A meta-synthesis of post-migration changes in marital relationships in Canada.
Guruge, Sepali ; Shirpak, Khosro Refaie ; Hyman, Ilene 等
Immigration to a new country constitutes a major life change that
can directly and indirectly affect health. Considerable research has
focused on the impact of immigration on individual psychosocial and
cultural adaptation and integration, but far less has examined "how
migration affects marital relationships or the processes by which
couples adapt to their new circumstances" (p.149). (1) This is a
key limitation in the literature given that the majority of immigrants
come as family units. (2)
Post-migration changes can both positively and negatively affect
marital relationships. For example, post-migration changes in gender
roles have been shown to have a profound effect on married couples.
(3-5) Immigrants' ways of thinking about couple relationships may
be rooted in understandings of human nature and social order that differ
from those that have set the foundations of Canadian culture and
institutions. (6-8) Changes in gender roles have been associated with
increases in stress, (2,9) marital conflict, (10,11) marital discord,
(12) and the risk of abuse. (13,14) The connection between changes in
gender roles and spousal abuse has been studied in a number of ethnic
communities in the United States including Mexican immigrants, (4)
Southeast Asian refugees.11 Chinese immigrants, (15) and Iranian
immigrants. (14) This connection was evident in a number of Canadian
studies as well. (1,3,5)
Immigration to a new country also offers couples the opportunity to
renegotiate and rebuild couple relations.1 For example, Cheung found
that although those with long-term happy marriages went through major
adjustments after they had immigrated to Canada, (16) a number of
significant factors affected their resilience: 1) adjustment to changing
gender relations, 2) increase in intimacy and mutual reliance, and 3)
management of conflict and willingness to compromise on differences.
However, we do not know if other post-migration changes are faced
by immigrant couples in Canada, whether these changes are common across
different ethnic communities, and the pathways through which these
post-migration changes lead to positive or negative outcomes in
couples' lives. This information is necessary for developing health
promotion interventions for immigrant couples.
Recently, there has been an increase in research on post-migration
changes and their impact on immigrants' health. In Canada, much of
this work has been qualitative. Individual studies focusing on specific
ethnocultural communities help improve our knowledge on the topic,
however, a systematic review of the individual studies' findings
across communities could provide a better framework for understanding
the topic. Meta-synthesis, in particular, is the "aggregating of a
group of qualitative studies for the purposes of discovering the
essential elements and translating the results into an end product that
transforms the original results into a new conceptualization"
(p.314). (17) Therefore, we conducted a metasynthesis to address the
overall research question of: What are the impacts of post-migration
changes on heterosexual couples' relationships? The subquestions
were: 1) What are the post-migration changes that couples face in
Canada? 2) What are the impacts of these changes on marital
relationships? 3) Are these changes common across different immigrant
communities in Canada? and 4) What are the pathways through which these
post-migration changes lead to positive or negative outcomes in
couples' lives?
<01_TB031>
METHODS
We completed computer searches on MEDLINE, CINAHL, Academic Search
Premier, Canadian Periodical Index, Proquest, Psycinfo, Sociological
Abstracts, Social Services Abstracts, and Worldwide Political Science
Abstracts. We conducted manual searches of selected journals that deal
specifically with marital relationships, such as Journal of Marriage and
Family, Marriage and Family Review, Marriage Partnership, Journal of
Marital and Family Therapy, and Journal of Sex and Marital Therapy. We
also searched Google Scholar for studies we might have missed. The
reference lists of all studies that met the inclusion criteria were
hand-searched. Various combinations of the following keywords were used
to conduct the search: post-migration changes, marital/couple
relationship, immigration, and Canada. Qualitative studies were selected
if they: 1) examined post-migration changes in heterosexual
couples' relationship within a Canadian context, 2) were published
in English in peer-reviewed journals or books, and 3) were published
from 1990 onwards.
Based on Noblit and Hare's (18) meta-ethnography and Paterson,
Thorne, Canam and Jillings' (19) meta-data method, we undertook the
following steps: 1) Read each study with attention to detail to
understand the author's description of the findings as a whole; 2)
Generated initial codes; 3) Created a list of the key metaphors,
phrases, ideas and/or concepts, and their relationships that were used
in each account; 4) Determined how the studies were related, and
translated the studies' findings into one another by comparing the
metaphors or themes of one study with the concepts of other studies; and
5) Synthesized translations to make a whole that is more comprehensive
than the individual studies' findings.
To ensure the rigour of the synthesis, we used the following
methods adapted from Paterson et al. (19) and Sandelowski (20): 1)
Primary study reports were independently reviewed by the team members;
2) The team members met regularly to identify differences in their
reviews of each primary study and to reach an agreement on the coding;
3) During team meetings, the members discussed methodological and
theoretical issues that arose during the process; and 4) The procedures
used and the decisions made during team meetings and throughout the
process of meta-synthesis, as well as the rationale for these, were
documented.
SYNTHESIS
Although we found many studies pertaining to the process, barriers,
facilitators and dynamics of the acculturation and assimilation of
immigrants to Canada, only 32 were related to the focus of this study.
Of these, four journal articles (1,21-23) and one book chapter5 met the
inclusion criteria of this study. We did not exclude any studies based
on their methodological approach in order to capture the depth and
breadth of the phenomenon of interest. (19,24)
Participants included in the five studies were from the following
immigrant communities in Canada: Iranian, Ethiopian, Sri Lankan,
Chinese, Ukrainian, Polish, Italian, Korean, and Vietnamese. The sample
sizes ranged from 16 to 68. Some studies' samples included
individuals while other studies included couples. Within these studies,
the number of couples included from each community varied from 1 to 8.
Additional characteristics of these studies are described in Table 1.
Three overarching themes describing post-migration changes emerged
from our meta-synthesis: 1) loss of or limited social networks and
support; 2) de-skilling and de-professionalization; and 3) changes in
gender and sexual relations. In addition, a fourth theme, importance of
communication, both within and outside the family, cut across the three
key themes. These changes were common across the nine communities
included in these studies. One positive (resilience) and three negative
(staying with each other, separation/divorce, and abuse) outcomes
occurred as a result of the post-migration changes. The pathways that
link the post migration changes and their outcomes in couples'
relationships are depicted in Figure 1.
[FIGURE 1 OMITTED]
The post-migration changes in social networks and support have the
potential to generate both positive and negative outcomes in marital
relationships. As indicated in the figure, the lack of familiar social
support systems may force couples to rely more on each other (i.e.,
increase mutual dependence), for example, for instrumental support such
as household work and child rearing. This situation requires the husband
to take on more household work that (along with improved communication
between the couple) leads to equal division or more equitable sharing of
household work, which in turn can lead to strong couple relations
(resilience). On the other hand, if a dispute occurs due to one partner
(often the man) resisting equal sharing of household work, this can lead
to conflict and abuse.
The downgrading of immigrants' skills and professional
experiences can result in the loss of social status for the family in
general and for the husband in particular. This change, often in the
context of associated financial constraints and stress, can lead to
conflict and spousal abuse, all of which are connected to ill health.
Alternatively, financial constraints in the family can make the
wife's income necessary. This necessity along with more
opportunities for the woman in the post-migration context for work
outside the home (albeit in low-status, low-paid jobs) can lead to a
relative increase in the woman's financial independence and
autonomy that may provide her with an opportunity to leave an abusive
husband. While this outcome might be considered positive for a woman in
an abusive relationship, the outcome might be considered negative for
the man. On the other hand, the overall economic hardship in the family
may compel women to remain in abusive relationships. In addition, the
financial strain and the necessity for both husband and wife to work
long hours outside the home can also lead to negative outcomes.
Last, changes in gender relations (e.g., more joint
decision-making) and sexual relations (e.g., greater assertiveness about
sexual needs) can promote immigrant couples' resiliencies in the
face of post-migration adjustments or they can lead to conflict and
abuse. Both partners may not respond the same way when faced with sexual
scripts and culture in Canada that may differ from or contradict their
home country's cultural beliefs, for example, about sexual
relations. One partner's post-migration expectations regarding
sexual relations might change significantly, which, in the context of
other pressures and stresses along with the other partner's
response to such expectations, might lead to sacrifice, tolerance,
infidelity, and separation or divorce. Yet some immigrant couples
redefine their gender and sexual relations, and experience a growing
love, better communication regarding each other's sexual needs and
expectations, and resilience.
DISCUSSION
This systematic review has a number of limitations. First, the
metasynthesis included only those Canadian studies published in English.
Second, although we performed an extensive search, some relevant studies
may have been missed because we included only the peer-reviewed
publications. Third, we might have mixed culturally, socially, and
linguistically incomparable concepts in our analysis. For example, it
was not possible to differentiate how the concepts of violence or
resilience were defined and understood in different communities. Also
unclear was the quality of the relationship when couples "stayed
with each other". Meta-synthesis as a method also has certain
limitations, (25) some of which are related to the heterogenic nature of
the study characteristics. For example, the study populations and/or the
theoretical foundations used in the studies were different. Other
limitations are related to the samples of the original studies. For
example, some studies included individuals and other studies included
couples. The number of couples from each of the communities varied from
1 to 8 across studies, and the studies that included individuals had
more women than men in their sample. Despite these limitations, we
believe that the findings of this meta-synthesis have implications for
shaping public health approaches to working with immigrant couples.
This meta-synthesis demonstrated that the three post-migration
changes (i.e., loss of or limited social networks and support;
deskilling and de-professionalization; and changes in gender and sexual
relations) were common across the nine ethnic communities. These changes
occur at and demonstrate their impacts at the level of the individual or
the couple. However, the determinants of these changes are at micro,
meso and macro levels. For example, the determinants of de-skilling and
de-professionalization are at the macro level of Canadian society and
their consequences are felt primarily at the micro level by individuals
and couples. This distinction has implications for designing strategies
for health promotion and violence prevention.
This synthesis also showed that these post-migration changes can
lead to positive and/or negative marital outcomes (i.e., resilience,
staying with each other, separation/divorce, and abuse) for the couple.
In addition, when the pathways depicting the processes through which
these changes affected the couple were identified, it became clear that
the changes could affect individual partners within the couple
differently. For example, de-skilling and de-professionalization affect
both partners, but more so the men who almost always experience this
change more negatively or more severely, perhaps because of the
patriarchal expectation of men as the primary or the sole breadwinner of
the family.
Understanding the pathways through which the post-migration changes
can translate into positive and negative marital outcomes can help
health care professionals determine where public health interventions
can be most effective in stopping the process from leading to negative
outcomes for the woman, man and couple. For example, health care
professionals can work with couples to rebuild social networks and
support systems for women and men that can effectively address issues
surrounding loss of social status, gender role socialization,
professional reinsertion/reorientation, more effective ways of
communicating stresses and frustration, and how/where to obtain formal
social support for informational, instrumental and financial needs that
might arise within the new context. In order to do so, health care
professionals must learn about the informal and formal resources
available to immigrants both within and outside of their communities and
make referrals to these based on the woman's, man's and the
couple's unique needs and preferences.
Recognition of post-migration changes and how they lead to negative
outcomes could help policy-makers, service providers, and researchers to
find ways to prevent conflicts in couples' relationships, promote
healthy marital relationships, and ensure couples' health and
wellness following their arrival in Canada. Some of the ways in which
health, settlement, and social workers can intervene include:
acknowledging the post-migration changes in the quantity and quality of
social supports and making more formal social supports available to
immigrant couples, enhancing communication within and outside the couple
unit, and highlighting the importance of accepting the fluid nature of
gendered roles and responsibilities and perhaps a need for renegotiating
expectations regarding sexual relations between the couple, in the new
context. Health care professionals also need to develop reciprocal and
collaborative partnerships with community leaders and agencies to
develop culturally appropriate health promotion materials and programs.
In fact, lessons learned from those who were able to develop and/or
maintain a positive marital life in spite of the hardships they faced
could be used to create health promotion models to manage the challenges
of immigration and settlement and inform the development of
community-based health promotion strategies.
Health care professionals can also act as advocates within the
health care system, identifying and challenging structural barriers that
the couples face in the post-migration context in Canada. This advocacy
must go beyond the health care system to address larger societal and
systemic barriers such as racism that continue to lead to de-skilling
and de-professionalization of immigrants, or to lobby for a better and
faster family reunification system. These changes can be realized only
by collaborating across health, social, settlement and legal sectors.
In summary, the changes that couples undergo following migration to
Canada points to the need for policy, programs and research to stop or
reduce the negative impact of post-migration changes while promoting
couples' resiliencies.
Acknowledgements: The first author gratefully acknowledges project
support she received from the Canadian Institutes of Health Research in
the form of a CIHR New Investigator Award.
Conflict of Interest: None to declare.
Received: September 1, 2009
Accepted: February 8, 2010
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Sepali Guruge, RN, PhD, [1] Khosro Refaie Shirpak, MD, MPH, PhD,
[1] Ilene Hyman, PhD, [2] Margareth Zanchetta, RN, PhD, [1] Denise
Gastaldo, RN, PhD, [3] Souraya Sidani, RN, PhD [1]
Author Affiliations
[1.] Daphne Cockwell School of Nursing, Ryerson University,
Toronto, ON
[2.] Dalla Lana School of Public Health, University of Toronto,
Toronto, ON
[3.] Lawrence S. Bloomberg Faculty of Nursing, University of
Toronto, Toronto, ON Correspondence and reprint requests: Dr. Sepali
Guruge, Associate Professor, Daphne Cockwell School of Nursing, Ryerson
University, 350 Victoria Street, Toronto, ON M5B 2K3, Tel: 416-979-5000,
ext.4964, Fax: 416-979-5332, E-mail: sguruge@ryerson.ca
Table 1. Characteristics of the Studies Used in the Meta-synthesis
Studies
Morrison et
Characteristics Shahidian (1999) (21) al. (1999) (5)
Aim of study To explore the ways in To examine the effects
which spatial of transition between
displacement Tamil and Canadian
transformed gender cultures on marriage
relations and sexuality patterns, partner
choices, sexuality, and
gender roles
Ethnic background Iranian Sri Lankan Tamil
of the study
participants
Sampling strategy Snowball and Non-probability quota
convenience sampling sampling
Sample size 68 (35 M, 33 F) 32
Data collection In-depth interviews, In-depth interviews
life histories, and
participant observation
Studies
Characteristics Hyman et al. (2004) (22) Cheung (2008)
Aim of study To document post- To understand the
migration changes in factors in marital
the lives of newcomer processes that lead to
couples the couples' resilience
in the immigration and
integration process
Ethnic background Ethiopian Chinese (Mainland China
of the study & Hong Kong),
participants Ukrainian, Polish,
Italian, Korean, and
Vietnamese
Sampling strategy Snowball and Purposive sampling
convenience sampling
Sample size 16 (8 couples) 16 (8 couples)
Data collection Focus group In-depth interviews
discussions, in-depth
interviews
Studies
Characteristics Hyman et al. (2008) (1)
Aim of study To examine the impact
of post-migration
changes on marital
relationships
Ethnic background Ethiopian
of the study
participants
Sampling strategy Purposive sampling
Sample size 16 (8 couples)
9 separated or
divorced individuals
Data collection Focus group
discussions, in-depth
interviews
