Rosaleen Ow

Family Secrets and the Disclosure of Distressful Information in Chinese Families

Multiple in-depth interviews with fifteen Chinese families in Singapore were conducted to study family adaptation arising from the diagnosis of chronic childhood illnesses. Disclosure of distressful information was found to be selective. Keeping secrets within the immediate family (i.e., between parents and children, between husband and wife, and between the family and the wider community) were governed by factors related to the support and protection of the family unit. Motivations for keeping family secrets appeared to be in keeping with the behavioral rules of a collectivist culture, emphasizing saving “face,” maintaining group harmony and hierarchical roles, and taking responsibility for mutual protection. Implications for practice in the health settings, policy issues (e.g., the right of the patient to knowledge about the illness), and intervention (e.g., the role of the social worker in facilitating open disclosure among family members to enhance family adjustments) are discussed.

Diverse Perceptions of Social Support: Asian Mothers of Children With Intellectual Disability

This study examined the extent and sources of social support of Chinese and Malay Muslim mothers of children with intellectual disability in Singapore and attempted to expand the understanding of relationship-based perceptions of social support in these 2 population groups. Analysis of 6 areas, namely, informational, emotional, social, financial, childcare, and practical needs showed that Chinese mothers have a larger and more diversified network of perceived social support than their Malay Muslim counterparts. Discussion includes the role of cultural variables in the perception of social support network, the role of relationship strength in perceived social support, and strategies for enhancing the mental well-being and coping of Asian mothers of children with intellectual disability.

Social work in a multicultural context

Social work practice and education are a reflection of the historical, social, economic and political context of the society the profession seeks to serve. This paper is a discussion of recent developments in multicultural Singapore in social service provisions for the elderly, the family and those with very low income, and the involvement of the social work discipline. The emphasis is on the fine balance in providing services which meet broad societal objectives and also reflect sensitivity to the cultural and social differences and needs of various subgroups.

Worldviews and Resilience in Children of Divorced Families

A qualitative study, involving face-to-face interviews and focused group discussion on the interaction of individual, family and social factors associated with resilience of Malay-Muslim children in divorced families. The sense of coherence reflecting an Islamic worldview provides the framework for understanding life and coping positively despite stressful conditions. Implications for social work practice with children in divorced families are discussed.

Malay Muslim Worldviews: Some Thoughts for Social Work Practice in Singapore

Singapore is a multicultural society with a population of about 5.1 million comprising mainly of people with Chinese, Malay, and Indian descent. This article focuses on a review of literature on the interface of religion and ethnic worldviews of the Malay-Muslim community in Singapore. In addition, it will utilize practice examples to show how these worldviews have implications for social work practice with the Malay-Muslim community particularly in the areas of health and family well-being. Help-seeking and the provision of help must acknowledge and use these worldviews as “strengths” in the delivery of social services. The article ends with an emphasis on the need for training in cultural competence for social workers in multicultural societies such as Singapore.

Exploring the experience of dignified palliative care in patients with advanced cancer and families: A feasibility study in Singapore

Abstract Dignity is an important concept in palliative care. Yet, the concept is ambiguous and there does not seem to be agreement on how care can be delivered that preserves dignity at the end of life. The aim of the study was to conduct a feasibility study to explore the experience of dignity in palliative care in Singapore. We conducted qualitative interviews with four patients with advanced cancer and their primary family caregiver from a local largest home hospice service. The preliminary findings showed that the experience of dignity in Singapore context consists of three factors, which reflected 12 themes. These are (1) social factor, which comprised of family, friends, relatives, and employers; (2) organizational factor, which comprised of the healthcare system, voluntary welfare organization, and private sector, and (3) spiritual factor, which was associated with existential values, cultural and religious belief systems of the patients, and their families. The preliminary findings suggest similarity to the Western findings: dignity can be preserved by holistic care that focuses on psychosocial, physical, and spiritual aspects. In addition, dignified patient care should encompass the knowledge and sensitivity to the multi-cultural and multi-ethnic practices and health beliefs of the patients and their families. In conclusion, the preliminary findings suggest that using systems perspective, it is feasible to conduct a study to develop an empirical model on dignified palliative care in the Singapore context.

Permanency Planning: Families of Children with Intellectual Disability

A qualitative study of 17 families with a child with intellectual disability in Singapore covering propensity towards permanency planning and systemic or individual factors that influenced the process are discussed. In a collectivistic society, the familial network is expected to assume long-term care of the child with disability at the disablement or demise of elderly parents. Several systemic and perceptual factors seemed to work against this ideal. Implications for supporting permanency planning at an early stage of the family life cycle are discussed.

Immigrant status and disparities in health care delivery in patients with myocardial infarction

BACKGROUND We investigated the differences in socioeconomic status and quality health care between Singapore-born citizens and immigrants presenting with ST-segment elevation myocardial infarction (STEMI). METHODS In a prospective study, patients admitted with STEMI were recruited for a questionnaire survey. The recruited patients were categorized based on their immigration status into Singapore-born citizens (SBC), foreign-born citizens (FBC), permanent residents (PR) and non-residents (NR). RESULTS Among the 374 recruited patients, 286 (76.5%) patients were categorized as SBC, and the remaining 88 (23.5%) as immigrants. Further breakdown of the immigrants revealed that 33 were FBC (median duration of living in Singapore, 53 years), 22 were PR (18 years), and 33 were NR (11 years). Significant differences in socioeconomic status among SBC, FBC, PR and NR were detected. NR were in the lowest, while PR in the highest, socioeconomic class based on occupation (p=0.003), education level (p<0.001), and average monthly household income (p=0.020). There were no disparities in the proportion of patients treated with primary PCI (SBC 88%, FBC 82%, PR 91%, NR 79%, p=0.555). Median door-to-balloon times were similar among the four groups (56, 52, 60, 56min, p=0.614). Compared with SBC, PR was associated with longer symptom-to-balloon times (median difference 54.1 min; 95% CI 9.0 to 99.2). CONCLUSION There were major differences in the socioeconomic status among SBC, FBC, PR and NR who presented with STEMI. Although there were no major disparities in access to high quality health care to these patients with different immigration status, symptom-to-balloon time differed substantially among the different migrant classes.

Towards a Cultural Accommodation Model for Effective Cross Counselling in Asia

This article uses the Cultural Accommodation Model developed by Leong and his colleagues as a theoretical framework for analysing different approaches to cross cultural counselling that has been described by the various articles in this special issue. Based on the tripartite model of the Universal, Group, and Individual dimensions to human personality and identity, the cultural accommodation model proposes that an integration of all three dimensions are essential for culturally relevant and culturally effective approaches to cross cultural counselling in Asia. In addition to describing the model, the authors also discussed some of the cultural issues raised by the various authors that need “accommodation” in order for effective cross cultural counselling to occur in these countries.

Mental Health Care: The Singapore Context

This article describes the remedial and preventive mental health care available in Singapore, with special emphasis on how world-views and other social-cultural factors influence the diagnosis and psychosocial treatment of the mentally ill. Certain behavioural concepts typical of the local population and significant in help-seeking therapy, especially in the area of family counselling and support, are included in the discussion on in-patient and community care. Effective delivery and usage of services are shown to be dependent on the ability to blend professional knowledge with the world-views and cultural expectations of the service-user.