Problems in cross‐cultural psychogeriatric research: contacting older Turkish immigrants in the UK

The need for research on the mental health needs of ethnic minorities remains a priority, particularly when there are cultural and linguistic barriers to delivery and uptake of relevant services. Compiling adequate sampling frames within ethnic minority communities for medical research is feasible in the UK (Chatervedi et al., 1993; McCracken et al., 1997; Richards et al., 1996; Richards and Brayne, 1996). However, success rates for recruitment into research projects may depend on the particular ethnicity. We report a series of diculties in contacting and recruiting older Turkish and Turkish Cypriot residents for research into depression, the principal investigator of which (TE) was a native Turkish psychiatrist. Our initial strategy was to approach social clubs for older Turkish community residents in the inner London area. Group meetings in two such clubs were arranged but no members expressed any interest in the study, and only one volunteer (one of the social club leaders) was recruited in this way. We then decided to approach Turkish people within north London health services. The manager of the Health Advocacy Services for the Turkish and Kurdish Speaking Community directed us to four GP practices in north London, and we selected a further ®ve practices in south London, based on proximity to appropriate communities. All nine practices provided a patient list. Since information on ethnicity and nationality was not coded on these lists, Turkish-speaking patients were identi®ed on the basis of name. One hundred and ninety-six subjects were identi®ed in this way. Brief letters, signed by TE and the GP, outlining the study and requesting participation, were sent to each of these patients. Forty-eight patients (24% of the total practice list sample) agreed to participate, of whom 13 were Turkish and 35 were Turkish Cypriot. These subjects provided demographic information and completed the Hamilton Depression Rating Scale (HDRS) and the Center for Epidemiological Studies Depression Scale (CES-D). Thus, strategies to recruit Turkish-speaking volunteers to a mental health-related research project resulted in only a small number of volunteers. Furthermore, since we did not have access to information on residents who refused participation, it was impossible to determine the degree to which these volunteers were representative of their communities. Based on comments from potential volunteers in this community, there are several possible reasons for such low complicity. First, the fact that the principal investigator of this study was of similar ethnicity to the target sample was clearly no guarantee of complicity. Some volunteers were pleased to be visited by a Doctor from Turkey, the country some Northern Turkish Cypriots refer to as the motherland. On the other hand, other volunteers had political reservations, based on the war in 1974. A second possible reason for non-compliance was lack of familiarity with the nature of psychiatry. Some volunteers emphasized that psychiatry is associated with `abnormal or mad people', and to be seen by a psychiatrist or `a doctor of mads' is a cause of social inferiority. Similar observations were also made to TE during recent contact with residents in Northern Cyprus. Third, although con®dentiality was carefully explained, some volunteers repetitively asked how we would use their data, re ̄ecting suspicion that it could be used by the state for non-research purposes. Consistent with this, none of the volunteers wished to sign a consent form, preferring to give verbal agreement only. It should also be noted that the participation of community leaders in recruitment was not of any help in the present case, as it has been in other communities (Abas et al., 1996). Nor was fact that letters were sent out signed by the GP, something which has previously been shown to aid recruitment to medical research (Smith et al., 1985).