African migrant men’s experiences and preferences for formal mental health help-seeking: meta-synthesis and recommendations

Figures & data

Figure 1. PRISMA 2020 flowchart.

Figure 2. Aggregated study quality assessment item ratings.

Table 1. Study and male participant characteristics.

Author (year), country	Study characteristics				Male participants			Total quality score
	Aim	Recruitment	Qualitative data collection	Qualitative data analysis	n (% of total N)	Mean age, years (SD)	Included countries of origin
Fauk et al. (2022), Australia	Explore personal, structural, sociocultural, and religious barriers to accessing mental health services among African migrants	African communities and migrant service organisations in South Australia were provided with study information	Individual interviews	Thematic analysis	10 (50%)	N/R for male participants	DRC, South Sudan, Ethiopia, Somalia	.85
Grupp et al. (2019), Germany	Understand help-seeking intentions and lay beliefs about cures for PTSD by asylum seekers from Sub-Saharan African countries living in Germany	Networked at cultural gatherings, and publicly approached potential participants; participants had participated in part 1 of the study and then consented to take part in a focus group	Focus groups (including 3 with participants from Somalia, 2 with participants from Cameroon)	Interpretative phenomenological analysis	24 (92%)	N/R for male participants	Somalia, Cameroon	.85
Lechner-Meichsner and Comtesse (2022), Germany	Identify illness beliefs and treatment expectations regarding prolonged grief disorder among Arab and sub-Saharan refugees	Convenience sample recruited via social media, word-of-mouth, and printed ads “in places frequented by refugees”	Individual semi-structured interviews	Qualitative content analysis	10 (44%)	N/R for male participants	Côte d’Ivoire, DRC, Ethiopia, Somalia	.90
Michlig et al. (2022), United States of America	Understand specific resistances to US mental health care contributing to the gap in which primary care is low among Somalis compared to other refugee groups	“Four gender-matched Somali facilitators recruited participants under the supervision of a Somali research team member”	Community forums (divided by gender) incorporating semi-structured focus groups (separate groups for youths, middle aged, and older participants)	“Critical discourse analysis”	84 (50%)	N/R	Somalia	.90
Mölsä et al. (2010), Finland	Examine how conceptions, expressions and treatment of mental distress are changing among Somalis living in Finland	“Participants were recruited with the help of two community activists”	Focus groups (2 with Somali seniors, divided by gender) and individual interviews (2 with Islamic healers)	Data translated from Somali/Finnish to English, and “organised thematically”	7 (35%)	N/R for male participants	Somalia	.80

DRC, Democratic Republic of Congo; N/R, not reported; SD, standard deviation

Table 2. Recommendations to facilitate formal mental health help-seeking by African migrant men.

Barrier(s)	Recommendation	Practical Implementation Guide
Stigma and discrimination related to mental illness	Improve mental health literacy in African migrant communities through access to culturally appropriate education and information	Co-design culturally sensitive, appropriate mental health literacy education programmes. Implement and/or bolster education programmes with current information on aeitology, symptoms and treatment options for psychological difficulties into African migrant communities in Australia. Leverage existing sources of information to communicate mental health knowledge, services, and access, e.g., communicating through the humanitarian off-shore programme or via employers of skilled migrants (Forshaw, 2011). Be mindful of the use of language and terminology that may be stigmatising, e.g., “mental illness”, and consider using less stigmatising language, e.g., “wellbeing” (Fauk et al., 2022).
Preferencing religious or traditional treatment over Western therapies	Improve the intergration of African migrant community members with mental health services	Develop collaborations between African migrant community leaders and religious healers (e.g., priests) with Australian mental health professionals to co-design and communicate culturally appropriate services. Consider opportunities to train community members as mental health care providers or lived experience advocates.
Uncertainty about mental health clinicians’ cultural competency and understanding	Mental health professionals to collaborate with community leaders and religious healers to develop trust alongside culturally appropriate services and understanding	Collaboration might build on previous programmes (e.g., the Beyond Blue’s NewAccess and NewRoots in Australia), and be facilitated and promoted through professional psychological and medical organisations. Build education on the impact of African cultural beliefs on mental health help-seeking into university curricula and continuous professional development schemes.
Structural barriers such as location, distance, and cost	Improve accessibility of services for African migrant men through free and anonymous digital mental health tools, telehealth, and location of mental health services	Researchers, mental health organisations, multicultural service providers, and African migrant men should co-design culturally appropriate digital mental health services. Availability of mental health assistance via telehealth should be promoted, where available, to African migrant communities. Increase accessibility of clinics through location near African migrant communities and/or provide African migrant men with education on accessing clinics via public transport.

Fauk, N. K., Ziersch, A., Gesesew, H., Ward, P. R., & Mwanri, L. (2022). Strategies to improve access to mental health services: Perspectives of African migrants and service providers in South Australia. SSM - Mental Health, 2, 100058. https://doi.org/10.1016/j.ssmmh.2021.100058

 Google Scholar

Grupp, F., Moro, M. R., Nater, U. M., Skandrani, S., & Mewes, R. (2019). ‘Only god can promise healing’: Help-seeking intentions and lay beliefs about cures for post-traumatic stress disorder among Sub-Saharan African asylum seekers in Germany. European Journal of Psychotraumatology, 10(1), 1684225. https://doi.org/10.1080/20008198.2019.1684225

 PubMed Web of Science ®Google Scholar

Lechner-Meichsner, F., & Comtesse, H. (2022). Beliefs about causes and cures of prolonged grief disorder among Arab and Sub-Saharan African refugees. Frontiers in Psychiatry, 13, 13. https://doi.org/10.3389/fpsyt.2022.852714

 Web of Science ®Google Scholar

Michlig, G. J., Johnson-Agbakwu, C., & Surkan, P. J. (2022). “Whatever you hide, also hides you”: A discourse analysis on mental health and service use in an American community of somalis. Social Science and Medicine, 292, 114563. https://doi.org/10.1016/j.socscimed.2021.114563

 PubMed Web of Science ®Google Scholar

Mölsä, M. E., Hjelde, K. H., & Tiilikainen, M. (2010). Changing conceptions of mental distress among Somalis in Finland. Transcultural Psychiatry, 47(2), 276–300. https://doi.org/10.1177/1363461510368914

 PubMed Web of Science ®Google Scholar

Forshaw, M. (2011). Inquiry into Australia’s relationship with the countries of Africa. Joint Standing Committee on Foreign Affairs, Defence and Trade. http://www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_Committees?url=jfadt/africa%2009/report.htm

 Google Scholar

Data availability statement

Data sharing is not applicable as no new data were created or analysed in this study.