Clinician experiences of managed mental health care: a rereading of the threat.

The threat mental health professionals perceive in managed care, as indicated by their writings on the subject, is re-examined in light of evidence from an ethnographic study. Fieldwork focusing on clinician experiences of managed care was carried out at an urban community mental health center. Existing explanations of "the threat"--the possibility of deprofessionalization and the potential for deterioration in the quality of care--proved inadequate to account for the power it wielded at this site, perhaps because its full impact had yet to be felt at the time of data collection. A "rereading" suggests the meaning of managed care for this group of clinicians lies in the prospect of being gradually, unknowingly, and unwillingly reprofessionalized from critics into proponents simply by virtue of continuing to practice in a managed care context, and in losing a moral vision of good mental health treatment in the process.

Beliefs, knowledge, and behavior about cancer among urban Hispanic women.

As part of a cancer prevention program aimed at minority and disadvantaged urban women, cancer beliefs, knowledge, and behaviors were assessed among home-health attendants in the Bronx, N.Y. Information, was gathered from 876 Hispanic women who comprised 62% of the female home-attendant study population from whom data were collected (n = 1413). Of these women, 82% (n = 718) were Spanish speaking and 18% (n = 158) were English speaking as defined by their choice to complete the survey questionnaire in Spanish or English. As a whole, the population reported high levels of obtaining screening tests and engaging in preventive behaviors. However, nearly 60% did not know what cervical cancer was. The most important predictor of inadequate cancer screening was lack of knowledge. Large numbers of women subscribed to cancer misconceptions, such as the belief that bumps or bruises cause cancer. Fifty-eight percent believed that surgery causes cancer to spread, a belief that may prevent a woman with breast cancer from undergoing early intervention procedures, such as lumpectomy. This survey indicated that Hispanic women in our population engaged in relatively high levels of cancer preventive behaviors, even though their knowledge base was limited. Many of them hold misperceptions about cancer that can have an impact on preventive behaviors. We conclude that cancer prevention programs targeting the Hispanic populations should emphasize the provision of factual information about cancer and cancer-screening behaviors in the context of an exploration of inaccurate beliefs about cancer that may inhibit preventive health behaviors.

Biculturality among Puerto Rican adults in the United States.

Identified the concept of acculturation as a cornerstone of immigration research, while questioning assumptions about zero-sum cultural change in acculturation scales and in procedures assessing biculturality. Involvements in the host society culture and the culture of origin should be assessed separately in order to reflect the complexities of the cultural interactions immigrants and their offspring experience. To evaluate this prescription, we convened focus groups of Puerto Rican adults to discuss their cultural experiences in Puerto Rico and in the United States. Discussions were content analyzed to develop acculturation items. Factor analysis of the responses of 403 first- and second-generation adults yielded two general factors, involvement in American culture and involvement in Puerto Rican culture, which demonstrated modest reliability, relative independence, and moderate correlations with traditional acculturation scale validators. Results of the study challenge the assumption of mutual cultural exclusivity in acculturative change; enable the measurement of degree of biculturality; and provide future directions for the assessment of acculturation in domains other than language usage. The concept of acculturation is integrated with recent formulations in community psychology which advocate a deeper and more extensive commitment to studying the implications of cultural phenomena and greater focus on the growing cultural diversity in the United States.

The mental health relevance of idioms of distress. Anger and perceptions of injustice among New York Puerto Ricans.

Cultural sensitivity in mental health research is enhanced by examining the collective perceptions of members of ethnic groups about their own idiomatic expressions of distress. Such an examination was conducted with Puerto Ricans living in New York City, beginning with focus group discussions. Their prevailing idioms of distress, based upon themes of anger and injustice, were correlated widely with professionally developed measures of anxiety, depression, and somatization and with utilization of professional mental health care. By examining the relationship between idioms of distress, saliently volunteered by members of the ethnic ingroup, on the one hand, and professional care and assessments of mental health, on the other, we increase our culturally based understanding of mental health in the community.

Help-seeking pathways: a unifying concept in mental health care.

The authors argue that the concept of help-seeking pathways, defined generically, oriented toward institutional structures, and put at the forefront of research, can help integrate much of what we know about the use of mental health care and how to make such care more accessible and effective among underserved populations. They focus the concept of help-seeking pathways on current issues and research findings pertinent to the onset of psychological distress, the contacting of mental health care facilities, and treatment in such facilities. Pathways are not random; they are structured by the convergence of psychosocial and cultural factors and have sufficient integrity to be studied directly as unfolding processes.

Acculturation and mental health status among Hispanics. Convergence and new directions for research.

Acculturation, the process whereby immigrants change their behavior and attitudes toward those of the host society, is a fundamental part of migration-induced adaptations to new sociocultural environments. A rapidly expanding research literature on acculturation has accompanied the growth of international migrations. In response to the need to integrate the growing literature on acculturation and mental health status among Hispanics in the United States, and to identify points of convergence and new directions for research, 30 publications were examined. Points of convergence are identified, as are problems and limitations. The research needs new directions, proceeding from but not constricted by the assumptions and procedures in the work already done.