Women's participation in a cervical cancer screening program in northern Peru.

Cervical cancer is often the most common cancer among women in developing countries, yet current screening efforts have not been effective in reducing incidence and mortality rates in these settings. In an effort to increase knowledge about screening participation in low-resource settings, this study sought to identify key factors affecting women's participation in a cervical screening program in north central Peru. We studied women who were exposed to various health promotion educational activities and compared a total of 156 women who sought screening between July 2001 and October 2003 with 155 women who did not. Results from logistic regression identified four significant predictors of screening: higher relative wealth, knowing other screened women, seeking care from a health facility when sick and satisfaction with services at the health facility. When we restricted our analysis to women who had experienced screening in the past, two additional predictors emerged: having a husband who was supportive of screening participation and attending an awareness-raising session. These results have important programmatic value for tailoring outreach efforts for women and indicate that different strategies may be required to best reach women who have never been screened.

Cultural influences on health care use: differences in perceived unmet needs and expectations of providers by Latino and Euro-American parents of children with special health care needs.

This study compares service use, perceived unmet needs, and expectations of providers of Latino and Euro-American families of children with disabilities enrolled in a Title V Program. Eighty-four families and 20 providers participated in open-ended, semistructured, and structured interviews. Latino families underused Title V services (p <.001). The Latino families were more likely to cite unmet needs in the following areas: an unresolved health problem (p <.05), rehabilitation therapy programs (p <.001), or need for more information or a support group (p <.001). The Euro-American families cited unmet needs in the following areas: lack of day care (p <.001), respite services (p <.001), recreational programs (p <.001), and home health aides (p <.007). Textual analysis of open interviews revealed that the two groups of families had different expectations of providers. Latino cultural values play a role in these differences, creating barriers for effectively communicating with providers and for meeting children's needs.

Puerto Rican understandings of child disability: methods for the cultural validation of standardized measures of child health.

Validating the cultural context of health is important for obtaining accurate and useful information from standardized measures of child health adapted for cross-cultural applications. This paper describes the application of ethnographic triangulation for cultural validation of a measure of childhood disability, the Pediatric Evaluation of Disability Inventory (PEDI) for use with children living in Puerto Rico. The key concepts include macro-level forces such as geography, demography, and economics, specific activities children performed and their key social interactions, beliefs, attitudes, emotions, and patterns of behavior surrounding independence in children and childhood disability, as well as the definition of childhood disability. Methods utilize principal components analysis to establish the validity of cultural concepts and multiple regression analysis to identify intracultural variation. Findings suggest culturally specific modifications to the PEDI, provide contextual information for informed interpretation of test scores, and point to the need to re-standardize normative values for use with Puerto Rican children. Without this type of information, Puerto Rican children may appear more disabled than expected for their level of impairment or not to be making improvements in functional status. The methods also allow for cultural boundaries to be quantitatively established, rather than presupposed.

Cultural diversity, stress, and depression: working women in the Americas

Social support lengthens life, and stressors induce morbidity early in life and death later. Social supports and stressors, however, particularly those embedded in daily social interactions, exhibit important forms of cultural variation not yet incorporated into stress measurements. This article reports a clinically useful measure of stress applicable to culturally diverse populations. Ninety working women with a wide range of ages, educational attainments, class backgrounds, and historical origins (Africa, northwest Europe, Hispanic, and Native Americans) provided cultural data on the meaning of stress. Consensus analysis, principal components analysis and Cronbach's alpha, and logistic regression document content validity of the stress scale. The meaning of social supports (words or acts that imply respect, equality, or help or otherwise lead one to feel special and important) and stressors (words or acts that demean, imply inferiority, impede achievement, or otherwise lead one to feel bad about oneself) experienced a risk of depressive symptoms 85 times higher than informants without such a history. Standardized cultural research methods yield an instrument based on potential cultural universals that can facilitate clinical assessment and management of stress and health outcomes, such as depression, in culturally diverse populations.(Au)

Power and gender: violence and affection experienced by children in Barbados, West Indies

Discourses on violence conceptualize the phenomenon as a property of (1) individuals, (2) social circumstances, and (3) social relationships. Rigorous comparative tests fail to support the first and second hypotheses. Survey data collected in 1990 from a national random sample of 407 men and women aged twenty to forty-five from the West Indian island of Barbados indicate that one of four experienced physical and emotional violence as children. Boys and girls were equally likely to be abused by both mothers (or other female caregivers) and fathers (or other male caregivers); stepparents were no more likely to treat children violently than were biological parents. However, the presence of a stepfather increased the likelihood that women battered their daughters and decreased the likelihood that women battered their sons. In general, powerful women protected their children from violence, treated them affectionately, and elicited affection for them from their men. The probability that a son experienced an affectionate relationship with a biological father rose with the length of time the two lived together, but only for sons with powerful mothers. By contrast, men battered powerless women and the children of powerless women. Powerless women battered their own children.(AU)

West Indian gender relations, family planning programs and fertility decline

Nearly all West Indian islands initiated marked fertility declines sometimes between 1960 and 1970. Family planning programs have not played an important role in these declines. Neither have other variables that conventional social theory tells us should promote reduced family sizes, like education and rising standards of living. The historical experience of Barbados and Antigua, which reached replacement-level fertility in the 1980s, suggest that West Indian fertility declines reflect structural changes in national economic that created job opportunities for women. Family planning programs need to be evaluated with reference to the distinctive health and human right goals other than fertility transition that they can effectively reach (AU)