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PubMed2000

Breast cancer screening among Cambodian American women.

Our aim was to describe and identify factors associated with breast cancer screening among Cambodian American women. We conducted a cross-sectional survey of 1,365 households using bilingual and bicultural interviewers. We found that low proportions of Cambodian American women were up to date on their clinical breast examinations (CBE; 42%) and mammograms (40%). More than 80% of women with female physicians have had at least one prior screening, and 52% have had the tests recently. Women with male Asian American physicians were less likely to have had screening as compared to women with female non-Asian physicians: ever had CBE (odds ratio [OR], 0.26); recent CBE (OR, 0.39); ever had mammogram (OR, 0.36); and recent mammogram (OR, 0.22). Breast cancer screening among Cambodian American women lags behind the general U.S. population. Tailored promotion efforts should address barriers and promote cancer screening by physicians, staff, and organizations serving this population.

Adolescent↗
PubMed2003

The Biomedical Humanities program: merging humanities and science in a premedical curriculum at Hiram College.

The Biomedical Humanities program at Hiram College, established in 1999, engages premedical and other qualified students in ethical and informed decision making, improves their ability to interact with persons of different backgrounds and cultures, provides them an active introduction to basic medical research and clinical practice, and coaches them in communicating across barriers, appreciating that scientists and humanists typically learn and work differently. The program offers both a major and a minor in biomedical humanities topics. The major requires the core biology and chemistry curriculum necessary for further studies in medicine as well as courses in genetics and statistics. The remainder of the major is devoted to four core areas: Communications, Relationships and Cultural Sensitivity, Ethics and Medical Humanities, and a nonacademic core area, Experiential Learning. Many of the ethics and medical humanities options are team-taught interdisciplinary courses. The Experiential Learning area requires students to take two special topics seminars, two service seminars, and two internships-one shadowing a professional in his or her area of interest and one engaging in basic biomedical research. The shadowing internship and service seminars focus not only on career exploration, but also on human interactions. Students reflect on the personal interactions they observe during their various experiences, and on their own strengths and weaknesses. Essays, designed to help students learn more about their roles in these settings, push them to deal with the sociopolitical issues involved in their service. The major, a robust and vital component of Hiram's undergraduate program, has attracted academically gifted students with a diverse array of career goals.

Bioethics↗
PubMed2005

Concordant spiritual orientations as a factor in physician-patient spiritual discussions: a qualitative study.

OBJECTIVES: To understand the impact of physicians' and patients' religious/spiritual orientation on discussions of spiritual issues. METHODS: We performed semi-structured interviews of 10 Missouri family physicians and 10 patients of these physicians, selecting subjects nonrandomly to represent a range of demographic factors, practice types, and chronic or terminal illness. We coded and evaluated transcribed interviews for themes. RESULTS: Respondents expressed that similar belief systems facilitate patient-physician spiritual interactions and bring confidence to their relationships. Those holding dissimilar faiths noted limited ability to address spiritual questions directly. They cited significant barriers to spiritual interaction but considered that ecumenism, use of patient-centered care, and negotiation skills lessen these barriers. CONCLUSIONS: Our respondents view spirituality similarly to other aspects of the physician-patient relationship involving differing viewpoints. Where discordance exists, cross-cultural, patient-centered, diplomatic approaches facilitate spiritual discussions.

Communication Barriers↗
PubMed2005

Spiritual beliefs and barriers among managed care practitioners.

PURPOSE: Ninety percent of American adults believe in God and 82% pray weekly. A majority wants their physicians to address spirituality during their health care visit. However, clinicians incorporate spiritual discussion in less than 20% of visits. Our objectives were to measure clinician beliefs and identify perceived barriers to integrating spirituality into patient care in a statewide, primary care, managed care group. METHODS: Practitioners completed a 30-item survey including demographics and religious involvement (DUREL), spirituality in patient care (SPC), and barriers (BAR). We analyzed data using frequencies, means, standard deviations, and ANOVA. FINDINGS: Clinicians had a range of religious denominations (67% Christian, 14% Jewish, 11% Muslim, Hindu or Buddhist, 8% agnostic), were 57% female and 24% had training in spirituality. Sixty-six percent reported experiencing the divine. Ninety-five percent felt that a patient's spiritual outlook was important to handling health difficulties and 68% percent agreed that addressing spirituality was part of the physician's role. Ninety-five percent of our managed care group noted 'lack of time' as an important barrier, 'lack of training' was indicated by 69%, and 21% cited 'fear of response from administration'. CONCLUSIONS: Managed care practitioners in a time constrained setting were spiritual themselves and believed this to be important to patients. Respondents indicated barriers of time and training to implementing these beliefs. Comparing responses from our group to those in other published surveys on clinician spirituality, we find similar concerns. Clinician education may overcome these barriers and improve ability to more fully meet their patients' expressed needs regarding spirituality and beliefs.

Adult↗
PubMed1998

Helping staff cope with change.

Change seems to be the one constant in health care. This article examines how employees react to change and provides guidelines to help them and managers overcome barriers to change. These guidelines include providing support during change, using appropriate interventions, helping staff find the challenge in change, helping them find the stamina for change, and fostering teamwork.

Adaptation, Psychological↗
PubMed2002

The health status of asylum seekers screened by Auckland Public Health in 1999 and 2000.

AIM: Approximately 1500 to 1800 applications for refugee status are made to the New Zealand Immigration Service each year. Approximately one third of these asylum seekers receive health screening from Auckland Public Health. We report here key findings from this screening programme for the period 1999 to 2000. METHODS: The files of patients attending the Auckland Public Health Protection Asylum Seekers Screening Clinic at Green Lane Hospital were reviewed. Data on demographics, medical examination, diagnostic testing and referrals were analysed. RESULTS: Nine hundred people, mainly from Middle Eastern countries, received screening. Important findings were: symptoms of psychological illness (38.4%); Mantoux skin test positivity ( 36.4%); active tuberculosis (0.6%); TB infection requiring chemoprophylaxis (18%) or chest X-ray monitoring (15%); gut parasite infection; carrier state for alpha and beta thalassaemia and the heterozygous states for HbS and HbE; incomplete immunisation; and the need for referral to a secondary care service (32.6%). CONCLUSIONS: Immigrant communities in New Zealand have special healthcare needs, as well as experiencing language barriers, cultural differences and economic difficulties. Healthcare providers should be alert to these needs. Appropriate resources are required to address these issues in a timely fashion.

Adolescent↗
PubMed2004

Predictors of clinical breast examination among South Asian immigrant women.

To determine predictors of clinical breast examination (CBE) among South Asian immigrant women residing in Toronto, Canada. A cross-sectional self-administered survey with women patients visiting family physician group practices. Fifty-four women participated in the study (response rate 77%). Twenty women (38.5%) "ever had" CBE. Compared to women who never had CBE, women who had CBE were statistically older, had lived more years in Canada, had better knowledge of breast cancer, had lower perceived barriers to CBE, and were more likely to have ever had a periodic health exam. No significant differences were found between the two groups for education, employment, English language abilities, perceived health, and perceived benefits of CBE. A direct logistic regression with five predictor variables, significant at a univariate level, was statistically reliable, chi(2) (5, n=51) = 34.7, p < 0.001 and explained 67% of the variance in the CBE status. Age and perceived barriers to CBE remained significant over and above other predictor variables. The odds of "ever had" CBE increased with age and decreased with more perceived barriers. The study highlights the need for education interventions on breast cancer and screening among SA recent immigrant women.

Adult↗
PubMed2006

'We couldn't function without volunteers': volunteering with a disability, the perspective of not-for-profit agencies.

Volunteers play an important role in many organisations that deliver services for the public good. Many people within the community choose to volunteer and there is a rich literature on the reasons why people do so, as well as the benefits that accrue to individuals, organisations and the community. However, there are few reports of people with long-standing disability becoming volunteers. The aim of this study was to explore the views of volunteer coordinators in not-for-profit organisations concerning people with long-standing disability as volunteers. Seven coordinators participated in two focus groups. The participants identified opportunities for people with a disability to contribute as volunteers, but were also quick to point out significant barriers. The findings from this exploratory study suggest that if people with long-standing disability are to volunteer, consideration must be given to their individual requirements and overcoming negative community attitudes.

Communication Barriers↗
PubMed2006

Perceived barriers and effective strategies to diabetes self-management.

AIM: This paper reports the perceived barriers to and effective strategies for self-management of adults with type 2 diabetes in a rural setting. BACKGROUND: Worldwide, diabetes is a major public health concern and financial burden. Research shows that, for people with diabetes, adhering to programs of self-care is often problematic. Despite the potential for improved metabolic control and quality of life, little is published on the barriers and effective strategies that people with diabetes successfully use to incorporate plans of care into their lifestyles. METHODS: Twenty-four adults diagnosed with type 2 diabetes were recruited from a rural primary care practice to participate in one of three audiotaped focus groups. Content analysis was conducted on the focus group transcripts and validity was strengthened through independent rankings of barriers and strategies by an expert panel and by the nurse researchers. The data were collected 2002. FINDINGS: The most frequently reported barriers were lack of knowledge of a specific diet plan, lack of understanding of the plan of care and helplessness and frustration from lack of glycaemic control and continued disease progression despite adherence. Effective strategies identified were developing a collaborative relationship with a provider, maintaining a positive attitude that prompts proactive learning and having a support person who provides encouragement and promotes accountability. CONCLUSIONS: These data highlight the importance of barrier and strategy identification in developing and implementing realistic self-management plans and the significance of collaborative alliances between patients and practitioners. Awareness of barriers, identification of strategies to overcome obstacles and the opportunity to problem solve with practitioners assists patients in managing a chronic illness that requires numerous daily decisions.

Adult↗
PubMed1996

Language, sociodemographics, and health care use of Hispanic adults.

This study examines the role of spoken language in access to health care for Hispanic adults. Analyzing the associations between personal characteristics and the use of Spanish as opposed to English reveals that monolingual Spanish speakers were more likely than others to be older, less educated, in poor health, uninsured, and in poverty. Further, Spanish speakers were less likely than English-speaking Hispanics to have a usual source of health care. Persons with no usual source of care were least likely to have seen a physician or to have had their blood pressure checked, whereas those with a regular doctor appeared to have the greatest access. The authors conclude that, whereas language is certainly associated with many barriers to health care, both economic well-being and having a usual source of care are of paramount importance for the Hispanic American population.

Adult↗
PubMed2000

Exploring barriers to utilization of poison centers: a qualitative study of mothers attending an urban Women, Infants, and Children (WIC) Clinic.

OBJECTIVE: Prior research regarding poison center utilization identified risk factors for underutilization including race/ethnicity and acculturation. The purpose of this study was to understand factors contributing to underutilization of poison centers by low-income and minority mothers. METHODS: Focus groups were conducted with women attending an urban Women, Infants and Children clinic. Transcripts were analyzed for themes and key points. RESULTS: Twenty-two English-speaking mothers and 21 Spanish-speaking mothers participated in 7 groups. Participants viewed poisoning as a serious problem to which all children are susceptible. English-speaking mothers had heard of the poison center but were unaware of services provided. They preferred to use the 911 system, which was viewed as immediate medical assistance and was an easy number to remember. Women questioned the credentials of the poison center staff. Spanish-speaking mothers had limited knowledge of poison centers and were concerned about language barriers. CONCLUSIONS: To increase utilization of poison centers, educational interventions must address these specific needs and misconceptions and should be produced in Spanish and English versions.

Adult↗
PubMedDate not supplied

Overcoming barriers to delivering information to cancer patients.

The benefits of providing high quality information to patients are well documented, and include promoting active participation in decision-making and improved psychological and physical well-being. Within this article the need for high quality information is discussed and some of the common pitfalls in producing patient information are examined and suggestions for avoiding these pitfalls are proposed. The article looks at some of the problems in ensuring that those people who require information have access to it, specifically the potential barriers that may arise because of ethnic background, gender and social class, and recommendations to reduce the impact of such factors are made. The implications for the practice of all healthcare professionals caring for people with cancer are evident.

Communication Barriers↗
PubMed1995

Educating African-Americans about cancer prevention and detection: a review of the literature.

The high incidence of cancer mortality and morbidity among African-Americans has led to a need for cancer education and detection programs designed for this underserved population. This review of the literature focuses on key cancer-related health beliefs, barriers to utilization, and methods of intervention that should be considered in developing programs for African-Americans. Implications for social work practice are discussed.

Black or African American↗
PubMed1999

Peer consultation reflection exercise.

OBJECTIVE: To explore participants' overall perception of the value of the Peer Consultation Reflection Exercise (PCRE); of barriers and facilitators to participation and learning during a PCRE; and of the transferability of the experience to participants' own settings. DESIGN: This study used the qualitative techniques of key informant interviews and a focus group. SETTING: Focus group and key informant interviews at the 1996 Annual Meeting of the College of Family Physicians of Canada's Section of Teachers. PARTICIPANTS: Family medicine teachers attending a PCRE. METHOD: Five key informant interviews and one focus group composed of five participants were conducted to explore participants' experience of participating and learning during a PCRE. MAIN FINDINGS: Participants viewed the PCRE as a valuable opportunity to interact and learn from colleagues a were especially impressed with the opportunity to listen. Confidentiality and the important role of the facilitator were identified as key components. The greatest perceived barrier was the formal structure of the PCRE. CONCLUSIONS: The PCRE is an innovative strategy for personal and professional development. It could be used in other settings.

Adult↗
PubMed2005

Patterns and barriers in information disclosure between health care professionals and relatives with cancer patients in Greek society.

The issue of whether, how and how much to tell cancer patients concerning diagnosis is still approached in various ways across different countries and cultures. The health care team-patient relationship is a triangle consisting of the health care professionals, the patient and the family. Each part supports the other two and is affected by the changes that happen in the triangle. The objective of the study was to investigate the communication context through which health care professionals and families with cancer patients interact. In Greece, physicians have the tendency to tell the truth more often today than in the past, although the majority still disclose the truth to the next of kin. Nurses in Greece are considered to be the most suitable health care professionals for the patients to share their thoughts and feelings with. Nevertheless, the decision on information disclosure lies with the treating physician. In Greek society the patient's family plays an important role in the provision of care and information disclosure. They often decide on the patient's behalf.

Attitude of Health Personnel↗
PubMed2000

Primary prevention studies and the healthy elderly: evaluating barriers to recruitment.

Although primary prevention studies are important tools in helping the healthy elderly stay healthy, recruiting from a community-based cohort of healthy elderly individuals for a primary prevention study involves numerous barriers. To better identify and understand these barriers, we conducted and evaluated a comprehensive recruitment strategy for a primary prevention study testing aspirin in an HMO population. In the recruitment phase, we identified healthy individuals (65 years of age or older) who were members of a large, group-model HMO in Oregon and Washington, and used computerized medical database screening, statistical sampling, health plan mailings, e-mail communication with primary care providers, and the experience of a well-established research clinic in an effort to enroll health elderly in this primary prevention trial. Among a random sample of 47,453 eligible patients over the age of 65, 44% responded to recruitment efforts, but only 3% were enrolled--an overall yield of slightly less than 2%. To evaluate these results, we then conducted focus groups with 225 randomly selected "eligible refusers." We determined that healthy elders were hesitant to give up their choice to use aspirin, unwilling to travel to the research center, and reluctant to risk their tenuous hold on good health to participate in a study of primary prevention. Awareness of these attitudes is an indispensable step toward designing effective recruitment strategies for primary prevention studies involving the healthy elderly.

Aged↗
PubMedDate not supplied

Perceptions of HIV/AIDS by deaf gay men.

Deaf gay men represent a subpopulation of the gay male community at particularly high risk for HIV/AIDS due to numerous barriers including language, stigma, and inequitable access to health services. The participants in this exploratory pilot study (N = 5) struggled with the ongoing threat of HIV infection and the pervasive nature of AIDS-related debilitation, death, and grief. Whether HIV infected or not, they described living at the intersection of multiple communities--the deaf, gay, and hearing--each characterized by unique communication styles, cultural expectations, and a propensity to marginalize outsiders. Health care providers were perceived as lacking compassion and largely ignorant to the needs of deaf persons, in general, and deaf gay men, in particular. Printed HIV materials were considered culturally inappropriate, incomprehensible, and ineffective. These findings suggest an extraordinary risk for adverse mental and physical health outcomes if care is not appropriately designed for this vulnerable population.

Adult↗
PubMed1982

SIDCARB: a clinical tool for rapid assessment of social exchange inequities and relationship barriers.

In this article, the development, standardization and clinical uses of the SIDCARB: Spousal Inventory of Desired Changes and Relationship Barriers are presented. The SIDCARB was developed to help the therapist gain some understanding of each spouse's unique perceptions of the conjugal exchange process. This instrument measures three dimensions of conjugal exchange: 1) desired changes, dissatisfaction with the equity of exchanges and commitment; 2) willingness to terminate the marriage and Internal-Psychological Barriers; and 3) External-Circumstantial Barriers. The uses of the SIDCARB as an aid to clinical assessment, treatment and evaluation are outlined, and several examples are offered. The limitations of the SIDCARB at its current state of development are discussed.

Adult↗