‘TOUGH AS TSINELAS’: A MIXED METHODS STUDY ON THE MENTAL HEALTH EXPERIENCES AND STRENGTH OF FILIPINA MOTHERS DURING THE COVID-19 PANDEMIC

Significance: There are approximately 4 million Filipino/a/x Americans (FilAms) in the United States as of 2019, making them the third largest origin groups among Asian American communities after Chinese Americans and Indian Americans, and 56.6% of them identify as women (Pew Research Center, 2019; U.S. Census Bureau, 2019). FilAms are currently facing the dual pandemic of COVID-19 and violence due to racism (Litam, 2020), yet remain to be one of the most under-researched groups (Budiman et al., 2019). FilAms are disproportionately impacted by COVID-19 and are overrepresented in the health care industry, specifically in the nursing profession (Chan & Litam, 2021a). FilAms comprise about 4% of the nursing population in the United States (National Nurses United, 2020). The National Nurses United Report (2020) also states that 31.5% of deaths among registered nurses of color were FilAms during this pandemic. Further, the increase of violence and discrimination coupled with COVID-19 related stressors have a negative impact on the health and mental health of FilAms, including Filipina mothers. Approximately 30.0% of FilAm households have their own children under the age of 18 living with them (U.S. Census Bureau, 2019). FilAms are at higher risk for experiencing depression, anxiety, suicidal ideation, diabetes, high blood pressure, and cardiovascular disease (Misra et al., 2020). Mainstream research has documented the detrimental impact that COVID-19 has on the overall mental health of mothers (Almeida et al., 2020; Cameron et al., 2020; Davenport et al., 2020). Mothers report higher rates of depression and anxiety due to lack of childcare support, isolation, balancing working and parenting, and more (Chiurazzi et al., 2020a). There is increasing research on the effects of the pandemic on the mental health of mothers; however, there is little research specifically on the mental health of Filipina mothers.

Research Questions: This research study seeks to answer the following research questions: (1) what factors are associated with depression and anxiety among Filipina mothers? (2) how does a Filipina mother experience the COVID-19 pandemic and mental health?

Approach: An explanatory sequential mixed methods study was utilized to gain insight into the mental health experiences of FilAm mothers, as well as contribute to the knowledge base regarding COVID-19 among diverse populations. In this mixed method study, the quantitative phase informed the qualitative phenomenological phase. Thus, data were collected in two phases: (1) the primary quantitative phase which consists of a survey; and (2) the qualitative phenomenological phase that includes semi-structured interviews (see figure 1). Individuals were screened for eligibility for the survey and interview. Purposeful and convenience sampling methods were used to recruit participants who meet the following inclusion criteria: (1) Filipina or Filipina American; (2) 18 years and older; (3) identifies as a mother with child(ren) ages 15 years and younger; (4) resides in the United States. Two sampling recruitment strategies were used: (1) social network and (2) through organizations that work with FilAms. The survey responses provided information on their mental health status and factors that impacted their mental health during the pandemic, and the interviews will provide rich details to the experiences of Filipina mothers. Interviews were offered in English and were conducted virtually for safety due to COVID-19 and for gaining access to a geographical diverse group of FilAm mothers. Together, these two approaches provided a comprehensive picture of the experiences of Filipina mothers and their mental health during the COVID-19 pandemic, a community that has been understudied and under supported.

Implications: This explanatory sequential mixed methods study provided implications for four levels: (1) practice, (2) research, (3) policy, and (4) community building. Practice implications included providing culturally relevant mental health support for Filipina mothers. Research implications included the importance of using culturally embedded strategies that center the voices of community members, so they are part of the process in the creation of culturally grounded interventions and mental health supports. Policy implications included recommendations for policies that support disaggregation of data for Asian Americans, and policies such as a federally paid maternity leave in the United States. Implications for education included embodying cultural values, such as kapwa, to build connection within the learning community. Lastly, community building implications included creating spaces for support, encouragement, and resource exchange among Filipina mothers as a survival strategy to navigate challenging times.