Human papillomavirus infection, vaccination, and cervical cancer communication: the protection dilemma faced by women in southern Appalachia.

Human papillomavirus is the most frequently occurring sexually transmitted infection and has been recognized as the necessary cause of cervical cancer. Understanding the shift in public awareness caused by recent changes to cervical prevention is critical to addressing cervical cancer disparities in Appalachia. Since the human papillomavirus vaccine was approved for prevention, little data have been collected regarding human papillomavirus risk assessment and vaccine perceptions among Appalachian women. The purpose of the authors in this study was to investigate communication and cultural issues via a social scripting framework that could influence human papillomavirus vaccine uptake among southern Appalachian women; and explore participants' perceptions of human papillomavirus, cervical cancer, and the vaccine. A qualitative, descriptive design was employed to examine these issues in eight counties in northeast Tennessee and southwest Virginia. Thirty-nine women aged 18-49 years participated in a single individual interview or focus group session from October 2007 through August 2008. Interview and focus group data were audio-taped and transcribed verbatim. Two major themes emerged from the data: the human papillomavirus vaccine protection dilemma and spheres of silence surrounding the human papillomavirus vaccine protection dilemma. Study findings suggested areas for future research and may assist healthcare professionals in approaching southern Appalachian women as they make decisions regarding cervical cancer prevention.

International medical graduate-patient communication: a qualitative analysis of perceived barriers.

PURPOSE: International medical graduates (IMGs) represent a substantial portion of all medical residents in the United States. Yet, IMGs may be disadvantaged in their communications with U.S. patients for a variety of reasons. The authors conducted a qualitative study to examine IMGs' perceptions of the barriers to their communication with patients. METHOD: A convenience sample of 12 IMGs participated in interviews that lasted 1 to 1.5 hours. Residents from the Caribbean, Colombia, Denmark, India, Iran, Pakistan, and Peru participated in individual interviews conducted on-site at one of three clinics. Interviews were transcribed and then coded independently and jointly. The authors used a qualitative analysis of interview transcripts to identify primary and secondary themes. RESULTS: IMGs' perceptions of the barriers to communication with their Appalachian patients fit into two broad themes: educational barriers and interpersonal barriers. Within each of these themes, the authors identified secondary themes: education-related barriers were science immersion and lack of communication training, and interpersonally related barriers were unfamiliar dialects, new power dynamics, and different rapport-building expectations. CONCLUSIONS: The analysis of the interview data yielded several important findings that residency programs should consider when designing orientations, training curricula, and communication interventions. Programs may need to address challenges related to regional dialect and "informal" English use, as well as communication barriers associated with cross-cultural differences in norms, values, and beliefs. Programs also need to draw on multilayered interventions to address the multidimensional challenges of cross-cultural physician-patient communication.

Culturally tailored cancer communication, education, and research: the highways and back roads of Appalachia.

We seek to start a dialogue about the challenges cancer control researchers and specialists may face in attempting to understand the Appalachians' experience with cancer. Through examples drawn from our own research among Appalachian communities, we discuss the hazards of defining a culture in order to develop culturally tailored cancer control interventions and programs. We also acknowledge that cancer control work in Appalachia requires "cultural mapping," highlighting cultural beliefs, norms, and realities that may be linked to cancer mortality and morbidity. Although cancer control specialists and researchers have to rely on cultural maps, they must also remain critical of such maps. Subsequently, we describe a mapping approach around the metaphor of "signposts," directional indicators that point to broad cultural attributes but do not reduce the culture to a narrow set of traits. The interplay of these signposts ultimately helps cancer educators, communicators, and researchers better understand authentic Appalachia.

Local implementation of cancer control activities in rural Appalachia, 2006.

Underserved communities with high cancer rates often are not involved in implementing state cancer control activities locally. An East Tennessee State University research team formed 2 Appalachian Community Cancer Research Review Work Groups, 1 in northeast Tennessee and 1 in southwest Virginia. During 4 sessions, the research team presented regional cancer data to the work groups. Work group participants explored research from a lay perspective and identified possible reasons for cancer disparities in central Appalachia. The fifth session was a community dissemination activity in which work group participants engaged in cancer education and action by presenting the research to their local communities in unique ways. During a sixth session, both work groups discussed these interventions and further attempted to answer the question, "What makes the experience of cancer unique in Appalachia?" This article describes the key steps of this community-based participatory research process.

The mountains hold things in: the use of community research review work groups to address cancer disparities in Appalachia.

PURPOSE/OBJECTIVES: To review regional findings about cancer disparities with grass roots community leaders in Appalachia and to identify perspectives about what makes the cancer experience unique in Appalachia. RESEARCH APPROACH: A community-based participatory approach that includes focus-group methodology. SETTING: Work groups gathered in well-known community locations in northeastern Tennessee and southwestern Virginia. PARTICIPANTS: 22 lay adult community members (12 in Tennessee and 10 in Virginia), all of whom had a personal and community interest in cancer and were reputed as informal community leaders. METHODOLOGIC APPROACH: Work groups engaged in a series of five sequential sessions designed to (a) review regional data about cancer disparities and identify perspectives about what makes the cancer experience unique in Appalachia, (b) promote dialogue between the work group members and healthcare providers to identify methods for improved collaboration, and (c) integrate the work group with regional efforts of the states' comprehensive cancer control plans. FINDINGS: Four major themes emerged from the focus group sessions with each work group: cancer storytelling, cancer collectivism, healthcare challenges, and cancer expectations. The community research review work groups proved to be a successful method to disseminate information about regional cancer disparities. CONCLUSIONS: Study findings provide a unique foundation so that healthcare providers and researchers can begin to address cancer disparities in the Appalachian region. INTERPRETATION: Nurses are in key positions to partner with trusted community leaders to address disparities across the cancer continuum in Appalachia.

Talking about human genetics within religious frameworks.

Information generated by the Human Genome Project is intended to result in better understanding of genetic variation and disease, affording opportunities to intervene in human health both prior to and after birth. The lay public's construction of meaning associated with these aims, however, has been given little systematic consideration. As God and religion are often invoked as structures to give meaning to technical and scientific discoveries, this project sought to examine public discussions associated with religious frameworks used to talk about human genetics. The results of 17 focus group discussions revealed a range of lay epistemologies that suggest how religious faith may impact individual perceptions, with some consistent differences in discourse for African Americans as compared to European Americans observed. The ethical and practical applications of this information are extended to suggestions for health promotion, care, and counseling.