Using health fairs to examine health promotion behaviors of older African Americans.

Unhealthy behaviors are responsible for high morbidity and mortality rates among older African Americans. For some older African Americans, changing unhealthy behaviors may be difficult to achieve due to limited knowledge and access to preventative health care services. Health fairs are just one venue of examining health promotion behaviors and providing health promotion information to older African Americans. The purpose of this article is to report the health promotion behaviors of older African Americans as a result of conducting two health fairs. The Transtheoretical Model served as the framework for examining health behavior change among older African Americans. Nursing implications will be discussed.     

Suicide Among African Americans: Reflections and a Call to Action

Suicide among African Americans is increasing at an alarming rate, and it deserves attention from numerous sectors in the society. This paper discusses some of the historical issues related to mental health care and African Americans. It suggests that sociocultural contexts are significant developmental shapers in the lives of African Americans. Several theoretical perspectives on suicide are presented, and Durkheim's concept of fatalism is useful in helping to unravel the dynamics of suicide. Issues related to the mental health system as currently experienced by African Americans conclude the discussion, along with a brief list of helpful resources.     

Suicide among African Americans: reflections and a call to action

Suicide among African Americans is increasing at an alarming rate, and it deserves attention from numerous sectors in the society. This paper discusses some of the historical issues related to mental health care and African Americans. It suggests that sociocultural contexts are significant developmental shapers in the lives of African Americans. Several theoretical perspectives on suicide are presented, and Durkheim's concept of fatalism is useful in helping to unravel the dynamics of suicide. Issues related to the mental health system as currently experienced by African Americans conclude the discussion, along with a brief list of helpful resources.     

Effectiveness of a cardiovascular health promotion education intervention on the attitudes of urban African American school-age children

African American children are at risk for high rates of morbidity and mortality associated with cardiovascular (CV) disease as they become adults, yet little is known about the effectiveness of CV risk-reduction interventions in African American children. This study explored the effectiveness of a concentrated CV health promotion educational program on health-related attitudes of 76 African American children enrolled in a mid-southern school system. The Children's Cardiovascular Health Promotion Attitude Scale was used to examine differences in attitude prior to and 2 weeks following a focused health education intervention. Results demonstrate that children have preconceived attitudes regarding practice of health behaviors and that these attitudes are modifiable with age and developmental level specific educational interventions. Findings indicate the need for health care providers to assume more active roles in reducing the risk of future CV disease and death in African Americans through health promotion education of individuals who influence the development of children's attitudes.     

Strategies for successful conduct of research with low-income African American populations

Health disparities among racial and ethnic minorities are associated with poor health outcomes. African Americans bear a disproportionate amount of the burden of health disparities. The elimination of health disparities among the nation's racial and ethnic groups requires immediate action that the health care community cannot accomplish in isolation. Eliminating health disparities calls for new and non-traditional partnerships across diverse sectors of the community that include research initiatives using culturally competent and participatory action methodologies. While there is much evidence documenting health disparities in racial and ethnic groups, there is little evidence of successful interventions that address health disparities in African Americans. Furthermore, there is little direction for successful strategies for recruiting African Americans for participation in health disparities research. This article addresses important factors to consider when conducting research with low income African Americans based on the authors' research experience in health promotion and cancer detection and prevention. Strategies for successful conduct of research with low income African American populations are offered.     

African American consumers: What should we know to meet their mental health needs?

National health care organizations have placed greater emphasis on meeting the mental care needs of minority clients in the United States. Disparities in mental health care use among various populations have been clearly demonstrated. This article discusses what is known about mental health care use among African Americans and the need for new knowledge to address current and future needs. Strategies for examining and addressing mental health disparities in this population are addressed, and implications for nurse clinicians and researchers are presented. (J Am Psychiatr Nurses Assoc [2002], 8, 188-93.)     

Barriers to screening for colorectal cancer

Rapidly growing interest in colon cancer screening is a crucial first step to identifying and reducing many of the barriers that impede population screening for this common disease. Promoting screening demands health care policy change to increase the percentage of Americans with insurance coverage that includes a colon cancer screening benefit. A systematic approach to screening with invitations that come from a clinician are likely to be the most effective way to prompt more individuals to be screened. Awareness campaigns and patient educational aids, including decision tools, implemented in multiple sites, such as worksites, community centers, health care systems, and physician offices, increase the percent of eligible Americans who understand their personal risk, the need for screening, and the options available to them.     

Long-term care: a health promotion challenge

There is a lack of health promotion for the elderly residing in long-term care facilities. It becomes imperative therefore for the nursing profession to readjust its thinking and practice to include health promotion strategies and interventions for institutionalized elderly in the long-term care sector. From using the empowerment theory in the discussion it is clear that nurses can help the elderly receive health promotion strategies and interventions to help the older person make informed choices about their lifestyle, health and treatment. The elderly population continues to grow and more than likely will spend some part of their life in a long-term care setting. Evidence from studies performed by Robertson (1991), Caserta (1995), Phillips (1994) and McBride (2000) suggests that health promotion efforts positively correlate with improved physical and psychological elements of health for the elderly. Nurses largely determine the kind of care that is given and thus can influence the quality of life that elderly client's experience. By advocating for health promotion interventions and strategies for their elderly clients, nurses are demonstrating to the community, their patients, and institution that nurses do have the power to make and influence change for the better. Nurses advocating for health promotion for their elderly patients not only empower choice, but also create an active and involved elderly population. Health promotion exists at all stages of life and does not cease when one is admitted to a long-term care facility (Hutchings, 1999; McBride, 2000).     

Self‐Image of Aging: A Method for Health Promotion

In 2020, 15.25% of the Thai population will be over 60. The elderly are those who are considered to be retired and unemployed. Their physical and mental conditions are rapidly changing. They experience many health problems as the result of deteriorating health. Consequently, the health‐care team needs to focus on the elderly's perception of health, self‐image, and health care provided. Understanding the nature of aging will enhance the elderly's health, such that they will perform self‐care and live a more enjoyable life. The aim of this study was to investigate the health perceptions, self‐image and methods of health promotion provided to the elderly. Focus discussion groups consisting of participants over 60 years of age, were formed. One hundred and eight participants from four Aging Clubs of large cities were invited to participate. The participants came from Chiang Mai (n = 30), Phitsanulok (n = 21), Siriraj (n = 20), and the 43rd Health Center Aging Club (n = 37), a suburb near Bangkok. Results: The majority of participants perceived that ‘Health is composed of a good physical and mental condition’ and ‘physical strength and happy mind’. All participants identified three things that made them healthy: exercise, good food, and having hobbies. The participants practised what they believed. Exercise was seen as excellent medicine, and lack of disease was seen as good fortune. Several participants emphasized that having regular check‐ups, avoiding smoking, and avoiding drinking alcohol, as being healthy. Few of the elderly, in a group of > 70‐year‐olds, from the 43rd Health Center and the Phitsanulok group, mentioned traditional treatment as promoting health. Several participants from Chiang Mai saw fresh air and good ventilation as facilitating health. All participants preferred to meet each other and join in recreational activities at the club for the elderly. Interestingly, the 60–70‐year‐old age group from the Siriraj Aging Club believed life planning and a good sexual relationship were essential for good health. All participants revealed good relationships in their families. They used religious principles to keep their equilibrium and to help maintain their spiritual well‐being. Four major factors were identified as contributing to making the participants feel old: physical changes, declined functions, declined health, and emotional instability. Several participants said they felt old when they were told they were old. Other participants complained of feeling old when they were dependent. They said it caused them to lose their self‐respect. Conclusion: The study revealed that the different groups of elderly participants had a mutual concept of health. The life experiences of the elderly were based on their beliefs of helpful heath‐care practises. Thus, caregivers need to develop and apply effective and humanistic methods of health promotion for the elderly.     

Barriers to health promotion and disease prevention in the Latino population

The Latino population of the United States is expected to increase substantially in the next 25 years. Although recent health promotion and disease prevention interventions have improved the health of the majority of Americans, the Latino community has derived less benefit from these advances. This is due to a number of interrelated factors, including a disproportionate representation of Latino Americans in the low socioeconomic strata and in the uninsured population. Even when insured, Latino Americans face significant barriers to health promotion and disease prevention. This policy analysis identifies barriers at the organizational and structural level of health care delivery, as well as at the level of the medical encounter. It provides a practical framework for intervention that is founded on the recruitment of Latino Americans into the health care workforce and leadership, the restructuring of health systems to be more responsive to the needs of diverse populations, and health care provider education on how to improve cross-cultural understanding and communication. By investing in a multifaceted approach that addresses barriers to health promotion and disease prevention in the Latino population, we can improve the quality of care delivered to this population and help eliminate racial and ethnic disparities in health care.     

Racial differences in next-of-kin participation in an ongoing survey of satisfaction with end-of-life care: a study of a study

Despite disparities in health care access and quality, African Americans are underrepresented in many areas of clinical investigation, including research in end-of-life care. Because of the importance of surrogate reports in assessing the quality of end-of-life care, this study examined racial differences in next-of-kin participation in an ongoing study of satisfaction with end-of-life care. The parent study includes after-death interviews with next-of-kin of elderly African Americans and Caucasians who died at Duke Hospital. This analysis included next-of-kin of elders who died at Duke Hospital from December 1, 2003 to December 31, 2004. During this period, there were 471 decedents whose next-of-kin were eligible for participation. Of these, 133 (28%) were African American and 338 (72%) were Caucasian. There were no racial differences in completion, contact, or overall response rates. Of those contacted, 39.8% of African Americans and 37.8% of Caucasians completed the study. In multivariate analysis, only the relationship of the next-of-kin to the decedent was an independent predictor of study completion. Children of decedents were significantly more likely to participate than spouses (odds ratio [OR] 2.1 [1.14, 3.86]). In this analysis, next-of-kin of African American and Caucasian decedents were equally likely to participate in an after-death interview assessing satisfaction with end-of-life care. The use of racially concordant interviewers, subject identification with the institution, and the absence of socioeconomic constraints may partly explain these findings. Given the growing diversity of the U.S. population, researchers in end-of-life care must use strategies aimed at recruiting racially and ethnically diverse samples.     

Workplace health promotion: the role and responsibility of health care managers

The World Health Organization's (WHO) Ottawa Charter for Health Promotion in 1986 provided the catalyst from which the Health Promoting Workplace movement emerged. Here, an extensive review of the available workplace-related health literature provides the basis for critical discussion and recommendations for health care managers. The findings suggest that health care managers, who practice in all health service settings, should be aiming to initiate and promote radical health promotion reform as set out in the WHO settings-based movement. Developing and implementing sustainable health promotion-orientated and organization-wide healthy workplace policy initiatives represent the most effective way for health care managers to directly benefit from the desirable outcomes that come from creating and maintaining a healthy workforce.     

Health promoting behaviors of urban African American female heads of household.

Nurse practitioners' understanding of the health status and health promoting behavior of African American women is only in its infancy. This study utilized the Health Promoting Lifestyle Profile to examine these behaviors in 198 females (73% African American) in an urban setting who were heads of household. The purpose was to identify their health promoting lifestyles. Such knowledge could be the basis for health promotion programs to meet the needs of these women. Findings revealed that being head of household had no significant relationship to health promoting behavior. Religiosity and education were positively associated with health promoting behavior, while smoking and ethnic background were inversely correlated. Age and marital status also influenced specific health promoting behaviors. Implications for development of programs to foster involvement of African American women in health promotion programs were presented.     

Improving the physical health of people with severe mental illness: Boundaries of care provision

There is compelling evidence that the physical health of people with severe mental illness is poor. Health‐promotion guidelines have been recommended as a mechanism for improving the physical health of this population. However, there are significant barriers to the adoption of evidence‐based guidelines in practice. The purpose of this research was to apply existing implementation theories to examine the capability of the health system to integrate physical health promotion into mental health service delivery. Data were collected within a regional city in Queensland, Australia. Fifty participants were interviewed. The core theme that emerged from the data was that of ‘care boundaries’ that influenced the likelihood of guidelines being implemented. Boundaries existed around the illness, care provision processes, sectors, the health‐care system, and society. These multilevel boundaries, combined with participants' ways of responding to them, impacted on capability (i.e. the ability to integrate physical health promotion into existing practices). Participants who were able to identify strategies to mediate these boundaries were better positioned to engage with physical health‐promotion practice. Thus, the implementation of evidence‐based guidelines depended heavily on the capability of the workforce to develop and adopt boundary‐mediating strategies.     

Primary Health Care in the Mental Health Workplace: Insights from the Australian Experience

In Australia, Primary Health Care and the mental health sector have always shared a philosophy. In 1978, Primary Health Care was first put forward as a strategy to improve “health for all.” Recently, the Australian Government included mental health as a national health priority, identifying six strategies consistent with a Primary Health Care approach to address the mental health of all Australians. Throughout this time, Primary Health Care has been highlighted in all models of care. However, in reality, it appears that in mental health services, mental health nurses, despite good intentions, are not delivering care in a planned or systematised way and that much needs to be done to further improve the situation for individuals accessing the health care system. Services currently focus on those identified as seriously mentally unwell; in order to really make an impact it is argued that services should be broader, offered to the population at large and, further, that the emphasis on case work at an individual level should be changed to an approach that considers prevention, maintenance, and follow-up as well as crisis intervention. This article reflects the Australian experience and offers some insights from that experience.     

Cultural mistrust and use of hospice care: challenges and remedies

Cultural mistrust is a prominent barrier to the involvement of African Americans in hospice care. While disavowing the theory that cultural mistrust has its origin in any single factor or event, it is argued that there needs only to exist the cultural construct of community for cultural mistrust to perpetuate itself among any ethnic group. The attitudes toward hospice care are advanced as illustrative of the relationship between African Americans and the health care system, and many other institutions of American society. From a perspective that accepts the existence of the phenomenon of cultural mistrust, suggestions for structuring training for cultural competence are discussed. These suggestions are relevant for workers in institutions that serve the African American community in critical health care areas in general, and administrators and staff of hospices in particular.     

Alternative medicine utilization by African Americans and improving life expectancy: is there a correlation?

The life expectancy of African Americans and Caucasians has been increasing in the United States and in many other countries around the world since the late 1800s. However, as long as statistics have been accrued on race and ethnicity, the life expectancy of African Americans and Blacks in general has been significantly lower than that of Caucasians. Basic public health and medical preventive education is needed because higher cardiovascular disease (CVD) rates is one of the primary reasons for the differences between life expectancy between African Americans and Caucasians. It is also of an apparent separate but perhaps related interest that several recent preliminary studies suggest that African Americans, more than any other race, may have some of the lowest uses of alternative medicine due to skepticism, as well as educational efforts and trust in their health care professional. Despite a common belief that African Americans harbor profound distrust of specific areas of the medical profession, it is of interest that this finding has not held validity in the area of alternative medicine. Therefore, since lifestyle changes are considered alternatives in most of these studies, this would suggest that a greater educational emphasis on behavioral modification could establish a foundation or a model of preventive medical education that can be utilized for underserved populations around the world.     

Contribution of attitudinal factors to blood donation in African American church attendees

BACKGROUND: Historically, African Americans have a general mistrust for the health care system that has contributed to significant health disparities. The goal of this study was to evaluate whether this distrust among African Americans affects attitudes toward blood donation. STUDY DESIGN AND METHODS: Fifteen African American churches in metropolitan Atlanta participated in an 81‐item self‐administered survey. The questionnaire assessed barriers and motivators for, and knowledge and beliefs about, blood donation in African Americans. Bivariate analysis and logistic regression models were performed. RESULTS: A total of 930 individuals responded to the survey. This group was 99% African Americans, 71% female, and 84% college educated, 54% with a household income of at least $50,000 and mean age of 47 ± 14 years. Donation history was 3% current donors, 46% lapsed donors, and 40% nondonors. Respondents who trusted versus distrusted hospitals had more knowledge of the blood supply and less fear of donation and were more likely to respond to blood needs of the community. In a multivariate logistic regression model, donors were more likely to trust hospitals (p = 0.003) and were more likely to have participated in research (p < 0.001) than nondonors. CONCLUSION: African American distrust of the health care system is associated with decreased likelihood of previous blood donation. This may be secondary to donor centers being viewed as a component of the health care system. Building trust between donor centers and African American community by ensuring the safety of donation may increase African American blood donation rates.     

Mental health service utilization by African Americans and Whites: the Baltimore Epidemiologic Catchment Area Follow-Up.

OBJECTIVE: To compare mental health service utilization and its associated factors between African Americans and whites in the 1980s and 1990s. DESIGN: Household-based longitudinal study with baseline interviews in 1981 and follow-up interviews from 1993 to 1996. SETTING: The Baltimore Epidemiologic Catchment Area (ECA) Follow-Up. SUBJECTS: Subjects included 1,662 adults (590 African Americans and 1,072 whites). MAIN OUTCOME VARIABLE: Use of mental health services, defined as talking to any health professional about emotional or nervous problems or alcohol or drug-related problems within the 6 months preceding each interview. RESULTS: In 1981, crude rates of mental health service use in general medical (GM) settings and specialty mental health settings were similar for African Americans and whites (11.7%). However, after adjustment for predisposing, need, and enabling factors, individuals receiving mental health services were less likely to be African American. Mental health service use increased by 6.5% over follow-up, and African Americans were no longer less likely to report receiving any mental health services in the 1990s. African Americans were more likely than whites to report discussing mental health problems in GM settings without having seen a mental health specialist. They were less likely than whites to report use of specialty mental health services, but this finding was not statistically significant, possibly because of low rates of specialty mental health use by both race groups. Psychiatric distress was the strongest predictor of mental health service use. Attitudes positively associated with use of mental health services were more prevalent among African Americans than whites. CONCLUSIONS: Mental health service use increased in the past decade, with the greatest increase among African Americans in GM settings. Although it is possible that the racial disparity in use of specialty mental health services remains, the GM setting may offer a safety net for some mental health concerns of African Americans.     

The prevention of heart failure in minority communities and discrepancies in health care delivery systems

This article discusses risk factors for cardiovascular disease in the minority community, including hypertension, obesity, diabetes,and diet. The minority community exhibits important population differences regarding risk and outcomes for cardiovascular disease.The complete explanation for these differential outcomes is lacking and likely to be multifactorial in origin; however, disparities in health care (differences in the quality of health care that are not due to access-related factors or clinical needs, to preferences, or to the appropriateness of the intervention) may emanate from decisions made by the patient, provider, or health care system. Hypertension as a disease entity is strikingly pathologic in African Americans. Correspondingly, the incidence of cardiovascular mortality due to hypertensive heart disease is fourfold higher in African Americans than in non-Hispanic whites. Hypertension and heart failure can be treated effectively in the minority community with a regimen of agents not dissimilar from that used for the general population. Treatment regimens should be individualized based on the disease presentation, associated comorbidity, and disease severity and not on something as arbitrary as race.