Juju is Not the Cause of My Pain: Pain Beliefs of the Igbo in the United StatesMiriam O. Ezenwa, MS, RN, Erica O’Brien, BSN, RN, Molly Hanson, BS, Sandra Ward, PhD, RN, FAAN

Ethnicity has been recognized as a factor that may influence pain expression, pain experiences, and the meanings ascribed to pain. The purpose of this study was to explore pain beliefs of the Igbo (a Nigerian ethnic group) in the U.S. Participants (N=10) completed the General Ethnicity Questionnaire-Igbo (GEQI, alpha = 0.88), a measure of acculturation (or conversely, heritage consistency), and were interviewed using a semi-structured interview guide, with questions derived from the Common Sense Model (CSM) of Illness Representation. The interview data were analyzed using content analysis. Kappa coefficient (k), was 0.94, demonstrating high agreement between the two coders. Participants ranged in age from 19 to over 65, and their mean (SD) years in the U.S. was 16.10 (8.33). Participants had high heritage consistency with a mean (SD) GEQI of 4.06 (0.40). While only one participant (10%) reported a belief that witchcraft (juju) was a cause of his/her pain, 90% believed that juju can cause pain. Sixty percent of participants used a folk remedy for pain treatment and all used over-the-counter pain medication. The findings suggest that the Igbo in the United States have modified their illness beliefs, which was reflected in their coping strategies, even though they had remained highly tied to their culture of origin.

Design Cross-sectional, descriptive, using individual interviews

Tsai, J.L., Ying, Y., & Lee, P.A. (2000). The meaning of “being Chinese” and “being American.” Journal of Cross-cultural Psychology, (3)31, 320-332.

ABSTRACT

PURPOSE

MATERIALS AND METHODS RESULTS

CONCLUSIONS

BIBLIOGRAPHY

Ethnicity has been recognized as a factor that may influence pain expression, pain Ethnicity has been recognized as a factor that may influence pain expression, pain experiences, and the meanings ascribed to pain. Pain management investigators have experiences, and the meanings ascribed to pain. Pain management investigators have extended research efforts to members of many ethnic groups in the U.S., but have not extended research efforts to members of many ethnic groups in the U.S., but have not studied many of the ethnic groups found within the African Diaspora in the United studied many of the ethnic groups found within the African Diaspora in the United States. One such ethnic group is the Igbo, an ethnic group from Nigeria. In order for States. One such ethnic group is the Igbo, an ethnic group from Nigeria. In order for optimal care to be a possibility for all, it is critical that we understand the pain optimal care to be a possibility for all, it is critical that we understand the pain experiences from the perspectives of the persons experiencing them.experiences from the perspectives of the persons experiencing them.

INTRODUCTION• This descriptive study is the first that explored the beliefs of the Igbo in the U.S. about the cause of pain and its treatment. • Results show that participants believe that although witchcraft (juju) is capable of causing pain, it was not believed to be the cause of their pain. • Participants reported using the following strategies to treat pain: Folk remedy, over-the-counter pain medication, consult a medical doctor, home remedy and Christian-related rituals.

CONCEPTUAL FRAMEWORK

Demographics N (%)

Age range

19-34

35-54

55-64

65+

3 (30)

4 (40)

2 (20)

1 (10)

Gender

Male

Female

4 (40)

6 (60)

Education

Some college or vocational

training

Completed college

Some graduate school

1 (10)

4 (40)

5 (50)

ACKNOWLEDGMENTS

Susan Hughes, MS, RN, Researcher, UW-Madison School of NursingSusan Hughes, MS, RN, Researcher, UW-Madison School of Nursing

The purpose of this descriptive study is to explore pain beliefs of the Igbo, an ethnic The purpose of this descriptive study is to explore pain beliefs of the Igbo, an ethnic group from Nigeria, in the United States. group from Nigeria, in the United States.

Leventhal’s Common Sense Model, a conceptual framework that focuses on Leventhal’s Common Sense Model, a conceptual framework that focuses on understanding lay beliefs about the causes and cure/control available for symptoms understanding lay beliefs about the causes and cure/control available for symptoms such as pain, was used in this study to understand the Igbo’s beliefs about the origins such as pain, was used in this study to understand the Igbo’s beliefs about the origins of and potential cures/control for pain.of and potential cures/control for pain.

Igbo Beliefs About Cure/Control of Pain

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Physical Therapy

Consult Medical Doctors

Over the Counter Medications

NutritionalSupplements/VitaminsHome Remedies

Restrict Movement

Folk Remedy

Christian-Related Rituals

MeasuresDemographic survey

Age, gender, marital status, level of education, occupation, religion, and length of stay in the United States.

General Ethnicity Questionnaire-Igbo (GEQI) Based on the GEQ-Chinese (Tsai, et al., 2000) Measures level of retention of one’s culture of origin 35 items assessing 6 facets of heritage consistency

o Language use and proficiencyo Affiliation with peopleo Prideo Participation in activitieso Exposureo Preference for food

Responses range from 1 (strongly disagree) to 5 (strongly agree) An overall score is calculated by taking the mean of the items Higher scores indicates high heritage consistency Cronbach’s alpha in the current study was 0.88

Interview Guide Based on the first two stages of the CSM , representations and coping 13 key questions and 11 probes Sample question: Some people think that some evil person can make them suffer with pain-any type of pain- by putting juju (curse) on them, or by invoking their spirits through witchcraft or sorcery. What is your belief about that? Questions pilot-tested with 1 Igbo man and 1 Igbo woman Inter-coder reliability (Kappa) was excellent (0.94)

Sample Sample Characteristics (N=10) Types of pain

Pain Location N (%)

Lower extremities 5 (50)

Back 2 (20)

Neck 2 (20)

Abdomen 1 (10)

Participants had high heritage consistency with mean (SD) of 4.06 (0.40), indicating they have maintained Igbo cultural beliefs.

PRACTICE IMPLICATIONS

• Clinicians should not assume that all ethnic persons in the U.S. still maintain cultural beliefs about causes of pain and pain treatments.• Clinician should be aware that although patients use Western treatments, some individuals may maintain traditional cultural beliefs and practices.

Igbo Beliefs About Cause of Pain

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Age

Heredity

Illness

Activity

Body Mechanics

Injury

Psychological