Rigor in cross-cultural nursing research

Five Dimensions of Needs for Help: The Efficacy of a Technology-Based Intervention Among Asian American Breast Cancer Survivors

Cancer survivors including Asian American breast cancer survivors have reported their high needs for help during their survivorship process. With the COVID-19 pandemic, the necessity of technology-based programs to address their needs for help without face-to-face interactions has been highlighted. The purpose of this randomized intervention study was to determine the efficacy of a technology-based program in reducing various types of needs for help among this specific population. This was a randomized clinical trial with repeated measures. A total of 199 participants were included in the data analysis. The recruitment settings included both online and offline communities/groups for Asian Americans. The needs for help were assessed using the Support Care Needs Survey-34 Short Form (SCNS) subscales measuring psychological, information, physical, support, and communication needs. Data analysis was conducted through an intent-to-treat approach. In the mixed effect models, psychological needs, information needs, physical needs, and communication needs decreased over time (P < .001). However, there were no significant group * time effects. Social support significantly mediated the effects of a technology-based intervention on psychological, information, and support needs at the pre-test and the post-1 month. This study supported significant decreases in the needs for help of Asian American breast cancer survivors by a technology-based intervention. Further studies are needed with other racial/ethnic groups of cancer survivors to confirm the efficacy of a technology-based intervention in reducing cancer survivors' needs for help during their survivorship process.

The impact of Confucianism on social and emotional health of Vietnamese adolescents: A phenomenological study

Confucianism has become an educational ideology in Vietnam and blended its philosophy with other religious and spiritual doctrines. The current study explores the impact of Confucianism on social and emotional health (SEH), which focuses on the skill-based aspect of Confucian Vietnamese adolescents. A hermeneutic phenomenological study was chosen as an appropriate approach for collecting and interpreting descriptions of 15 Confucian Vietnamese adolescents to explore how these lived experiences have shaped their current perceptions of SEH. We have labeled the two shared common characteristics in the participants' various SEH experiences, including (1) Authentic perception of Confucian philosophy strengthens the self-esteem; (2) Positive practice of the 5-essential human virtues helps establish and maintain healthy, supportive relationships. The two essences reflected the positive impact of Confucianism on SEH of Vietnamese adolescents. The adolescents' SEH experiences are consistent with Confucian philosophy while at the same time not conflicting with other religious doctrines. The findings of this study have broadened our understanding of the applicability of socio-emotional competence models to promote positive psychological development in adolescents, and the feasible goal-setting in counseling and psychotherapy from different psychological theories about the combination of religious and spiritual practices.

Cross-cultural adaptation of four instruments to measure stigma towards people with mental illness and substance use problems among primary care professionals in Chile

Stigma toward people with mental illness and substance use problems is a significant global concern, and prevents people with these conditions from accessing treatment, particularly in primary health care (PHC) settings. Stigma is a cultural phenomenon that is influenced by particular contexts and can differ by country and region. The majority of stigma research focuses on Europe or North America leading to a lack of culturally relevant stigma research instruments for the Latin American context. The present study describes and discusses the methodology for cross-culturally adapting four stigma measurement scales to the Chilean context. The cross-cultural adaptation process included nine phases: (1) preparation; (2) independent translations; (3) synthesis 1 with expert committee; (4) focus groups and interviews with researchers, PHC professionals, and PHC users; (5) synthesis 2 with expert committee; (6) independent back translations; (7) synthesis 3 with expert committee; (8) pilot with PHC professionals; and (9) final revisions. The adaptation process included an array of diverse voices from the PHC context, and met three adaptation objectives defined prior to beginning the process (Understandability, Relevance, and Acceptability and Answer Options). The resulting, culturally adapted questionnaire is being validated and implemented within PHC settings across Chile to provide in-depth insight into stigma among PHC professionals in the country. The authors hope it will be useful for future research on mental illness and substance use stigma in similar settings across Latin America.

Item bias on the geriatric depression scale (GDS): investigating the quality and generalizability of GDS on Chinese and Korean community-dwelling elderly population

BACKGROUND

Although some previous studies have reported the impact of cultural factors on individuals' cognition and decision making, a shortage of research has led to this comparison study for Chinese and Korean elderly, a growing population with depression. This study aimed to explore depression levels in Chinese and South Korean elderly individuals by focusing on testing the generalizability of the Geriatric Depression Scale (GDS).

METHODS

The data of 493 community-dwelling Chinese and Korean elderly individuals over the age of 60 years were used to examine GDS. To test the dimensionality, item quality, and reliability of the GDS, the item response theory, Rasch analysis was performed. The detection of differential item functioning (DIF) of the GDS between the two countries was determined by performing a hybrid ordinal logistic regression.

RESULTS

The four-dimensional framework of the GDS, categorized into agitation, cognitive concerns, dysphoria, and vigor/withdrawal was fit for measuring depression levels in Chinese and Korean elderly individuals. In addition, good item quality and reliability of the GDS indicate that almost all items in this scale contribute to measuring the intended trait. Meanwhile, 18 out of 28 items of the GDS were detected as country-related DIF with five items having a large effect size.

CONCLUSIONS

Although China and Korea are close geographically and culturally, the item bias shown by severe country-related DIF implies that different cultural backgrounds impact how the elderly interpret GDS items. The cultural issues related to the specific DIF items, the implication to accuracy of individual scores estimation, and the optimal decision to treat individuals were discussed.

Cross-cultural differences in user-centred research: An international living lab survey

Digital health applications and interactive technologies increasingly allow organisations to transcend national boundaries and expand the provision of tools and services to communities across the world. Making the transfer beyond the context in which applications were originally conceptualized is challenging, as these have to be tailored towards local end-user needs and regulations. Such information is not always readily available, which risks successful uptake in novel settings. Living labs help to bridge this gap, by performing user experience research and supporting user-centred design for cross-border projects. Dissimilarities in recruitment and participation of end users could however influence study outcomes. Therefore, this study explores to what extent living labs are aware of potential cross-cultural differences. The sample consists of 36 living labs from 20 countries, most focusing on health and care, the silver economy and information technology. Regional differences are reported on participants' motivation and on the impact of gender, age, professional status and socio-economic status on participants' contribution. Awareness of potential differences during recruitment and grouping and supporting equal contribution in sessions could improve the quality of user-centred research in international contexts, while still maintaining sufficient standardisation. Further research with larger international samples is needed to replicate and extend these findings.

Components of Culturally Tailored Interventions: A Discussion Paper

The purpose of this article is to propose essential components of culturally tailored interventions through analyzing practical issues in 3 studies that tested culturally tailored interventions among Asian American women. Practical issues in the studies were analyzed using a content analysis according to the evaluation criteria for rigor in cross-cultural research. Seven essential components of culturally tailored interventions were identified through the analysis: (a) respecting cultural uniqueness; (b) understanding cultural contexts; (c) using cultural examples; (d) having flexibility; (e) adopting multiple languages; (f) having bilingual and/or culturally matched research team members; and (g) engaging community consultants and research participants. Key words: Asian, culture, intervention, issue, rigor.

The Preliminary Efficacy of a Technology-Based Cancer Pain Management Program Among Asian American Breast Cancer Survivors

With few existing technology-based programs to support cancer pain management, the need for culturally tailored programs to support ethnic minority cancer survivors has been highlighted. The purpose of this study was to explore the preliminary efficacy of the technology-based CAncer Pain management support Program for Asian American survivors of breast cancer, a technology-based cancer pain management program, in improving the cancer pain experience of Asian American breast cancer survivors. This pilot study adopted a randomized repeated-measures pretest/posttest control group design with a sample of 94 Asian American breast cancer survivors. Study measures included the Brief Pain Inventory-Short Form, Support Care Needs Survey-34 Short Form, and Mishel Uncertainty in Illness Scale-Community. Data were analyzed using descriptive and inferential statistics including repeated-measures analysis of covariance. Although there were no significant differences in pain, there were significant changes in perceived isolation (F = 9.937, P < .01), personal resources (F = 6.612, P < .05), support care need (F = 8.299, P < .01), and degree of uncertainty (F = 8.722, P < .01) in the intervention group from pretest to posttest. These findings support the positive effects of CAncer Pain management support Program for Asian American survivors of breast cancer on the cancer pain experience of Asian American breast cancer survivors.

African American Nurses Describe Experiences of Mistrust and Trust While in Nursing School

AIM

This qualitative descriptive study is a secondary analysis of previously collected data to describe the consequences of the racial experiences of nursing school for African American students.

BACKGROUND

African Americans' health outcomes are negatively influenced by racism and historic oppression. A racially integrated health care workforce can improve health outcomes, yet nursing does not attract or retain an adequate number of African American students.

METHOD

The sample for this qualitative descriptive study included 14 African American nurses who reflected on their nursing school experiences.

RESULTS

Two key paradoxical themes across the transcripts were mistrust and trust of European American faculty members.

CONCLUSION

While working to build trusting relationships with African American students, forge relationships over time, and serve as mentors, faculty members need to understand the impact of societal stereotypes and mistrustful behaviors (e.g., stereotyping, saying one thing and doing another, using a double standard).

Professional Development: Iranian and Swedish Nurses’ experiences of Caring for Dying People

Our world is rapidly becoming a global community. This creates a need for us to further understand the universal phenomena of death and professional care for dying persons. A transcultural study was undertaken using a phenomenological approach to illuminate the meaning of nurses’ experiences of professional development in the contexts of Iran and Sweden. Eight registered nurses working in oncology units in Tehran, Iran, and eight working in the context of a hospital and private homes in northern Sweden were interviewed. The interviews were analyzed using the principles of phenomenological hermeneutics inspired by Paul Ricoeur. A naive reading guided a structural analysis, which yielded four main themes: coping with existential, organizational, and cultural contexts; sharing knowledge, experiences, and responsibilities; using embodied knowledge; and developing personal competence. The interpreted comprehensive understanding revealed that the meaning of professional development is that it actualizes other-oriented values and self- oriented values. Caring professionally for dying people was a learning process that could help nurses to develop their personal and professional lives when they were supported by teamwork, reflective practice, and counselling.

Culture matters: indigenizing patient safety in Bhutan

Studies show that if quality of healthcare in a country is to be achieved, due consideration must be given to the importance of the core cultural values as a critical factor in improving patient safety outcomes. The influence of Bhutan's traditional (core) cultural values on the attitudes and behaviours of healthcare professionals regarding patient care are not known. This study aimed to explore the possible influence of Bhutan's traditional cultural values on staff attitudes towards patient safety and quality care. Undertaken as a qualitative exploratory descriptive inquiry, a purposeful sample of 94 healthcare professionals and managers were recruited from three levels of hospitals, a training institute and the Ministry of Health. Interviews were transcribed verbatim and analysed using thematic analysis strategies. The findings of the study suggest that Bhutanese traditional cultural values have both productive and counterproductive influences on staff attitudes towards healthcare delivery and the processes that need to be in place to ensure patient safety. Productive influences encompassed: karmic incentives to avoid preventable harm and promote safe patient care; and the prospective adoption of the 'four harmonious friends' as a culturally meaningful frame for improving understanding of the role and importance of teamwork in enhancing patient safety. Counterproductive influences included: the adoption of hierarchical and authoritative styles of management; unilateral decision-making; the legitimization of karmic beliefs; differential treatment of patients; and preferences for traditional healing practices and rituals. Although problematic in some areas, Bhutan's traditional cultural values could be used positively to inform and frame an effective model for improving patient safety in Bhutan's hospitals. Such a model must entail the institution of an 'indigenized' patient safety program, with patient safety research and reporting systems framed around local patient safety concerns and solutions, including religious and cultural concepts, values and perspectives.

Improving menopausal symptoms through promoting physical activity: a pilot Web-based intervention study among Asian Americans

OBJECTIVE

Based on previous studies, a Web-based physical activity promotion program with educational modules on menopausal symptoms and physical activity has been developed for Asian American midlife women to reduce their menopausal symptoms through increasing their physical activity. The purpose of this pilot randomized intervention study was to determine the efficacy of the Web-based program in improving menopausal symptom experience of Asian American midlife women.

METHODS

This was a randomized repeated measures pretest/posttest (pretest, post 1 month, and post 3 months) control group study among 29 Asian American midlife women. Multiple instruments were used, including the Midlife Women's Symptom Index and the Kaiser Physical Activity Survey. The data were analyzed using a mixed-model growth curve analysis.

RESULTS

Over time, total severity scores decreased for the control group (-0.53, P < 0.10), whereas they did not exhibit a meaningful change for the intervention group. Both study groups experienced improvement in active living habits over time, but such an improvement was greater for the intervention group (β = 0.29, P < 0.001) than for the control group (β = 0.08, P < 0.10). The time × group interactions for total severity scores were not statistically significant anymore after controlling for physical activity (-0.34 for the control group, P = 0.10).

CONCLUSIONS

The findings supported the feasibility of a 3-month Web-based intervention for menopausal symptom management among Asian American midlife women and the preliminary efficacy of the program in increasing their physical activity.

Planning focus group interviews with asylum seekers: Factors related to the researcher, interpreter and asylum seekers

The aim of this article was to discuss factors related to the researcher, interpreter and asylum seekers when planning focus group interviews with asylum seekers. Focus group interview is one of the basic data collection methods in descriptive nursing and health research. It has been used in multicultural research, allowing an opportunity to participate without literacy and to have linguistic and cultural support from other participants. Asylum seekers form a specific, vulnerable group, and the growing number of asylum seekers increases the need for research related to them. A culturally, methodologically and ethically high-quality focus group interview is based on the researcher's special knowledge and skills, acknowledgement of asylum seekers as both individuals and part of cultural and communal groups, and careful planning of the interpreter's role during the interviews.

A French Translation of the Pleasure Arousal Dominance (PAD) Semantic Differential Scale for the Measure of Affect and Drive

Multivariate studies have repeatedly confirmed that three basic dimensions of human emotional behavior, called pleasure (P), arousal (A) and dominance (D) are persistent in organizing human judgments for a wide range of perceptual and symbolic stimuli. The Mehrabian and Russell’s PAD semantic differential scale is a well-established tool to measure these categories, but no standardized French translation is available for research. The aim of this study was to validate a French version of the PAD. For this purpose, (1) Mehrabian and Russell’s PAD was translated through a process of translations and back-translations and (2) this French PAD was tested in a population of 111 French-speaking adults on 21 images of the International Affective Picture System (IAPS). A confirmatory factor analysis revealed the expected three-factor structure; the French PAD also distributed the images in the affective space according to the expected boomerang-shape. The present version of PAD is thus a valid French translation of Mehrabian and Russell’s original PAD.

Use of instruments to measure quality of life among healthy and ill adults in community settings

International interest in quality of life (QoL) has been affected by patients' prolonged survival, the increasingly aging population, the increase in chronic conditions and the increasing costs of health care. This has also led to the development of QoL instruments that meet the psychometric criteria necessary for reliable and valid outcome measures in research, health policy decision-making and, increasingly, in clinical practice. Despite the proliferation of QoL instruments available to inform best practice, clinicians seldom routinely apply them. One of the barriers to using QoL instruments is the unfamiliarity nurses have with existing instruments. In order to increase community health nurses' familiarity with existing QoL assessments, the aim of this paper is to describe five instruments and modules that have been developed by the World Health Organization's Quality of Life Assessment Group for the assessment of QoL among healthy and ill adults and to describe how their applicability could enhance evidence-based practice in community nursing.

Nursing student profiles and occurrence of early academic failure: Findings from an explorative European study

BACKGROUND

In the European context regulated by the Bologna Process principles, there is little evidence to date on the different profiles, if any, of nursing students enrolled in the 1st academic year and their academic outcomes.

AIMS

To describe and compare the nursing student profiles and their academic outcomes at the end of the 1st year across European Bachelor of Nursing Science (BNS) courses.

DESIGN

An exploratory multicentre cohort study involving five countries: Nursing students who were enrolled in nursing programmes for the academic year 2011/2012 in the participating BNS courses, willing to participate and regularly admitted to the 2nd academic year, were included in this study undertaken in 2013. Individual and faculty level variables were collected after having ensured the validity of the tools developed in English and then appropriately translated into the language of each participating country.

FINDINGS

A total of 378/710 (53.2%) students participated in the study. They attended from 390 to 810h of lessons, while clinical experience ranged from 162 to 536h. The students reported a mean average age of 21.4 (Confidence of Interval [CI] 95%, 21.0-22.3) and foreign students were limited in number (on average 3.7%). The students reported adopting mainly individual learning strategies (92.9%), duplicating notes or lecture notes prepared by professors (74.4%), and concentrating their study before exams (74.6%). The majority reported experiencing learning difficulties (49.7%) and a lack of academic support (84.9%). Around 33.2% reported economic difficulties and the need to work while studying nursing on average for 24h/week. Personal expectations regarding the nursing role were different (45.6%) than the role encountered during the 1st year, as learning workloads were higher (57.2%) with regard to expectations. Around one-third of students reported the intention to leave nursing education while the proportion of those reporting early academic failure was on average 5.6%.

CONCLUSIONS

More strategies aimed at harmonising nursing education across Europe, at supporting nursing students' learning processes during 1st year, and identifying factors influencing their intention to leave and their academic failure, are recommended.

A practical field guide to conducting nursing research in low- and middle-income countries

OBJECTIVES

The purpose of this report is to offer practical guidance to nurse investigators interested in international research in low- and middle-income countries (LMICs). Lessons learned and strategies for planning and implementing an international research project are addressed.

METHODS

Four nurse researchers who conducted studies in diverse international settings (Argentina, India, South Africa, and Tanzania) describe their collective experiences regarding study planning and implementation; data collection using a variety of methods; and cultural, contextual and ethical considerations.

RESULTS

Nurses who undertake international health research projects, particularly in LMICs, can face unique challenges and opportunities. Recommendations for success include advance planning, remaining flexible, having a backup plan, cultivating an attitude of curiosity and cultural humility, establishing collaborative and respectful partnerships, and budgeting adequate time.

CONCLUSIONS

Nurse scientists often receive little training and support to conduct international research. Guidance to undertake research projects in LMICs can build capacity for nurses to make significant contributions to global health.

Methodological considerations when translating "burnout"

No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout.

Innovative strategies for teaching nursing research in Taiwan

BACKGROUND

Evidence-based practice is imperative in clinical settings because it bridges the gap between research findings and clinical practice. Promoting nursing student interest and enthusiasm for research is therefore crucial when teaching nursing research.

OBJECTIVE

The aim of thus study was to develop innovative teaching strategies that increase nursing students' interests and engagement in research.

METHODS

This study employed a descriptive, pretest-posttest, quasiexperimental design with 103 participants in the experimental group and 106 in the control group. The Attitudes toward Research Questionnaire, Classroom Engagement Scale, Self-Directed Learning Instrument, Nursing Eight Core Competencies Scale, Value of Teams survey, and a research knowledge test were applied to evaluate the outcomes of the innovative teaching strategies.

RESULTS

Scores for the research knowledge test were significantly higher in the experimental group than in the control group in posttest 1 and posttest 2. After the intervention, participants in the experimental group exhibited higher scores on attitudes toward research, eight core competencies in nursing,value of teams, classroom engagement, and self-directed learning than participants in the control group. Students in the experimental group perceived a lower degree of pressure and higher degrees of interest, enjoyment, and acceptance of the research course than students in the control group.

CONCLUSIONS

This study confirmed that using innovative teaching strategies in nursing research courses enhances student interest and enthusiasm about evidence-based practice.

Building competence through cross-cultural collaboration in the aftermath of a tsunami: experiences of Indonesian teachers

The aim of this study was to describe the reported experiences of Indonesian nursing teachers who participated in a two-year cross-cultural project designed to build pedagogical and professional competence after the tsunami in Aceh province in 2004. Eleven Indonesian teachers who had participated in the competence project answered an open-ended questionnaire in November 2007. The data were analyzed by qualitative content analysis, and the main theme "an empowered nursing teacher" emerged. The teachers expressed positive experiences, as having more self confidence, feeling inspired to develop one's potentiality and feeling strength and happiness in one's work. The theme constituted four categories: "encouraged by collaboration and teamwork", "more independent as a teacher", "encouraged by more active students" and, "inspired to develop further competence". The overall result showed that the teachers in the competence developing project reported mostly positive experiences by participating in the project. However, two years is a short time to develop both pedagogical and professional competence. They expressed a desire to continue building their competence, especially in direct clinical practice.

The N2N instrument to evaluate healthy work environments: an Italian validation

OBJECTIVES

The aims of the study were to (a) validate N2N Healthy Work Environment tool, (b) assess the healthiness of work environments as perceived by nurses themselves and (c) identify the factors associated with Italian nurses' perception of work environment healthiness.

METHODS

The linguistic and cultural adaptation of USA-N2N Healthy Work Environments was achieved through a process of forward/backward translation. Content validity was assessed by three expert nurses. The stability of the instrument was checked with a test/retest evaluation. The instrument psychometric properties, the confirmatory factor analysis as well the healthiness of the work environment and its determinant factors were evaluated with a sample of 294 nurses.

RESULTS

The content and face validity of the N2N Healthy Work Environment instrument was confirmed. The instrument demonstrated good internal consistency (α of 0.82), excellent stability values (ρ > 0.70) and high levels of acceptability (response rate: 96.4 %). The confirmatory factor analysis has corroborated the existence of two factors as documented in the original instrument (Mays et al. in J Nurs Manag 19:18-26, 2011). Eighty-seven (29.6 %) nurses perceived the work environment where they work as "healthy". Working under a functional model of care delivery (χ(2) 24.856, p 0.000) and being responsible for one project or more (χ(2) 5.256, p 0.021) were associated with healthy environments.

CONCLUSIONS

The instrument--valid and reliable, short in the number of items, easy to understand and based on international standards--allows a systematic assessment of the healthiness of the environment and might provide not only the opportunity to evaluate the effects of new organizational models and interventions, but also the possibility to activate a process of self-analysis and a process of ongoing review. The instrument can be used to systematically check the healthiness of Italian working environments, allowing for organizational diagnosis, targeted interventions and international comparisons.

A systematic survey instrument translation process for multi-country, comparative health workforce studies

BACKGROUND

As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems.

OBJECTIVES

To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey.

DESIGN AND SETTINGS

We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe.

PARTICIPANTS

Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field.

METHODS

The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context.

RESULTS

The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation.

CONCLUSIONS

The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation.

Interpreters in cross-cultural interviews: a three-way coconstruction of data

Our focus in this article is research interviews that involve two languages. We present an epistemological and methodological analysis of the meaning of qualitative interviewing with an interpreter. The results of the analysis show that such interviewing is not simply exchanging words between two languages, but means understanding, grasping the essential meanings of the spoken words, which requires an interpreter to bridge the different horizons of understanding. Consequently, a research interview including an interpreter means a three-way coconstruction of data. We suggest that interpreters be thoroughly introduced into the research process and research interview technique, that they take part in the preparations for the interview event, and evaluate the translation process with the researcher and informant after the interview.

Cross-cultural adaptation and translation of a quality of life tool for new mothers: a methodological and experiential account from six countries

AIM

To examine the challenges and solutions encountered in the translation and cross-cultural adaptation of an English language quality of life tool in India, China, Iran, Portugal, Brazil, and Poland.

BACKGROUND

Those embarking on research involving translation and cross-cultural adaptation must address certain practical and conceptual issues. These include instrument choice, linguistic factors, and cultural or philosophical differences, which may render an instrument inappropriate, even when expertly translated. Publication bias arises when studies encountering difficulties do not admit to these, or are not published at all. As an educative guide to the potential pitfalls involved in the cross-cultural adaptation process, this article reports the conceptual, linguistic, and methodological experiences of researchers in six countries, who translated and adapted the Mother-Generated Index, a quality of life tool originally developed in English.

DATA SOURCES

Principal investigator experience from six stand-alone studies (two published) ranging from postgraduate research to citywide surveys. DISCUSSION/IMPLICATIONS FOR NURSING: This analysis of a series of stand-alone cross-cultural studies provides lessons about how conceptual issues, such as the uniqueness of perceived quality of life and the experience of new motherhood, can be addressed. This original international approach highlights practical lessons relating to instrument choice, and the resources available to researchers with different levels of experience. Although researchers may be confident of effective translation, conceptual and practical difficulties may be more problematic.

CONCLUSION

Instrument choice is crucial. Researchers must negotiate adequate resources for cross-cultural research, including time, translation facilities, and expert advice about conceptual issues.

Fostering excellence: development of a course to prepare graduate students for research on migration and health

Canada is an immigrant-receiving nation and many graduate students in nursing and other disciplines pursue immigrant health research. As these students often start with inadequate understanding of the policy, theoretical, and research contexts in which their work should be situated, we became concerned that the theses and dissertations were less sophisticated than were both possible and desirable. This led to development of a PhD-level course titled Migration and Health in the Canadian Context. In this study, we provide an analytic overview including course description, objectives, assignments, and specific class topics. Areas of focus include historical and theoretical considerations; determinants of immigrant health; refugee health; cultural competence and cultural safety; research challenges, approaches, and skills; policy-relevant research; and educational imperatives in the health and related disciplines. Salient research is introduced in each of these classes. While Canada is the main focus, comparative data are provided and there is relevance for nurse-researchers in other immigrant-receiving countries.

Protecting family interests: an interview study with foreign-born parents struggling on in childhood cancer care

Sweden's population is gradually changing to become more multiethnic and diverse and that applies also for recipients of health care, including childhood cancer care. A holistic view on the sick child in the context of its family has always been a cornerstone in childhood cancer care in Sweden. The purpose of this study was to gain knowledge about the experiences and main concern of foreign-born parents in the context of paediatric cancer care. Interviews were performed with eleven foreign-born parents and data were analysed using a classic grounded theory approach. Foreign-born parents often feel in a position of powerless dependence, but family interests are protected in their approaches to interaction with healthcare staff, through cooperation, contesting, and reluctant resigning. Healthcare staff need to listen to foreign-born parents and deal with their concerns seriously to prevent powerless-dependence and work for trustful cooperation in the common fight against childhood cancer.

A qualitative study of the work environments of Mexican nurses

BACKGROUND

Studies of the nursing work environment are increasingly common in developed countries, but few exist in developing countries. Because of resource differences between the two contexts, researchers need to clarify what aspects of the work environments are similar and different.

OBJECTIVES

To study the perspectives of Mexican nurses about their work environments to determine similarities and differences to results from developed world studies.

DESIGN

A secondary, directed content analysis of qualitative data from 46 Spanish language interviews using workplace-oriented themes.

SETTING

Purposively selected Mexican states from four regions of the country that reflect the country's socioeconomic differences.

PARTICIPANTS

Practicing Mexican nurses with at least 1 year of clinical experience and currently working in nursing. Participants were recruited through convenience and snowball sampling techniques.

METHODS

Initial data collection occurred in 2006 and 2008 during a broader study about professionalization processes that occurred in Mexican nursing between 1980 and 2005. The secondary, directed content analysis focused on an in-depth exploration of a central theme that emerged from the two original studies: the workplace. The directed content analysis used themes from the global nursing work environment literature to structure the analysis: professional relationships, organizational administrative practices, and quality of care and services.

RESULTS

The three themes from the global literature were relevant for the Mexican context and a new one emerged related to hiring practices. By category, the same factors that created positive or negative perceptions of the work environment matched findings from other international studies conducted in developed countries. The descriptors of the category, however, had different conceptual meanings that illustrate the health system challenges in Mexico.

CONCLUSIONS

Findings from this study suggest that studies that seek to measure nursing work environments will most likely apply in Mexico and other Latin American or middle-income countries. Instruments designed to measure the work environment of nurses in these countries may prove relevant in those contexts, but require careful adaptation and systematic translations to ensure it.

Evidence-based medicine: opportunities and challenges in a diverse society

In this article we explore the discourse and practice of evidence-based medicine (EBM) in the context of social and cultural diversity. The article consists of 2 parts. First, we begin by defining EBM, describing its historical development and current ascendance in medical practice. We then note its importance in contemporary psychiatry, comparing dynamics between the United States and Canada. Secondly, we offer a constructive critique of the application of EBM and evidence-based practices in the context of ethnocultural diversity, as one consistent reflection on the EBM literature is that it is does not adequately address issues of diversity. In doing so, we use the situation here in Canada as an extended case study, though our observations will likely be applicable in other diverse nations, such as the United States, the United Kingdom, and Australia. We critically examine the following 6 issues related to the practice of EBM in a diverse society: generalizability and transferability of evidence-based interventions; diversifying standards of evidence in EBM; strategies to address diversity in EBM research; cultural adaptations of evidence-based interventions; integrating idiographic knowledge; and, training and health service delivery. Concurrent with our critique, we offer research and practice suggestions that may address outstanding challenges vis-à-vis the practice of EBM in a diverse society. These include a need for more effectiveness research, more openness to diverse sources of knowledge, better integration of idiographic and nomothetic knowledge, and a critical approach to extrapolation and transfer of knowledge.

Inequity in provision of and access to health visiting postnatal depression services

AIM

This paper is a report of a study of equity in the provision of a public health nursing postnatal depression service.

BACKGROUND

Postnatal depression is a global public health concern. Health visitors are nurses involved in the early detection and treatment of postnatal depression. However, research has revealed that all women are not assessed for postnatal depression particularly women in minority ethnic groups.

METHODS

A case study was conducted involving 21 observations of health visitors visiting postnatal women, interviews with 20 health visitors, 6 managers, 12 English women, 9 Bangladeshi women and 3 other personnel. Data were collected between 2003 and 2005 and analysis was completed in 2008.

FINDINGS

The organization had a policy to create equitable postnatal depression services, but practitioners were not clear whether it was to be implemented, and it did not address the needs of a diverse population. All health visitors received specialized training and were consequently expected to assess and treat all women. The training based on the policy had not equipped health visitors with knowledge and skills to assess and treat women in minority ethnic groups.

CONCLUSION

While a policy was in place, equity in care was not achieved. An analysis of women's needs is recommended prior to policy development and policy implementation should be planned. To achieve equity, training should include knowledge and skills for cultural competency. Research is needed to illuminate the characteristics of equitable nursing services.

A pilot study of a systematic method for translating patient satisfaction questionnaires

AIMS

This paper is a report of a descriptive comparative pilot study of use of a method that simultaneously tests the content validity and quality of translation of English-to-Chinese translations of two patient satisfaction questionnaires: the La Monica-Oberst Patient Satisfaction Scale and Hospital Consumer Assessment of Healthcare Providers and Systems.

BACKGROUND

Patient satisfaction is an important indicator of the quality of healthcare services. In China, however, few good translations of patient satisfaction instruments sensitive to nursing services exist.

METHODS

The descriptive pilot study took place in 2009 and used content validity indexing techniques to evaluate the content, context and criterion relevance of a survey question. The expert raters were 10 nursing faculty and 10 patients who evaluated the two patient satisfaction questionnaires. The experts evaluated the relevance of each item on a scale of 1-4 and the research team compared their responses to choose the most appropriate. Only the nurse faculty experts, who were bilingual, evaluated the quality of the translation using a binary rating.

RESULTS

The 'Nurse Rater' relevance scores of the LaMonica-Oberst Patient Satisfaction Scale and the Hospital Consumer Assessment of Healthcare Providers and Systems were 0·96 and 0·95 respectively, whereas the patient's overall relevance scores were 0·89 and 0·95. A Mann-Whitney U-test demonstrated that results between the two groups were statistically significantly different (P = 0·0135).

CONCLUSIONS

Using content validity indexing simultaneously with translation processes was valuable for selecting and evaluating survey instruments in different contexts.

Giving birth: the voices of Armenian women

PURPOSE AND STUDY DESIGN: The purposes of this qualitative descriptive study were to describe the perceptions of Armenian childbearing women about the meaning of giving birth and to conduct an outcomes evaluation of the Erebuni Women's Wellness Center.

METHOD

Fifteen women who had given birth to healthy term infants during the past 8 months and who received health-care services at the Erebuni Medical Center, Yerevan, Armenia participated in audiotaped interviews. Questions were asked about the meaning of their childbirth experience and their satisfaction with their health care.

RESULTS

Themes included the meaning of giving birth within the Armenian sociocultural context, enriching the family perspective across generations of Armenian families and receiving supportive quality health care.

DISCUSSION AND CLINICAL IMPLICATIONS

This research is an example of an international collaborative work conducted with the American International Health Alliance (AIHA) who established women's wellness centres in Eastern Europe in conjunction with United States Agency for International Development. Outcomes data is very important in order to ensure the quality of health care provided. Clinical personnel found evaluative data were helpful in improving services to women and newborns. Because of dramatic socioeconomic situation in Armenia and many changes that have happened in their health care over the past 18 years, it is important to document the outcomes of AIHA partnership programmes in improving the health of childbearing women and their families. Listening to the voices of Armenian childbearing women is essential to guide health-care initiatives.

Hispanic Labor Friends Initiative: supporting vulnerable women

PURPOSE

To evaluate the qualitative aspects of the Hispanic Labor Friends Initiative.

METHODS

"Hispanic Labor Friends," bilingual Hispanic community women who were themselves mothers, were recruited by clinic and hospital personnel. Women who agreed were educated, received translation certification, and were oriented to the initiative. Pregnant Hispanic immigrant women seen in the health center who met criteria set by the multidisciplinary health care team were assigned a Hispanic Labor Friend by 32 weeks' gestation. Hispanic Labor Friends assisted women with communication with healthcare providers and provided social support. Qualitative evaluation of the program consisted of interviews with several groups: (1) Hispanic immigrant women who had a Hispanic Labor Friend, (2) Hispanic immigrant women who were not in the Hispanic Labor Friends program, (3) Hispanic Labor Friends, (4) healthcare providers for Hispanic women. Data saturation was reached, and data were analyzed by the research team using descriptive qualitative inquiry.

RESULTS

The Hispanic immigrant women described positive outcomes from being involved in the Hispanic Labor Friends program, including feeling supported and comforted. "I felt as though my family were at my side." One woman who had standard care said, "It is hard for me to communicate. When I gave birth, the nurses asked me things, and I didn't understand anything. I stayed quiet." One of the nurses who was interviewed said: "I think they [the HLF patients] get better care. Sometimes we think we can communicate with them with their little bit of English and our little bit of Spanish. But you get an HLF and it's a totally different story. We can more adequately tell what's going on with them...They end up getting better care." One Hispanic Labor Friend said, "The women are very appreciative that I was there to help them through a critical time." Women who participated in the study identified the need to have a continuing association with Hispanic Labor Friends in the early postpartum period.

CLINICAL IMPLICATIONS

The provision of culturally appropriate social support is critical in the care of Hispanic immigrant childbearing women. Programs such as the Hispanic Labor Friends Initiative can help improve support and promote positive outcomes in these vulnerable and disadvantaged women.

Cross-cultural nursing research

BACKGROUND

International cross-cultural comparative nursing research is considered important for the advancement of nursing knowledge offering a global perspective for nursing. Although this is recognised in policy statements and quality standards, international comparative studies are rare in database citations.

OBJECTIVES

To highlight the need for cross-cultural comparative research in nursing and to share some of the insights gained after conducting three international/cross-cultural comparative studies. These are: an examination of patients' autonomy, privacy and informed consent in nursing interventions BIOMED 1998-2001, the ICProject International Patient Study 2002-2006 and the Ethical Codes in Nursing (ECN) project 2003-2005.

RESULTS

There are three critical issues raised here for discussion from the international cross-cultural studies. These are: the planning and formulating of an international study, the conduct of cross-cultural research including the implementation of rigorous data collection and analysis and the reporting and implementing the results.

CONCLUSION

International and cross-cultural nursing research is powerful tool for the improvement of clinical nursing practise, education and management and advancement of knowledge. Such studies should be carried out in order to improve European evidence based health care development in which the patients' perspective plays an important part in the evaluation and benchmarking of services.

Ethnocultural women's experiences of breast cancer: a qualitative meta-study

A growing number of studies have been conducted that explore the breast cancer experiences of women from diverse ethnocultural groups. To advance knowledge and provide a foundation for future research, a synthesis was conducted of 15 qualitative research studies focusing on women from ethnocultural groups diagnosed with breast cancer. A qualitative meta-study approach was used that included analysis of the theoretical orientations and methodological approaches underlying the research, and an interpretive synthesis of research findings. Ethnocultural groups represented in the studies included Asian American, Aboriginal, Hispanic, and African American women. The synthesis revealed diverse experiences within and among these ethnocultural groups represented in 5 major themes: (a) the "othered" experience of a breast cancer diagnosis, (b) the treatment experience as "other," (c) losses associated with breast cancer, (d) the family context of breast cancer experiences, and (e) coping with cancer through spirituality and community involvement. The integration of findings from the 15 studies also revealed how methodological and theoretical approaches to conducting this research influenced understandings of the experiences of breast cancer. Further experiential breast cancer research with ethnocultural groups is needed, as well as the use of research methods that illuminate the ways that ethnicity, class, age, and gender relations are played out in healthcare settings.

Empowerment of nursing students in the United Kingdom and Japan: a cross-cultural study

AIM

This paper is a report of a study to explore the phenomenon of empowerment cross-culturally by comparing the situations in which nursing students from the United Kingdom and Japan experienced empowerment and disempowerment in clinical practice.

BACKGROUND

Empowerment has been the focus of many studies, but most focus on the experience of Registered Nurses and few have explored the phenomenon cross-culturally.

METHOD

This was a cross-cultural, comparative study using the critical incident technique. Anonymous written data were collected from nursing students in Japan and United Kingdom between November 2005 and January 2006. Japanese data were translated and back-translated. Analysis of the transcripts revealed three themes: Learning in Practice, Team Membership, Power.

FINDINGS

Nursing students in these countries are exposed to different educational and clinical environments, but their experiences of empowerment and disempowerment are similar. For both, learning in practice, team membership and power are associated with either empowerment or disempowerment; depending on the context. United Kingdom students are aware of the importance of acting as patient advocates, although they cannot always find the voice to perform this. Japanese students however, appear to be unaware of the concept of advocacy.

CONCLUSION

Student nurse empowerment may transcend cultural differences, and learning in practice, team membership and power may be important for the empowerment of nursing students globally. Further cross-cultural exploration is required into the association between advocacy and empowerment.

Methodological aspects of rigor in qualitative nursing research on families involved in intensive care units: a literature review

Rigor has important ramifications for the entire qualitative research process. The aim of this study was to evaluate aspects of methodological congruence by focusing on four dimensions of rigor in qualitative nursing research related to the presence of patients' family members in the intensive care unit. Eight research papers covering the years 1990-2004 were analyzed by means of one of Burns and Grove's standards, methodological congruence, for critique and consistency. The results show that there are varying degrees of focus on procedural rigor, such as limitations and bias. Ethical rigor is described clearly in some papers, while others lack descriptions of confidentiality and the voluntary nature of participation. However, all papers contain descriptions of qualitative data analysis. In conclusion, there were strengths in procedural rigor and auditability, but also some limitations in the identification of theoretical development and the scientific tradition on which the article is based.

Cross-cultural interview studies using interpreters: systematic literature review

AIM

This paper reviews how the interpreter's role is described in empirically based, qualitative cross-cultural interview studies and how trustworthiness is determined.

BACKGROUND

Increased immigration during the past decades has created a multiethnic society in many countries. This development poses a challenge to healthcare staff, in that they need to understand how people from different cultures experience health and illness. One way to assess immigrants' experiences is through cross-cultural interview studies, involving an interpreter. Thorough knowledge of the interpreter's role is needed in order to increase the trustworthiness of this kind of nursing research.

METHOD

Literature searches were conducted from October to November 2004 using PubMed, CINAHL, Psycinfo, Sociological abstract, Your Journals@ovid, and Eric databases. Qualitative interview studies written in English and performed with an interpreter were included. The Matrix Method was used to review the literature.

FINDINGS

In almost all of the 13 relevant papers found, the role of the interpreter(s) in the research process was only sparsely described. In addition, all studies except one employed different techniques to established trustworthiness. The most common techniques were prolonged engagement, member check or triangulation, the latter performed either on the data, investigators or methods.

CONCLUSION

Methodological issues with respect to interpreters have received only limited attention in cross-cultural interview studies. Researchers in the field of nursing need to consider (1) the interpreter's role/involvement in the research process; (2) the interpreter's competence and the style of interpreting; (3) the interpreter's impact on the findings. This information is a prerequisite when trying to determine the trustworthiness of a cross-cultural study.