Role and quality of nurse practitioner practice: a policy issue.

Nurse practitioners (NPs) are at a crucial period in the development of their profession. The increasing demand for primary care practitioners is changing the environment in which they practice. As they face both increased opportunity and continuing opposition to independent practice, NPs must define their role in healthcare delivery and establish their capabilities. The debate around what is and is not an appropriate role for the NP often focuses on quality of care; however, the real issues may be turf and economic defensiveness in an increasingly competitive market. This article discusses the challenges NPs face in establishing the quality of care they provide, and it reviews the literature on the subject, identifying its strengths and weaknesses and recommending policy changes.

Cultural tailoring for mammography and fruit and vegetable intake among low-income African-American women in urban public health centers.

BACKGROUND: It is widely accepted that disease prevention efforts should consider cultural factors when addressing the needs of diverse populations, yet there is surprisingly little evidence that doing so enhances effectiveness. The Institute of Medicine has called for randomized studies directly comparing approaches that do and do not consider culture. METHODS: In a randomized trial, 1227 lower-income African-American women from 10 urban public health centers were assigned to either a usual care control group, or to receive a series of six women's health magazines with content tailored to each individual. By random assignment, these magazines were generated from either behavioral construct tailoring (BCT), culturally relevant tailoring (CRT) or both (BCT + CRT). The CRT magazines were based on four cultural constructs: religiosity, collectivism, racial pride, and time orientation. All tailored magazines sent to women ages 40-65 promoted use of mammography; magazines sent to women ages 18-39 promoted fruit and vegetable (FV) intake. Analyses examined changes from baseline to 18-month follow-up in use of mammography and servings of FV consumed daily. RESULTS: Women receiving BCT + CRT magazines were more likely than those in the BCT, CRT, and control groups to report getting a mammogram (76% vs. 65% vs. 64% vs. 55%, respectively), and had greater increases in FV servings consumed daily (+0.96 vs. + 0.43 vs. + 0.25 vs. + 0.59). CONCLUSIONS: Systematically integrating culture into tailored cancer prevention and control interventions may enhance their effectiveness in diverse populations.

Responses to behaviorally vs culturally tailored cancer communication among African American women.

OBJECTIVE: To examine whether tailored cancer communication for African American women can be enhanced by tailoring on 4 sociocultural constructs: religiosity, collectivism, racial pride, and time orientation. METHODS: In a randomized trial, participants (n=1,227) received a women's health magazine tailored using behavioral construct tailoring (BCT), culturally relevant tailoring (CRT), or both (COMBINED). Two follow-up interviews assessed responses to the magazines. RESULTS: Responses to all magazines were positive. The health focus of the magazines was initially obscured in the CRT condition, but this disappeared over time, and CRT magazines were better liked. CONCLUSIONS: Implications for developing and understanding effects of tailored cancer communication are discussed.