Lack of access to care, funding limitations, cultural, and social barriers are challenges specific to tribal communities that have led to adverse cancer outcomes among American Indians/Alaska Natives (AI/AN). While the cancer navigator model has been shown to be effective in other underserved communities, it has not been widely implemented in Indian Country. We conducted in-depth interviews with 40 AI/AN patients at tribal clinics in Idaho and Oregon. We developed the survey instrument in partnership with community members to ensure a culturally appropriate semi-structured questionnaire. Questions explored barriers to accessing care, perceptions of the navigator program, satisfaction, and recommendations. AI/AN cancer patients reported physical, emotional, financial, and transportation barriers to care, but most did not feel there were any cultural barriers to receiving care. Navigator services most commonly used included decision making, referrals, transportation, scheduling appointments, and communication. Satisfaction with the program was high. Our study provides a template to develop a culturally appropriate survey instrument for use with an AI/AN population, which could be adapted for use with other indigenous patient populations. Although our sample was small, our qualitative analysis facilitated a deeper understanding of the barriers faced by this population and how a navigator program may best address them. The results reveal the strengths and weakness of this program, and provide baseline patient satisfaction numbers which will allow future patient navigator programs to better create evaluation benchmarks.
Cites: Cancer Epidemiol Biomarkers Prev. 2012 Oct;21(10):1673-81 PMID 23045542
Cites: MMWR Surveill Summ. 2004 Jun 4;53(3):1-108 PMID 15179359
Causal attributions of mental health problems play a crucial role in shaping and differentiating illness experience in different sociocultural and ethnic groups. The aims of this study were (a) to analyze older Somali refugees' causal attributions of mental health problems; (b) to examine the associations between demographic and diagnostic characteristics, proxy indicators of acculturation, and causal attributions; and (c) to analyze the connections between causal attributions and the manifestation of somatic-affective and cognitive depressive symptoms. A sample of 128 Somali refugees aged 50-80 years living in Finland were asked to list the top three causes of mental health problems. Depressive symptoms were analyzed using the Beck Depression Inventory (BDI). The results showed that the most commonly endorsed causal attributions of mental health problems were jinn, jealousy related to polygamous relationships, and various life problems. We identified five attribution categories: (a) somatic, (b) interpersonal, (c) psychological, (d) life experiences, and (e) religious causes. The most common causal attribution categories were life experiences and interpersonal causes of mental health problems. Men tended to attribute mental health problems to somatic and psychological causes, and women to interpersonal and religious causes. Age and proxy indicators of acculturation were not associated with causal attributions. Participants with a psychiatric diagnosis and/or treatment history reported more somatic and psychological attributions than other participants. Finally, those who attributed mental health problems to life experiences (e.g., war) reported marginally fewer cognitive depressive symptoms (e.g., guilt) than those who did not. The results are discussed in relation to biomedical models of mental health, service use, immigration experiences, and culturally relevant patterns of symptom manifestation.
The purpose of this study was to assess whether similar environmental factors predict adolescents' smoking in two different cultures: in the Pitkäranta district in Russian Karelia and in eastern Finland. The data were gathered by self-administered questionnaires from ninth-grade students in 10 comprehensive schools in Pitkäranta (n = 385) and from age-matched students in 24 schools in eastern Finland (n = 2,098). Structural equation modeling (SEM) was used to test whether similar path structures fit for boys and for girls in Pitkäranta and in eastern Finland, and to test whether regression coefficients were similar between the cultures by sex. Smoking by family members and best friends was positively related to adolescents' smoking both directly and indirectly. Environmental factors were similar predictors of smoking between the cultures for boys. For girls, different regression coefficients in Pitkäranta and in eastern Finland were found. Best friend's smoking was the most important predictor of adolescents' own smoking in every sub-sample. When indirect relationships were identified, the significance of parents' and siblings' smoking, in addition to smoking by best friends, was strongly supported.
To describe immigrant women's postpartum health, service needs, access to services, and service use during the first 4 weeks following hospital discharge compared to women born in Canada.
Data were collected as part of a larger cross-sectional study.
Women were recruited from 5 hospitals purposefully selected to provide a diverse sample.
A sample of 1,250 women following vaginal delivery of a healthy infant; approximately 31% were born outside of Canada.
Self-reported health status, postpartum depression, postpartum needs, access to services, service use.
Immigrant women were significantly more likely than Canadian-born women to have low family incomes, low social support, poorer health, possible postpartum depression, learning needs that were unmet in hospital, and a need for financial assistance. However, they were less likely to be able to get financial aid, household help, and reassurance/support. There were no differences between groups in ability to get care for health concerns.
Health care professionals should attend not only to the basic postpartum health needs of immigrant women but also to their income and support needs by ensuring effective interventions and referral mechanisms.
First Nations' perspectives on health and health care as delivered by doctors, nurses, and Canada's former Indian hospital system form a significant part of Canada's medical history, as well as a part of First Nations people's personal histories. Oral histories collected in Alberta and British Columbia suggest that First Nations people who experienced the Nanaimo and Charles Camsell Indian hospitals between 1945 and 1965 perceive the value of their experiences to be reflected in their survivance, a concept recalled through narratives emphasizing both humour and pain, as well as past and present personal resilience.
This article discusses nurses' and elderly patients' perceptions of the realization of autonomy, privacy and informed consent in five European countries. Comparisons between the concepts and the countries indicated that both nurses and patients gave the highest ratings to privacy and the lowest to informed consent. There were differences between countries. According to the patient data, autonomy is best realized in Spain, privacy in the UK (Scotland), and informed consent in Finland. For the staff data, the best results tended to concentrate in the UK. The conceptual and methodological limitations of the study are identified and discussed. Implications of the results are divided into three areas: nursing practice, education and research. In practice, the analysis of patients' values and the ethical sensitivity of nurses are important as part of ethically good care. In nurse education, students should learn to recognize ethical problems, generally and particularly, among vulnerable groups of patients. Multicultural international research is needed in this area. This is the last of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.
The focus of this article is on elderly patients' and nursing staff perceptions of informed consent in the care of elderly patients/residents in five European countries. The results suggest that patients and nurses differ in their views on how informed consent is implemented. Among elderly patients the highest frequency for securing informed consent was reported in Finland; the lowest was in Germany. In contrast, among nurses, the highest frequency was reported in the UK (Scotland) and the lowest in Finland. In a comparison of patients' and nurses' perceptions, nurses had more positive views than patients in all countries except Finland. Patients with less need for nursing interventions in Greece and Spain gave their consent less often. The German and Greek patients were older, and the results also point to an association between this and their lower frequency of giving consent. In Spain, patients who were married or who had a family member or friend to look after their personal affairs were more likely to be included in the group whose consent was sought less often. This is the fourth of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.
The focus of this article is on elderly patients' and nursing staff perceptions of privacy in the care of elderly patients/residents in five European countries. Privacy includes physical, social and informational elements. The results show that perceptions of privacy were strongest in the UK (Scotland) and weakest in Greece. Country comparisons revealed statistically significant differences between the perceptions of elderly patients and also between those of nurses working in the same ward or long-term care facility. Perceptions of privacy by patients and their nursing staff were quite similar in Finland, Germany and the UK. In contrast, in Greece and Spain these perceptions were different: nurses believed that they took account of their patients' privacy needs more often than the patients themselves felt this was the case. Among Spanish and UK patients, an association was found between lower levels of independence and comparatively less positive perceptions of privacy. No associations were established between nurses' perceptions and their demographic factors. This is the third of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.
The focus of this article is perceptions of elderly patients and nurses regarding patients' autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients received information from nursing staff or were offered opportunities to make decisions. This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented.