.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingreasoning

    PAR in this context captured the discriminated community's reality at a micro level as the women shared their discriminatory practices and sought help for type 2 diabetes.

    “PAR in this context captured the discriminated community's reality at a micro level as the women shared their discriminatory practices and sought help for type 2 diabetes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The women increased their knowledge and understanding about their diabetes and tried to take control of it by acquiring information, although that was rather limited and fragmented.

    “They increased their knowledge and understanding about their diabetes and tried to take control of it by acquiring information although that was rather limited and fragmented.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The women became more involved in their local communities and discussed how local healthcare practice could be improved regarding diagnosis and treatment of diabetes.

    “They became more involved in their local communities and discussed how local healthcare practice could be improved regarding diagnosis and treatment of diabetes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The delay in being diagnosed left the women feeling confused, lonely, and ignored.

    “The delay in being diagnosed left the women feeling confused, lonely, and ignored.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Findingnone given

    The Ph.D. research project using PAR methodology enabled participants to give voice to their concerns in a way that exceeded the expectations of the participants and the researcher.

    “The Ph.D. research project using PAR methodology enabled participants to give voice to their concerns in a way that exceeded the expectations of the participants and the researcher.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The women retained their identity as they grappled with oppression and marginalization, but experiences of discrimination and race re-emerged as they tried to obtain a diagnosis for diabetes.

    “They had left Guyana many years ago, retained their identity as they grappled with oppression and marginalization but the experiences of discrimination and race had re-emerged as they tried to obtain a diagnosis for diabetes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Most women wanted a confirmed diagnosis before they felt confident in making lifestyle changes.

    “Most wanted a confirmed diagnosis before they felt confident in making lifestyle changes (Odette et al., 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Odette et al., 2004 source

  • May combine two claims.

    Findingown data

    The PAR study enabled the women to adjust to more modified diets, take more regular exercise and regularly check their glucose levels.

    “Surprisingly the PAR study enabled the women to adjust to more modified diets, take more regular exercise and regularly check their glucose levels.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The women in the PAR study responded to change favorably, leading to significant changes in their lifestyle as they became more assertive with the health care team.

    “Within this context of Friere's work, the women in the PAR study had responded to change favorably leading to significant changes in their lifestyle as they became more assertive with the health care team in relation to their care and treatment of their diabetic condition.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The women were ready to change their culturally influenced diet to a more varied one, resulting in a behavioral change.

    “They were ready to change their culturally influenced diet to a more varied one resulting in a behavioral change.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    The women in the study were totally unaware that they had Type 2 Diabetes even though they had accessed health care services on several occasions.

    “The women in the study were totally unaware that they had Type 2 Diabetes even though they had accessed health care services on several occasions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The women realized their identity was strong as they shared experiences and spoke with pride about their home country and what it was like to be Guyanese.

    “The women realized their identity was strong as they shared experiences and spoke with pride about their home country and what it was like to be Guyanese.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Applying an intersectionality framework would have provided the ability to recognize that the women's experiences in not accessing relevant services may have been influenced by ethnicity, discrimination and marginalization.

    “In applying the intersectionality framework it would have provided the ability to recognize that the women's experiences in not accessing relevant services may have been influenced by a number of other factors such as ethnicity, discrimination and marginalization.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Overlaying an intersectionality framework to the original PAR study would have given the work an improved understanding of health disparities.

    “I would conclude that overlaying an intersectionality framework to the original PAR study would have given the work an improved understanding of health disparities.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Overlaying intersectionality would have privileged the Guyanese women's accounts more.

    “The argument is presented that by doing so the women's accounts in the research study would have been privileged more”
    • Also stated in: § Linking Intersectionality to Par · hedged
      “Intersectionality would have privileged the accounts from the Guyanese women in more detail”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    If intersectionality had been used in the PAR study, the focus would have shifted more onto health and social inequalities and oppressive practices the women faced.

    “I therefore believe that if intersectionality had been used as a framework in the PAR study (Mitchell, 2004) the focus would have shifted more onto the health and social inequalities and the oppressive practices that the women faced within society.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mitchell, 2004

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    This involvement could be interpreted as activism on a micro scale showing early indications of intersectionality as they strived to bring about change with others having similar long-term conditions.

    “This could be interpreted as activism on a micro scale showing early indications of intersectionality as they strived to bring about change with others having similar long-term conditions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Intersectionality has been successful because it acknowledges the potential for "black" and other women of color not to remain on the margins by challenging the micro and macro systems in society.

    “Intersectionality has been successful because it acknowledges the potential for “black” and other women of color not to remain on the margins by challenging the micro and macro systems in society.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The PAR study privileged the voices of one particular racial group about a particular health condition but less on a health disparity among "black" women per se.

    “The PAR study privileged the voices of one particular racial group about a particular health condition but less on a health disparity among “black” women per se.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationreasoning

    If intersectionality had been integrated in the study, the women's suggestion would have been shared more widely with the community to activate change in local diabetic services for minority groups.

    “If intersectionality had been integrated in the study the women's suggestion would have been shared more widely with the community to activate change in local diabetic services for minority groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Overlaying the original PAR study with an intersectionality framework would have enhanced the study.

    “The article concludes that the PAR study would have been enhanced by overlaying it with an intersectionality framework.”
    • Also stated in: § Background · hedged
      “I now feel that overlaying an intersectionality framework could have enhanced and enriched the study especially the data analysis element.”
    • Also stated in: § Discussion · hedged
      “On reflection, an intersectionality framework would have enhanced the body of the PAR study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Overlaying intersectionality would have encouraged activism to bring about change in current practices.

    “and activism encouraged in bringing about change to current practices”
    • Also stated in: § Linking Intersectionality to Par · hedged
      “and encouraged them in activism to bring about change in current practices.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Overlaying intersectionality would have helped avoid perpetuating existing oppressions.

    “and avoiding perpetuating existing oppressions.”
    • Also stated in: § Conclusions · hedged
      “helping to avoid perpetuating existing oppressions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Implementing an intersectional approach to data generation and analysis would have acknowledged power dynamics such as privilege and oppression.

    “Implementing an intersectional approach to the data generation and analysis would have acknowledged power dynamics (i.e., privilege and oppression)”
    • Also stated in: § Linking Intersectionality to Par · hedged
      “Implementing an intersectional approach to the data generation and analysis would have acknowledged power dynamics such as privilege and oppression.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Implementing an intersectional approach would have helped identify potential gaps in diabetic provision that are currently invisible or inequitable due to interventions designed for a homogeneous White middle class society.

    “and help to identify potential gaps in diabetic provision which are currently invisible or inequitable due to interventions designed to meet the needs of a homogeneous White middle class society.”
    • Also stated in: § Linking Intersectionality to Par · hedged
      “This would help identify potential gaps in diabetic provision currently invisible or inequitable resulting from interventions designed to meet the needs of a homogeneous White middle class society.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    Integrating intersectionality with PAR in a disadvantaged community would have enabled a fuller understanding of health disparities.

    “Integrating intersectionality with PAR in a disadvantaged community would have enabled a fuller understanding of health disparities (Kelly, 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kelly, 2009 source
31 of 31

  • The paper relies on this without support.

    The women did not experience the same amount of health benefits as white women.

    “The women did not experience the same amount of health benefits as white women.”

  • The paper relies on this without support.

    Racism and sexism could not be easily disentangled as the women grappled with both at the same time.

    “Racism and sexism could not be easily disentangled as they grappled with both at the same time.”

  • The paper relies on this without support.

    The institutional systems of health care use their structures to advance health inequity in marginalized groups.

    “However, the potential of intersectionality has now heightened my awareness of how the institutional systems of health care use its structures to advance health inequity in marginalized groups.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Mitchell study cited with conflicting years

    Minor

    The text cites the PAR study as Mitchell (2004), but the Mitchell thesis listed in the references is dated 2014.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 9

  1. Brydon-Miller, 2015, Widening the circle: eyhical reflection in action research and the practice of structured ethical reflection,
  2. 2012, Health and Social Care Act
  3. Douglas, 2017, The struggle to find a voice on Black women's health: from personal to the political,, 91
  4. Friere, 1970, Pedagogy of the Oppressed.
  5. Habermas, 1984, The Theory of Communicative Action. Vol 2: Lifeworld and System: A critique of Functionalist Reason
  6. McCall, 2009, Introduction,, 1
  7. Mens-verhulst, 1991, ‘Sociocultural equities in the health research: what does the intersectionalities framework offer?’, Intersect. Health Res, 1
  8. MitchellH. A. A Participatory Action Research study with Guyanese Women Living with Type 2 Diabetes In England, (Unpublished Thesis) University Of Surrey, Surrey2014
  9. Waterman, 2013, Action research and health,, 148

Cited by

Still being checked.

Related

Authors
Mitchell, H. A.
Affiliations
The Open University (GB)
Corresponding author
Mitchell, Helena Ann
ORCID
Mitchell, Helena Ann
Venue
Frontiers in Sociology
Publisher
Frontiers Media SA
Published
2020-04-09
Volume
5
Pages
23-23
ISSN
2297-7775 (ISSN-L)
DOI
10.3389/fsoc.2020.00023
PMC
PMC8022778
OpenAlex
W3015450649
Cited by
0
References
30
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Sociology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Open Research Online - ORO (The Open University) (acceptedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
  • Social Sciences › Sociology and Political Science › Participatory Visual Research Methods
  • Health Sciences › Health Professions › General Health Professions › Community Health and Development
Keywords
migrant women, type 2 diabetes, participatory action research, intersectionality, collaborative storytelling, health care access, health disparities, women of color, power relations, privilege and oppression

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