Souls in Extremis: Enacting Processes of Recovery from Homelessness Among Older African American Women.

In a midwestern city of the USA, the authors implemented the Leaving Homelessness Intervention Research Project-and its eight subprojects-to further understand homelessness as experienced by older minority women, develop intervention strategies to facilitate the movement of the participants out of homelessness, and illuminate the women's recovery process. After reviewing the social issue of homelessness among older African American women in the USA, and offering a framework on recovery and qualitative themes of recovery among participants involved in the Telling My Story subproject, the authors present a four-factor model of recovery-focused practice. The model reflects two recovery paradigms: one that is responsive to the negative consequences people experience as a result of their exposure to extreme situations, such as homelessness, and a proactive one in which assistance is designed to help people in recovery advance their own self-development and move forward their process of individuation.

The relationship between spiritual resources and life attitudes of African American homeless women.

Little is known about the relationships between spiritual resources and life attitudes of homeless African American women. Spiritual resources may serve as protective factors for women leaving homelessness. This descriptive study examines spiritual resources, life attitudes, and selected demographics of 160 African American women who were homeless in the Midwestern United States. Participants ranged in age from 30-62 years of age and reported being homeless 1-9 times, with a mean of 1.94 (SD = 1.53) times. The authors draw inferences for how spiritual resources and life attitudes can influence women's efforts to leave homelessness and identify implications for nursing practice.

Self-efficacy as a unifying construct in nursing-social work collaboration with vulnerable populations.

The authors consider self-efficacy practice as an organizing construct guiding nursing-social work action research in partnership with older homeless and formerly homeless African-American women. The authors, both academics who together have worked with members of this vulnerable population for a decade and a half, report on their unifying action research perspective immersed in self-efficacy theory. We examine how our adaptations of Bandura's classic four sources of self-efficacy form a distinctive intervention practice designed to help older African-American women emerge from homelessness. We amplify the incorporation of the four sources (vicarious experience and exposure to powerful role models, emotional arousal and accompanying catharsis, verbal persuasion, and role performance) into a grand strategy useful in working collaboratively with members of vulnerable populations, so they can achieve outcomes that improve their functional health, well-being and ultimately their quality of life.

Building a registry of research volunteers among older urban African Americans: recruitment processes and outcomes from a community-based partnership.

PURPOSE OF THE STUDY: An emerging strategy for increasing public participation in health research is volunteer registries. Using a community-based participatory research framework, we describe recruitment processes and outcomes in building a research volunteer registry of older urban African Americans. The specific research question examined retrospectively was: How does a community outreach partnership between older residents and academic researchers of the Healthier Black Elders Center facilitate recruitment of older urban African Americans for a research volunteer registry? DESIGN AND METHODS: We adapted program evaluation methods, specifically, the logic model, for clarifying how community outreach health education activities supported development of a research volunteer registry of older urban African Americans. RESULTS: Paralleling the 7 years in which an annual health reception was held, enrollees in a research volunteer registry increased from 102 to 1,273 enrollees. IMPLICATIONS: Targeted outreach to underrepresented groups to build a registry of volunteers for health research may be a promising strategy for addressing recruitment disparities in African Americans' research participation.

Self-care production experiences in elderly African Americans with hypertension and cognitive difficulty.

PURPOSE: The purpose of this qualitative descriptive study was to explore self-care production experiences in older African Americans who, despite some cognitive dysfunction, were able to produce hypertension-related self-care behaviors or blood pressure control successfully. DATA SOURCES: Participants were 10 urban, community-dwelling older African Americans, 60-89 years of age, living in a Midwest region of the United States. A semi-structured interview was conducted in participants homes' using Kvale's "conversational discourse" approach. Oral recordings were transcribed and analyzed for themes and codes. CONCLUSIONS: Elders' experiences with the production of self-care were characterized by three themes: preparation, monitoring, and evaluation. Self-care production was found to be cognitively challenging consistent with the finding that 60% of the participants had difficulty with a cognitive task requiring complex cognitive skills. This finding may explain why the production of self-care became a social phenomenon in which elders demonstrated resourcefulness in seeking assistance from surrounding support systems. IMPLICATIONS FOR PRACTICE: Nurse practitioners can support better health outcomes in older adults with hypertension by using valid and reliable measures for assessing complex cognitive skills, assessing individuals' progress in self-care production, and identifying individuals' use of social and professional supports to produce self-care.

Building a responsive network of support and advocacy for older African American homeless women through developmental action research.

This paper describes the Leaving Homelessness Intervention Research Project (LHIRP), a multimodal intervention that addresses the structural barriers and personal issues older African American women face in overcoming homelessness in a large mid-western city of the United States. The project incorporates a developmental action research design in partnership with homeless and formerly homeless women. Through developmental testing of interventions, LHIRP identifies promising practices at the individual, group life, intentional community, and city levels. The paper offers a rationale for the integration of both developmental research and action research, particularly community-based participatory inquiry. The authors document the nature of the helping network, identify and describe the project's aims, organizing framework, and methods that document the lived experience of homelessness. Action research strategies that support the design and intervention activities are described, as are the tools used to test promising practices that are useful in helping older women transition and remain out of homelessness. The paper identifies the knowledge products of the intervention project including lexicon, theory, and frameworks, considers the vicious cycle that serves as an advanced organizer of relevant intervention, illuminates core principles, and examines the importance of the web of affiliation that the project seeks to form among participants, staff, and technical assistants.

Five dimensions of faith and spiritually of older African American women transitioning out of homelessness.

BACKGROUND: Homelessness among older African American women is emerging as a serious social problem. The increasing cost of living, diminishing community resources, and shrinking retirement benefits, as well as reduced social services are resulting in greater numbers of older minority women becoming homeless. AIMS: This investigation explores the relevance of faith and spirituality to an advocacy assessment designed to help participants resolve issues that operate as barriers to their leaving and staying out of homelessness. METHODS: A substudy of a larger research and development project was undertaken, in which qualitative interview methods were used to illuminate the role of faith and spirituality resources in the lives of 84 older homeless African American women. Comparative thematic analysis of illustrative cases was undertaken to better understand the role of faith and spirituality in the women's lives and in how they used faith and spirituality in coping with homelessness. FINDINGS: Five dimensions of faith and spirituality, (a) identity and beliefs; (b) affiliation and membership; (c) involvement; (d) practices; and (e) benefits, served as promising resources in understanding life spaces of homeless minority women and identified promising advocacy strategies. Two cases describe the realities of homelessness for older minority women endeavoring to transition out of homelessness and illustrate how faith and spirituality can buffer stress, facilitate coping, and sustain motivation. CONCLUSIONS: How older homeless African American women use their faith and spiritual resources to cope with demands of homelessness, challenges of transition, and recovery from the multiple traumas resulting from being homeless makes the assessment of faith and spirituality an important part of the advocacy process.

The telling my story quilting workshop: innovative group work with older African American women transitioning out of homelessness.

This article examines the use of a quilting workshop as a strategy for helping older African American women address the consequences of their homeless experience. In this examination, four studies are addressed: the original, the re-analysis, the interviews, and the quilting intervention. The relationship of quilting to group work and social support is described, and the use of quilting in the Telling My Story homeless research project is demonstrated. The researchers used the lay definition of quilting that implies the general meaning of attaching many disparate and unique pieces of material together into a whole. The researchers also describe the relevance of the group work method inherent in the quilting workshop in helping women successfully transition out of homelessness and progress in their recovery from its consequences.

Enabling older homeless minority women to overcome homelessness by using a life management enhancement group intervention.

This paper describes the importance of a life management enhancement (LME) group intervention for older minority women in developing personal control and self-confidence in social relationships as they overcome homelessness. Women in the treatment group showed significantly greater personal control and higher levels of self-confidence following the six-week intervention than women in the control group. Increasing personal control and developing self-confidence in social relationships can help individuals achieve desired outcomes as a result of their actions, efforts, and abilities. These attributes can help women increase and sustain appropriate coping methods and overcome homelessness.

Homelessness among older african-american women: interpreting a serious social issue through the arts in community-based participatory action research.

This article describes the incorporation of the arts into a community-based participatory action research (CBPAR) project formulated to develop and test practices for helping homeless older African-American women. Studying how older African-American women become homeless has evolved into developing and testing promising interventions by the Leaving Homelessness Intervention Research Project (LHIRP). The women's participation in creative group activities helped them to communicate their experience with homelessness, express their concerns, develop personal strengths, and obtained mutual understanding. The use of multiple art forms has revealed a number of creative strengths among the participants, which have in turn inspired innovative artistic strategies and methodologies as part of the multiple methods that LHIRP incorporates. These interventions have been useful in helping participants resolve their homelessness. The role and benefit of the arts in CBPAR is described to show how creative activities help researchers and the public to better understand the complexities of homelessness.

Relationship between depression and specific health indicators among hypertensive African American parents and grandparents.

African Americans are at greater risk for hypertension than are other ethnic groups. This study examined relationships among hypertension, stress, and depression among 120 urban African American parents and grandparents. This study is a secondary analysis of a larger nurse-managed randomized clinical trial testing the effectiveness of a telemonitoring intervention. Baseline data used in analyses, with the exception of medication compliance, were collected at 3 months' follow-up. Health indicators, perceived stress, and social support were examined to determine their relationship with depressive symptoms. A total of 48% of the variance in depressive symptomology was explained by perceived stress and support. Health indicators including average systolic blood pressure explained 21% of the variance in depressive symptomology The regression analysis using average diastolic blood pressure explained 26% of the variance in depressive symptomology Based on study results, African Americans should be assessed for perceived stress and social support to alleviate depressive symptomology.

Telling my story: from narrative to exhibit in illuminating the lived experience of homelessness among older African American women.

The authors document the integration of methods from the arts and humanities into a social research and development project, the objectives of which are to create and test promising interventions helpful in assisting older homeless African American women get and stay out of homelessness in the city of Detroit, Michigan, USA. The exhibit incorporates multiple forms of narrative, includes performative features, promotes public awareness of homelessness in the city of Detroit, and engages homeless and formerly homeless women in social action. The authors examine the prototype design and the involvement of participants in creating artistic portrayals of their homeless experience.

Effects of nurse-managed telemonitoring on blood pressure at 12-month follow-up among urban African Americans.

BACKGROUND: Nearly one in three adults in the United States has hypertension. Hypertension is one of the largest risk factors for cardiovascular diseases, and it is growing in prevalence, especially among African Americans. OBJECTIVES: To test the hypothesis that individuals who participate in usual care (UC) plus blood pressure (BP) telemonitoring (TM) will have a greater reduction in BP from baseline to 12-month follow-up than would individuals who receive UC only. METHODS: A two-group, experimental, longitudinal design with block stratified randomization for antihypertensive medication use was used. African Americans with hypertension were recruited through free BP screenings offered in the community. Data were collected through a structured interview and brief physical exam. Cross tabs, repeated measures analysis of variance, and independent t tests were used to analyze the study's hypothesis. RESULTS: The TM intervention group had a greater reduction in systolic BP (13.0 mm Hg) than the enhanced UC group (7.5 mm Hg; t = -2.09, p = .04) from baseline to the 12-month follow-up. Although the TM intervention group had a greater reduction in diastolic BP (6.3 mm Hg) compared with the enhanced UC group (4.1 mm Hg), the differences were not statistically significant (t = -1.56, p = .12). DISCUSSION: : Telemonitoring of BP resulted in clinically and statistically significant reductions in systolic BP over a 12-month period; if maintained over a longer period of time, the reductions could improve care and outcomes significantly for African Americans with hypertension.

Mentoring in community-based participatory research: the RCMAR experience.

Community-based participatory research (CBPR) has been identified as a useful strategy to overcome disparities in minority elders. However, little consensus exists with respect to appropriate CBPR training and mentoring mechanisms. In this paper, we summarize the mentoring activities in each of the six currently funded Resource Centers on Minority Aging Research (RCMAR). In addition to mentoring trainees and/or junior faculty, we also explore the bi-directional mentoring that occurs when faculty at academic health centers develop partnerships with members of their target communities.

Parental stress among African American parents and grandparents.

The purpose of this study was to examine the relationships among parental stress, health (defined as level of systolic and diastolic blood pressure and body mass index), childcare characteristics, and social support. The study used a correlational research design and the setting was the metropolitan Detroit area. The sample consisted of 120 hypertensive African American parents and grandparents who reported caring for 1 to 9 children living in the household. Several variables (average diastolic blood pressure, number of children/grandchildren in home, child/grandchild is physically/mentally disabled, ability to decrease stress) were statistically significant predictors of parental stress. These results indicate that the multiple demands of parenting may become a barrier to making life-style changes for parents and grandparents diagnosed with hypertension. Nursing implications of the findings are discussed.

Poor nutrient intake and high obese rate in an urban African American population with hypertension.

OBJECTIVE: To describe the nutrient intake patterns and general health conditions in an African American (AA) hypertensive population living in Detroit, MI. METHODS: Demographic, anthropometric, general health condition and 3-day dietary recalls were collected from 387 AAs in community-based settings. Only data from 342 participants who met the inclusion criteria were reported. RESULTS: The obesity and type 2 diabetes prevalence in this minority population were significantly higher, and both energy and nutrient intakes were significantly lower than the RDAs or those reported in NHANES. Female participants reported their highest weight at an earlier age but their body weight reduced in the older group. No such trend was observed in male participants. Both males and females consumed significantly fewer servings of fruit, vegetable and grains as recommended by USDA. As household income increased, the consumption of fruits and vegetables were also increased. CONCLUSION: In order to reduce the incidence of obesity and hypertension in this minority population, dietary intervention should begin at adolescence or even earlier. DASH diet would be beneficial for this population.

Urban Hypertensive African American Grandparents: Stress, Health, and Implications of Child Care.

Because stress is a major factor in hypertension, research on parenting stressors and lifestyle behaviors of grandparents with hypertension is important. This study describes urban African Americans caring for grandchildren and examines effects of perceived parenting stress-ors on hypertension self-management. Hypertensive African American grandparents (N = 49) residing in a large Midwestern city participated in the study. Structured interviews collected descriptive data and the Index of Parental Attitudes (IPA). Participants' ages ranged from 30 to 82 years, were mostly female (77%), and had from 1 to 6 grandchildren. Participants were sedentary (51%), cigarette smokers (47%), and obese (67%). Mean systolic blood pressure was 157 and mean diastolic blood pressure was 89. IPA scores averaged 12.7, with scores >/= 30, indicating high levels of parental stress. Some participants (8.4%) had clinically stressful relationships with their grandchildren. The correlation between blood pressure and parental stress was not statistically significant, with a significant negative correlation found between participants' ages and diastolic blood pressure. The correlation between the number of hours spent caregiving and age produced a statistically significant relationship.

Depression, stress, and blood pressure in urban African-American women.

African-American women have disturbingly high rates of hypertension, exceeding those of African-American men and other ethnic groups. Reasons for these disparities are not understood. Depression, more common in women than men, has been linked to endothelial dysfunction, inflammation, metabolic and hematologic abnormalities, and increased sympathetic nervous system activity--all factors associated with cardiovascular disease. A descriptive correlational design was used to test the following hypotheses: 1) African-American women with higher levels of depression will have higher blood pressure (BP) levels, more cardiovascular risk factors, greater stress, and lower social support; and 2) depression will mediate the relationship between stress and BP. A convenience sample of 245 hypertensive African-American women (mean age, 61+/-12.7 years) was recruited through free BP screenings offered in the community. All data were collected during a structured interview and brief physical examination. Pearson r correlation coefficients, analysis of variance, and multiple regression analyses were used to analyze the hypotheses. Women with higher levels of depression had higher diastolic BP and were more likely to smoke, eat fewer fruits and vegetables, and have more stress and less social support. Depression mediated the relationship between stress and diastolic BP. The findings emphasize the importance of assessing both behavioral and psychosocial factors in urban African-American women with hypertension.

Identification and characteristics of older homeless African American women.

More older African American women are homeless, with this issue receiving little research attention. An exploratory study examined demographics and health characteristics of 100 women. Their mean age was 52.55 years (SD = 3.57) and ranged from 50 to 74 years. Most were unmarried, homeless more than three months, reported more than two diagnoses, and self-rated their health as fair or good. Length of time homeless did not significantly influence self-reported health. Medical diagnoses increased with time homeless, and rates of some chronic diseases were higher than domiciled African American elders 60 years of age and over Nearly half (48.5%) of women who were homeless more than 12 months reported emotional/mental illness.