Introduction: African American (AA) high school-age girls are more likely to have had sex before age 13 years and have higher rates of all sexually transmitted infections. Cognition and religion/spirituality are associated with adolescent sexuality, therefore, the purpose of this study was to identify cognitive and religious substrates of AA girls’ risky sexual behaviors. Method: A descriptive study was conducted with 65 AA girls aged 15 to 20 years using computerized questionnaires and cognitive function tasks. Results: Average age was 17.8 ± 1.9 years and average sexual initiation age was 15.5 ± 2.6 years. Overall, 57.6% reported a history of vaginal sex. Girls who reported low/moderate religious importance were significantly younger at vaginal sex initiation than girls for whom religion was very/extremely important. Girls who attended church infrequently reported significantly more sexual partners. Implications: Health care providers can use these findings to deliver culturally congruent health care by assessing and addressing these psychosocial factors in this population.
Purpose: To improve health and reduce health disparities, research partnerships with American Indian and Alaska Native communities should build on existing traditions and strengths. The overall goal of this pilot project was to clarify the needs of tribal community members and determine strengths and resources available to the community. Design: Community-based participatory research was the approach used to obtain community input. Data collection methods included, Photovoice (n = 16), digital storytelling (n = 4), and community capacity surveys (n = 128). Results: Quantitative and qualitative findings supported the need to (1) address youth suicide and substance abuse on the reservation and (2) use preexisting resources available in the community. The results led to the development of a strengths-based intervention incorporating the Gathering of Native American’s curriculum. Conclusion: Integral to the development, implementation, and sustainability of the intervention was the truly reciprocal relationship developed between community and university partners.
Purpose: This exploratory qualitative study examines Chinese adolescents’ health information sharing habits on social network sites. Method: Ten focus group meetings with 76 adolescents, ages 12 to 17 years, were conducted at community-based organizations in Chicago’s Chinatown. The research team transcribed the recording and analyzed the transcripts using ATLAS.ti. Results: Chinese adolescents are using different social network sites for various topics of health information including food, physical activity, and so on. Adolescents would share useful and/or interesting health information. Many adolescents raised credibility concerns regarding health information and suggested evaluating the information based on self-experience or intuition, word-of-mouth, or information online. Conclusion: The findings shed lights on future intervention using social network sites to promote health among Chinese adolescents in the United States. Implications for Practice: Future interventions should provide adolescents with interesting and culturally sensitive health information and educate them to critically evaluate health information on social network sites.
Purpose: To explore the range of teaching approaches and cultural-tailoring elements used in diabetes educations directed at Chinese patients and to determine the strategies that appeared to best address Chinese patients’ needs. Design: A case study approach in three countries was employed, using multiple ethnographic data collection methods including participant observations and qualitative interviews. Findings: Data were collected from 39 participant observations and 22 interviews across seven cases. Collective didactic education was most common. Individual clarification at the end of an education session was used to allow patients to derive their own management plan. Clinicians mainly provided information and used knowledge reinforcement to facilitate behavioral change. Participatory diabetes education models borrowed from the West did not translate well culturally and did not appear to meet Chinese patients’ needs. Conclusion and Practical Implications: Diabetes education for the Chinese may be enhanced by building on traditional Confucian education strategies.
Purpose: The aim of the study was to examine, from an intersectional perspective, how immigrant women with prolonged illness experience the conditions for physical activity. Method: Focus groups were used. Twenty-two women from primary care representing 14 countries were included. Systematic text condensation was applied for analysis. Results: Five conditions were identified: Dual cultures to relate to, Isolation an invisible danger, Keys to physical activity, Physical activity for whom, The power to decide the agenda. Discussion and Conclusion: This study shows the importance of raising the intersectional perspective for immigrant women’s possibilities to perform physical activity. Immigrant women’s vulnerability to power relations and their adjustment to society’s expectations are significant considerations to be aware of. Implications for Practice: Our findings emphasize the significance of collaborating in biomedical and psychosocial issues, considering that the obstacles are more comprehensive than society assumes regarding prior knowledge, isolation, and cultural rules.
Purpose: Nursing remains a female-dominated profession around the world. The masculinity and male identity of men who choose nursing careers is questioned by the general public in many countries. Few studies report the situation of novice male nurses at their first year. The purpose of this study was to explore the lived experience of novice male nurses when they first enter the workplace. Design and Method: A qualitative descriptive study was conducted using purposive and snowball sampling for recruitment. Fourteen participants, 21 to 25 years old, were recruited, all of whom had at least 5 months of work experience. On average, in-depth, face-to-face interviews lasted 1 hour, with more than one follow-up telephone interview per participant. Findings: The following six themes emerged from the transcribed verbatim data based on content analysis: choosing appropriate work departments based on personality and needs, facing the pressure and frustration of independent work, getting help, obtaining acceptance among female cliques, reflecting on the relationship between gender and profession, and concerns about dependents and financial needs. Conclusions and Implications for Practice: This study addresses masculinity issues and gender stereotyping. In addition, male nurses were very concerned about their career options and development and the likelihood of promotion. This research not only has implications for better understanding of novice male nurses’ needs and the challenges in their social life but also makes suggestions for nursing practice to attract and keep more male nurses in the nursing profession. The results illustrate how culturally congruent nursing care can be achieved when we more concern male nurses’ role pressure and address traditional gender sensitivity to promote male nurses’ career development.
Background: Two thirds of respondents of a recent survey, primarily self-identified urban immigrant Dominican females, indicated that cancer was the health problem they worried about the most. Purpose: The purpose of this qualitative study was to gain a greater understanding of the cancer worry experienced by Dominican women. Design: Giorgi’s descriptive existential phenomenological framework and methodology guided the study. Setting: Washington Heights/Inwood community, New York City, New York. Participants: Thirty-eight urban Dominican immigrant women were included in the study. Method: Data were gathered using focus group interviews. All interviews were digitally recorded, transcribed verbatim from Spanish to English. The transcripts were analyzed using Giorgi’s existential phenomenological data analysis process. Findings: Four essences unfolded: Cancer as Destiny, Faith, Influential Relationships, and Knowledge Acquisition. Conclusion: New knowledge was generated on the contextual factors that influence cancer worry among a major Hispanic subgroup. Implications for nursing research and practice are described.
Purpose: We sought to understand decision making, family involvement, and cultural factors that influence palliative care for Guatemalans. Design: A qualitative descriptive study was conducted in Guatemala to explore palliative care experiences among seven participants. Findings: The overarching theme was Relief from Suffering, reinforced by three support systems: the family, community rezadora, and priest. The family made decisions and provided physical care. The rezadora sang prayers and prepared the home altar. The priest provided traditional sacraments. Discussion: The role of the rezadora should be considered in providing palliative care to Guatemalans. Some Guatemalans are unfamiliar with or have difficulty understanding the role of the nurse in palliative and end-of-life care. Implications: We suggest training opportunities using international resources to enhance the role for Guatemalan nurses in end-of-life care. Palliative care nurses in the United States may benefit from incorporating the rezadora into strategies that extend these services to Guatemalans.
Introduction: Comprehensive breast cancer care includes not only diagnosis, staging, and treatment of cancer but also assessment and management of the physical, psychological, social, and informational needs, collectively known as supportive care. Several studies have documented the importance of addressing supportive care factors among breast cancer survivors. However, there appears to be a paucity of research concerning African American breast cancer survivors (AABCS). Therefore, the purpose of this study was to describe and understand the patient-centered supportive care factors among self-identified AABCS. Method: Using a qualitative descriptive approach, an open-ended question explored supportive care factors that were used by N = 155 AABCS. Results: Four supportive care factors were identified: faith, supportive structures, optimism, and access to information. Discussion: An understanding of these factors might facilitate discussion between survivors and the health care team. The resultant effect could also inform and promote the delivery of culturally specific health care to address the supportive care needs among these women.
Background: Honduras is the second poorest country in Central America. The already high burden of disease is disproportionately worse among individuals with less education and limited access to health care. Community engagement is needed to bridge the gap in health care resources with the need for health promotion and education. Culturally relevant health promotion activities can foster transcultural partnerships. Purpose: The purpose of this study was to partner nursing students with village leaders to assess a community’s health needs and implement health promotion activities in Honduras. Design: Participatory action research was used in the study. Method: U.S. nursing students (n = 4) partnered with a nonprofit organization and community partners in Villa Soleada to interview mothers in Villa Soleada, a Honduran village of 44 families, and implement health promotion activities targeted to the health priorities of their families. Results: Structured interviews with 24 mothers identified gastrointestinal issues, health care access and quality, and malaria as the top three priorities. Ninety-two percent of respondents were interested in nurse-led health promotion. Activities engaged new community partners. Discussion: This partnership and learning model was well received and sustainable. The U.S. nurses involved in the partnership gained exposure to Honduran health issues and led locally tailored health promotions in Villa Soleada. The community’s response to health promotion were positive and future activities were planned. Implications: Nursing student’s immersion experiences to support population-based health activities in low-resource settings are a replicable model that can help build healthier communities with a sustainable local infrastructure. Transcultural nursing experiences enhance students’ perspectives, increase personal and professional development, strengthen nursing students’ critical thinking skills, and for some students, confirm their desire to practice in an international arena.
Purpose: To examine prevalence, nutrition and activity, and overweight and obesity prevention and management in Saudi Arabia. Design: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria, PubMed, Web of Science, PyschINFO, Global Health, Family Studies Worldwide, Middle Eastern Studies, and Sociological Abstracts was searched from January 1, 2003 to January 31, 2016. Inclusion criteria included peer-reviewed articles published in Arabic and English that focused on prevalence, overweight or obesity in children 2 to 20 years of age, body mass index percentile, and interventions. Findings: Three themes were identified: epidemiological features, where the eastern region had the highest prevalence of overweight and obesity, risk factors, which included higher parental education, and lifestyle factors, which included increased consumption of calorie-dense food and a sedentary lifestyle. Conclusion: Childhood obesity is increasing in Saudi Arabia at an alarming rate. Implications for Practice: Practitioners need to consider the cultural influences of the increasing obesity epidemic in Saudi Arabia.
Purpose: This article examines the concept and use of the term cultural safety in Canada and the United States. Design: To examine the uptake of cultural awareness, cultural sensitivity, cultural competence, and cultural safety between health organizations in Canada and the United States, we reviewed position statements/policies of health care associations. Findings: The majority of selected health associations in Canada include cultural safety within position statements or organizational policies; however, comparable U.S. organizations focused on cultural sensitivity and cultural competence. Discussion: Through the work of the Center for American Indian Resilience, we demonstrate that U.S. researchers engage with the tenets of cultural safety—despite not using the language. Conclusions: We recommend that health care providers and health researchers consider the tenets of cultural safety. Implications for Practice: To address health disparities between American Indian populations and non–American Indians, we urge the adoption of the term and tenets of cultural safety in the United States.
Purpose: In recent years, there has been much focus on compassion in nursing care, and concern has been raised in a number of reports and media stories regarding decreased compassion. The aim of this study was to explore similarities and differences in the understanding and demonstration of compassion in nursing practice across 15 countries. Design: A total of 1,323 nurses from 15 countries responded to questions in relation to compassion, via an international online survey. Results: The data revealed the impact of sociopolitical influences on perceptions of compassion, and the conscious and intentional nature of compassion. Discussion and Conclusion: The study demonstrated shared understandings of the importance of compassion as well as some common perceptions of the attributes of compassionate care. The differences reported were not as significant as had been expected. Implications for Practice: Further research is needed to explore the country and culture differences in the enactment of compassion.
Purpose: To develop a Thai questionnaire ชีวิตละสุขภาพของวัยรุ่นในประเทไทย (TYQ) to explore girls’ and boys’ living conditions, lifestyles, and self-reported health with special focus on sexuality, based on a Swedish questionnaire, Liv & Hälsa ung (SYQ). Challenges in developing a youth questionnaire for comparative studies are described. Design: A multistep translation, sociocultural adaptation procedure, and a mixed-method validation test were performed using English as a common language within the research group. Three versions of SYQ were used as a pool of questions to develop the questionnaire. Findings: From a field test, unclear questions were identified and minor adjustments made. Life & Health Young People in a Thai version was successfully developed. The English version was used to bridge the language gap. Conclusion: This unique multistep methodology, including mixed-method validation procedure, can be used by researchers in countries where English is not the main language.
Purpose: The risk behaviors of Hong Kong ethnic minority students are understudied. This exploratory qualitative study aimed to explore culturally nuanced factors for the development and prevention of risk behaviors among Pakistani and Indian students in Hong Kong. Method: Twenty-three students participated in four focus groups. All interviews were transcribed verbatim and analyzed using thematic analysis. Results: The participants reported bullying, delinquency, gambling, alcohol, cigarette, and drug uses as risk behaviors. Four themes emerged in the development and prevention of risk behaviors: (a) Parental and peer influence, (b) An unsafe community environment were perceived by the participants as essential factors for the development of risk behaviors, (c) Parental monitoring, and (d) Strong religious beliefs were believed as protective factors for the prevention of risk behaviors. Conclusion: Further research and practice may investigate and focus on the factors embedded in the Hong Kong ethnic minorities’ sociocultural contexts to prevent risk behaviors.
Purpose: Workplace aggression (WPA) is an international problem; however, no published reports of WPA in Cuba were found. This research describes WPA in Cuba and identifies prevention strategies for adoption in the United States. Design: A qualitative case study design was used. Procedures included visiting several health care settings in the region of Havana, Cuba. Interviews were conducted with 18 Cuban key informants and digital photographs documented the environment. Findings: WPA is a rare occurrence and typically demonstrates as verbal abuse. The use of illicit substances and prolonged wait times, common U.S. factors associated with WPA, are less problematic in Cuba. Discussion and Conclusion: Primary reasons for the low incidence of WPA may be the caring Cuban culture itself, tolerance for wait times, and less access to illicit and controlled substances. Implications for Practice: Adopting Cuba’s model to acknowledge WPA risk and implement prevention plans could reduce WPA incidence in the United States.
Background: Cancer-screening rates are low among Old Order Anabaptists; the burden of cancer is unknown. Purpose: To investigate cancer and health in the Old Order Anabaptist context. Specifically, to describe health priorities and health-seeking behaviors, crudely estimate cancer burden, and identify predictors of cancer screening. Method: A cross-sectional survey was distributed to households around Perth County, Ontario, in January 2014. Results: Response rate was 45%. Cancer burden was low. Cancer was a lower priority than general and mental health. After adjustment, family/friends motivated cancer screening for regular screeners (OR: 6.38, 95% CI [1.93, 21.07]) and symptoms was reported to motivate those underscreened/never screened (OR: 0.48, 95% CI [0.24, 0.96]). Conclusion: Cancer-screening participation may be low because the burden of cancer is low and there are other high-priority health concerns. Implications: Integrated cancer screening and holistic care may improve participation.
Purpose: This study aimed to describe the perceived level of organizational commitment and organizational culture of Korean American Registered Nurses (KARNs) and to investigate predictors of job satisfaction. Design: A total of 163 KARNs working in U.S. hospitals responded to a Web survey. Descriptive analysis, t test, analysis of variance, and stepwise regressions were used for data analysis. Results: KARNs reported moderate levels of job satisfaction (3.5 ± 0.58). Job satisfaction was positively correlated with both organizational commitment (r = .85, p < .001) and culture (r = .66, p < .001). KARNs who were aged ≥50, married, hospital-employed, had longer nursing experience, and experienced turnover at least once were more likely to report higher job satisfaction compared with other nurses. Organizational commitment, culture, marital status, and workplace were significant predictors of and explained 76.8% of the variance in job satisfaction. Conclusion: This study provides evidence to help nursing managers and health policy makers develop educational programs aimed at enhancing job satisfaction and retention of KARNs.
Purpose: This study explored the experiences of Korean women of advanced maternal age undergoing prenatal genetic screening and diagnostic testing. Design: A descriptive, qualitative design was used to guide the study. Method: Ten participants were purposely recruited from a large metropolitan Korean hospital for clinical observations and individual, semistructured interviews. The content analysis method was used to analyze field notes and interview transcripts. Findings: Three themes emerged: reacting to an unfavorable screening result, dealing with the anticipated consequences of diagnostic testing, and realistically embracing the unborn child. Conclusions: The findings of this study inform the development of tailored interventions aimed at reducing the heavy emotional burdens placed on pregnant women and the stigma of bearing children with genetic conditions. Clear reciprocal communication and shared decision making should be promoted in the day-to-day practice of delivering health care for pregnant Korean women.
Purpose: Parents are the most significant contributor to care of children with autism spectrum disorder (ASD), and as such research on African American parenting in ASD is conspicuously absent. Findings relevant to parenting are discussed from a study with urban African American families caring for children with ASD. Design: An ethnonursing study was conducted with 24 African American family members of children with ASD and 28 professionals. Data were analyzed and reported as themes. Findings: Two universal themes of were found of respect and faith in God and family that influenced parental care. Two diverse themes of mother’s watchful care and father’s protective care, along with differences in feelings of isolation and dependence on supports were found among single- and two-parent families. Discussion and Practice Implications: When health care professionals increase their knowledge and understanding of cultural practices in the parental care of children with ASD, they provide health care that is culturally congruent.
Purpose: The prevalence of diabetes is increasing in Hmong Americans, an understudied ethnic minority group. This research sought to identify barriers and facilitators related to the diabetes education experience of Hmong Americans with type 2 diabetes, living in central California. Method: This qualitative study employed a hybrid design to identify barriers and facilitators to diabetes education. Two focus group interviews were conducted among 16 participants. Findings: The three barriers identified are language, self-management, and stress; the three facilitators are focused culturally specific education, use of media, and peer support group. A priori elements of the Study of Access framework were confirmed. Discussion/Conclusion: There is a need for diabetes education in Hmong Americans. Health care access and education should incorporate culturally appropriate strategies that could improve health outcomes for the Hmong. Implication: To improve diabetes care in the Hmong population, health educators should consider the use of cultural competency, language assistance, and culturally appropriate education to achieve better clinical outcomes.
We aimed to examine the psychometric properties of a modified 16-item Attitudinal Index (AI), a measure of Chinese older adults’ beliefs about preventive health screenings. We used the 2013 Shanghai Elderly Life and Opinion data including 3,418 respondents age 60+ who were randomly split into training and validation samples. We examined the validity and reliability of the modified AI. Psychometric evaluation of the modified AI revealed good response patterns. The overall scale had good reliability (Cronbach’s α = .835). Exploratory factor analysis yielded four factors: barriers, fatalism, unnecessary, and detects (Cronbach’s α = .815-.908). Confirmatory factor analysis of the modified AI’s factor structure verified its four-factor structure (comparative fit index = 0.913, standardized root mean square residual = 0.048). The validity and reliability of the modified AI support its cultural appropriateness in measuring health beliefs among Chinese elderly. Further psychometric evaluation should focus on testing concurrent and criterion validity.
Purpose: Papanicolau (Pap) screenings disparities exist for immigrant women in the United States. This study sought to have an understanding of factors influencing Pap screening among sub-Saharan African immigrant women. Method: This is a qualitative descriptive study. Women were recruited from the community and by word of mouth following institutional review board approval. Data were gathered through in-depth focus group and demographic questionnaires. Interview sessions were digitally recorded and transcribed verbatim. Transcripts were analyzed for themes. Findings: Twenty-two women aged 24 to 65 years were interviewed. Barriers to screening included low knowledge of screening, cost, cultural beliefs, fear and communication issues. Motivators to improve Pap use include provider’s recommendations, enlightenment, and family support. Discussion: Interventions addressing the barriers peculiar to this population may alleviate these barriers and improve Pap screening use in this population. Providers have the opportunity to influence screening attitudes of African-born women by providing awareness and patient-targeted interventions.
Purpose: This study investigated the health beliefs of Taiwanese women in Anping, an urban district in Taiwan that was introduced to Western medicine in the 1860s. Design: A qualitative design with content analysis was used. Fourteen Anping women aged 44 to 84 years were interviewed. Results: The women integrated both traditional and Western biomedicine without any dissonance. Three themes were found: cultural beliefs about medicine–diet homology or the lack of a distinction between medicine and food, reliance on both doctor and deity, and a pattern of health practice based on situational decision making about which health practice to employ. Implications: Understanding health-related viewpoints in Chinese culture and its rationale will help health workers provide culturally competent care.
Purpose: To determine the barriers to health care access by chronic disease and depression/anxiety diagnosis in Mexican Americans living in El Paso, TX. Design: A secondary analysis was conducted using data for 1,002 Hispanics from El Paso, TX (2009-2010). Logistic regression was conducted for financial barriers by number of chronic conditions and depression/anxiety diagnosis. Interaction models were conducted between number of chronic conditions and depression or anxiety. Results: Depressed/anxious individuals reported more financial barriers than those with chronic conditions alone. There were significant interactions between number of chronic conditions and depression/anxiety for cost, denied treatment because of an inability to pay, and an inability to pay $25 for health care. Conclusion: Financial barriers should be considered to maintain optimal care for both mental and physical health in this population. Implications for Practice: There should be more focus on the impact of depression or anxiety as financial barriers to compliance.
Purpose: Dominant discourse contains negative stereotypical images of First Nations males that are steeped in colonialism. These racialized images can influence First Nations men’s sense of self as well as the care that nurses deliver. The objective was to (a) explore practices that support positive First Nations identity and (b) provide suggestions for practicing culturally safe care. Design: The theory of Two-Eyed Seeing guided this study. Data were collected via two semistructured interviews and Anishnaabe Symbol–Based Reflection from three First Nations men living in Toronto, Canada. Findings: Having mentors, knowing family histories, and connecting with healthy Aboriginal communities fostered positive First Nations identities for participants. Implications: There is potential to advance nursing practice by enacting creative means that may support client’s positive First Nations identity and well-being. Nursing education that focuses on strength-based and decolonizing frameworks, as well as reflexive practices that promote culturally safe care, is needed.
Purpose. Caregiving to parent stroke survivors in China is increasing and adult child–parent relationships are being challenged. The purpose of this study was to explore whether mutuality and filial piety have a protective role against caregiver depression. Design. A cross-sectional correlational study was conducted with a nonproportional quota sample of 126 caregivers. Surveys were conducted at hospitals or in homes using structured questionnaires: the 15-item Mutuality Scale, the 4-item Filial Attitude Scale, the 9-item Filial Behavior Scale, and the 10-item Center for Epidemiological Studies Depression Scale. Results. Higher mutuality and stronger filial attitudes were significantly associated with less caregiver depression after the covariates were controlled. Mutuality explained 5.5% (p < .01) and filial attitude explained 4.6% (p < .01) of the variance in caregiver depression. Conclusion. Mutuality and filial attitude may be protective factors against caregiver depression. Implications for Practice. Supportive strategies can be implemented to enhance mutuality and filial attitude.
Purpose: Specific stressors associated with caregiving in Mexican American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. This article describes these understudied families who are poorly served by contemporary health systems because their characteristics are unknown. Design: Descriptive, multisite, longitudinal mixed-methods study of MA caregiving families. Findings: We identified three types of collective caregivers: those providing care for multiple family members simultaneously, those providing care successively to several family members, and/or those needing care themselves during their caregiving of others. Discussion and Conclusions: Collective caregiving of MA elders warrants further investigation. Implications for Practice: Exploration of collective caregiving may provide a foundation for tailored family interventions.
The purpose of this study is to describe the reasons 88 Latinas with breast cancer selected specific supportive others to participate in an 8-week psychosocial intervention. Participants were asked one open-ended question during the baseline assessment for a larger clinical trial: "Could you tell me more about why you selected [insert name] to participate in the study with you?" A content analysis of the responses found three thematic categories: source of informational or emotional support, concern for the informal caregiver’s welfare, and special characteristics or qualities of the informal caregiver. These findings reflected both the cultural value of familism, the woman’s role as caregiver to the family (marianismo), and the man’s role of provider (machismo). Findings provide support for including the supportive person identified by the patient during a health crisis rather than the provider suggesting who that should be. Psychosocial services designed and implemented through such a cultural lens are more likely to be successful.
An understanding of symptoms in heart failure (HF) among different cultural groups has become increasingly important. The purpose of this study was to compare symptom reporting and symptom clusters in HF patients between a Western (the United States) and an Eastern Asian sample (China and Taiwan). A secondary analysis of a cross-sectional observational study was conducted. The data were obtained from a matched HF patient sample from the United States and China/Taiwan (N = 240 in each). Eight selective items related to HF symptoms from the Minnesota Living with Heart Failure Questionnaire were analyzed. Compared with the U.S. sample, HF patients from China/Taiwan reported a lower level of symptom distress. Analysis of two different regional groups did not result in the same number of clusters using latent class approach: the United States (four classes) and China/Taiwan (three classes). The study demonstrated that symptom reporting and identification of symptom clusters might be influenced by cultural factors.
Nurses’ attitudes and experiences may affect the level of patient exposure to complementary health approaches (CHA), both now and in the future. The purpose of this study was to describe nurses’ experience of CHA and their personal and professional attitudes to the use of CHA. The sample consisted of 220 nurses working at a university hospital in Antalya, Turkey. Data were collected using a questionnaire developed by the researchers. Nurses had a positive attitude toward CHA and reported mixed experiences of CHA for allergies, pain, and stress. This study may contribute to increased awareness of the potentially important role of nurses in delivery of CHAs. Hospital nurses should receive more training on CHA. Nurses should discuss the potential benefits and risks of CHA with patients.
African American (AA) adults are disproportionally affected by type 2 diabetes and are diagnosed at an earlier age, but are less adherent to diabetes medications compared with the general population. This qualitative study sought to describe the experiences of taking diabetes medications among midlife AA men and women with type 2 diabetes and to identify factors that influence these experiences. Fifteen AAs completed semistructured interviews. Using the Roy adaptation model, thematic analysis coded for both adaptive and ineffective experiences. Adaptive experiences included self-confidence in one’s ability to control diabetes, a belief in the value of diabetes medication, assuming responsibility for one’s health, developing a routine for taking medication, and positive relationships with the care team. Ineffective experiences for medication taking included: feeling powerless over diabetes, self-blame, and fear. One’s self-concept as a person with diabetes, as well as assuming the role of "medication taker," were prominent themes.
This study aimed to identify major barriers to Papanicolaou (Pap) test uptake and human papillomavirus (HPV) vaccine acceptability. Three focus groups with 16 young Korean immigrant women residing in a community in the Midwest were conducted. Braun and Clarke’s six phases of thematic analysis were used to develop themes. Three major themes emerged as barriers: (a) limited knowledge about cervical cancer and preventive behaviors, (b) culture-specific barriers, and (c) low accessibility to health care services. These themes were multifactorial and interrelated barriers to Pap test uptake and HPV vaccine acceptability among young Korean immigrant women. These findings indicate that culturally tailored cervical cancer education is needed to promote Pap test uptake and HPV vaccination in this underserved population.
Purpose: The key to improving the health and well-being of Native Hawaiians is to understand the historical events that have caused change to their diet and nutrition, and identify the connection between food, life, and the land. The purpose of this article is to (a) present a review of the literature addressing nutrition and diet as it relates to health and well-being of Native Hawaiian kūpuna (elders) and (b) identify limitations and gaps to promote future research. Design: This systematic literature review focused on 29 studies. Findings: Native Hawaiians have the highest body mass index levels, highest daily energy (kilocalorie) intake, and lowest multivitamin use. They have the highest prevalence of diabetes and hypertension compared with Whites. Traditional Hawaiian diet programs and family support were beneficial to improving health and well-being. Conclusion: Future research of traditional Hawaiian diet programs and revitalization of the culture may lead to improving the health and well-being of Native Hawaiians.
The purpose of this study was to identify cultural enablers and barriers to dietary management of type 2 diabetes in M’Bour, Senegal. This qualitative study used the PEN-3 cultural model to explore diabetes dietary management within a cultural framework. Content analysis identified emergent themes based on the PEN-3 model. Forty-one individuals completed interviews. Themes reflecting ways that culture affects adherence to the diabetic diet included (a) having a different diet or eating separately from the communal family plate creates feelings of social isolation; (b) forgoing the diabetic diet sometimes occurs so that family members have enough food; (c) reducing servings of traditional foods feels like abandoning culture; and (d) women being responsible for preparing food, while men typically manage money for purchasing food yet do not provide input on what food is purchased. Results suggest that educating family units on the dietary management of diabetes may be more effective than individual education.
People from non-White racial groups and other underserved populations, including Latinos, are frequently reluctant to participate in research. Yet their participation into research is foundational to producing information that researchers and health care providers need to address health disparities. The purpose of this article is to describe challenges we have encountered along with culturally relevant strategies we used in five research studies to recruit Mexican American participants from community settings, some of whom were also of low socioeconomic status. We found that the most effective recruitment strategies reflect the common cultural values of personalismo, simpátia, confianza, respeto, and familismo.
Immigration often results in the separation of families, and in particular transnational parenting, which is the separation of mothers from children. Transnational mothers may have greater risks for poor mental health and behavioral conditions such as substance abuse, violence, sexual risk, and depression. This study was a secondary analysis of self-reported data from 425 Hispanic mothers (328 with no separations, 60 separated from an adult child, and 37 separated from a minor child) enrolled in a randomized trial of a sexual health group intervention in South Florida (USA). Separations were related to mother’s age, years in the United States, family income, number of people living on income, acculturation to the United States, occupational/economic stress, immigration stress, and lifetime exposure to abuse. A follow-up analysis described the types of childhood or adulthood abuse experienced by mothers with separations. These findings provide new information for nurses about the experience of immigrant mothers.
The purpose of this study was to develop a participant-informed technology-based physical activity (PA) promotion tool for young overweight and obese African American (AA) women. A mixed-method 3-phase study protocol design was used to develop text messages to promote PA in AA women attending the University of Alabama at Birmingham during the Spring of 2013. Nominal focus groups and a 2-week pilot were used to generate and test participant-developed messages. Participants (n = 14) had a mean age of 19.79 years (SD = 1.4) and mean body mass index of 35.9 (SD = 5.926). Focus group data identified key themes associated with the use of text messages to promote PA including message frequency, length, tone, and time of day. Participants preferred text messages that were brief, specific, and time sensitive. Results showed that text messaging was a feasible and acceptable strategy to promote PA in overweight and obese AA women in a university setting.
Purpose: This study sought to determine whether (a) Hispanic nurses differ in assessment and management of pain for Hispanic versus non-Hispanic patients and (b) relationships exist between measures of acculturation and Hispanic nurses’ assessment and pain management. Method: A descriptive, cross-sectional correlation design study used three survey instruments to identify Hispanic nurses’ cultural beliefs and how they approach pain management in clinical settings. Results: The average nurse had inadequate knowledge. However, a sample strength was accurate pain assessment for both non-Hispanic and Hispanic patients; they had higher pain management decision-making scores for Hispanic patients. Conclusion: Results are consistent with empirical findings that nurses in general have inadequate knowledge of pain management, with important implications regarding needing further research and training in this area. Implications for Practice: Future research should examine whether other ethnic groups are more likely to make correct decisions in pain management for members of their ethnic group.
Purpose: The authors designed a community-based participatory research study to develop and test a family-based behavioral intervention to improve cancer literacy and promote mammography among Navajo women. Method: Using data from focus groups and discussions with a community advisory committee, they adapted an existing questionnaire to assess cancer knowledge, barriers to mammography, and cancer beliefs for use among Navajo women. Questions measuring health literacy, numeracy, self-efficacy, cancer communication, and family support were also adapted. Results: The resulting questionnaire was found to have good content validity, and to be culturally and linguistically appropriate for use among Navajo women. Conclusions: It is important to consider culture and not just language when adapting existing measures for use with AI/AN (American Indian/Alaskan Native) populations. English-language versions of existing literacy measures may not be culturally appropriate for AI/AN populations, which could lead to a lack of semantic, technical, idiomatic, and conceptual equivalence, resulting in misinterpretation of study outcomes.
Many cancers in American Indians (AIs) are not diagnosed early leading to effects on physical, social, and emotional well-being or quality of life (QOL). Little research has been done on QOL of AIs in Oklahoma. This study examined the experience of living with cancer of AIs in Oklahoma to gain greater understanding of QOL issues and provide a basis for interventions to improve QOL. Twenty AIs diagnosed with cancer and receiving care in Oklahoma participated in this pilot study through semistructured interviews. Data were analyzed using thematic analysis. Themes identified included circles of support, finding meaning in the experience, and facing personal challenges such as health care–related issues, including mental health needs and fragmented care. The findings from this pilot study provide insights into the cancer experience of AIs in Oklahoma and demonstrate that care navigation and social support are important aspects to address in intervention development.
Background: Identifying gaps in the literature regarding Puerto Rican childbearing women and intergenerational caregiving will facilitate future nursing practice and research regarding the amelioration of poor maternal–fetal outcomes. Method: A literature search using PubMed and CINAHL, sensitized by Bronfenbrenner’s Ecological-Environmental Model on Latinas and intergenerational caregiving, generated 18 peer-reviewed research articles (2009-2014) for analysis. Results: Categories and themes included the following: Latinas are the primary caregivers within their families and communities; caregiving is described; however, none of the studies classified caregiving as intergenerational and none sought to understand the overall impact on Latinas simultaneously caring for other members of their caregiving networks. Conclusion: Gaps in the literature need to be addressed to facilitate design of health care programs to address disparities and increase supports for childbearing Latinas involved in intergenerational caregiving who are at risk for higher incidences of challenging life experiences.
Purpose: The purpose of this study was to evaluate sleep quality and to explore its associations with participant characteristics, anemia, excessive daytime sleepiness, and physical activity in older Turkish adults with hypertension. Method: This cross-sectional study included 128 adults aged 60 years or older with hypertension. Data were collected by using a personal information form, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the International Physical Activity Questionnaire. Anemia was assessed by hemoglobin levels. Results: Eighty-one patients (63.3%) reported poor sleep quality. Anemia was present in 35.2% of the patients (defined as hemoglobin <13 g/dL for males and <12 g/dL for females). Female gender, the presence of anemia, and low levels of physical activity were associated with poor sleep quality. Conclusion/Implication: The majority of the participants had poor sleep quality. Better understanding of risk factors associated with poor sleep quality may contribute to more effective interventions to improve health and well-being.
The United States resettles close to 70,000 refugees each year more than any other country in the world. Adult refugees are at risk for negative health outcomes and inefficient health resource use, and meeting the multiple health needs of this vulnerable population is a challenge. The purpose of this study was to assess the impact of a home health care (HHC) pilot project on meeting the needs of older adult refugee patients. A retrospective chart review of 40 refugee adult patients who participated in an HHC pilot was done to analyze their health outcomes using OASIS-C data. Participants’ pain level, anxiety level, medication management, and activities of daily living management all significantly improved over the course of their HHC episode. Results of this study indicate that HHC has great potential to improve the health of vulnerable refugee populations and assist the families involved in their care.
Commonalities are presented from the experiences of U.S. nurse researchers who conducted studies in India, Jordan, Aotearoa/New Zealand, and Trinidad and Tobago. While planning research, it is important to engage collaborators who are members of the culture to be studied to understand what are culturally appropriate aims and methods. It is also vital to observe cultural etiquette, especially while gaining entrée and collecting data. Issues related to data collection include timing it around local holidays and events, and adapting individualist methods for obtaining consent and data to be more respectful for those in a collectivist culture. Care must be taken to give back, to sharing findings, and insure sustainability for future research in the host culture. Based on these and other reflections, recommendations are offered to support investigators planning research in a culture that is not their own.
Objective:This study examined the role of English language use in the reported frequency of musculoskeletal pain among Hispanic and non-Hispanic White youth. Method: This is a secondary data analysis using a cross-sectional sample of 12,189 Hispanic and non-Hispanic White adolescents recruited for the National Longitudinal Study of Adolescent to Adult Health. Respondents were classified into three groups: (a) English-speaking non-Hispanic Whites, (b) English-speaking Hispanics, and (c) Spanish-speaking Hispanics. Results: After controlling for body mass index and demographic, socioeconomic, and behavioral variables, Spanish-speaking Hispanics reported the least frequent musculoskeletal pain (OR = 0.415, 95% CI [0.361, 0.477]; p < .001), followed by English-speaking Hispanics (OR = 0.773, 95% CI [0.690, 0.865]; p < .001). Conclusion: The experience of musculoskeletal pain is a physiological as well as a cultural phenomenon. Implications for Practice: Health care providers should consider the role of language use in reports of pain in Hispanic and non-Hispanic White adolescents.
There are benefits and challenges associated with conducting research in a familiar setting, especially when the researcher is more an insider than an outsider. The aim of this article is to explore the author’s experience as a native scholar conducting ethnographic research among the Swahili peoples of Lamu, Kenya. This article focuses on methodological issues related to conducting ethnographic research among the author’s own people, including examining the issues of anthropological reflexivity as a native ethnographer and highlighting the author’s experiences embodying multiple identities. Native ethnographers must consider the challenges associated with negotiating multiple roles in the research setting, especially in the presence of sociocultural factors such as gender stratification, complex kinship networks, socioeconomic hierarchies, illiteracy, and poverty. Embracing rather than being confused by the multiple levels of understanding native researchers bring to studies of their communities opens up new avenues of research and possibilities.
Background:Transitional care, assisting patients to move safely through multiple health care settings, may be insufficient for older Hispanic patients. Purpose: Describe home health care services referral rates for Hispanic and non-Hispanic White (NHW) patients and factors that influence case managers’ (CMs’) discharge planning processes. Design: Organized by the Ethno-Cultural Gerontological Nursing Model, health records were reviewed (n = 33,597 cases) and supplemented with qualitative description (n = 8 CMs). Findings: Controlling for gender, insurance type, age, and hospital length of stay, NHW older adults received more home health care services referrals (odds ratio = 1.23). Insurance coverage was the most frequent determinant of CMs’ post–hospital care choices, rather than patients’ being Hispanic. NHW older adults were more likely to have insurance than Hispanic older adults. Implications: Insurance coverage being CMs’ primary consideration in determining patients’ dispositions is a form of systems-level discrimination for Hispanic vulnerable groups, which combined with other hospital-level constraints, should be addressed with policy-level interventions.
This study aimed to explore the levels of John Henryism (JH) active coping and its association with acculturation status and psychological health (specifically perceived stress, acculturative stress, anxiety, and depression) in Korean immigrants to the United States. In 102 Korean immigrants, JH active coping was measured by the JH Scale; acculturation by the Bidimensional Acculturation Scale; perceived stress by the Perceived Stress Scale; acculturative stress by the Social, Attitudinal, Familial, and Environmental Scale; anxiety by the State Anxiety Subscale of the Spielberger State-Trait Anxiety Inventory; and depression by the Center for Epidemiological Studies Depression Scale. The levels of JH active coping in this sample of Korean immigrants appear to be lower than the levels reported in other racial groups. Independent of demographic factors, JH active coping was a significant predictor of higher acculturation status and better psychological health as indicated by lower levels of perceived stress, acculturative stress, anxiety, and depressive symptoms.
Purpose: The authors determined the prevalence of smoking among Arab immigrants living in Colorado. The authors also evaluated the relationship between acculturation and tobacco use, including both cigarettes and hookah among Arab immigrants. Method: A cross-sectional survey of 100 adult Arab immigrants living in Colorado was carried out. Results: The results revealed that 19% of the study participants were current cigarette smokers and 21% were current hookah smokers. Participants who were more integrated into Arab culture were more likely to use tobacco products (p = .03) and to have family members (p = .02) and friends who use tobacco products (p = .007). Conclusions: Acculturation plays a major role in affecting the health habits of Arab immigrants living in Colorado, especially in the area of hookah smoking. Implications for Practice: Understanding some culturally relevant predictors of tobacco use might assist health care providers in designing successful smoking cessation programs.
Purpose: The level of cultural self-efficacy indicates the degree of confidence nursing professionals possess for their ability to provide culturally competent care. Cultural adaptation and validation of the Cultural Self-Efficacy Scale was performed for nursing professionals in Colombia. Design: A scale validation study was conducted. Method: Cultural adaptation and validation of the Cultural Self-Efficacy Scale was performed using a sample of 190 nurses in Colombia, between September 2013 and April 2014. This sample was chosen via systematic random sampling from a finite population. Results: The scale was culturally adapted. Cronbach’s alpha for the revised scale was .978. Factor analysis revealed the existence of six factors grouped in three dimensions that explained 68% of the variance. Conclusion: The results demonstrated that the version of the Cultural Self-Efficacy Scale adapted to the Colombian context is a valid and reliable instrument for determining the level of cultural self-efficacy of nursing professionals.
Purpose: This study assessed the feasibility of adapting a patient-centered educational intervention for type 2 diabetes (T2D) self-management for a Hispanic population with low health literacy skills. Design: A descriptive qualitative study design and phenomenological analyses were used. Nine Hispanic adults with T2D recruited from a rural community health center participated in an educational program that instructed on low glycemic food choices, meaningful glucose self-monitoring, and physical activity to decrease blood glucose spikes. Participants’ feedback was recorded during four 2-hour focus group sessions. Findings/Results: Participants’ feedback clustered around four themes: information and knowledge, motivation and barriers to change, experiences with new behaviors, and personal responsibility. Discussion/Conclusions: Data support the feasibility of adapting an established health-enhancing approach for promoting self-management of T2D to a low health literacy Spanish-speaking population. Implications for Practice: The findings may help in further development of tools and strategies for improved T2D self-management in the study population.
Purpose: This article describes strategies for recruiting and retaining Chinese elders in a longitudinal research study related to hypertension management. Design: Chinese participants were recruited for a pilot, longitudinal intervention study. The information presented represents observations on both the recruitment process and participant retention. Results: Recruiting via convenience sampling, offering frequent incentives, and having culturally competent research staff were important in this study with Chinese elders as participants. Among the various approaches used, the highest recruitment rate (50% [11/22]) was obtained from personal referrals with a retention rate of 91% (20/22) over a 6-month intervention period. Conclusion/Practice Implication: Personal referral is the best approach for recruiting Chinese elders in the study. In addition, frequent incentives and reminder calls are helpful in retaining participants.
Purpose: The aim of this study was to explore the meaning of transition to self-management in sickle cell disease. Design/Method: Twelve audio-recorded semistructured interviews were conducted with a sample of 21- to 25-year-olds recruited from a comprehensive sickle cell center in the northeast region of the United States. Data were analyzed using an existential framework according to van Manen’s phenomenological method. Findings: The meaning of transition to self-management was found in lived time, space, body, and human relationship. The emerging themes highlighted in this article include: Best Mother Ever, Growing up in the Hospital, I’m Not Trying that Again, Doing it on My Own, Living Day-by-Day, and Not a Kid any Longer. The themes reflected meaning and insight into this unique experience. Conclusion/Practice Implications: Study results emphasize the culturally constructed meaning of transition to sickle cell disease self-management and need to integrate transcultural perspectives into nursing practice to support this emerging phenomenon.
Unique drug responses that may result in adverse events are among the ethnocultural differences described by the Agency for Healthcare Research and Quality. These differences, often attributed to a lack of adherence on the part of the older adult, may be linked to genetic variations that influence drug responses in different ethnic groups. The paucity of research coupled with a lack of knowledge among health care providers compound the problem, contributing to further disparities, especially in this era of personalized medicine and pharmacogenomics. This article examines how age-related changes and genetic differences influence variations in drug responses among older adults in unique ethnocultural groups. The article starts with an overview of age-related changes and ethnopharmacology, moves to describing genetic differences that affect drug responses, with a focus on medications commonly prescribed for older adults, and ends with application of these issues to culturally congruent health care.
Purpose: Nondisclosure of terminal prognosis in the context of intercultural interactions can cause moral distress among health care providers guided exclusively by informed consent. However, cultural humility can show that revealing and withholding prognostic information are two equally valid paths to the goal of protecting the patient from harm. Design: Assumptions and history giving rise to the preference for truth telling in the United States(US) are examined. Principles of biomedical ethics are described within the context of US, Chinese, and Latin American cultures. The process of cultural competence in the delivery of health care services is explained and introduces the concept of cultural humility. Implications for Practice: By focusing more on biases and assumptions brought forth from the dominant culture, health care providers may experience less moral distress and convey increased caring in the context of intercultural interactions and nondisclosure of prognosis of a terminal illness.
The aging population is growing increasingly more diverse, with one in four older adults from an ethnic minority group by 2050, while the nursing force will largely remain members of a single race White population. The purpose of this review is to appraise the state of nursing knowledge in relationship to meeting the needs of elders in unique racial/ethnic groups using two approaches: evaluating the efficacy of current knowledge and evaluating the state of nursing knowledge about ethnocultural gerontological nursing based on an integrative review of nursing literature. Thirty-four articles were reviewed. Most articles used qualitative methodology focused on a single ethnic group, with several articles focused on health promotion/prevention. Cultural perspectives were better addressed than aging concepts and few articles integrated ethnocultural and gerontological nursing concepts. This evaluation indicates many gaps in the knowledge base about ethnocultural gerontological nursing. Specific areas for future knowledge development are identified.
Purpose:To evaluate self-rated health (SRH) and determine its associations with participant characteristics, glycemic control, family support, and health-related quality of life in older Turkish adults with type 2 diabetes. Method: This cross-sectional study included 113 adults aged 60 years or older with type 2 diabetes. Data were collected by using an information form, the Perceived Social Support From Family Scale, and the Nottingham Health Profile. SRH was assessed by a single-item question. Glycemic control was measured by glycosylated hemoglobin levels. Results: Ninety-seven patients (85.8%) evaluated their health as fair or poor. The glycemic target level (glycosylated hemoglobin <7.5%) was achieved in 47.8% of the patients. Female gender, a low or moderate family income, and lower levels of family support were associated with poorer SRH. Conclusions/Implications: The majority of the participants considered their health to be fair or poor. Better understanding of risk factors associated with SRH may provide more effective interventions to improve health outcomes.
African Americans are twice as likely as Caucasian Americans to choose aggressive hospital treatment when death is imminent. Repeat hospitalizations are traumatic for patients and drain patient and health system resources. Hospice care is a specialized alternative that vastly improves patient quality of life at end-of-life. This study was conducted to determine if hospices partnering with African American churches to disseminate hospice education materials could increase utilization of hospice services by African Americans. Members of two African American churches (N = 34) participated in focus group discussions to elicit beliefs about hospice care. Focus group transcripts were coded and comments were grouped according to theme. Six themes were identified. Lack of knowledge about hospice services and spiritual beliefs emerged as the top two contributing factors for underutilization of hospice services. Study findings support partnerships between hospices and African American churches to provide hospice education to the African American community.
Korean Americans have the highest smoking rate within the Asian American population. This study examined the feasibility and acceptability of a culturally adapted telephone cessation intervention for Korean Americans. Participants were recruited from advertisements on a Korean radio station channel in New York City. All received a combination of telephone cessation counseling and nicotine patches. Thirty-one (2 women and 29 men) participated in the study. At 3-month follow-up, 14 (45.2%) reported 7-day point prevalence abstinence and 13 (41.9%) achieved 3-month prolonged abstinence. Except for two who lived alone, self-reported abstinence was corroborated by a family member. The findings point to the direction that a nationally centralized Korean-language quitline service should be established to help Korean Americans quit smoking. Furthermore, the service should be adapted at a deep level of the culture.
This qualitative study explored the beliefs held by adult Caribbean immigrants regarding type 2 diabetes (T2D) and their practices in preventing it. A purposive sample of 15 immigrants living in Ontario, Canada participated in the study. Semistructured interviews were used to collect data from participants. Four themes emerged from the data: beliefs that protect participants from developing T2D, cultural practices to stay healthy, preserving culture through preparation of meals, and cultural practices determine number of servings of fruit and vegetables per day. Findings indicate how beliefs and cultural practices influence prevention of T2D and the need to design culturally tailored interventions for ethnic groups. Future research should explore health beliefs and cultural practices of other high-risk groups and use their findings to design and evaluate culturally tailored interventions to prevent T2D.
Introduction: Perceptions of health-related quality of life (HRQOL) are influenced by sociodemographic variables and by cultural-religious concepts of health, disease, and old age, among others. Purpose: To assess the HRQOL of older people in a population with a long history of multiculturalism, the city of Ceuta (Spain), and to compare the results with Spanish reference values. Method: A total of 372 individuals (55.4% females) were interviewed using the Spanish version of the Short Form-36 questionnaire. The subjects’ mean age was 70.9 (SD = 5) years: 253 were Christians, 93 Muslims, and 26 Jews, representing the proportions in the overall population of these cultural-religious groups. Results: HRQOL differs according to the cultural-religious affiliation, which specifically affects social and psychological dimensions. Discussion and Conclusions: All groups obtained lower social function scores than the reference values, especially the Muslim and Jewish groups. Implications for Practice: Health care providers may consider integrating culturally sensitive interventions to improve HRQOL.
Purpose: This was a descriptive–correlational study designed to determine factors associated with the healthy lifestyle behaviors of high school students in Turkey. Design: The study sample consisted of 812 high school adolescents. The Adolescent Lifestyle Profile scale was used to identify the healthy lifestyle behaviors of adolescents. Results: The total Adolescent Lifestyle Profile mean score of 2.75 ± 0.33 and the mean score on the Interpersonal relations subscale were found to be the highest scores while the mean score on the Health responsibility subscale was found to be the lowest. Significant predictors of healthy lifestyle behaviors of adolescents were good relationships with family and friends, having a father who was a college graduate, and good health perception. Conclusions: The study revealed similar results among adolescents of different cultures. Implications for Practice: These findings can be used as a guide in developing an adolescent health promotion program for school nurses.
Purpose: The study aimed to analyze the professional autonomy of Japanese nurses when caring for non-Japanese patients and to identify its contributing factors. Method: A descriptive cross-sectional design was used. Participants included 238 clinical nurses working at 27 hospitals in Japan. The Intercultural Sensitivity Scale (Chen and Starosta), and the Scale for Professional Autonomy in Nursing (Kikuchi and Harada) were used to measure intercultural sensitivity and professional autonomy. Stepwise multiple regression analysis was used to identify the most significant factors affecting professional autonomy. Results: Professional autonomy of Japanese nurses caring for non-Japanese patients was significantly lower than when caring for Japanese patients (142.84 vs. 172.85; p < .001). Contributing factors were intercultural sensitivity (p < .001), length of nurse experience (p < .05), and availability of interpretation service (p < .05). Conclusion: Incorporating transcultural nursing content into training programs in schools and hospitals could enhance professional autonomy of Japanese nurses by promoting intercultural sensitivity.
Purpose: In the United States, African American babies die more than twice as often as White babies. The cause for this difference remains elusive, yet is likely complex with one factor being inadequate cultural care of pregnant African American women. The purpose of this study was to explore African American women’s perspectives of meaningful prenatal care. Design: Community-based participatory research was employed for this study using photovoice. The sample included 11 African American mothers in an urban community in Midwestern United States. Findings: Five themes were abstracted from the data: (1) Access to Care; (2) Soul Nourishment; (3) Companionship; (4) Help Me, Teach Me; and (5) The Future. Discussion/Conclusion: Meaningful prenatal care is influenced by culture. African American women need physical, social, and soulful support to enhance meaningfulness of care during pregnancy. Practice Implications: The findings support that meaningfulness of prenatal care for African American women may be enhanced by accessible and uniquely designed, culturally congruent models of prenatal care.
Purpose: To determine the predictors of agreement with writing advance directives (ADs) among older Korean adults. Design: This was a secondary analysis of a study that compared the differences in knowledge, experience, and preference about ADs between community and facility-dwelling older adults. Data were collected through self-reported questionnaires. In this study, after 25 cases were excluded from the original sample (N = 181) for incomplete data, a sample of 156 was analyzed using multiple logistic regression analysis. Results: Older adults’ experiences with having thought about life-sustaining treatments, odds ratio (OR) = 4.02, 95% confidence interval (CI) [1.56, 10.38], agreements with legalization of ADs, OR = 4.68, 95% CI [1.69, 12.96], and wishes to obtain information about medical status, OR = 3.78, 95% CI [1.66, 8.64], were identified as the predictors of agreement with writing ADs. Implications for Practice: Discussion channels and educational programs about ADs should be developed for older Korean adults.
The purpose of this study was to explore associations of spiritual well-being, spiritual perspective, and religiosity with self-rated health in a convenience sample of 340 adult Jordanian Arab Christians. Data were collected through church and community groups. Results indicated that spiritual well-being and religiosity were positively associated with self-rated health, but in the final regression model only spiritual well-being retained a significant association after controlling for the other spiritual and religious measures. In conclusion, spirituality and religiosity are important to Jordanian Arab Christians’ health and well-being, and the implications for nursing practice are explored.
Background: Patient satisfaction reflects how an individual’s expectations, goals, and preferences are met by health care providers or services. Most research on patient expectations and satisfaction has been conducted in developed countries; there was no Portuguese language instrument to measure pregnant women’s expectations and satisfaction with prenatal care. Purpose: To adapt and test the Patient Expectations and Satisfaction with Prenatal Care (PESPC) instrument for use in Brazil. Design: We conducted a systematic cultural and linguistic adaptation of the PESPC into Brazilian Portuguese and tested the validity of the adapted instrument. Results: Implementation of this rigorous methodological process resulted in a valid, reliable, culturally, and linguistically appropriate instrument. Implications for Practice: We recommend further assessment of the Brazilian Portuguese PESPC with more diverse samples of Portuguese-speaking pregnant women in Brazil and other countries. Application of this structured approach to cultural and linguistic instrument adaptation is one way to further transcultural nursing research.
Purpose: There is a lack of clarity regarding nursing roles and strategies in providing culturally meaningful end-of-life care to elderly immigrants admitted to Australian hospitals. This article redresses this ambiguity. Method: A qualitative exploratory descriptive approach was used. Data were obtained by conducting in-depth interviews with a purposeful sample of 22 registered nurses, recruited from four health services. Interview transcripts were analyzed using content and thematic analysis strategies. Results: Despite feeling underprepared for their role, participants fostered culturally meaningful care by "doing the ground work," "facilitating families," "fostering trust," and "allaying fear." Discussion and Conclusion: The Australian nursing profession has a significant role to play in leading policy, education, practice, and consumer engagement initiatives aimed at ensuring a culturally responsive approach to end-of-life care for Australia’s aging immigrant population. Implications for Practice: Enabling elderly immigrants to experience a "good death" at the end of their lives requires highly nuanced and culturally informed nursing care.
Purpose: Measuring the cultural competence of nurses is becoming an increasingly important aspect to assess the quality care for individuals in multicultural populations such as Turkey. The purpose is to adapt the Nurse Cultural Competence Scale (NCCS) into the Turkish language and to determine its validity and reliability. Design: A total of 235 nurses were included in the methodological study in Antalya, Turkey. The NCCS-Turkish (NCCS-T) form was used after linguistics and psychometric measurements. Results: Cronbach’s α value was .96, which demonstrated high reliability, and item–total correlations were between .66 and .81.Test–retest reliability correlation was .90. The content validity index was .98, and the 20 items of the NCCS-T loading on one factor varied between .70 and .83, explaining 59.02% of the variance. Conclusions: Psychometric properties of the NCCS-T were highly reliable and valid. Implications for Practice: The scale can be used in the cross-cultural studies to compare nurses’ cultural competency.
The purpose of this phenomenological study was to seek a better understanding of needs and access issues among pregnant, low-income Hispanic women. Hispanic women who attended a community prenatal education program participated in follow-up focus groups to explore their experiences regarding prenatal education, pregnancy resources, access to, and satisfaction with, the care available to them. Focus groups were facilitated by a leader, bilingual in English and Spanish, with knowledge of the Hispanic culture. Sessions were audiotaped, then translated into English for transcription. Data were analyzed according to guidelines by Colaizzi and three themes emerged: pregnant Hispanic women experienced a sense of anguish (la angustia) from questions and unknowns rampant during pregnancy, leading to a yearning (el anhelo) to learn and understand more, but with a desire to do so without sacrificing native identity (la identidad). Implications of these themes for improving prenatal care for this population are explored.
Purpose: There are only a few measures to assess quality of life among patients with liver disorders. The aim of this study was to determine the psychometric properties of the Liver Disease Symptom Index Version 2.0 (LDSI 2.0), a disease specific measure of health-related quality of life (HRQOL), in Persian-speaking patients with chronic hepatitis B. Method: Using a cross-sectional design, 312 patients were recruited. Data were collected from the patients using the LDSI 2.0, Chronic Liver Disease Questionnaire, and EuroQol. Convergent and discriminant validity were investigated. Known-groups validity and factor structure of the scale were also determined. Receiver operating characteristics was used to discriminate patients based on their general health status. Results: Significant correlations were found between HRQOL measures. Disease duration, disease stage, and serum aspartate aminotransferase differentiated patients. Factor analysis determined a seven-factor solution that explained 70% of the total variance. Area under the curve in receiver operating characteristics analysis was 0.706; 95% confidence interval = [0.648, 0.764]. Conclusions: The LDSI2.0 is an appropriate HRQOL scale for use among Iranian patients with chronic hepatitis B based on its solid psychometric properties in this population.
Purpose: The aim of this study was to examine the psychometric properties of the Turkish versionof the Compliance Questionnaire on Rheumatology (CQR-T) for patients with Behçet’s disease (BD). Method:A sample of 105 Turkish patients with BD participated in this study. The scale was cross-culturally adapted through a process including translation, comparison with versions in other languages, back translation, and pretesting. Construct validity was evaluated by factor analysis, and criterion validity was evaluated using the Morisky Medication Adherence Scale. Results: The CQR-T demonstrated acceptable internal consistency (Cronbach’s α = .832), adequate test–retest reliability (intraclass correlation coefficient = .630), and correlations with Morisky Medication Adherence Scale scores (r = –.389, p< .001), indicating convergent validity. Conclusion:The CQR-T was found to be a valid and reliable instrument for evaluating the compliance of Turkish BD patients with prescribed medications. Implications for Practice: The CQR-T might be a helpful tool in two ways: for determining the level of compliance of patients with BD and for adjusting their management and follow-up based on the results.
Purpose: To identify Korean nursing students’ level of intent to migrate and the factors influencing their intention to migrate. Method: Using a cross-sectional correlational design, data were collected from 886 nursing students in two nursing schools. Data were analyzed using descriptive statistics, chi-square tests, and hierarchical multiple regressions with SPSS version 18. Results: Nursing students had moderate levels of intent to migrate. Variables that were independently associated with intention to migrate were class year and having previously considered the possibility of overseas employment on admission to nursing school. The full model accounted for 45.1% of the variance in intention to migrate. Conclusion: The most significant predictor of intent to migrate by nursing students was the possibility of overseas employment on admission to nursing school. To more positively manage the intent to migrate, appropriate strategies to enhance the nursing work environment should be investigated.
Clinical research requires representation of racially and ethnically diverse participants to accurately represent the general population. Overall life expectancy of African Americans is shorter than that of the general U.S. population. Compared with the other ethnic groups in the United States, African Americans have higher rates of hypertension, stroke, obesity, and diabetes, and higher rates of mortality related to stroke and cancer. Although many health disparities exist among African Americans, they are well underrepresented in clinical research. This article provides an overview of barriers that may influence participation in clinical research among African Americans. Issues of trust, experimentation, communication, and logistics are the most commonly identified barriers. The barriers and facilitators identified in this review may be useful in the development and implementation of recruitment and research strategies that are culturally sensitive and that may enhance trust and willingness to participate among African Americans.
Purpose: Migrating and establishing a new life in another culture can have diverse health effects especially for women. This article explores the struggles and social adjustment issues that might constitute negatively to the health of West African migrant women living in Australia. Design: Qualitative storytelling. Audiotaped voluntary stories from 20 West African migrant women living in Sydney, Australia were transcribed and analyzed. Findings: Three themes are presented for discussion: (1) But it is different here: life in a new country; (2) I have to do it all by myself: communal versus individual living; and (3) They don’t listen to parents: perceived threats to the family unit. Conclusion/Implication for Practice: The demand for and the importance of nurses and midwives in supporting migrant families is demonstrated by findings suggesting that social adjustment into the Australian culture has a significant impact on both the nuclear and extended family unit of women.
This study reported the differences in factor structure of the Spiritual Well-Being Scale (SWBS) among Jordanian Arab and Malaysian Muslim participants and further examined its validity and reliability. A convenience sample of 553 Jordanian Arab and 183 Malaysian Malay Muslim university students was recruited from governmental universities in northern Jordan. The findings of this study revealed that this scale consists of two factors for the Jordanian Arab group, representing the "Religious Well-Being" and the "Existential Well-Being" subscales, and consists of three factors for the Malaysian group, representing the "Affiliation/Meaning and Purpose," "Positive Existential Well-Being/God Caring and Love," and "Alienation/Despair" subscales. In conclusion, the factor structure of the SWBS for both groups in this study was psychometrically sound with evidence of acceptable to good validity and reliability. Furthermore, this study supported the multidimensional nature of the SWBS and the earlier notion that ethnicity shapes responses to this scale.
Purpose: The study explored how service providers address the challenges of providing culturally competent care within disability services in the United Kingdom. Design/Method: Focus groups and interpretative phenomenological analysis were used to explore the experiences of 20 service providers from a range of professions, working with South Asian families. Results/Findings: Two superordinate themes emerged. The first concentrated on difficulties with language and communication and the challenges posed by the use of interpreters. The second included five subthemes that broadly described a five-stage process of dealing with barriers and engagement to service delivery, followed by reflections on the effort made to provide culturally competent care in the face of limited resources and training. Discussion/Conclusion: The study makes recommendations for cultural competency within health and social care services.
Background: There are large numbers of short-term medical mission (STMM) groups traveling yearly from the United States to underdeveloped countries. Medical professionals educated in the Western biomedical model of treatment have an ethnocentric view of how to treat illness. Purpose: The purpose of this pilot study was to demonstrate that a 2-hour culturally sensitive educational program administered to medical professionals travelling to Haiti on a STMM could raise their cultural competency as measured by a specific tool. Method: The participants were invited to a short educational program designed to help them understand their own biases and make better treatment decisions for their patients based on the five constructs of Dr. Campinha-Bacote’s cultural competence model. Findings: Following an evidence-based educational program, the members of the STMM groups demonstrated improved levels of cultural competency. Implications: This program could provide an appropriate way to raise the cultural competency of medical mission health care providers.
Purpose: This study explored Latino migrant/seasonal farmworkers’ (MSFWs’) adherence to hypertension treatment. Design: A cross-sectional correlational study was conducted. Method: Forty-five Latino MSFWs from two farmworker health clinics completed Spanish versions of the Morisky Medication Adherence Scale, the Blood Pressure Knowledge Scale and Blood Pressure Self-Care Scale, the Perceived Stress Scale, the Acculturation Rating Scale for Mexican Americans–II, the Short Assessment of Health Literacy for Spanish-Speaking Adults, health care access questions, and blood pressure measurements. Results: MSFWs had poor medication adherence (51%). Blood pressure knowledge, perceived stress, acculturation, health literacy, and health care access accounted for 49% of the variance in blood pressure self-care. Higher acculturation level and health literacy were associated with better blood pressure control (p = .01). Discussion: MSFWs had poor medication adherence and blood pressure control. Blood pressure knowledge and acculturation played a role in blood pressure self-care. Implications: Culturally appropriate educational programs are needed to help MSFWs’ adherence to hypertension treatment.
Background: Surgical nursing within humanitarian contexts is complex, sporadically described in literature and little understood. Aim: To achieve a deeper understanding of the lived experience of New Zealand nurses providing humanitarian aid within surgical settings and war zones in developing countries. Method: In-depth conversational interviews were undertaken with four New Zealand nurses whose humanitarian experience lay in general surgical, military, and intensive care settings. A qualitative descriptive method as described by Sandelowski, informed by van Manen’s phenomenology in terms of analysis, was used. Results: Specialized knowledge and nursing expertise are recognized to be essential but not sufficient for humanitarian work. Understanding local cultures contributes to positive feelings about work effectiveness. Themes included feeling anxious and misunderstood, practicing differently, and adjusting to life back home. Discussion: This study highlights the need to better prepare nurses who volunteer for humanitarian work, with implications for recruiting organizations, educators, and clinicians.
This study examined the utilization of clinical breast examinations (CBEs) and mammograms among Korean American immigrant women and investigated how the six constructs of Health Belief Model (HBM) are associated with the receipt of breast cancer screening. Using a quota sampling strategy, 202 Korean American immigrant women were recruited in metropolitan areas in the northeastern United States. Approximately 64% of the participants reported having had at least one CBE in their lifetime, and about 81% of the sample had undergone at least one mammogram in their lifetime. Women who perceived themselves to be susceptible to breast cancer were more likely to have undergone a CBE, and women who had lower barriers to screening or demonstrated a higher level of confidence were more likely than their counterparts to undergo a mammogram. Findings suggest that HBM constructs such as susceptibility, barriers, and confidence should be considered when designing interventions aimed at promoting breast cancer screening.
Purpose: The objective of this study was to explore the maternal health risk factors and sentinel events among women in the Solomon Islands, from the viewpoints of health care providers in the Solomon Islands. Design and Method: Three focus group interviews were conducted in July and August 2011 at a secondary referral hospital in an urban area. The study consisted of 10 registered nurses and 11 skilled birth assistants. Thematic analysis was used for this qualitative data analysis. Findings: Six major themes were emerged from the data: (a) environmental hazard: malaria, (b) malnutrition: iron deficiency anemia, (c) adolescent pregnancy, (d) betel nut chewing, (e) cultural beliefs influencing women’s health, and (f) difficulty accessing health care services. Conclusions and Implications for Practice: The results of this study provide a useful first step toward identifying specific maternal health risks among women in the Solomon Islands. The findings may assist the health sector and midwives/antenatal educators to better understand the health risks and reduce the disease burden among pregnant women in South Pacific countries. The results may also contribute to the development of policies to improve maternal health and to accelerate progress toward the fifth target goal of UNICEF’s Millennium Development Goals.
Purpose: The purpose of the present study was to learn about the perspectives on end-of-life decision making among older Chinese people in Macau. Method: A qualitative approach was used, and interviews were conducted with 18 Chinese aged 65 years or older. Results: Four major themes were identified: (a) institutionalized care at the end of life was preferred as not to be a burden on family, (b) life-prolonging measures were not preferred, (c) funeral arrangement preferences were based on personal and religious beliefs, and (d) end-of-life decision making would be deferred to others. Discussion and Conclusions: These themes provide an understanding of personal preferences of older Chinese on end-of-life issues, and personal preferences are always secondary to their respect toward family and medical doctors. This compliance with family and medical authority can be understood through Chinese cultural beliefs. Implications for Practice: Knowledge of cultural influences is needed for nursing professionals to deal effectively with older adults and families regarding end-of-life issues.
Purpose: To describe the care relationships between caregivers and elderly people in Uruguayan nursing homes. Design: A qualitative study with an ethnographic approach conducted at nine nursing homes for elderly people located in four Uruguayan departments. Twenty-three purposively and theoretically selected participants were interviewed and observed between January 2011 and January 2012. Results: Study of relationships among caregivers, managers, and residents revealed a number of issues: perception and experience of elder abuse, suffering when faced with death, and existential pain. Conclusion: A cultural context of discrimination against the elderly and other factors converge to perpetuate elder abuse and suffering in care homes: the lack of adequate regulations covering safety and quality of care, lack of a care model and regular inspections, absence of minimum training requirements for caregivers, and lack of support in situations that have psychic and spiritual repercussions. The inclusion of nurses could promote the development of educational interventions to modify abusive conduct. Nursing home managers need knowledge, skills, and communication strategies to identify and manage inappropriate behavior. An urgent review of nursing home regulations is required to protect elderly people’s rights.
Purpose: The aim of this study was to examine the relationship between acculturation, medication adherence, lifestyle behaviors (e.g., physical activity, nutrition, weight control), and blood pressure control among hypertensive Arab Americans. Design: The study utilized a cross-sectional descriptive design. A convenience sample of 126 participants completed questionnaires and had measures of blood pressure, weight, and height. Forty-six participants were hypertensive and were included in the analysis. Results: Only 29.2% of participants reported high medication adherence. High medication adherence was associated with lower diastolic blood pressure, eating a healthy diet, and following lifestyle modifications. Acculturation was significantly associated with physical activity and body mass index. Conclusion: Our study found that acculturated participants were more adherent to medications and physical activity and had better blood pressure control. Further studies are needed to explore how acculturation improves adherence and what factors contribute to better adherence in order to design culturally sensitive interventions.
Breast and cervical cancers continue to contribute to high cancer mortality rates in American Indian/Alaska Native women; culturally appropriate interventions are needed to influence screening behaviors and to reduce delays in obtaining care. In a pilot feasibility study designed to influence Pacific Northwest American Indian/Alaska Native women’s health screening knowledge and behaviors (breast and cervical), we employed a community-based participatory research approach. Data from interviews with study participants, those involved in implementation of the study and observations were included in the analysis. Study questions focused on training of staff, recruitment of participants, and implementation of the protocol and data management. The complexities of translational, transcultural research and the importance of reporting pilot feasibility studies to the advancement of transcultural research are highlighted in the findings of this research effort.
Background: The aim of this study was to examine the effect of nursing education on students’ knowledge, attitudes, and preferences to work with older adults in an ethnically diverse Israeli society. Methods: In a cross-sectional design, Kogan’s Old People Scale was used to measure attitudes toward older adults and Palmore’s Facts on Aging Quiz-1 to assess the level of knowledge of nursing students in four cohorts. Results: Of the 224 nursing students who responded to the survey, 55% were Jewish and 45% were Arabs. Ethnicity and knowledge were the strongest correlates (p < .0001) of attitudes, and attitudes and ethnicity (p < .0001) correlated with work preferences. Conclusions: While knowledge of old age among students increased, preferences for future career in geriatrics declined with education. Ethnicity was a strong predictor of attitudes and future intentions to work with older adults. Culturally tailored educational programs focused on changing the attitudes toward aging are critically needed.
The Ayoreo population constitutes one of Bolivia’s most vulnerable ethnic groups in terms of HIV/AIDS. Being a woman, indigenous, and a sex worker signifies belonging to a high-risk group. The aim of this study is to explore the Ayoreo sex workers’ and health agents’ perceptions of HIV/AIDS prevention programs in order to identify variables that could influence their success or failure. This study used an ethnographic methodology that included participant observation and semistructured interviews. In the data collection, participant observation and semistructured interviews with sex workers and key informants were conducted. Three themes emerged from the inductive data analysis: health prevention efforts, cultural inadequacy of prevention programs, and the eventuality of interventions. We conclude that nursing can develop culturally-adequate HIV/AIDS prevention interventions and programs as well as promote health within these populations.
This exploratory descriptive study examined perceived vulnerabilities to human papillomavirus (HPV) and the correlation to factors influencing vaccine beliefs and vaccine decision making in young Hispanic males attending a large public urban university. Only 24% of participants believed that the HPV vaccine could prevent future problems, and 53% said they would not be vaccinated. The best predictors of HPV vaccination in young Hispanic men were agreement with doctor recommendations and belief in the vaccine’s efficacy. Machismo cultural norms influence young Hispanic men’s HPV-related decision making, their perceptions of the vaccine, and how they attitudinally act on what little HPV information they have access to. This study provides culturally relevant information for the development of targeted health education strategies aimed at increasing HPV vaccination in young Hispanic men.
Addressing the health care needs of a 21st-century nation that is experiencing increased diversity and disparity will require new models of educating future providers. The cultural competence and confidence model was the guiding framework in a study evaluating the influence of cultural educational offerings on the transcultural self-efficacy (TSE) perceptions in baccalaureate nursing students. The Transcultural Self-Efficacy Tool was used to measure perceived TSE in a pretest (N = 260), posttest (N = 236) study over an academic year. Significant changes were demonstrated in overall self-efficacy and on the cognitive, practical, and affective subscales. A classification and regression tree analysis identified social orientation as the demographic variable most predictive of the TSE level. This study supports previous research where positive changes were found in students’ TSE based on the inclusion of cultural interventions in the nursing curriculum.
Purpose: The purpose of this systematic review is to explore the perceptions of acute, persistent, and disease-specific pain and treatment options held by adult African Americans. Underassessment and undermanagement of pain in African Americans has been well documented; however, the cultural continuum of pain perceptions and their influence on pain assessment and management has not been synthesized. Design: Electronic database searches of the Cumulative Index for Nursing and Allied Health Literature and PubMed, Web-based searches of the pain-specific journals plus a manual search of reference lists identified 41 relevant articles addressing perceptions of pain and/or pain management. Findings: Analysis of the literature revealed six themes: (a) meaning of pain, (b) description of pain, (c) coping with pain, (d) impact of pain, (e) patient–provider relationship, and (f) treatment approaches. Conclusion: These findings warrant further research and indicate the need for more precise evaluation of pain in African Americans, highlighting an imperative to incorporate cultural patterns into pain management practice and education.
Successful aging is gaining increasing attention given the growth in the older adult population. Criteria and definitions within multiple disciplines vary greatly in Western literature, with no consensus on its meaning. Sociocultural, economic, and political differences between the Western view of successful aging and its view in China add to the confusion. Similarities and differences in the meaning of successful aging in the United States and China are examined, and potential for a common definition useful to nursing in both countries is explored. Using concept analysis, shared criteria for successful aging were the following: decreased incidence of disease and disability, life satisfaction, meaning and purpose in life, and ability to cope effectively to achieve goals based on personal values and priorities. A comprehensive, multidimensional definition of successful aging for nursing and a midrange nursing theory of successful aging were identified that may be useful to guide nursing research, practice, and policy.
Purpose: To translate and examine the psychometric properties of the Arabic version of the Summary of Diabetes Self-Care Activities. Design: An instrument translation and validation study. Settings: A total of 243 participants (33 first sample and 210 second sample) diagnosed with type 2 diabetes mellitus were recruited from four primary health care centers in Saudi Arabia. Methods: The study was guided by the World Health Organization guidelines for translation and validation of instrument. Results: Translation indicators showed satisfactory outcomes for each included process in the forward-translation, an expert panel, and back-translation stages. Reliability and validity outcomes were as follows: test–retest, r = .912 and p < .001; split-half = .9; and Cronbach’s alpha (α) = .76. The alpha scores for the subscales were as follows: diet, .89; exercise, .83; blood glucose testing, .92; and foot care, .77. Principal component analysis revealed the presence of four components with eigenvalues greater than 1.0, explaining 34.4, 16.4, 15.4, and 11.2% of the variance in everyday practices for these items, respectively (accumulated = 77.1%). Conclusions: The translation and validation processes revealed acceptable psychometric properties. The instrument could evaluate diabetes self-care in Saudi Arabia and has the potential to be used in other Arabic-speaking populations.
Web-based literature search engines may not be user-friendly for some readers searching for information on female genital mutilation. This is a traditional practice that has no health benefits, and about 140 million girls and women worldwide have undergone it. In 2012, the website FGMReview was created with the aim to offer a user-friendly, accessible, scalable, and innovative knowledge management tool specialized in female genital mutilation. The design of this website was guided by a conceptual model based on the use of benchmarking techniques and requirements engineering, an area of knowledge from the computer informatics field, influenced by the Transcultural Nursing model. The purpose of this article is to describe this conceptual model. Nurses and other health care providers can use this conceptual model to guide their methodological approach to design and launch other eHealth projects.
Every day minority migrant nurses (MMNs) work shoulder to shoulder with domestic nurses in health care settings worldwide. Published studies offer reports of research where work–life experiences of MMNs have been explored. The following literature review focuses on experiences of perceived prejudice and discrimination as described by MMNs. Background and significance of the topic are described and the purpose of the review is presented, followed by definitions of relevant terms, search strategy, and theoretical considerations. Feagin and Eckberg’s discrimination typology is the framework used to organize MMNs’ reported experiences of perceived prejudice and discrimination. A theory-linked summary, including policy, practice, and research implications, concludes the article.
Purpose: Little is known about barriers that Latinas in the United States face in preventing unintended pregnancies beyond those of language and cost. This study examined factors inhibiting contraceptive use among 18- to 30-year-old Latinas in the Midwest. Method: Individual interviews (N = 31) were conducted in Spanish with Latinas residing across the state. The interview protocol included questions about contraceptives and unintended pregnancies. Interviews were recorded, transcribed, translated, and coded for themes related to barriers. Results: The majority of the barriers were related to communication but not English proficiency. Respondents talked about specific situations and experiences in which communication presented obstacles to using contraceptives. Discussion: While language and cost are important barriers, attention needs to be paid to the other communication issues that women face related to culture, religion, partners, family, and spontaneity. Implications: Health care providers need to address the range of communication barriers that affect Latinas’ contraceptive use.
The purpose of this article is to present the findings of a literature review regarding the use of Leininger’s ethnonursing research methodology (ENRM) in studies addressing adult cancer survivors. It is important to learn about differences and similarities among cancer survivors’ experiences so that patient-centered, culturally congruent care can be provided. A review of the literature was conducted using databases such as CINAHL and MEDLINE. Search terms included variations on ENRM and cancer survivors. The results were a small number of published studies that used the ENRM examining breast cancer survivors’ perceptions and experiences. A review instrument was developed to estimate study quality based on established criteria. The studies are critiqued in relation to the theory-based methodology, evaluation criteria for qualitative research, and study findings are summarized. The author concludes that although there is a paucity of research using ENRM with adult cancer survivors, the preliminary findings of the included studies contribute to what is known about breast cancer survivors. Implications for research include recommendations to increase the use of ENRM to discover the universal and diverse experiences of care practices in adult cancer survivors and use the evidence to develop patient-centered, culturally congruent, quality care for cancer survivors.
Storytelling is a basic cultural phenomenon that has recently been recognized as a valuable method for collecting research data and developing multidisciplinary interventions. The purpose of this article is to present a collection of nursing scholarship wherein the concept of storytelling, underpinned by cultural phenomena, is explored for data collection and intervention. A conceptual analysis of storytelling reveals key variables. Following a brief review of current research focused on storytelling used within health care, three case studies among three vulnerable populations (American Indian teen mothers, American Indian cancer survivors, and African American women at risk for HIV/AIDS) demonstrate the uses of storytelling for data collection and intervention. Implications for transcultural nursing regarding storytelling are discussed.
Purpose: Few studies have examined the behavioral and clinical indicators of sleep difficulty among older African Americans diagnosed with arthritis. This study aimed to examine the association of sleep, pain, and comorbid indicators among this population. Method: Using a cross-sectional design, 193 older African Americans (70.4 ± 9.11 years of age) completed a series of questions assessing health, pain, and sleep. Results: Findings showed that young old participants (β = –.28, p < .001) reported more difficulty sleeping and being awakened due to pain (β = –.17, p < .05) than the old old adults. Conclusion: There is significant within-group variability, with young old adults being most affected by sleep difficulties. Implications for Practice: While the relationship between pain and sleep may be intuitive for majority populations, the dynamics of this association may be useful in promoting sleep awareness and providing resources for caregivers and health care professionals to better meet the needs of this population.
Purpose: Palliative care options are limited for Native Americans (NA) in South Dakota (SD). This exploratory study offers the perspectives of Native and non-Native health care professionals regarding palliative care specific to NAs. Design: Semi-structured interviews were conducted (N = 7) with participants representing NA (4) and non-Native (3) ethnicities. Non-Native participants were practicing health care professionals in palliative medicine, whereas the NA health care professionals had experience with palliative care. Findings: Concept analysis revealed two main themes and five subthemes: (a) barriers to palliative care, for example, insufficient funding, lack of infrastructure, and misconceptions; and (b) implementation strategies, for example, openness and listening and creating the right team. Discussion: Genuine interest and concern exists for the provision of palliative care to NA communities using collaborative and innovative approaches. Implications: To address the health disparities of the NA population specific to palliative care, public health policy reform and education for health professionals are necessary.
Purpose: To identify gender differences in prehospital delay time (PDT) and its associated factors among acute coronary syndrome (ACS) patients. Design: Descriptive cross-sectional comparative study. Methods: This study was conducted among 249 ACS patients at two tertiary care hospitals of a large metropolitan city of Pakistan. Data were collected through the modified Response to Symptoms Questionnaire. Results: The median PDT of women was found to be 7 hours, compared to 3.5 hours among men (p = .001). Results of the regression analysis indicated that most women delayed because of social factors, such as attendants’ responses to their symptoms (p = .002), and because they were worried about expenses required for the treatment (p = .002); yet, most men delayed owing to individual factors, such as waiting for symptoms to subside (p< .001), and not recognizing the symptoms as being cardiac related (p< .001). Having anxiety and lack of knowledge about symptoms was associated with extended PDT among both genders. Conclusion: Women delayed longer than men in seeking treatment for their ACS symptoms. Different factors were associated with PDT in women and men. This study may provide important insights for designing interventional studies to reduce PDT in Pakistani ACS patients.
Purpose: The purpose of the study was to provide a greater understanding of the experience of the new Indonesian mother. Design: This study was a hermeneutic phenomenological study. Data were obtained from 13 first time Indonesian mothers through semi-structured interviews. Findings: Two main themes were identified: "trying to be a good mother " and "confirming my destiny as a woman." A number of subthemes were identified to understand of how women in rural West Java perceived the meaning of being a new mother. These themes and subthemes described the woman’s responsibilities as a new mother and some of the challenges that she accepted as a part of her destiny. Conclusion: This study provides nurses and others with insights into the experiences of Indonesian women with early motherhood, their feelings about taking on the mothering role, and some of their needs during this period.
Achieving English language proficiency, while key to successful adaptation to a new country for internationally educated nurses (IENs), has presented more difficulties for them and for educators than previously recognized. Professional communication within a culturally diverse client population and maintaining collaborative relationships between nurses and other team members were perceived as new challenges for IENs. Learning an additional language is a long-term, multistage process that must also incorporate social and cultural aspects of the local society and the profession. This article provides a descriptive review of current research literature pertaining to English language challenges, with a focus on oral language, experienced by IENs. Educational strategies for teaching technical language skills as well as the socio-pragmatics of professional communication within nursing programs are emphasized. Bridging education programs must not only develop students’academic language proficiency but also their ability to enter the workforce with the kind of communication skills that are increasingly highlighted by employers as essential attributes. The results of this review are intended to facilitate a clearer understanding of the English language and communication challenges experienced by IENs and identify the implications for designing effective educational programs.
The author reviewed cultural competence models and cultural competence assessment instruments developed and published by nurse researchers since 1982. Both models and instruments were examined in terms of their components, theoretical backgrounds, empirical validation, and psychometric evaluation. Most models were not empirically tested; only a few models developed model-based instruments. About half of the instruments were tested with varying levels of psychometric properties. Other related issues were discussed, including the definition of cultural competence and its significance in model and instrument development, limitations of existing models and instruments, impact of cultural competence on health disparities, and further work in cultural competence research and practice.
This study qualitatively explored the meaning of teenage motherhood to young Appalachian mothers. Fourteen in-depth interviews at the homes of mothers between the ages of 18 and 22 from the South Central Appalachian region were conducted. Findings indicate that teenage motherhood is symbolically reproduced by filling a void and providing escape from the drug culture. Analysis of these findings indicates that the meaning of motherhood is characterized by salvation. This salvation is shaped by the emotional chasm that motherhood fills, as well as the protective barrier it provides between the mother and the surrounding drug culture. Implications of these findings might include a need to examine the protective effects of motherhood from negative sociocultural forces among other subcultures. Also, the pervasive drug culture that surrounds young people in Appalachia should be taken into consideration when shaping policy and interventions for teenage pregnancy prevention.
Purpose: The purpose of this study was to determine the validity and reliability of the Tilburg Pregnancy Distress Scale–Turkish version (TPDS-T). Methods: The sample consisted of 214 healthy pregnant women in maternity clinics in an urban center in western Turkey. The instruments included a demographic questionnaire and TPDS-T. Results: The internal consistency reliability coefficient of the TPDS-T was .70. The correlation coefficients between the lower dimension item scores and lower dimension total scores were .20 to .73. According to the confirmatory factor analysis, the model fit indexes of the scale were determined as root mean square error of approximation = .051, goodness-of-fit index = .91, comparative fit index = .92, and nonnormed fit index = .90. Conclusion: The TPDS-T is a valid and reliable scale that can be used to determine distress of pregnant women in Turkey. Implications for Practice: This scale can be used as a guide by Turkish midwives and obstetric nurses planning pregnancy follow-up care.
Background: Malnutrition is an urgent problem in the developing world, especially for children under 5 years of age. The article describes the utilization of a standard of practice designed to prevent illness in a malnourished, under-5 indigenous population and reinforced by weekly basic health messages taught by lay community health promoters. Method: The two villages were chosen for observation after administration of the standard of care among the Maya-Kíché, the most numerous Mayan group in Guatemala. The standard of practice, 20 mg of daily oral zinc, was administered for 10 days in the home and followed by daily vitamin supplementation that continued throughout the 3 months of the project. All patients received four monthly clinic visits, with one of the village groups receiving weekly health promoter visits. Results: Data evaluated after the quality improvement project showed significant differences in adherence to the zinc regimen (2 = 3.677, p ≤ .05) as well as lower rates of diarrheal illnesses (2 = 5.850, p ≤ .05), with both of these improved in the health promoter group. Discussion: This study suggests that the training and implementation of para–health professionals from the lay community in response to specific health care needs could be considered a best practice in developing countries. Implications: Public health professionals are key to health promoter training and direction, and their importance in the global setting cannot be understated.
Purpose: The aim of this study was to describe the cultural factors that have an impact on military nursing care for Iraqi patients. The results were part of a larger study in which the purpose was to understand nurses’ experiences of delivery of care for Iraqi patients. Method: Three focus groups, consisting of military registered nurses and licensed practical nurses, were used to generate rich descriptions of experiences in a military combat support hospital in Iraq. Data were analyzed using thematic analysis methods. Findings: Culturally, the differences between the Iraqi patients and the nurses included variations in communication, diet, and beliefs and values in reference to gender and patient dependency. Conclusion: The findings indicated that the nurses need language skills and cultural customs and beliefs training to provide care to culturally diverse patients. In addition, support services, such as dieticians, need to be involved in the plan of care to address applicable cultural issues. Implications: Implementation of learning to provide nurses language skills and cultural awareness of the diet, customs and beliefs of Iraqi people as well as the economic, political, and social factors that have an impact on their lives will promote quality nursing care and optimal health outcomes.
Purpose: Hypertension treatment rates are disproportionately lower among Hispanics compared to non-Hispanic Whites and non-Hispanic Blacks. The purpose of this study was to examine the relationship among acculturation, health literacy, and illness perceptions of hypertension among Hispanics. Design: A cross-sectional correlational design was used, including 144 Hispanic adults with a self-reported diagnosis of hypertension. Method: The instruments used included the Short Acculturation Scale for Hispanics, the Newest Vital Sign instrument to measure health literacy, and the Brief Illness Perception Questionnaire. Results: Significant relationships were found among acculturation, health literacy, and several illness perceptions (consequences, control, symptoms, and emotions). Conclusion: Acculturation and health literacy play an important role in illness perceptions of hypertension among Hispanics. Implications: Findings could be helpful in the development of tailored health promotion interventions to improve hypertension management among Hispanic adults.
Despite extensive evidence supporting the health benefits of breastfeeding, significant disparities exist between rates of breastfeeding among African American women and women of other races. Increasing rates of breastfeeding among African American women can contribute to the improved health of the African American population by decreasing rates of infant mortality and disease and by enhancing cognitive development. Additionally, higher rates of breastfeeding among African American women could foster maternal–child bonding and could contribute to stronger families, healthier relationships, and emotionally healthier adults. The purpose of this article is twofold: (a) to use the social-ecological model to explore the personal, socioeconomic, psychosocial, and cultural factors that affect the infant feeding decision-making processes of African American women and (b) to discuss the implications of these findings for clinical practice and research to eliminate current disparities in rates of breastfeeding.
Purpose: This study aimed to describe the environment and the family support needs of families of Japanese nationals rearing children who are temporarily working in the Southwestern United States. Design: Mixed methods were utilized based on the Concentric Sphere Family Environment Model. Data collection occurred over 132 days, with 25 families participating in formal interviews and 40 families completing a written questionnaire survey. Findings/Results: "Mutual support from relatives and friends in Japan, and with local Japanese peers," and other themes, six in all, were extracted. Japanese families require intervention for measures related to the global environment in their daily lives. Discussion and Conclusions: The common factor for those families with high intervention needs was the inability to access family external resources that were usually available in Japan. Implication for Practice: The building of peer support and intervention to promote their participation in the community are necessary.
Purpose: Poor sexual health is a significant contributor to morbidity in young African American women. Knowing how sexual knowledge is transmitted to Black girls is needed to develop effective preventive interventions. The purpose of this study was to explore the ways in which Black mothers transmit sexual values and knowledge to their daughters. Design: Interviews were conducted with 14 mothers, aged 25 to 34 years, with daughters aged 8 to 16 years. Data were analyzed using constant comparative analysis. Findings: The themes derived were (a) truth telling, (b) building strength through self-esteem, and (c) spirituality as helper. The overarching cultural theme was "Growing Strong Black Women." Discussion/Conclusions: Mothers’ discussions with their daughters were infused with cultural meaning derived from their experiences. Black girls’ behavioral responses to their mothers’ strategies need to be studied. Implications: The findings will help nurses develop effective interventions that take into account the cultural realities of Black mothers.
Purpose: Determine the extent to which the lifestyles of Jamaican men with hypertension met the guidelines of the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Design and Methods: Following informed consent, a convenience sample of Jamaican men with hypertension (n = 48), of African ethnicity, attending a Type 5 Health Center was interviewed over a four week period, using a 31-item interview schedule. Results: Mean age of respondents was 65.2 (± 12.1) years (range = 35-89 years) with 33% having blood pressure (BP) controlled to 130/80 mmHg. Those meeting the guidelines were normal weight 23 (47.9%), DASH (dietary approaches to stop hypertension) diet zero, medication 7 (14.6%), exercise 14 (29.2%), alcohol restriction 38 (79.2%), and smoking cessation 40 (83.3%). Medication adherence was associated with BP control (r = –0.30, p < .04). More than half of the respondents believed that hypertension could be cured and that they could stop all treatment if their BP was normal. Discussion and Conclusions: Only a third of the sample had BP controlled to ≤130/80 mmHg. Adherence to the JNC 7 lifestyle guidelines was inadequate. Implications for Practice: A nurse led intervention, focusing on perceptions and lifestyle practices, is indicated.
Purpose: The study explored health care experiences among Asian Indian immigrants living in the Southeastern United States. Design and Method: A concurrent triangulation mixed methods design was used with a purposive sample of 125 Asian Indian immigrants aged between 40 and 64 years in the survey and 10 participants in the focus group. Results: The majority of the participants had health insurance and higher socioeconomic status. They had a moderate level of knowledge on the U.S. health care system and health insurance while presenting moderate satisfaction with the system. Barriers to health care services and needs in the health care system were identified from both quantitative and qualitative data. Some of the barriers were high costs, dissatisfaction with services, and inconvenience in accessing services. Participants called for self-management and community-based health programs as well as culturally tailored health care services. Discussion and Conclusion: Findings congruent with prior studies further support the importance of comprehending Asian Indians’ unique cultural background and experiences in the health care system. This study can be the foundation for culturally competent care to advance the body of transcultural nursing knowledge. Implications for Practice: Culturally congruent community-based health care programs are needed to provide better care for the ethnic minority to maintain and promote their health status.
Purpose: The purpose of this study was to explore factors that influence urban adolescent American Indian (AI) girls’ sexual risk behavior. Design: A qualitative study was conducted with grounded theory methodology to reveal factors and processes that influence sexual risk behavior. Method: Talking circles, individual interviews, and event history calendars were used with 20 urban AI 15- to 19-year-old girls to explore influences on sexual risk behavior. Results: The generated theory—framing sexual risk behavior—describes social and structural factors and processes that influenced the girls’ sexual risk behavior. The theory extends Bronfenbrenner’s ecological model by identifying microsystem, mesosystem, and macrosystem influences on sexual risk behavior. Discussion: Urban AI girls reported similar social and structural influences on sexual risk behavior as urban adolescents from other racial and ethnic groups. However, differences were noted in the family structure, cultural heritage, and unique history of AIs. Implications: This theory can be used in culturally responsive practice with urban AI girls.
Purpose:This study compares knowledge and practice of infant vitamin D supplementation among immigrant, refugee, and Canadian-born mothers. Method: Focus group discussions with 94 mothers of children aged 0 to 3 years recruited from early childhood centers and a refugee health clinic. Findings: Both immigrant and Canadian-born mothers indicated good knowledge and use of infant vitamin D supplementation. In contrast, Canadian government-assisted refugees were less likely to supplement with vitamin D. The main source of information about vitamin D was public health prenatal classes. Many mothers reported inconsistent guidance from health care providers. Discussion and Conclusions: Exclusively breastfed infants of refugees may be more at risk of vitamin D deficiency. All mothers require clear recommendations, both in clinical and public health settings. Implications for Practice: Mothers, both new Canadian and Canadian-born, require clear and consistent messaging from health professionals. Refugee mothers, however, require more educational support to promote infant vitamin D supplementation.
Purpose: A systematic review of the research on barriers and facilitators to mammography in Latinas was conducted to determine if the challenges faced by these women are unique to this population. Method: Medline and CINAHL database searches for the years 2005-2013 were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to guide this review. Results: Of the 174 articles identified, 18 articles met inclusion criteria. The most consistent findings were that income and education were associated with screening. Conclusions: Financial barriers and social characteristics were significant predictors of mammography in these studies, which were composed almost exclusively of low-income Latinas. These findings are similar to those found in other populations of low-income women and therefore are not likely unique to Latinas. Implications for Practice: It is likely that there is little difference between poor Latinas and other populations of poor, non-English-speaking women in barriers and facilitators to mammography.
The prevalence of diabetes and related complications are disproportionally higher in Native Americans. Diabetes self-management (DSM) is instrumental in preventing complications. The results presented here are a part of a larger hermeneutic phenomenology study to explore living with diabetes for one Pacific Northwest tribe. This study identified barriers to DSM within the worldview of the tribal people. Using purposive sampling, 10 Coeur d’Alene tribal members, ages 26 to 86 years, participated in in-depth interviews. Data interpretation used a three-step method leading to integrated themes across the transcripts. Perceived unsatisfactory care emerged as the major barrier to self-management, including communication barriers (distrust, misunderstanding, and educational methods) and organizational barriers (quality of care and access issues). Findings highlight the need to improve cross-cultural communication and calls for different approaches to diabetes education. Our profession is challenged to create new DSM and diabetes educational approaches for acceptable and compassionate cross-cultural nursing care.
Background: The experience of pain associated with surgery has been a challenge for health care professionals for many years, and culture is said to influence pain. Purpose: This study focused on patients’ experiences of postoperative pain (POP) and factors that affect POP. Design: The study employed qualitative ethnographic principles. Method: Data were collected through individual face-to-face interviews. Data were saturated after analyzing data from 13 patients from two hospitals in Ghana. Findings: Themes that emerged were the subjective nature of pain, which described pain dimensions and communication; psycho-sociocultural factors, such as personal inclinations and sociocultural background; and health system factors, such as personnel attitudes and health financing. Implications for Future Research and Practice: Health professionals need to understand the sociocultural effects of pain in order to give effective care. Conclusion: The study highlighted the need for patient education and the importance that health care professionals understand context-specific factors that influence POP management.
Purpose: The purpose of this study was to examine how the cultural factors, stigma, being strong, and religiosity influence symptom distress in African American cancer survivors. Methods: This descriptive correlational study was designed using the Sociocultural Stress and Coping Framework. Seventy-seven African American cancer survivors, recruited from oncology clinics and the community in North Carolina, completed a questionnaire that consisted of measures of demographic and illness characteristics, the Perceived Stigma Scale, the Ways of Helping Questionnaire, the Religious Involvement Scale, and the Symptom Distress Scale. Results: The two cultural factors that were significantly associated with symptom distress were stigma (β = .23, p < .05) and organized religion (β = –.50, p < .05). No significant associations were found between being strong or nonorganized religiosity and symptom distress. The most commonly reported symptoms were fatigue (M = 2.44, SD = 1.20), pain (M = 2.26, SD = 1.43), and insomnia (M = 1.95, SD = 1.25). Conclusions: The findings of this study indicate that the cultural factors, stigma, and organized religiosity were significantly associated with symptom distress. Implications for Practice: The results from this study can be used to guide researchers in developing culturally appropriate interventions aimed at alleviating symptom distress in African American cancer survivors.
This article is a report of the process and results of a feasibility pilot study to improve the quality of maternity care in a sample of 31 women and their newborns delivering in a public, tertiary hospital in the Dominican Republic. The pilot study was the first "action step" taken as a result of a formative, community-based participatory research (CBPR) study conducted between 2008 and 2010 by an interdisciplinary, international partnership of U.S. academic researchers, Dominican medical/nursing personnel, and Dominican community health workers. Health personnel and community health workers separately identified indicators most important to measure quality of antepartum maternity care: laboratory and diagnostic studies and respectful, interpersonal communication. At the midpoint and the completion of data collection, the CBPR team evaluated the change in quality indicators to assess improvement in care. The pilot study supports the idea that joint engagement of community health workers, health personnel, and academic researchers with data creation and patient monitoring is motivating for all to continue to improve services in the cultural context of the Dominican Republic
The purpose of this study was to evaluate the psychometric properties of the Appraisal of Diabetes Scale (ADS) in Korean patients with Type 2 diabetes. The English-language version of the ADS was translated into Korean using a forward-and-backward translation technique. The Korean version of the ADS (ADS-K) was administered to 250 patients who were recruited from two university hospitals. The data were analyzed using principal-component analysis, Cronbach’s alpha, analysis of variance, t test, and Pearson’s correlation. Six of seven items were meaningfully clustered into a two-factor structure by principal-component analysis, these factors accounting for 63.75% of the total variance. The underlying structure was consistent regardless of either gender or the presence of complications. The Cronbach’s alpha of the subscales ranged from .71 to .79, indicating an acceptable internal consistency reliability. As hypothesized, the ADS-K score was moderately correlated with the diabetes-specific quality of life and had satisfactory convergent validity. The known-groups validity of the ADS-K was established using depression groups and HbA1c control status. The ADS-K demonstrated good psychometric properties. In addition, it possessed satisfactory practical properties, such as acceptability and feasibility. Therefore, the ADS-K appears to be suitable for use in both clinical research and clinical practice.
Purpose: Evidence suggests that the construct of ethnic identity (EI) in adolescents changes over time and is related to factors including social connectedness, social competence, coping, and self-worth. Transitional changes of EI in middle adolescence have not been studied. Method: This analysis, part of a longitudinal study of health behaviors, explored how EI changes from the first year of high school to the last, and it examined relationships among EI, social connectedness, indicators of social competence, coping, and self-worth in 602 youth (49% Hispanic, 59% female). Results: EI was significantly related to social connectedness, social competence, coping, and self-worth as adolescents entered and prepared to exit high school. EI increased significantly over time for both genders and for Hispanics more so than for non-Hispanics. Discussion: Findings support and extend the conceptual framework and previous research. Socialization with one’s ethnic group is associated with developing competence and self-worth. EI development continues throughout high school. Conclusion: Findings extend our understanding of the salience of EI in adolescents in transition throughout high school. Implications: Strengthening EI may contribute to adolescents’ feelings of self-worth, skills in coping, and competence within an ethnically diverse society. Nurses might plan interventions to strengthen EI throughout adolescence.
Purpose: The authors examined population-specific risk factors that increase emerging adults’ risk of acquiring sexually transmitted infections (STIs), including the human papillomavirus (HPV). Design and Method: A cross-sectional sample of 335 diverse, emerging adults ages 18 to 24 years was recruited from a health center at a large university in the Southeastern United States. The mean age was 20.6 ± 1.9 years, majority were females (74.0%), and 61.0% were Hispanic. Results: Findings revealed inconsistent condom use, reasons for not using condoms, and a need for more culturally specific intervention strategies. Discussion and Conclusions: Healthcare providers should identify culturally specific reasons for inconsistent condom use, examine cultural and geographic differences in sexual risk behaviors among groups and communities, and modify communication, educational programs, and interventions accordingly. Implications for Practice: By adopting a multicultural approach to the control of STIs, nurses can address specific cultural attitudes and behaviors that may influence exposure to STIs, including HPV.
Aim: The purpose of this study was to examine facilitators and barriers that migrant women in Turkey identified related to breast self-examination, clinical breast examination, and mammography. Design: Focus group method was conducted with 39 women. An interview guide based on the Health Belief Model (HBM) and the Health Promotion Model (HPM) was used. Results: Three main themes became apparent as a result of data analysis: (a) knowledge and awareness about breast cancer, (b) personal factors, and (c) medical service provider and social environment. Conclusions: Focus groups conducted in line with HBM and HPM were effective in explaining barriers and facilitators toward participation of women in screening behaviors. Lack of information, indifference, and cultural factors are the most important barriers of women. Recommendations for Practice: The study will shed light on health care professionals working in primary health care organizations for developing the health training programs and consulting strategies in order to increase breast cancer screening practices of migrant women.
Purpose: Vietnamese American women diagnosed with cervical cancer are more likely to have advanced cancer than non-Hispanic White women. We sought to (a) develop a culturally sensitive Vietnamese translation of the Revised Susceptibility, Benefits, and Barriers Scale; Cultural Barriers to Screening Inventory; Confidentiality Issues Scale; and Quality of Care from the Health Care System Scale and (b) examine the psychometric properties. Design: Cross-sectional study with 201 Vietnamese immigrant women from the Portland, Oregon, metropolitan area. Method: We used a community-based participatory research approach and the U.S. Census Bureau’s team approach to translation. Results: Cronbach’s alpha ranged from .57 to .91. The incremental fit index ranged from .83 to .88. Discussion and Conclusions: The instruments demonstrated moderate to strong subscale internal consistency. Further research to assess structural validity is needed. Implications for Practice: Our approaches to translation and psychometric examination support use of the instruments in Vietnamese immigrant women.
Purpose: To explicate whether knowledge, perception of health threat, efficacy, and personal beliefs act as predictors for women’s intention to have a normal vaginal birth. Design: The study uses a mixed approach. Simultaneously, 290 pregnant women who visited prenatal clinics completed the study. Quantitative and qualitative data were collected using a structured questionnaire based on Witte’s extended parallel process model and four focus groups, respectively. Results: Women perceived lower risk but higher levels of efficacy. Perceived self-efficacy, severity, and response efficacy were identified as significant predictors of intention to experience vaginal birth. Participants’ insufficient knowledge and misconceptions about birth methods were dominant. Two major themes were identified and divided into negative and positive beliefs about vaginal birth. Discussion: The extended parallel process model provides a useful framework to assess women’s intention to have a vaginal birth, especially when it is combined with a qualitative approach. Within Iranian women, self-confident mothers are more likely to intend to deliver vaginally. Implication for Further Practice: Prenatal care provides an opportunity for nurses and midwives to explore mothers’ beliefs and intended childbirth method prior to offering medical intervention.
Purpose: This article evaluates the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) questionnaire, a measure of essential knowledge for type 2 diabetes self-management, after it was modified for English- and Spanish-speaking Mexican Americans. Method: We collected surveys (SKILLD, demographic, acculturation) and blood for A1C analysis from 72 community-recruited participants to analyze the SKILLD’s internal consistency, interrater reliability, item analysis, and construct validity. Clinical experts evaluated content validity. Results: The SKILLD demonstrated low internal consistency but high interrater reliability and content and construct validity. There were significant correlations in expected directions between SKILLD scores and acculturation, education, and A1C and significant differences in SKILLD scores between and within groups after an educational intervention and between high- and low-acculturated participants. Conclusion/Implications: The SKILLD generates useful information about Mexican Americans’ diabetes knowledge. Lower SKILLD scores suggest less diabetes knowledge, lower health literacy, and participants’ difficulties understanding items. Further modifications should improve use with low-acculturated Mexican Americans.
The aim of this study was to assess the coronary heart disease risk factors in the Asian Indian community living in a large city in Australia. A cross-sectional survey was conducted at the Australia India Friendship Fair in 2010. All people of Asian Indian descent who attended the Fair and visited the health promotion stall were eligible to participate in the study if they self-identified as of Asian Indian origin, were aged between 18 and 80 years, and were able to speak English. Blood pressure, blood glucose, waist circumference, height, and weight were measured by a health professional. Smoking, cholesterol levels, and physical activity status were obtained through self-reports. Data were analyzed for 169 participants. More than a third of the participants under the age of 65 years had high blood pressure. Prevalence of diabetes (16%) and obesity (61%) was significantly higher compared with the national average. Ten women identified themselves as smokers. Physical activity patterns were similar to that of the wider Australian population. The study has provided a platform for raising awareness among nurses and promoting advocacy on the cardiovascular risk among Asian Indians. Strategies involving Asian Indian nurses and other Asian Indian health professionals as well as support from the private and public sectors can assist in the reduction of the coronary heart disease risk factors among this extremely susceptible population.
This study explores the meaning of the lived experience of childbirth and parenting of Japanese men who became fathers in a foreign country. Japanese men have been raised to maintain very strict gender roles, excluding them from sharing with their wives the experience of childbirth and the day-to-day parenting of young children. The study employed a descriptive phenomenological approach with in-depth interviews. Participants included nine Japanese men born and raised in Japan who were living in Honolulu. Three theme categories emerged from the data: "making active efforts in preparation for childbirth in a foreign country"; "challenges in pregnancy, childbirth, child care, and as husbands or partners"; and "challenges in transition to parenthood." Japanese men successfully altered their transitional and authoritarian gender role to a family orientated social structure, under the influence of Western values, when living in foreign country. By spending more time with their new family, they acknowledged the processes of becoming a father. The ability to adapt their expectations of fatherhood in line with Western values was enhanced by the support of coworkers, their mature age, rich educational background, and the personal financial resources of the male participants in the study.
Purpose: Some nursing scholars assert that race and racism require a more explicit focus in cultural nursing education if the profession is to positively impact health care disparities. This study explored what White BSN cultural educators think, believe, and teach about race, racism, and antiracism. Method: Phenomenological methods were used to analyze interview data from 10 White BSN faculty members who taught cultural content. Findings: Four themes were identified: living and learning in White spaces, a personal journey toward antiracism, values transformed through personal relationship, and race at the margins. Discussion/Conclusions: Whiteness obscured the participants’ understanding and teaching of race; White nursing faculty were not well prepared to teach about race and racism; learning about these topics occurs best over time and through personal relationships. Implications: Faculty development regarding race and racism is needed to facilitate student, curricular, and institutional change.
Purpose: Native Hawaiian and other Pacific Islanders (NHOPIs) have the highest prevalence of overweight and obesity in the world. We identified the proportion of our NHOPI sample in each body mass index (BMI) category and explored relationships between BMI and demographic characteristics. Design/Method: Our descriptive correlational study included 364 NHOPI caregiver adults in Utah (n = 155) and Hawaii (n = 209). We gathered demographic information with a questionnaire. Height and weight were measured for BMI calculations. Results: According to the Centers for Disease Control and Prevention’s BMI categories, 84.3% of our sample was overweight or obese. Participants in Utah had significantly higher BMIs than participants in Hawaii. Educational attainment was inversely related with BMI; however, age, gender, and income were not significantly related with BMI. Discussion: NHOPIs on the U.S. mainland may be at greater risk for obesity than those in Hawaii; food price differences between locations may help explain this. NHOPIs in early adulthood had high BMIs; overtime this situation could worsen without intervention. Implications for practice: NHOPIs with low education levels or in areas of low food prices are at increased risk for obesity. Future research should focus on culturally sensitive interventions to reduce NHOPI obesity and associated risks.
Purpose: In Saudi Arabia, the health system is mainly staffed by expatriate nurses from different cultural and linguistic backgrounds. Given the potential risks this situation poses for patient care, it is important to understand how cultural diversity can be effectively managed in this multicultural environment. The purpose of this study was to explore notions of cultural competence with non-Saudi Arabian nurses working in a major hospital in Saudi Arabia. Design: Face-to-face, audio-recorded, semistructured interviews were conducted with 24 non-Saudi Arabian nurses. Deductive data collection and analysis were undertaken drawing on Campinha-Bacote’s cultural competence model. The data that could not be explained by this model were coded and analyzed inductively. Findings: Nurses within this culturally diverse environment struggled with the notion of cultural competence in terms of each other’s cultural expectations and those of the dominant Saudi culture. Discussion: The study also addressed the limitations of Campinha-Bacote’s model, which did not account for all of the nurses’ experiences. Subsequent inductive analysis yielded important themes that more fully explained the nurses’ experiences in this environment. Implications for Practice: The findings can inform policy, professional education, and practice in the multicultural Saudi setting.
Introduction: American Indian and Alaska Native (AIAN) women have relatively high breast cancer mortality rates despite the availability of free or low-cost screening. Purpose: This qualitative study explored issues that influence the participation of older AIAN women in mammography screening through tribally directed National Breast and Cervical Cancer Early Detection Programs (NBCCEDPs). Methods: We interviewed staff (n = 12) representing five tribal NBCCEDPs and conducted four focus groups with AIAN women ages 50 to 80 years (n = 33). Results: Our analysis identified four main areas of factors that predispose, enable, or reinforce decisions around mammography: financial issues and personal investments, program characteristics including direct services and education, access issues such as transportation, and comfort zone topics that include cultural or community-wide norms regarding cancer prevention. Conclusion: This study has implications for nurse education and training on delivering effective mammography services and preventive cancer outreach and education programs in AIAN communities.
How intimate partner violence (IPV), depression, and barriers to services affect Arab American women in the United States is not very well documented. This cross-sectional exploratory descriptive study examines (a) the relationship between depression and IPV and (b) whether living in the United States 10 or more years decreases barriers to reporting intimate partner violence and depression in a sample (N = 312) of Arab American women 19 years and older. Findings demonstrate significant relationships between women who were at risk for IPV and depression scores (r = .44, p < .001), and number of years living in the United States and barriers to service (r = .25, p < .001). There was a significant negative relationship between barriers to service and depression (r = –.30, p < .001), and barriers to service and IPV (r = –.23, p < .001), and number of years living in the United States and depression (r = .25, p < .001). Findings underscore the importance of screening referral and follow-up for Arab American women experiencing IPV and depression.
Purpose: The purpose of this synthesis is to explore the experience of the transition from cancer patient to survivor in African Americans with breast cancer, addressing the risk/ protective factors that have an influence on successful transition using the social ecological model. Methods: The investigator searched CINAHL, PubMed, and PsycInfo databases. Articles were assessed for content addressing risk and protective factors of transition in African American breast cancer survivorship. Eleven research articles were obtained and synthesized. Results: Risk and protective factors exist at all levels of the social ecological model. Emotional issues are prevalent after the cessation of cancer treatment, enhanced by the lack of social support in this population. Spirituality was shown to be present in many levels as a protective factor during this period. Conclusions and Implications for Practice: The entrance to survivorship represents a time of increased stressors and subsequent coping. Through careful identification of influencing factors, health care providers can develop strategies to attenuate the emotional distress and negative complications of the transition specific to this vulnerable population. Illuminating the experiences of African American women during this transition period provides insight into the interventional needs during and after the cessation of breast cancer treatment.
Minority involvement in clinical trials is necessary to promote diversification in health-related research. The clinical trials nurse is uniquely qualified to advocate for and ensure the success of the minority participant in clinical trials research during the processes of recruitment, informed consent, and retention of subjects. This article incorporates a review of literature in conjunction with the American Nurses Association’s standard of practice number 7 regarding ethics to demonstrate how the role of the clinical trials nurse as subject advocate can facilitate successful participation of minorities in clinical trial research.
Purpose: Substantial health disparities exist between Māori—the indigenous people of Aotearoa New Zealand—and non-Māori New Zealanders. This article explores the experience and impact of racism on Māori registered nurses within the New Zealand health system. Method: The narratives of 15 Māori registered nurses were analyzed to identify the effects of racism. This Māori nursing cohort and the data on racism form a secondary analysis drawn from a larger research project investigating the experiences of indigenous health workers in New Zealand and Canada. Jones’s levels of racism were utilized as a coding frame for the structural analysis of the transcribed Māori registered nurse interviews. Results: Participants experienced racism on institutional, interpersonal, and internalized levels, leading to marginalization and being overworked yet undervalued. Discussion and Conclusions: Māori registered nurses identified a lack of acknowledgement of dual nursing competencies: while their clinical skills were validated, their cultural skills—their skills in Hauora Māori—were often not. Experiences of racism were a commonality. Racism—at every level—can be seen as highly influential in the recruitment, training, retention, and practice of Māori registered nurses. Implications for Practice: The nursing profession in New Zealand and other countries of indigenous peoples needs to acknowledge the presence of racism within training and clinical environments as well as supporting indigenous registered nurses to develop and implement indigenous dual cultural-clinical competencies.
Many challenges exist when providing international education to those who care for people at the end of life. Though issues related to culture and language may vary, the one commonality that crosses all nations is that its people die. In general, societies seek to provide the best care they are trained to give. Many have few resources to provide this care well. Traditions of the past influence norms and dictate policies and procedures of the present. Since its inception in 2000, the End-of-Life Nursing Education Consortium Project has provided palliative care education to nurses and other members of the interdisciplinary team in six of the seven continents. This article describes the efforts of this project to improve education around the globe, with the goal of providing excellent, compassionate palliative care, irrespective of location, financial status, political views, religion, race, and/or ethnicity.
Purpose: To determine the community resources most often used, most needed, and most difficult to use for immigrants. Design: A naturalistic study using principles of community-based participatory research. Method: A group of 106 abused immigrant women were interviewed in person with the Community Agency Use, Frequency, Helpfulness, and Difficulty form as part of a 7-year prospective study. Results: The most frequently noted service needed most was counseling (n = 34, 33.0%) followed by legal services (n = 23, 22.3%) and social services (n = 13, 12.6%). Law enforcement was the most commonly used service (n = 63, 59.4%) and the most difficult to receive (n = 16, 48.5%). Counseling (n = 6, 18.2%) and legal services (n = 5, 15.2%) were also reported as difficult. Discussion: Law enforcement is often called on to help in partner violence, but immigrant women report difficulty in using this service. Conclusions: Abused immigrant women have risk factors for abuse, and they face barriers in accessing the services they need. Implications for Practice: It is important for service providers in the community to be aware of the unique challenges of abused immigrant women and to address their needs accordingly.
Childhood obesity affects approximately 20% of U.S. preschool children. Early prevention is needed to reduce young children’s risks for obesity, especially among Hispanic preschool children who have one of the highest rates of obesity. Vida Saludable was an early childhood obesity intervention designed to be culturally appropriate for low-income Hispanic mothers with preschool children to improve maternal physical activity and reduce children’s sugar-sweetened beverage consumption. It was conducted at a large southwestern United States urban health center. Presented here are the methods and rationale employed to develop and culturally adapt Vida Saludable, followed by scoring and ranking of the intervention’s cultural adaptations. An empowered community helped design the customized, culturally relevant program via a collaborative partnership between two academic research institutions, a community health center, and stakeholders. Improved health behaviors in the participants may be attributed in part to this community-engagement approach. The intervention’s cultural adaptations were scored and received a high comprehensive rank. Postprogram evaluation of the intervention indicated participant satisfaction. The information presented provides investigators with guidelines, a template, and a scoring tool for developing, implementing, and evaluating culturally adapted interventions for ethnically diverse populations.
Purpose: This qualitative study was conducted with 14 South Asian women in Hong Kong to explore their perception and experiences of domestic violence by an intimate partner. Design: All interviews were transcribed and then coded based on the process of coding suggested by Strauss and Corbin, including both open and axial coding. Results: Data analysis resulted in two main core categories, "Women’s perception of domestic violence" and "Cultural factors that influence their help-seeking behavior," denoting that the context in which domestic violence is experienced influences women’s perception and understanding of domestic violence. Participants also drew on the discourse of culture to explain its role in their experiences of domestic violence. Conclusion: Domestic violence is a concern among this group of South Asian women. Culturally appropriate domestic violence services and public education on domestic violence are needed for this community.
The purpose of this pilot study was to examine the effect of a 9-week instructional intervention designed to increase 24 Caucasian American occupational therapy students’ awareness of personal racial attitudes toward African Americans. The learning content focused on specific cognitive-perceptual biases thought to play a role in the formation of racial attitudes. A pre- to posttest implicit measure of racial bias indicated an increase in bias in some students following the intervention and a decrease of bias in others. Students’ perception of the instruction and subsequent stereotype activation are discussed as possible moderators of the intervention’s effectiveness. Several implications for future instruction and research are suggested to address factors that may limit antibias instruction.
Purpose: To critically analyze the power relations underpinning New Zealand maternity, through analysis of discourses used by Korean migrant mothers. Design: Data from a focus group with Korean new mothers was subjected to a secondary analysis using a discourse analysis drawing on postcolonial feminist and Foucauldian theoretical ideas. Results: Korean mothers in the study framed the maternal body as an at-risk body, which meant that they struggled to fit into the local discursive landscape of maternity as empowering. They described feeling silenced, unrecognized, and uncared for. Discussion and Conclusions: The Korean mothers’ culturally different beliefs and practices were not incorporated into their care. They were interpellated into understanding themselves as problematic and othered, evidenced in their take up of marginalized discourses. Implications for Practice: Providing culturally safe services in maternity requires considering their affects on culturally different women and expanding the discourses that are available.
The purpose of this study was to explore diabetes self-management strategies and underpinnings of behaviors among Vietnamese with type 2 diabetes. Using Leventhal’s illness representation model, semistructured interviews were conducted with a convenience sample of 23 participants, 14 women and 9 men. NVivo 8 software was used for content analysis. Data revealed that participants constructed implicit theories of the identity, causes, consequences, timeline, and controllability of diabetes, which were inconsistent with the biomedical literature. Participants labeled diabetes by their symptoms of hypo-/hyperglycemia, and they focused on the relief of these symptoms. However, the participants’ focus on symptomatology undermined their use of blood glucose monitoring to manage diabetes as a majority of the participants had diabetes-related complications. Participants integrated the continuum of Eastern and Western treatment belief systems to achieve a balance to create harmony between the two systems.
Purpose: To explore Australian nursing students’ perceptions of spirituality, religiosity, and personal belief. Background: Spiritual and religious literature support the benefits to patients’ physical and mental health. Nurses have an ethical obligation to understand and incorporate patient’s spiritual beliefs and values into the care plan. Method: A cross-sectional survey was conducted using the 32-item WHO-QOL-SRPB questionnaire. Sample: The sample consisted of 483 undergraduate nursing students in Sydney, Australia. Results: There were 21% male and 79% female students; age ranged from 18 to 56 years, with a mean age of 26.53 (SD = 7.32). There were no significant difference between male and female nursing students, but there were difference in SRPB scores between first-, second-, and third-year students and between religious affiliations. Conclusions and Implications: Spirituality is multidimensional and multilevel and is interconnected with religiosity and personal belief. Nurses need to understand their own spirituality before they can incorporate spirituality in their patient care.
Increasing cultural diversity in the United States and significant health disparities among immigrant populations make acculturation an important concept to measure in health research. The purpose of this cross-sectional, descriptive study was to examine acculturation and health of Korean American adults. A convenience sample of 517 Korean American adults in a Midwestern city completed a survey in either English or Korean. All four groups of Berry’s acculturation model were identified using cluster analysis with Lee’s Acculturation Scale. Assimilation, integration, and separation were found in the English survey sample, whereas integration, separation, and marginalization were found in the Korean survey sample. Moreover, the findings revealed that acculturation is a bidimensional process, and the unique nature of samples may determine acculturation groups. Physical health and mental health were significantly related to acculturation in the English survey sample. However, there was not a significant relationship between health and acculturation in the Korean survey sample.
Purpose: This study demonstrates preliminary evidence of the utility of an optimality index as a simple tool for monitoring complications across the perinatal period. Method: The medical records of 147 Latina women participating in a preventive randomized controlled trial for perinatal depression were reviewed for outcomes across the perinatal period. Results: Application of the optimality index found optimality scores ranging from 77.3% to 97.7% in a Latina immigrant population known to have low rates of low–birthweight infants and preterm birth. Optimality scores were significantly lower among women who had a preterm birth or low–birthweight infant. Discussion: The ability of optimality indices to capture within-group variability will allow for a more nuanced understanding of the antecedents and sequelae of negative birth outcomes. Implications for Practice: Increasing reliance on electronic medical records will facilitate the calculation of optimality scores that can be used to track patterns of perinatal health disparities.
The Swahili of Lamu, Kenya, understand illness as the result of a spiritual imbalance caused by personal transgression or an attack by harmful forces directed by an envious person. Another underlying component of the Swahili concept of illness is that each person’s physical body operates in conjunction with personal attributes that are fixed at birth and determine moral character, behavior, and predisposition to ailments. When physical symptoms occur, the Swahili focus on identifying the human or supernatural entity that caused the illness in consultation with a range of healers who specialize in a variety of curing strategies. Two case studies illustrate how culturally congruent nursing care can be achieved when health care providers understand the Swahili framework of diagnosing and treating illness.
Purpose: The purpose of this study was to evaluate the attitudes of nursing and medical students toward older people in Turkey. Method: This was a cross-sectional and comparative descriptive study. The Turkish version of Kogan’s Old People Scale was used to evaluate attitudes toward older people among 618 students. Results: Medical students showed more positive attitudes toward older people than nursing students. Students who were females, whose economic income was less than expenditure, and who were not interested in working with older people after graduation showed less positive attitudes. Conclusion: The results suggested that positive attitudes toward older people exist; despite this, it is obvious that more efforts are required to enhance these attitudes. Implications for Practice: Revision and improvement in curricula are needed to enhance the attitudes of students toward older people, and lecturers in schools should further consider the need to prepare students for their roles as caregivers for this particular group.
Type 2 diabetes mellitus (T2DM) is a steadily growing epidemic in the United States, especially for overweight Latino youth who are among the highest at-risk for T2DM development. Although dietary interventions are not often inferred to patients prior to T2DM diagnosis, they may be implicated in risk reduction. The purpose of this review is to examine the use of dietary fiber in reducing the risk of T2DM in Latino youth. The main results of this examination found that a wide variation in use of dietary fiber intake or supplementation resulted in an overall inverse relationship and association with visceral adipose tissue, metabolic syndrome, and insulin resistance. However, due to inconsistencies in fiber definition and/or implementation, dietary and supplemental fiber intake must be further explored in randomized controlled trials so that more agreement may be reached on fiber recommendations, especially in populations at high risk for T2DM such as Latino youth.
Purpose: The aim of this study was to evaluate the reliability and validity of the Turkish version of the Beliefs about Dietary Compliance Scale (BDCS-T). Methods: This methodological study enrolled a sample of 140 patients. Data were collected by using a questionnaire form, the BDCS-T, and the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire. Descriptive statistics, the one-sample Kolmogorov-Smirnov test, Mann–Whitney U test, correlation coefficients, and psychometric tests were used for the analysis of data. Results: The factor analysis confirmed that the BDCS-T had a two-factor structure (perceived benefits and perceived barriers) explaining 58.7% of the total variance. The BDCS-T had acceptable internal consistency (Cronbach’s alpha coefficients: perceived benefits = .91; perceived barriers = .66), test–retest reliability (intraclass correlation coefficients: perceived benefits = .93; perceived barriers = .79), concurrent validity with the Dialysis Diet and Fluid Restrictions Nonadherence Questionnaire scores, and known group validity with intensity of diet nonadherence. Conclusions: The BDCS-T was found to be a reliable and valid tool for assessing the beliefs related to salt-restricted diet in patients on hemodialysis. Implications for Practice: Nurses are recommended to make tailored interventions by taking the benefits and barriers that the patients perceive toward low-salt dietary adherence into account.
Purpose: Two tools were created to help international students to better understand culture by becoming more astute observers of nonverbal behaviors, particularly behaviors depicting emotions among Norwegian students. Design/Method: The two tools were a trilingual list of words illustrating emotions and an exercise with images to practice verbalizing their observations of emotional expression. Findings: Students compared the subdued behaviors of Norwegians to the Israelis’ very vivid behaviors. The intense emotional expression of Israelis influenced their interpretations. By making comparisons and through the experiences with Israelis, they learned more about culture and their own emotional expression. Discussions and Conclusions: Creative strategies can contribute to students understanding and reflection of patients in a different culture. Implications for Practice: Encouraging students to grasp the nuances of emotional expression is part of understanding a different culture. Students, like faculty, learn that self-exploration is an evolving process that requires checking out one’s assumptions and interpretations.
Purpose: To translate and test the psychometric properties of the Turkish version of the Infertility Self-Efficacy Scale–Short Form (TISE-SF). Methods: The convenience sample consisted of 120 infertile women. A psychometric research design was used with content and construct validity and reliability. Results: Cronbach’s alpha of .78 showed moderate reliability, whereas item–total correlations ranged from .30 to .54. Factor analysis extracted a single component, explaining 40.3% of the variance. Kendall W showed agreement with each expert regarding the appropriateness of the items, confirming the content validity of the translated TISE-SF. Conclusion: The results supported the construct validity and reliability of the TISE-SF for measuring infertility self-efficacy in a population of Turkish women. Implications: Evaluating infertile women’s perception of self-efficacy with the TISE-SF may be useful in clinical studies in Turkey. TISE-SF can be used by professionals as a counseling tool to help guide women in managing their treatments at infertility centers.
Spain has seen a significant increase of the immigrant population in the past two decades. There are 5.6 million registered immigrants in this country, and 63% of them range in age between 16 and 41 years; 47% of the immigrant population are women. This situation requires additional health care, particularly as it pertains to the sexual and reproductive health of female immigrants. The objective of our study was to determine if there were differences between women of Spanish origin and immigrant women in terms of obstetric outcomes (obstetric history, gestational age at end of gestation, and at delivery) and various psychological variables during the immediate postpartum period. This was a cross-sectional study—we evaluated 30 women of Spanish origin and 30 immigrant women during the immediate postpartum period. During the 4 months after delivery, we proceeded to gather perinatal data for the study participants from their health records, partograms, and nursing assessment notes. Additionally, and following the immediate postpartum period, participants filled out the Stress Perception and Stress Vulnerability Questionnaires, as well as the Optimism Scale. Immigrant women have greater perception of stress (p = .00) and vulnerability to stress (p = .001) than do Spanish women. However, no group differences were found in obstetric variables.
Purpose: The purpose of this study was to develop a scale to measure the social smoking motives of adult male smokers using a Chinese social context. Design: Three phases were conducted between February 2006 and May 2009. First, the initial instrument development was guided by a literature review, interviews with smokers, and item analysis. Second, the validity and reliability of the refined scale were tested. The factor structures of the Social Smoking Measures (SSM-12) scale were validated. Results: The final scale consists of 12 items. Two factors that account for 49.2% of the variance emerged from the exploratory factor analysis. Cronbach’s alpha was .88, and test–retest reliability was .82. The results of the confirmatory factor analysis indicated that the SSM model was a two-correlated factor. Conclusion: Field testing revealed the SSM-12 to be a reliable and valid Chinese-language instrument to measure social smoking motives, which can be used to guide nursing interventions that support culturally and socially appropriate smoking cessation programs.
Introduction: Eight out of 10 Mapuche indigenous women have a musculoskeletal disorder (MSD) and do not seek early medical aid. Purpose: To study both the cultural meanings and implications of MSD from the Mapuche worldview. Design: Ethnographic study carried out from 2008 to 2011 on indigenous reserves in southern Chile. Sixty-four Mapuches participated in comprehensive interviews, which were transcribed and analyzed by the research team. Findings: Five cultural domains: (a) foro kutran/bone disease is the general denomination of MSD; (b) Re-Rume Kutran/progressive and incurable course, refers to the course of the disease; (c) Kalül fücha mawiza/body is an old tree, describes internal manifestations such as worn bones, dry body, weak blood, and spiritual weakness; (d) witrür tripai foro/deformation is the external manifestation of MSD; and (e) Reñma ka lof kutran/family and community suffering refers to the impact of MSD. Conclusions: The explanation of MSD is consistent with the integrated body–nature–spirit worldview of the Mapuche. Practice Implications: To provide cultural nursing health care so that patients receive prompt diagnosis and care.
Purpose: The purposes of the study are to (a) assess the incidence and frequency of psychological violence (verbal abuse) among Jordanian hospital nurses, (b) explore the complaints and the reactions of nurses to such violence, and (c) identify the factors that contribute to workplace violence and the management modalities from the Jordanian nurses’ point of view. Design: A descriptive survey was used to investigate verbal abuse among a convenience sample of 422 Jordanian nurses. The Questionnaire of Workplace Violence, which was developed in 2003 by the International Labor office, International Council of Nurses, World Health Organization, and Public Services International, was used to collect the data. Results: The findings indicated that almost 70% of participants was exposed to verbal abuse in the workplace. Patients’ families were the main perpetrators of these incidents. The contributing factors to psychological violence as perceived by participants were related to administration, staff, patients and their families, workplace setting, and security. The majority of participants indicated that their employers had no polices against psychological workplace violence. Implications: Helpful strategies for reducing psychological violence include implementing security measures, restricting public access, and maintaining adequate staffing.
Study Purpose: Describe the comparative birthing experiences of Pakistani immigrant women in Pakistan and the United States. Conceptual Framework: The framework was drawn from Berry’s cultural adaptation, Glick-Schiller et al.’s transnationalism and Berkman’s social network. Methodology: Qualitative design using purposive sample of 26 women immigrants who originated from any province in Pakistan and experienced childbirth in Pakistan and in the United States. Individual interviews were conducted in Urdu and English in participants’ homes which lasted for approximately 60 minutes. Telephone follow-up augmented the audiotaped interviews. Findings: Women experienced difficulties associated with inability to observe cultural traditions and loss of extended, gendered kin support. Adaptive strategies were evident through development of social networks of weak ties with nonkin groups in the United States, maintenance of transnational ties with kin back in Pakistan, and assimilation of less gender-defined roles by women and their spouses.
This study assessed the reliability, validity, sensitivity, specificity, and predictive values of the Spanish Postpartum Depression Screening Scale (PDSS–Spanish Version) for Mexican women. The scale was administered at 6 weeks (T1; n = 149) and between 4 and 6 months postpartum (T2; n = 156). Women also completed the Beck Depression Inventory–Second Edition (BDI-II) and the mood module of the Standardized Clinical Interview for DSM-IV (SCID). At both time points, the internal consistency value of the PDSS-Spanish Version was α = .96. Concurrent validity was adequate, compared with the BDI-II (T1: r = .75; T2: r = .74, ps < .01) and the SCID (T1: r = .43; T2: r = .36, ps < .01). Based on receiver operator characteristic curves, cutoff scores on the PDSS-Spanish Version of 60 for depressive symptoms (BDI-II as gold standard) and 80 for major depression (SCID) showed high sensitivity (>88.9%) but low specificity (60.9% to 70.6%). More parsimonious values are obtained at a cutoff of 77 for subsyndromal depression and 95 for major depression. The choice for using different cutoff scores may depend on the purpose of using the instrument. Overall, the psychometric properties for the PDSS-Spanish Version in Mexican women are similar to the ones obtained in Hispanic women in the United States.
Aims:To describe the translation process of nursing instruments into Arabic and discuss the equivalence issues arising from this process. Method: Review of the literature. Results: The Arabic language is essentially three different languages: Classical Arabic; Modern Standard Arabic (fuS-Ha or MSA); and colloquial Arabic (Lahja A’mmeya), which is itself divided into five different regional Arabic dialects. The Arabic fuS-Ha language is the dialect most widely used in the translation of instruments into Arabic. The literature reveals that only a few studies focused on the linguistic issues in the translation of instruments into Arabic. Brislin’s back-translation emerged as the most common method widely used by researchers in studies with Arabic-speaking subjects, but not the perfect one. Conclusion: Linguistic issues in nursing research have not been sufficiently described and discussed in the context of Arabic language and culture. Although there is no standard guideline for instrument translation, the combined translation model is the most recommended procedure to use in cross-cultural research. Linguistic differences between the source culture and the target Arabic culture should be taken into account. Finally, we recommend the use of the fuS-Ha dialect and trilingual translators in the translation of nursing instruments into Arabic.
Purpose: This study aimed to describe the nursing interventions that nurses in Thailand identify as most important in promoting dignified dying. Design: This study used a cross-sectional descriptive design. Method: A total of 247 Thai nurses completed a paper-and-pencil survey written in Thai. The survey included both demographic questions and palliative care interventions, listed with summative rating scales, from the International Classification for Nursing Practice (ICNP) catalogue Palliative Care for Dignified Dying. Descriptive statistics were used to analyze the data. Findings: The five most important nursing interventions to promote dignified dying, ranked by average importance rating, were (a) maintain dignity and privacy, (b) establish trust, (c) manage pain, (d) establish rapport, and (e) manage dyspnea. Conclusions: This research identified the palliative care nursing interventions considered most important by nurses in Thailand to promote dignified dying. Implications for Practice: The ICNP catalogue Palliative Care for Dignified Dying can be used for planning and managing palliative nursing care in Thailand.
Purpose: Patients with lung disease develop coping strategies to relieve dyspnea. The coping strategies of Korean immigrants, however, are poorly understood. The purpose of this study was to describe the strategies that Korean immigrants with asthma or chronic obstructive pulmonary disease (COPD) use to cope with dyspnea and to compare similarities and differences in coping strategies between the two conditions. Design: Outpatients with asthma (n = 25) or COPD (n = 48) participated in a cross-sectional descriptive study. Method: Open-ended questions and a structured instrument were used to describe coping strategies for dyspnea. Descriptive and inferential statistics were used to analyze the data. Results: The most prevalent strategy was "I keep still or rest." Korean immigrants also used traditional therapies to manage dyspnea. Conclusions: Although the coping strategies of Korean immigrants were similar to those of other ethnic groups, they incorporated elements of Asian medical practice and herbs. This finding enables health care providers to better understand Korean immigrants’ efforts to overcome dyspnea and to guide their patients’ approach to coping.