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PubMed1988

[Adjustment processes of foreign exchange high school students in Japan].

The main purpose of the present study was to excavate the adjustment problems of 93 high school exchange students in Japan. Questionnaires including Cornell Medical Index (CMI) were administered longitudinally. In addition, individual interviews were held with those who had failed to adjust to the Japanese society. As for the subjective psychosomatic symptoms manifested in CMI, there was no significant sex difference while Asians were successively found to be significantly more liable to diseases and less adjusted than non-Asians. The questionnaires other than CMI disclosed difficulties which exchange students found in adjusting at Japanese home, including delicate personal relationships with host siblings, apparent lack of affective gestures (hugs and kisses), and early curfew. In the meanwhile, language barrier and trifling rules constituted the primary difficulties they faced at host school. On account of prejudice against women, girls had more unpleasant experiences than boys. Through individual interviews, all of the early returners were found to have already had a basic problem in their home countries.

Adolescent↗
PubMedDate not supplied

Overcoming the barriers to effective clinical supervision.

Clinical supervision remains one of the most misunderstood practices in modern nursing. It provides a nurturing and supportive service for nurses, helping them to reflect critically on their actions in the provision of patient care. The aim of this article is to explore and examine the current role and status of clinical supervision in the NHS.

Clinical Competence↗
PubMed1986

EDB: a case study in communicating risk.

This is a report on the Environmental Protection Agency's (EPA's) efforts to communicate with the public about the risks of ethylene dibromide (EDB), what the agency said it was doing about these risks and what information the public actually received through television and newspapers. Although special in many ways, the EDB case illustrates the problems that regulatory agencies have when they must take regulatory action and assure the public that the risks in question are being dealt with adequately. It also illustrates issues that the press faces. Above all, it illustrates the barriers to communication presented by the different perspectives of regulatory agencies and individuals and the types of information they each are most interested in.

Carcinogens↗
PubMed2002

Optimize patient health by treating literacy and language barriers.

More than 90 million Americans have limited literacy skills. Almost two million US residents cannot speak English, and millions more speak it poorly. The stigma of illiteracy or the inability to speak a country's predominant language keep patients from disclosing their limitations. Recognizing these facts is an important first step in improving health education for this vulnerable population. By adapting teaching techniques to patients' special needs, nurses can ensure that patients understand their health problems and plan of care. Statistics dramatically demonstrate the high cost of neglecting these needs. Patients who do not understand their plan of care do not comply with instructions and, therefore, suffer unnecessary complications. Health care providers who can communicate with their patients through multilingual, low literacy patient education materials and with the use of qualified interpreters markedly improve the quality of care for their patients and the resulting outcomes.

Attitude to Health↗
PubMedDate not supplied

Parent's language of interview and access to care for children with special health care needs.

OBJECTIVE: To examine the association between the parent's language of interview and the access to care for children with special health care needs (CSHCN). METHODS: We used the 2001 National Survey of Children with Special Health Care Needs to compare socio-demographic characteristics and health care access variables among CSHCN with parents who interviewed in English and another language. Additional multivariate analyses explored the effect of language of interview on access to health care for the subgroup of Hispanic respondents. RESULTS: CSHCN with non-English-speaking parents were from less-educated and lower-income families and were more likely to lack insurance and have conditions that greatly affected their activities. These children were also more likely to have inadequate insurance (odds ratio [OR]=11.29), have an unmet need for family support services (OR=1.88), lack a personal doctor or nurse (OR=1.98), lack a usual source of care (OR=1.89), and lack family-centered care (OR=1.74). Non-English-speaking parents were more likely to report having employment consequences (OR=1.94) and spending over $500 out-of-pocket annually on the child's health care needs (OR=1.49). The likelihood of Hispanic children experiencing health care access barriers compared with non-Hispanic children was reduced when language was controlled for and several disparities between Hispanic children and other children became insignificant. CONCLUSIONS: CSHCN with non-English-speaking parents were more likely to be from disadvantaged families and to experience barriers to access than were CSHCN with English-speaking parents. Systems of care for CSHCN should consider the needs and challenges experienced by families whose primary language is not English.

Adolescent↗
PubMed2006

Satisfaction with care and ease of using health care services among parents of children with special health care needs: the roles of race/ethnicity, insurance, language, and adequacy of family-centered care.

OBJECTIVES: To examine whether racial/ethnic disparities exist in parental reports of satisfaction with care and ease of using health care services among children with special health care needs (CSHCN) and to identify factors associated independently with satisfaction with care and ease of use of health care services among CSHCN. METHODS: We analyzed data for 38,886 CSHCN <18 years of age in the National Survey of CSHCN, conducted from 2000 to 2002. Outcome variables included perceived satisfaction with care and ease of service use. Covariates included sociodemographic factors, insurance, interview language, condition severity and stability, adequacy of family-centered care measures, and having a personal doctor/nurse. RESULTS: The prevalences of reported dissatisfaction with care and problems with ease of using services among parents of CSHCN were 8% and 25%, respectively. Black and Hispanic parents were significantly more likely than white parents to be dissatisfied with care (13% and 16% vs 7%) and to report problems with ease of service use (35% and 34% vs 23%). Hispanic/white disparities in satisfaction with care and ease of use of services disappeared only after multivariate adjustment for parental interview language. Black/white disparities in satisfaction with care disappeared after adjustments for adequacy of family-centered care measures, but black/white disparities in ease of using services persisted. The severity of the child's condition, lack of insurance, parental interview in Spanish, and inadequate family-centered care were associated significantly with dissatisfaction with care and problems with ease of using health care services. CONCLUSIONS: Policies and strategies that reduce language barriers, promote insurance coverage and family-centered care, and improve ease of use of services among minority CSHCN have the potential to reduce racial/ethnic disparities in satisfaction with care and to promote ease of use of services among families with CSHCN.

Attitude↗
PubMed2004

Physician attitudes and practices on providing care to individuals with intellectual disabilities: an exploratory study.

A dearth of literature exists regarding barriers to physicians providing medical care to patients with intellectual disabilities. Using an exploratory study, we assessed current physician practice for this population of patients. We mailed a 17-question anonymous survey to primary care physicians (PCPs) in Connecticut. Results showed that many physicians care for patients with intellectual disabilities, but approximately 62% of physicians believed caring for this group to be more difficult compared to other groups. Lack of training and education pertaining to patients with intellectual disabilities, issues of communication, and interruptions in continuity of patient care affect physicians' ability to care for this population. Future research should establish best practices and examine nationwide practices in providing care to patients with intellectual disabilities.

Adult↗
PubMed1999

Hospice access and use by African Americans: addressing cultural and institutional barriers through participatory action research.

This article describes a participatory action research project addressing the problem of African American access to and use of hospice. Qualitative interviews conducted with six African American pastors resulted in the identification of major themes used for development of a scale to measure barriers to hospice. A subsequent quantitative study documenting these barriers was conducted with 127 African American and European Americans. Results of both studies, which were used to further social action efforts in the community, indicated the cultural barriers of differences in values regarding medical care and differences in spiritual beliefs between African Americans and European Americans. Results also indicated institutional barriers, including lack of knowledge of services, economic factors, lack of trust by African Americans in the health care system, and lack of diversity among health care staff. Implications for social work practice and policy are discussed.

Black or African American↗
PubMed2005

Acceptance, motivators, and barriers in attending breast cancer genetic counseling in Asians.

AIM: Cancer genetic risk assessment clinics represent the primary prevention arm in oncology in identifying high-risk patients for screening and prevention, but deals with the taboo subject of cancer risk prediction. Low knowledge level and traditional beliefs may pose significant barriers to its acceptance in Asia. METHODS: We conducted a questionnaire survey to evaluate the acceptance of breast cancer genetic counseling. RESULTS: More than 70% of the 438 respondents indicated interest and perceived potential benefits. Higher education level and use of English were associated with greater acceptance. Learning about cancer risk and cancer detection, helping the family, and the doctor's recommendation, were important motivators, while misperception that cancer patients could not gain personally, concerns of not understanding the information, cost issues, and fears of bad news, were important barriers. CONCLUSIONS: Singaporean women were receptive to cancer genetics counseling. Education to correct misperceptions may optimize utilization of a cancer genetics service.

Adult↗
PubMedDate not supplied

Information-seeking, research utilization, and barriers to research utilization of pediatric nurse educators.

This study used Roger's diffusion of innovations model to examine information-seeking, research utilization, and perceived barriers to research utilization of pediatric nurse educators in National League for Nursing accredited baccalaureate degree nursing (BSN) programs. A four instrument survey was mailed to 409 pediatric nurse educators. The response rate was 52 per cent. The most frequently selected sources of information for updating instruction of BSN students were nursing journals, educational activities by specialty groups, and nursing texts. The level of research utilization was estimated using the Nursing Practice Questionnaire-Education (NPQ-E). The level of research utilization for the eight nursing practices related to pediatric pain assessment and management was at the implementation stage. The highest perceived barriers to research utilization in clinical settings using the Barriers instrument were characteristics of the nurse followed by characteristics of the setting, the presentation, and the research. Pediatric nurse educators who selected nursing journals among their top three sources of information had significantly higher research utilization scores than those who did not select nursing journals among their top three sources of information.

Communication Barriers↗
PubMed2005

We've had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting.

The present study assesses barriers to identification and referral of domestic violence (DV) victims by staff at a health care institution following a 3-hr DV training program in which 752 health care providers participated. Focus groups are conducted with staff in hospital departments that serve a high volume of women. Responses to focus group questions identify system-wide and individual hospital department barriers. These barriers have implications for health care organizations trying to implement DV screening protocols through training alone to change staff behavior in diverse clinical settings. Limitations of this study and future research recommendations are also discussed.

Adult↗
PubMedDate not supplied

Effective communication with older people.

There are many potential barriers to effective communication between nurses and clients. This article describes how communication with older people can be enhanced.

Aged↗
PubMed2005

The role of health literacy in achieving oral health for elders.

A mismatch between the literacy skills of individuals and the demands of oral health services may erect an unnecessary barrier to preventive care and treatment. Findings from the 1992 survey of adult literacy in the United States indicate that more than two-thirds of adults over the age of sixty were limited in their ability to use written health materials in prose format, had problems finding and processing quantitative information, and were very limited in their ability to use documents such as forms, lists, charts, and graphs. Thus, many older adults face barriers to oral care, to needed information, to full participation in decision making and informed consent, and for follow-up activities. The pathways between literacy and health outcomes are being examined, and the body of literature linking literacy to health continues to grow. However, similar studies examining literacy and oral health outcomes have not yet been undertaken. Research in this area might well begin with consideration of the skills needed to perform important oral health tasks. Rigorous studies of the impact of improved communication strategies on elders' access to care, participation in services, and action steps would lend insight into needed change.

Aged↗
PubMed1988

Proposal for APS-IUPS convention for diagraming physiological mechanisms.

As physiological research reveals the existence of systems of increasing complexity and the existence of important interactions between them, the diagrammatic depiction of those systems and their interactions becomes an essential step in clarifying our own concepts in scientist-to-scientist communication and in teaching. Although control engineers, electronic engineers, and computer programmers long ago established their own diagrammatic conventions, physiologists are only now beginning to feel the need for a uniform convention suited to their own special needs in place of the numerous (and mostly ad hoc) diagram types that have recently proliferated in the literature. The convention proposed here is based on a formal theory of mechanism developed by W. Ross Ashby (An Introduction to Cybernetics, 1956). Its purely mechanistic structure transcends traditional interdisciplinary barriers to communication. Wide acceptance of the convention proposed here would therefore enhance the ability of physiology to encompass mechanisms from molecular and cell biology and integrate them with general and systems physiology in a metadisciplinary effort to comprehend "the wisdom of the body." Among its many advantages is its simplicity; diagrams may be drawn at various levels of detail and complexity by use of a few basic rules, and they can be readily understood without knowledge of the theory.

Algorithms↗
PubMed2006

English proficiency and physicians' recommendation of Pap smears among Hispanics.

BACKGROUND: Hispanics have one of the highest incidence rates of cervical cancer. Physician recommendation is one of the most important cues to cancer screening; however, low English proficiency among Hispanics may hinder health providers' recommendation of Pap smears. METHODS: Analysis of data from the 2000 National Health Interview Survey. All Hispanic women, age > or =18, without a Pap smear in the past 3 years or ever and who visited a health care provider in the past year were included. The main outcome was receipt of Pap smear recommendation by a health care provider. RESULTS: A total of 314 Hispanic women were included in the analysis, 44.9% were highly English proficient. Only 7.7% of low English proficient Hispanics not up-to-date in cancer screening reported a recommendation for a Pap smear as compared to 14.3% of highly proficient Hispanics. After adjusting for sociodemographics and health access and utilization factors, highly English proficient Hispanics were more than two times as likely to report receiving a recommendation for a Pap smear as compared to the less proficient (aOR 2.2, 95% CI 1.1-4.5). CONCLUSIONS: Low English language proficiency is a barrier to receive a recommendation for Pap smear among Hispanic women not up-to-date with cervical cancer screening. Further research is needed to explore specific mechanisms responsible for the low recommendation rates and to assess the impact of interpreters or Spanish-speaking providers on Pap smear recommendation rates.

Adult↗
PubMed2005

Interagency collaboration between child protection and mental health services: practices, attitudes and barriers.

OBJECTIVE: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. METHOD: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers, 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). RESULTS: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. CONCLUSIONS: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level.

Adult↗
PubMed2004

Discharge planning for the elderly ambulatory surgical patient.

Discharge planning for the elderly ambulatory surgery patient should begin as soon as the patient's procedure is booked. Successful discharge planning relies on 1) comprehensive preoperative assessment; 2) effective communication among the surgical facility's caregivers, the physician's office, the patient, and the family; 3) consideration of the patient's preoperative status; and 4) a strong patient and family education plan. The challenges of planning the aftercare are compounded by the physical, social, financial, cognitive, and sensory changes related to the normal aging process as well as to systemic diseases, which are more prevalent in the older population than in younger patients. The elderly patient's discharge plan should identify and address age-related barriers to communication, incorporate the patient's existing physical and medical condition, diminish the negative effects of social support challenges, and address environmental issues that can be improved to support recovery. The elderly population often deals with the imperfect: isolation from family or friends, aging bodies, hearing and visual loss, financial limitations, and emotional challenges. Although the nurse cannot reverse these challenges of old age, he or she can still make a difference by providing guidance and resources to blunt the potential complications of surgery and anesthesia.

Age Factors↗
PubMed2000

Development of a cervical cancer control intervention program for Cambodian American women.

Southeast Asian immigrants have lower levels of Pap testing than any other racial/ethnic group in the US, and are particularly unfamiliar with western culture and biomedical concepts of prevention. We completed an ethnographic study (N = 42) focusing on cervical cancer screening among Cambodian American women. We also conducted a community-based survey (N = 413) to examine the generalizability of our qualitative results. This report summarizes the results, and describes how we used our findings to influence the content of a multifaceted intervention program targeting Cambodian immigrants. The following constructs were found to be barriers to cervical cancer control: a traditional orientation to the prevention, causation, and treatment of disease; lack of familiarity with western early detection concepts; low levels of knowledge about cervical cancer; concerns about the Pap testing procedure; and health care access issues. In general, the quantitative results confirmed our ethnographic findings. The intervention program, which is delivered by bicultural outreach workers, includes home visits, presentations at small group meetings, barrier-specific counseling, use of a Khmer-language video, and tailored logistic assistance (e.g., transportation and medical interpretation). Both the video and presentation provide cultural context while simultaneously addressing multiple barriers to screening (e.g., women's fear of surgery and preference for female providers). Outreach workers are trained to counsel women about 10 potential barriers including avoidance of biomedicine, perceptions that gynecologic exams are embarrassing, and lack of English proficiency. Our results reinforce the importance of considering health problems within the context of a population's traditional belief systems and daily routines.

Adult↗