Coping and social support resources among Latinas with arthritis

Lack of awareness of systemic lupus erythematosus and its consequences in a cohort of moderate and severe patients in Spain: The LupusVoice study

BACKGROUND AND OBJECTIVES

Systemic lupus erythematosus (SLE) is an autoimmune condition that can highly impact patients' quality of life (QoL). However, there is a lack of knowledge about SLE, affecting the general population and health care professionals (HCPs) alike. This lack of knowledge has negative implications for patients and the healthcare system, worsening prognosis, negatively impacting QoL, and increasing healthcare utilization. The aim of this paper is to draw attention, according to the perspective of the participants of this study, to the lack of awareness of SLE and its consequences in Spain, and to suggest improvements.

PATIENTS AND METHODS

This qualitative, descriptive, observational, multicenter, and cross-sectional study included 40 patients with moderate or severe SLE, recruited during their routine visits in six university hospitals in Spain. The study also included 11 caregivers and 9 HCPs. All participants were individually interviewed. Data from the interviews were coded and analyzed thematically by two anthropologists following a phenomenological perspective.

RESULTS

Our study identified a lack of disease awareness among primary care physicians, emergency medicine doctors, and other specialists treating SLE symptomatology. This led to diagnostic delays, which had a clinical and emotional impact on patients. Furthermore, symptom awareness was found to be context dependent. Differences in symptom awareness between HCPs and patients led to a mismatch between the severity evaluation made by doctors and patients. Some HCPs did not consider the limitations of the current severity evaluation of SLE, and therefore attributed symptoms potentially caused by SLE to the unfavorable socioeconomic conditions patients lived in. Finally, a lack of social awareness among friends, family members, and romantic partners led to lower social support, increased isolation, and negative physical and emotional impact for patients. Gender differences in the provision of support were identified.

CONCLUSION

This study highlights the need to increase SLE awareness among patients, HCPs, and the broader public in order to improve patient QoL. Being aware of the clinical and emotional impact of such lack of awareness, as well as the role played by context on the patient experience of SLE, is a crucial step towards achieving this goal.

Digital Narratives of Living With Lupus: Lived Experiences and Meanings for Latin American and Latino Patients and Their Families

OBJECTIVE

Systemic lupus erythematosus (SLE) disproportionately affects Latin American and Latino populations, with worse outcomes compared to nonminority populations. Understanding patients' views is critical to provide culturally competent care. The objective of this research is to analyze lived experiences with SLE from comments made by Latin American and Latino patients, and their relatives and friends, on the public Facebook group "Hablemos de Lupus" (in English: "Let's Talk about Lupus").

METHODS

Deidentified narratives posted as a reaction to the most popular resources shared by the page were extracted using the Facepager application. We conducted a thematic analysis under an interpretative medical anthropology framework.

RESULTS

Five core themes were demonstrated by social media comments: lived experiences with lupus, religious/spiritual thoughts, metaphors, heredity, and experiences of family and friends. Being diagnosed with lupus is perceived as a life-changing event. The fluctuating course of the disease causes uncertainty, and the perception of invisibility within the patient's social circle generates feelings of being misunderstood. Faith and spiritual thoughts are coping strategies. Patients use metaphors about the disease's meaning and their lived experiences (the purple butterfly, not belonging, bellicose metaphors) to communicate with others. Relatives and friends are impacted by their loved one's distress.

CONCLUSION

Patients perceive lupus as an unpredictable illness and use metaphors to foster empathy and communicate their experiences to others. Religion is as important as medical treatment to cope with the disease, and the experience of having lupus extends to family and friends. Findings can be used to improve physician-patient communication and lupus education campaigns in the Latin American and Latino population.

Qualitative Exploration of Dyadic Influence on Physical Activity Between Latina Patients With Osteoarthritis and a Supporter of Their Physical Activity

OBJECTIVE

Research indicates that social support may promote physical activity; however, most Latina individuals with osteoarthritis (OA) are not sufficiently active. The purpose of this qualitative dyadic study was to explore how Latina patients with OA and a self-selected physical activity "supporter" motivate each other to be more active. Furthermore, perceptions of how OA symptoms impact support and physical activity were examined.

METHODS

Semistructured dyadic interviews were conducted with Latina patients with OA and a member of their social network age ≥16 years who supports their physical activity (n = 14 dyads). We used framework analysis to reduce qualitative data to themes and subthemes.

RESULTS

Daughters (n = 5), spouses (n = 4), sons (n = 2), a granddaughter (n = 1), a nephew (n = 1), and a friend (n = 1) provided support for the target behavior. In many cases, members of dyads said the motivation to engage in physical activity was reciprocated rather than focused solely on Latina patients with OA. Support was often reciprocated by engaging in physical activity together, using pressure, talking about being active, modeling physical activity, and helping with household responsibilities. Although participants agreed that physical activity was beneficial and Latina patients desired additional support when experiencing OA symptoms, there was concern about the safety of activity in the presence of symptoms. Several adult daughters indicated that their mothers' OA symptoms motivated their own physical activity.

CONCLUSION

Dyadic strategies for promoting physical activity among Latina patients with OA and how support may be reciprocated were identified.

Patients' views on the causes of their polymyalgia rheumatica: a content analysis of data from the PMR Cohort Study

OBJECTIVE

To explore primary care polymyalgia rheumatica (PMR) patient beliefs about the causes of their PMR.

DESIGN

Qualitative content analysis was conducted on patients' written responses to the question of what they thought had caused their PMR. All data were coded and emergent categories of causal beliefs identified.

SETTING

Community patients receiving primary care at general practitioner (GP) practices across England.

PARTICIPANTS

Participants were recruited from a primary care PMR inception cohort (n=654). Between June 2012 and June 2014 GPs referred 739 people with a new PMR diagnosis in the past 3 years into the study. Patients were mailed a baseline self-completion questionnaire, which included the question, 'What do you think caused your PMR?'. Responses to this question form the data set for the present study.

RESULTS

296 (45%) patients gave a possible cause for their PMR, while 276 (42%) respondents wrote 'no idea'. Common attributions include ageing (45, 18%), medication (18, 5%) and personal stress (53, 14%). 24 respondents (6%) thought their PMR was as a result of another medical condition.

CONCLUSIONS

This is the first study to examine causation beliefs in PMR, identifying a number of possible causes such as ageing, stress and as a complication of other medical problems. Understanding these patient beliefs may impact on treatment adherence and patient outcome.

Religiosity, Religious Coping, and Distress

Religious involvement was measured in a sample of 49 lower socio-economic status Hispanic women who were newly diagnosed with early-stage breast cancer. Religious coping and emotional distress were assessed at pre-surgery, post-surgery, and at 3-, 6-, and 12-month follow-ups. Among Catholic women, greater religiosity tended to be associated with more distress throughout the year; among Evangelical women, in contrast, greater religiosity tended to be associated with less distress throughout the year. These correlations were significantly different at two measurement points. Similarly, religious coping tended to have divergent effects in the two groups. Among Catholics, church attendance at 6 months predicted greater distress at 12 months; among Evangelical women, obtaining emotional support from church members at 6 months predicted less distress at 12 months. These various differences are interpreted in terms of differences in the ideologies of the two religious groups.

The Pain Experience of Hispanic Americans: A Critical Literature Review and Conceptual Model

Although the Hispanic population is a burgeoning ethnic group in the United States, little is known about their pain-related experience. To address this gap, we critically reviewed the existing literature on pain experience and management among Hispanic Americans (HAs). We focused our review on the literature on nonmalignant pain, pain behaviors, and pain treatment seeking among HAs. Pain management experiences were examined from HA patients' and health care providers' perspectives. Our literature search included variations of the term "Hispanic" with "AND pain" in PubMed, Embase, Web of Science, ScienceDirect, and PsycINFO databases. A total of 117 studies met our inclusion criteria. We organized the results into a conceptual model with separate categories for biological and/or psychological and sociocultural and/or systems-level influences on HAs' pain experience, response to pain, and seeking and receiving pain care. We also included information on health care providers' experience of treating HA patients with pain. For each category, we identified future areas of research. We conclude with a discussion of limitations and clinical implications.

PERSPECTIVE

In this critical review of the literature we examined the pain and management experiences of the HA population. We propose a conceptual model, which highlights findings from the existing literature and future areas of research.

Missed Opportunity: Spirituality as a Bridge to Resilience in Latinos with Cancer

Going through adverse life events can help a person learn how to cope with life's challenges, overcome them, learn from the adverse experiences, grow, and be positively transformed by them. Spirituality is a resource that supports adaptation and resilience to improve quality of life in patients with cancer or other chronic illnesses. For Latinos, spirituality is an important core cultural value. As such, it is crucial to pay close attention to how cultural values play a role in health-related concerns when caring for Latino cancer patients, and to how spirituality, being an important aspect of Latino culture, influences how Latinos adjust and cope with cancer. Understanding how to facilitate resilience in the face of potentially negative life events, such as cancer, can not only help Latino cancer patients in active treatment, but can also impact effectiveness of managing and coping with the consequences of cancer during survivorship.

Religiosity among U.S Chinese Older Adults in Greater Chicago Area-Findings from the PINE Study

BACKGROUND

Religiosity influences health and well-being. We assessed religiosity among U.S. Chinese older adults.

METHODS

Data were drawn from the PINE study based on 3,159 community-dwelling U.S. Chinese older adults aged 60+ in the greater Chicago area. Two items retrieved from Duke University Religion Index (DUREL) were used to assess the frequency of participating in religious activities, and a separate item was used to assess the importance of religion.

RESULTS

Overall, 35.4% of participants perceived religion to be important. This study correlated the higher frequency of participation in religious observances with older age groups of the sample, being female, having a higher income, being unmarried, longer duration of residency in the U.S., and not having been born in Mainland China. Higher frequency of participating in organized religious services was correlated with better quality of life.

CONCLUSIONS

Religion is important among U.S Chinese older adults. Future longitudinal research is needed to explore aging and religiosity.

Depressive and anxiety symptoms and social support are independently associated with disease-specific quality of life in Colombian patients with rheumatoid arthritis

OBJECTIVE

To examine the relationship between disease-specific Quality of Life (QOL) and socio-demographic, medical, and psychosocial factors in Colombian patients with Rheumatoid Arthritis (RA).

METHODS

One hundred and three RA patients recruited from ambulatory centers in Neiva, Colombia were administered the Disease Activity Scale 28 (DAS-28), QOL-RA, Zung Self-Rating Depression Scale, State-Trait Anxiety Inventory (STAI), Interpersonal Support Evaluation List-12 (ISEL-12), and Symptom Checklist-90 Revised (SCL-90R).

RESULTS

Lower QOL-RA was associated with lower socio-economic status (SES; r=0.26, p<0.01), higher likelihood of using opioids (t=-2.51, p<0.05), higher likelihood of comorbid pulmonary disease (t=-2.22, p<0.05), and lower ISEL-12 sub-scales (r's=0.41-0.31, p's<0.001). Lower QOL-RA was associated with higher DAS-28 (r=-0.28, p<0.01), Visual Analog Scale (VAS; r=-0.35, p<0.001), Zung Depression (r=-0.72, p <0.001), STAI-State (r=-0.66, p<0.001), STAI-Trait (r=-0.70, p<0.001), SCL-90R Global Severity Index (r=-0.50, p<0.001), SCL-90R Positive Symptom Total (r=-0.57, p<0.001), and all SCL-90R sub-scales (r's=-0.54--0.21, p's<0.01). A multivariate linear regression model indicated that SES (B=2.77, p<0.05), Zung Depression (B=-0.53, p<0.001), STAI-State (B=-0.26, p<0.05), and ISEL-12 Belonging (B=1.15, p<0.01) were independently associated with QOL-RA, controlling for significant associations.

CONCLUSIONS

More depressive and anxiety symptoms were independently associated with lower disease-specific QOL, while higher perceptions of having people to do activities with (belonging social support) and higher SES were independently associated with higher disease-specific QOL. Psychosocial factors impact QOL in RA above and beyond disease activity. Additional research into the benefits of psychosocial assessment of RA patients and provision of comprehensive care to improve QOL is warranted.

Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association

BACKGROUND AND PURPOSE

This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA's 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers.

METHODS

Writing group members were nominated by the AHA's Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before consideration and approval by the AHA Science Advisory and Coordinating Committee.

RESULTS

This statement documents the status of knowledge regarding CVD among Hispanics and the sociocultural issues that impact all subgroups of Hispanics with regard to cardiovascular health. In this review, whenever possible, we identify the specific Hispanic subgroups examined to avoid generalizations. We identify specific areas for which current evidence was less robust, as well as inconsistencies and evidence gaps that inform the need for further rigorous and interdisciplinary approaches to increase our understanding of the US Hispanic population and its potential impact on the public health and cardiovascular health of the total US population. We provide recommendations specific to the 9 domains outlined by the chair to support the development of these culturally tailored and targeted approaches.

CONCLUSIONS

Healthcare professionals and researchers need to consider the impact of culture and ethnicity on health behavior and ultimately health outcomes. There is a need to tailor and develop culturally relevant strategies to engage Hispanics in cardiovascular health promotion and cultivate a larger workforce of healthcare providers, researchers, and allies with the focused goal of improving cardiovascular health and reducing CVD among the US Hispanic population.

Predictors of coping in a group of Turkish patients with physical disability

AIM AND OBJECTIVE

To describe coping strategies used and determine the influence of demographic/health-related variables and perceived social support to the prediction of coping strategies in patients with physical disabilities.

BACKGROUND

The period of psychosocial adaptation following a physical disability is very stressful. The use of effective coping strategies may be helpful in adapting to disability. However, no information is available about the coping strategies used by Turkish patients with physical disability.

DESIGN

The study was designed as a cross-sectional survey. The data were obtained from 51 patients with physical disability in a rehabilitation centre in Ankara, Turkey between May 2004-September 2005.

METHODS

Data were collected using a questionnaire form, the Multidimensional Scale of Perceived Social Support and the Coping Strategy Indicator. Descriptive statistics, reliability analysis, Mann-Whitney U tests, Kruskal-Wallis test, chi-square test, Pearson's correlation coefficients and stepwise multivariate regression analysis were conducted.

RESULTS

The most frequently used coping strategy was problem-solving, followed by avoidance coping and seeking social support. Significant predictors of overall coping strategies were age, financial status, the caregiver's presence and perceived social support, after controlling for specific variables.

CONCLUSIONS

This study demonstrated that patients who were older and had a caregiver were more likely to use problem-solving strategy. Seeking social support was more common among patients who had a caregiver and those with more perceived support from friends, whereas patients who had financial difficulties used more avoidance coping.

RELEVANCE TO CLINICAL PRACTICE

Better understanding the coping strategies used by individuals with physical disabilities and factors affecting coping is provide interventions that reduce the stress and support their adaptation. Nurses should be aware of the factors that affect to coping strategies used to deal with stress.

Patient disease perceptions and coping strategies for arthritis in a developing nation: a qualitative study

Background

There is little prior research on the burden of arthritis in the developing world. We sought to document how patients with advanced arthritis living in the Dominican Republic are affected by and cope with their disease.

Methods

We conducted semi-structured, one-to-one interviews with economically disadvantaged Dominican patients with advanced knee and/or hip arthritis in the Dominican Republic. The interviews, conducted in Spanish, followed a moderator's guide that included topics such as the patients' understanding of disease etiology, their support networks, and their coping mechanisms. The interviews were audiotaped, transcribed verbatim in Spanish, and systematically analyzed using content analysis. We assessed agreement in coding between two investigators.

Results

18 patients were interviewed (mean age 60 years, median age 62 years, 72% women, 100% response rate). Patients invoked religious and environmental theories of disease etiology, stating that their illness had been caused by God's will or through contact with water. While all patients experienced pain and functional limitation, the social effects of arthritis were gender-specific: women noted interference with homemaking and churchgoing activities, while men experienced disruption with occupational roles. The coping strategies used by patients appeared to reflect their beliefs about disease causation and included prayer and avoidance of water.

Conclusions

Patients' explanatory models of arthritis influenced the psychosocial effects of the disease and coping mechanisms used. Given the increasing reach of global health programs, understanding these culturally influenced perceptions of disease will be crucial in successfully treating chronic diseases in the developing world.

Association between social isolation and left ventricular mass

BACKGROUND

Social isolation is associated with progression of cardiovascular disease, with the most socially isolated patients being at increased risk. Increased left ventricular mass is a predictor of cardiovascular morbidity and mortality. It is not yet clear whether social isolation is a determinant of increased left ventricular mass.

METHODS

We performed a cross-sectional study of Northern Manhattan Study participants who were free of clinical cardiovascular disease and had obtained transthoracic echocardiograms (n=2021) and a baseline questionnaire on social habits. Social isolation was defined as the lack of friendship networks (knowing fewer than 3 people well enough to visit within their homes). Echocardiographic left ventricular mass was indexed to height(2.7), analyzed as a continuous variable and compared between exposure groups.

RESULTS

The prevalence of social isolation was 13.5%. The average left ventricular mass was significantly higher (50.2 gm/m(2.7)) in those who were, as compared with those who were not (47.6 gm/m(2.7)), socially isolated (P<.05). Higher prevalence of social isolation was found among those less educated, uninsured, or unemployed. There were no significant race-ethnic differences in the prevalence of social isolation. In multivariate analysis, there was a trend toward an association between social isolation and increased left ventricular mass in the total cohort (P=.09). Among Hispanics, social isolation was significantly associated with greater left ventricular mass. Hispanics who were socially isolated averaged 3.9 gm/ht(2.7) higher left ventricular mass compared with those not socially isolated (P=.002). This relationship was not present among non-Hispanic blacks or whites.

CONCLUSION

In this urban tri-ethnic cohort, social isolation was prevalent and associated with indices of low socioeconomic status. Hispanics who were socially isolated had a greater risk for increased left ventricular mass.

Arthritic pain among Latinos: results from a community-based survey

OBJECTIVE

To examine factors associated with pain among Latinos with arthritis, identify common coping strategies and potentially effective interventions, and determine whether pain levels affect the level of interest in potentially useful programs.

METHODS

Using a convenience sampling approach and a combination of face-to-face and telephone surveys, 588 Latino adults in Oregon with arthritis were interviewed. The intensity of pain during a typical day was assessed using a scale ranging from 0 (no pain) to 10 (worst pain). A score of >or=7 was defined as severe pain.

RESULTS

More than 60% of Latinos reported severe pain. Results from an ordinary least square regression indicated that among Latinos with arthritis, women, those with lower levels of education, and those reporting poor or fair self-rated health and functional limitations had higher levels of pain, after controlling for confounders. Those with severe pain were more likely than those with lower levels of pain to use over the counter medicine and home remedies to manage their arthritis. In addition, Latinos with greater pain were more likely to be interested in arthritis management programs.

CONCLUSION

These findings have important implications for public health policy. The strong interest of Latinos in various arthritis and joint pain management programs could prove to be an important avenue for supporting a population with high levels of arthritic pain and lack of health insurance. These pain management programs are all the more appealing, given the availability of a number of evidence-based, low-cost interventions.

Pain coping in Latino populations

Although there has been a rapid increase in Latino populations in the United States over the last 10 years, health research with Latino cultural groups is sorely lacking. In the area of pain-coping research, one consequence of the limited research is that very little is known about pain coping among Latinos. The purpose of this paper is to review the existing literature on pain coping in Latino populations, and to propose new directions for the future study of pain coping in Latino populations. This review is divided into 4 sections. In the first section, the challenges of defining Latino populations are discussed. In the second section, the current literature on pain coping in Latinos is reviewed. Third, we discuss the implications of existing findings for pain-coping assessment and pain treatment. Finally, we offer ideas for future research on pain coping in Latino populations.

PERSPECTIVE

In this review article, we identify gaps in our current understanding of pain coping in Latino cultural groups, and associated implications for pain assessment and treatment. We also highlight potential directions for future pain-coping research with Latino populations.

Patterns of psychosocial risk and long-term outcomes in rheumatoid arthritis

This study examined the extent to which patterns of psychosocial risk were uniquely associated with long-term outcomes of rheumatoid arthritis (RA), after demographic factors and self-reported symptom severity over time were accounted for. Data were collected over an 8-year period from 561 individuals with RA who were participants in the ongoing UCSF RA Panel Study in 1995. Panel members were interviewed annually, using a comprehensive structured telephone interview. Psychosocial factors assessed included mastery, perceptions about adequacy of social support, the impact of RA and self-assessed ability to cope with RA and satisfaction with health and function. Cluster analysis of psychosocial factors identified three distinctive patterns/levels of psychosocial risk (high, medium and low risk). The unique effects of psychosocial risk status on changes in depressive symptoms, basic functional limitations, global pain ratings and average annual doctor visits over an 8-year period were estimated, using growth curve analyses. Analyses controlled for demographic factors (gender, marital/partner status, education, age and ethnicity), disease duration and year in the panel and time-varying self-reported symptom severity (morning stiffness, swollen joint counts, co-morbid medical conditions, extra-articular RA symptoms and changes in joint appearance), as well as self-reported medications taken over time (disease-modifying antirheumatic drugs [DMARDS], and prednisone). Overall, 32.4% of total variance in depressive symptoms was accounted for by the fully-estimated model, with 12.9% uniquely associated with psychosocial risk status. Half of the total variance (50.0%) in basic functional limitations was explained, with 12.1% of variance uniquely predicted by psychosocial risk status. Psychosocial risk status accounted for comparatively little total explained variance in global pain ratings (total = 38.6%, incremental = 3.2%), and average annual total doctor visits (total = 10.9%, incremental = 1.5%). Thus, psychosocial risk factors are more closely linked to depressive symptoms and function over time. Global pain and utilization appear to be more closely related to disease factors.

Daily spiritual experiences of older adults with and without arthritis and the relationship to health outcomes

OBJECTIVE

Strategies to improve coping with chronic disease are increasingly important, especially with the aging US population. For many, spirituality serves as a source of strength and comfort. However, little is known about the prevalence of daily spiritual experiences (DSE) and how they may relate to physical and mental health.

METHODS

We surveyed older adults age>50 years with chronic health conditions seen in a primary care setting about their DSE, health perceptions, pain, energy, and depression.

RESULTS

Of 99 patients, 80% reported DSE most days and many times per day. Women had significantly lower DSE scores than men (reflecting more frequent DSE, mean+/-SD 37.3+/-15.0 versus 45.8+/-17.5; P=0.012). African American women reported the most frequent DSE and white men reported the least frequent DSE (mean+/-SD 35.9+/-13.6 versus 52.2+/-19.1). Frequent DSE were significantly associated with a higher number of comorbid conditions (P=0.003), although not with age, education, or employment status. Persons with arthritis reported significantly more DSE than those without arthritis (mean+/-SD 35.2+/-12.1 versus 47.1+/-18.6; P<0.001). After adjustment for age, race, sex, pain, and comorbid conditions, more frequent DSE were associated with increased energy (P<0.009) and less depression (P<0.007) in patients with arthritis.

CONCLUSION

DSE are common among older adults, especially those with arthritis. Increased DSE may be associated with more energy and less depression. DSE may represent one pathway through which spirituality influences mental health in older adults.

Disentangling the effects of race and SES on arthritis-related symptoms, coping, and well-being in African American and White women

This study examined both unique and interactive effects of race and socioeconomic status (SES) on arthritis-related symptoms, coping, and well-being in African American and White women. Participants included 77 African American and 98 White women, aged 45 to 90, who completed structured, face-to-face interviews. A series of 2 x 2 MANCOVAs examined race (African American, White) and SES (high/low education or high/low occupational status) differences in arthritis-related symptoms, coping, and well-being. African Americans used more religious coping, wishful-thinking, seeking social support, and emotional expression than Whites. Individuals with low SES reported worse arthritis-related symptoms, poorer well-being, and greater use of coping strategies that tend to be maladaptive. Race x SES interactions revealed higher depressive symptoms in African Americans with low versus high education and coping differences in African Americans with low versus high occupational status; however differences in depressive symptoms and coping based on SES were not evident for Whites. Results demonstrate unique and interactive race and SES differences for arthritis-related symptoms, coping, and well-being showing the complexity of race and SES in the realm of physical and mental health.

Coping responses of Asian, Black, and Latino/Latina New York City residents following the September 11, 2001 terrorist attacks against the United States

This study examined mechanisms for coping with adversity in a sample of 24 Asian, Black, and Latino/Latina residents of New York City following the September 11, 2001 World Trade Center (WTC) terrorist attacks. Using consensual qualitative research methodology (C. E. Hill, B. J. Thompson, & E. N. Williams, 1997), the authors identified 7 broad coping domains used by the participants: (a) sought additional information about the WTC tragedy, (b) expressed a range of emotions, (c) sought or gave support, (d) engaged in religious or spiritual activities, (e) avoidance, (f) forbearance, and (g) used indigenous healing techniques. Although there were similarities across racial or cultural groups and genders with regard to the coping responses used, there also were unique coping strategies by racial or cultural background and gender.

Rheumatic diseases in minority populations

Rheumatic diseases are expressed in all ethnic populations, but differ in prevalence, genetic associations, clinical features, and responses to interventions. Most data describing these differences do so in reference to and comparisons with white populations. These are sparse data that evaluate differences within minority populations where there is more homogeneity of external factors, such as social, cultural, and behavioral attitudes. This article reviews the features that are unique to various rheumatic diseases within minority populations.

Religiosity/spirituality and pain in patients with sickle cell disease

Religion/spirituality has been identified by individuals with sickle cell disease (SCD) as an important factor in coping with stress and in determining quality of life. Research has demonstrated positive associations between religiosity/spirituality and better physical and mental health outcomes. However, few studies have examined the influence religiosity/spirituality has on the experience of pain in chronically ill patients. Our aim was to examine three domains of religiosity/spirituality (church attendance, prayer/Bible study, intrinsic religiosity) and evaluate their association with measures of pain. We studied a consecutive sample of 50 SCD outpatients and found that church attendance was significantly associated with measures of pain. Attending church once or more per week was associated with the lowest scores on pain measures. These findings were maintained after controlling for age, gender, and disease severity. Prayer/Bible study and intrinsic religiosity were not significantly related to pain in our study. Positive associations are consistent with recent literature, but our results expose new aspects of the relationship for African American patients. We conclude that religious involvement likely plays a significant role in modulating the pain experience of African American patients with SCD and may be an important factor for future study in other populations of chronically ill pain sufferers.

Social support and psychological adjustment among Latinas with arthritis: a test of a theoretical model

BACKGROUND

Among people coping with chronic illness, tangible social support sometimes has unintended negative consequences on the recipient's psychological health. Identity processes may help explain these effects. Individuals derive self-worth and a sense of competence by enacting social roles that are central to the self-concept.

PURPOSE

This study tested a model drawing from some of these theoretical propositions. The central hypothesis was that tangible support in fulfilling a highly valued role undermines self-esteem and a sense of self-efficacy, which, in turn, affect psychological adjustment.

METHODS

Structured interviews were conducted with 98 Latina women with arthritis who rated the homemaker identity as being of central importance to the self-concept.

RESULTS

A path analysis indicated that, contrary to predictions, tangible housework support was related to less psychological distress. Emotional support predicted greater psychological well-being. These relationships were not mediated by self-esteem or self-efficacy. Qualitative data revealed that half of the sample expressed either ambivalent or negative feelings about receiving housework support.

CONCLUSIONS

Results may reflect social and cultural norms concerning the types of support that are helpful and appropriate from specific support providers. Future research should consider the cultural meaning and normative context of the support transaction. This study contributes to scarce literatures on the mechanisms that mediate the relationship between social support and adjustment, as well as illness and psychosocial adaptation among Latina women with chronic illness.

Preferences for arthritis care among urban African Americans: "I don't want to be cut"

Despite greater disability from knee osteoarthritis among Blacks, Whites are 3-5 times more likely to have total knee replacement (TKR). The authors explored whether beliefs among Blacks about arthritis and surgery contribute to this disparity. Ninety-four Blacks, ages 50 to 89, with knee arthritis underwent semistructured qualitative interviews regarding disability, beliefs about arthritis, beliefs about TKR, and treatment preferences. Content analyses yielded 6 themes: preference for natural remedies, negative expectations of surgery, beliefs about God's control, preference for continuing in their current state, relationships with specialists, and fear of surgery or death. Given its high levels of disability, this cohort had low expectations of TKR. Culturally sensitive educational programs might improve patient altitudes and beliefs regarding TKR, ultimately increasing appropriate usage.

En las manos de Dios [in God's hands]: Religious and other forms of coping among Latinos with arthritis

This study tested a theoretical model concerning religious, passive, and active coping; pain; and psychological adjustment among a sample of 200 Latinos with arthritis. Respondents reported using high levels of religious coping. A path analysis indicated that religious coping was correlated with active but not with passive coping. Religious coping was directly related to psychological well-being. Passive coping was associated with greater pain and worse adjustment. The effects of active coping on pain, depression, and psychological well-being were entirely indirect, mediated by acceptance of illness and self-efficacy. These findings warrant more research on the mechanisms that mediate the relationship between coping and health. This study contributes to a growing literature on religious coping among people with chronic illness, as well as contributing to a historically under-studied ethnic group.

Religious and nonreligious coping methods among persons with rheumatoid arthritis

OBJECTIVE

To examine religious and nonreligious coping methods among persons with rheumatoid arthritis (RA). To identify positive and negative religious coping methods and personal characteristics associated with them.

METHODS

Persons with RA (n = 181) completed a religious coping questionnaire, 6 subscales from a nonreligious coping inventory, and a depression scale.

RESULTS

Religious and nonreligious coping were moderately correlated. The scores of all positive religious coping subscales were positively related to the importance persons attributed to religion. Scores of all negative religious coping subscales were positively associated with self-reported depressive symptoms.

CONCLUSIONS

Correlations of religious and nonreligious coping methods were neither completely independent of each other nor functionally redundant, suggesting that each made unique contributions to coping with RA. Persons with no (or few) depressive symptoms who reported that religion was important to them tended to make positive use of their religion as they coped with the emotional stress of RA. A significant number of self-reported depressive symptoms were correlated with a negative use of religion.

Racial disparities in joint replacement use among older adults

BACKGROUND

Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.

OBJECTIVE

This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.

DESIGN

Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

SETTING

National probability sample of US community-dwelling older adults.

PATIENT POPULATION

AHEAD participants (n = 6159) aged 69 to 103 years.

MEASUREMENTS

The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).

RESULTS

Older minorities reported arthritis-related joint replacements (black: 0.98%; Hispanic: 0.97%, annually) less frequently compared with white persons (1.48% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95% CI, 0.22, 0.95).

CONCLUSIONS

These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.

Coping and distress among women under treatment for early stage breast cancer: comparing African Americans, Hispanics and non-Hispanic Whites

This study examined coping and distress in African American (n=8), Hispanic (n=53), and non-Hispanic White (n=70) women with early stage breast cancer. The participants were studied prospectively across a year beginning at the time of surgery. African American women reported the lowest levels of distress (particularly before surgery) and depression symptoms. Hispanic women reported the highest levels of self-distraction as a coping response, non-Hispanic Whites reported the highest use of humor. Hispanics reported the highest levels of venting, African Americans reported the lowest levels. African American and Hispanic women reported more religious coping than non-Hispanic Whites. The data also provided evidence of a maladaptive spiral of distress and avoidant coping over time. Although some ethnic differences were identified, findings also point to a great many similarities across groups.

The role of social support in the self-management of diabetes mellitus among a Hispanic population

The rising incidence of diabetes mellitus continues to be a major health concern among Hispanic Americans. Social support has been found to be a relevant factor in diabetes self-management, however, it has not been explored within a Hispanic community. This cross-sectional study was therefore conducted with 95 insulin-requiring Hispanic adults to explore the composition of the support network, the type of assistance needed, the degree of satisfaction with support received, and the relationship between social support and diabetes self-management. Overall, the participants had fairly large networks, composed primarily of family members. The greatest need for assistance was associated with transportation or interactions that involved speaking English, and the assistance offered in these areas was viewed as highly satisfactory. Participants were least satisfied with the help they received for diabetes-related self-care, personal care, and financial assistance. Social support was not strongly related to diabetes self-management. Community health nurses must be aware that this population may have needs that are unsatisfactorily met. They should provide education and resources for support persons and carefully evaluate the support network, not only for availability, but also for satisfaction. Effort should also be directed toward developing alternative support for those without available family.

Epidemiology and impact of rheumatic disorders in the United States Hispanic population

The emergence of a sizable Hispanic population in the US is a relatively recent historical phenomenon, and thus much is still unknown about this group of North Americans. Data from national surveys suggest small differences between Hispanic and non-Hispanic white populations in the age-adjusted prevalence of self-reported arthritic conditions. However, the rate of activity-limitation attributable to arthritis is higher among Hispanic patients. This likely reflects the poorer socioeconomic conditions and lack of health insurance that prevail among Hispanic populations, which may limit their access to rheumatologic care. Osteoporotic vertebral and hip fractures are less frequent, and proximal femoral mineral density is higher, in Hispanic individuals than in non-Hispanic white individuals. The mechanisms for these observations are currently under investigation. There have been no studies of the prevalence of osteoarthritis, rheumatoid arthritis, or systemic lupus erythematosus among Hispanic populations. However, important immunogenetic, clinical, and psychosocial differences between Hispanic and non-Hispanic patients in regard to rheumatoid arthritis and systemic lupus erythematosus have been reported. There is no published information on the prevalence or characteristics of other rheumatic diseases in the US Hispanic population. Emerging evidence suggests considerable underuse of certain health services for arthritis among Hispanic patients, likely due in part to socioeconomic factors. Further research is needed to determine whether biologic, cultural or psychosocial factors contribute to underuse as well. There is clearly a need for data on the prevalence and characteristics of arthritis and other rheumatic and musculoskeletal diseases in this emerging US population.

An exploratory study of social support, distress, and life disruption among low-income Hispanic women under treatment for early stage breast cancer

Relationships between distress and perceived availability of social support were examined in 51 Hispanic women being treated for early stage breast cancer. Distress and different types (emotional, instrumental) and sources (spouse, women family members, other family members, friends) of support were measured at presurgery, postsurgery, and at 3-, 6-, and 12-month follow-ups. Emotional support from friends and instrumental support from spouse at presurgery predicted lower distress postsurgery. No other prospective benefits of perceived support emerged. Distress at several time points predicted erosion of subsequent support, particularly instrumental support from women in the family. In contrast to the adverse effects of distress (and independent of them), illness-related disruption of recreational and social activities at 6 months elicited greater support at 12 months.

Chronic fatigue syndrome: sociodemographic subtypes in a community-based sample

Most chronic fatigue syndrome (CFS) studies are based on information about patients from primary or tertiary care settings. These patients might not be typical of patients in the general population. This investigation involved examinations of individuals with CFS from a community-based study. A random sample of 18,675 in Chicago was interviewed by telephone. Individuals with chronic fatigue and at least four minor symptoms associated with CFS were given medical and psychiatric examinations. A group of physicians then diagnosed individuals with CFS, who were then subclassified based on three sociodemographic categories--gender, ethnicity, and work status. Sociodemographic subgroups were analyzed in terms of symptom severity, functional disability, coping, optimism, perceived stress, and psychiatric comorbidity. Women, minorities, and nonworking individuals with CFS reported greater levels of functional disability, symptom severity, and poorer psychosocial functioning than men, Caucasians, and working individuals, suggesting sociodemographic characteristics may be associated with poorer outcomes in urban, community-based samples of CFS individuals.

Prayer and spirituality

Many patients with arthritis are strongly influenced by religious beliefs and often participate in religious healing activities such as prayer and worship attendance. Scientific studies demonstrate, and most patients confirm, that faith and involvement in religious healing activities can be helpful in preventing and treating illness, recovering from surgery, reducing pain, and improving quality of life. To improve the care of patients, clinicians should develop a patient-centered, spiritually sensitive form of medical practice in which religious issues are addressed gently and appropriately with dignity, respect, and integrity.

Cultural diversity issues in the development of valid and reliable measures of health status

The development of instruments for use in culturally diverse settings and populations really involves much more than mere translation. Measurements must be tested for content validity and appropriate meaning among members of the group to be studied. Attention to issues of validity, reliability, and cross-cultural differences will lead to effective assessment, culturally competent health care, and the enhancement of the client/provider relationship. The concerns surrounding the use of quantitative measurement in diverse cultural groups are substantial. While the refinement of scales to meet the needs of various groups is a challenging task, such effort is essential to the diagnosis of disease, determination of health status, and the measurement of health outcomes in the diverse subgroups of this country's population.

Latinas with arthritis: effects of illness, role identity, and competence on psychological well-being

Tested a theoretical model on the effects of social role identity, illness intrusion, and competence on psychological well-being among 109 low-income Latinas with arthritis. All six roles studied were rated as highly important identities. Sex-role nontraditionalism was associated with less importance of the homemaker, mother, and grandmother roles. Negative affect increased as a function of intrusions into valued identities. Having important role identities contributed to feelings of competence (i.e., self-esteem and self-efficacy), which in turn, contributed to psychological well-being. Competence also mediated the effects of pain, identity, and illness intrusions on psychological well-being. Results suggest competence processes play an important role in well-being.