Nurse Faculty Scholars - Community Health

Exploring the Role of Community Health Workers in Providing Cancer Navigation: Perceptions of African American Seniors

kdeming — Tue, 02 Oct 2012 18:15:29 +0000

Published Date:

Tue, 2012-05-01 (All day)

The purpose of this study was to to obtain experiential data regarding African American older adult survivors' perceptions of and recommendations on the role of community health workers (CHWs) in providing a cancer navigation intervention.

Purpose/Objectives: To obtain experiential data regarding African American older adult survivors' perceptions of and recommendations on the role of community health workers (CHWs) in providing a cancer navigation intervention.

Research Approach: Focus groups.

Setting: Rural Virginia and urban Maryland.

Participants: 48 African American solid-tumor cancer survivors, aged 65 years or older, with Medicare insurance.

The Power of the Drug, Nature of Support, and Their Impact on Homeless Youth

lsharp — Mon, 14 Mar 2011 13:12:54 +0000

Published Date:

Thu, 2009-10-01 (All day)

The purpose of this study was to explore homeless youths' perspectives on the power of drugs in their lives, the preferred type of drugs used, barriers to treatment, and strategies to prevent drug initiation and abuse. This was a descriptive, qualitative study using focus groups with a purposeful sample of 24 drug-using homeless youth. The results provided insight into the lives of drug-using homeless youth. The most commonly used drugs were marijuana and alcohol. Reported reasons for drug use were parental drug use, low self-esteem, and harsh living conditions on the streets. Barriers to treatment were pleasurable enjoyment of the drug, physical dependence, and non-empathetic mental health providers. Strategies to prevent initiation and abuse of drugs were creative activities, such as art, sports, and music, and disdain for parental/family drug use and abuse. Comparative research is needed on specific personal factors that cause initiation and deterrence of drugs use/abuse among homeless youth.

Exploring cancer support needs for older African-American men with prostate cancer.

lsharp — Tue, 19 Oct 2010 14:18:34 +0000

Published Date:

Sun, 2010-08-22 (All day)

PURPOSE: The purpose of this study was to explore cancer support and financial issues related to cancer care experienced by African-American men with prostate cancer and to understand whom they relied on for resource issues during diagnosis and treatment.

METHODS: This is a descriptive qualitative study of 23 rural and urban 65 years old and older African-American prostate cancer survivors. Five focus groups were conducted containing African-American prostate cancer survivors who were recruited from community-based centers (e.g., churches, barbershops, diners, and primary care clinics) in central Virginia and Maryland. Focus group discussions were audiotaped, transcribed, and coded. Data were organized and managed using a qualitative analysis software program. Emerging themes uncovered specific problems for older rural African-American men with cancer, and focus group data were examined for potential solutions to these problems.

RESULTS: Two common themes emerged: (1) family and physician support are important, and (2) insurance is a necessity for appropriate health care. A difference between rural and urban African-American prostate cancer survivors emerged as well: difference in spirituality during diagnosis and treatment.

CONCLUSIONS: Rural and urban African-American prostate cancer survivors' major support resource was their wives. Health insurance played a critical role as a support source by decreasing anxiety and financial hardships. Understanding rural and urban African-American prostate cancer survivors' support needs and challenges in relation to cancer diagnosis and treatment will allow nurses and other health-care providers to tailor cancer health plans more effectively for this population.

Engaging Urban Residents in Assessing Neighborhood Environments and Their Implications for Health

nfs — Wed, 29 Sep 2010 12:09:54 +0000

Published Date:

Mon, 2006-05-01 (All day)

Researchers have worked to delineate the manner in which urban environments reflect broader social processes, such as those creating racially, ethnically and economically segregated communities with vast differences in aspects of the built environment, opportunity structures, social environments, and environmental exposures. Interdisciplinary research is essential to gain an enhanced understanding of the complex relationships between these stressors and protective factors in urban environments and health. The purpose of this study was to examine the ways that multiple factors may intersect to influence the social and physical context and health within three areas of Detroit, Michigan. We describe the study design and results from seven focus groups conducted by the Healthy Environments Partnership (HEP) and how the results informed the development of a survey questionnaire and environmental audit tool. The findings from the stress process exercise used in the focus groups described here validated the relevance of a number of existing concepts and measures, suggested modifications of others, and evoked several new concepts and measures that may not have been captured without this process, all of which were subsequently included in the survey and environmental audit conducted by HEP. Including both qualitative and quantitative methods can enrich research and maximize the extent to which research questions being asked and hypotheses being tested are driven by the experiences of residents themselves, which can enhance our efforts to identify strategies to improve the physical and social environments of urban areas and, in so doing, reduce inequities in health.

Fruit and vegetable access differs by community racial composition and socioeconomic position in Detroit, Michigan.

nfs — Wed, 29 Sep 2010 11:59:53 +0000

Published Date:

Fri, 2006-12-01 (All day)

OBJECTIVE: To compare the availability, selection, quality, and price of fresh fruit and vegetables at food stores in four Detroit-area communities: 1) predominately African-American, low socioeconomic position (SEP); 2) racially heterogeneous, low SEP; 3) predominately African-American, middle SEP; and 4) racially heterogeneous, middle SEP.

DESIGN: Cross-sectional observational survey, conducted fall 2002.

SETTING: Detroit, Michigan

SAMPLE: Overall, 304 food stores located in the four communities were evaluated: chain grocery, large independent grocery, "mom-and-pop" grocery, specialty (meat, fruit and vegetable markets), convenience without gasoline, and liquor stores.

MAIN OUTCOME MEASURES: Availability was indicated by whether a store carried fresh fruit or vegetables, selection was based on a count of 80 fruit and vegetables, quality was evaluated according to USDA guidelines for a subset of 20 fruit and vegetables, and price was assessed for 20 fruit and vegetables by using the lowest-cost method.

RESULTS: Mean quality of fresh produce was significantly lower in the predominately African-American, low-SEP community than in the racially heterogeneous, middle-SEP community. Differences in the types of stores present only partially explained this quality differential. The predominately African-American, low-SEP community had more than four times more liquor stores and fewer grocery stores per 100,000 residents than the racially heterogeneous, middle-SEP community. Mean overall selection and price of fresh produce at stores did not differ among communities.

CONCLUSIONS: Increasing access to high-quality fresh produce in low-income communities of color is a critical first step toward improving health through better dietary practices in this population.

Fruit and Vegetable Intake in African Americans: Income and Store Characteristics

nfs — Wed, 29 Sep 2010 11:47:49 +0000

Published Date:

Fri, 2005-07-01 (All day)

Background The purpose of this study was to examine whether the characteristics of retail food stores where African-American women shopped mediated the association between their income and intake of fruits and vegetables. Food store characteristics included store type (supermarket, specialty store, limited assortment store, independent grocer), store location (suburbs, city of Detroit), and perceptions of the selection/quality and affordability of fresh produce for sale.

Methods The analysis drew upon data from a probability sample of 266 African-American women living in 2001 in eastside Detroit, which had no supermarkets. Structural equation modeling was used to calculate a path model of direct and indirect effects.

Results Women shopping at supermarkets and specialty stores consumed fruit and vegetables more often, on average, than those shopping at independent grocers. More positive perceptions of the selection/quality, but not affordability, of fresh produce at the retail outlet where they shopped was positively associated with intake, independent of store type and location as well as age, per capita income, and years of education. The results suggested an indirect association between income and fruit and vegetable intake; women with higher per capita incomes were more likely to shop at supermarkets than at other grocers, which in turn was associated with intake.

Conclusions Previous studies have shown that few supermarkets are located in the city of Detroit, a symptom of economic divestment over the past several decades. Results of this study suggest this may have negative implications for dietary quality, particularly among lower-income women.

Background
The purpose of this study was to examine whether the characteristics of retail food stores where African-American women shopped mediated the association between their income and intake of fruits and vegetables. Food store characteristics included store type (supermarket, specialty store, limited assortment store, independent grocer), store location (suburbs, city of Detroit), and perceptions of the selection/quality and affordability of fresh produce for sale.

Neighborhood Racial Composition, Neighborhood Poverty, and the Spatial Accessibility of Supermarkets in Metropolitan Detroit

nfs — Wed, 29 Sep 2010 11:40:32 +0000

Published Date:

Fri, 2005-04-01 (All day)

Objectives. We evaluated the spatial accessibility of large "chain" supermarkets in relation to neighborhood racial composition and poverty.

Methods. We used a geographic information system to measure Manhattan block distance to the nearest supermarket for 869 neighborhoods (census tracts) in metropolitan Detroit. We constructed moving average spatial regression models to adjust for spatial autocorrelation and to test for the effect of modification of percentage African American and percentage poor on distance to the nearest supermarket.

Results. Distance to the nearest supermarket was similar among the least impoverished neighborhoods, regardless of racial composition. Among the most impoverished neighborhoods, however, neighborhoods in which African Americans resided were, on average, 1.1 miles further from the nearest supermarket than were White neighborhoods.

Conclusions. Racial residential segregation disproportionately places African Americans in more-impoverished neighborhoods in Detroit and consequently reduces access to supermarkets. However, supermarkets have opened or remained open close to middle-income neighborhoods that have transitioned from White to African American. Development of economically disadvantaged African American neighborhoods is critical to effectively prevent diet-related diseases among this population.

Objectives. We evaluated the spatial accessibility of large "chain" supermarkets in relation to neighborhood racial composition and poverty.
Methods. We used a geographic information system to measure Manhattan block distance to the nearest supermarket for 869 neighborhoods (census tracts) in metropolitan Detroit. We constructed moving average spatial regression models to adjust for spatial autocorrelation and to test for the effect of modification of percentage African American and percentage poor on distance to the nearest supermarket.

Neighborhood Characteristics, Adherence to Walking, and Depressive Symptoms in Midlife African American Women

nfs — Mon, 27 Sep 2010 13:20:10 +0000

Published Date:

Sat, 2009-08-01 (All day)

Background African American women have more symptoms of depressed mood than white women. Adverse neighborhood conditions may contribute to these symptoms. Although reductions in depressive symptoms with physical activity have been demonstrated in white adults, little research has examined the mental health benefits of physical activity in African American women. Further, it is unknown whether physical activity can offset the effects of living in disadvantaged neighborhoods on depressive symptoms. The purpose of this study was to examine the relationships among neighborhood characteristics, adherence to a physical activity intervention, and change over time in depressive symptoms in midlife African American women. Methods Two hundred seventy-eight women participated in a home-based, 24-week moderate-intensity walking intervention. Either a minimal treatment (MT) or enhanced treatment (ET) version of the intervention was randomly assigned to one of the two community health centers. Walking adherence was measured as the percentage of prescribed walks completed. Objective and perceived measures of neighborhood deterioration and crime were included. Results Adjusting for demographics, body mass index (BMI), and depressive symptoms at baseline, walking adherence and objective neighborhood deterioration were associated with significantly lower depressive symptoms, whereas perceived neighborhood deterioration was associated with significantly higher depressive symptoms at 24 weeks. Conclusions Adherence to walking as well as aspects of the environment may influence depressive symptoms in African American women. In addition to supporting active lifestyles, improving neighborhood conditions may also promote mental health among African American women.

Background

Self-Transcendence and Well-Being in Homeless Adults

nfs — Wed, 26 Aug 2009 16:52:39 +0000

Published Date:

Wed, 2007-03-14 (All day)

This study examines the relationships of spiritually and physically related variables to well-being among homeless adults. A convenience sample of 61 sheltered homeless persons completed the Spiritual Perspective Scale, the Self-Transcendence Scale, the Index of Well-Being, and items measuring fatigue and health status. The data were subjected to correlational and multiple regression analysis. Positive, significant correlations were found among spiritual perspective, self-transcendence, health status, and well-being. Fatigue was inversely correlated with health status and well-being. Self-transcendence and health status together explained 59% of the variance in well-being. The findings support Reed's theory of self-transcendence, in which there is the basic assumption that human beings have the potential to integrate difficult life situations. This study contributes to the growing body of evidence that conceptualizes homeless persons as having spiritual, emotional, and physical capacities that can be used by health care professionals to promote well-being in this vulnerable population.

Enabling Older Homeless Minority Women to Overcome Homelessness by Using a Life Management Enhancement Group Intervention

nfs — Wed, 26 Aug 2009 16:22:27 +0000

Published Date:

Sat, 2009-01-31 (All day)

This paper describes the importance of a life management enhancement (LME) group intervention for older minority women in developing personal control and self-confidence in social relationships as they overcome homelessness. Women in the treatment group showed significantly greater personal control and higher levels of self-confidence following the six-week intervention than women in the control group. Increasing personal control and developing self-confidence in social relationships can help individuals achieve desired outcomes as a result of their actions, efforts, and abilities. These attributes can help women increase and sustain appropriate coping methods and overcome homelessness.