Racial identity from an African Amercian perspective

Mortality and morbidity rates for African Americans remain high. Many of the contributing factors to these deaths may be associated with lifestyle. Research has shown that racial identity influences the lifestyles of African Americans. Racial identity includes the adoption of personal behaviors and identification with a group of people with similar characteristics. Clarifying the notion of racial identity may lead to a better understanding of how racial identity influences health behaviors. The purpose of this study was to explore racial identity from a qualitative perspective. A focus group of African Americans residing in a metropolitan (n = 12) city of the United States was used for data collection. Seventy-five percent of the sample were female (n = 16) with a mean age of 43 years (s.d. = 7.26) and a range of 36 to 54 years of age. After analyses of the data, three themes emerged. These themes were "Racial Identity When Growing Up," "Becoming Aware of Racial Differences," and "Present Racial Identity." Sub-themes of each were explored in detail.     

A qualitative perspective of barriers to health-promoting behaviors of African Americans.

African American mortality and morbidity rates remain alarmingly high. Implementation of health promotion strategies can be effective in reducing these rates. Yet, African American health-promoting behaviors remain inadequate. Exploration of perceived barriers to implementing health-promoting behaviors from a qualitative perspective may lead to a better understanding of African American barriers to healthier lifestyles. The purpose of this study was to explore barriers to health promotion for African Americans from a qualitative perspective. Focus group interviews were held in two southeastern states. The results yielded three themes. These were cost, lack of discipline versus not having enough time, and a lack of motivation. When health care professionals develop treatment strategies for African Americans, these barriers should be considered to aid in the development of more efficacious plans of care.     

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.     

Focus groups as an intervention for low-income African American smokers to promote participation in subsequent intervention studies

African Americans are often underrepresented in smoking cessation research. Focus groups were examined as an intervention to increase readiness to quit smoking, the processes of change, and the odds of randomized clinical trial (RCT) participation of non-treatment-seeking, low-income African American smokers. Ten focus groups were conducted. Smokers completed baseline and/or post-group assessments of readiness to quit, the processes of change, and focus group quality. Significant increases were discerned in readiness to quit smoking and the processes of change. Seventy-six percent of participants enrolled in a self-help RCT, which was associated with readiness to quit smoking and plans to set a quit date. One-session focus groups among low-income African American smokers appear to facilitate cognitive changes and participation in RCTs.     

Religion and spirituality: influence on health/risk behavior and cancer screening behavior of African Americans.

In spite of the diversity in the principles, expression and practice, it is believed that significant improvements can occur in the health status of African Americans if health education and outreach efforts are presented and promoted through religious, spiritual and faith-based venues. Several reports published in the peer-reviewed literature address issues related to religion, spirituality and cancer control among African Americans. This growing body of literature describes outcomes of several cancer prevention and control programs designed for and conducted within the African American faith community. However, few efforts have been undertaken to examine the influence of religion and spirituality on health/risk behavior and cancer screening practices of African Americans within the faith community. This report presents the outcomes of an exploratory study undertaken to examine the influence of religion and spirituality on the health/risk behavior and cancer screening practices of African American congregants. Data suggest a need for tailored and targeted health education, outreach and programming among the targeted group of congregants focused specifically on tobacco control, diet and nutrition, exercise and physical activity, weight management, and cancer screening. The same appears to be the case relative to the need for education, outreach and programming focused on communication with primary care providers.     

African American culture and hypertension prevention

A qualitative study was done to explore attitudes and beliefs of African Americans regarding hypertension-preventive self-care behaviors. Five focus groups, with 34 participants, were held using interview questions loosely based on the Theory of Planned Behavior (TPB). Analysis revealed themes broadly consistent with the TPB and also identified an overarching theme labeled "circle of culture." The circle is a metaphor for ties that bind individuals within the larger African American community and provides boundaries for culturally acceptable behaviors. Three subthemes were identified: One describes how health behaviors are "passed from generation to generation," another reflects a sense of being "accountable" to others within the culture, and the third reflects negative views toward people who are "acting different," moving outside the circle of culture. Findings provide an expanded perspective of the TPB by demonstrating the influence of culture and collective identity on attitude formation and health-related behaviors among African Americans.     

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.     

Involving communities in community assessment

Focus groups provide an effective means of incorporating the perspectives of "hidden" populations in assessments of community health needs and assets. A series of focus groups was conducted with specifically targeted segments of a community to develop a comprehensive picture of community health. The authors describe the focus group process, major findings, and the use of focus group results in a highly multicultural community. Despite differences in age, length of residence, and ethnicity, the focus groups were remarkably similar in the issues raised. The majority of participants viewed the multicultural nature of the community as an asset but voiced some of the difficulties of living in a multiethnic and multilanguage environment. Similar areas of concern in the community arose from all of the focus groups, including housing and other environmental issues and problems of access to health care. Focus group findings have been used to initiate activity addressing identified community problems. Focus group participation had the added benefit of increasing community members' participation in other community endeavors.     

The process of changing health risk behaviors: an Oregon rural clinic experience

PURPOSE: A counseling intervention was conducted by nurse practitioners (NPs) at a rural clinic in Oregon. The intervention was designed to help individuals change health risk behaviors. Three focus groups were conducted to aid in understanding the barriers to changing health behaviors and to identify resources that rural individuals needed to succeed in behavior change. DATA SOURCES: Quantitative data were collected using appraisal forms that were specific to five behaviors. Qualitative data were from written comments submitted by focus group participants in answer to questions sent prior to each meeting and from written summaries of focus group meetings submitted by the focus group leader. CONCLUSIONS: Most participants were not successful in changing their health behaviors. The issues raised in the focus group discussions provide an overview of the barriers to health behavior change as perceived by a group of adults in a rural environment. Both individual lack of will and the rural community environment were barriers to adopting new health behaviors. IMPLICATIONS FOR PRACTICE: NPs in rural health care clinics could provide important support for individuals attempting to adopt new health behaviors. Specific suggestions from focus group participants included discussing risky behaviors more often, forming support groups that do not charge a fee, and developing a peer-mentoring program.     

Exploring quality of care for African Americans

The continuous health disparities for African Americans when compared with Caucasians raise the question of whether health care objectives designed for African Americans actually address their needs and wants. To explore quality-of-care dimensions from the African American perspective, a combined focus group and modified Delphi approach were used. Three quality-of-care dimensions (patient, provider, and setting roles) were deduced from the data. Qualitative thematic narratives were abstracted. Because African Americans emphasized processes of care, their health outcomes may improve if process factors are judged as important as those of input and outcome in an adapted quality-of-care framework.     

Factors influencing participation of African American elders in exercise behavior

This study was designed to examine factors influencing exercise behavior of older African American adults. Using the Transtheoretical Stages of Change Model and focus group methodology, 103 participants were assigned to gender and stage specific groups of 5 to 12 each. The focus group discussion guide was developed to explore the meaning of health and exercise, and factors that influence exercise behavior for each stage of the model. Responses varied by stage and gender. Men and women alike described health as the ability to remain active and participate in desired activities. The meaning of exercise varied, by stage, from the ability to perform household chores to engaging in aerobic activities. Many factors such as health, social support, efficacy, and motivation influenced the desire and ability to exercise. Women were more likely than men to identify family responsibility as a barrier to participation in exercise activities. Participants identified strategies to recruit and retain African American elders in exercise programs. Findings of the study have implications for health professionals designing exercise health promotion programs for older African American adults in community settings.     

Promoting the mental health of elderly African Americans: a case illustration

Promoting mental health in an illness-oriented health care delivery system is challenging. Health promotion from a holistic perspective requires that mental health be viewed as important as physical health. The mental health needs of the elderly are numerous and often not addressed during routine visits for primary health care. Research consistently reports that elderly African Americans are not equal participants in the formal health care system. Consequently, promoting mental health in the African American elderly is a challenge made even more complicated because of this group's limited access to and use of mental health care services. Promoting the health of African Americans confronts many traditional values and practices of health care institutions and mental health practice. Therefore, health care providers must be innovative and creative to facilitate mental health promotion in this population of clients. The authors suggest that the Revised Health Promotion Model can serve as a framework for guiding the mental health care of elderly African Americans. Aspects of the model are particularly relevant for this population. The case of an elderly Black woman is presented as an illustration of ways in which the model may be applied with many cultural nuances.     

Older African American women's beliefs, attitudes, and behaviors about breast cancer

Breast cancer poses a greater risk for African American than Caucasian women due to persistent health disparities. To reduce mortality risk, culturally specific knowledge is needed to support and encourage regular breast cancer screening and risk-reduction behaviors in older African American women. The specific aims of this study were to identify social, cultural, and behavioral factors associated with regular participation in breast cancer screening and risk-reduction behaviors; examine health beliefs that may influence regular participation in breast cancer screening and risk-reduction behaviors; and identify perceived facilitators and barriers to regular breast cancer screening and risk-reduction behaviors. African American women older than 65 (N = 57) participated in six focus groups. Analysis of focus group data revealed six major themes: Being Blessed, Cancer as a Death Sentence, Fear/Fear of Disfigurement, Avoiding Finding Out, Beliefs About Breast Cancer, and Tending to One's Family. These themes could be used by health care providers to develop culturally relevant educational initiatives to promote breast health practices and risk-reduction behaviors in this vulnerable population, thus helping reduce breast cancer disparities.     

Attitudes toward participation in breast cancer randomized clinical trials in the African American community: a focus group study

Participation of African Americans in research trials is low. Understanding the perspectives of African American patients toward participation in clinical trials is essential to understanding the disparities in participation rates compared with whites. A qualitative study was conducted to discover attitudes of the African American community regarding willingness to participate in breast cancer screening and randomized clinical trials. Six focus groups consisting of 8 to 11 African American women (N = 58), aged 30 to 65, were recruited from local churches. Focus group sessions involved a 2-hour audio-taped discussion facilitated by 2 moderators. A breast cancer randomized clinical trial involving an experimental breast cancer treatment was discussed to identify the issues related to willingness to participate in such research studies. Six themes surrounding willingness to participate in randomized clinical trials were identified: (1) Significance of the research topic to the individual and/or community; (2) level of trust in the system; (3) understanding of the elements of the trial; (4) preference for "natural treatments" or "religious intervention" over medical care; (5) cost-benefit analysis of incentives and barriers; and (6) openness to risk versus a preference for proven treatments. The majority (80%) expressed willingness or open-mindedness to the idea of participating in the hypothetical trial. Lessons learned from this study support the selection of a culturally diverse research staff and can guide the development of research protocols, recruitment efforts, and clinical procedures that are culturally sensitive and relevant.     

Views on dignity in providing health care for older people

AIM: The aim of this study was to explore the salience and meaning of dignity and dignified care for care providers and the implications for the proviosion of care. The project forms part of an international study being undertaken in different European countries comparing health and social care workers' views on dignity. METHOD: Focus groups were chosen as the primary method of data collection. Twelve focus groups were carried out involving a total of 52 participants representing a range of occupational groups. RESULTS: All participants stated that dignity and respect were important for people of all age groups. The evidence that emerged from these focus groups showed that, in spite of the appropriate intentions of providers, older people were not consistently provided with dignified care. CONCLUSION: In order to ensure dignity in providing care for older people, tasks need to be organised around older people's needs and time frames. Without such changes there is a danger that 'institutional ageism' will persist in the health service.     

African-American spirituality: a concept analysis

Culturally competent care for African Americans requires sensitivity to spirituality as a component of the cultural context. To foster understanding, measurement, and delivery of the spiritual component of culturally competent care, this article presents an evolutionary concept analysis of African-American spirituality. The analysis is based on a sample of multidisciplinary research studies reflecting spirituality of African Americans. Findings indicate that African-American spirituality involves quintessential, internal, external, consoling, and transformative attributive dimensions. Findings are considered in relation to previous conceptual analyses of spirituality and suggest that defining attributes of African-American spirituality are both global and culturally prominent. Implications for practice and research are discussed.     

Methodological considerations in children's focus groups

Focus groups are a well-known qualitative approach to gathering data in health science research. The literature on focus groups, however, primarily discusses adults as subjects. Unfortunately, the scant reports of studies using children as participants in focus groups have not described their methods in detail. This article discusses the use of children (age 6-12) in focus groups, and highlights methodological considerations in this approach, with particular attention to the integration of developmental principles. Focus groups with children can capture their perspectives, original ideas, and insights, which are often neglected in more traditional pediatric research. Focus groups can also serve as an innovative approach to understanding children's experiences from a developmental perspective. Further, focus groups free children and investigator from the data-gathering limitations placed by literacy/reading levels that plague quantitative methods using self-report. By using relatively homogeneous groups, common cultural, emotional, and cognitive processes and responses are revealed that normally would not come to light in structured data collection. Focus groups offer a rich, interactive and developmentally effective approach to planning, content and evaluation in research with children.     

Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups

Aims. This integrated literature review seeks to identify the key considerations in conducting focus groups and discusses the specific considerations for focus group research with culturally and linguistically diverse groups. Background. The focus group method is a technique of group interview that generates data through the opinions expressed by participants. Focus groups have become an increasingly popular method of data collection in health care research. Although focus groups have been used extensively with Western populations, they are a particularly useful tool for engaging culturally and linguistically diverse populations. The success of focus groups in this context is dependent upon the cultural competence of the research team and the research questions. Methods. The electronic databases Medline, CINAHL, Embase, Psychlit and the Internet using the Google Scholar search engine were explored using the search terms ‘focus group’, ‘cultural sensitivity’, ‘transcultural nursing’, ‘transcultural care’, ‘cultural diversity’ and ‘ethnic groups’. Hand searching of reference lists and relevant journals was also undertaken. English language articles were selected for the review if they discussed the following issues: (i) methodological implications of the focus group method; (ii) strengths and limitations of the focus group method; (iii) recommendations for researchers and (iv) use of the focus group in culturally and linguistically diverse groups. Conclusions were drawn from each of the articles and consensus regarding a summary of recommendations was derived from a minimum of two authors. Results. Findings from this review revealed several key issues involving focus group implementation including recruitment, sample size, data collection, data analysis and use within multicultural populations. Strengths and limitations of the focus group method were also identified. Conclusions. Focus groups are a useful tool to expand existing knowledge about service provision and identify consumer needs that will assist in the development of future intervention programmes, particularly within multicultural populations. Careful planning related to methodological and pragmatic issues are critical in deriving effective data and protecting participants. Relevance to clinical practice. Focus groups can facilitate increased understanding of perspectives of culturally and linguistically diverse groups and thereby shape clinical practice to better meet the needs of these groups.