Sociocultural influences on disability status in Puerto Rican children.

BACKGROUND AND PURPOSE: This article describes culturally defined meanings of childhood function and disability in Puerto Rico to provide a context for the interpretation of test scores from the Spanish translation of the Pediatric Evaluation of Disability Inventory (PEDI). SUBJECTS AND METHODS: More than 600 Puerto Rican teachers, parents and caregivers of children with and without disabilities, and members of the general community participated in ethnographic interviews, which were designed to describe their beliefs, attitudes, and knowledge about childhood function and disability. RESULTS: Qualitative and quantitative data analysis confirmed that differences exist between Puerto Ricans and the norms established in the United States for the performance of functional skills by children, and the analysis also described Puerto Rican beliefs and attitudes toward disability. DISCUSSION AND CONCLUSION: Puerto Rican values of interdependence, a?o?ar (pampering or nurturing behaviors), and sobre protectiva (overprotectiveness) influence parental expectations for the capability of children with disabilities and should be considered when interpreting scores from the PEDI and establishing plans of care. Additional research is needed on the influence of contextual variables on child development and behavioral adaptations to disability.     

Understanding caregivers' help-seeking for Latino children's mental health care use

BACKGROUND: Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why. OBJECTIVE: The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users. SUBJECTS: Data were collected from a random Puerto Rican community sample of caregiver-child dyads. MEASURES: Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems. STATISTICAL METHODS: The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care. RESULTS: The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis. CONCLUSION:: Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need.     

Focus groups: examining a community-based group intervention for depressed Puerto Rican women

Puerto Ricans manifest high rates of depression but avoid seeking treatment. The purpose of this pilot was to learn directly from Puerto Rican women how culturally appropriate they would consider a proposed community-based intervention for treating depression. Interactive activities were reviewed by two focus groups of women (N = 16), all working in community-based health programs. All activities (e.g., writing, role playing, and music) except individual drawing were deemed appropriate. Categories that emerged were family/community values, mainland/non-mainland cultural variances, communication style, religion, education/occupational variances, health beliefs, Puerto Rican traditions/customs, emotions, and coping skills. Categories provided guidance for refining a community-based intervention for treating depression in Puerto Rican women.     

Focus Groups: Examining a Community-Based Group Intervention for Depressed Puerto Rican Women

Puerto Ricans manifest high rates of depression but avoid seeking treatment. The purpose of this pilot was to learn directly from Puerto Rican women how culturally appropriate they would consider a proposed community-based intervention for treating depression. Interactive activities were reviewed by two focus groups of women (N = 16), all working in community-based health programs. All activities (e.g., writing, role playing, and music) except individual drawing were deemed appropriate. Categories that emerged were family/community values, mainland/non-mainland cultural variances, communication style, religion, education/occupational variances, health beliefs, Puerto Rican traditions/customs, emotions, and coping skills. Categories provided guidance for refining a community-based intervention for treating depression in Puerto Rican women.     

Environmental Tobacco Smoke Exposure Among Hispanic Women of Reproductive Age

Abstract Exposure to environmental tobacco smoke is a potential health risk for women of reproductive age and their children. Household and workplace exposures were estimated for 4256 Hispanic women age 12 to 49 who participated in the Hispanic health and nutrition examination survey. Age-specific household exposure for nonsmokers was 31% to 62% for Mexican-Americans, 22% to 59% for Puerto Ricans, and 40% to 53% for Cuban-Americans. Exposure was significantly high for Puerto Rican and Mexican-American adolescents, 59% and 62%, respectively. Workplace exposure for nonsmokers was 22% to 35% for Mexican-Americans, 28% to 33% for Puerto Ricans, and 33% to 49% for Cuban-Americans. Young Mexican-American and Puerto Rican and all Cuban-American women reported high exposure to environmental tobacco smoke in the home or workplace. Assessment of family living and smoking patterns, understanding cultural values and norms, and household smoking control and cessation strategies that are mutually derived are useful for nurses and Hispanic and Latino populations to meet the environmental tobacco smoke health objectives for the nation.     

What has the literature taught us about culturally competent care of women and children

This article describes what is currently in the literature about culturally competent care for women and children. With the population of the United States growing increasingly diverse, there is a developing need for cultural competency among nurses and throughout healthcare organizations. Cultural competence includes both culture-specific and culture-generic knowledge, attitudes, and skills. While databased literature on cultural competency still requires further development, we do have evidence of positive outcomes of culturally competent care. The end result of the provision of culturally competent care by culturally competent nurses and healthcare organizations can be significant improvements in the health and well-being of women and children.     

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.     

Listening to the quiet voices of Hispanic migrant children about health

There is a paucity of literature related to school-aged migrant children's perceptions of their own health. To best provide culturally competent care, more information is needed about migrant children's experiences. Focus-group methodology allowed the voices of migrant children to be heard by primary health care providers at a summer school program for children of migrant farm workers in south Georgia. Seventy-three children participated in 14 focus-group sessions. Six themes emerged from the data that were analyzed by using a qualitative software system. They are healthy behaviors, acculturation issues, environmental influences, health care actions, health behavior outcomes, and learning needs. Emerging patterns within each theme render insight about these migrant children. The findings suggest implications for pediatric nurses related to culturally competent care.     

Culture as a determinant of "humanistic traits" in medical residents

In this cross-cultural study of Puerto Rican and Texas physicians, we have tested the hypothesis that physicians' "humanistic attributes" are culturally related. Differences (P = .05 to .01) were found between mean responses of the two groups of residents to seven of the questions on the Totalitarian-Authoritarian-Dogmatism scale. Factor analysis determined that the two principal components of disagreement were medical political and ethical issues (P = .001) but not patients and their problems. Faculty responses provided additional evidence that customs and traditions influence how professional subgroups manifest attitudes: Puerto Rican faculty rated residents highest on "humanistic traits" if they self-reported high ethical scores, and lowest if they self-reported high radical scores; Baylor faculty reflected the "age-drag" on changing values by differing (P = .05 to .001) from both groups of residents on 38% of the questions. The difficulty of rating residents with a universal standard of "humanistic traits" is supported by the culture and age-specific differences reported herein.     

Self-Management of Diabetes in a Puerto Rican Population

A convenience sample of 74 clients with type II diabetes mellitus was followed in the home by public health nurses. Participants were observed and interviewed to determine the pattern of self-management behaviors in the areas of insulin administration, urine testing, and dietary intake. One-third to one-half of the respondents could be judged as being noncompliant with one or more aspects of the treatment plan: over one-half (38) reported skipping insulin doses; 52 varied the time they administered their insulin; and 25 had stopped testing their urine. Breaks in procedures of insulin administration were also in evidence, with the most serious being cessation or taking incorrect doses by 21 respondents. Meal skipping was reported by the majority: 41 skipped their bedtime snack and 25 skipped breakfast. Quantitative dietary analysis showed close to adequate nutrient intake with the exception of calcium and iron. Traditional Puerto Rican foods such as rice and beans were present in 53 percent of the meals despite the overriding belief that these foods should be avoided by persons with diabetes mellitus. Case data revealed interference factor in the spontaneity of life imposed by the diabetic management plan. This shows the need for flexible approaches to home care of Puerto Rican diabetics and for increased knowledge of how effectively to alter the plan of care to meet the demands of daily living.     

The Crossroads of Culture and Health Among the Roma (Gypsies)

Purpose: To alert health care providers to commonly encountered cross-cultural impediments to optimal health care delivery for the Roma (also known as Gypsies) and to offer suggestions for avoiding culturally based problems in treating this subculture.
Organizing framework: Understanding of sociocultural bases of health-related behaviors is necessary for culturally competent and effective health care.
Methods: Review of literature and personal interviews.
Findings: Cultural factors that can affect health care delivery include: concepts of pollution, cleanliness, ideal weight, death, and views of medical procedures such as immunizations and surgery. Responsiveness of health care providers to expectations of Roma about their involvement of family and the hierarchy of age and sex also can enhance patient-provider relationships that in turn can improve compliance and satisfaction with health care regimens .
Conclusion: The Roma have some culturally distinct beliefs and behaviors related to their health and health care. Knowledge of these characteristics and accommodations to cultural differences are important in their health care.     

An examination of ethnic differences in cigarette smoking intention among female teenagers

PURPOSE: To describe and compare predictors of cigarette smoking intention, as defined by the theory of planned behavior, among African American, Puerto Rican, and non-Hispanic white female teenagers. DATA SOURCES: A convenience sample of 430 English-speaking female teenagers (141 African American, 146 Puerto Rican, and 143 non-Hispanic white teenagers), aged 13-19 years, who were patients at family planning clinics in eastern Pennsylvania. The data were obtained through a self-administered questionnaire. CONCLUSIONS: Regression analyses demonstrated attitude, subjective norm, and perceived behavioral control predicted 70% of the variance in smoking intention in African American, 69% in Puerto Rican, and 88% in non-Hispanic white teenagers. In addition, ethnic group differences were identified. For African Americans, smoking intention was mediated principally by perceived behavioral control, whereas for Puerto Rican and non-Hispanic white teenagers, attitudes were the greatest predictor of intention to smoke. Moreover, non-Hispanic white smokers had a stronger intention to smoke than either the African American or Puerto Rican smokers. IMPLICATIONS FOR PRACTICE: Cigarette smoking is the leading preventable cause of death in the United States, with the majority of smokers initiating the habit in their teen years. Nurse practitioners are in key positions to counsel young women about the dangers of smoking. The identification of cultural-specific predictors of smoking will assist in the development of tailored antismoking messages.     

Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients

BACKGROUND: Health care providers and health care training institutions need more specific, relevant, and useful information for providing culturally sensitive health care. OBJECTIVE: We sought to determine what patients considered to be culturally sensitive health care. RESEARCH DESIGN AND PARTICIPANTS: We conducted 20 focus group interviews with 135 mostly low-income primary care patients from three different ethnic/cultural groups (African American, European American, and Latino American). Focus group interviews were recorded, transcribed, and analyzed into themes by two researchers using the constant comparative method. MEASURES: Participants' responses were grouped into primary and secondary themes. RESULTS: Results revealed the following universal themes of health care delivery by physicians that all three racial or ethnic groups identified as indicators of culturally sensitive health care: people skills, individualized treatment, effective communication, and technical competence. Results also revealed some ethnic group-specific themes. Other factors including physical environment characteristics (eg, culturally sensitive art, pictures, music, and reading materials) and office staff behaviors were unique indicators of culturally sensitive health care identified by African American and Latino American participants but not by European American participants. CONCLUSIONS: These findings can be incorporated into training programs for health care providers, possibly resulting in more effective health care delivery to patients from diverse cultural backgrounds. Future research is needed to evaluate the impact of incorporating patient-identified cultural sensitivity into health care delivery on important outcome measures such as patient satisfaction and treatment adherence.     

Paediatric respite care: a literature review from New Zealand

This paper reviews relevant international and New Zealand literature, policy documents and reports on respite provision for children who are dying and their families. The literature describes why respite care for children is necessary, and evaluates present respite services in accord with recent reports and literature. The service provisions needed for dying children and their families are explored, including suggestions for the improvement of services and future research. The literature reveals that, although respite care for terminally ill children and their families is necessary, service provisions are uncoordinated, not always culturally sensitive and very limited for children and their families. Improvement in paediatric respite services is necessary and research needs to be conducted in this area to facilitate the development of more appropriate respite services for children and their families.     

Racial and ethnic differences in the mental health problems and use of mental health care

OBJECTIVES: We compared rates of mental health problems and use of mental health care across multiple racial and ethnic groups using secondary data from a large, nationally representative survey. METHODS: We pooled cross-sectional data from the 2001-2003 National Surveys on Drug Use and Health. Our sample included 134,875 adults classified as white, African American, American Indian/Alaskan Native, Asian, Mexican, Central and South American, Puerto Rican, other Hispanic-Latino, or those with multiple race and ethnicities. For each group, we estimate the past year probability of: (1) having 1 or more mental health symptoms in the past year, (2) having serious mental illness in the past year, (3) using mental health care, (4) using mental health care conditional on having mental health problems, (5) reporting unmet need for mental health care, and (6) reporting unmet need for mental health care conditional on having mental health problems. RESULTS: We found significantly higher rates of mental health problems and higher self-reported unmet need relative to whites among American Indian/Alaskan Natives and lower rates of mental health problems and use of mental health care among African American, Asian, Mexican, Central and South American, and other Hispanic-Latino groups. These differences generally were robust to the inclusion of clinical and socio demographic covariates. CONCLUSIONS: Overall, our study shows wide variation in mental health morbidity and use of mental health care across racial and ethnic groups in the United States. These results can help to focus efforts aimed at understanding the underlying causes of the differences we observe.     

Bridging Cultures for Latino Children: School Nurse and Advanced Practice Nurse Partnerships

TOPIC:  Barriers to use of mental health services by Latino families include stigma, service costs, and disparity of services with cultural values and traditions. School nurses are in key positions to recognize mental health needs of Latino children and form relationships that facilitate family connections with mental health services. Advanced practice psychiatric nurses may be contracted by school districts to provide consultation to school nurses or may be available to school nurses through connections with school-based health centers. Case examples are provided to illustrate the value of school nurse consultation with an advanced practice psychiatric nurse in promoting awareness of cultural influences on children's symptoms and behaviors and developing culturally sensitive approaches to engage Latino children and families in school and health services.
PURPOSE:  This paper aims to review literature on Latino mental health and present rationale for school nurse and advanced practice nurse partnerships to promote culturally sensitive approaches that facilitate Latino family access and utilization of health services.
SOURCES:  Published literature and case scenarios.
CONCLUSIONS:  With advanced practice nurse consultation, school nurses identify mental health needs of Latino children and develop culturally sensitive approaches that bridge Latino families' access to and utilization of health services.     

Strategies to Facilitate Lifestyle Change Associated with Diabetes Mellitus

Purpose: To critically examine the literature about strategies and factors that influence lifestyle change in people with diabetes mellitus.
Method: This integrative literature review included an extensive search of published literature about strategies to facilitate lifestyle change related to diabetes mellitus. Articles reviewed were empirical studies focused on lifestyle change and were published between 1985 and 1999. Meta-analyses and relevant reviews of the literature were also included. Over 90 articles were initially identified, 72 met the specified criteria and could be categorized according to a theoretical framework or a broad topic area.
Findings: Studies were clustered into the categories of educational, behavioral, cultural, and health beliefs that influence or are barriers to lifestyle change. Studies indicate that positive outcomes are associated with diabetes education programs that focus on self-management, emphasize behavioral strategies, and provide culturally relevant information.
Conclusions: Theoretically grounded research in diabetes care is imperative for the future. Expansion of research methods, continued methodological rigor of studies, and instrument development would contribute to knowledge development in diabetes care. Research priorities are proposed.