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Schaefer KR, Todd MR, Trinidad SB, Robinson RF, Dillard DA. Patient and primary care perspectives on hypertension management: short report of a qualitative study in a tribal health system. Int J Circumpolar Health 2022; 81:2049054. [PMID: 35285773 PMCID: PMC8928790 DOI: 10.1080/22423982.2022.2049054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
Abstract
The prevalence of self-reported hypertension is higher among Alaska Native and American Indian (ANAI) individuals than in the majority USA population. Although hypertension is the primary modifiable risk factor for cardiovascular disease and stroke, it can be difficult to manage successfully. The objective of this study was to explore patients' and providers' perspectives about hypertension, hypertension management strategies, and patient-provider communication strategies within a tribally-owned and operated health system in Alaska. We conducted four focus groups that included 16 ANAI patients and five primary care providers. Patient participants tended to consider hypertension a transient state, in contrast with providers' understanding of hypertension as a chronic condition. Differences were noted in participants' perceptions regarding providers' counselling and education efforts, with providers feeling that current strategies are effective and patients desiring a more personalised discussion about hypertension. Patients expressed preferences for behaviour change approaches compared with pharmacotherapy; providers often resorted to medication as a first step towards controlling blood pressure. Our findings suggest areas of potentially promising future research with respect to patient-provider communication and treatment of hypertension.
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Affiliation(s)
| | - Michael R. Todd
- Southcentral Foundation, Research DepartmentAnchorage, AK, USA
| | - Susan Brown Trinidad
- University of Washington, Department of Bioethics and Humanities, Seattle, AK, USA
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Alidosti M, Shahnazi H, Heidari Z, Zamani-Alavijeh F. Development and psychometric assessment of cutaneous leishmaniasis prevention behaviors questionnaire in adolescent female students: Application of integration of cultural model and extended parallel process model. PLoS One 2022; 17:e0273400. [PMID: 35984864 PMCID: PMC9390913 DOI: 10.1371/journal.pone.0273400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cutaneous Leishmaniasis (CL) is an important public health issue in at least 83 countries, including Iran. Individuals' behavior modification is believed to be one of the best ways for CL prevention. However, no comprehensive questionnaires have been psychoanalyzed for identification of CL prevention behaviors and its numerous associated factors, as well as the impact of educational messages. Thus, the present study was conducted to develop and psychometrically assess CL prevention behaviors questionnaire in female students. METHODS The present study was performed from October 2020 to May 2021 by developing a preliminary questionnaire based on integration of Cultural Model and Extended Parallel Process Model. The questionnaire was completed online by 460 adolescent female students living in endemic areas of Isfahan, Iran. Exploratory factor analysis was performed using SPSS 24 to ensure the construct validity. Internal reliability was assessed via Cronbach's alpha and external reliability was determined using the test-retest method based on the intraclass correlation coefficient (ICC) index. RESULTS The first version of the questionnaire contains 110 items, out of which 82 remained according to content validity ratio (CVR) and content validity index (CVI) criteria. Afterwards, 11 items were removed due to low factor load in the construct validity process using the factor analysis technique. Ultimately, a 71-items questionnaire was developed and 12 factors were extracted from it. According to Cronbach's alpha index, the internal reliability for the questionnaire was 0.877 and the ICC index calculated the external reliability as 0.833. CONCLUSIONS Integration of a Cultural Model with individual model was used for the first time to measure the factors related to CL prevention behaviors in this questionnaire; owing to the strength of the factor structure and appropriate psychometric properties, the questionnaire is applicable in the evaluation process of educational interventions concerning CL prevention, especially in female students.
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Affiliation(s)
- Masoumeh Alidosti
- Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Shahnazi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Mohammadinia N, Rezaei MA, Morowatisharifabad MA, Heydarikhayat N. The effect of education based on PEN-3 cultural model on students' menstrual health behaviors: a mixed method study. HEALTH EDUCATION RESEARCH 2021; 36:239-247. [PMID: 33608708 DOI: 10.1093/her/cyab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Indexed: 05/27/2023]
Abstract
Menstruation is a natural process in girls, but sometimes it is accompanied by beliefs and behaviors with cultural roots that result in poor health consequences; this study aimed to consider perceptions of individual, families and community to current cultural beliefs, and to determine the effect of education based on the PEN-3 cultural model on students' menstrual health behaviors in Iran. Study had a mixed method design. In the qualitative phase, data were collected from students, their mothers and teachers through focused group discussion and in-depth interviews. In the quantitative phase, training was done in four 2-h sessions for intervention group. The data were collected immediately and 2 months after the training by a questionnaire and they were analyzed by Friedman and Wilcoxon non-parametric tests. Training was effective on all of the model structures and significantly increased mean score of the health behavior after training and 2 months later by 8.74 and 13.86, respectively, in intervention group (P<0.05). The perception and behavior of the others and access to sanitary services and products, especially cultural factors affect girls'' menstrual health behaviors, therefore, it is necessary to design the health plans regarding each of these factors, and the cultural context of each community.
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Affiliation(s)
- Neda Mohammadinia
- Department of Community Health Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Mohammad Ali Rezaei
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Mohammad Ali Morowatisharifabad
- Department of health education and promotion, school of public health, social determinants of health research center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Beans JA, Woodbury RB, Wark KA, Hiratsuka VY, Spicer P. Perspectives on Precision Medicine in a Tribally Managed Primary Care Setting. AJOB Empir Bioeth 2020; 11:246-256. [PMID: 32940567 PMCID: PMC7606746 DOI: 10.1080/23294515.2020.1817172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Precision medicine (PM) research and clinical application is moving forward at a rapid pace. To ensure ethical inclusion of all populations in PM, in-depth understanding of diverse communities' views of PM research and PM implementation is necessary. METHODS Semi-structured interviews were conducted to explore perspectives on PM in a tribally managed healthcare organization. Thematic analysis was used to analyze data from 46 interviews. RESULTS Participants described gains in diagnostic efficiency, risk identification for preventable disease, and the advancement of population-specific biomedical research as key benefits of PM. Concerns expressed related to privacy risks associated with data-sharing, overpromising on PM, and managing patient expectations related to PM. Stakeholders encouraged PM implementation to be preceded by health education activities that leverage a range of communication strategies. CONCLUSION Perspectives described in this study may aid in and should be considered prior to implementation of PM in this and other healthcare systems, especially those serving diverse populations.
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Affiliation(s)
| | | | | | | | - Paul Spicer
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, USA
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Yuan NP, Schultz JL, Nair US, Bell ML. Predictors of Tobacco Cessation Among American Indian/Alaska Native Adults Enrolled in a State Quitline. Subst Use Misuse 2019; 55:452-459. [PMID: 31694464 PMCID: PMC9710533 DOI: 10.1080/10826084.2019.1683204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: High rates of smoking are documented among some American Indian and Alaska Native (AI/AN) communities, with potential variability by region and urban/rural settings. Quitlines are a cost-effective strategy for providing evidence-based cessation treatment, but little is known about the effectiveness of quitline services for the AI/AN population. Objectives: This study compared demographic characteristics, tobacco use, and cessation and program utilization behaviors between AI/AN (n = 297) and Non-Hispanic White (NHW; n = 13,497) quitline callers. The study also identified predictors of 30-day cessation at 7-month follow-up among AI/AN callers and determined if predictors were different between AI/AN and NHW callers. Methods: Data from callers to the Arizona Smokers' Helpline between January 2011 and June 2016 were analyzed. Results: At enrollment, AI/AN callers were less likely to use tobacco daily and were less dependent on nicotine compared to NHW callers. Both groups reported similar rates of 30-day cessation at 7-month follow-up (37.3% and 39.7% for AI/AN and NHW callers, respectively). For AI/AN callers, 30-day cessation was significantly associated with tobacco cessation medication use (OR = 2.24, 95% CI: 1.02-4.93), number of coaching sessions (OR = 1.14, 95% CI: 1.04-1.26), and other smokers in the home (OR = 0.41, 95% CI: 0.19-0.91). The effect of other smokers in the home was significantly different between AI/AN and NHW callers (p = .007). Conclusions: Different individual characteristics and predictors of cessation among AI/AN callers compared to NHW callers were documented. Findings may be used to inform the development of culturally-tailored strategies and protocols for AI/AN quitline callers.
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Affiliation(s)
- Nicole P. Yuan
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer L. Schultz
- Arizona Smokers’ Helpline, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Uma S. Nair
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
- Arizona Smokers’ Helpline, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Melanie L. Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
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Moeini B, Rezapur-Shahkolai F, Jahanfar S, Naghdi A, Karami M, Ezzati-Rastegar K. Utilizing the PEN-3 model to identify socio-cultural factors affecting intimate partner violence against pregnant women in Suburban Hamadan. Health Care Women Int 2019; 40:1212-1228. [PMID: 31166150 DOI: 10.1080/07399332.2019.1578777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Intimate partner violence occurs in all settings. In this paper the authors describe socio-cultural factors affecting intimate partner violence against pregnant women in suburban Hamadan.The PEN-3 model was utilized by semi-structured interviews with 18 pregnant women. According to women, cultural perceptions (patience in case of facing violence, faith in fate and normalization of violence), enablers (communication skills, economic status, and availability of legal support), and nurturers (family support and social expectation of obedience to men) were found to be important factors that influence violence.A better understanding of the cultural perceptions can help decision-makers in identifying the cultural appropriateness of interventions.
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Affiliation(s)
- Babak Moeini
- Social Determinants of Health Research Center & Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Forouzan Rezapur-Shahkolai
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shayesteh Jahanfar
- School of Health Sciences, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Asadollah Naghdi
- Department of Social Sciences, Buali Sina University, Hamadan, Iran
| | - Manoochehr Karami
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khadije Ezzati-Rastegar
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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de Heer HD, Bea J, Kinslow B, Thuraisingam R, Valdez L, Yazzie E, Schwartz AL. Development of a culturally relevant physical activity intervention for Navajo cancer survivors. ACTA ACUST UNITED AC 2019; 2. [PMID: 33615234 DOI: 10.33596/coll.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite well-documented benefits of physical activity for cancer survivors, few interventions have been developed for Native American cancer survivors, the population with the poorest survival rates of any group. This paper describes the development and cultural adaptation of a physical activity intervention for Navajo cancer survivors using Intervention Mapping (IM). IM procedures were guided by the PEN-3 (Perceptions-Enablers-Nurturers) and Health Belief Models and informed by a qualitative study with 40 Navajo cancer survivors and family members. For each theoretical construct (perceived benefits, barriers, enablers of healthy behaviors, etc.), a measurable objective was identified. These objectives were then matched with intervention strategies. The IM process indicated the need for a highly culturally sensitive environment (site and providers), culturally acceptable measurements and materials, and integrating cultural and environmental activity preferences. Program objectives aligned directly with these areas. Intervention strategies included: (a) collaboration with providers sensitive to historical/cultural context and environmental barriers; (b) cultural adaptation of surveys, non-invasive physical measurements, no biospecimen storage; (c) materials, terminology and symbols embracing cultural values of return to harmony; (d) physical activities that are flexible and aligned with cultural preferences and environment/travel issues (e.g., outdoor walking; community and home-based options; portable, inexpensive resistance equipment; local resources; family/friends participation and more community cancer education); (e) clinical adaptations by site and symptoms. This study is the first to document the process of adaptation of a physical activity program for Navajo cancer survivors. Objectives and strategies incorporated via IM are expected to foster sustainability and enhance uptake, satisfaction, and adherence.
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Affiliation(s)
- Hendrik D de Heer
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ
| | - Jennifer Bea
- Department of Medicine, University of Arizona, Tucson, AZ
| | - Brian Kinslow
- Department of Physical Therapy, Northern Arizona University, Flagstaff, AZ
| | | | - Luis Valdez
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
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