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Culturally Competent Health Promotion/Education
Alcalay R. Alvarado M. Balcazar H. Newman E.
Huerta E. Cardiovascular disease (CVD) is the leading cause of death for Latinos living in the United States. This population is generally unaware of important lifestyle or behavioral changes that can prevent CVD. The National Heart, Lung, and Blood Institute (NHLBI) designed and implemented Salud para su Corazon (Health for Your Heart), a culturally appropriate, community-based, theory-driven intervention model. NHLBI's goals were:
An agency-community partnership, under the leadership of the Community Alliance for Heart Health, guided all stages of the community intervention project. The multimedia bilingual community intervention included television telenovela format public service announcements (PSAs), radio programs, brochures, recipe booklets, charlas, a promotores training manual, and motivational videos. An evaluation survey assessed the impact of the intervention. A pre-post intervention survey was conducted with more than 300 participants, and results showed that the respondents were substantially more aware of risk factors for CVD, and had greatly increased their knowledge of ways to prevent heart disease. Dissemination efforts have resulted in numerous requests by health organizations, universities, and health maintenance organizations (HMOs) for educational materials and communication strategies produced by Salud para su Corazon. In addition, Univision, the largest Spanish-language broadcast television network, is airing the initiative's PSAs. Also, training seminars for promotores are being conducted in different regions of the United States, and several locations are planning to replicate this study. Bailey EJ. Erwin DO. Belin P. Breast cancer and early detection of the disease is a significant issue for all women. Moreover, the sociocultural implications in the differential mortality rates increased interest in possible barriers to screening practices. Recently, a number of studies have investigated African Americans' cultural beliefs associated with breast cancer. This study is based upon qualitative focus group data gathered from 1989 to 1991 and 1996. This article provides focus group data that informed a culturally competent community-based cancer education program for African-American women--the Witness Project. Analysis of the qualitative data along with the quantitative outcome data revealed a direct relationship between cultural beliefs and patterns with mammography utilization. The once perceived cultural barriers can actually be applied as a cultural intervention strategy to improve breast cancer screening initiatives designed specifically for African-American women. Barnhart JM. Mossavar-Rahmani Y. Nelson M. Raiford
Y. Wylie-Rosett J. Thirty African-American women (mean age 60.5 years) participated in a church-based, three-session workshop pilot program that focused on increasing fruit and vegetable intake. The program was designed and presented by a medical school-based health professional team in consultation with the church's Nurses' Unit. Fruit and average daily vegetable intake increased from 0.89 to 1.2 and from 0.81 to 1.1 servings, respectively. Evaluation indicated that cookbooks, food co-ops, and workshops were preferred methods for learning about increasing fruit and vegetable intake. Collaboration with the church's Nurses' Unit facilitated tailoring a nutrition program to the church membership and networking with other churches. Barnes-Boyd C. Norr KF. Nacion KW. This paper describes an interagency home visiting program, Resources, Education and Care in the Home (REACH), designed to reduce preventable causes of morbidity among normal, socioeconomically disadvantaged infants at risk for adverse outcomes due to social factors. Home nursing visits by a trained nurse-community worker team were made throughout the first year of life to 1,269 infants from predominantly African American families. Results demonstrate that repeated home visits with ongoing infant health monitoring plus individualized and culturally sensitive teaching helped mothers maintain good health practices and identify illnesses early. Infants' outcomes during the neonatal period and at 12 months showed consistent, though statistically nonsignificant, positive effects on physical health. The postneonatal mortality rate among REACH infants was 4.7 deaths per 1000 live births in communities where rates for nonparticipants ranged from 5.2 to 10.9 per 100. The evaluation demonstrates a need in this population for more intensive services with greater continuity of care. Specific areas where more education is needed include home safety, skin care, and early identification and treatment of upper respiratory infections. Infants from communities with high infant mortality rates present numerous preventable morbidities requiring interventions, even when they are not considered medically high-risk at birth. Beechem MH. This is a case study of a young Mexican-American woman who suffered from end-stage renal disease and severe depression in Texas, before the availability of hospice care. The patient, while struggling to retain her cultural identity in a renal care unit which stressed efficiency, was labeled noncompliant by the medical team. Through knowledge gained from staff discussions, the medical team was able to integrate cultural sensitivity and hospice principles into the treatment plan. With an increased focus on her psychosocial needs, the patient was able to die with a sense of dignity and cultural integrity. (26 ref) Bell RA. Alcalay R. This study examined how acculturation mediated the impact of the California Wellness Guide/La Guia del Bienestar on Hispanic women's knowledge, efficacy beliefs, and behaviors. Knowledge gaps were found between acculturated and less acculturated women. Acculturated mothers had more confidence in their abilities to acquire wellness-related information both before and after Guide/Guia distribution and also had more assistance-seeking efficacy. Guide/Guia recipients were more knowledgeable, had greater confidence in their knowledge and their abilities to acquire information, and possessed better information acquisition strategies than nonrecipients. The publication also enhanced low-acculturated recipients' assistance-seeking self-efficacy. High-acculturated and low-acculturated recipients of the Guide/Guia were equally likely to have retained and used their copies, to anticipate using the publication in the future, and to have made a change in behavior as a result of the guide. Finally, the Guide/Guia did not increase the knowledge gap between high- and low-acculturated guide recipients. Bell TS. Branston LK. Newcombe RG. Barton GR. Objective To increase the uptake of breast screening in three inner city GP practices with a high proportion of ethnic minority patients. Setting The study was carried out in May and June 1997 in the South East Wales division of Breast Test Wales (BTW). Three inner city general practices in Cardiff, with a low uptake in the previous round of breast screening and a high proportion of ethnic minority women on their lists, were targeted to receive interventions to increase uptake. This preliminary study was not randomized but sought to offer insights into the interventions which may be worth pursuing and the groups that are harder to reach. Design Interventions:
Results Of 369 women invited, 187 attended for screening. This gives an uptake of 50.7% compared with an uptake of 35.2% in the previous screening round, a statistically significant increase of 15.5%. (95% CI + 8.2% to + 22.5%). Conclusion Findings show that translated literature, GP endorsement letter and language support by linkworkers were beneficial. The provision of free transport was ineffective and under-utilized. Uptake was highest amongst Urdu and Gujarati speaking groups and lowest for Bengali and Somali speakers which are hardest to reach. There is scope for improving the attendance rate amongst ethnic minority groups but this can prove costly. (30 ref) Bird JA. McPhee SJ. Ha NT. Le B. Davis T. Jenkins
CN. Purpose: We describe a controlled trial of a community outreach intervention to promote recognition, receipt, and screening-interval maintenance of clinical breast examinations (CBE), mammograms, and Pap smears among Vietnamese-American women.
Results: In the intervention community, recognition of screening
tests increased significantly between pre- and postintervention surveys:
CBE, 50 to 85%; mammography, 59 to 79%; and Pap smear, 22 to 78% (P =
0.001 for all). Receipt of screening tests also increased significantly:
CBE, 44 to 70% (P = 0.001); mammography, 54 to 69% (P = 0.006); and Pap
smear, 46 to 66% (P = 0.001). Best-fitting logistic regression models,
adjusting for preintervention rates and significant covariates, also showed
statistically significant odds ratios for the intervention effect (P <
0.0001). Conclusions: Trained Vietnamese lay health workers significantly increased Vietnamese women's recognition, receipt, and maintenance of breast and cervical cancer. Blackford J. Street A. Physical dislocation of people from their homelands either as refugees, immigrants or exiles has resulted in the creation of multicultural communities which have diverse health needs. Like elsewhere, nurses in Australia have been faced with the challenge of responding to an ever-changing migrant population. A modified problem-based learning project was conducted in Melbourne to assist nurses to enhance their practice of caring for children and families of non-English speaking backgrounds (NESB). Clinical nurses worked with the researchers to develop and trial problem-based educational packages. The packages were designed for use in the clinical areas and graduate nursing programs to assist nurses overcome the cultural and communication difficulties they experienced when caring for people of NESB. Briscoe VJ. Pichert JW. Some African Americans with (or at risk for) diabetes underutilize health care services. We report short-term results of a "training of trainers" workshop designed to address this problem. The training program includes culturally sensitive educational materials, including materials developed for the ADA's African American Program (AAP). Workshops were presented to
Evaluations were based on program satisfaction and an "intention to change" procedure that assessed participants' actions and the obstacles they faced 6 months later. Sixty-four group representatives from 13 states participated. They completed a satisfaction questionnaire and were asked to complete a form that asked them to check any of 12 diabetes-related actions (distributing ADA risk tests, offering AAP classes, etc.) they intended their church/community group to take within six months. Activities not listed could be added. Follow-up contact information was solicited. Satisfaction surveys were positive. 39 (61%) returned checklists with complete contact information. Intentions included: arrange for congregation/community group to take risk test (71% of respondents), distribute diabetes materials at community health fairs or church services (67%), present AAP modules (59%), promote healthy foods at pot luck suppers (56%) and arrange cooking or exercise classes (38%). Respondents were contacted by telephone 6 months post-workshop and asked whether they had fulfilled their intentions. Contact information for 6 (15%) was no longer valid, and we were unable to reach 7 others despite repeated attempts. Approximately 30% of intentions were fulfilled by nurses guild members, but less than 10% by other groups. Half of all fulfilled intentions occurred in a community served by an active ADA AAP Coalition. Barriers to fulfilling intentions included lack of time/support, group not ready to act or doing other programs, and failure to collaborate with the ADA or others for mutual assistance. Existing agencies, especially churches with nurses guilds, offer a means for promoting diabetes screening and awareness in African American communities. A training workshop was well received and influenced some participant groups' self-reported actions. Participants appear more likely to fulfill intentions to conduct diabetes-related programs when they collaborate with other churches, agencies and/or the ADA. Brown SA. Hanis CL. Purpose: Few culturally competent health programs have been
designed for Mexican Americans, a group that bears a disproportionate
burden of Type 2 diabetes. In Starr County, a Texas-Mexico border community,
investigators designed and tested a culturally competent intervention
aimed at improving the health of this targetpopulation. The purpose of
this article is to describe the development process of this diabetes education
and support group intervention. Methods: The development stages were
Results: Focus group participants identified knowledge deficits
regarding diabetes and self-management strategies, and suggested characteristics
of an effective intervention for Mexican Americans. Outcome measures included
metabolic control indicators, a newly developed knowledge instrument,
and an existing health belief instrument. Preliminary analyses indicated
that the intervention was successful in significantly improving metabolic
control in the target population. Conclusions: Developing successful diabetes interventions for minority groups requires a number of stages, careful planning, assessment of cultural characteristics of the target population, and a systematic approach to implementation. Carrol AM, Wong C, Yang K, Moua N, Purpose: To review the findings from the Hmong Quality of Care
Project related to the patients’ interactions with their health insurance
plans and health education materials, and to highlight implications and
recommendations for future health education, promotion, and outreach in
the Hmong community. Methods: Qualitative in-depth interviews were conducted with ten Hmong community leaders, as well as two focus groups with hypertensive Hmong patients from Fresno, CA, in order to understand the contextual issues related to quality of care. This qualitative data also led to the development a culturally relevant, Hmong-adapted, quantitative quality of care survey instrument which was administered to 200 hypertensive Hmong patients recruited from the health department in Fresno, clinics, churches, and through outreach activities. The findings from both the qualitative and quantitative data will be presented here to demonstrate a clearer understanding of these themes. Findings: Although most study participants are insured in a local managed care plan under either Medi-Cal or Medicare, an alarmingly high proportion did not know the name of their health care plan. In addition, despite an acceptable proportion of patients responding correctly to questions testing level of knowledge around hypertension and heart disease, most were not able to correctly report when health care services should be sought when experiencing specific symptoms. These findings have important implications regarding the interactions between this traditionally underserved and non-English speaking Hmong population and the health care plans that serve them, particularly in regards to potential areas for health education, health promotion, and health care delivery system outreach. Chen MS Jr.. Zaharlick A. Kuun P. Li WL. Guthrie
R. This article describes the setting for the first Office of Minority Health funded Minority Community Health Demonstration Grant Project targeted toward the Southeast Asian minorities of Cambodians, Laotians, and Vietnamese, explains how the theoretical basis of the Indigenous Model was implemented, and offers lessons learned and suggestions for future minority health programs. Three examples of how the Indigenous Model was applied, in some instances, in unanticipated ways are discussed. Lessons related to implementing the Indigenous Model for minorities are suggested. (6 ref) Cooper LA Several studies document underutilization of outpatient specialty mental health services by African Americans. However, African Americans with depression are just as likely as whites to receive care in primary care settings. Despite their use of primary care services, African American patients are less likely than whites to be recognized as depressed, offered pharmacotherapy, and to initiate or complete pharmacotherapy or psychotherapy for depression. African American patients express stronger preferences for counseling and more negative attitudes toward antidepressant medication, the most common form of treatment of depression used by primary care physicians. African Americans are also more likely to see depression and its treatment through a spiritual or religious framework. Studies show that African Americans receive less optimal technical and interpersonal health care than whites for many conditions. Depression is a common chronic condition that results in substantial morbidity, functional disability, and resource use. Despite the proven efficacy of pharmacotherapy and psychotherapy for treatment of depression, the gap between research findings and clinical practice is wide for management of depression in primary care. Recent intervention work has shown that quality improvement strategies for depression in primary care are effective. Research also shows that cultural adaptations can improve adherence and retention in care for ethnic minority patients. We have created a cultural adaptation that includes many of the components of recent successful quality improvement interventions for depression in primary care. The proposed study uses a patient-centered, culturally tailored, education and activation intervention with active follow-up by a depression case manager. It also includes academic detailing and structured mental health consultation tailored to physicians’ needs and emphasizes cultural competence to improve care for African American primary care patients with major depressive disorder. Thirty physicians and 250 patients will be randomized to either usual care or the combined patient and physician intervention. The main hypothesis is that patients in the intervention group will have higher remission rates from depression, lower levels of depressive symptoms, and better functional status at 12 months than patients in the usual care group. We will also measure patient adherence to guideline concordant care and several process measures (patient and physician satisfaction with technical and interpersonal care, and depression care, patient and physician attitudes towards depression, and self-efficacy in managing depression. This study will add to knowledge about how to effectively engage African American patients in care of depression and serve as a prototype of how to incorporate cultural sensitivity in programs to improve care for common conditions in ethnically diverse populations. Davis SM. Lambert LC. Gomez Y. Skipper B. The Southwestern Cardiovascular Curriculum is a multidisciplinary school-based program to promote cardiovascular health behavior change in fifth grade Navajo and Pueblo students. The curriculum was implemented at 11 elementary schools located on or near American Indian reservations in rural New Mexico. The five-year program was designed to be culturally relevant to rural American Indian children in the southwest, incorporating Native American traditions and values into lessons and activities. Participating schools were randomly assigned to curriculum or control conditions. Students in the curriculum group showed significant increases in knowledge when compared with controls for both Navajos and Pueblos. A higher proportion of students in the curriculum group reported a decrease in the frequency of salt use at the table and butter on bread or tortillas. Of students who had tried smoking at baseline, boys and Pueblo students in the curriculum group reported decreasing their smoking habits more than controls. Similarly, boys and Navajo students who had tried smokeless tobacco at baseline, and received the curriculum, reported using less smokeless tobacco at the post-test than controls. In the curriculum group, 70 percent of students reported increasing the amount they exercised since baseline. These results indicate that culturally appropriate school-based programs can help promote behavior changes that lead to healthy lifestyles in American Indian children. (22 ref) Dignan MB. Michielutte R. Jones-Lighty DD. Bahnson
J. The Forsyth County Cervical Cancer Prevention Project was a 5-year community-based health education program funded by the National Cancer Institute. The program was developed to reduce cervical cancer mortality among black women in Forsyth County, and it was targeted to those ages 18 and older. The program tried to educate the target population through a combination of mass media and direct education. This paper reports on an experiment conducted to investigate sources of influence on the effectiveness of direct mail, a technique used to augment mass media health education. Direct mail has shown promise as a method for reaching target populations that are difficult to reach with other mass media approaches. Using commercially prepared mailing lists sorted by zip code and other characteristics of the resident, health-related materials can be targeted to persons at their homes. A randomized experiment involving 1,000 households was carried out to estimate the influence of type of postage and address (name versus "resident or occupant") on the response rate to direct mail. Results indicated that there was no significant advantage from use of first class over bulk rate postage, but the return was significantly greater when the envelope bore a name rather than "resident or occupant." Dignan MB. Michielutte R. Wells HB. Sharp P.
Blinson K. Case LD. Bell R. Konen J. Davis S. McQuellon RP. Although age-adjusted mortality rates from cancer among Native-Americans are generally lower than for the US population as a whole, cervical cancer mortality rates are higher. This report presents results from a National Cancer Institute-funded health education program conducted among the Lumbee tribe in North Carolina that was designed to increase the proportion of women, age 18 and older, who receive Pap smears to screen for cervical cancer. The Solomon Four Group research design was used for this project. Participants were selected at random from the enrollment records of the Lumbee tribe and data collection was carried out during face-to-face interviews. The health education program was provided one-on-one in women's homes by a trained lay health educator and included verbal, print and videotape information. A total of 979 women were enrolled in the study, and 125 were lost to follow-up between the pre-test and post-test. Women who received the education program were found to be more likely to have knowledge of the Pap smear and to report a Pap smear in the past year at the post-test than those in the control group, regardless of whether they received the pre-test interview, P < 0.05. Women most likely to respond to the education program were also likely to have reported that they receive an annual physical examination. Women with better knowledge of the Pap smear tended to have more education, higher income and greater identification with Native-American culture than those with less knowledge. We conclude that the health education program was associated with greater knowledge about cervical cancer prevention and higher proportions of Lumbee women obtaining Pap smears in the past year. (28 ref) Duffy SA. Bonino K. Gallup L. Pontseele R. A community assessment was conducted by nursing students to determine the educational needs of Native American women whose infants were at risk for infant mortality. As a result, a culturally based community baby shower was provided for the women and their infants which incorporated health education. Games, prizes, and lunch were provided for the mothers upon completion of educational newborn care, immunizations, and infant safety learning activities. The intervention project based upon maintaining a Native American cultural theme was used with cake, favors, prizes, invitations, and advertisements. In addition, a recognized Native American spiritual leader was invited to begin the shower with a traditional blessing. Multiple community resources such as businesses, stores (including drug), churches, hospitals, a local nursing home, and several private individuals also contributed time, money, and baby care items for the shower. From the advertising, many women expressed interest in attending the baby shower than could be accommodated. Press releases provided exposure for the school of nursing, contributors, participants, and many members of the Native American community. A pre- and posttest survey indicated that by the end of the baby shower, all 10 key Native American women participants were able to demonstrate the use of the information taught by the nursing students. The baby shower enhanced the Native American mothers' self confidence and provided them with culturally sensitive care. The welcoming atmosphere created by the students for the Native Americans was also important to the success of the project. (5 ref) Earp JA. Flax VL. Purpose: Since the 1970s, health promotion and disease prevention programs that rely on lay health advisors have proliferated, making it important to ascertain the levels and types of activity that can reasonably be expected from such advisors. This report describes the activities of lay health advisors participating in a program to increase mammography screening by older African American women and shares lessons that the authors learned about evaluating advisors' activities. Description of Study: Between September 1994 and January 1996,
144 lay health advisors, associated with the North Carolina Breast Cancer
Screening Program, were asked to complete, on a periodic basis, a standardized,
self-administered activity report that asked about group presentations
in the past 3 months and one-on-one contacts in the past week. Eighty-five
advisors submitted one or more reports. The authors tabulated responses
for lay health advisors overall, for those turning in one or more reports,
and for those reporting a specific type of activity. Results: The responses showed that North Carolina Breast Cancer Screening Program lay health advisors made approximately one group presentation every 3 months and had one to three individual contacts per week. Group presentations were commonly in churches and homes, and focused on who needs a mammogram, how then, and where to get one. During one-on-one encounters, advisors primarily encouraged women to get mammograms or discussed fears about mammograms. Clinical Implications: Information about lay health advisor activities serves several important purposes. Such information allows programs to identify the types of messages that lay health advisors transmit and the number of contacts they make, while also identifying the groups that are more and less difficult to reach, and the topics and locations favored by advisors and the women they contact. Activity data may indicate what resources or other support the advisors need, whether in-service training is necessary, and how to enhance the recruitment and training of additional lay health advisors. Edwards N. Ciliska D. Halbert T. Pond M. An intersectoral immigrant health promotion project in Hamilton, Ontario is described. The project goal was to facilitate the entry of new immigrants to the Ontario health care system and equip them with knowledge and skills to strengthen their preventive and promotive health practices. A needs assessment preceded project development. The three phases of the project are described. The first phase commenced with the development of culturally sensitive health promotion resource materials to be used with immigrants enrolled in English as a Second Language Classes. In phase two, activities focussed on strengthening the ability of ESL teachers to incorporate a preventive and promotive health focus in their classes. The final phase shifted to a community-based project. During this phase, a core immigrant group developed their skills as health advocates for their immigrant community. Erwin DO. Spatz TS. Stotts RC. Hollenberg JA. Purpose: This study examines the effectiveness of the Witness
Project, a culturally competent cancer education program that trains cancer
survivors to promote early detection and increased breast self-examination
and mammography in a population of rural, underserved, African American
women. Description of Study: The primary setting for the Witness Project-an
intensive, community-based, culturally sensitive educational program that
incorporates spirituality and faith-was the African American church. Baseline
and 6-month follow-up surveys were obtained from 206 African American
women in two intervention counties and from 204 African American women
in two control counties in the rural Mississippi River Delta region of
Arkansas. Results: Witness Project participants significantly increased
(P <.0001) their practice of breast self-examination and mammography
(P <.005) compared with the women in the control counties. Clinical Implications: These results demonstrate that intensive, community-based, culturally sensitive educational programming incorporating the spiritual environment of the faith community, such as the Witness Project, can positively influence breast cancer screening behaviors among rural, underserved African American women. Through the use of community churches and cancer survivors, breast cancer screening activities can be improved in this population. Erwin DO. Spatz TS. Stotts RC. Hollenberg JA.
Deloney LA. Background: The five-year survival rate for African American
women with breast cancer is notably lower than the rate for white women;
thus, appropriate cancer education and screening efforts are needed to
increase mammography and breast self-examination practices by African
American women. Methods: The Witness Project is a theory-based intervention designed
to provide culturally sensitive messages, from African American breast
cancer survivors, in churches and community organizations. These messages
emphasize the importance of early detection to improve survival. Results: Intervention research in eastern Arkansas with 204 African
American women demonstrated a significant increase in the practice of
breast self-examination (p < 0.001) and mammography (p < 0.001)
after participation in the Witness Project. There was no significant difference
between the pre- and postintervention scores for scaled items for the
health-belief model and locus of control. Conclusions: Results demonstrate that culturally appropriate cancer education programs are able to change behavior by meeting the beliefs of participants rather than attempting to change their beliefs. Erwin DO. Spatz TS. Turturro CL. Minorities and indigent populations have low participation rates in breast cancer education and screening programs, and suffer from higher morbidity and mortality. Attitudes, norms, and values of such populations are best addressed by breast cancer patients of the same race and cultural background who serve as role models. This article describes the development and pilot study of an intervention program using role models as part of a "Witness" presentation. Programs were held in participants' local African-American churches and community centers. The organization of the program was based on an educational model (4MAT) that identified learning styles and brain hemisphere dominance. Preliminary results with 78 African-American women indicate that the program design is effective in reaching low-income, less-educated African-American women who did not believe themselves to be at high risk for breast cancer. Three-month follow-up demonstrated a significant increase in the practice of BSE and 19% had a mammogram. Ferguson, Stephanie Lida Abstract: This study determined the effects of peer counseling in a culturally-specific pregnancy prevention program for African American females. Social learning theory was used as the theoretical framework. The study took place in Charlottesville, Virginia. A random pretest and multiple posttest comparison group design was used to obtain data on a total sample size of 63 African American adolescent females, ages 12-16, who lived in four local public housing developments. Descriptive data and tests of significance were calculated to evaluate the effectiveness of the intervention of peer counseling on preventing pregnancy, delaying sexual intercourse, increasing knowledge related to reproduction, sexually-transmitted diseases, and contraceptives and using effective contraceptives if sexually-active. A total of 52 females remained in the study at the 3-month posttest. None of the participants who received the intervention of peer counseling became pregnant within 3 months of the intervention. Likewise, none of the comparison group participants became pregnant during the study. There was no delay in sexual intercourse for the sexually-experienced participants in the experimental group or in the comparison group. However, the majority of sexually-experienced participants in the experimental group reported having no sexual intercourse within the last 4 weeks at both pretest and 3-month posttest. Findings further revealed that a statistically significant increase in knowledge of reproduction, sexually-transmitted diseases, and contraceptives occurred within the experimental group when comparing their pretest and 8-week posttest scores. Their average knowledge scores remained the same when comparing 8-week posttest and 3-month posttest scores. The comparison group participants improved their knowledge scores significantly based on 8-week and 3-month posttest scores. Finally, there was not a statistically significant difference between the sexually-experienced participants in the experimental and comparison groups in their use of effective methods of contraception. Recommendations for nursing include:
Flaskerud JH. Nyamathi AM. The purpose of this study was to test the effects of an AIDS education program on the knowledge, attitudes and practices of low income black and Latina women. A pretest-posttest nonequivalent control group design was used with a 2-3 month retest of the experimental group. The sample consisted of 506 experimental and 206 control group women who were clients of the Public Health Foundation's Nutrition Program for Women, Infants and Children in Los Angeles County. The program included a slide-tape presentation, and educational and resource brochures in English and Spanish. Knowledge, attitudes, and sexual and drug use practices were measured using a structured questionnaire that was developed in English and Spanish. Content validity and reliability of the questionnaire were established. A 2-way repeated measures ANOVA examined differences in pretest-posttest knowledge, attitudes, and practices for experimental and control groups and for both racial/ethnic groups. The experimental group made significant gains over the control group on pretest-posttest measures of knowledge and attitudes. Both experimental and control groups made significant changes in practice. Changes in knowledge were retained on retest; changes in practices came close to significance on retest. Blacks and Latinas differed on pretest knowledge and attitudes but not practices. Blacks had more knowledge and positive attitudes on pretest. However, posttest improvements for both knowledge and attitudes were greater in Latinas than in blacks. A multiple regression analysis revealed that the best predictors of knowledge, attitudes and practices were racial/ethnic group, education, and religion. It is concluded that a didactic audio visual program can positively affect the knowledge and possibly the practices of participants and that these are retained over time but that changes in attitudes will take further efforts. Flaskerud JH. Nyamathi AM. Uman GC.
Methods: The study design was prospective and longitudinal involving pre-test, post-test and retest measures over a 2-year period. The study employed an experimental group and a comparison group which did not receive the intervention. The study group was comprised of a convenience sample of 508 low-income Latina women who were recruited from the Public Health Service nutrition programme for women, infants and children (WIC). The comparison group (n = 51) was recruited from the same setting. A battery of instruments was selected to measure HIV knowledge and practices, the social support received, self-esteem, the level of acculturation and sociodemographic characteristics. The instruments were administered at pre-test, 2 weeks post-test and 1 year retest. The HIV antibody serostatus was assessed at pre-test and retest. An intervention protocol based on cultural competence, women as traditional health care givers and the major transmission categories was provided after the pre-test and was reinforced post-test. Finally, qualitative data were collected from the focus group participants (n = 55) to evaluate the intervention protocol. Results: The participants in the study made significant improvements in HIV knowledge and reported condom use practices from pre-test to post-test that were retained on retest. The comparison group subjects did not make significant pre-test-post-test improvements on these measures. Conclusions: It should be noted that the changes in practices made by the study group did not necessarily reduce their risk of HIV infection or transmission and were not related to the demonstrated knowledge and skills improvement. Of special significance to programme planners, educators and researchers, both the quantitative and qualitative data revealed problem areas with the intervention protocol related to cultural norms and the possible fragmentation of information based on the behavioral transmission categories. Flaskerud JH. Uman G. In 1988 and again in 1990, the National Center for Health Statistics conducted a survey of the AIDS related knowledge and beliefs of Hispanic and non-Hispanic adults in the United States. A survey of Los Angeles Hispanic women was conducted in 1990, using the 1988 survey instrument. This study is an examination of the trends in knowledge and beliefs by comparing those of Hispanic Los Angeles women in 1990 to Hispanic and non-Hispanic female respondents in the 1988 national sample. Despite intense public health, local community, and media efforts to educate the public about AIDS, the women in the Los Angeles sample did not show appreciable differences in knowledge and beliefs compared with the 1988 national sample, and in many areas they were less knowledgeable. These results may be related to differing education and acculturation levels as well as possible differences in ethnicity. Hispanic groups will need focused prevention efforts which take into account specific areas of knowledge, educational level of information, adherence to traditional beliefs and practices, and ethnicity of the targeted community. Fowler BA, Risner PB These programs are vital for Black Americans who experience distressing disparity in the leading causes of mortality and morbidity when compared to White Americans. Black Americans also experience poorer health as a result of racism, prejudice, discrimination, economic issues, and social ills such aspoverty and lack of access to health care. The major purpose of this study was to examine the effects of a nurse-delivered six-month pilot HPP on the health awareness and reported health behaviors of Black Americans in the workplace. Approximately 50 employees participated in the HPP. The overall health screening and evaluation survey results indicated that the HPP was effective in increasing health awareness and in changing health behaviors. Nurses can play an important leadership role in improving the health of Black Americans in the workplace. Gilliland SS. Carter JS. Perez GE. Two Feathers
J. Kenui CK. Mau MK. The experience from the Native American Diabetes Project and the Native Hawaiian Diabetes Intervention Program illustrates the intervention development and adaptation process in two minority populations. The recommendations presented may be useful to health practitioners and researchers interested in developing or adapting culturally competent diabetes interventions for minority populations affected with diabetes. (44 ref) Griffin JA. Gilliland SS. Perez G. Helitzer D.
Carter JS. Purpose: The purpose of this paper is to report on participant
satisfaction with the Native American Diabetes Project diabetes education
program. Methods: A questionnaire was designed to measure satisfaction
among participants in the diabetes education program, which consisted
of five sessions designed according to the Transtheoretical Model of Change
and Social Action Theory with input from community members. Eight pueblo
communities participated in the program. Sessions were taught by community
mentors in three sites in New Mexico. One site taught sessions in a one-on-one
format, and two sites taught sessions in a group format. Results: The results showed that participant satisfaction did
not vary based on session delivery type or by session site. Overall, participants
responded positively to sessions designed according to Social Action Theory
and with cultural competency. Retention rates for the sessions were 81%
for group sessions and 91% for one-one-one sessions. Conclusions: Using a strong theoretical framework and community input to design diabetes education sessions may be important factors in participant satisfaction and retention in diabetes lifestyle education sessions. Hartman TJ, McCarthy PR, Park RJ, Schuster E,
Kushi LH Objective: To obtain information to direct the design and development of a nutrition intervention program targeted at a low-literacy audience. SUBJECTS: Thirty-nine female and two male clients of the Expanded Food and Nutrition Education Program (EFNEP) participated in five focus-group discussions. The focus groups included 23 African American, 9 white, 4 Southeast Asian, 1 American Indian, 2 Hispanic American, and 2 Middle Eastern EFNEP participants. Design: All focus groups were moderated and co-moderated by University of Minnesota staff members. The focus groups were tape-recorded and transcribed. A written report was generated based on the independent evaluation of two staff members.
Conclusions: Clients with limited literacy skills have valuable opinions and insights that program developers targeting this hard-to-reach group should hear. The EFNEP participants wanted simple, practical, and relevant information about what foods to eat and how to prepare them. They considered lectures an ineffective way to receive nutrition information, and they expressed a preference for hands-on activities that were enjoyable and allowed participants to share ideas and experiences. Hartweg DL. Berbiglia VA. The Hispanic/Latino population is the second largest and fastest growing minority in the United States, with Mexican Americans comprising 60.4% of the total. Existing research instruments and procedures must be made culturally specific, both theoretically and empirically, for use with this population. Our purpose in the present study was to determine whether one part of the Health Promotion Self-Care Interview Guide (HPSCIG), developed to identify self-care actions that promote well-being in healthy, middle-aged Anglo American and African American women (Hartweg, 1991, 1993), was culturally sensitive for use with Mexican American women. This was a necessary step before the full HPSCIG was translated into Spanish for a larger bilingual study. Twenty Mexican American women identified 232 self-care actions they took to promote well-being as they defined it. More than 81% of the self-care actions were performed to meet the universal self-care requisites, 11% were performed to meet the developmental requisites of middle-age, and 2% were performed to meet health deviation self-care requisites. Six percent of the actions could not be classified using the theoretical coding scheme. Inherent in the study were questions about the congruence and relevance of self-care as a concept in this population. The findings support the use of the HPSCIG with healthy, middle-aged Mexican American women. Hewitt, Nicole Bridgette. Adolescents, particularly African American adolescents, are at risk of HIV infection. Few studies have examined HIV risk-reduction interventions that promote a sexual abstinence message or that match African American adolescents' Africentric world views. The purpose of this study was to examine whether African American adolescents' level of Africentricity would moderate the effects of two theory-based HIV risk-reduction interventions. I hypothesized that high Africentric adolescents who were matched with an Africentric intervention and low Africentric adolescents who were matched with a Generic intervention should show greater reductions in HIV risk behavior and the theoretical mediators of such behavior than would mismatched adolescents. The participants were 124 African American adolescents. Their mean age was 13.19 years (SD = 0.82). Approximately, 61.3% were female and 38.7% were male. Adolescents were randomly assigned to an Africentric HIV risk-reduction intervention, a Generic, culturally sensitive HIV risk-reduction intervention, or a control, general health promotion intervention led by specially trained adult or peer co-facilitators. The interventions lasted 5 hours and were structurally similar and developmentally appropriate. Participants completed preintervention, postintervention, and 3-month follow-up questionnaires. Participants' individual differences in Africentricity were measured prior to the interventions. The results revealed that adolescents' level of Africentricity moderated the effects of the interventions on adolescents' HIV risk behavior. However, the matching hypothesis was not supported. As predicted, among low Africentric adolescents, those in the Generic intervention were less likely to report engaging in sexual intercourse in the past 3 months than were those in the control intervention. In addition, low Africentric adolescents in the Generic intervention reported less frequent sexual intercourse and less frequent unprotected sexual intercourse than did their counterparts in the control intervention. Contrary to predictions, low Africentric adolescents in the Africentric intervention also reported less frequent sexual intercourse and unprotected sexual intercourse than did low Africentric adolescents in the control intervention. Furthermore, high Africentric adolescents in the Africentric intervention did not differ in HIV risk behavior compared with high Africentric adolescents in the control intervention. Thus, both HIV risk-reduction interventions greatly reduced low Africentric African American adolescents HIV risk behavior. Jackson J. Kennedy BL. Mandel D. Carlson M. Cherry
BJ. Fanchiang SP. Ding L. Zemke R. Azen SP. Labree L. Clark F. As the percentage of older adults of diverse ethnicities increases in the United States, the call for culturally sensitive health care service strategies that target the special needs of older people grows. The present report describes methods used to adapt a health care program so that it would better meet the needs of a group of well, older Mandarin-speaking Chinese residents of Los Angeles. The specific qualitative research procedures that we used to adapt the treatment program are described, along with the particular adaptations that emerged. Additionally, outcomes from a randomized pilot experiment are presented that are consistent with the notion that the adapted program was effective in reducing health-related declines among older Mandarin-speaking men and women. The overall outcome of this project is in agreement with other reports in the health care literature that address the importance of providing culturally sensitive health care service for elders. Litrownik AJ. Elder JP. Campbell NR. Ayala GX.
Slymen DJ. Parra-Medina D. Zavala FB. Lovato CY.
Methods: A total of 660 Hispanic migrant families participated
in a randomized pre-post control group study that was utilized to determine
the impact of the intervention on parent-child communication. Both treatment
and attention-control groups of youth were exposed to an eight-session
culturally sensitive program presented by bilingual/bicultural college
students. Parents jointly attended three of the eight sessions and participated
in helping their child complete homework assignments supporting the content
of each session. The content of the treatment intervention included (1)
information about tobacco and alcohol effects, (2) social skills training
(i.e., refusal skills), and (3) the specific development of parent-child
communication skills to support healthy youth decisions. Results: Significant intervention by household size interactions
for both parent and youth perceptions of communication were found indicating
that the treatment was effective in increasing communication in families
with fewer children. Based on the effect size and the previously established
relationship between communication and susceptibility to tobacco and alcohol
use, it was determined that the intervention effect could be translated
into a future 5 to 10% decrease in susceptibility for these smaller families.
Conclusions: A culturally sensitive family-based intervention for migrant Hispanic youth was found to be effective in increasing perceived parent-child communication in families with fewer children. It is expected that increases in this important protective factor will lead to later observed decreases in tobacco and alcohol use. Mala TA. Gottlieb KL. Purpose: To design a health care program that allows Alaska Natives to receive culturally appropriate health services in their homes, thus avoiding the trauma of institutionalization and significantly increasing the quality of the patient's life during the course of the treated illness. Method: Utilizing the culturally appropriate sensitivity that is found within Tribal Health Corporations, Southcentral Foundation is designing a federally based community health care model to bring health support services into the patient's home. Health Aides and Community Health Representatives play an important role in extending this model into an urban community setting. The cost of care is significantly reduced, as it is more cost-effective to keep patients in their own home environments rather than in institutions. Results: Major outcomes for patients are increased cultural sensitivity to their needs, personal comfort, dignity, and care in their own home surroundings. Outcomes for the federal care system are significant savings and more efficient personalized health care Marin G. Marin BV. Perez-Stable EJ. Sabogal F.
Otero-Sabogal R. Tested a 7-month, media-based, community intervention among Hispanics in San Francisco designed to change levels of information on the damaging effects of cigarette smoking and on the availability of culturally appropriate cessation services. Three community-wide surveys of Hispanics were conducted with independent random samples, two as baselines (n = 1,660 and 2,053) and one postintervention (n = 1,965). Results showed that changes in the level of awareness of cessation services had taken place after implementation of the intervention. Furthermore, those changes took place primarily among the less acculturated Spanish-speaking Hispanics who were the target of the intervention. The changes in information reported here demonstrate that a culturally appropriate information dissemination campaign that utilizes multiple channels can produce changes in a community's level of information even when the campaign is implemented for a relatively short period. Marin G. Perez-Stable EJ.
Purpose: Our goal was to evaluate the effectiveness of the Programa
Latino Para Dejar de Fumar (PLDF) in disseminating smoking-cessation information
in San Francisco's Latino community. Methods: Annual cross-sectional telephone surveys were conducted
from 1986 to 1993 of Latino adults, 18-65 years of age, living in census
tracts with at least 10% Latinos. Surveys in 1986 and 1987 formed the
base line for comparison of PLDF effects. Results: Awareness of a Hispanic smoking-cessation program (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.09-1.14), awareness of PLDF specifically (OR = 1.14; 95% CI = 1.10-1.17), awareness of available printed information to help smokers quit (OR = 1.09; 95% CI = 1.06-1.12), and having a copy of the Guia Para Dejar de Fumar (OR = 1.09; 95% CI = 1.05-1.14) were significantly associated with year of survey. In addition, those same variables were significantly associated with a lower acculturation score (respective ORs = 3.95, and 95% CI = 3.57-4.37; OR = 5.40, and 95% CI = 4.86-6.01; OR = 0.63, and 95% CI = 0.58-0.69; and OR = 4.54, and 95% CI = 3.89-5.30). Women were more likely than men to report awareness of a Hispanic smoking-cessation program (OR = 0.88; 95% CI = 0.81-0.96), awareness of PLDF (OR = 0.84; 95% CI = 0.77-0.92), and awareness of available printed information (OR = 0.78; 95% CI = 0.72-0.85). Cigarette-smoking prevalence decreased from 1986 through 1990, stabilized in 1991, and appeared to increase among all groups in 1993. Prevalence of smoking cessation remained stable overall, but it showed a steady increase among less acculturated respondents. CONCLUSION: We conclude that a culturally appropriate community intervention to promote nonsmoking can be successful at disseminating information about smoking cessation. Latino community norms about smoking are evolving, leading to decreased social acceptability. Mattson S. Lew L. Objective: To evaluate the success of the Southeast Asian Health Project in terms of client satisfaction with the prenatal care and other services. To obtain additional data about Southeast Asian women's health practices regarding childbearing. Design: Survey through questionnaires administered as interviews. Setting: In clients' homes or via telephone. Participants: 119
women from SEAHP's case files of recently delivered clients. Measurements
and Main Results: Interviews were conducted by four community workers
fluent in Cambodian or Lao. The majority of women were satisfied with
SEAHP, particularly the interpretation and education in native languages.
Women were also satisfied with SEAHP, encouraging others to seek care.
Conclusions: SEAHP appears to meet prenatal care needs of Southeast Asian women in Long Beach, California. More objective outcome data await analyses, but the program's approach may ensure access to and use of health services. (14 ref) McAvoy BR. Raza R. Objectives: To determine the effects of three different methods of providing health education on the uptake of cervical smear testing among Asian women, and to evaluate the acceptability of different health education materials. Design: Prospective cohort study over one year of effects of written materials by post, personal visit to give written materials, and personal visit to show a video on the uptake of smear testing. Techniques included a personally administered questionnaire. Setting: Leicester, a city with a large Asian population. Subjects: 737 randomly selected Asian women aged 18 to 52 who were not recorded on the central cytology laboratory's computer as ever having had a cervical smear test. 159 declined to participate or were not contactable. Interventions: Women were randomised into four groups: visited and shown a video (263), visited and shown a leaflet and fact sheet (219), posted a leaflet and fact sheet (131), not contacted at all (124). Main Outcome Measures: Cervical smear test recorded on computer within four months after intervention. Results: 57 (37%, 26% of group) of the women visited and given leaflets and 80 (47%, 30% of group) shown the video attended for cervical smears. Only six (5%) of those who were not contacted and 14 (11%) of those sent leaflets had a smear test during the study. Conclusion: Health education interventions increased the uptake of cervical cytology among Asian women in Leicester who had never been tested. Personal visits were most effective irrespective of the health education materials used, but there was some evidence that home viewed videos may be particularly effective in one of the most hard to reach groups: Urdu speaking, Pakistani Moslems. Written translated materials sent by post were ineffective. McPhee SJ. Bird JA. Davis T. Ha NT. Jenkins CN.
Le B. Introduction: We investigated barriers to breast and cervical
cancer screening among Vietnamese women in San Francisco and Sacramento,
California. Methods: Face-to-face interviews were conducted in 1992 of 306
Vietnamese women in San Francisco and of 339 women in Sacramento. Results: In both communities, only about one half of Vietnamese
women had ever had routine check-ups, clinical breast examinations, mammograms,
and Pap smear tests, and only about one third were up-to-date for these
screening examinations. Among women age 40 or older, 35% had never even
contemplated having a mammogram. This study identified several significant
barriers to recognition, receipt, and currency of screening tests. Negative
predictors of test recognition included low level of education and not
having a regular physician. Negative predictors of test receipt included
low level of education, not having a regular physician, short duration
of residence in the United States, and never having been married. A major
negative predictor of test currency was low level of education. With a
few exceptions, attitudes and beliefs generally were not important predictors.
Conclusions: Health education and screening programs for early breast and cervical cancer detection among Vietnamese women must be culturally appropriate and conducted in the Vietnamese language. Special outreach efforts are needed to assist recent immigrants in obtaining recommended breast and cervical cancer screening examinations. Michielutte R. Sharp PC. Dignan MB. Blinson K. Cancer is the third-leading cause of death among American Indians. The persistent disadvantage in cancer survival rates among American Indian populations emphasizes the importance of developing effective cancer control programs for prevention and early detection. However, substantial cultural differences between American Indians and whites can affect the success of these programs. This paper examines the concept of cultural sensitivity in the context of developing cancer control programs for American Indian populations. It explores fundamental differences in beliefs, behaviors, and values between American Indian and white majority cultures, and presents examples of culturally sensitive health education programs. The paper highlights insights and experiences gained in developing the North Carolina Native American Cervical Cancer Prevention Project, and gives recommendations for the development of future programs. Miano LY. Rojas MS. Trujillo M. Purpose: The United States Hispanic population has tripled since the mid-1950s and is projected to be the largest growing segment of the population through the year 2000. The traditional support group model has not been effective in reaching this population. Healthcare professionals must become innovative to better understand and provide programs for Spanish-speaking cancer patients. Description of Project: At the M.D. Anderson Cancer Center, a
group program titled "Platicas y Merienda" was developed that derived
from several group modalities: education, social, and peer support. The
program is coordinated and facilitated by Spanish-speaking social workers
and uses other professionals within the institution as speakers to promote
a multidisciplinary approach to providing support services. Findings: Participants experienced an increased sense of social and emotional well-being, expanded their knowledge of health-related information, and became aware of other services and benefits available to them. Clinical Implications: During this time of change in the healthcare environment, innovation in clinical practice and program development is necessary to address the needs of the growing Hispanic population. (8 ref) Naish, J., J. Brown, et al.
Design: Qualitative study by means of focus group discussions between October 1993 and March 1994. Setting: East London Subjects: Non-health specific established community groups and specially convened groups of Bengali, Kurdish, Turkish, Urdu and Punjabi, and Chinese speaking women. Conclusion: Contrary to popular belief among general practitioners in east London, women from ethnic minorities are enthusiastic about cervical cytology screening once they understand the purpose of the test and the call and recall procedures. It is possible to consult with community groups in their own language through focus group discussions, working with bilingual health advocates who have had a short practical training in facilitating small group discussions. This form of user consultation could be carried out focussing on other aspects of health promotion. Nevid JS. Javier RA. Purpose: The Purpose of this study was to compare a culturally specific, multicomponent behavioral smoking cessation program for Hispanic smokers with a low-intensity, enhanced self-help control condition. Design: Participants who completed pretreatment assessment were randomly assigned to treatment conditions. Smoking status was evaluated at posttreatment, 6-month follow-up, and 12-month follow-up intervals. Setting. The study was based in predominantly Hispanic neighborhoods in Queens, New York. Participants. Ninety-three Hispanic smokers participated: 48 men and 45 women. Intervention: The multicomponent treatment involved a clinic-based group program that incorporated a culturally specific component consisting of videotaped presentations of culturally laden smoking-related vignettes. The self-help control program was enhanced by the use of an introductory group session and follow-up supportive telephone calls. Measures: Smoking outcomes were based on cotinine-validated abstinence and self-reported smoking rates. Predictors of abstinence were examined, including sociodemographic variables, smoking history, nicotine dependence, acculturation, partner interactions, reasons far quitting, self-efficacy, and linguistic competence. Results: Significant group differences in cotinine-validated abstinence rates in favor of the multicomponent group were obtained, but only at posttreatment. With missing data included and coded for nonabstinence, validated abstinence rates at posttreatment were 21% for the multicomponent group and 6% for the self-help group. At the 6-month follow-up, the rates were 13% for the multicomponent group and 9% for the self-help group. By the 12-month follow-up the rates declined to 8% and 7% for the multicomponent and self-help groups, respectively. A dose-response relationship between attendance at group sessions and abstinence status was shown at posttreatment and 6-month follow-up intervals. Conclusions: The results of the present study failed to show any long-term benefit from use of a clinic-based, culturally specific multicomponent smoking cessation intervention for Hispanic smokers relative to a minimal-contact, enhanced self-help control. (37 ref) Nevid JS. Javier RA. Moulton JL 3rd. Factors predicting participant attrition in a community-based, culturally specific smoking-cessation program enrolling 93 Hispanic smokers were examined. Analysis of univariate predictors showed noncompleters (n = 18) to have lower incomes, to have expressed greater initial confidence in their ability to stop smoking, and to have perceived themselves to be in poorer general health and poorer health in relation to peers, than completers. Noncompleters were also more likely to have reported cardiovascular problems. Multivariate logistic regression analysis showed that confidence in stopping smoking, health compared with that of peers, and reported cardiovascular problems contributed significantly to prediction while controlling for other significant univariate predictors. The results are discussed in terms of factors that might mitigate premature termination in community-based smoking-cessation interventions targeting Hispanic smokers. Rubin, Deborah Block. Children with serious emotional difficulties often receive services from disparate service sectors. Case management services for these children and their families can provide coordination of care, support parents and help children remain at home. This study examined parent satisfaction with case management services and parents' perceptions of the cultural competence of their children's case managers. One hundred forty-six randomly selected parents of children with extensive mental health needs were interviewed. Twenty-six additional families receiving services from an agency providing intensive case management services were also interviewed. All families received medical assistance for some or all of their child's treatment. New measures of case management satisfaction and cultural competence were administered and required parents to rate specific aspects of satisfaction and cultural competence on a 1 to 5 scale, Interviews also included five measures of child and family functioning. Summary scores from these measures were used to construct a severity index. Case management services were categorized for all respondents as either 'traditional' or 'intensive'. Results from the study showed that mothers of children who were employed were significantly more satisfied with case management services than those who were not employed. Other demographic variables were not significant. Parents receiving intensive case management were more satisfied than those receiving traditional case management when controlling for demographic variables and functional status of the child and the family. Cultural competency scores were significantly related to overall satisfaction scores and intervened in the relationship between type of case management and parent satisfaction. There appeared to be conceptual overlap in the instruments used to measure satisfaction and cultural competency. Cultural competency appears to be difficult to operationalize as a discreet concept although racial match of the parent and case manager was significantly related to cultural competency but not satisfaction scores. No relationship was found between functional status and type of case management suggesting that children receive case management services for reasons other than severity of their or their families' problems. Further research is needed to determine who receives intensive case management and to refine measures of cultural competency. Shapiro J. Simonsen D. Experiences and observations based on an ongoing parent education-support group for Mexican-origin Latino parents of children with Down syndrome were described. Culturally mediated concepts were discussed in terms of their relevance to specific aspects of group functioning, including group structure, membership, and leadership. Problems of particular concern to this population that might adversely affect maintenance and growth of the group were also examined. Finally, the potential value of such support groups for this parent population were considered as were guidelines for enhancing the group experience. [References: 35] Shintani T. Beckham S. O'Connor HK. Hughes C.
Sato A. The Waianae Diet Program (WDP) is a community-based program designed at the Waianae Coast Comprehensive Health Center in response to the high rates of obesity and chronic disease among Native Hawaiians. Its foundation is a 3-week program of traditional Hawaiian diet and cultural teachings. It employs 8 innovations in clinical nutrition and health promotion theory:
It has demonstrated significant weight loss with no calorie restriction, improvement in blood pressure, serum glucose, and serum lipids. It appears to have wide acceptance in the Hawaiian community. More studies are warranted to determine the long-term effect of this program. Soto Mas FG. Kane WM. Going S. Ford ES. Marshall
JR. Staten LK. Smith JE. Despite the popularity and widespread use of theory in health education, practitioners still find it difficult to design and implement theory-based interventions. This is especially true when working with ethnic/racial minority groups, including Hispanic groups. Practitioners working with Hispanic communities face additional barriers that may often discourage them from using theories when planning interventions. These barriers include the diversity that exists within the Hispanic population, lack of reliable data, and issues related to cross-cultural applicability of current behavior theories. However, the use of theory constitutes a valuable tool for developing more effective programs, and theorist researchers should be more sensitive to practitioners' needs. By explaining the processes for selecting and applying theory in the same detail as outcome results, researchers will contribute to increasing practitioners' interest in theory. This article describes Camine con Nosotros, a theory-based physical activity program for Hispanic women, and explains the process of selecting the theoretical framework of the program and connecting theory and practice. (64 ref) Stevenson HC, Gay KM, Josar L Video education is the most popular and effective medium for informing the adolescent population. This study investigated the impact of a culturally relevant HIV/AIDS video education. One hundred and ninety-four African-American teenagers were assigned to either a culturally sensitive or culturally dissimilar video education intervention. Results indicate that both interventions were effective in increasing AIDS knowledge scores. An interaction effect was found between levels of perceived AIDS risk knowledge and participation in the culturally sensitive intervention (CSV). Only the CSV intervention was effective with adolescents who claimed to "know a lot" about AIDS (e.g., "Know-It-All" subgroup). Students in both conditions who were worried about getting AIDS demonstrated higher AIDS risk knowledge at post-assessment. This study provides further evidence of within-ethnicity diversity among African-American youth and for developing culture- and subgroup-specific HIV/AIDS education. Stillman FA, Bone LR, Rand C, Levine DM, Becker
DM Background: This article provides a descriptive overview of the implementation process of the Heart, Body, and Soul program. The program objective was to test strategies to reduce the prevalence of cigarette smoking among urban African-Americans in East Baltimore. Method: This study constitutes a prospective randomized trial among inner-city African Americans designed to improve quit rates among church attenders. A random-digit-dialing survey was conducted to establish baseline levels of self-reported cigarette smoking, examine attendant attitudes, and determine the presence of known cardiovascular risk factors among community residents of the catchment area. A similar survey was conducted among churchgoers to establish a baseline. Twenty-two churches were recruited and randomly assigned to either intensive or minimal (self-help) intervention strategies. Baseline health screenings were held in all participating churches. Innovative culturally specific smoking cessation strategies mediated through lay volunteers from participating churches were implemented in the intensive intervention churches. Results: Pastors of all churches were directly involved in all aspects of the planning and implementation process. A total of 29 volunteer lay smoking-cessation specialists were trained and successfully implemented the intensive interventions in churches. An additional 272 church members were trained to conduct their church's health screenings. Conclusion: The essential component of this successful implementation process were building trust and acceptance and providing the technical support to encourage smoking-cessation strategies. This description of the project is presented to assist others involved in church-based trials in urban African American communities. Sung JF. Blumenthal DS. Coates RJ. Williams JE.
Alema-Mensah E. Liff JM. Introduction: We conducted a randomized controlled trial to determine if an in-home educational intervention conducted by lay health workers (LHWs) could increase adherence among low-income, inner-city, African-American women to breast and cervical cancer screening schedules. Methods: We recruited 321 African-American women from diverse
inner-city sources. After baseline interviews, they were randomly assigned
to either the intervention (n = 163) or the control (n = 158) group. Those
in the intervention group were visited in their homes up to three times
by LHWs who provided a culturally sensitive educational program that emphasized
the need for screening. Results: Ninety-three (93) women in the intervention group and
102 in the control group completed the postintervention interview. For
Pap smears, the increase in screening was similar in both groups. For
clinical breast exams (CBEs), however, there was a modest increase in
the intervention group. The improvement was greatest for mammography,
for which there was a 10% to 12% increase. Among women who were not on
recommended schedules at baseline, the improvement was substantial and
greater in the intervention group. Conclusions: LHWs' intervention appeared to improve the rate at which inner-city women obtained CBEs and mammograms, but had no effect on Pap smears. A high attrition rate weakened our ability to make conclusive statements about the exact impact of the intervention. Wang CY. Abbott LJ. Purpose of this project was to develop rapport with a Chinese Community Association and then establish preventive diabetic and hypertension programs with the Chinese in Chinatown, Hawaii. Subjects were recruited from this Chinese Community Association. Two hundred Chinese responded to the invitation. Among these, 75 individuals had either Type 2 diabetes, hypertension or both. Thirty-six males and 39 females ranging in age from 51 years old to 96 years old (Mean = 71.76, SD = 9.58) participated. Surveys and educational programs were carried out in Chinese. Results were described in terms of quantitative measures (family support and health outcomes) and qualitative experiences (case studies). Eighty percent of participants had decreased their diastolic blood pressure from above 95 mmHg to below 90 mmHg and systolic blood pressure from above 155 mmHg to below 140 mmHg. Ninety-five (n = 71) percent of participants had maintained their glucose level within the 90 mg/dL to 150 mg/dL range with a mean reduction of 57.86 mg/dL in one year. The hardest thing for families was the glucose self-monitoring. Case studies suggested that open-minded active listening and persistence formed the basis for developing a culturally sensitive community-based self management program for chronic diseases. Collaboration among the community, public health nurses, and diabetes nurse educators facilitated the process of community education and health promotion. Wong C, Yang K, Moua N, Mouanoutoua L, Carroll
A, Purpose: To review the findings from the Hmong Quality of Care Project related to interpersonal and technical processes of care and patient satisfaction including use of qualitative information to augment quantitative survey. Methods: Qualitative approaches, using in-depth interviews with Hmong leaders and focus groups with Hmong hypertensive patients, were used to develop a quantitative quality of care survey instrument. Using this culturally tailored, 94-item survey tool, we interviewed 200 Hmong hypertensive patients to assess their health services needs. Patients were recruited from clinics, health department and through outreach activities. Findings: Among those surveyed, almost all were insured under MediCal or Medicaid, spoke little or no English and frequently rated their health as poor. Although almost all were on hypertensive medications, more than half were told that their blood pressure levels were high during recent office visit, were often not explained how to take their medications nor discussed use of Hmong traditional treatments. Patients reported that their providers often did not explain reasons for and results of blood tests. Most respondents reported having difficulty finding information about hypertension. Overall, Hmong reported being satisfied with their care and more often gave a high score when rating their satisfaction with providers. In conclusion, Hmong patients receive less than optimal care for their hypertension management. However, they reported satisfaction with their providers and hypertension care. Results from the qualitative interviews suggest low expectations of health care providers, little knowledge about patient rights, providers’ roles and health plan responsibilities that underlie these observed incongruencies. Learning Objectives: Participants in this presentation will learn about Hmong health services needs and on ways to obtain reliable information to evaluate health care delivery for Hmong and other ethnic minorities. Wright AL. Naylor A. Wester R. Bauer M. Sutcliffe
E. Although many attempts have been made to promote breastfeeding in a variety of contexts, few programs have explicitly incorporated cultural beliefs in these efforts. This article describes a breastfeeding promotion program conducted on the Navajo reservation. This program was designed to be culturally appropriate. Background information regarding beliefs and factors affecting infant feeding practices in this setting is provided, followed by a description of the intervention. The intervention, which incorporated both social marketing and community participation techniques, consisted of three components: an intervention in the health care system, a community intervention, and an individual intervention. Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful. This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change. Yancey AK. Tanjasiri SP. Klein M. Tunder J. Background: Electronic media have demonstrated efficacy in increasing knowledge and promoting health-protective behavior among individuals at high risk for chronic disease. In "Stimulating Cancer Screening among Women of Color through Video" (A. K. Yancey and L. Walden, 1994, J Cancer Educ 9:46-52) the development of a cost-effective documentary format for culturally sensitive health education videos was described. These videos could not be independently evaluated within the cancer control program for which they were developed. Methods: A quasi-experimental study design tested the hypothesis that exposure to these videos increases cervical cancer screening behavior among samples of women from two clinic populations of predominantly low-income African-Americans and Latinos in New York City and Los Angeles. A 1-week-on-1-week-off design was utilized, in which the videos were continuously displayed in designated waiting rooms during on (intervention) weeks, with each facility serving as its own control during off weeks. Results: The proportion of women seen as patients during the
intervention weeks who subsequently obtained Pap smears was significantly
higher than that of those seen during the control weeks at each site (P
< 0.05).
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is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please let us know if you have other examples to include here. |
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