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PubMed1990

Factors relating to frequency of breast self-examination among low-income Mexican American women. Implications for nursing practice.

This descriptive study of low-income Mexican American women examined the central role of self-efficacy, or perceived capacity to perform a given activity, as it related to the frequency of breast self-examination (BSE), an important health practice for the early detection of breast cancer. Previous studies document the importance of self-efficacy as a predictor of health status, preventive self-care, and disease self-management. In turn, social support from others is a factor relating to self-efficacy. For Mexican Americans, previous research substantiates English language proficiency and barriers to access of health care as other predictors of compliance with recommended health care behaviors. Using bivariate correlations and analysis of variance, the findings revealed a strong relationship between self-efficacy and frequency of BSE. Neither social support nor barriers to health care had a significant effect on self-efficacy or frequency of BSE. The effects of English language proficiency are indirect and mediated by self-efficacy. This paper describes how these findings can be applied to the clinical practice goal of facilitating consistent and correct usage of BSE in the Mexican American community.

Adult↗
PubMed2004

Tutorial dynamics and participation in small groups: a student perspective in a multicultural setting.

AIM: This study investigated the language and cultural backgrounds of medical students, and explored their perspectives of the influences on student participation in small-group tutorial settings. METHOD: A task group of students and staff from a variety of cultural backgrounds designed a cross-sectional survey using an anonymous questionnaire. The survey was conducted at the Christchurch School of Medicine and Health Sciences (a campus of the University of Otago). Students attending a 4th-year and a 5th-year lecture were invited to participate. RESULTS: Seventy-five percent of students enrolled in the medical course responded to the survey. Half of the sample self-identified as New Zealand European or Maori. Sixty-four percent of students identified English as their first language. Ninety-one percent of students stated a preference for small-group tutorials rather than lectures. Most students reported that there was a 'lack of prior preparation' by students in these tutorials (no statistically significant difference between students with English as first or second language). Two thirds of students (66%) students felt there was a lack of full participation in small-group teaching. Personality, cultural, and language differences were perceived as contributing factors to the lack of participation. CONCLUSIONS: Lack of participation should not be assumed to be due to language difficulties. Barriers to participation are perceived differently by students from a variety of language and cultural backgrounds. Moreover, interactions between students who dominate and under-participate may influence student participation. Further research is needed to determine whether language and cultural backgrounds affect students' participation in small group teaching.

Asian People↗
PubMed2003

Longitudinal care improves disclosure of psychosocial information.

BACKGROUND: While longitudinal primary care is thought to promote patient rapport and trust, it is not known if longitudinality helps overcome barriers to communication that may occur when the patient and physician are of different ethnicities and/or sexes. OBJECTIVE: To examine if longitudinal pediatric care ameliorates disparities in parent disclosure of psychosocial information associated with ethnic and gender discordance between parent and physician. DESIGN: Longitudinal, observational study of parent-physician interaction at early visits and over the course of 1 year. PARTICIPANTS: Parents (90% African American and 10% white mothers or female guardians) and their infant's assigned primary care physician (white first- and second-year pediatric residents). MAIN OUTCOME MEASURE: Parents' psychosocial information giving measured by the Roter Interaction Analysis System. RESULTS: Sex- and race-related barriers to disclosure of psychosocial information were evident early in the parent-physician relationship. At early visits, African American mothers made 26% fewer psychosocial statements than white mothers; this discrepancy was not affected by physician sex. At early visits, white mothers made twice as many psychosocial statements when seeing white female compared with white male physicians. CONCLUSIONS: Patient-centeredness is an important factor promoting psychosocial information giving for African American and white mothers, regardless of physician sex. Longitudinal relationships facilitate mothers' disclosure to physicians of a different ethnicity or sex, but only if physicians remain patient-centered.

Adolescent↗
PubMed1998

Access barriers to health care for Latino children.

BACKGROUND: Latinos will soon be the largest minority group in the United States, but too little is known about major access barriers to health care for this group and whether these barriers result in adverse consequences. OBJECTIVE: To identify important access barriers to health care for Latino children, as cited by parents. DESIGN: Cross-sectional survey of parents of all 203 children coming to the pediatric Latino clinic at an innercity hospital. Questions focused on barriers to health care experienced prior to receiving care at the Latino clinic. RESULTS: Parental ethnicity included Dominican (36%), Puerto Rican (34%), Central American (13%), and South American (11%). Only 42% of parents were American citizens, whereas 36% had green cards, and 13% had no documentation. Eight percent of parents and 65% of the children were born in the United States. Parents rated their ability to speak English as follows: very well/well, 27%; not very well, 46%; and not at all, 26%. The median annual household income was $11,000; 40% of parents never graduated from high school, and 49% headed single-parent households. Forty-three percent of the children were uninsured. A sick child was routinely brought to hospital clinics by 56% of parents, to the emergency department by 21%, and to neighborhood health centers by 21%. When asked to name the single greatest barrier to health care for their children, parents cited language problems (26%), long waiting time at the physician's office (15%), no medical insurance (13%), and difficulty paying medical bills (7%). When parents were asked if a particular barrier had ever caused them not to bring their children in, transportation was cited by 21%; not being able to afford health care, 18%; excessive waiting time in the clinic, 17%; no health insurance, 16%; and lack of cultural understanding by staff, 11%. Some parents who spoke little or no English reported that medical staff not speaking Spanish had led to adverse health consequences for their children, including poor medical care (8%), misdiagnosis (6%), and prescription of inappropriate medications (5%). Multivariate analyses of selected health outcomes using 7 independent variables showed that low family income was significantly associated with greater odds of a child's having suboptimal health status (odds ratio, 1.5; 95% confidence interval, 1.04-2.2) and an increased number of physician visits in the past year (P<.04), but reduced odds (odds ratio, 0.6; 95% confidence interval, 0.4-0.9) of the child's being brought to the emergency department for a routine sick visit. Children whose parents had resided in the United States for fewer than 8 years were at reduced odds (odds ratio, 0.5; 95% confidence interval, 0.2-0.9) for having spent a day or more in bed for illness in the past year. CONCLUSIONS: Parents identified language problems, cultural differences, poverty, lack of health insurance, transportation difficulties, and long waiting times as the major access barriers to health care for Latino children. Language problems can result in adverse health consequences for some children, including poor medical care, misdiagnosis, and inappropriate medication and hospitalization. Low family income is an important independent risk factor among Latino children for suboptimal health and high utilization of health services.

Adult↗
PubMed2003

Access to diabetes services: the experiences of Bangladeshi people in Bradford, UK.

Recent years have seen a renewed emphasis in UK healthcare policy on access to services, yet there has been little research into possible inequalities in access for people from different ethnic backgrounds. This paper examines access from the point of view of a group of Bangladeshi people with diabetes, whose views were obtained as part of a wider evaluation of diabetes services. Their message is a powerful one. The problems they experienced, however, cannot be attributed solely to cultural insensitivity, in which providers adopt a 'like it or lump it' approach. The wider evaluation provides a context within which to identify similarities with, as well as differences from, other groups in the community, and the findings show that the experiences of this vulnerable group highlight more general weaknesses in service provision. The paper also shows that conventional analysis of access in terms of barriers to be overcome misses a crucial dimension: the ability to make full use of services. Gaining access does not mean that needs will be met appropriately, and patients vary in the extent to which they are able and enabled to play an active role in obtaining the services they need.

Adult↗
PubMed2002

Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals.

OBJECTIVE: The primary aim of this study was to evaluate among health care professionals their attitudes, perceived barriers, perceived skill level, and training needs in the management of child and adolescent obesity. METHODS: A national needs assessment consisting of a mailed questionnaire was conducted among a random sample of health care professionals. The survey was completed by 202 pediatricians, 293 pediatric nurse practitioners, and 444 registered dietitians. RESULTS: The majority of all respondents felt that childhood obesity was a condition that needs treatment (75%-93%), and affects chronic disease risk (76%-89%) and future quality of life (83%-93%). The most frequent barriers were lack of parent involvement, lack of patient motivation, and lack of support services. Registered dietitians were less likely to identify barriers to treatment compared with pediatricians or pediatric nurse practitioners. The most common areas of self-perceived low proficiency were in the use of behavioral management strategies, guidance in parenting techniques, and addressing family conflicts. All 3 groups expressed high interest in additional training on obesity management of children and adolescents, especially in the area of behavioral management strategies and parenting techniques. Those practitioners with >10 years of practice reported the greatest interest in training. CONCLUSIONS: Pediatric practitioners view child and adolescent obesity with concern and feel that intervention is important. However, several important barriers interfere with treatment efforts and will need to be addressed. There is also a need for increased training opportunities related to obesity prevention and treatment. The results of this study provide directions and priorities for training, education, and advocacy efforts.

Adolescent↗
PubMed2001

Informal and incidental learning with patients who use continuous ambulatory peritoneal dialysis.

Adults learn continuously from the complex interplay of experiences in their day-to-day lives. This article reports on qualitative research conducted with 8 individuals with a diagnosis of end stage renal disease (ESRD) (6 women, 2 men) who were using continuous ambulatory peritoneal dialysis (CAPD). Interviews with each individual in his or her home focussed on how the participants made sense and learned from their experiences. The authors examined the data to determine the informal and incidental learning in the patients' homes, as well as the conditions that supported or limited this learning. Learning themes included understanding of medical and professional language, trusting their own experience, and living on the border of life and death. Barriers to learning included a diminished sense of personhood and the low literacy level of participants. Aspects of informal and incidental learning theory (Watkins & Marsick, 1992) are used to examine the informal learning that occurred. The authors acknowledge the adult learning implications and urge nurses to examine informal learning more closely.

Adaptation, Psychological↗
PubMed1999

Lessons from the field--health care experiences and preferences in a Latino community.

As part of Midwest Bioethics Center's PATHWAYS to Improve End-of-Life Care project, we conducted an exploratory study in the Latino community of Kansas City to understand health beliefs, practices, and values, particularly as they relate to end-of-life care. We conducted ten focus groups and interviewed more than seventeen individuals who serve the Latino community in a social service, ministry, or health care capacity. We found that people were very concerned with "barriers to health care" (our term), and very willing to reveal their preferences for health care decision making and end-of-life care treatment options. We believe that bioethicists should conduct other, similar projects because they can improve our engagement with the Latino population and help Latinos find a greater voice in health care settings.

Communication Barriers↗
PubMed1999

The street/treatment barrier: treatment experiences of Puerto Rican injection drug users.

This study describes, through ethnographic interviews, the treatment experiences of Puerto Rican long-term heroin users who are at extremely high risk for HIV infection and the barriers they perceive to drug treatment. On the basis of this information we suggest policy recommendations for increasing drug treatment access for Puerto Rican long-term injectors of heroin. It is critical that Puerto Rican populations access drug treatment facilities given their risk factors for HIV infection and the high rate of poverty in Puerto Rican communities that exacerbates drug use.

Adult↗
PubMed1999

Communication of socioeconomic research findings.

Socioeconomics is research that identifies, measures and compares the costs and the clinical, economic and humanistic consequences of diseases and healthcare interventions. Research findings must be communicated to be valuable. Publication moves research findings into the public domain and exposes hard won ideas to critical appraisal. The analyst or researcher informs the decision process by defining an answerable question, applying standard economic methodology, developing a credible study, and using appropriate analytical and communication tools. The decision-maker is more likely to listen if the message is relevant, clear, simple and timely, and if he/she has influence over the relevant budget. Traditional print media provide a standardised process for quality control, whereas electronic media can provide speed of publication and wide access, usually at the expense of quality. The quality of both published medical and socioeconomic research articles varies widely. Published checklists can greatly assist in determining the structural quality of a study, but they cannot guarantee that the content of an article is useful to a decision-maker. Barriers to communication include perceived lack of study credibility, lack of relevance to the decision under consideration, suspicion of bias and inadequate training of the readers. Journal editors aim to improve the readability and clarity of articles and to bring them into conformance with journal policies. Recommendations for effective communication include the following: determine the target audience(s) and develop the appropriate perspective; set the study in its clinical context; keep the language simple where possible and use multiple communication media. Well conducted and well communicated studies can influence policy and outcomes.

Bibliometrics↗
PubMedDate not supplied

[Emergency contraception in Brazil: facilitators and barriers].

A multi-centered qualitative study was conducted in Brazil, Chile, and Mexico to assess the acceptability of emergency contraception both among potential users and possible providers, authorities, and opinion-makers, and to identify (according to participants' perceptions) factors facilitating or hindering the method's use and the most appropriate strategies to disseminate information and provide the method. Data were collected through semi-structured interviews, group interviews, and discussion groups, which were tape-recorded and transcribed. A thematic analysis of this material was conducted. Acceptability of emergency contraception was high among participants, who also felt that there were no barriers towards its acceptance by the population. Participants felt that the method's acceptability would be greater if it were included in reproductive health programs, emphasizing its prescription for emergency situations. Participants highlighted that strategic components in Brazil would be training of providers and inclusion of the method in family planning services.

Brazil↗
PubMed2006

Identifying needs and barriers to diabetes education in patients with diabetes.

OBJECTIVE: To assess the needs, awareness and barriers to diabetes education for self management and to facilitate the initiation of an education programme promoting self care among diabetics and their families. METHODS: A qualitative study was conducted among adult diabetics attending outpatient clinics in a tertiary care teaching hospital in Karachi, Pakistan. Semi-structured interviews were conducted on 27 subjects (11 men; 16 women) to identify dominant themes and priority issues. RESULTS: Participants displayed great deal of variation with respect to level of knowledge and motivation for education. Most believed that diabetes was caused by stress. Family was perceived to be a source of positive support. Relative ease of adherence to pharmacological regimens as compared to diet and exercise was reported. Participants expressed frustration at chronicity of disease and fear of developing certain specific complications and inheritance by their children. Barriers to enhancing knowledge included 'No need for further information', distance from training institutions and other priorities. CONCLUSION: Knowledge, beliefs and fears about diabetes, family influence and accessibility of healthcare, affects management behaviours and learning. Understanding needs and expectations of people with diabetes is essential in initiating and improving the outcomes of education programme for diabetes self care.

Adolescent↗
PubMed1990

Apoplastic domains and sub-domains in the shoots of etiolated corn seedlings.

Light Green, an apoplastic probe, was applied to the cut mesocotyl base or to the cut coleoptile apex of etiolated seedlings of Zea mays L. cv. Silver Queen. Probe transport was measured and its tissue distribution determined. In the mesocotyl, there is an apoplastic barrier between cortex and stele. This barrier creates two apoplastic domains which are non-communicating. A kinetic barrier exists between the apoplast of the mesocotyl stele and that of the coleoptile. This kinetic barrier is not absolute and there is limited communication between the apoplasts of the two regions. This kinetic barrier effectively creates two sub-domains. In the coleoptile, there is communication between the apoplast of the vascular strands and that of the surrounding cortical tissue. No apoplastic communication was observed between the coleoptile cortex and the mesocotyl cortex. Thus, the apoplastic space of the coleoptile cortex is a sub-domain of the integrated coleoptile domain and is separate from that of the apoplastic domain of the mesocotyl cortex.

Biological Transport↗
PubMed2006

Assessment of barriers to utilization of poison centers by Hispanic/Latino populations.

Previous research suggests that Spanish-speaking parents and residents of areas with large Hispanic and Latino populations are likely to underutilize the assistance that is available through poison control centers (PCCs). In order to examine any real and perceived barriers to utilization of the New Jersey Poison Information and Education System (NJPIES), the only poison control center in the state, an intercept survey was conducted with self-identified Hispanics/Latinos at Women, Infant, and Children (WIC) centers and in nearby grocery stores, bus stops, and public laundromats. Only 38% of the study sample (n = 206) had heard of NJPIES. Common ways to have heard of NJPIES included school or church bulletins, family members, and friends. Twenty-three percent knew the NJPIES's toll-free phone number; 23% knew it was available 24 h per day; and 22% knew that Spanish-speaking personnel were available for assistance. Potential barriers to utilization included not knowing the phone number of the poison center, not speaking English, and not knowing if the poison center could offer any help. Respondent-recommended strategies for increasing awareness of NJPIES among Hispanics/Latinos included advertising on TV, and distributing information through school and church bulletins.

Adult↗
PubMed2005

Physician-identified barriers to intimate partner violence screening.

BACKGROUND: Intimate partner violence (IPV) causes approximately 2 million injuries and 1300 deaths each year. Despite the high frequency of IPV among women seeking healthcare, only a small proportion report being asked by healthcare professionals about abuse. This study examined perceived barriers to IPV screening among obstetricians/gynecologists, family physicians, and internists, so that protocols for IPV training can be tailored to those particular areas of difficulty. METHODS: A cross-sectional survey of 143 obstetricians and gynecologists, family practice physicians, and internists in a medium-sized upstate New York city was conducted. Factor analysis was performed. Two IPV barrier domains emerged and were examined using a multivariate analysis to determine associations between the domains and physician characteristics. RESULTS: For general knowledge, there were greater perceived barriers if the respondent was male but fewer perceived barriers if the respondent was an obstetrician/gynecologist and fewer perceived barriers if the respondent had 5-10 years in practice. For practice policy, there were greater perceived barriers if the physician was in a private practice setting and fewer perceived barriers if the physician was an obstetrician/gynecologist. CONCLUSIONS: These findings provide direction for training in IPV recognition. They support a need for continued training throughout the physician's career. More importantly, the findings support a need for better practice systems to encourage routine screening for IPV by healthcare providers.

Adult↗
PubMed2001

Drug treatment services for ethnic communities in Victoria, Australia: an examination of cultural and institutional barriers.

Under-representation of ethnic minorities at drug treatment services represents under-utilisation rather than a lower need. To explore barriers to drug treatment among ethnic communities we undertook a comprehensive review of international and Australian literature to identify problems their members experience upon the discovery of illicit drug use in their community, how drug treatment is addressed and challenges for improved drug treatment outcomes. The concepts and themes derived from the literature were then compared with our research findings from key informant interviews and consultations with non-illicit drug-using spokespersons from eight ethnic communities in Victoria, Australia. Intense shame and loss of face linked to illicit drug use was common in ethnic communities and as a consequence seeking help for drug treatment was fraught with difficulties. Accessing drug treatment services often occurred following a crisis, but a sense of despair and confusion often prevailed owing to a lack of knowledge of available assistance. Even when treatment services were accessed most key informants and ethnic communities viewed them as culturally insensitive, inflexible and with language barriers that obstructed the flow of effective information. Understanding of the ethnic family ethos was of pivotal importance but frequently ignored by treatment services, contributing to the exclusion of ethnic communities from appropriate assistance. Ethnic communities need to be assisted to participate in drug issue discussions and community development strategies in order for their utilisation of drug treatment services to be improved.

Communication Barriers↗
PubMed2005

Engaging Asian Americans for mental health research: challenges and solutions.

Asian American communities have important and unmet mental health needs, but there is comparatively little research data on process and outcomes that can guide evidence-based approaches to mental health care. This paper describes our experience of building research programs in a community-based health care facility, some of the challenges we faced, and barriers that were overcome. We have learned that a) mental health services research can be carried out in a community health center with minimal intrusion on usual patient flow; b) the effort must be shared between the health center and the community; c) barriers to participation in mental health research programs are multifactorial ranging from conceptual, cultural, and attitudinal biases to practical concerns inherent in the ethnic minority population; and d) resistance can be overcome by working with participants' cultural and social needs and using their explanatory belief models when developing and pursuing studies.

Asia↗
PubMed2005

Lesbian perinatal depression and the heterosexism that affects knowledge about this minority population.

The medical literature about homosexuality and mental health is expanding; however, a paucity of research about lesbian mental health remains. No research about lesbian perinatal depression has been published. This paper highlights the heterosexism that perpetuates research and health care disparities between heterosexual and lesbian/gay/bisexual individuals. We acknowledge barriers that distance lesbian women from research and health care, and emphasize the importance of moving beyond these barriers to fill in gaps of knowledge about the specific health care needs of this minority population. We use an analysis of stress factors as a framework to generate hypotheses about perinatal depression in lesbian women. We conclude with suggestions for future study in the form of questions that should be asked and pursued in research.

Attitude of Health Personnel↗