Ethnicity and cardiovascular risk factors among Asian Americans residing in Michigan.

Asian Americans are at least 4% of the US population, but there are very few studies about the prevalence of cardiovascular risk factors among this group. Cardiovascular disease (CVD) is the leading cause of death among Asian Americans in the United States. Limited research that studied cardiovascular risks among Asian Americans were available, therefore, more information is urgently needed. Cross-sectional surveys and blood tests were conducted at community-based health fairs in southeastern Michigan. A total of 388 Asian participants provided data for this analysis. The results showed that four Asian groups differ in the level of specific risk factors; in particular, the most urgent hypertension and cholesterol problems were found among Chinese and Filipino participants, while the risk of diabetes may be highest among the Hmong participants. The results from the multivariate analysis showed that after controlling for demographic and medical care-related factors in the model, ethnicity is still a significant predictor that contributed to the differences in CVD risks. The results show that cardiovascular and diabetes risks are high in the Asian American populations studied. Attention needs to be paid to the extent and nature of ethnic-specific health problems because each culture's health-related habits and beliefs affect their entry into preventive care so that strategies can be designed and implemented to effectively reduce and ultimately eliminate health disparities.

Married Iranian Women's Knowledge, Attitude and Sense of Self-efficacy about Oral Contraceptives: Focus Group Discussion.

BACKGROUND: Oral contraceptive pills effectiveness is lower in actual use than in clinical trials. The views of a group of married Iranian women were sought as a step toward improving the enhanced use of contraceptive pills. METHODS: Two focus groups of current pill users (n=13) and two focus groups of women not currently taking the pills (n=14) were held. Leaders trained facilitators; themes were identified from line-by-line analysis of transcripts. RESULTS: The majority of the participants were primary school graduates with a mean age of 34 years. Knowledge about mechanisms of action was low; some women wanted more information. Both users and non-users recognized positive and negative characteristics of contraceptive pills. For non-users, physical and emotional side-effects were the most important; and anecdotal information from their social network was more important. They tended to trust more traditional methods. For users, their own experience and more reality-based understanding of side-effects mitigated concerns about side-effects. They also felt that health clinic staff had a negative attitude toward the pills. A stronger expression of self-efficacy seemed to be associated with more positive attitudes toward oral contraceptive pills. CONCLUSION: Although Iran has had a government-funded family planning program since 1990, and pills are the single most popular modern contraceptive method, women who take OCPs can provide important information that could increase effective health education about their use.

Why Iranian married women use withdrawal instead of oral contraceptives? A qualitative study from Iran.

BACKGROUND: Withdrawal as a method of birth control is still used in Iran. The aim of this study was to explore married women's perspectives and attitudes on withdrawal use instead of oral contraceptive (OC) in Tehran, Iran. METHODS: This was a qualitative study. Participants were 50 married women, not currently pregnant, not desiring pregnancy and who had been using withdrawal for contraception. Face-to face interviews were conducted to collect data. Content analysis was performed to analyze the data. RESULTS: Four major themes were extracted from the interviews: advantages, disadvantages, barriers for OC use, and husband-related factors. Advantages of withdrawal use were identified as: easy to use, convenient, ease of access, natural. Even those participants who had experienced unwanted pregnancy while using withdrawal, relied on withdrawal as their contraceptive method. Disadvantages of OC included concerns about side effects. Barriers related to use of OC included the need for medical advice, vaginal examination and daily use. Husband-related factors included: the husband wanted to be the primary decision maker on the number of children and that he preferred withdrawal. CONCLUSION: Health providers should address misunderstandings that exist about OC and highlight the non-contraceptive health benefits of OC to balance the information provided for women. We suggest that not only women but also their spouses be advised in family planning programs.

Effective colorectal cancer education for Asian Americans: a Michigan program.

Asian Americans are among the fastest growing population groups in the USA. Despite the fact that colorectal cancer (CRC) is the second most common cancer for this group, Asian Americans have low CRC screening rates. An established health promotion program, Healthy Asian Americans Project (HAAP), expanded to include community-based CRC education during 2005-2006. Using Asian-language media, HAAP promoted awareness throughout local Asian Indian, Chinese, Filipino, Hmong, Japanese, Korean, and Vietnamese American communities and recruited men and women over 50 years to attend health fairs at local community/cultural centers. Evaluation data from 304 participants in an evidence-based educational intervention showed significantly increased knowledge and attitudes about the importance of screening. Follow-up conducted between 6 and 12 months showed that 78% of those receiving the educational intervention had been screened in the last 12 months, compared with the 37% who had ever been screened with any of the tests prior to the study. This community-based health promotion program reached underserved populations and the educational intervention improved CRC screening rates. This and similar programs may help lower CRC mortality among Asian Americans.

Effects of nursing intervention on the beliefs and behavior of early detection of breast cancer among Shanghai women / 中华护理杂志

Objective To evaluate the effects of nursing intervention on the beliefs and behavior of early detection of breast cancer. Methods Four communities in Shanghai were selected by convenient sampling process. Then these four communities were randomly assigned to intervention group and control group. One hundred and eighty women who met the criteria of this study were selected from each group by convenient sampling process.Altogether 739 women were recruited. In intervention group,a one-year nursing intervention guided by health belief model was implemented,such as health education seminars,telephone follow in the third,sixth,and ninth months,and flyers of breast health care in the sixth month. Control group only received conventional education. Results After intervention women became aware of breast cancer (B=0.210,P＜0.01),perceived more benefits from attending early breast cancer detection (B=0.105,P＜0.01),and less difficulties in attending the activities of early detection of breast cancer (B=-0.086,P＜0.05). The number of women who performed breast self-examination once per month increased and more women received clinical breast examination (OR=3.0946) and mammogram after intervention (OR=2.746). Conclusion The nursing intervention,guided by health belief model,is helpful to improve women's beliefs and behaviors of breast cancer detection.

Culturally competent training program: a key to training lay health advisors for promoting breast cancer screening.

The lay health advisor (LHA) training program for breast cancer screening was conducted among Chinese- English bilingual trainees residing in Southeast Michigan. Guided by Bandura's Social Learning Theory, the development of the training curriculum followed the health communication process recommended by the National Cancer Institute. Data analysis based on questionnaires completed by 79 LHAs indicated that the breast cancer screening training program significantly increased LHAs' knowledge and self-efficacy (p < .01, t test, two-tailed) and LHAs had a positive perception with regard to the training manual. Regression analysis found that LHAs who were younger, employed, and demonstrated a positive perception of the training manual tended to have higher self-efficacy in promoting breast cancer screening (R(2) = .30). This study suggests that a culturally competent training program effectively increases LHAs' self-efficacy. The findings have implications for developing effective LHA training programs in Asian American communities where LHA interventions are rarely implemented.

Why do women miss oral contraceptive pills? An analysis of women's self-described reasons for missed pills.

Inconsistent use of oral contraceptives (OCs) exposes women to risks of unintended pregnancy. This study explored women's self-described reasons for missed OC pills. Data from diary cards completed by 141 women were studied to see how reasons for missing pills were related to patterns of pill use. The findings suggest that practitioners might improve OC use by focusing on the reasons that women miss pills, thus providing a more tailored approach that addresses individual risks based on women's personal experiences.

Cultural competence of nurse practitioner students: a consortium's experience.

Professional standards require culturally competent care, but competencies are rarely assessed. An instrument adapted from the work of cultural competence experts was used to assess the cultural competence of nurse practitioner students (n = 122). The 30-item instrument indicated adequate reliability scores (.78 to .87). Students reported high levels of comfort with people who are different from themselves and felt that cultural knowledge was important. Students scored fairly low on engaging in community-related culturally relevant behaviors. Predictors of culturally competent behaviors in clinical practice and the community were: comfort with others who are different from themselves, the degree of importance attached to cultural knowledge, and likelihood of future practice in rural areas. Nurse practitioner programs need to concentrate on increasing students' comfort with culturally diverse client groups and stressing a deeper cultural knowledge in clinical practice.

Communication channels to help build an international community of education and practice.

Two-way communication is required if nurses are to build knowledge networks of international communities of nursing education and practice. Are expensive new technologies feasible or preferred for effective communication and productive outcomes? In this report from a longstanding partnership between schools of nursing at Peking University and the University of Michigan, case study methodology is used to evaluate more than a decade of experience with communication modalities: in person, postal mail, express mail, e-mail, fax, telephone, hand delivery by other travelers, and Web sites. Although each education and practice community develops unique ways to build its shared knowledge, a communications plan is suggested, with use of multiple communication techniques, especially those that are low cost and the most dependable. High-cost technologies are not always feasible or preferred. For the project described, they were not necessary to the major outcome, a nursing education and practice network that resulted in the first nurse-managed community-based clinic in China.

Exploring contraceptive pill taking among Hispanic women in the United States.

Data from the 1995 National Survey of Family Growth have previously shown greater risk of inconsistent contraceptive pill use among Hispanic women. We used the same data to test aculturally based model of pill use among the subsample of Hispanic women. Hierarchical logit analyses revealed that primary use of Spanish, negative attitudes about women in the workplace, two or more recent sex partners, and recent pill adoption were factors that increased the odds of inconsistent use. Living alone or with non-kin was associated with more consistent use, as were showing preference for a stay-at-home model of motherhood, frequent church attendance, and frequent sexual intercourse. Our findings suggest that the strong effects of behavioral variables (e.g., duration of pill use, number of sex partners) are mediated by cultural indicators (e.g., primary use of Spanish, attitudes about sex roles). The extent to which programs address important cultural dimensions of health behaviors could enhance effectiveness.

Adolescents' experiences of childbirth: contrasts with adults.

Most of what is known about the meaning women assign to the experience of childbirth in the United States is based primarily on studies of Euro American, highly educated, married women of middle to higher income levels. Yet almost half a million adolescents give birth annually. This exploratory, qualitative study was conducted with 25 adolescents in an alternative school, partnered with the juvenile justice system, who had given birth. An open-ended question format was used for the interviews, and analysis was conducted by using extended case methodology. The study revealed a number of differences between the existing literature reports about women's interpretations of birth and the meanings assigned to childbirth experiences by the adolescents in this study. A key difference was the relationship between the pain of childbirth and responsibility for their child. The results provide an entrée into understanding unique characteristics of giving birth as an adolescent and potential roles health care providers can play to promote a positive experience.

Educational implications of nurse practitioner students and medical residents' attitudes toward managed care.

The increasing number of individuals enrolled in managed care organizations is a key consideration when planning effective models of education for future health care professionals. This study compares attitudes toward managed care between medical residents (MRs) (n = 431) and advanced practice nursing students (APNSs) (n = 153) in a Midwestern U.S. state, and it reports the results of a factor analysis of the attitude survey. MRs and APNSs completed a 34-item questionnaire. Results show that MRs were more likely than APNSs to believe that cost has priority over quality of care in a managed care setting and that managed care threatens the autonomy of health care providers. APNS were more likely than MRs to believe that managed care encourages preventive health care. Other comparisons related to Medicaid, capitation, practice guidelines, and success factors are discussed. Findings indicate that MRs were more inclined to see managed care as an economic threat to quality of care than APNSs. At the same time, MRs were somewhat less enthusiastic about practice guidelines and patient outcomes as measures of success in managed care settings than APNSs. Educational implications of findings are discussed.