A qualitative analysis of barriers and facilitators to reducing sedentary time in adults with chronic low back pain.

BACKGROUND: Sedentary time (SED) is associated with many detrimental health outcomes, yet little is known about what factors influence one's ability to reduce SED. Even less is known about these factors in specific patient populations for whom high levels of SED may influence symptoms, such as those with chronic low back pain (cLBP). The purpose of this study was to qualitatively explore participants' perceptions of factors that influenced their ability to reduce SED across an 8-week intervention to reduce SED in adults with cLBP and elevated depressive symptoms. METHODS: Three months after a theory-based intervention to break up and reduce sitting, semi-structured interviews explored factors that influenced reducing SED. Three researchers independently coded each conversation. Codes were charted and mapped with participants reviewing their own transcripts and the merged codes. The research team then defined key themes. Factors that were perceived to either facilitate behavior change or acted as barriers were identified and thematized as positive or negative determinants. RESULTS: Common barriers for reducing SED included environmental constraints, opposing social norms, and productivity; these barriers were frequently encountered in the workplace. Common facilitators for reducing SED included habit development, self-monitoring tools, restructuring the physical environment, and social accountability. Notably, back pain was not a frequently reported barrier or facilitator for reducing SED. CONCLUSION: This sample of patients with cLBP and elevated depressive symptoms had similar determinants for reducing SED as previously reported in non-patient populations and did not appear to need strategies specific to dealing with chronic pain. Since work-related social norms and environmental factors were perceived as significant barriers to sitting less, workplace interventions that provide standing desks, offer standing meetings rooms, and/or institution-wide standing breaks may help reduce SED at work. The use of an activity monitor with sitting reminders and education regarding how to use the reminders as external cues to develop new sitting habits may also aid in adoption and adherence to this behavior change across settings. Developing coping plans and restructuring physical environments were perceived as successful strategies for overcoming social and environmental barriers. Future interventions targeting SED reductions may benefit from incorporating these strategies.

Revising Diabetes Programming for Black Men and Their Families.

Type-2 diabetes has increased 160% for African American males in the United States. This two-part study's purpose was to apply social marketing theory to understand the Type-2 diabetes education needs of men in Iowa. Study One was a preference assessment of Type-2 diabetes education strategies. Four African American men participated in a series of four focus groups and indicated that they were interested in diabetes prevention programming with their families but not in having it labeled as diabetes education. Participating men would rather increase their physical activity as opposed to tracking their food intake. As a follow-up to this study, nine other African American males took part in Study Two, which used cooking demonstrations and recipe taste-testing with the men to examine their relationship to food in the context of managing their Type-2 diabetes. The findings of both studies, which provided insight into these African American men's lifestyle as related to their Type-2 diabetes, could be useful for nursing professionals who have a critical role in navigating cultural, gender, and family norms while developing care plans, offering patient education, and promoting quality of life.

Experiences of Persons With Parkinson's Disease Engaged in Group Therapeutic Singing.

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder that leads to altered neural control of movement, including the control of voice, respiration, and swallowing. There is a prevalent need to provide therapy for voice, respiration, and swallowing difficulties because current pharmacological and surgical treatments do not effectively treat these impairments. Previous research has demonstrated that singing may be a treatment option to target voice, respiratory, and swallowing impairments, as well as quality of life. However, participants' perspectives related to reasons for enrolling and engaging in programs as well as evaluation of singing programs have been neglected. OBJECTIVE: The purpose of this descriptive study was thus to solicit participants' views of their involvement in a group singing intervention (GSI) led by credentialed music therapists. METHODS: Twenty persons with PD were interviewed 4 to 6 months after completing the singing intervention. Participants were asked about 1) why they chose to participate, 2) what were the beneficial and non-beneficial aspects of participating, and 3) how to improve overall design and delivery of the GSI. RESULTS: Using content analysis procedures, we learned that participants regarded their involvement in the study as mutually beneficial, fun, and engaging. Participants appreciated the fellowship with other persons with PD and offered minimal constructive criticism. CONCLUSIONS: This study provided greater insight into how a therapeutic singing program may benefit participants and positively impact their lives.

Black Women's Recommendations for Developing Effective Type 2 Diabetes Programming.

The purpose of this study was to learn from 29 Black women how to develop effective Type 2 diabetes programming. Three focus groups were held in Des Moines, Iowa, during fall 2012. Results highlighted themes related to diabetes knowledge, diabetes management and prevention, physical activity, diet, and diabetes management programming. Opinions were shared as to whether family members should be included in programs for supporting those diagnosed with diabetes. These results provided guidance and ideas to scholars and health care professionals aiming to improve effectiveness of diabetes programs for Black women and families.

The Influence of Stress, Gender, and Culture on Type 2 Diabetes Prevention and Management Among Black Men: A Qualitative Analysis.

This study used focus-group methodology to seek understanding about the unique influence of stress, gender, and culture on type 2 diabetes mellitus (t2dm) prevention and management among Black men. Twenty men from Iowa were recruited from a larger longitudinal study on Black families; each of these men participated in one of three focus groups. Ninety-five percent of the men in the sample were Black and all were either diagnosed with t2dm (n = 10), were prediabetic (n = 1), or had experience with t2dm through family and friends (n = 9). Our results revealed the existence of significant stress and some pessimism with respect to perceived ability to prevent and manage t2dm. The participants made it clear that, while their families are primary sources of support for managing stress, including t2dm, they can also be a source of stress, particularly with respect to parenting. Black men had mixed opinions on their relationships with respect to their health care providers; some had positive, long-standing relationships while others reported little or no relationship with their providers. In response to life stress, Black men reported experiencing inadequate and disrupted sleep as well as consuming too much alcohol at times. Some of the participants reported engaging in physical activity to manage their stress. The study concluded that, as researchers develop t2dm prevention and management programs, they should continue to consider the unique role that stress in its various forms, plays in the lives of Black men.

Determinants and Long-Term Effects of Attendance Levels in a Marital Enrichment Program for African American Couples.

Although most efficacious marital enrichment programs are multisession, few studies have explored whether outcomes differ according to session attendance, particularly among minority groups with lower than average participation in prevention programs. This study therefore investigates attendance levels and long-term improvements in couple functioning among 164 couples participating in the Promoting Strong African American Families program. Structural equation models indicated session attendance predicted 2-year changes for men's reports of communication, commitment, and spousal support (marginally) but not for women's. Individual and couple characteristics that predicted attendance levels were also identified. Results highlight distinct gender differences in the effects of sustained attendance as well as characteristics that provide early identifiers for African American couples at increased risk of low program attendance.

Prevention effects on trajectories of African American adolescents' exposure to interparental conflict and depressive symptoms.

The present study investigates the trajectory of children's exposure to interparental conflict during adolescence, its effects on adolescents' psychological adjustment, as well as the ability of a family-centered prevention program to alter this trajectory. A total of 331 African American couples with an adolescent or preadolescent child participated in a randomized control trial of the Promoting Strong African American Families program, a newly developed program targeting couple and cocaregiving processes. Using a multi-informant, latent growth curve approach, child exposure to interparental conflict during adolescence was found to be stable over a period of 2 years among families in the control group, but significantly declined among families in the treatment condition. Rates of change were significantly different between intervention and control groups based on parents' report of youth exposure to interparental conflict, but not for child's report. Structural equation models found trajectory parameters of interparental conflict predicted changes in adolescent depressive symptoms, with increasing rates of changes in conflict associated with increases in adolescent internalizing symptoms over the 2-year duration of the study. Finally, a significant indirect effect was identified linking treatment, changes in parents' reports of child exposure to interparental conflict, and adolescent depressive symptoms. The implications for research and intervention are discussed.

Developing Effective Diabetes Programming for Black Men.

The purpose of this study is to obtain feedback from 20 men on developing effective programming to reduce the impact of diabetes (t2dm) among Black men. Three focus groups were convened in Des Moines, Iowa. Men were recruited, all either diagnosed with t2dm (n = 10), pre-diabetic (n = 1), or experienced t2dm through family and friends (n = 9). The results highlighted themes related to t2dm knowledge, masculinity, and behavioral health; gender-centered diabetes management education; and family support and functioning. Men provided recommendations for program format and content, desirable facilitator characteristics, and whether to include spouses/partners, relatives, and friends. These results provide guidance and ideas to nurses wishing to enhance t2dm education and patient outcomes for Black men.

The effect of communication change on long-term reductions in child exposure to conflict: impact of the promoting strong African American families (ProSAAF) program.

African American couples (n = 331) with children, 89% of whom were married, were assigned to either (a) a culturally sensitive couple- and parenting-enhancement program (ProSAAF) or (b) an information-only control condition in which couples received self-help materials. Husbands averaged 41 years of age and wives averaged 39 years. We found significant effects of program participation in the short term on couple communication, which was targeted by the intervention, as well as over the long term, on self-reported arguing in front of children. Long-term parenting outcomes were fully mediated by changes in communication for wives, but not for husbands. For husbands, positive change depended on amount of wife reported change. We conclude that wives' changes in communication from baseline to posttest may be more pivotal for the couples' long-term experience of decreased arguing in front of children than are husbands' changes, with wives' changes leading to changes in both partners' reports of arguments in front of children.

Married Black Men's Opinions as to Why Black Women Are Disproportionately Single: A Qualitative Study.

This study's purpose was to explore the reasons Black women are disproportionately single according to the unique viewpoint of married Black men. The sample comprised 52 married Black men who resided in northeast Georgia (mean age = 43). Qualitative interviews were conducted in 2010 as part of the Pathways to Marriage study. The authors analyzed the data in a collaborative fashion and utilized content analyses to explore the relationships in the data which were derived from qualitative interviews with the men. Findings on the reasons for the disproportionality of singlehood among Black women reflected these four themes: gender relations, marriage education and socialization, individual development, and a preference for gay/lesbian relationships. Recommendations for future research are discussed.

Elucidating Parenting Processes That Influence Adolescent Alcohol Use: A Qualitative Inquiry.

This study's purpose was to learn why some youth who participated in the Strong African American Families (SAAF) program increased alcohol use after 2 years whereas other youth did not. Using a sample of 28 African American caregiver-youth dyads, the authors collected qualitative data to explore these issues. Findings underscore the importance of caregivers' practicing vigilant monitoring to keep their adolescents from experimenting with alcohol. Recommendations for limiting access to alcohol and encouraging vigilant parenting are discussed.

Engaging African American men in empirically based marriage enrichment programs: lessons from two focus groups on the ProSAAM project.

To better meet the needs of eligible African American men who were reluctant to enroll in a 5-year study called the Program for Strong African American Marriages (ProSAAM), we employed two focus groups to listen to the voices of a sample of the population being recruited and to explore their feedback about taking part in such a marriage enrichment program and how best to recruit other African American men. We explain our application of the focus group results to our recruitment of African American married couples for ProSAAM. The positive outcomes from the implementation of these results can provide potential ideas for those seeking innovative means to improve recruitment of African American men to programs that strengthen marital relationships.

It takes a village: protecting rural African American youth in the context of racism.

Prior research demonstrates negative consequences of racism, however, little is known about community, parenting, and intrapersonal mechanisms that protect youth. Using a mixed-methods approach, this study illuminated linkages between positive and negative contextual influences on rural African American adolescent outcomes. Quantitative results provide support for Structural Ecosystems Theory, in that the influence of discrimination and collective socialization on adolescent outcomes was mediated by racial socialization and positive parenting. Parenting and community influences contributed to adolescent racial identity and self image, which protected against common negative responses to racism; including academic underachievement, succumbing to peer pressure, and aggressive tendencies. Qualitative results indicate that current measures of discrimination may underestimate adolescents' experiences. Adolescents reported racist experiences in the domains of school, peers, and with the police (males only). Moreover, qualitative findings echoed and expanded quantitative results with respect to the importance of the protective nature of parents and communities.

PRAYER AND MARITAL INTERVENTION: A CONCEPTUAL FRAMEWORK.

Discomfort with the integration of spiritual activities into marital interventions may be a response by practitioners to the weakness of available conceptual frameworks. We offer a framework that allows for integration of prayer into marital interventions (educational or therapeutic), and argue that when culturally appropriate, prayer can serve multiple functions in interventions that are consistent with traditional goals of skill-based approaches. Several specific ways in which prayer can be either an alternative or an addition to existing intervention strategies are outlined. The potential negative effects of prayer for couples and the dangers of integrating prayer into programs are also discussed. We conclude that effective skill-based family intervention and prevention with some traditionally underserved groups may require increased attention to integration of spiritual practices that are common in those groups.