Staying healthy: the salience and meaning of health maintenance behaviors among rural older adults in North Carolina

Not all negative emotions are equal: the role of emotional expression in online support groups for women with breast cancer

The repression/suppression of negative emotions has long been considered detrimental for breast cancer (BC) patients, leading to poor coping, progression of symptoms, and general lower quality of life. Therapies have focused on encouraging the expression of negative emotions. While group therapies have proven to be successful for BC patients, no study has looked at the role of expressing negative emotions during the therapeutic interaction. We examined written expressed emotions by women participating in a common form of psychosocial support, Internet based bulletin boards (BBs). Fifty-two new members to BC BBs were studied. They completed measures of quality of life and depression. After 6 months the measures were again assessed and messages during that time were collected and analyzed for emotional content. For the 52 women, results showed that greater expression of anger was associated with higher quality of life and lower depression, while the expression of fear and anxiety was associated with lower quality of life and higher depression. The expression of sadness was unrelated to change scores. Our results serve to challenge the commonly held belief that the expression of all negative emotions are beneficial for BC patients. Instead, expressing specific negative emotions are beneficial, while others are not.

Aging and eating in the rural, southern United States: beliefs about salt and its effect on health

This paper draws upon qualitative research conducted among older adults in the rural, southern United States in which they articulated their beliefs and experiences with nutrition and foods, and lay models of the connection of diet with chronic disease. Salt emerged as a focus of contention. The goals of the paper are to (1) present the culturally constructed meaning of salt, (2) contrast the cultural meaning with biomedical views, and (3) discuss how these findings can be applied to health education and better doctor-patient communication. Data were collected in two rural communities characterized by high rates of poverty and a high proportion of minority residents. A total of 116 African American, Native American and white adults aged 60 years and older participated in 55 in-depth interviews or seven focus groups. A systematic analysis of text showed that salt was a highly contested component of food. While valued for its role in traditional foods and cuisine, it also held negative connotations because of biomedical links to chronic diseases prevalent in the population. We suggest that attempts to control salt intake are made difficult by the changes in taste perceptions that accompany aging. Respondents' articulation of salt's role in health and disease shows cross-over among different chronic diseases and a lay interpretation of blood as the medium through which salt affects disease. These older adults' narratives demonstrate their attempts to reconcile the important role of traditional foods in their identity as Southerners with their attempts to meet medical recommendations for healthy eating.

Self-reported goals of older patients with type 2 diabetes mellitus

OBJECTIVES

New diabetes mellitus guidelines from the American Geriatrics Society promote the individualization of treatment goals and plans for patients aged 65 and older. Communicating with older patients about such complex medical decisions presents new challenges for providers. The self-reported healthcare goals, factors influencing these goals, and self-care practices of older patients with diabetes mellitus were explored.

DESIGN

Exploratory study involving semistructured interviews.

SETTING

Four clinics of a midwestern, urban academic medical center.

PARTICIPANTS

Patients aged 65 and older with type II diabetes mellitus (N=28).

MEASUREMENTS

Semistructured, one-on-one interviews were conducted. Interviews were audiotaped, transcribed, and evaluated for recurring themes using a grounded theory approach.

RESULTS

The majority of patients expressed their healthcare goals in a social and functional language, in contrast to the biomedical language of risk factor control and complication prevention, even when specifically asked about goals for diabetes mellitus care. Patient's predominant healthcare goals centered on maintaining their independence and their activities of daily living (71%). Medical experiences of friends and family (50%), social comparison with peers (7%), and medical professionals (43%) shaped patients' goals. Self-reported medication adherence and glucose monitoring was high, but more than one-quarter of patients failed to adhere to any dietary recommendations, and one-third failed to adhere to their exercise regimens.

CONCLUSION

As diabetes mellitus care recommendations for older patients grow more complex, providers could enhance their communication about such medical decisions by exploring patients' specific circumstances and reframing diabetes mellitus treatment goals in patients' own language. These may be crucial steps to developing successful individualized care plans.

The Process of Changing Health Risk Behaviors: An Oregon Rural Clinic Experience

PURPOSE

A counseling intervention was conducted by nurse practitioners (NPs) at a rural clinic in Oregon. The intervention was designed to help individuals change health risk behaviors. Three focus groups were conducted to aid in understanding the barriers to changing health behaviors and to identify resources that rural individuals needed to succeed in behavior change.

DATA SOURCES

Quantitative data were collected using appraisal forms that were specific to five behaviors. Qualitative data were from written comments submitted by focus group participants in answer to questions sent prior to each meeting and from written summaries of focus group meetings submitted by the focus group leader.

CONCLUSIONS

Most participants were not successful in changing their health behaviors. The issues raised in the focus group discussions provide an overview of the barriers to health behavior change as perceived by a group of adults in a rural environment. Both individual lack of will and the rural community environment were barriers to adopting new health behaviors.

IMPLICATIONS FOR PRACTICE

NPs in rural health care clinics could provide important support for individuals attempting to adopt new health behaviors. Specific suggestions from focus group participants included discussing risky behaviors more often, forming support groups that do not charge a fee, and developing a peer-mentoring program.

Milieux sociaux d'appartenance et représentations de la santé chez un groupe de femmes âgées francophones du Nouveau-Brunswick

Le présent article fait état des résultats d'une étude portant sur l'influence qu'exerce le milieu social d'appartenance sur les croyances, les connaissances et les comportements associés à la santé et à la maladie chez un groupe de femmes âgées francophones demeurant dans la région urbaine de Moncton, au Nouveau-Brunswick. L'objectif de cette recherche consistait à repérer des représentations de la santé chez trois groupes de femmes âgées issues du milieu populaire, de la classe moyenne et de l'élite locale, introduisant ainsi la notion de culture de milieu et son incidence sur les attitudes et les comportements associés à la santé. Les résultats de cette étude nous ont permis de dégager un certain nombre d'idées partagées par l'ensemble des répondantes au sujet de la santé et de la maladie ainsi que de mettre en lumière des éléments de représentation de la santé propres aux femmes issues du milieu populaire, d'une part, et de la classe moyenne, d'autre part. Les résultats obtenus ne nous ont cependant pas permis de dégager des éléments constitutifs d'une représentation de la santé qui soit caractéristique des femmes faisant partie de l'élite. Globalement, pour les femmes âgées issues du milieu populaire, la santé et la maladie s'expliquent en référence au destin, à la chance/malchance, au travail ainsi qu'aux habitudes de vie. Pour les femmes âgées issues de la classe moyenne, la santé et la maladie sont davantage liées à la responsabilité et à la volonté personnelles. Quant au discours des femmes issues du milieu de l'élite sur la santé et la maladie, il est caractérisé davantage par le thème du contraste entre le monde passé et le monde actuel. Cette étude contribue directement à l'élargissement des connaissances sur la diversité relative aux milieux d'appartenance dans le champ de la gérontologie sociale et sur l'impact qu'elle a sur l'intervention sociale et sanitaire.