Juju is Not the Cause of My Pain: Pain Beliefs of the Igbo in the United States

1. Juju is Not the Cause of My Pain: Pain Beliefs of the Igbo in the United States Miriam O. Ezenwa, MS, RN, Erica O’Brien, BSN, RN, Molly Hanson, BS, Sandra Ward, PhD, RN, FAAN ABSTRACT MATERIALS AND METHODS RESULTS 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 Participants had high heritage consistency with mean (SD) of 4.06 (0.40), indicating they have maintained Igbo cultural beliefs. Sample Sample Characteristics (N=10) Types of pain CONCLUSIONS • Measures • Demographic 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 • Language use and proficiency • Affiliation with people • Pride • Participation in activities • Exposure • 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) 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. Ethnicity has been recognized as a factor that may influence pain expression, pain 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 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 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. 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. PURPOSE The purpose of this descriptive study is to explore pain beliefs of the Igbo, an ethnic group from Nigeria, in the United States. ACKNOWLEDGMENTS CONCEPTUAL FRAMEWORK Susan Hughes, MS, RN, Researcher, UW-Madison School of Nursing Leventhal’s Common Sense Model, a conceptual framework that focuses on 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 of and potential cures/control for pain. BIBLIOGRAPHY 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.