Challenges to Cross-Cultural Research

Chapter 2

The Concept of Posttraumatic Growth in an Adult Sample from Port-au-Prince, Haiti

A Mixed-Methods Study | Grant J. Rich, Skultip (Jill) Sirikantraporn, and Wismick Jean-Charles

In recent years, resilience has been examined more frequently in cross-cultural contexts in order to better capture the nuances of the recovery/thriving process after trauma as it varies around the globe. This chapter focuses upon posttraumatic growth (PTG) in a sample of adult Haitians from Port-au-Prince, Haiti’s largest city and capital, and the site of its devastating 2010 earthquake.

A BRIEF HISTORY OF TRAUMA IN HAITI

Haiti is a Caribbean nation that is located in the Greater Antilles archipelago, where it occupies the western quarter of the island of Hispaniola (the eastern portion of the island is the Dominican Republic). It population is estimated at between 10 and 11 million, and thus it is the second most populous nation in the Caribbean (Dash, 2010). Today, French is spoken, though Haitian Kreyòl predominates, and the population is 95 percent white and 5 percent white or mixed (Haiti, 2017). Its Gini index indicates extremely high economic inequality between the wealthy and the poor, and it ranks very low on the UN Human Development Index, a composite measure of life expectancy, education, and per capita income, ranking 163rd out of 188 nations in 2016 (list of countries by Human Development Index, 2017).

Haiti has a diverse history. The region was originally inhabited by the indigenous people, the Taínos. Christopher Columbus landed there on his first voyage in 1492, near the present-day cities of Limonade and Cap Haitian. The Spanish brought infectious diseases, creating small pox epidemics, and maltreatment of the natives included the forced labor encomienda system and forced conversions to Catholicism. The native population was decimated over time and piracy flourished. After Spanish rule from 1492 to 1625, French rule dominated, and the western part of the island was renamed Saint Domingue (the 1697 Treat of Ryswick formally ended the French-Spanish hostilities). The French imported and enslaved thousands of Africans, transporting them to Saint Domingue to work in the sugarcane and coffee plantations. The colonial whites became vastly outnumbered by the enslaved Africans, and other additional social groups emerged, such as free blacks and free coloreds (Dubois, 2004; Geggus, 2014; Girard, 2010; James, 1963).

Eventually, free coloreds, as well as enslaved and free blacks, agitated for rights and freedom. In the 1790s, revolts such as that led by Ogé and Chavannes paved the way for the Haitian Revolution, which was led by Toussaint L’Ouverture, a former slave (and notably slave owner himself), and was in part inspired by the 1789 French Revolution. The Haitian Revolution resulted in the end of slavery and the defeat of Napolean Bonaparte’s army. Thus, in 1804 Haiti became not solely the only nation in the world that was created as a result of a successful slave revolt (in 1804), it also became the first independent country in Latin America and the Caribbean, and the second republic in the Americas (Dubois, 2004; Geggus, 2014; Girard, 2010; James, 1963).

Unfortunately, the ensuing decades were tumultuous ones politically, socially, and economically for Haiti, with many leadership transitions, including an almost 20-year-long occupation by the United States and its forces from

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1915 to 1934. Soon after arrival, the US Marines took control of Port-au-Prince and the banks, declared martial law, and censored journalists (Dash, 2010; Dubois, 2004, 2013; Farmer, 2005; Girard, 2010). During the Duvalier dynasty (1957–1986), severe abuses and corruption continued under both Papa and Baby Doc Duvalier, as evidenced by the rulers’ use of the Tontons Macoutes group, which kept order by terrorizing the general public, especially political opponents. Political instability continued, with coups d’etat in 1991 and 2004 especially notable. The most significant event of the past decade was the magnitude 7.0 earthquake that struck Haiti on January 10, 2010. Estimates of the death toll ranged from 100,000 to over 200,000. Over 1.6 million were left homeless, and infrastructure was decimated, especially in Port-au-Prince, the national capital and largest city. The aftermath of the earthquake included a large cholera outbreak, adding to and prolonging the devastation. Haiti was the poorest nation in the Western hemisphere before the earthquake, and its institutions and recovery were further destroyed by the earthquake. Humanitarian aid from foreign governmental and nongovernmental groups was not always received, was not received in timely fashion, or was distributed in corrupt fashion, causing further problems for Haitians (Dubois, 2013; Farmer, 2011; Katz, 2013). Indeed, Haiti often ranks among the most corrupt countries in the world on the Corruption Perceptions Index, and crime, especially in Port-au-Prince, is a continuing concern, especially in areas such as Cité Soleil (e.g., Schwartz, 2010). Poverty is often associated with social problems, and indeed in Haiti, there is a notable challenge of modern-day slavery (known as restavec), in which poor, vulnerable children are sent to live and work with an adult, sometimes a distant relative, in what amounts in many cases to brutal servitude (Cadet, 1998; Haiti, 2017).

In October 2016, Hurricane Matthew struck Haiti as a Category 4 storm. Death toll estimates ranged from the official figure of 546 to over 1,000 and damage estimates approached US$2 billion, with approximately 175,1000 left homeless (Hurricane Matthew, 2017). Much of the worst of the hurricane was in southern Haiti, though gusts of 60 MPH reached Port-au-Prince. Data collection for the present chapter was conducted in Port-au-Prince, Haiti, approximately one month later in November 2016.

METHOD

Participants

For the quantitative portion of this study, there were 113 participants. They were sampled from Port-au-Prince, Haiti’s largest city, and the site of the 2010 earthquake. Table 2.1 revealed the descriptive results of the demographic variables. The demographic questionnaire revealed that the mean age of the participants was 26.56 (SD= 5.60, min-max= 19–48). The sex ratio of the participants was relatively equal with 46.9 percent female and 52.2 percent male. For marital status, 83.8 percent identified as single and 6.3 percent reported being married. About 55.1 percent reported having a four-year college education and 17.8 percent a master’s degree; 40.4 percent reported moderate income and 50.5 percent low to very low income; and 80.9 percent self-identified as Christian. One Hundred percent of the sample reported having experienced at least 3 types (out of 17) of traumatic events with 50.8 percent reporting at least 11 traumatic events.

Table 2.1 Descriptive Characteristics of the Sample (N=113)

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Variables Number (%) Mean Range

Age 26.56 19- 48 Gender

Female 53 (46.9) Male 59 (52.2)

Marital Status Single 93 (83.8) Married 7 (6.3) Divorced 1 (.9) Decline to answer 9 (8.1)

Income Very high 2 (1.8) High 8 (7.3) Moderate 44 (40.4) Low 38 (34.9) Very low 1 7 ('I 5.6)

Education High school 3 (2.8) Two-year college 21 (18 .6) Four-year college 59 (55.1) Master's 19 (17.8) Advanced degree 2 ('I. 9) Dec line to answer 3 (2.8)

Employment Employed for wages 14 (12.7) Self-employed 2 (1.8) Out of work for more than one year 5 (4.5) O ut of work for less than one year 4 (3.6) Student 84 (76.4)

Religion Christianity 89 (80.9) O ther (but did not specify) 14 ('12.7) Decline to answer 7 9 (6.40)

Life Event Total 11 3-1 7 Frequency

3- 5 events 3 (6.1) 6-10 events 28 (43.2) 11-13 events 20 (30.8) 14-1 7 events 13 (20)

Type of event Natural Disaster 81 (95.3) Fire or Explosion 61 (65.6) Transportation Accident 67 (71.3) Serious accident at work, home 51 (54.3) Exposure to toxic substance 40 (43.5) Physical assaul t 62 (64.6) Assault w ith a weapon 54 (58.8) Sexual assault 42 (44.2)

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In part 2 of the study, that is, the in-depth interview, 11 out of 113 total participants participated. All participants were female.

Measures

A total of 113 participants were administered a survey consisting of six questionnaires: a demographic form, the life events checklist (LEC), the PTG inventory (PTGI) scale, the Adult Resilience Measure (ARM), the Meaning in Life Questionnaire (MLQ), and the Satisfaction with Life Scale (SWLS).

Life Events Checklist The LEC scale is a self-report measure of participants’ lifelong exposure to traumatic events according to the posttraumatic stress disorder (PTSD) criterion A diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5. Subjects are given a list of 17 traumatic stressors to choose whether the trauma happened to them, they witnessed it, they learned about it, or it was part of their job, or else they indicate they are not sure, or that the question doesn’t apply (Gray, Litz, Sue, & Lombardo, 2004).

Posttraumatic Growth Inventory Scale The PTGI scale is a 21-item Likert scale measuring participants’ degree of PTG according to Tedeschi and Calhoun (1996) in the following five subscales: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life. Each subscale consists of possible responses from a Likert scale of 1–6 (1= I did not experience this change as a result of my crisis; 6= I experienced this change to a very great degree as a result of my crisis).

The PTGI scale has been shown to have satisfactory internal consistency among the total and subscales scores and test-retest reliability (Taku, Cann, Calhoun, & Tedeschi, 2008). Studies have examined the cross-cultural validity of the PTGI scale and whether the items are more influenced by personality or culture. A study by Taku and Oshio (2015) assessed whether the items in the subscale truly measured PTG variables, using a Japanese sample. The results showed that PTG measured by the scale is more likely to occur when core beliefs are challenged, and few occur without cognitive effort. Thus, the significant personality factor in PTG measured by the PTGI scale shows that it is likely a largely universal phenomenon, or at least one present in multiple cultures. Additional cross- cultural studies have suggested that differences in the degree of PTG dimensions are culturally influenced (Cormio, Romitto, Giotta, & Mattioli, 2015; Ho, Law, Wang, Shih, Hsu, & Hou, 2013).

Adult Resilience Measure-28 The ARM is a 28-item Likert scale that was adapted from the Child and Youth Resilience Measure-28 (CYRM-28; Ungar & Liebenberg, 2011), one of the most culturally sensitive resilience measures (Windle, Bennett, & Noyes, 2011). The measure was derived from data collected in 12 different countries over 3 different continents. The ARM­

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28 has three subscales (individual, relational, and contextual resilience). Reliability analyses were conducted, which demonstrated that the CYRM-28 and its subscales were internally consistent (Leibenberg, Ungar, & Van de Vijver, 2012).

Meaning in Life Questionnaire The MLQ is a ten-item scale rated on a seven-point scale from “Absolutely True” to “Absolutely Untrue” on the person’s perception of meaning in life. There are two subscales: the presence of meaning subscale, measuring how full individuals feel their lives are of meaning (Steger, Frazier, Oishi, & Kaler, 2006), and the search for meaning subscale, measuring how motivated individuals are in finding meaning in their lives. The MLQ has good reliability (presence: α= .82, and search: α= .87), test-retest stability, and good fit factor structure (Steger, Frazier, Oishi, & Kaler, 2006).

Satisfaction with Life Scale The SWLS is a five-item scale measuring cognitive judgments of one’s life satisfaction (Diener, Emmons, Larsen, & Griffin, 1985). Respondents answer how much they agree or disagree with each of the five items, using a seven- point scale that ranges from 7 = strongly agree to 1 = strongly disagree. A meta-analysis study found that 62 articles that investigated the reliability of the SWLS in different populations found an average of .76 reliability coefficients (Vassar, 2007).

Semi-structured Interview Guide An interview guide included 20 open-ended questions in French and aimed to explore in-depth experiences and understanding of the concept of PTG. The questions were based on recent research and clinical literature on PTG and on cultural literature on the Haitian culture and society (Cadet, 1998; Dash, 2010; Dubois, 2013; Girard, 2010). Participants could answer the interview questions in French or in Haitian Kreyòl.

DATA ANALYSES

Quantitative Data

Descriptive statistics were used for frequency findings on the demographic variables, LEC, PTGI, ARM, MLQ, and SWLS. Reliability analyses were utilized to test each measure’s internal reliability (Cronbach alpha’s; see Table 2.2 for the reliability results). T-test analyses were used to examine whether there were any mean differences of LEC, PTGI, ARM, MLQ, and SWLS among different demographic groups. Pearson correlation analyses were used to analyze correlations between the study main variables. A multiple linear regression model was used to examine the effects of independent variables (demographic variables, PTGI, MLQ, SWLS) on the dependent variable (ARM subscales). All significant results were set at p value < .05.

Table 2.2 Reliability Analyses Results

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Qualitative Data

The Grounded Theory was used to generate an emergent theory through the discovery of themes (Glaser & Strauss, 1967) from a purposively recruited group of people who have experienced the same phenomenon, which is the 2010 Earthquake. Maximum variable sampling (Maykut & Morehouse, 1994) was attempted by recruiting from all adult age groups and socioeconomic status. The sample size was determined by the concurrent process of data collection and coding procedures until the saturation point was met, the point at which no new themes were forthcoming (Maykyt & Mayhouse, 1994). Constant comparative analysis through three stages of coding (open coding, axial coding, and selective coding) was used to discover emerging themes and an overarching theory (see Glaser & Strauss, 1967). There were several strategies utilized to increase trustworthiness of the study findings. First, peer scrutiny of the research project was used where three coders independently coded the data and compared emerging categories and themes until the final version of categories and themes were agreed upon. Second, an audit trail and journaling among researchers was utilized to increase researchers’ reflexivity and progressive subjectivity (Lincoln & Guba, 1985) to minimize the intrusive influence of the researchers’ own biases on the research procedures and findings.

RESULTS AND DISCUSSION

Quantitative Results

Reliability Analysis Results A total of 113 Haitians participated in the study by completing six questionnaires. The reliability analysis (Cronbach’s alpha) was utilized to examine internal reliability of PTGI, ARM, MLQ, and SWLS with p value < .05. The results showed acceptable to great reliability for PTGI subscales (except for spiritual change) as follows: relating to others (α = .81), new possibilities (α = .72), appreciation of life (α = .74), personal strength (α = .72), total PTG (α = .93), and spiritual change (α = .49). The results showed good reliability for ARM subscales as follows: individual (α = .74), relational (α = .76), contextual (α = .70), and total resilience (α = .85). The results

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showed acceptable reliability for MLQ subscales as follows: presence of meaning in life (α = .70) and search for meaning (α = .76). Lastly, the results showed acceptable reliability for SWLS (α = .77).

Table 2.3 revealed the descriptive results of each main variable of the study and correlation matrix of the main variables.

Table 2.3 Intercorrelation Matrix of PTGI, MLQ, ARM, and SWLS (N=113)

Bivariate Correlation Results As shown in Table 2.3, Pearson correlation analyses showed the relationship between PTGI and other main variables as follows: (1) PTGI-relating to others was significantly related in the positive direction to all subscales of ARM, the presence of meaning subscale of MLQ, and SWLS; (2) PTGI-new possibilities was significantly related in the positive direction to all subscales of ARM (except for relational resilience), the presence of meaning subscale of MLQ, and SWLS; (3) PTGI-personal strengths was significantly related in the positive direction to individual resilience and contextual resilience, the presence of meaning subscale of MLQ, and SWLS; (4) PTGI-appreciation of life was significantly related in the positive direction to the presence of meaning subscale of MLQ and SWLS; and (5) PTGI-total was significantly related in the positive direction to all subscales of ARM (except for relational resilience), the presence of meaning subscale of MLQ, and SWLS. Lastly, PTGI-spiritual change was found to be significantly related in the positive direction to SWLS only.

Pearson correlation analyses showed the relationship between MLQ and other main variables as follows: (1) the presence of meaning subscale was significantly related in the positive direction to all subscales of ARM, all subscales of PTGI, and SWLS; (2) the search for meaning subscale was found to not be significantly related to any other variables.

Pearson correlation analyses showed the relationship between SWLS and other main variables as follows: (1) total life satisfaction was significantly related in the positive direction to all subscales of ARM; (2) total life satisfaction was significantly related in the positive direction to all subscales of PTGI; (3) total life satisfaction was significantly related in the positive direction to the presence of meaning subscale of MLQ but not the search for meaning subscale of MLQ.

Multiple Linear Regression Results To clarify the relationship between PTG construct and resilience construct, a multiple linear regression was calculated to predict the effects of PTGI subscales and other main variables (MLQ and SWLS) on resilience (ARM)

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subscales. A significant regression equation was found for individual resilience (F(8,56) = 7.226, p < .000), with R2

of .508. Participants’ predicted individual resilience is equal to 28.40 (B) + 1.004 (PTGI-total) + 1.239 (PTGI­ relating to others) + 1.811 (PTGI-new possibilities) +1.224 (PTGI-personal strength) + .264 (presence of meaning).

A significant regression equation was found for relational resilience (F(8,52) = 2.484, p < .023), with R2 of .276. Participants’ predicted relational resilience is equal to 23.304 (B) + 1.194 (PTGI-new possibilities) + 2.75 (presence of meaning).

Qualitative Results

Eleven (all female) participants who completed the quantitative part volunteered to participate in the in-depth interview for qualitative analysis. There are five emergent categories (appreciation of life, personal strength, change in interpersonal relations, the role of religion in trauma recovery, perceived happiness) and eight themes.

This section presents exemplary quotations that capture the major categories found, together with their major themes (at least 60 percent of participant endorsement); discusses the themes of PTG that emerged from the data by the Grounded Theory method; and compares these themes with previous literature on Tedeschi and Calhoun’s model of PTG. Five categories and ten themes emerged from the data (see Figure 2.1).

Figure 2.1 Grounded Theory for Posttraumatic Growth Model in the Haitian Sample (N=11).

Category 1: Appreciation of Life

This category depicted themes that are related to the participants’ endorsement of the sense of appreciation of life. This category is closely aligned with appreciation of life, one of the main domains in the original PTG model by Tedeschi and Calhoun (1996). There are two prominent themes in this category.

Theme 1: “Do not Take Life for Granted” Ten of 11 participants (90 percent) mentioned statements that they learned to not take life for granted after having experienced life trauma. Quotes from participants to illustrate this theme include:

What gives you hope: Because I was alive, and there were other people who did not have that chance. (P#3)

The fact that I’m living and I’m not sick. I wake up everyday, I come here and I can see my friends. (P#6)

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I see that life is short so we have to make our mark during our time here because like fire, it goes by fast. (P#7)

I always hear other says life is short, and it can be gone in one instant (very quickly). (P#9)

Theme 2: Living Life in the Moment to the Fullest Nine of 11 participants (81 percent) also stated that they learned to live life in the moment and accept all the good and the bad that it presents. Quotes from participants to illustrate this theme include:

To take advantage of the present moment because we do not know when we’re going to die, or when we will perish somewhere in the world or at least when life will end on earth, we do not know, so we must take advantage of the experience, the present moment to enjoy life fully. (P#1)

You come to realize that everything is temporary, just live the present moment….It’s like enjoying every moment whether it was good or bad because it’s all of the little things together which makes life. (P#9)

We should…as long as we’re living, we should live life to the fullest and realize that we’re alive and after this trauma that we have experienced. Try to live as much as we can. (P#4)

It is to celebrate the present moment. (P#10)

Category 2: The Role of Religion in Trauma Recovery

This category is closely related to spiritual change domain in the Tedeschi and Calhoun’s model (1996). This category captures themes that participants mentioned how religion has helped them cope with trauma and crisis in life. There are two themes in this category.

Theme 1: Recovery through God and Prayers Eleven of 11 participants (100 percent) endorsed that they have recovered from life crisis through God, their connection with God, or prayers. Quotes from participants to illustrate this theme include:

Sometimes I don’t even want to live, I even thought of killing myself sometimes, but my God helps me stay hopeful. (P#4)

Religion…yes, it’s true after a traumatic event I lean more toward prayer. (P#5)

I always referred to the Bible, I’m always…the people who often support me are the priests, so I can say religion influenced [my recovery]. (P#6)

Spirituality because I truly believe in God. When I know that I am really traumatized and I pray often. (P#7)

Theme 2: Knowing that “I am not alone” with Support from Church Seven out of 11 participants (63 percent) mentioned that the reason that regularly going to church helped them cope with life problems is because they got to learn about other people’s struggles, which helped them know that they were not alone in their struggles and life hardship. Quotes from participants to illustrate this theme include:

I’m also a choir member. Although there are difficulties in life that does not mean that you are the only one who’s going through it. (P#4)

I pray often, I go to church, I sing and because I sing and pray so I forget what has just happened, and get out of myself. And I see that I’m not the only one who is in this situation and that there are other people who has been through it as well. (P#7)

Category 3: Perceived Happiness

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As part of trauma recovery, the concept of happiness was tapped into, and two different themes with regards to perceived happiness were identified.

Theme 1: Peace and Freedom to Enjoy Life Ten out of 11 participants (90 percent) stated that happiness to them means “being free,” “being at peace with oneself,” and/or “having the freedom to enjoy life.” Quotes from participants to illustrate this theme include:

I believe that happiness is being free to take life as it is without resigning oneself of the bad thing of life or at least, the traumatic experience, to learn to be guided by the good thing of life without worrying about the problems that happen to us every day. (P#1)

You’re free with your choices, your actions, and to be the person that you want to be, to have good friends and family. (P#3)

Happiness is when I am at peace with myself. (P#4)

You are happy when you’re feeling good and at peace in your place. (P#11)

Theme 2: Money is Necessary for People when they do not have Enough While none of the participants endorsed money as their own source of happiness, 10 out 11 participants (90 percent) believed that money is a source of happiness for other Haitians. Quotes from participants to illustrate this theme include:

¾ of Haitians would say they want to have money because we do not have enough. (P#3)

Money is more important for Haitians because we live in a society that is poor I can say that money will always be more important to them. (P#8)

I will not speak in general; I will speak about my friends who are Haitians. They think that having a lot of money is what can make them happy. (P#10)

Category 4: Personal Strength

This category depicts the themes in relation to the recognition of their personal assets in overcoming trauma in life.

Theme 1: Self-acceptance and the Ability to Move Forward Eight out of 11 participants (72 percent) endorsed the idea that accepting one’s self and one’s ability to move forward helped them cope with the tragic incident. Quotes from participants to illustrate this theme include:

It is to overcome…I mean to surpass what has happened and use it as a lesson, yes that’s it. (P11)

Then you learn to accept yourself for who you are after these things, I think. (P3)

It’s accepting that you have been through what happened. Try to live with it day by day until the pain is completely gone. (P#4)

Accept that it when something bad happened to you then you learn from the traumatic experience, it helped you to blossom personally. (P#8)

Theme 2: Strength to Overcome Nine out of 11 participants (81 percent) reported that they saw their own inner strength as a way to get through trauma. Quotes from participants to illustrate this theme include:

I learned that that I was stronger than I thought. (P#3)

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I think I was a child also whom could not face a series of traumatic events but after I become stronger when going through traumatic events. (P#5)

I always believe in my strength….I learned that I am someone who is strong of character after I’m traumatized (P#6)

I simply told myself I have been through this already so I can overcome other obstacles and there is no need to be afraid. (P#7)

Category 5: Change in Interpersonal Relations

This category captured the ways in which the participants’ relationships with others have changed after trauma. Two themes emerged in this category.

Theme 1: Increased Desire to Help People who are in Need Eight out of 11 participants (72 percent) stated that they have an increased desire to help people in need. Quotes from participants to illustrate this theme include:

I take time to help others who are weaker than me. (P#7)

I now concentrate more in my studies and said to myself that I will be a future psychologist, I would like to be more present for the people who surround me and need my help. (P#4)

I now dedicate my life to help others. It helps and comforts me. (P#11)

Theme 2: Be Kinder to People in Life Eight out of 11 participants (72 percent) mentioned the change in their approach when it comes to their existing and new relationships. More specifically, the participants want to be kinder to their family and close friends and “treat them right,” but when it comes to new relationships, many of them responded that they are being less open and more discriminative about who they can trust. Quotes from participants to illustrate this theme include:

I have learned to respect people, to love people, and to treat people as they should be treated. One must also learn to honor people, learn how to tell people how wonderful they, how important they are in our lives since we do not know exactly when that person may leave the world. (P#1)

I think that this person if I approached him/her, I would speak to him/her more gently, and not rush him because the earthquake really marked the Haitian people. They (my family) did their best to be there for me as much as possible also. (P#4)

It is to spend time with my family and the people I love. They mean a lot to me. (P#11)

CONCLUSION

Haiti has suffered much trauma in its history. In addition to the legacy of colonialism and slavery, occupation by foreign powers, and, in recent decades, frequent political turmoil and corruption, Haiti has suffered tragic natural disasters. Most significantly, the 2010 earthquake led to deaths estimated between 100,000 to over 200,000 persons, leaving 1.6 million homeless and decimating much infrastructure. In 2016, shortly before data collection for the present study, Hurricane Matthew struck Haiti, leading to deaths estimated from over 500 to over 1,000, leaving approximately 175,000 homeless, with damages estimated at nearly US$2 billion.

Studies from several disciplines have shown that the trauma exposure has taken a societal and psychological toll on Haitians (Cadet, 1998; Dubois; 2013; Farmer 2013; Girard, 2010; Katz, 2013; Nicolas, 2013; Schwartz, 2010). Internationally, outside of Haiti, the PTG literature has revealed promising results related to the positive changes that may result from the struggle to cope with trauma, enhancing scholars’ and practitioners’ understanding of the effects of trauma on individuals (Calhoun & Tedeschi, 2006, 2013; Joseph & Linley, 2008; Theron, Liebenberg, &

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Ungar, 2015; Weiss & Berger, 2010). This study was one of the first attempts aiming to understand the concept of PTG from local Haitians in Port-au-Prince, all of whom were affected by the 2010 earthquake. Quantitative results indicate correlations between various PTGI subscales and various subscales of the ARM and the MLQ. Additionally, total life satisfaction (SWLS) was significantly correlated with all subscales of both the PTGI and the ARM. The study found that PTGI (except for the spiritual change subscale) may be a culturally appropriate measure to assess PTG. The Grounded Theory analysis of the qualitative data revealed five prominent categories and ten themes that are essential for the experience of PTG in the Haitian sample. Qualitative results suggest growth components including gratitude and appreciation for life, increased role of religion, a changed sense of perceived happiness and role of money, increased personal growth and personal strength, and enriched connections with others. In sum, these results carry significance for clinical application development.

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