Development of the Expectations of Filial Piety Scale--Spanish version

AIMS: This paper reports the development of the Expectations of Filial Piety Scale for use with Hispanic/Latino parents regarding their expectations of care and support from their adult children. BACKGROUND: Filial piety, a term used to describe a set of family values in relation to parental care and respect, has strong cultural underpinnings. To date, there have been no measures of this construct for use with Hispanic/Latino populations. METHODS: A convenience sample of 318 Hispanic/Latino adults in North Carolina and Texas in the United States of America completed a brief biographical survey and field-tested a new Spanish version of the Expectations of Filial Piety Scale in 2003. RESULTS: Principal component factor analysis with orthogonal rotation (varimax method) was used to extract four factors, which accounted for 60% of the variance in scale scores. These factors were: I, respect for parents (23.6%); II, honouring parents (12.5%); III, supporting parents (11.9%); and IV, family unity (11.7%). Overall scale reliability was 0.82, with individual factor reliability coefficients ranging from 0.66 to 0.84. CONCLUSIONS: Increasingly, large numbers of Hispanic/Latino elders will look to their families for support as they reach advanced ages. Culturally relevant translations of family caregiving constructs, such as filial piety, will be essential nursing tools for clinical practice and in developing contemporary family caregiver research agendas.     

Effects of acculturation and social exchange on the expectations of filial piety among Hispanic/Latino parents of adult children

This study explores the effects of acculturation and social exchange variables on the expectations of filial piety (values and beliefs about parents' care) among Hispanic/Latino parents of adult children. A convenience sample of 318 Hispanics/Latinos with adult children was assembled in Texas and North Carolina, USA, for face-to-face interviews in order to collect information about their families and to assess their expectations of filial piety by their adult children. The number of years in the USA, age, gender, the eldest child's age, and living with a person > or = 65 years of age had significant relationships to scores from a new Spanish version of the Expectations of Filial Piety Scale (EFPS). The significant variables explained 46.3% of the variance in the EFPS scores. A conceptual model that includes both acculturation and social exchange variables is a useful approach for understanding the expectations of filial piety by Hispanic/Latino parents of adult children.     

Prevalence of Metabolic Syndrome Among Hispanics/Latinos of Diverse Background: The Hispanic Community Health Study/Study of Latinos

OBJECTIVE

Approximately one-third of the adult U.S. population has the metabolic syndrome. Its prevalence is the highest among Hispanic adults, but variation by Hispanic/Latino background is unknown. Our objective was to quantify the prevalence of the metabolic syndrome among men and women 18–74 years of age of diverse Hispanic/Latino background.

RESEARCH DESIGN AND METHODS

Two-stage area probability sample of households in four U.S. locales, yielding 16,319 adults (52% women) who self-identified as Cuban, Dominican, Mexican, Puerto Rican, Central American, or South American. The metabolic syndrome was defined according to the American Heart Association/National Heart, Lung, and Blood Institute 2009 Joint Scientific Statement. The main outcome measures were age-standardized prevalence of the metabolic syndrome per the harmonized American Heart Association/National Heart, Lung, and Blood Institute definition and its component abnormalities.

RESULTS

The metabolic syndrome was present in 36% of women and 34% of men. Differences in the age-standardized prevalence were seen by age, sex, and Hispanic/Latino background. The prevalence of the metabolic syndrome among those 18–44, 45–64, and 65–74 years of age was 23%, 50%, and 62%, respectively, among women; and 25%, 43%, and 55%, respectively, among men. Among women, the metabolic syndrome prevalence ranged from 27% in South Americans to 41% in Puerto Ricans. Among men, prevalences ranged from 27% in South Americans to 35% in Cubans. In those with the metabolic syndrome, abdominal obesity was present in 96% of the women compared with 73% of the men; more men (73%) than women (62%) had hyperglycemia.

CONCLUSIONS

The burden of cardiometabolic abnormalities is high in Hispanic/Latinos but varies by age, sex, and Hispanic/Latino background. Hispanics/Latinos are thus at increased, but modifiable, predicted lifetime risk of diabetes and its cardiovascular sequelae.     

Seeking and obtaining mental health services: what do parents expect?

This study examined parents' expectations about seeking and obtaining mental health care. Using the Expectations of Mental Health Care survey, structured interviews were conducted with 235 parents with children between the ages of 5 and 19; most were African American. Expectations were assessed in four areas: treatment effectiveness, provider/client relationship, accessibility of mental health services, and social and cultural factors, e.g., stigma. Parents reported a number of negative expectations, and black parents had significantly more negative expectations than white parents. The findings suggest that attitudes and expectations may influence parents' decision to seek mental health care for their child.     

Hispanic ethnicity,race and blood donation in the United States

summary The aim of this study was to assess the hypothesis that blood donation rates vary with Hispanic ethnicity (family origin in Spanish‐speaking countries) in addition to race in the United States. Lower blood donation rates have been reported among African Americans (AAs) compared with non‐Hispanic European Americans (EAs). Adequate published reports on donation rates are not available for Hispanic Americans (HAs). Using data from a 2002 national survey, which included 4923 men and 7600 women aged 15–44 years with complete data, we tested the hypothesis using weighted bivariate and multivariate statistics. Among men aged 25–44 years, the percentage [95% confidence limits (95% CL)] with a history of blood donation since 1985 was similar at ages 25–34 years (46%, 42–49) and 35–44 years (41%, 37–45). It was highest in non‐Hispanic EA (49%, 45–52%), intermediate in AA (35%, 30–40%) and lowest in HA (30%, 25–36%) (P < 0·001). Other variables significantly (P < 0·01) associated with history of blood donation in bivariate analyses were nativity (United States/other), education (<12/≥12 years), poverty (<200%/≥200% poverty limit) and married (yes/no). Variables that are not significantly associated were age, metropolitan residence (yes/no), receipt of public assistance (yes/no), current labour‐force participation (yes/no) and religion raised. Compared with non‐Hispanic EA, the adjusted odds ratios were essentially the same for Hispanics 0·66 (95% CL 0·47–0·92) and AAs 0·64 (95% CL 0·49–0·84). Only 34% of women had donated blood, but the association with race/ethnicity was similar. Similar patterns were also seen at ages 15–24 years. HAs and AAs have similar low blood donation rates compared with non‐Hispanic EAs. The difference is not explained by sociodemographic variables.     

Reliability and validity of the self-efficacy for exercise and outcome expectations for exercise scales with minority older adults

Older African Americans and Latinos tend to exercise less than older Whites and are more likely to have chronic diseases that could benefit from exercise. Measurement of self-efficacy of exercise and exercise outcome expectations in this older population is required if exercise is to be monitored carefully and enhanced in this population. The purpose of this study was to test the reliability and validity of the Self-Efficacy for Exercise Scale (SEE) and Outcome Expectations for Exercise Scale (OEE) in a sample of African American and Latino older adults. A total of 166 individuals, 32 males (19%) and 134 females (81%) with an average age of 72.8 +/- 8.4 years participated in the study. The SEE and OEE scales were completed using face-to-face interviews. There was evidence of internal consistency for both scales with alphas of .89 and .90 for the SEE scale and .72 and .88 for the OEE scale. There was some evidence of validity for both scales based on confirmatory factor analysis and hypothesis testing, because factor loadings were greater than .50 in all but two items in the OEE, and there were significant relationships between self-efficacy and outcome expectations and exercise behavior at all testing time-points. The measurement models showed a fair fit of the data to the models. The study provided some evidence for the reliability and validity of the SEE and OEE when used with minority older adults, and it provides some guidelines for future scale revisions and use.     

Leisure time activity of Mexican Americans with diabetes

Background. Diabetes is a worldwide health problem with increasing prevalence, particularly among ethnic minorities. Activity is a major component of diabetes management that can help to prevent the deadly complications of the disease. Assessment of the activities in which individuals with diabetes from specific ethnic groups such as Mexican Americans engage may facilitate identification of strategies to encourage activity among those who do not participate in activity or have only minimal, sporadic participation. Aims. The aims of this research were to determine: (1) What proportion of Mexican Americans with diabetes do and do not exercise? (2) What are the preferred types of leisure time activity by gender and age? (3) What the relationship is between leisure time activity and treatment of diabetes? Methods and instrument. A secondary analysis of data from the third National Health and Nutrition Examination Survey (NHANES) (1988–1994) was conducted to explore leisure time activities of self‐identified Mexican Americans with diabetes. Results. Mexican American adults in this study indicated gardening (33·7%) and walking (31·5%) as the leisure time activities in which they engaged most frequently in the month preceding data collection. Gardening and walking were frequent leisure activities of study participants for all categories of pharmacological management of the diabetes. Many did not participate in any leisure time activity in the month preceding data collection. Only six of every 10 Mexican Americans (61%) with diabetes exercised. Males (n = 136; 71%) were more likely to engage in physical activity than females (n = 171; 54%). Limitations. Only leisure time activity was assessed; occupational activity and household activity were not included. Data were based on self‐report rather than an objective measure of subject activity. Subject knowledge of the need for activity as a component of diabetes management was not assessed and may not be recognized as an integral part of care. Conclusions. Diabetes is a significant health problem for many ethnic groups, including the Mexican American population, and regular physical activity is a critical component of disease management. Facilitating activity in this ethnic group is integral to controlling complications of this chronic disease.     

Predictors of birth outcome among Hispanic immigrant women

Eliminating racial and ethnic disparities in health is a major goal of Healthy People 2010. Health care providers and institutions can address the specialized cultural expectations and needs of Hispanic Americans by assessing acculturation status of the population, an intervening variable in patient compliance, and health outcomes. This article reports on maternal acculturation status and the relationship to birth outcomes of 382 Hispanic pregnant women in the southwest United States. The majority of these women were Mexican-oriented and had healthy pregnancies and healthy birth outcomes. Findings support the hypothesis that traditional Mexican cultural practices serve protective functions for the childbearing woman.     

Parents' Wishes and Expectations for Children With Chronic Conditions

This qualitative study investigated the wishes and expectations that parents had for their children with chronic physical health conditions. Participants included parents of 21 African American, 20 Hispanic, and 22 European American children. Results indicated that many parents' wishes were specifically related to the child's chronic condition, including that the condition would not exist, would be cured, or would improve. Other wishes focused on the psychosocial well-being of the child, independent living skills, education, having a family, behavioral issues, and religion. Although all of the wishes had a positive connotation, some of the expectations were positive and others were negative. Expectations were about the child's condition, the child's psychosocial well-being, independent living skills, education, and social concerns. Two characteristics of the chronic conditions, mental retardation and mobility impairment, affected the types of wishes that parents had. Differences among the three ethnocultural groups were noted in two types of wishes, education and behavioral issues, as well as in parents' expectations about social problems.     

Attitudes toward life-sustaining treatment: the role of race/ethnicity

This study explores attitudes regarding life-sustaining treatments between Korean American and Mexican American older adults. A cross sectional design was employed to survey 122 older adults residing in an urban area on the West Coast (64 Korean Americans and 58 Mexican Americans). Face to face interviews were conducted using a structured questionnaire. Results show that Mexican Americans as compared to Korean American older adults hold more favorable attitudes toward life-sustaining treatments. Participants who were male were more likely to have positive attitudes toward life-sustaining treatments than female. Findings emphasize the importance of culturally sensitive end-of-life care practices which consider cultural variations in life-sustaining treatment preferences.     

Predictors of regular exercise among older residents of long‐term care institutions

The purpose of this study was to apply self‐efficacy theory to explore predictors of regular exercise among older residents of long‐term care institutions. Convenience sampling was used to collect data from 151 older adults residing in three residential care homes in Taiwan. Data collection instruments included a background data sheet, Self Efficacy for Exercise Scale, Outcome Expectations for Exercise Scale and self‐reported regular exercise. Results indicated that older residents who exercised regularly had fewer chronic diseases, better perceived health status and functional status, and higher self‐efficacy expectations and outcome expectations related to exercise. Older residents with a regular exercise habit prior to institutionalization were more likely to engage in regular exercise. Logistic regression analysis indicated past exercise participation and self‐efficacy expectations to be significant positive predictors of regular exercise. To promote regular exercise within this population, these can be potential target areas for interventions. These factors should be targeted in the development and implementation of interventions to promote regular exercise among older residents of long‐term care institutions.     

The Chicago Parent Program: Comparing 1-year outcomes for African American and Latino parents of young children

Data were merged from two prevention randomized trials testing 1‐year outcomes of a parenting skills program, the Chicago Parent Program (CPP) and comparing its effects for African‐American (n = 291) versus Latino (n = 213) parents and their preschool children. Compared to controls, intervention parents had improved self‐efficacy, used less corporal punishment and more consistent discipline, and demonstrated more positive parenting. Intervention children had greater reductions in behavior problems based on parent‐report, teacher‐report, and observation. Although improvements from the CPP were evident for parents in both racial/ethnic groups, Latino parents reported greater improvements in their children's behavior and in parenting self‐efficacy but exhibited greater decreases in praise. Findings support the efficacy of the CPP for African American and Latino parents and young children from low‐income urban communities. © 2012 Wiley Periodicals, Inc. Res Nurs Health 35:475–489, 2012     

Usual source of health care among Hispanic children: the implications of immigration

Deep inequities continue to exist in the access to and sources of care across racial and ethnic groups in the United States. This research examines differences in the regular source of usual health care for children among Hispanic subgroups of the United States. The immigration status of the mother -- including nativity, duration in the United States, and citizenship status -- as well as sociodemographic factors are considered as significant influences on the type of regular sources of care. Using the National Health Interview Survey from 1999 to 2001, multinomial logistic regression models are estimated to compare Mexican American and other Hispanic children with non-Hispanic whites and blacks. Both Mexican Americans and other Hispanics were more likely to report the use of clinic or the emergency room over private doctor's office as their regular source of health care compared with non-Hispanic whites. Together, the impact of the mother's nativity, duration, and citizenship status explains much of the differentials in the sources of care among Mexican American and other Hispanic children compared with non-Hispanic whites.     

Type 2 Diabetes Self‐Management Social Support Intervention at the U.S.‐Mexico Border

ABSTRACT Objectives: To pilot test the efficacy of a culturally tailored diabetes self‐management social support intervention for Mexican American adults with Type 2 diabetes (T2DM) living in the U.S.‐Mexico border region and to test the feasibility of recruiting and training promotoras to participate in intervention delivery. Design and Sample: This study used a single‐group pretest and posttest design. The convenience sample consisted of 21 Mexican American adults with T2DM. The setting for the study was a community in the Arizona‐Sonora, Mexico border region. Interventions: A bilingual, bicultural certified diabetes educator (CDE) and a nurse researcher developed the intervention to improve T2DM self‐management activities for Mexican Americans. Data were collected using self‐report questionnaires, glycosolated hemoglobin (HbA_1c), and anthropometric measures. Results: Intervention efficacy was demonstrated by an increase in participants' diabetes self‐management activities and diabetes knowledge and a decrease in diabetes‐related distress and sedentary behaviors. There were no significant changes in physiologic outcomes. Feasibility of recruitment and training of 2 promotoras who participated in intervention delivery was established. Conclusions: Promotoras, in collaboration with a CDE, successfully delivered a culturally tailored diabetes self‐management social support intervention for Mexican American adults with T2DM. This intervention positively affected diabetes self‐management behaviors.     

Mexican immigrant mothers' expectations for children's health services

Women of Mexican descent living in the United States raise children who use health care services. What do immigrant Mexican mothers expect from children's health care services? And how do their expectations for children's health services compare to acculturated Mexican American mothers' expectations? This focused ethnographic study, based on repeated interviews with 28 mothers of varying acculturation levels, describes their expectations and experiences with children's health care services in the United States. Findings support a shared core of expectations for both Mexican immigrant and Mexican American mothers, and differences in health care access and financing, time spent in health care encounters, and cultural and linguistic expectations for care. Health care providers can use this information to approach Mexican-descent mothers and children with their expectations in mind, and craft a negotiated plan of care congruent with their expectations.     

Physician utilization by Hispanic elderly persons: national perspective

BACKGROUND: The number of elderly Hispanic Americans is projected to more than double by 2010 and account for 16% of all elders by 2050. The complex health needs and diversity of that growing population poses challenges for planning and delivery of health services. OBJECTIVES: The behavioral model of health services utilization was used to examine predisposing, enabling, and need factors associated with physician use by Hispanic elders and to assess whether Mexican American, Cuban American, and Puerto Rican elders differ in their likelihood of use. RESEARCH DESIGN: Data are from the 1988 National Survey of Hispanic Elderly People, which is a nationally representative sample of Hispanic elders living within telephone exchanges with at least 30% concentration of Hispanics. SUBJECTS: There were 2,299 completed interviews. Analyses are based on a subsample of 773 Mexican Americans, 714 Cuban Americans, and 368 Puerto Ricans. MEASURES: The dependent variable, physician utilization, was self-reported number of visits in the previous year. It was dichotomized because of skewness. Independent variables include predisposing, enabling, and need factors. RESULTS: Using hierarchical logistic regression, all three sets of factors contributed to the likelihood of a visit. Enabling factors, especially insurance coverage and adult children, had the greatest impact. Cuban Americans and Puerto Ricans were 2.3 and 2.6 times more likely, respectively, to have seen a physician than were Mexican Americans. CONCLUSIONS: In seeking to improve access and use of physician services, health care providers and policy makers should consider the role of social and economic factors and national origin group.