Facilitators and barriers to leadership and career opportunities in minority nurses in public health departments.

OBJECTIVES: Elicit information from minority public health nurses regarding experiences and opportunities for leadership development and career advancement in public health departments (PHDs). DESIGN: Qualitative research design to determine minority nurses' experiences of opportunities and barriers influencing leadership development and career advancement in PHDs. SAMPLE: Thirty-nine minority nurses from all regions of the United States participated in a telephone interview. Demographics reveal that 46% were African American or Mixed Race, 31% were Hispanic/Latina, 18% were Asian, and 5% were Indian heritage. MEASUREMENTS: Participants completed the researcher-designed, open-ended interview which was audio-recorded. The researcher conducted all interviews. Transcriptions were coded for major concepts and then codes were collapsed into major themes by the researcher and consultant in qualitative research. RESULTS: Six themes were identified from the data: commitment to public health, motivation for leadership development, barriers for leadership development, racism: influence on nurses from minority backgrounds, supports for leadership development, and survival skills. CONCLUSIONS: Participants desired an opportunity for career advancement and leadership development, but encountered entrenched systemic/organizational barriers and obstacles in fulfilling this important role impacting healthcare delivery of minority and underrepresented groups. Public health officials and administrators are challenged to strengthen opportunities for career advancement and leadership development for minority nurses in PHDs.

The World Health Organization - Community Empowerment Model in Addressing Food Insecurity in Low-Income African-American Women: A Review of the Literature.

Numerous researchers have examined the serious consequences of food insecurity and food deserts affecting the nutritional health of poor or low-income African-American women and their families. Food insecurity is defined as having limited or uncertain capacityfor acquiring sufficient, safe, and nutritious food at all times to meet one's dietary needs, while food deserts refer to economically and socially-deprived inner city areas with inadequate food supply that are often inhabited by low-income groups. Researchers have found that despite the capacity of community-level resources such as SNAP (Supplemental Nutrition Assistance Program) and WIC (Women, Infants, and Children) supporting healthy nutrition, food insecurity persists among some recipients of both nutritional resources. Both food insecurity and food deserts had a negative effect on the emotional eating, emotional coping, coping strategies, and depressive symptoms in low-income African-American women. Even more concerning is that food deserts have been linked to decreased physical activity in low-income African-American women. Neighborhoods with fewer food supermarkets in which to purchase fresh produce and other healthy nutritious foods also emphasized junk food displays. Thus, neighborhoods with persons that have powerful influences (e.g., local merchants and community liaisons) must bear responsibility to help eliminate food deserts that were linked to obesity, high BMI measures, and Type 2 diabetes in African-American women. Food inse- curity was viewed from the lens of the World Health Organization - Community Empowerment Model (CEM) that incorporates 5 core processes or barometers for change: community coalitions, critical consciousness raising, exerting public pressure, lobbying, advocacy and mediation, and reframing and reorienting health services. Each of the processes plays a powerful role in assisting communities in taking charge of their health and assuming responsibility for improving access to healthy nutritious foods and eliminating food deserts in low-income communities. The implications of change and community involvement rely on all persons with a vested interest in address- ing the disturbing problem offood insecurity and food deserts affecting the nutritional health and well-being of African-American communities.

Obesity in African-American Women--The Time Bomb is Ticking: An Urgent Call for Change.

The "time bomb is ticking" because there is an obesity crisis associated with higher rates of chronic diseases such as stroke, hypertension, type 2 diabetes, and some forms of cancer in African-American women compared to White women. African-American women incur higher medical costs from hospitalizations, decreased productivity in the work setting, lost wages, the needfor medical benefits and pharmacy-associated costs, and more time away from family than White women. Numerous factors, such as the socio-cultural context of eating, acceptance of a larger weight status, the emotionally liberating effects offood, and preference for highfat and high caloric, sugary-content, and sodium-laden food influences the obesity crisis in African-American women. The interplay of poverty and lower socioeconomic status, residential segregation, health literacy, availability of fast foods and scarce produce in local convenience food marts, physical inactivity, and conflicting messages from social media public service announcements (PSAs) and ads in national magazines affect the obesity crisis in African-American women. There is an urgent call for sustainable, community-driven health policy initiatives that improve access to healthy foods in lower-income, minority communities. Furthermore, African-American women are challenged to modify their health behaviors by preparing healthy meals for themselves and theirfamilies, and by engaging in physical activity.

Claiming health: mammography screening decision making of African American women.

PURPOSE/OBJECTIVES: To develop a substantive theory that explains how African American women aged 50 years and older of different socioeconomic status (SES) make decisions about mammography screening. DESIGN: Qualitative, grounded theory. SETTING: Churches, places of employment, or women's homes in a large city in Ohio. SAMPLE: 30 women aged 52-72 years; 16 in the initial sample and 14 in the theoretical sample. METHODS: Audiotaped interviews and extensive written field notes; interviews were transcribed verbatim and analyzed using the constant comparison method, resulting in saturation of data. MAIN RESEARCH VARIABLES: Decision-making processes explaining mammography screening. FINDINGS: "Claiming health" emerged as the substantive theory explaining decisions that affect mammography screening and was embedded in the social contexts of cultural heritage and learned kinship values, religious beliefs and supports, and prior negative experiences with healthcare professionals and the healthcare system. Claiming health involved sisterhood and fellowship relationships fostered in the church. Claiming health was differentiated by age and SES, with older women of lower SES reporting greater reliance on cultural heritage and negative recollections of the healthcare system when making decisions regarding mammography. Each subconcept of claiming health was equally important and influenced decision making. CONCLUSIONS: Oncology nurses can benefit from the information presented by assisting older women of lower SES who may have encountered negative experiences in the healthcare system to develop effective assertiveness and communication skills when interacting with healthcare professionals. IMPLICATIONS FOR NURSING: Further research is needed to determine whether claiming health is a way of thinking about health generally or is used solely to explain experiences with mammography screening.

Collaborative breast health intervention for African American women of lower socioeconomic status.

PURPOSE/OBJECTIVES: To describe all phases of a collaborative breast health intervention delivered by paraprofessionals or specially trained community health advisors (CHAs) for African American women designed to increase mammography screening. DESIGN: Collaborative pretest, post-test breast health intervention. SETTING: Large city in Ohio. SAMPLE: 68 African American women with a median age of 57.8 (SD = 5.28) obtained mammography screening and participated in the breast health intervention. METHODS: Specially trained CHAs used aggressive recruitment strategies to increase mammography screening and knowledge of breast health and mammography screening in African American women aged 50 and older. MAIN RESEARCH VARIABLES: Knowledge scores of breast health and mammography screening. FINDINGS: Ninety women (81%) met the inclusion criteria and were recruited into the intervention, but only 68 (76%) obtained mammography screening. The women demonstrated increased knowledge by change in pre- to post-test scores. Several questions were statistically significant. CONCLUSIONS: Collaborative breast health interventions delivered by trained CHAs are effective in increasing screenings as well as knowledge of breast health and mammography screening in African American women. The unique role of the CHA is especially important in recruitment of hard-to-reach women and was vital to the success of the educational intervention. Most importantly, the women valued the individualized attention to their breast health and agreed to share the information with significant others. Further collaborative interventions designed to increase screenings and increase knowledge of breast health and mammography screening are needed to reduce the health disparities of later-stage detection and poorer survival of breast cancer in African American women. IMPLICATIONS FOR NURSING: Oncology nurses should build on the findings and deliver further outreach programs to increase mammography screening and knowledge of breast health in a larger number of women of lower socioeconomic status. Future research is needed to determine the influence of reminder phone calls for mammography screening. Oncology nurses should incorporate evaluation strategies at baseline and periodically throughout an intervention to provide more comprehensive data and enhance the credibility of findings. To maximize success, oncology nurses should work collaboratively with other healthcare professionals such as certified x-ray technicians and influential people in the community to increase knowledge of breast health and mammography screening.

An outsider's experiences in conducting field research in an African-American community.

Researchers agree that the conduct of field research is a challenging and enlightening experience. This article describes an African-American (AA) researcher's experiences in accessing and conducting field research in an AA community. These experiences were from a Grounded Theory (GT) qualitative research study to understand the social contexts and processes, and other interrelated factors such as beliefs in God or a higher being and role expectations on mammography-screening decision-making in older, urban AA women of various socioeconomic strata. The field experience of accessing and recruiting AA women into a GT study were partly influenced by two prior historical studies conducted by the Federal government that resulted in violation of human rights. These historical experiences greatly impacted the researcher's entrée into the AA community and success in conducting the GT study. The researcher realized the benefit of establishing professional relationship with key informants (church nurses) for the success of accessing and recruiting individuals into research studies. Of utmost importance, the researcher was viewed as an "outsider" and represented the separate, distinct world of the university. Particularly noteworthy was the fact that holding the same ethnicity of the AA community does not guarantee automatic initial or ongoing entrée into the community or recruitment of participants.