Underserved Ethnic Minority Research Articles

Engaging Girls’ Sociohistorical Identities in Science

What does it mean for ethnic minority girls, who have historically been marginalized by schools, to “see themselves” in science? Schools fail to create spaces for students to engage their identity resources in the learning of science or to negotiate and enact new science-related identities. This study investigates relationships among identity, engagement, and science discourse and provides a conceptual argument for how and why underserved ethnic minority girls engage in collective identity work, with science learning as a valued byproduct. The primary context for the study was Lunchtime Science, a 4-week lunchtime intervention for girls failing their science courses. There were 4 distinct ways the girls engaged in learning during Lunchtime Science: gleaning content for outside worlds, supporting the group, negotiating stories across worlds, and critiquing science. Each pattern had a signature profile with variations in the sociohistorical narratives used as resources, the positioning of one another as competent learners, and the type of science story critiqued and constructed. These findings indicate that when the girls were given opportunities to engage their personal narratives, and when science was open to critique, ethnic minority girls leveraged common historical narratives to build science narratives. Moreover, the girls’ identity work problematizes the commonplace instructional notion of “bridging” students’ everyday stories with science stories, which often privileges the science story and the composing of “science” identities. It also challenges researchers to investigate how the construction of narratives is broader than 1 community of practice, broader than 1 individual, and broader than 1 generation.

Scientific Hero: Dr. James E. K. Hildreth

Scientific Hero: Dr. James E. K. Hildreth

Healthcare-Seeking Behavior among the Chakma Ethnic Group in Bangladesh: Can Accessibility and Cultural Beliefs Shape Healthcare Utilization?

Existing studies lack qualitative information on the perceived reasons for ethnic minority groups' healthcare choices, attitudes toward healthcare services, and common practices based on traditional cultural belief systems in Bangladesh. This study noted the important influence of culture and beliefs with regard to availing healthcare services. Informal sector providers such as para-professionals and traditional healers take the lead in rendering physically, financially, and culturally accessible healthcare services in the context of under-utilization of public healthcare facilities. Salient factors determining the choice of therapy were the perceived causes of illness and physical and financial access to the health services. These drivers of health seeking behavior in an increasingly pluralistic healthcare system need to be taken into account to strengthen the current healthcare delivery system and to design specific health education and healthcare promotion programs for the poor, hard-to-reach, and under-served ethnic minority.

Self-care self-efficacy, religious participation and depression as predictors of poststroke self-care among underserved ethnic minorities

Underserved ethnic minorities have multiple chronic disease risk factors, including tobacco, alcohol and substance use, which contribute to increased incidence of stroke. Self-efficacy (self-care self-efficacy), religious participation and depression may directly and indirectly influence engagement in post stroke self-care behaviors. The primary aim of the present study was to investigate the effects of self-care self-efficacy, religious participation and depression, on tobacco, alcohol and substance use in a sample of largely ethnic minority, underserved stroke survivors (n=52). Participants previously recruited for a culturally tailored secondary stroke prevention self-care intervention were included. The treatment group received three stroke self-care sessions. The usual care group completed assessments only. Both groups were included in these analyses. Main outcome measures included tobacco, alcohol and substance use. Self-care self-efficacy, religious participation and depression were also assessed. Logistic regression analyses, using self-efficacy, religious practice and depression as the referents, were used to predict binary outcomes of tobacco, alcohol and substance use at 4-weeks post-stroke. Higher depression and self-care self-efficacy were associated with reduced odds of smoking and substance use. Greater participation in religious activities was associated with lower odds of alcohol use. We can conclude that incorporating depression treatment and techniques to increase self-care self-efficacy, and encouraging religious participation may help to improve stroke self-care behaviors for underserved and low socioeconomic status individuals. Results are discussed in the context of stroke self-management.

Self-Care Self-Efficacy, Religious Participation and Depression as Predictors of Poststroke Self-Care Among Underserved Ethnic Minorities.

Underserved ethnic minorities have multiple chronic disease risk factors, including tobacco, alcohol and substance use, which contribute to increased incidence of stroke. Self-efficacy (self-care self-efficacy), religious participation and depression may directly and indirectly influence engagement in post stroke self-care behaviors. The primary aim of the present study was to investigate the effects of self-care self-efficacy, religious participation and depression, on tobacco, alcohol and substance use in a sample of largely ethnic minority, underserved stroke survivors (n=52). Participants previously recruited for a culturally tailored secondary stroke prevention self-care intervention were included. The treatment group received three stroke self-care sessions. The usual care group completed assessments only. Both groups were included in these analyses. Main outcome measures included tobacco, alcohol and substance use. Self-care self-efficacy, religious participation and depression were also assessed. Logistic regression analyses, using self-efficacy, religious practice and depression as the referents, were used to predict binary outcomes of tobacco, alcohol and substance use at 4-weeks poststroke. Higher depression and self-care self-efficacy were associated with reduced odds of smoking and substance use. Greater participation in religious activities was associated with lower odds of alcohol use. We can conclude that incorporating depression treatment and techniques to increase self-care self-efficacy, and encouraging religious participation may help to improve stroke self-care behaviors for underserved and low socioeconomic status individuals. Results are discussed in the context of stroke self-management.

Improving secondary stroke self-care among underserved ethnic minority individuals: a randomized clinical trial of a pilot intervention

The overall purpose of this study was to pilot a multibehavioral, brief, stroke self-care treatment adapted for implementation with underserved racial/ethnic minority groups and to test the moderating effects of anxiety and depression on engagement in secondary stroke-prevention behaviors. Fifty-two participants were randomized to the secondary stroke prevention (STOP) (N=27) or usual care (N=25) group. The STOP program consisted of 3 culturally tailored information sessions and goal-setting activities that were delivered in person by a research assistant. Participants were assessed at baseline and 4-week follow-up for stroke knowledge, exercise, fruit and vegetable consumption, tobacco and alcohol use, and medication adherence (primary outcomes) and anxiety and depression (moderator variables). Between-groups analysis of covariance and logistic multiple regressions revealed significant between-group differences for stroke knowledge, tobacco use and moderating effects between tobacco and anxiety, and improved alcohol use. The STOP program decreased secondary stroke risk factors among underserved racial/ethnic minorities and should be tested in large-scale trials.

Effect of a Short-Duration, Culturally Tailored, Community-Based Diabetes Self-management Intervention for Korean Immigrants

The purpose of this pilot study was to assess the effectiveness, feasibility, and acceptability of a short-duration, culturally tailored, community-based diabetes self- management program (CTCDSP) for Korean immigrants with type 2 diabetes delivered at a non-clinic-affiliated community center. Forty-one Korean adults with type 2 diabetes participated in a 2-session CTCDSP delivered by a bilingual nurse practitioner at a Korean community center. Outcome measures included biological, behavioral, and general health well-being; diabetes knowledge; and self-efficacy assessed at baseline, post-education, and 3-month follow-up. Repeated-measures analyses of variance were used to explore mean differences in outcomes across the 3 assessment points. From baseline to 3-month follow-up assessment, participants exhibited significant improvement on several physiological and behavioral measures. Mean levels of hemoglobin A1c and waist circumference decreased, whereas high-density lipoprotein levels increased. Additionally, participants reported an increase in weekly feet checks, and there was a trend increase in participants' reported frequency of exercise activities. The feasibility of the CTCDSP was established, and participant satisfaction with the program was high. A short-duration CTCDSP may be an effective, feasible, and favorably received approach to improving diabetes outcomes in Korean and potentially other underserved ethnic minority immigrants who have limited access to mainstream clinic-based diabetes self-management programs.

Effectiveness of multicultural health workers in chronic disease prevention and self-management in culturally and linguistically diverse populations: a systematic literature review

With a large and increasing culturally and linguistically diverse (CALD) population, the Australian health care system faces challenges in the provision of accessible culturally competent health care. Communities at higher risk of chronic disease include CALD communities. Overseas, multicultural health workers (MHWs) have been increasingly integrated in the delivery of culturally relevant primary health care to CALD communities. The objective of this systematic review was to examine the effectiveness of MHW interventions in chronic disease prevention and self-management in CALD populations with the aim to inform policy development of effective health care in CALD communities in Australia. A systematic review protocol was developed and computerised searches were conducted of multiple electronic databases from 1 January 1995 until 1 November 2010. Thirty-nine studies were identified including 31 randomised controlled trials. Many of the studies focussed on poor and underserved ethnic minorities. Several studies reported significant improvements in participants' chronic disease prevention and self-management outcomes and meta-analyses identified a positive trend associated with MHW intervention. Australian Government policies express the need for targeted inventions for CALD communities. The broader systemic application of MHWs in Australian primary health care may provide one of the most useful targeted interventions for CALD communities.

A Randomized Trial of a CAM Therapy for Stress Reduction in American Indian and Alaskan Native Family Caregivers

Although it is widely recognized that caregivers of individuals with dementia experience elevated stress that places them at increased risk for health problems, little is known about how caregiving stress may be alleviated among underserved ethnic minority populations. The purpose of this study was to compare a complementary and alternative medicine therapy, polarity therapy (PT), to an enhanced respite control condition (ERC) to reduce stress and depression and improve quality of life for American Indian (AI) and Alaskan Native family caregivers. Forty-two AI family caregivers of individuals with dementia, living on and off reservations in the Pacific Northwest, were randomized to an 8-session trial of PT or ERC. PT is a touch therapy that uses gentle pressure on energy points and biofields to help the client achieve physiological relaxation. ERC included respite care for the person with dementia and a choice of activities for the caregiver. Average age of caregivers was 50 years (range 27-69 years); 90% were women; 52% daughters, 10% wives, 7% sons, and 31% other relatives. Outcome assessments administered at baseline and posttreatment included caregiver perceived stress, depression, quality of life, sleep quality, worry, and physical health. PT participants improved significantly more than ERC participants on stress (p = .01), depression (p = .045.), bodily pain (p = .02), vitality (p = .03), and general health (p = .01). These results indicate that the delivery of PT to AI dementia family caregivers is feasible and culturally acceptable and may be an important approach to reducing stress, depression, and pain.

The Clinical, Psychosocial, and Socioeconomic Concerns of Urban Youth Living With Diabetes

Young people with chronic diseases face the challenge of moving from the pediatric to the adult health care environment, in addition to the normal hurdles of young adulthood. To most effectively help them through this process, we must first understand their perspective. Qualitative study of the social and emotional impact of having diabetes. Young adults (n=23), aged 19-26, who had been living with diabetes for a median of 12 years (range 4-19) were contacted; all but one were from underserved ethnic minorities. Semistructured telephone interviews were conducted, transcribed, and coded. Having diabetes profoundly affected the life choices and expectations of these young people; their feelings and attitudes evolved over time. Financial and insurance concerns were key, because managing diabetes care on one's own as an adult was a major challenge. Most young people reported that family, friends, and coworkers were sources of support, but that disclosure of their diabetes was problematic. Offering emotional and practical support to young adults coping with diabetes is key to ensuring adequate medical management as they move into the adult system and assume full responsibility for their health.

Research partnership with underserved African-American communities to improve the health of older persons with disability: a pilot qualitative study

Underserved ethnic minorities are often under-represented in clinical investigations, often in the context of poor relationships between academic institutions and their minority communities. The aim of this study was to investigate an African-American community's perceptions about the barriers that hinder participation in research studies and, more broadly, on the status of institution/community relationships. We conducted a pilot qualitative study, based on semi- structured interviews of leaders of African-American communities in Winston-Salem, North Carolina. Relevant themes were abstracted from the interviews by a standardized iterative process. Interviewees identified barriers to participation of African- Americans in research, and suggested that existing barriers may be overcome with an innovative model of a community/institution relationship, which would include open communication and cooperation, mutually beneficial programs, holistic approaches to health and disease, participatory and balanced partnerships with communities, and the establishment of multiethnic advisory boards. This study suggests strategies that public health researchers should consider to establish effective institution/community relationships, in order to enhance participation of underserved ethnic minorities in research studies, and to improve the health status of their most disabled and demanding seniors.

Strategies for Academic and Clinician Engagement in Community-Participatory Partnered Research

THERE HAVE BEEN RECENT PRACTICE AND POLICY CONcerns over the “quality chasm,” or gap between the promise of evidence-based medicine and the realities of community practice with little variation by geographic and sociodemographic factors. Studies document disparities in access of care for particular conditions, and there is widespread concern about disparities in health status and health risk factors disadvantaging underserved ethnic minority and lower-socioeconomic status groups. Addressing quality gaps and health disparities will require implementation of programs to address social determinants of health and improve services delivery across diverse communities. Doing so for underserved communities may be especially challenging owing to resource constraints, underdevelopment of research, and historical distrust in research and health care in some groups. Experts recommend promoting public participation and engagement of diverse communities in research as a strategy to enhance its relevance and to address disparities more effectively Community-based participatory research (CBPR) is the prevailing paradigm to facilitate these goals by promoting mutual transfer of expertise and power sharing in decision making and data ownership across community and academic partners. A recent review identified relatively few English-language CBPR studies in health but wide variation in extent and type of participation. Community-based participatory research has been used more as a paradigm for public health than for clinical or health services research. Many features of CBPR—such as spending time in the community, power sharing, and action research methods—might challenge physicians, given their clinical training that often requires interactions under time pressure, the hierarchical structure of academic medicine, and the focus of medical research on controlled trials as the standard for evidence. However, opportunities (such as the recent National Institutes of Health announcement for CBPR research [http://grants.nih.gov/grants /guide/pa-files/PAR-07-004.html]) are emerging for conducting CBPR in substantive areas for which physician leadership could be helpful. It is timely to familiarize clinical investigators with principles of participatory research and to offer strategies to build effective research partnerships that facilitate clinician leadership in efforts to improve health for all communities. Over several years, we collaborated in exploring ways of blending concepts and approaches from clinical services research and CBPR in research initiatives, research training of physicians in the Robert Wood Johnson Clinical Scholars Program (http://www.hsrcenter.ucla.edu/csp), and a multicenter effort to develop infrastructure to support community-based research. This approach is based on community-partnered participatory research (CPPR), a form of CBPR developed by Healthy African American Families and Charles R. Drew Medical University with support from the Centers for Disease Control and Prevention (CDC), that emphasizes authentic community-academic partnerships as distinct from many collaborative research activities conducted at community sites without partnership in design, implementation, or product ownership. In collaboration with Keith Norris and Paul Koegel, we blended this model with methods from services research initiatives, such as Partners in Care, that addressed quality disparities. Communitypartnered participatory research promotes equal community and academic partnership and power sharing in all phases of research, grounded in evidence-based practice as defined from academic and community perspectives, a framing of CBPR that is suited to physician coleadership. This Commentary provides lessons learned from these applications. Recent examples are available at http://www .communitytrial.org. Many components of CPPR are partly based on CBPR models but are organized into a particular approach.

Health Literacy in Low-Income Latino Men and Women Receiving Antiretroviral Therapy in Community-Based Treatment Centers

Health literacy is an important and well known predictor of health-seeking behaviors and health status. Some populations of persons living with HIV/AIDS (PLHA) are reported to have low levels of health literacy. Factors contributing to low levels of health literacy in traditionally underserved ethnic minority groups seeking community-based treatment services are many and include individual level predisposing and enabling factors as well as system enabling factors. The purpose of this study was to describe deficits in health literacy in a sample of 90 low-income HIV-infected Latino men and women reported to have problems with treatment adherence. Additionally, correlates of health literacy were examined to identify the relative impact of these factors in predicting lower levels of health literacy in this at-risk population. Results of the study indicated that years of education was associated with understanding HIV terms and accurately reading and understanding instructions on prescription bottles. In a multivariate context, individual predisposing and system enabling factors accounted for 22% of the variance in patients' understanding HIV terms. Individual predisposing and individual enabling factors accounted for 17% of the variance in reading and understanding instructions on prescription bottles. Further research is needed to examine the role of treatment programs in mediating relationships between individual predisposing factors and health literacy and the linkages between health literacy, health promotion behaviors, and subsequent health status in at-risk populations.

After a Long Journey Psychiatrist Helps at Home

After a Long Journey Psychiatrist Helps at Home