Adapting E-cigarette prevention programming to reach the latinx community

PURPOSE

E-cigarettes are the most commonly used tobacco product among youth in the United States. Yet evidence-based prevention programming is limited due to the rapid onset of this threat. Community-based efforts to address vaping largely target youth in school settings. Although parents can play an important role in youth tobacco control efforts, messages about the dangers of vaping, use among adolescents, and strategies for intervening have not reached many Spanish-speaking parents in low-income Latinx communities. Our community-academic team developed e-cigarette prevention programming for use by promotor/as de salud to address this unmet need.

METHODS

During the 1-year project, the team worked closely with a Project Advisory Committee to: review existing evidence-informed materials; conduct focus groups with parents, youth and promotor/as to guide program development; develop a curriculum to prepare promotor/as to educate low-literacy, Spanish-speaking parents about vaping; craft Spanish language resources for promotor/as to use in community education sessions; train 61 promotor/as to deliver the program; and support program delivery to 657 community members.

RESULTS

Focus groups with promotor/as and community members, key-informant interviews, and brief surveys informed program development and assessment. Community member feedback was essential to development of appropriate materials. Promotor/as demonstrated significant pre- to post- training increases in e-cigarette knowledge and confidence in delivering vaping prevention education. Community members demonstrated a mastery of basic e-cigarette concepts and expressed intention to discuss vaping with their children.

CONCLUSIONS

Promotor/a-led programming for parents represents a promising approach to vaping prevention and control in the Latinx community.

Development and psychometric validation of the Colorectal Cancer Literacy Scale-Uruguay Version

Colorectal cancer is a leading cause of cancer death in Uruguay, yet less than half of the eligible population is up to date with screenings. Research is hampered because no measures exist to assess psychosocial factors that influence screening decisions in this population. To address this gap, we report on the development and psychometric validation of the Colorectal Cancer Literacy Scale-Uruguay Version, a scale based on the health literacy model. We developed an item pool based on the extant literature, obtained feedback from experts, and conducted focus groups with community participants and health care providers. After revision, we conducted a psychometric validation with a national community sample of 405 participants. Through an exploratory factor analysis, we identified four factors that were collapsed into two for theoretical and pragmatic reasons, representing (a) disposition toward cancer prevention and (b) attitudes, beliefs, and emotions about cancer. A third factor, knowledge about colorectal cancer, was examined separately given its distinct focus. Subsequently, we conducted a confirmatory factor analysis with the remaining sample participants using Rasch measurement theory for validation purposes and to further assess the scales' psychometric properties. The resulting 44-item scale presented a good model fit with adequate EAP reliabilities and good initial discriminant validity. Further criterion-related validity analyses should be performed when additional measures are available. The Colorectal Cancer Literacy Scale-Uruguay Version is a theoretically based measure that can bring to light barriers and facilitative factors in an underscreened population at risk. Implications for theory, research, and practice are discussed.

PEARL: A Guide for Developing Community-Engaging and Culturally-Sensitive Education Materials

Community outreach and engagement has been a regular activity of the National Cancer Institute at its designated Cancer Centers. However, in 2016, community outreach and engagement became a required activity for all cancer centers. Yet there is a gap in the literature that provides guidelines for developing materials that resonate with communities. We developed the PEARL rubric to fulfill that gap from our work developing culturally sensitive breast cancer education materials for African American and Immigrant African women. We conducted a targeted literature review to understand the approaches that have been used for developing education materials for communities. We reviewed the literature and distilled key elements into our PEARL guide for creating culturally appropriate education materials. PEARL consists of five elements: Plain language and understandability, Explicit data, statistics, and graphs, Affirmative framing, Representative content, and Local connection. PEARL is a modern comprehensive guide that researchers can use for creating culturally sensitive materials. It is designed to guide researchers develop educational materials who have little to no experience in community engagement.

"I never heard anything about it": Knowledge and psychosocial needs of Latina breast cancer survivors with lymphedema

Objective:

Breast cancer is the most commonly diagnosed form of cancer and the leading cause of cancer-related death among Latina women in the United States. One aspect of recovery that has been underrepresented in the English-language literature is the recovery of Latina women who have developed lymphedema, a debilitating condition characterized by persistent swelling of the arm, hand, chest, and/or breast. To fill this research gap, a study was conducted to examine the lived experiences of Latina women with breast cancer-related lymphedema.

Methods:

Given the limited scholarship on this topic, qualitative methods were used to obtain a foundational and nuanced understanding of Latina women’s experiences. Semi-structured interviews were conducted with a sample of 10 Latina survivors with breast cancer-related lymphedema. Data were analyzed through thematic analysis and constant comparison methodology.

Results:

The data analysis yielded three major themes: knowledge of lymphedema, impact of lymphedema diagnosis, and coping with lymphedema. Participants had limited knowledge of lymphedema and its risk factors upon diagnosis, in addition to barriers accessing quality care. They also noted psychological distress related to a significant financial burden as well as social anxiety related to interacting with others while wearing compression gloves or sleeves. A major coping strategy was receiving social support from friends, family, peers in structured support groups, and spiritual/religious groups or practices.

Conclusions:

Our findings bring to light contextual factors that may place Latina breast cancer survivors at increased risk for lymphedema and for experiencing a high burden managing their condition. Recommendations are provided for primary, secondary, and tertiary prevention.

Creating community: Expanding access to psychosocial programs for Latina breast cancer survivors

OBJECTIVE

Breast cancer survivors often derive benefits from psychosocial interventions, but less is known about Latina women's experiences. Given the disproportionately high disease burden faced by Latina survivors, it is critical to examine ways to enhance access for this population. Thus, the present study aimed to (a) examine women's perceptions of factors associated with effective delivery of a psychosocial program designed for Spanish speaking women with limited access to care, and (b) identify the mechanisms by which the program enhanced women's psychological well-being.

METHODS

In a qualitative study, in-depth interviews were conducted with 15 immigrant Latina breast cancer survivors who previously received psychosocial services at a community-based organization. Grounded theory was used to analyze the data.

RESULTS

Through open, axial, and selective coding, we arrived at the core category achieving a sense of community. The psychosocial program promoted access and enhanced women's psychological well-being by creating a sense of community among participants. This was facilitated by three primary aspects of service provision: access factors, a holistic approach to health, and therapeutic factors imparted through a biweekly support group.

CONCLUSIONS

Psychosocial services promoted a sense of community among Latina breast cancer survivors while reflecting their cultural values and unique psychosocial needs. Findings may guide the development of interventions to increase access to care, enhance health outcomes, and create and maintain a sense of community among medically underserved populations.

Development of Patient Education Materials for Total Joint Replacement During an International Surgical Brigade

Temporary brigade trips to deliver international surgical care are increasingly common. For the purposes of this work, we use the term brigade to describe self-contained short-term medical or surgical mission trips where healthcare professionals are brought in from foreign regions to provide care to an underserved population. Many brigade programs have begun to collect and publish data on outcomes and complications, but few have examined their own patient education practices.

Counseling Psychologists and Behavioral Health: Promoting Mental and Physical Health Outcomes

On the occasion of the 50th Anniversary of The Counseling Psychologist, we reflect on the many contributions that counseling psychologists have made and are poised to make in the areas of behavioral health and behavioral health care. We note that psychologists’ engagement in health promotion and prevention of behavioral, mental, and emotional disorders is consistent with counseling psychology values. We provide a concise review of theories that are widely applied in behavioral health contexts and discuss ways in which counseling psychologists may apply these theories to help ameliorate health disparities, empower communities to take control of their own health, and promote social justice. In addition, we highlight the need to create interdisciplinary partnerships to conduct culturally sensitive research on the bi-directional relationship between mental health and physical health. The article ends with wide-ranging implications and recommendations for theory development, research, training, practice, and advocacy.

Mapping literacies

Purpose

Information literacy and health literacy skills are positively correlated with indicators of quality of life. Assessing these literacies, however, can be daunting – particularly with people that may not respond well to prose-based tools. The purpose of this paper is to use information horizons methodology as a metric that may be reflective of literacies.

Design/methodology/approach

Following a power analysis to insure statistical significance, a sample of 161 participants was recruited from a university population and given formal, vetted measures of information literacy and health literacy and then was asked to create an information horizons map within a health-related context. The information horizons maps were evaluated in two different ways. First, the number of sources was counted. Then, the quality of sources was factored in. Multiple regression analysis was applied to both metrics as independent variables with the other assessments as dependent variables. Anker, Reinhart, and Feeley’s model provided the conceptual framework for the study.

Findings

Information horizons mapping was not found to have a significant relationship with measures of information literacy. However, there were strong, statistically significant relationships with the measures of health literacy employed in this study.

Originality/value

Employing information horizons methodology as a means of providing a metric to assess literacies may be helpful in providing a more complete picture of a person’s abilities. While the current assessment tools have value, this method has the potential to provide important information about the health literacy of people who are not traditionally well represented by prose-based measures.

Efficacy of a Spanish-Language Self-Administered Stress Management Training intervention for Latinas undergoing chemotherapy

BACKGROUND

Cancer patients often report increased stress during chemotherapy. Stress management training has been shown to reduce this adverse outcome, but few interventions exist for Spanish-speaking Hispanic and Latina women (Latinas).

METHODS

Following community feedback (including focus groups/in-depth interviews), we transcreated the Spanish-Language Self-Administered Stress Management Training (SL-SAT) intervention based on our previously developed and implemented English-based intervention. Latinas about to begin chemotherapy were randomized to SL-SAT (n = 121) or usual care (n = 119). A Spanish-speaking interventionist met with SL-SAT participants who received the SL-SAT toolkit containing instructions in 3 well-established stress management techniques (deep breathing, progressive muscle relaxation and guided imagery, and use of coping self-statements). Usual care participants received an educational booklet about coping with chemotherapy. All patients were instructed by nurses on their chemotherapy medications and given a resource listing of local support groups. Outcomes were obtained at baseline, and 7 and 13 weeks after starting chemotherapy. Primary outcomes included anxiety and depression, cancer-related distress, emotional well-being, and spiritual well-being. Secondary outcomes included functional well-being, social/family well-being, physical well-being, symptom severity, and self-efficacy for managing stress. Data were analyzed by using mixed models.

RESULTS

In both groups, improvements were observed in emotional well-being (P = .01), and declines were observed in functional well-being (P = .05), and physical well-being (P < .0001). Symptom severity increased across the follow-up period (P < .001).

CONCLUSIONS

To be effective, stress management interventions for Latinas receiving chemotherapy may necessitate more attention from an interventionist, delivery of the intervention over a longer interval, and/or a group-based format.

Communicating with underserved audiences

Purpose

The purpose of this research is to understand how low-income, ethnically diverse, Medicaid recipients read, interpret and use culturally tailored health communications, specifically health plan report cards and health intervention/wellness program recruitment materials.

Design/methodology/approach

The paper reports two exploratory studies on message design. Researchers considered 12 focus groups for Study 1, consisting of 51 African-American, Hispanic and non-Hispanic White men and women who were enrolled in Medicaid and had a behavioral health diagnosis and a chronic disease. Researchers considered 22 focus groups for Study 2, consisting of 102 Hispanic, African-American and non-Hispanic White women enrolled in Medicaid.

Findings

The paper provides qualitative insights into how underserved populations interpret the visual and verbal aspects of health communications. Key findings include problems with cultural tailoring and monetary incentives for health improvement program participation, message components that show respect and are more likely to be read, how visuals can expand verbal messages and provide symbolic models and specifics on the desired image content.

Research limitations/implications

Because of the qualitative approach, the research results may lack generalizability. Thus, researchers suggest conducting quantitative studies to test these findings.

Practical implications

The paper includes implications for the development of powerful verbal and visual messaging for underserved populations. Additionally, the findings suggest a need to include emotional response in health communication theories and to incorporate visual communication theories in message design studies.

Originality/value

Research on health communication with underserved populations is limited, yet these populations have higher incidences of death and disability from disease. This paper fulfills a need to discover best health communication practices with underserved populations.

Ethics, Risk, and Media Intervention

Breast cancer incidence and mortality rates are of concern among Latin American women, mainly due to the growing prevalence of this disease and the lack of compliance to proper breast cancer screening and treatment. Focusing on Venezuelan women and the challenges and barriers that interact with their health communication, this paper looks into issues surrounding women's breast cancer, such as the challenges and barriers to breast cancer care, the relevant ethics and responsibilities, the right to health, breast cancer risk perception and risk communication, and the media interventions that affect Venezuelan women's perceptions and actions pertaining to this disease. In particular, it describes an action-oriented research project in Venezuela that was conducted over a four-year period of collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include positive indications on more effective interactions between physicians and patients, increasing satisfactions about issues of ethical treatment in providing healthcare services, more sufficient and responsible media coverage of breast cancer healthcare services and information, a widely supported declaration for a national response against breast cancer in Venezuela, and the creation of a code of ethics for the Venezuelan NGO that led the expansion of networking in support of women's breast cancer healthcare.

Qualitative Exploration of an Effective Depression Literacy Fotonovela with at Risk Latina Immigrants

While depression is prevalent among immigrant Latinas, mental health literacy is low. Culturally tailored health narratives can improve mental health literacy and are now increasingly featured in Spanish language fotonovelas (i.e., booklets in a comic book format with posed photographs and dialogue bubbles). The purpose of this qualitative study is to explore why a depression literacy fotonovela proved effective with Latina immigrants at risk for depression in a quantitative randomized control study. This study is the qualitative companion of the previously published quantitative piece of a mixed methods study, the latter revealing posttest improvements in depression knowledge, self-efficacy to identify the need for treatment, and decreased stigma towards mental health care (Hernandez and Organista in Am J Community Psychol 2013. doi: 10.1007/s10464-013-9587-1 ). Twenty-five immigrant Latinas participated in structured interviews, in the current qualitative study, 3 weeks after participating in the quantitative study. Results suggest depression literacy improved because participants evidenced high recall of the storyline and characters, which they also found appealing (e.g., liked peer and professional support offered to depressed main character). Further, identification with the main character was reflected in participants recalling similar circumstances impacting their mental health. Despite some improvement, stigma related to depression and its treatment remained for some women. Future research for the improvement of health literacy tools is discussed.

Ethics, Risk, and Media Intervention: Women's Breast Cancer in Venezuela

Breast cancer incidence and mortality rates are of concern among Latin American women, mainly due to the growing prevalence of this disease and the lack of compliance to proper breast cancer screening and treatment. Focusing on Venezuelan women and the challenges and barriers that interact with their health communication, this paper looks into issues surrounding women's breast cancer, such as the challenges and barriers to breast cancer care, the relevant ethics and responsibilities, the right to health, breast cancer risk perception and risk communication, and the media interventions that affect Venezuelan women's perceptions and actions pertaining to this disease. In particular, it describes an action-oriented research project in Venezuela that was conducted over a four-year period of collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include positive indications on more effective interactions between physicians and patients, increasing satisfactions about issues of ethical treatment in providing healthcare services, more sufficient and responsible media coverage of breast cancer healthcare services and information, a widely supported declaration for a national response against breast cancer in Venezuela, and the creation of a code of ethics for the Venezuelan NGO that led the expansion of networking in support of women's breast cancer healthcare.

Development of a Spanish language fertility educational brochure for pediatric oncology families

STUDY OBJECTIVE

Education materials detailing fertility preservation options geared towards pediatric oncology patients are inadequately available, particularly materials that are culturally tailored. An English language pediatric fertility preservation brochure was developed in 2011, and given the significance of family building among Hispanics, it is important to transcreate materials for these audiences using learner verification to explore the unique preferences of the population.

DESIGN

Qualitative face-to-face interviews and focus groups.

PARTICIPANTS

Spanish-speaking patients (n = 10), parents (n = 10), and healthcare providers (n = 5). Suggestions for revisions were tested with focus groups of the same population (N = 16).

MAIN OUTCOME MEASURES

Design, readability, likelihood to read, and overall opinion.

RESULTS

Feedback was organized into 2 distinct themes: design and reader action. Overall the majority of parents and patients wanted personal accounts of other patients who had undergone fertility preservation, as well as photos of actual patients. The medical terminology in the brochure was acceptable and understood by most. The majority of participants who preferred the design with vivid colors and patterns explained this was because that brochure also contained more relevant information; however, both brochures had identical information. Many participants explained they would be receptive to receiving the brochure and the reproductive health information should be reinforced throughout cancer care.

CONCLUSIONS

A learner verification approach to create pediatric educational materials can judiciously identify unique preferences for information. These results will be utilized to educate Spanish-speaking pediatric oncology patients and their parents to improve decision-making processes regarding future parenthood.

A content analysis of visual cancer information: prevalence and use of photographs and illustrations in printed health materials

Researchers and practitioners have an increasing interest in visual components of health information and health communication messages. This study contributes to this evolving body of research by providing an account of the visual images and information featured in printed cancer communication materials. Using content analysis, 147 pamphlets and 858 images were examined to determine how frequently images are used in printed materials, what types of images are used, what information is conveyed visually, and whether or not current recommendations for the inclusion of visual content were being followed. Although visual messages were found to be common in printed health materials, existing recommendations about the inclusion of visual content were only partially followed. Results are discussed in terms of how relevant theoretical frameworks in the areas of behavior change and visual persuasion seem to be used in these materials, as well as how more theory-oriented research is necessary in visual messaging efforts.

Health information preferences among Hispanic/Latino immigrants in the U.S. rural Midwest

We investigated whether length of residence and other socio-demographic factors affect how rural Hispanic/Latino immigrants in the U.S. prefer to receive general health information. As part of a federally-funded participatory research project, we surveyed 894 adult Hispanics who were recruited through schools, community-based organizations (CBO) and faith-based organizations (FBO) in six rural communities of Illinois. Data suggest that workshops in Spanish at community settings are the most preferred health information strategy and home visits the least. Preference for these two strategies decreased significantly in the second generation, while preference for mailed printed materials increased. We further explored the role of length of residence in the U.S. on 'in-person' and 'impersonal' health information preferences controlling for other relevant socio-demographic factors finding that first generation and less educated Hispanic immigrants' prefer 'in-person' strategies. These findings suggest that rural health organizations and practitioners should implement not only culturally-appropriate but also acculturation-sensitive approaches to address Hispanic/Latino immigrants' specific health information needs.

Perceived visual informativeness (PVI): construct and scale development to assess visual information in printed materials

There is a paucity of research on the visual images used in health communication messages and campaign materials. Even though many studies suggest further investigation of these visual messages and their features, few studies provide specific constructs or assessment tools for evaluating the characteristics of visual messages in health communication contexts. The authors conducted 2 studies to validate a measure of perceived visual informativeness (PVI), a message construct assessing visual messages presenting statistical or indexical information. In Study 1, a 7-item scale was created that demonstrated good internal reliability (α = .91), as well as convergent and divergent validity with related message constructs such as perceived message quality, perceived informativeness, and perceived attractiveness. PVI also converged with a preference for visual learning but was unrelated to a person's actual vision ability. In addition, PVI exhibited concurrent validity with a number of important constructs including perceived message effectiveness, decisional satisfaction, and three key public health theory behavior predictors: perceived benefits, perceived barriers, and self-efficacy. Study 2 provided more evidence that PVI is an internally reliable measure and demonstrates that PVI is a modifiable message feature that can be tested in future experimental work. PVI provides an initial step to assist in the evaluation and testing of visual messages in campaign and intervention materials promoting informed decision making and behavior change.

Impact of a bilingual education intervention on the quality of life of Latina breast cancer survivors

PURPOSE/OBJECTIVES

To test the effectiveness of a bilingual education intervention to improve the quality of life (QOL) of Latina breast cancer survivors (BCSs) after completing primary treatment for breast cancer.

DESIGN

A two-group prospective, longitudinal, randomized, controlled trial.

SETTING

An ambulatory-care setting of a designated comprehensive cancer center in southern California.

SAMPLE

52 English- and Spanish-speaking Latina BCSs.

METHODS

Women were randomly assigned to the experimental or attention control group and completed measures of QOL, uncertainty, distress, and acculturation at baseline, and at three and six months postintervention.

MAIN RESEARCH VARIABLES

QOL, uncertainty, and distress.

FINDINGS

After controlling for acculturation, the four dimensions of QOL increased slightly in the groups or remained unchanged without significant group-by-time interaction. The social and psychological well-being subscales had the lowest scores, followed by physical and spiritual well-being. Although the group-by-time interaction was not statistically significant, the post-hoc difference for total QOL between time 2 and time 3 in the experimental group approached significance, with a slight increase in total QOL.

CONCLUSIONS

Latina BCSs have multiple survivorship and QOL concerns that might put them at risk for poor QOL.

IMPLICATIONS FOR NURSING

More culturally congruent intervention studies are needed to address the paucity of intervention research with Latina BCS.

KNOWLEDGE TRANSLATION

Core values must be incorporated in the development of health education programs. Those programs also should be linguistically appropriate and available to non-English-speaking Latinas. In this way, the informational and supportive needs of all BCSs can be met.

Survivorship education for Latina breast cancer survivors: Empowering Survivors through education

OBJECTIVES

Nueva Luz is an English and Spanish quality of life (QOL) intervention developed to address the educational needs of Latina breast cancer survivors and provide strategies to assist in their transition into survivorship.

METHODS

A qualitative approach was used to evaluate the English and Spanish educational intervention (Nueva Luz). A purposive sample of eight Latina breast cancer survivors was selected from the group who received the intervention to participate in a digitally recorded interview. Data was analyzed using thematic analysis.

RESULTS

Findings provide evidence that the one-on-one tailored approach is a feasible and acceptable method of providing a bilingual psychosocial intervention. The provision of printed bilingual information along with the verbal instruction from a bilingual and culturally competent health care provider can be effective in helping Latina breast cancer survivor's transition successfully into survivorship, improve QOL and contribute to better patient outcomes.

CONCLUSIONS

The study informs our understanding of the cultural context in patient education content and delivery of psychosocial interventions. The findings may also have relevance for other ethnic minority cancer survivors.

Fatal falls in an ethnically diverse urban community: the link between demographic factors and the circumstances surrounding fatal falls

OBJECTIVES

Fatal falls cause more than 15,000 deaths per year in the United States. Despite this, the circumstances surrounding fatal falls in elderly adults are poorly understood. It is unknown whether these circumstances differ across ethnicities, although Hispanic American individuals are at reduced risk for fatal falls. This study sought to describe fatal falls in an urban, predominantly Hispanic, and white non-Hispanic community and to determine the association of demographics with the circumstances surrounding these falls (proximate factors).

METHODS

The death certificates and medical examiners' reports for all 328 elderly individuals experiencing a fatal fall in Miami-Dade County, FL, from 2005 to 2007 were reviewed for demographic and proximate factors such as the preceding activity and fall location.

RESULTS

Fatal falls in elderly adults were experienced mostly by individuals living in the community (80%) and affected all demographic subgroups, although 80% occurred in individuals older than 74 years. Most fatal falls occurred at home (74%), indoors (75%), and during nonvigorous activities such as walking (58%) and these tended to affect the oldest elderly. In addition, a significant number of fatal falls occurred in public locations, outdoors, and during vigorous activity, with these falls tending to affect younger individuals living without family. Hispanic ethnicity was not associated with proximate factors.

CONCLUSIONS

Fatal fall prevention is needed for elderly individuals living in the community and should target the oldest elderly adults living at home while helping to ensure that individuals who are living without family have the appropriate support. These data suggest that Hispanic individuals may benefit from prevention strategies developed in other populations.

"Weaving balance into life": Development and cultural adaptation of a cancer symptom management toolkit for Southwest American Indians

INTRODUCTION

Self-management of cancer symptoms has the potential to decrease the suffering of cancer survivors while improving their health and quality of life. For many racial/ethnic groups, culturally appropriate self-management instruction is not readily available. This paper reports on the first symptom management toolkit developed for American Indian cancer survivors.

METHODS

Part of a larger research study, a three-phase project tested a cancer symptom self-management toolkit to be responsive to the unique learning and communication needs of American Indians in the Southwest U.S.A. American Indian cancer survivors and family members participated in 13 focus groups to identify cultural concepts of cancer and illness beliefs, communication styles, barriers, and recommendations for self-management techniques. Sessions were audiotaped and transcriptions were coded using grounded theory.

RESULTS

Participants expressed a need for an overview of cancer, tips on management of common symptoms, resources in their communities, and suggestions for how to communicate with providers and others. The "Weaving balance into life" toolkit is comprised of a self-help guide, resource directory, and video. Preferred presentation style and content for the toolkit were pilot tested.

DISCUSSION/CONCLUSIONS

American Indian survivors favor educational materials that provide information on symptom management and are tailored to their culture and beliefs. Suggestions for adapting the toolkit materials for other American Indian populations are made.

IMPLICATIONS FOR CANCER SURVIVORS

Many cancer survivors lack effective self-management techniques for symptoms, such as pain, fatigue, and depression. The toolkit promotes self-management strategies for survivors and provides family members/caregivers tangible ways to offer support.

Cultural Acceptability of a Smoking Relapse Prevention Intervention for Pregnant Women in Puerto Rico: Providers' Feedback

Hispanic women are more likely than non-Hispanic women to quit smoking during pregnancy, indicating that relapse-prevention interventions may benefit this population. We conducted qualitative interviews with health care providers in Puerto Rico who serve pregnant women regarding the cultural acceptability of Libres Para Siempre Por Mi Bebé y Por Mi (transcreated from the English version, Forever Free for Baby and Me), a smoking relapse-prevention booklet series. Providers praised the overall quality of the content, interactive activities, vignettes, and partner booklet. Recommendations included condensing the content, and distributing the booklets during one-on-one counseling and via "charlas"(community themed presentations). Overall, these smoking relapse-prevention materials are culturally acceptable among health care providers, yet there is a need to attend to local cultural preferences for delivering the intervention.

Development and pilot testing of a culturally sensitive multimedia program to improve breast cancer screening in Latina women

OBJECTIVE

Our study goal was to assess the effects of a brief patient video on breast cancer knowledge and attitudes among Latina women at a community health center.

METHODS

We conducted pre- and post-testing of knowledge and attitudes in women aged 40 years or older with active screening referrals (n=91). We compared pre- and post-test knowledge and attitudes overall and by baseline values.

RESULTS

Mean knowledge increased from 5.8/10 to 6.9/10 (p<0.05), with the greatest increases in those with low baseline knowledge (p<.001). There were no changes in mean attitudes, which were high at baseline (3.8/5); however, among the 16 women with negative/neutral attitudes, 50% developed positive attitudes after watching the video (p<0.05). Baseline intention to complete screening was high at 98%.

CONCLUSION

Although the overall effects were modest, the greatest improvements were in those with low baseline knowledge scores and negative/neutral baseline attitudes. Future testing should examine the effects in a community-based sample.

PRACTICE IMPLICATIONS

A brief patient video has promise for influencing patient knowledge and perhaps attitudes while being amenable to integration into clinical flow.