A Feasibility Study of Muslim Cancer Survivors' Experience in the United States: Recruitment and Data Collection

BACKGROUND

Studies with U.S. Muslims have had difficulty recruiting participants.

METHOD

This article, which was part of a larger qualitative study, aimed to describe the effectiveness of targeted recruitment and data collection strategies in Muslim cancer survivors. The purpose of the larger qualitative study was to gain an understanding of the experiences of Muslim cancer survivors in the United States. Four recruitment approaches were implemented to determine timeliness, diversity in respondents, and success in completing the interview.

RESULTS

Eighteen Muslim cancer survivors participated (12 males, 6 females). Ten Muslim participants were identified by community leaders, two by posted flyers, four using social media, and two by a physician. No burden was voiced by participants related to length, time, or location of interviews.

DISCUSSION

We demonstrated the feasibility of recruiting and interviewing Muslim cancer survivors. Using culturally sensitive approaches is important to encourage recruitment and participation in studies of Muslim cancer survivors.

Culture Care Beliefs and Practices of Ethiopian Immigrants

INTRODUCTION

The purposes of this mini study were to identify and describe the culture care beliefs and practices of Ethiopian immigrants in the mid-Atlantic region of the United States and to advance the science of transcultural nursing.

METHODOLOGY

Leininger's theory of culture care diversity and universality guided the research and was the framework for the design of this qualitative ethnonursing mini study. Data were collected from 15 participants through in-depth interviews.

RESULTS

Five themes and 14 care patterns merged from the data, including preserving cultural heritage, supporting family and friends, importance of religion and prayer, valuing freedom, cultural caring, and therapeutic communication.

DISCUSSION

Participants valued health care and medical technology in the United States. They wanted nurses to inquire about their culture, language preference, food and dietary practices, and family dynamics. Perceived lack of caring by nurses and unavailability of interpreters in health care settings negatively affected access to care.

Marital Violence During War Conflict: The Lived Experience of Syrian Refugee Women

INTRODUCTION

Marital violence increases during times of war. This study aims to describe the lived experience of marital violence toward Syrian refugee women during the current war in Syria.

DESIGN

A descriptive phenomenological research methodology was used to conduct semistructured interviews with 16 purposively selected Syrian refugee women residing in displacement centers in Jordan. Colaizzi's steps of data analysis were used.

RESULTS

Four themes identified were identified: (1) Loss, insecurity, and suffering; (2) Shame and humiliation; (3) Justifying and enduring marital violence; and (4) Ways of coping with marital violence.

CONCLUSION

The Syrian War conflict changed women's lifeway and created a context for marital violence. Study findings suggests addressing marital violence during wartime and allocating resources to provide care and support of victims of violence in the displaced countries.

Culturally Relevant Palliative and End-of-Life Care for U.S. Indigenous Populations: An Integrative Review

PURPOSE

American Indians/Alaska Natives (AIs/ANs) have higher rates of chronic illness and lack access to palliative/end-of-life (EOL) care. This integrative review ascertained the state of the science on culturally acceptable palliative/EOL care options for Indigenous persons in the United States.

DESIGN

Databases searched: CINAHL, PubMed/MEDLINE, SocINDEX, PsycINFO, PsycARTICLES, ERIC, Health Source: Nursing/Academic Edition, and EBSCO Discovery Service 1880s-Present. Key terms used: palliative care, EOL care, and AI/AN.

INCLUSION CRITERIA

peer-reviewed articles published in English. Findings/Results: Twenty-nine articles were identified, 17 remained that described culturally specific palliative/EOL care for AIs/ANs. Synthesis revealed four themes: Communication, Cultural Awareness/Sensitivity, Community Guidance for Palliative/EOL Care Programs, Barriers and two subthemes: Trust/Respect and Mistrust.

DISCUSSION/CONCLUSION

Limitations are lack of research funding, geographic isolation, and stringent government requirements. Palliative/EOL care must draw on a different set of skills that honor care beyond cure provided in a culturally sensitive manner.

Improving Culturally Congruent Health Care for Children With Disabilities: Stakeholder Perspectives of Cultural Competence Training in an Interdisciplinary Leadership Training Program

INTRODUCTION

Racially/ethnically diverse children with disabilities experience increased risk for health care disparities when compared to non-Hispanic White children with disabilities or racially/ethnically diverse children without disabilities. The purpose of this study was to progress culturally congruent health care by exploring cultural competence (CC) for an interdisciplinary leadership training program designed to improve services for children with disabilities. The study also sought to bridge a gap in the literature by including the perspectives of diverse health care consumers.

METHOD

Q-methodology was used to support participant groups' sorting of CC training outcomes by importance to identify factors of CC.

RESULTS

Data collected from 51 participants were subjected to a by-person factor analysis that yielded six factors explaining 50% of variance.

DISCUSSION

Findings validate some common elements of existing CC models and provide new perspectives regarding potentially overlooked aspects of CC, with many new perspectives provided by racially/ethnically diverse parents of children with disabilities.

Cancer Worry Among Urban Dominican Women: A Qualitative Study

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.

Community-Informed Health Promotion to Improve Health Behaviors in Honduras

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.

Beliefs about diabetes and medication adherence among Lumbee Indians living in rural southeastern North Carolina

This study assessed personal beliefs about the causes and meaning of having diabetes among the members of the Lumbee Indian tribe living in rural southeastern North Carolina. The sample included 20 males (50%) and 20 females (50%); the mean duration of having diabetes was 9.82 years. The average body mass index (BMI) for females was 34.76 (range, 24.21-55.44), whereas the average BMI for males was 35.10 (range, 22.71-59.71). Ninety percent reported a family history of diabetes. The majority of participants held beliefs that diabetes was a serious and chronic condition and that the disease was amenable to personal control. Participants perceived that diabetic medications were an essential and effective part of their treatment regimen, and they reported greater comfort in adhering to prescribed medication regimens than making long-term lifestyle changes. This study highlights the high prevalence of diabetes among Lumbee Indians and also the need for future studies in this area.

Aging, Genetic Variations, and Ethnopharmacology: Building Cultural Competence Through Awareness of Drug Responses in Ethnic Minority Elders

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.

Can Faith and Hospice Coexist: Is the African American Church the Key to Increased Hospice Utilization for African Americans?

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.

Understanding Sociocultural Factors Contributing to HIV Risk Among Ayoreo Bolivian Sex Workers

The Bolivian indigenous Ayoreo ethnic people are vulnerable to sexually transmitted infections and HIV. Ayoreo women who also work in sex trades belong to an extremely high-risk group, and prevention programs are not delivering effective outcomes for them. The aim of our study was to explore, describe, and understand behavioral and cultural patterns related to sexual and reproductive health in Ayoreo sex workers. A qualitative-ethnographic study was designed; data were collected through participant observation and in-depth interviews with sex workers and key informants. Two fundamental themes contributing to HIV risk for female Ayoreo sex workers in Bolivia emerged: reproductive/sexual freedom and sociocultural risk determinants. We concluded that the in-depth examination of the sexual-reproductive culture amongst the Ayoreo has provided useful information, which might contribute to the cultural adaptation and design of future policies and prevention programs for sexually transmitted infections and HIV in this group.

Factors Associated With Healthy Lifestyle Behaviors in a Sample of Turkish Adolescents: A School-Based Study

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.

Does a Culture of Appalachia Truly Exist?

Some disagreement exists about whether an Appalachian culture exists. Common notions about Appalachia's people are tied to myths that disguise truths about those that claim a heritage tied to place. Living in the region is different from having multiple generations of ancestors and a family legacy associated with place. Conclusions suggest that cultural traits of some residents are recognizable as unique from others in the nation's mainstream, but they are not generalizable to all people living in the Appalachian region.

Nurses leading the fight against Ebola virus disease

The current Ebola crisis has sparked worldwide reaction of panic and disbelief in its wake as it decimated communities in West Africa, particularly in Guinea, Liberia, and Sierra Leone, including its health care workers. This article affirms the crucial role nurses play in maintaining health and preventing diseases, connects the devastating havoc of the Ebola virus disease to another issue of nursing shortage in underdeveloped countries, and asserts the key leadership nurses play in protecting the communities they serve while maintaining their safety and those of other health care workers. Nurses must actively seek a place at the table, as echoed by the American Academy of Nursing and American Nurses Association and the American Nurses Association, when decisions are being made regarding Ebola virus disease: at care settings, in the board room, and at federal, state, and local levels.

Guiding the Process of Culturally Competent Care With Hispanic Patients: A Grounded Theory Study

PURPOSE

To explore nursing care actions that lead to culturally competent care for Hispanic patients.

BACKGROUND

Nurses report apprehension when delivering nursing care because of language barriers and a lack of Hispanic cultural understanding. Research is needed to inform culturally aware nursing practice actions for Hispanic patients.

DESIGN

The study used a qualitative, grounded theory design to address the questions: (a) What cultural knowledge should nurses have when caring for Hispanic patients and families and (b) What nursing actions should nurses take to provide culturally competent care? Hispanic lay health promoters and Hispanic community members were interviewed to make recommendations for care.

RESULTS

A model was identified that informs culturally competent nursing care. "Connectedness," the central phenomenon, describes nursing actions and contains subthemes explaining influences on nursing care. "Up to You" and "At the Mercy of the System" are descriptive themes influencing connectedness.

CONCLUSION

Connectedness is central to culturally well-informed nurse-patient interactions.

Impermanence and Sense of Coherence: Lessons Learned From the Adaptive Behaviors of Sri Lankan Buddhist Nuns With a Chronic Illness

PURPOSE

The purpose of this study was to explore the influence of traditional Buddhist spiritual beliefs and practices on coping with chronic illness.

DESIGN

The study was a descriptive ethnography. Participant observation and semistructured interviews were used with 45 Sri Lankan Buddhist nuns with a chronic illness and 20 secondary informants. Cultural domains and taxonomies were explored to uncover themes pertaining to traditional Buddhist spirituality and experiences of chronic illness.

FINDINGS

A repeating cultural theme, responsibility, was identified. Responsibility took four forms: to the Buddha, to the social circle, to self-liberation through meditation, and to finding security in old age. Nuns shaped spiritual practices (some with folk origins) to fulfill these responsibilities. Coping ranged from health-seeking to resigned acceptance.

CONCLUSIONS

Responsibilities and coping were situated in a context of Buddhist spiritual beliefs about impermanence. Findings were congruent with Antonovsky's model of salutogenesis, in particular, the construct of sense of coherence.

Successful aging in the United States and China: a theoretical basis to guide nursing research, practice, and policy

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.

Cultural Awareness: Nursing Care of Iraqi Patients

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.

A Korean version of the Appraisal of Diabetes Scale (ADS-K): psychometric evaluation with a population of Koreans with type 2 diabetes

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.

Evaluation of the spoken knowledge in low literacy in diabetes scale for use with Mexican Americans

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.

Risk factors for coronary heart disease among Asian Indians living in Australia

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.

The relationship between select demographic characteristics and body mass index among Native Hawaiian and other Pacific Islander caregiving adults

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.

Factors that influence mammography use among older American Indian and Alaska Native women

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.

Breast cancer in African Americans: from patient to survivor

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.

A Comprehensive Approach to Risk Reduction for Asian and Pacific Islander American Women With HIV/AIDS

As HIV incidence rises globally, Asian and Pacific Islander communities are increasingly affected. While often overlooked, Asian and Pacific Islander American women have shown the greatest percentage increase in HIV diagnosis rates. The development of a multilevel and multistrategy approach to HIV/AIDS education, prevention, and treatment among Asian and Pacific Islander females requires health care providers to identify personal and cultural barriers to prevention and treatment and implement culturally sensitive and specific measures. The purpose of this article is to illuminate barriers to HIV-related prevention, treatment, and care among Asian and Pacific Islander American females and provide practical application-based suggestions for providers, which may enhance Asian and Pacific Islander female inclusion in comprehensive HIV prevention.