mapping nondominant voices into understanding stress‐coping mechanisms

A R T I C L E

MAPPING NONDOMINANTVOICES INTO UNDERSTANDINGSTRESS-COPING MECHANISMS

Yoshitaka IwasakiTemple University

Judith Bartlett, Kelly MacKay,Jennifer Mactavish and Janice RistockUniversity of Manitoba

This study reports key findings from a research project, which examinedthe stress and coping mechanisms of several nondominant groups ofindividuals. The groups were based in Winnipeg, Manitoba, Canadaand included (a) Aboriginal individuals with diabetes, (b) individualswith disabilities, and (c) gays and lesbians. Our analyses of personalnarratives and life stories have led to develop an interpretive map offindings that depicts mechanisms of how stress and coping operate.Specifically, the interpretive map consists of personal and structuralstressors, meanings of stress, and personal and structural resources, aswell as of two constructs termed intersectionality and social exclusion.Not only are nondominant voices and lived experiences recognized andincorporated into an emergent interpretive map, but this map alsoarticulates the complex ways in which multiple identities intersect (i.e.,intersectionality) and the realities of being excluded socioeconomically,culturally, and politically among nondominant groups (i.e., socialexclusion). �C 2008 Wiley Periodicals, Inc.

INTRODUCTION

Despite the growth and proliferation of stress and coping research (Folkman &Moskowitz, 2004), further efforts are needed to more appropriately acknowledge thediversity of our society (e.g., Chun, Moos, & Cronkite, 2006; Franklin-Jackson & Carter,2007). This article aims to cross-fertilize and integrate emerging multicultural

Correspondence to: Yoshitaka Iwasaki, Department of Therapeutic Recreation, College of HealthProfessions, Temple University, 1700 N. Broad Street, Suite 313, Philadelphia, PA. E-mail: [email protected]

JOURNAL OF COMMUNITY PSYCHOLOGY, Vol. 36, No. 6, 702–722 (2008)

Published online in Wiley InterScience (www.interscience.wiley.com).

& 2008 Wiley Periodicals, Inc. DOI: 10.1002/jcop.20251

perspectives on stress and coping, with the use of telling stories to address diversitychallenges being recently advocated in the field of community psychology. First, asillustrated in Wong and Wong’s (2006) edited book, Handbook of Multicultural Perspectivesof Stress and Coping, there is the need to broaden our understanding of what stress andcoping actually are by giving careful and critical attention to the ways in which theseconcepts are understood from different cultural perspectives. Second, as shown by aspecial issue of the American Journal of Community Psychology edited by Bond and Harrell(2006), diversity stories give insights into the diversity-related challenges and theapproaches to dealing with them to ‘‘draw out themes, lessons learned, and guidingprinciples’’ (p. 158). A broader community psychology perspective, however,encompasses stress and coping by highlighting complex intersections of such diversitydimensions as gender, class, sexual orientation, and disability/ability beyond race andethnicity rather than artificially separating these diversity dimensions.

DIVERSITY PROJECT ON STRESS AND COPING IN WINNIPEG, MANITOBA,CANADA

With the aim of cross-fertilizing/integrating these two relatively independent lines ofinquiries, our diversity research project gave voices to several nondominant groups ofindividuals about their perceptions and meanings of stress and coping based on theirlived experiences in cultural and community settings. The target population groupswere strategically selected based on the overall aim of the project, stated above.Specifically, participants were drawn from a Western Canadian city (i.e., Winnipeg,Manitoba) and included Aboriginal individuals with diabetes, individuals withdisabilities, and gays and lesbians.

The conceptual rationale for intentionally choosing these groups for this study isBond and Harrell’s (2006) argument and unsettling sense about the lack of coverage ofdilemmas faced among specific nondominant or marginalized groups of people.Particularly, in their special issue introductory article, they cautioned that despite thebroad range of diversity-story collection, the voices of people with disabilities andindividuals within gay and lesbian communities were mostly hidden, beyond racialandethnic minorities such as indigenous or Aboriginal population groups. This point is inline with other researchers’ call for the need of greater attention given to individualswith disabilities (Goodley & Lawthom, 2005; McDonald, Keys, & Balcazar, 2007),lesbians and gay men (D’Augelli, 2003), and indigenous or Native people (Gone,2006). Consequently, the inclusion of those multiple diversity dimensions (i.e.,disability/ability, gay/lesbian, and Indigenous/Aboriginal) in a single study provides acontext for examining the intersection of a complex multidimensional humandiversity, as advocated by Bond and Harrell (2006). In addition, this approachextends multicultural perspectives on stress and coping because these perspectivesexplicitly acknowledge cultural diversity and complexity (Wong & Wong, 2006).

MERGING MULTICULTURAL PERSPECTIVES ON STRESS AND COPINGWITH A STORY-TELLING APPROACH TO UNDERSTANDING WAYS OFDEALING WITH DIVERSITY CHALLENGES

To provide a context for our research, in this section we give an illustration ofmulticultural perspectives on stress and coping, as well as a story-telling approach togiving voices to the ways of dealing with diversity challenges in community psychology.

Nondominant Voices About Stress and Coping � 703

Journal of Community Psychology DOI: 10.1002/jcop

First, as shown in Chun, Moos, and Cronkite’s (2006) conceptual model of stress andcoping, culture serves as a macro-social or ecological system that influences every aspectof stress and coping processes including the ongoing environmental and person systems,transient life conditions, cognitive appraisal and coping, and health and well-being.Studies of stress and coping processes among specific cultural groups have, however,been conducted rather extensively. For example, Huaibin (2006) explored the notion ofConfucian coping and its relations to mental health. Her study demonstrated thatConfucian coping consists of optimism in the adversity, the viewpoints to ‘‘fate,’’ theresponsibility as human beings, and the role of adversity to individual growing.

Ramos’ (2004) study with Puerto Ricans caring for older relatives showed thatstress and coping processes are influenced by ethno-cultural factors, particularlyfatalism (i.e., the practice of traditional familial norms of filial responsibility) andspiritual/religious aspects (i.e., Catholic and Pentecostal). The critical role of hope orhopeful thinking among such oppressed minorities as African Americans washighlighted in Adams, Rand, and Kahle’s (2003) study. Based on research with NativeAmerican women in Indian reservations in Montana, Hobfoll, Jackson, and Pierce(2002) provided evidence that in collectivist culture, a sense of shared efficacy (termedcommunal mastery) is more central to people’s resiliency in dealing with life stressorsand challenges than self-mastery.

The notion of coping with ‘‘triple jeopardy’’ was the focus of Bowleg, Huang,Brooks, Black, and Burkholder (2003) study on multiple minority stress among Blacklesbians. Their findings helped to gain insights into the complex intersections ofsexism, racism, and homophobia. In Walters and Simoni’s (2002) ‘‘indigenist’’ stress-coping model of Native women, enculturation, spiritual coping, and traditionalhealing practices were identified as ‘‘cultural resilience,’’ which was proposed to helpdeal with the ‘‘soul wound’’ of traumas (e.g., colonization). In addition, Kimhi andShamai’s (2004) study on individuals who had lived close to the Israel–Lebanon borderfound that community resilience served as a key resource to cope with the threatcreated by war and terror.

Wong and Wong’s (2006) edited volume set the stage for a more concerted effortto examine the topic of culture and stress coping. This volume with its international,multiethnic panel of 45 contributors explored not only the roles of cultures in shapingstress and coping processes, but also how to modify and expand the basic concepts ofstress and coping from multicultural perspectives. For example, suffering (Chen,2006), agony, silent grief, and deep frustration (Abi-Hashem, 2006) were suggested askey terms to more accurately describe culturally based stress phenomena. The otherconcepts highlighted throughout the volume include coping with acculturative stress(Berry, 2006; Padilla & Borrero, 2006), collectivistic and collective coping (Yeh, Arora,& Wu, 2006; Zhang & Long, 2006), transformation as a coping strategy such asBuddist and Taoist transformational approaches (Chen, 2006), and spiritual andexistential coping particularly the role of meaning-making in survival and thriving(Wong, Reker, & Peacock, 2006).

On the other hand, community psychologists have increasingly recognized thepower of narratives and story telling for more deeply understanding the lives ofnondominant populations including rape survivors (Ahrens, 2006), Chinese immi-grant subgroups in a parish community (Borg, 2006), urban youth of color (Ross,2006), low-income African Americans on neighborhood safety issues (Suarez-Balcazar& Kinney, 2006), domestic violence survivors (Chronister, 2006), and individuals withserious mental illness (Felton, 2005). In particular, this narrative or story-telling

704 � Journal of Community Psychology, August 2008


approach has implications for community psychologists who conduct research oncomplex human diversity issues such as how people cope with discrimination andoppression.

For example, McDonald, Keys, and Balcazar (2007) showed the utility of culturalnarratives to exemplify how living with learning disability co-occur or intersect withother sociopolitical minority statuses including race/ethnicity and gender among low-income women and men of color with learning disability. Suyemoto and Tree (2006)offered reflections on how racial minority students engaged in antiracist educationthrough the collaborative work of Native American, Asian American, and AfricanAmerican facilitators with their attempt for creating alliances among people of color.Gone’s (2006) community action research in an American Indian communityconcerning the delivery of mental health service focused on sharing personal livedexperiences of difficulty and distress and the ways of redressing these. Kidd andDavidson (2007) revealed homeless youth’s stories about their struggles to survive andnegotiate meaningful and healthy lives, as well as about their strengths and resilience.

Brodsky and Faryal’s (2006) study provided both insider and outsider perspectiveson honoring and respecting cultural differences and ultimately bridging thesedifferences in the context of Afghanistan and Pakistan cultures. Importantly, beyondacademic advancement, a narrative and story-telling approach has implications for theresponsibility of community psychologists to empower marginalized populations(Balcazar, Garate-Serafini, & Keys, 2004), as exemplified by D’Augelli (2003) on thelives of lesbians and gay men in proactively overcoming psychosocial challenges theyface. Also, speaking of the art of storytelling in research, Harper, Lardon, andRappaport (2004) discussed the role of sharing and shaping personal and communitynarratives in promoting personal and social change.

These emerging efforts are important not only to acknowledge the increasingdiversity of our society, but also to appreciate the voices of nondominant communitygroups. In particular, the use of a narrative or story-telling approach to gaining richinsights into coping with stresses and diversity challenges seems to be a promisingapproach. Consequently, our present study aimed to gain a culturally groundedunderstanding about the essence of stress and coping and their interrelationships, bygiving voices to three nondominant groups of individuals noted earlier.

METHOD

Grounded in a qualitative framework, focus groups were used to enable individuals toopenly express themselves and tell stories and narratives (Krueger & Casey, 2000). Intotal, nine focus groups with participants (n 5 78) segmented by gender wereconducted (i.e., three focus groups for each target population). Phenomenology(Creswell, 1998), adopted as the analytic framework for this study, facilitatesunderstanding of people’s lived experiences (Gubrium & Holstein, 2000). Appliedin the present project, the focus was on describing and interpreting experiences andmeanings associated with stress, and the mechanisms used for coping.

Participants

Various recruitment strategies were used to access prospective participants in eachtarget group. To recruit Aboriginal peoples with diabetes, posters outlining theresearch, eligibility criteria, and contact information were displayed in prominent



areas within one urban Aboriginal community health center. The criteria forparticipation included (a) self-identification as a First Nations or Metis person (i.e.,two of the three major Aboriginal groups in Canada), and (b) diagnosed with diabetes.Twenty-six individuals who met the above criteria participated in one of three focusgroups: (a) First Nations women with diabetes (n 5 8), (b) First Nations men withdiabetes (n 5 9), and (c) Metis women with diabetes (n 5 9).

For individuals with disabilities, recruitment occurred in cooperation with thedirectors of two agencies who serve clients with a disability. As a convenience sample,these agencies sent an invitation letter to their clients on behalf of the research team.From this pool, participants were selected on the basis that they had a diagnosed formof physical disability, specifically one that resulted in permanent mobility impairment(e.g., spinal cord injury). Twenty-two individuals engaged in one of three focus groups:(a) women only group (n 5 9), (b) men only group (n 5 4), and (c) mixed gender group(n 5 4 women and n 5 5 men).

Finally, for gays and lesbians, recruitment posters describing the study weredisplayed at several gay and lesbian centers in the city. Advertisements were also placedin selected local gay and lesbian newsletters/newspapers. Interested individualsvoluntarily called the research assistant to set up scheduling for a focus group session.Self-identification as a gay or lesbian adult was the sole criterion for selection. Thirtyindividuals participated in one of three focus groups: (a) lesbians only group (10women), (b) gay men only group (10 men), and (c) mixed lesbians and gay men group(4 women and 6 men).

Focus Group Procedures

Focus group sessions were held at a local research firm and conducted by the sameexperienced professional moderator. The rationale for using the single moderator wasto ensure consistency across all sessions besides her extensive experiences infacilitating focus groups with various nondominant population groups. In eachsession, the moderator followed a questioning route developed by the research teamand guided by the research aim. The questioning route followed a formatrecommended by Krueger and Casey (2000). Table 1 presents the content of thequestioning route (e.g., introductory questions, transition questions, key questions).The moderator allowed sufficient time for all participants to share their views at eachstage of questioning without attempting to formulate consensus. At the conclusion ofeach session, the participants completed an exit questionnaire to provide socio-demographic background information (see Table 2 for profiles of the participants).Each focus group lasted approximately 90 minutes. The audio-recordings from focusgroups were transcribed for analyses.

Data Analysis Procedures

In the first step of phenomenological data analyses, substantive statements (i.e., directquotes) relevant to the phenomena of stress and coping were identified. Eachstatement was treated as having equal value (i.e., ‘‘horizontalization’’ of the data;Moustakas, 1994). Next, these statements were clustered into themes or meaning unitsby removing repetitive and overlapping statements (Creswell, 1998). Meaning unitswere formulated by reflectively reading and rereading the transcripts to ensure thatthe substantive statements were consistent with the original context. Two researchersfor each target group individually engaged in this process. The resulting theme



clusters were then referred back to the original descriptions for further validation. Therationale for two researchers individually performing a phenomenological analysis foreach target group was to ensure the ‘‘triangulation’’ of analysts, as a key approach tofacilitate trustworthiness or credibility of findings (Creswell, 1998).

Consistencies between the two researchers’ analyses were retained as overallthemes. Discrepancies of divergent analytical aspects were either integrated intosimilar theme clusters, or new clusters were created with consensus between theresearchers. This process resulted in an overall description of the phenomena underexamination (Patton, 1990). Then, the participants were sent a summary of the resultsfor reviews. Those participants who replied unanimously agreed that the descriptionswere consistent with the views expressed during the focus groups.

Subsequently, all research team members contributed to a cross-case analysisworkshop to identify overarching themes. First, each member came prepared for theworkshop after carefully examining the summary reports based on the group-specificanalyses. The researchers then familiarized themselves with the full data set and beganto look for common themes across groups and themes unique to specific groups.

For the next process called a ‘‘building the wall’’ exercise, each researcher carefullyexamined and compared the descriptors displayed on the wall, and individuallyidentified and categorized key themes, which were either similar across the groups, ordifferent/unique to a particular group(s). These themes were categorized into fourprimary areas: (a) general similar themes, (b) woman-specific similar themes, (c) man-specific similar themes, and (d) different/unique themes.

Table 1. Outline of Focus Group Questioning Route

Opening Comments:�Welcome and statements regarding the purpose of the study, focus group procedures, and ethical issues.

Opening Question:� Please tell us a little bit about yourself.

Introductory Question:� Stress is something you hear a lot about these days because many people feel stressed. When thinkingabout your daily life, what does stress mean to you? How do you define stress?

Transition Questions:� Is stress a negative factor in your life? If so, explain how it is negative.� Is stress a positive factor in your life? If so, in what ways it is positive.

Probes: What is it about stress that makes it good or bad?Key Questions:� What are the things that make you stressed?

Probes: (a) Do you have any particular health concerns that contribute to your feelings of stress? Canyou tell us more about this? (b) Besides possible health concerns, is there anything else that adds to yourfeelings of stress? Please describe. (c) Group-specific probe (e.g., Does being an Aboriginal personcontribute to your feelings of stress? If so, describe how.)� What are the ways or things that you do or use to help you deal with stress in your daily life?

Probes: (a) What are your typical ways of coping with stress in your life? (b) What role, if any, does leisureplay in helping you deal with stress? (c) Would your thoughts change if you were thinking about vacationsand/or holidays (alone and/or with other people)?

Ending Questions:� All things considered, what would you say is the major cause of stress in your life?� Of all the ways of dealing with stress that we’ve talked about tonight, which have you found to be mostuseful or effective in your life?� Is there anything about stress or coping that we haven’t talked about that you would like to raise beforewe leave tonight?



Table 2. Summary of Focus Group Characteristics

Aboriginal individualswith diabetes

Individuals withdisabilities

Gays andlesbians

Number of participants 26 22 30Gender

Female 17 13 14Male 9 9 16

Self-identified raceAboriginal (First Nations) 17 4 3Aboriginal (Metis) 9 2 3African/Black 0 1 1Asian 0 0 1Caucasian 0 14 21Central American 0 1 0French Canadian 0 0 1

Age20–24 0 1 525–34 6 5 935–44 8 7 1445–54 7 5 255–64 4 2 065–74 1 2 0

Yearly household income$100,0011 0 1 0$80,001–100,000 0 0 2$60,001–80,000 0 0 4$40,001–60,000 1 2 5$30,001–40,000 1 7 5$20,001–30,000 5 2 7$10,001–20,000 9 4 3o$10,000 9 6 4No response 1 0 0

Highest levels of educationGraduate degree 0 1 2Bachelor degree 0 7 12College or some degree 0 1 2Currently university student 0 1 2Business/trade certificate 0 1 4Grade 12 6 9 5oGrade 12 16 1 3No response 4 1 0

Relationship statusMarried 3 9 NASingle 6 9 11Divorced or separated 4 2 1Common-law 10 1 NAWidowed 3 1 NALiving with partner NA NA 11In relationship but living separately NA NA 5Dating NA NA 2

Occupational statusEmployed, fulltime (Z35 h/week) 3 2 17Employed, part-time (o35 & 410 h/week) 2 4 6Employed, casually o10 h/week) 1 2 4Household worker 0 0 0Unemployed 18 9 3Retired 1 4 0No response 1 1 0

Note. NA 5 Not applicable.



Then, the research team collectively reviewed the results and determined themeplacements across the groups. By carefully examining these clusters of themes, severaloverarching themes of stress or coping were identified that appropriately captured themeaning of each theme. The findings presented in this article are selected results ofthe cross-case analyses relevant to the aim of this particular examination.

FINDINGS AND DISCUSSION

This section begins with describing key themes (i.e., stressors, meanings of stress, andresources) and subthemes derived from our collective analyses of the data. Then,interrelationships among these themes are illustrated. Because of the space limitation,only selected numbers of subthemes are described in this article. Our previouspublications have already addressed many of these aspects, by focusing on oneparticular community group (e.g., Aboriginal peoples with diabetes). An original andunique aspect of the present article is that key outcomes from our data analyses acrossall three groups are reported here.

Stressors

First, stressors represent the sources or causes of stress, which can be personal orstructural in nature. Three selected key stressors are described below: identity; by-products of challenges; and societal, cultural, political, and historical stressors.

Identity. First, one primary source of stress was concerned with individuals’ identities.For example, stigma about Native or Aboriginal identity is illustrated in the followingquotes: ‘‘Some people like to say stuff about Native people. They joke about Indianpeople. ‘Oh, I’m glad I’m not Indian,’ they say.’’ ‘‘Because the child is a Native, does itmeans that their mother or father was drinking while they were having her or him?These preconceived notions, you have to confront them. The racism is alive and it’ssomething that we face every day.’’

Many individuals with disabilities suggested that the public’s negative attitudetoward persons with disabilities is a major source of stress. For example, one womanadmitted that she has been discouraged by some people’s misconception—i.e.,disability being regarded as a contagious ‘‘disease’’—‘‘I couldn’t get anybody even tocut my hair, because they were afraid that I was going to give them some disease.’’

Gays and lesbians discussed conflict over one’s sexuality and the public’s attitudetoward gays and lesbians: ‘‘You live a gay life trying to fit into a heterosexual lifestyle.’’‘‘I run into homophobia practically daily. It just happens.’’ One lesbian complained anegative societal view about lesbians as not normal—‘‘I wish being a lesbian was just soordinary and boring like being left-handed. But I’m very self-conscious about it.’’Countering this viewpoint, one lesbian emphasized, ‘‘I’m just a human being with apreference.’’

By-products of challenges. Another key theme of stress is termed by-products ofchallenges, through living with chronic ill-health or disability, and dealing with othergroup-specific challenges. Aboriginal peoples with diabetes indicated that the difficultyin controlling their own health due to diabetes often makes them feel helpless, asillustrated by the following two quotes—‘‘It’s hard for me to control my sugar and I



feel sorry for myself. I don’t know who to turn to’’; ‘‘When I feel like I’ve got stress,I’ve got no self-control.’’

Individuals with disabilities described the lack of independence and control as a by-product of challenges. One woman mentioned, ‘‘You have to start relying on othersmore and that in itself is really bad.’’ Another woman said that having homecaregenerates a feeling of ‘‘lost control.’’ Still, another issue unique to people with disabilitieswas the lack of accessibility, as illustrated in the following quote: ‘‘It’s lack of mobility,being unable to go where I want, when I want. You’re really so limited. It’s just horrible.’’

Many lesbians and gay men identified ‘‘coming out’’ issues as a major source ofstress. One lesbian admitted, ‘‘My coming out was like a disaster and really traumatic,’’while being afraid in a work setting, one gay man indicated, ‘‘I am still not feeling freeenough to come out. You’re denying half of who you are.’’ Some lesbians suggestedthat if they were ‘‘straight,’’ their mothers ‘‘would love me.’’

One challenge of life raised by Aboriginal persons with diabetes is a sense ofinsecurity—‘‘worrying about everything’’—because of their disadvantaged life circum-stances (e.g., socioeconomically), and another is concerned with the difficulty in relatingto health professionals mainly due to cultural differences—‘‘I have nobody to talk toabout my diabetes.’’ Commenting on the latter aspect, one First Nations man suggested:

Doctors. They keep on loading you onto different people. I noticed that theydo that to a lot of people. Once I get used to one doctor, he turned around andsay it’s my attitude, and he quit being my doctor. I gotta start all over withanother doctor. I’ve given up on believing anything that the doctor tells you.

Societal, cultural, historical, and political stressors. Besides mostly individual-orientedstressors, many participants across all groups described structural or contextual factorsas major sources of stress, which deal with societal, cultural, historical, and/or politicalaspects embedded in their lives.

For example, one First Nations man with diabetes talked about the difficulty ofliving in ‘‘two worlds’’—the Aboriginal communities versus the dominant groups ofCanadians, while another First Nations man considered his ‘‘residential school lawsuitagainst the Federal Government for seven years’’ as ‘‘long-term stress.’’ One Metisman described evidence of ‘‘deep-rooted racism’’ in various contexts from schoolsettings and local communities to government programs:

I have to run to the school every time they’re trying to put my child into aprogram, a ‘‘learn how to speak English’’’ program, because they have anaccent. You face these kinds of racism, deep-rooted racism, that even theteachers don’t even understand. y The North End is considered the corearea, but we have a lot of different people, immigrants that came into the city,and Native people are just a minority there. But when they refer to the NorthEnd, the majority is ‘‘drunken Indians.’’ They sure can go after the Nativegangs. They put into a $4 million prison, just so that they can convict them—that was a waste of money. They should have done something better with thatmoney. You see these kinds of things all the time.

Many individuals with disabilities suggested that societal systems are not fullyresponsive to the needs of people with disabilities. For example, one woman admitted,‘‘If you’re disabled, working with the system can be very stressful. Trying to get help,trying to get work, and running to things all the time.’’ Articulating a similar concern



about ‘‘living in a world in between,’’ one man with a disability commented, ‘‘You feeluncomfortable living in society. You think you’re not any part of the communitybecause sometimes people don’t want to know you better. Before they get to know you,you’ve already passed through a lot of emotional torture.’’

Cultural or structural aspects were raised by gays and lesbians, as well. Forexample, one gay man talked about difficulty with his partner due to culturaldifferences in the views about sexual orientation:

On my side they had no problem with my openness and my family has noproblem with his openness. But on his side because of the cultural differences,they’re not so openly gay—it’s not accepted. Because a thing like culturemakes a big difference in how you perceive the world and relationships.

Meanings of Stress

Despite a wide range of stressors that study participants experienced, the datafrom this study suggested that people attach specific meanings to these experiences.Such meanings of stress emphasized in the study include stress as life itself, stressas negative and/or positive, and perceived control (out-of-control versus in-controlover one’s life).

Stress as life itself. First, there was consensus across all groups that stress is life itself.That is, stress represents a prevalent and inherent aspect of one’s life. The followingcollection of quotes captured this meaning of stress: stress is literally ‘‘everyday life’’ or‘‘on-going day-to-day stuff ’’ (Aboriginal persons with diabetes); stress is ‘‘y just life.That just builds’’ (individual with a disability); and stress is ‘‘fact of life,’’ ‘‘dailychallenges,’’ and ‘‘a lifestyle’’ (gay or lesbian).

The specific experiences and meanings of stress, however, are influenced byspecific life circumstances of individuals. First, because many Aboriginal participantsdwelled on hardships, survival was an inevitable issue, as described by one FirstNations woman who is always concerned with ‘‘How am I gonna make it through theday?’’ In this context, stress was equated with ‘‘everyday things, worrying abouteverything’’ such as ‘‘money,’’ ‘‘family,’’ ‘‘health,’’ (First Nations woman). When askedabout the meaning of stress, one First Nations man suggested, ‘‘Stress is somethingthat we live with every day.’’

Individuals with disabilities emphasized that some activities which are commonlytaken for granted (e.g., ‘‘putting a jacket on’’) can generate stress, as summarized byone person with a disability saying, ‘‘It [stress] can be all over you.’’ Illustrating thispoint, one participant who uses a wheelchair stated, ‘‘Life itself is very stressful. It canbe just nothing—somebody’s shoes in the way. All the little things add up.’’

Stress as negative and positive. Despite the stressful nature of life, most participantssuggested that stress could be positive as well as negative. One woman with a disabilitysummarized this point:

It [stress] is negative when you’re going through a situation, but thenthe way you work it through, it changes into a positive for you because youthink, ‘‘I’m not going to let this happen to me again. I’m gonna be ready.I’ll do the right thing to stop it next time.’’ That’s how it’s both negative andpositive.



Specific negative aspects of stress raised across all groups included its detrimentaleffects on one’s health, attitude, and daily life. For example, men with disabilitiestalked about feeling ‘‘depressed’’ and a series of ‘‘must-do’s’’ as negative aspects ofstress, whereas gays and lesbians noted ‘‘get[ting] panicky from stress,’’ ‘‘stress thatcauses me to close up, turning into the stone-faced person,’’ and things that make you‘‘becoming someone else you don’t like.’’ Aboriginal participants mentioned evidenceof racism, as shown earlier.

On the contrary, positive aspects of stress included stress as a ‘‘motivator,’’ alearning experience, a source of positive change, an awareness-facilitator, and an‘‘opportunity’’ for growth. For example, a First Nations man talked about stress as‘‘one of the learning tools of life,’’ whereas a man with disability noted that stress‘‘makes you think and mentally aware of your surrounding.’’ One lesbian said, ‘‘Youuse it [stress] to turn it into a positive, and that’s what makes you grow.’’ Besidesbringing positive changes in life, stress can be ‘‘spiritual’’ and provide a learningexperience, as described by a woman with a disability:

At times, negative is dragging me down, but there are times it’s really spiritualand it brings changes to your life. Say, a downswing in a relationship will pushfor a change in habits or change your bad stuff, and then an upswing makesyou learn how to cope after you’ve dealt with the bad part of the relationship.

Despite the potential of stress being perceived as positive, several individuals ineach group indicated that stress could seldom be positive. One lesbian noted, ‘‘It’salways been a negative,’’ while woman with a disability stated ‘‘I’ve never found it to bepositive. I hate stress!’’

Perceived control: Out of control versus in control. Concerning negative and positive aspectsof stress, all groups raised being out of control as negative and being in control orhaving high control as positive. For example, one lesbian indicated, ‘‘If you don’t feelany control of the situation, then it’s more negative. y It can be positive if you cancontrol things.’’ One gay man commented on another control issue: ‘‘A negative stress?Pressures that are put on you that you don’t ask to have put on you—timelines that areunfair, workloads that are unfair, situations that are unfair, that you didn’t create foryourself but were created for you by somebody else.’’

Aboriginal persons with diabetes noted that the difficulty in controlling their ownhealth often makes them feel helpless. For example, one First Nations woman said,‘‘It’s hard for me to control my sugar and I feel sorry for myself. I don’t know who toturn to.’’ Speaking of a control issue from a gendered perspective, one First Nationswoman raised a problem with her controlling and jealous partner—‘‘I’m a womanhere, he is a man, you have no control.’’ Individuals with disabilities also described theneed to ‘‘keep an extra control of self ’’ due to their disabilities—‘‘Did I do this? Did Ido that? Should I do this? You get tired after a while.’’ There was also a feeling of ‘‘lostcontrol’’ generated by having homecare—‘‘They’re not doing it the way I do it. Thatadds to the stress.’’

Coping Resources

The findings also suggested that participants utilize a variety of coping resources todeal with stress at both personal and structural levels. In this article, two selected



resources are described including positive attitude and outlook, and cultural orsubcultural strengths.

Positive attitude and outlook. One key theme of personal resources identified is the use ofpositive attitude and outlook. Specifically, many participants with disabilities dealt withstress by using positive mind strategies or affirmations including self-talk. Forexample, one woman with a disability recited a personal mantra, ‘‘I’m not weak, I’mstrong, I can do it,’’ while one man with a disability indicated that believing ‘‘nobody isperfect,’’ and knowing ‘‘everybody has problems’’ and ‘‘you’re not the only onesuffering’’ were the keys for ‘‘living strong.’’

Also, viewing one’s stress-coping experiences as opportunities for self-learning andconfidence building, was a popular perspective among participants with disabilitiesillustrated by the following quotes: ‘‘You do need to learn how to deal with it. Goingthrough a lot of crap builds character. It’s true, it does.’’ ‘‘As I’ve gotten older, yourealize we’ve had such a struggle to get to this point. This is another day and you’ll getthrough it.’’ This point of view is echoed by a gay man, ‘‘I’m grateful for the bad timesas well as the good times. I find I learn more when things are rough than when thingsare good.’’ In addition, several gays and lesbians described such positively framedcoping approaches as seeing ‘‘something bad’’ as ‘‘an opportunity,’’ and ‘‘doing morebetter things for myself and trying to live a lot healthier.’’

Furthermore, many Aboriginal individuals with diabetes discussed the role ofculturally contextualized laughter and humor as a way of dealing with stress, asemphasized by one First Nations woman—‘‘Laughter is so good for you. And to laughis really healthy,’’ and one First Nations man—‘‘Laughter is a big healer when you’redown. My grandparents, they’re gone now, but one of the things they taught me is,when you have a problem you have to talk about it and also put a little bit of laughter init. And it heals. Laughter is a big thing.’’

Cultural strengths. Our data analyses yielded another theme for coping resourcesrelevant to all groups at a broader structural level. This resource theme, termed culturalstrengths, involves interdependence within culture and the facilitation of culturalidentities. First, many Aboriginal individuals with diabetes emphasized the promotionof Aboriginal cultural identity as an important way of coping with stress or healing. Forexample, one Metis woman suggested that being involved in group projects linked toMetis identity and history was an effective way of dealing with stress since it gave her alift when she was ‘‘feeling down,’’ and it provided a sense of purpose in life:

I’m involved in a lot of projects. A whole bunch of Metis people are gettingtogether, and we’re going to recreate the oxcart trail from Pembina toWinnipeg. And we’re building the carts like in the old days. No modern thingsat all. We’re going to coincide it with the opening of the Indigenous Games.And we saved the Metis cemetery in Pembina last year. It was in the paper.[Moderator; Would you say that those kinds of things assist you in dealing withyour stress every day? Getting actively involved?] Yeah. If I’m feeling down, Ihave to look at my calendar, ‘‘Oh, I’ve got to go to a meeting.’’

Many Aboriginal participants agreed that they enjoy seeing ‘‘pow-wows,’’ whichportray their cultural strength. For example, one First Nations man indicated that hefelt good about pow-wows and had respect for it, which was taught by his parents, ‘‘Yousee these guys wearing the Indian chief head. I feel good about seeing what I see. I



have respect for whatever I see in this world and what I was taught from my parents.They told me, ‘Listen, there’s a lot of things out there that you’re gonna see. Treat itwith respect.’’’

Several Metis women spoke of educating their children about Metis history andshowing them Metis traditions such as Metis tea and dance as a way of coping/healing(e.g., ‘‘We dance together, that was a lot of fun.’’). One Metis woman mentioned thatshe did ‘‘a lot of Native arts,’’ which gave her a sense of ‘‘satisfaction.’’

In addition, many lesbians and gay men described the significant role of gainingstrength within the context of gay culture. For example, some pointed out thatspending time at gay bars was an effective way of coping with stress since these wereconsidered ‘‘a safe environment’’ where they experienced a sense of belonging (e.g.,‘‘You can feel like you belong.’’). One gay man even indicated that people at the barwere considered ‘‘a family in itself,’’ which provides ‘‘real support.’’

Furthermore, many individuals with disabilities suggested that the support andencouragement gained through disability cultural groups are important to cope withstress. For example, as described previously, two women with disabilities indicated thatsocializing with friends who never talk about having a disability as an issue was ‘‘a nicerelief ’’ and helped to ‘‘feel normal,’’ including ‘‘going out and being around peoplethat won’t look at me and say, ‘she has a disability,’’’ which was considered as ‘‘a goodcircle of friends.’’ One Aboriginal woman with a disability also emphasized theimportance of gaining culturally appropriate social support: ‘‘Belonging to groups,just for get-togethers. They’re all my culture, they’re all Native. Even just going sittingthere, listening to them talk. I always come home with such a light feeling because theyshare so many wonderful stories with me, and it makes me feel good and happy.’’

An Interpretive Map of Project Findings About Stress and Coping

Beyond data analyses at a descriptive level, our team performed a higher level of cross-case and cross-thematic analyses to interpret the findings. This process led us to developan integrative interpretive map of findings about stress and coping mechanisms (seeFigure 1). This map was constructed, based on a series of team meetings anddiscussions in our collective attempt (as described in the Method section) to bestillustrate the results from our research project. Overall, this map depicts dynamicinterrelationships among key factors or constructs that appear essential to explainingthe mechanisms of how stress and coping operate. Specifically, the interpretive mapconsists of (a) personal and structural stressors, (b) meanings of stress, and (c) personaland structural resources, as well as of two constructs termed (d) intersectionality and (e)social exclusion, which were identified as important conceptual frameworks to interpretthe stress and coping mechanisms within the context of our research. Figure 1 alsoincludes a complete list of these factors although this article focuses only on keyselected factors, which have been described in the previous sections.

Filtering roles of intersectionality and social exclusion. As illustrated in Figure 1, onceindividuals experience personal and/or structural stressors, these stressors are likelyfiltered or mediated through intersectionality, which is closely interacted with socialexclusion in developing the meanings of stress for individuals. First, the complex waysin which socially and culturally constructed and power-laden concepts such as gender,race/ethnicity, class, age, disability/ability, and sexual orientation intersect with eachother (i.e., intersectionality) become a filter through which the meanings of stress arecreated because of facing various stressors. Our findings about multiple identities



as a source of stress underlie the importance of intersectionality as a key conceptualframework of stress. For example, one Aboriginal gay man talked about his schooldays as very stressful due to his multiple identities, ‘‘I was the outcast kid in myschool, I was a Native in a white school, poor in a rich school, a gay in a straight school.I was smart, one of the smartest kids. It’s like I had every strike against me thatyou could have in high school.’’ This quote describes the stressful nature of anAboriginal gay person’s life because he had to deal with racism, homophobia/heterosexism, and classism as he grew up, illustrating the intersection of race withsexual orientation and class.

For another example, the findings suggested that while women in general tend toexperience gender-based discrimination or oppression (i.e., sexism) as a major sourceof stress, not all women are influenced by stress in the same way. For instance, olderwomen with disabilities were often stressed by the double ‘‘whammy’’ or intersection ofaging and disability, as described by one of the oldest participants:

Aging with a disability. Now I just about can’t do anything. I feel so weak.There’s no energy left for it. Well, I’m getting old, but you don’t like it. Youwant to do things, your brain says ‘Yeah, I’m gonna do this,’ but your bodysays ‘No, you’re not.’ So I find that very stressful.

On the other hand, the nature of stress experienced by racial minority lesbians wasfound to be unique due to their multiple identities. Besides evidence of homophobiaand heterosexism, being a racial minority added another level of challenge and

Figure 1. Interpretive map of findings about stress and coping mechanisms.



complexity in the identities and lives of lesbian participants. This aspect was illustratedby one Black lesbian who pointed out that she is first seen as a Black woman and beinglesbian second: ‘‘My first identity is as a Black woman. People who see me on the streetdon’t see me as a lesbian unless they’re in the know. But my identity is as a Blackwoman. People see that as I’m walking down the street and so that’s first.’’

As described in the above quote, the multiple identities a person has may notalways operate at the same level. In some contexts, one identity may supercede ordominate over the others—culture (or more specifically, race/ethnicity) being the onethat appears to play a most central role in one’s identities.

At the same time, the structures and dynamics of inequality and disadvantage withrespect to opportunities available and access to resources (i.e., social exclusion) seemedto contextually influence this intersecting process in the creation of stress meanings.For example, for many individuals with disabilities, negotiating social systems that donot always accommodate the needs of people with disabilities was a major source ofstress. Addressing this issue, one woman with a disability stated that ‘‘working with thesystem can be very stressful,’’ and another man with a disability added, ‘‘The majorityset the rules. They don’t go, ‘Hey, you disabled people, how’d you like society to be?And then we’ll just do it that way.’ No, it doesn’t work that way. They do it their wayand then you live in between and that’s the way it works.’’ This quote highlighted thereality of social exclusion, particularly, the unfair structure of society that does not fullyaccommodate the needs of minorities.

The prevalence of homophobia as an aspect of social exclusion is a major concernfor lesbians and gay men, as pointed out by one gay man, ‘‘Homophobia. It justhappens. If you want to deal with it, you deal with it; if you don’t, you just walk away. Itstill blows me away in this day and age that there is still so much crap going on.’’ Evensubtle, negative attitudes toward gays and lesbians are evident, as noted by onelesbian—‘‘There’s the whispers and the foreign ground that is the subtle, but it’s there.’’

Furthermore, Metis people tended to be caught in the ‘‘middle’’ betweenCaucasian and First Nation groups, which is seen as an example of being excludedfrom either group of people because of the unique mixed identity of being Metis. Thisuniqueness was illustrated in the following quote: ‘‘I have White friends that want meto pretend I’m White, and then I have Indian friends that want me to pretend I’mIndian. They don’t like each other and I’m stuck in the middle.’’ Also, social exclusiondue to poverty was evident among many socioeconomically disadvantaged studyparticipants. For example, as noted earlier, some Aboriginal individuals equated stresswith ‘‘everyday things, worrying about everything’’ such as ‘‘money.’’ More detaileddescriptions about intersectionality and social exclusion as key conceptual frameworkswill be provided following the end of this section.Mechanisms of coping with stress. The interpretive map then suggests that once themeanings of stress are gained, individuals use various resources in their pursuits ofcoping with stress. Once again, intersectionality seems to play a role in the stress-coping processes. That is, intersections among gender, race/ethnicity, class, age,disability/ability, sexual orientation, and so on are likely to influence the use ofresources when dealing with stress. For example, as shown earlier, an Aboriginalwoman with a disability relied on specific coping resources (e.g., a culturally groundedspiritual resource) partly because of her multiple identities in terms of her race,gender, and disability.

Furthermore, the interpretive map illustrates that successful or unsuccessfulcoping with stress tends to have an impact on one’s stressors and resources. That is,



depending on how well individuals have coped with stress, both stressors andresources can act uniquely in the subsequent stress-coping processes. Thus, theoutcomes of coping are likely to have feedback effects on stressors and resources.Consequently, the nature of stressors and resources is not static but rather dynamicand changeable due to the feedback effects of coping. For example, successful copingwith an interpersonal stressor may subsequently reduce the magnitude of this stressor,as well as may further strengthen formal and informal support as a key resource todeal with this type of stressor.

At the same time, the reality of social exclusion evident in one’s life tends to influencethe nature of stressors and resources for each individual constantly, as illustrated withfeedback effects of social exclusion on personal and structural stressors and resources inthe map. Interactive linkages between social exclusion and intersectionality also appearto operate always in the dynamic stress-coping processes, as depicted with reciprocalarrows between the two concepts in the map. Generally, social exclusion mostly bringsstructural or contextual influences on individuals at a broader level, whereasintersectionality tends to act as a personal filter for people’s experiences and meaningsof life including stress and coping as central elements of their lives.

In summary, our interpretive map is based on our team’s cross-case and cross-thematic analyses and interpretations of the data. Not only does the map identify manyof the key factors or concepts central to explaining the nature of stress and coping, but italso illustrates dynamic interrelationships among these factors/concepts (i.e., stress andcoping mechanisms). In short, this interpretive map represents an integrative andholistic summary of the findings from our project, which strived to explore the realitiesof stress and coping among three nondominant and marginalized groups (i.e.,Aboriginal individuals with diabetes, individuals with disabilities, and gays and lesbians).

Two Overarching Frameworks: Intersectionality and Social Exclusion

As introduced earlier, our research team’s collective data analyses and interpretationshave identified intersectionality and social exclusion as two overarching conceptualframeworks to explain our key findings in an integrative, coherent, and meaningfulway. Given the centrality of these frameworks, detailed descriptions of these conceptsare provided in this section.

Intersectionality. First, the term, intersectionality is being used in such disciplines aswomen’s studies and cultural studies. It acknowledges that people have differentexperiences because of the ways the axes of power in society (e.g., gender, race/ethnicity,class, age, disability/ability, sexual orientation) intersect and overlap with one another,and that these axes have different impacts depending on people’s identities and sociallocations (Crenshaw, 1995; Garnets, 2002; Iglesias & Cormier, 2002). In the context ofour study findings, intersectionality is a helpful concept to understand the meaningsand lived experiences tied to stress and coping for individuals because issues ofgender, race/ethnicity, class, and other axes of power in society are inseparable.

Overall, the project findings suggested that having or juggling multiple layers ofidentities can be stressful or even traumatic. However, the nature of stress or traumaexperienced by those individuals with multiple identities is also unique becauseof the differences in the combinations of individuals’ identities, as well as of thesubsequent differences in their life circumstances and social locations in society.More specifically, the findings provided evidence that people with multiple identities



face different types of discrimination, oppression, or challenge, which maynot be possible to accurately be explained by a single axis of power in society(e.g., gender or race alone). ‘‘Isms’’ that are created by society (e.g., sexism, racism,ageism, classism, ableism, and/or homophobia/heterosexism) overlap and intersectwith each other in a unique and complex way. These consequently have an impact onthe nature of stress experienced by individuals with multiple identities. AlthoughBowleg et al.’s (2003) Black lesbian study emphasized a ‘‘triple jeopardy’’—combinedexperiences of racism, sexism, and homophobia/heterosexism, we argue that the waysthe key axes of power in society intersect are more complex than simply quantitativelyadding multiple marginalities. Our findings provided some important insights intosuch complexity.

To date, the framework of intersectionality has rarely been applied to stress andcoping research. We know very little about the true nature of stress experienced by (orthe lived experiences of stress among) individuals with multiple identities. Ourresearch findings provided some original insights into the nature of stress from threenondominant groups of individuals, by revealing some detailed, specific ways in whichkey axes of power in society intersect.

Social exclusion. Originated in Continental Europe (more specifically, in France in 1974),the concept of social exclusion is now being given greater attention worldwide includingthe United Kingdom, the United States, Canada, and other developed and developingcountries (Hills, Le Grand, & Piachaud, 2002). According to the Social Exclusion Unit(2004) established by the British government, ‘‘Social exclusion includes poverty and lowincome, but is a broader concept and encompasses some of the wider causes andconsequences of deprivation’’ (p. 4). Thus, social exclusion deals with the dynamics ofincome, inequality, deprivation (both material and nonmaterial), and disadvantage(Galabuzi, 2004). It is a multidimensional concept, dealing with, but not limited to: (a)labor market exclusion (e.g., unemployment, underemployment), (b) economic exclusion(e.g., poverty), (c) institutional exclusion (e.g., structural discrimination), (d) social isolation(e.g., limited social networks and social contacts), (e) cultural exclusion (e.g., inability to liveaccording to the culturally accepted norms and values), and (f) spatial exclusion (e.g., poorhousing, insecure and unsafe residential areas; Byrne, 1999; Gray, 2003).

Social exclusion is considered a critical concept to explain structural andpower relations within a society (Guildford, 2000). It is now also acknowledgedas a major social determinant of health (Wilkinson & Marmot, 2003). This conceptacknowledges that exclusion from society happens to people as a result of governmentpolicies and social changes rather than simply due to characteristics of people (Shaw,Dorling, & Davey-Smith, 1999). Given the policy and service implications the notion ofsocial exclusion has, recognizing the linkages between social exclusion and stress-copingis important to more appropriately address practical issues (including policy-making andservice-provision) related to stress and coping in our diverse society. Consequently, ourstudy findings instilled some important ideas relevant to these practical areas.

CONCLUSION

The key results from our research project have provided some important new insightsinto the complexity of stress and coping phenomena in our diverse society. A majorunique and original aspect of our study is that by giving voices to three selectednondominant groups of people, the realities of these people’s lives are appreciated and



incorporated into an emergent interpretive map of stress and coping mechanisms(Figure 1). This interpretive map has not been developed priori; rather, it has beendeveloped after respectfully listening to and sincerely bringing forward the livedexperiences of three groups of people: Aboriginal persons with diabetes, individualswith disabilities, and lesbians and gay men. Consequently, this interpretive map isgrounded in the realities and lived experiences of these individuals without beingunduly predetermined by the existing knowledge about stress and coping.Intentionally, our research team had avoided to make such predetermination by‘‘bracketing’’ our presumptions about findings, and had let results naturally emerge orcome out from what our participants had told us (i.e., life stories). In fact, thisprocedure is consistent with phenomenology, including the use of process calledbracketing (Creswell, 1998).

The trustworthiness and credibility of this interpretive map have already beenjustified through the process of member-checking, which has involved bringing thefindings back to the participants and providing them with an opportunity to critiqueour analyses and interpretations. Beyond academic/scientific reports, our team hasdeveloped a user-friendly summary of the key findings, which has been distributed tothe participants. Both written and verbal feedback has overwhelmingly supported thefindings, which imply the trustworthiness and credibility of our interpretive map.

Besides our conscious effort to incorporate the perspectives directly of non-dominant groups of individuals into data analyses and interpretations by acknowl-edging the diversity of our society, another original and unique aspect of this study isthe identification of intersectionality and social exclusion in our interpretive map. Ourpeople- and community-grounded findings have supported that intersectionality andsocial exclusion act as two primary overarching frameworks that help to link the notionsof stress (including the meanings of stress) and coping conceptually within the lives ofthree selected nondominant groups of individuals. Not only is recognizing the complexways in which multiple identities intersect (i.e., intersectionality) important, butrealizing the realities of being excluded socially, economically, culturally, and politicallyamong nondominant groups (i.e., social exclusion) is also essential to moreappropriately conceptualize the concepts of stress and coping.

These two frameworks appear to have important implications for advancing theliterature on stress and coping, by more explicitly acknowledging non-dominant people’ssocial locations, life conditions, and lived experiences. The integration of bothintersectionality and social exclusion frameworks into stress and coping conceptualiza-tions seems to facilitate a greater understanding about the processes and mechanisms ofstress and coping in the context of our diverse society. Not only do the findings from thisresearch extend the basic concepts of stress and coping from non-dominant perspectivesas alluded in Wong and Wong’s (2006) edited volume, but the research alsodemonstrates the utility of a narrative or story-telling approach to giving voices tonondominant groups of individuals as advocated by Bond and Harrell (2006) and others.

Although the generalizability of this interpretive map, of course, is to be tested anddetermined in subsequent research efforts, the findings from this study seem to havebroad implications for nondominant and disfranchised population groups at largebeyond the three groups examined in this research. That is because nondominantgroups appear to share key common challenges in life such as discrimination,oppression, and stigma regardless of differences in group memberships. On the otherhand, unique characteristics of different nondominant population groups deserve in-depth independent studies.



Nevertheless, this newly developed and evidence-based interpretive map offerssome important ideas about stress and coping pathways, particularly from non-dominant and marginalized perspectives, which include the realities of oppression anddiscrimination in our power-based society, as well as of human strengths and resilience.Understanding these people’s lived experiences and insights into stress and coping isvery important to more appropriately conceptualize culturally grounded stress andcoping phenomena. Consequently, such understanding is critical to develop moreculturally adequate intervention programs to help those in need. Given thatnondominant groups of people tend to be oppressed by more dominant groups ofpeople and pressured under high stress, developing people-oriented, community-based, and culturally relevant stress management programs is important. Stress andcoping research can make a difference by helping to achieve the goal of making oursociety a better place to live for all people with a top priority deserved to be given tonondominant and disfranchised groups of individuals.

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mapping nondominant voices into understanding stress‐coping mechanisms

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