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Coping Strategies and Psychological Well-Being Among

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Coping Strategies and Psychological Well-Being Among COPING STRATEGIES AND PSYCHOLOGICAL WELL-BEING AMONG BHUTANESE REFUGEES RESETTLED IN OTTAWA, CANADA by Anita Subedi A thesis submitted to the School of Nursing in conformity with the requirements for the degree of Master of Science Queen’s University Kingston, Ontario, Canada (September, 2016) Copyright © Anita Subedi, 2016 Abstract Since 2008, more than 6000 Bhutanese refugees have been resettled in over 21 communities across Canada, with nearly 300 individuals residing in Ottawa. This resettling process is associated with physical and psychological stress, as individuals acclimatize to a new country. A lack of understanding of the impact of this transition exists. This study assessed the relationship between coping strategies and psychological well-being of Bhutanese refugees resettled in Ottawa. A cross sectional survey of a representative sample of Bhutanese adults (n = 110) was conducted between November and December 2015. Coping strategies and psychological well-being were measured using the Brief COPE and General Well-being (GWB) scales. The total GWB mean score of 69.04 ± 12.09 suggests that respondents were in moderate distress. GWB did not significantly differ by sex, marital status, religion, employment, part time or full time job, or length of stay in Canada. Using multiple linear regression, significant independent variables from univariate analysis with GWB (age, education, positive reframing, self-blame and venting) were modeled to determine the best predictors of general well-being (GWB, F (11, 96) = 3.61, p < .001, R² = 21.2%). Higher levels of education and positive reframing were associated with greater GWB scores while self-blame and ages 41-50 were inversely associated with general well-being. It was found that above 66% of the unemployed participants were from age groups 41 and above. This finding suggests that career guidance services and vocational training to address unemployment may benefit this community. Nurses can provide support and counseling to assist refugees to minimize the use of negative coping ii strategies like self-blame and venting and promote positive coping strategies. Further, collaboration between nurses, other interdisciplinary professionals and community organizations is necessary to address social determinants of health and enhance refugee psychological well-being. iii Acknowledgements This study would not have been possible without the expertise and support of many people. I would like to thank, first and foremost, my thesis supervisor Dr. Dana S. Edge for her continuous support, expert guidance and encouragement that has made my learning most valuable. I am truly grateful for her generosity throughout my graduate study. I would like to extend my gratitude to my thesis supervisory committee: Dr. Monakshi Sawhney and Dr. Katie Goldie for their feedback, guidance and critique, which enhanced the thesis and encouraged me to strive for perfection. It was an honor to be a student of such great minds. I would also like to thank the amazing Bhutanese people who participated in this study and community leaders Mr. Brian Khadka and Mr. Shankar Dhital who made this study possible at Ottawa. In addition, I would like to thank the Catholic Center for Immigrants, Ottawa for the dissemination of the survey information and helpful suggestions to conduct a survey. Special thanks to Mr. Daya Nidhi Kharel and Mr. Tek Bahadur Chhetri for their valuable time spent translating the GWB tool into Nepali. I wish to express my heartfelt gratitude to my parents, my in-laws, my sister and brother inspiring me to pursue my dream and aim for higher education away from home and believing in me during the toughest moments of my study. Furthermore, I would like to thank my husband for his motivation, unfailing support and my lovely son for his patience and love throughout my educational journey. Finally, I would like to acknowledge Queen’s University Schools of Nursing and Graduate Studies for providing me with the Faculty Award 2015 and M.N Francis Fellowship, which not only boosted my morale but also assisted in financial aspects. iv Table of Contents Abstract ............................................................................................................................... ii Acknowledgement ............................................................................................................. iv List of tables ..................................................................................................................... viii List of figures ..................................................................................................................... ix List of abbreviations ............................................................................................................ x Chapter 1 Introduction ......................................................................................................... 1 Introduction and rationale for the study ........................................................................... 1 Chapter 2 Background ......................................................................................................... 4 Theoretical framework ..................................................................................................... 4 Conceptual model for the current study ........................................................................... 7 Definitions ........................................................................................................................ 7 Overview of coping and psychological well-being .......................................................... 9 Coping strategies ............................................................................................................ 10 Negative coping strategies .......................................................................................... 10 Positive coping strategies ........................................................................................... 13 Relationship between coping strategies and psychological well-being ........................ 14 Well-being of refugees ................................................................................................... 16 Health problems .......................................................................................................... 16 Access to health care .................................................................................................. 17 Mental health among refugees .................................................................................... 18 Psychological well-being of Bhutanese refugees ....................................................... 20 Study justification ........................................................................................................... 22 Research questions ......................................................................................................... 22 Chapter 3 Methods ............................................................................................................. 23 Research design .............................................................................................................. 23 Community engagement ................................................................................................. 23 Sample and eligibility criteria ........................................................................................ 24 Survey tools and translations .......................................................................................... 25 Brief COPE ................................................................................................................. 25 General well-being schedule ...................................................................................... 26 Study variables ............................................................................................................... 27 Additional questions ................................................................................................... 28 Questionnaire development and pre-test ........................................................................ 28 Data collection ................................................................................................................ 29 Ethical considerations ..................................................................................................... 30 v Data cleaning ................................................................................................................ 31 Data analysis ................................................................................................................... 32 Chapter 4 Results ............................................................................................................... 35 Response rate .................................................................................................................. 35 Demographics ................................................................................................................. 36 Descriptive results of additional questions ..................................................................... 38 Statistical analysis of study variables ............................................................................ 41 Research question 1 .................................................................................................... 41 t-test ...........................................................................................................................
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