Comparison of Health-Promoting Behaviors of Nursing Students From Different Racial/Ethnic Groups.

BACKGROUND: Despite the known benefits of maintaining a healthy lifestyle in preventing many health-related issues, few nursing students practice health-promoting behaviors (HPB). METHOD: This cross-sectional, descriptive, correlational study included 866 undergraduate nursing students who were members of the National Student Nurses' Association. RESULTS: The difference in mean Health-Promoting Lifestyle Profile-II scores between White people and Asian Americans was statistically significant (F [4, 861]) = 2.95, p = .019). The difference in the mean self-efficacy scores between Black people and Asian Americans also was statistically significant (F [4, 861] = 4.41, p = .002). The regression model was significant (F [1, 862] = 6.683, p = .001, R2 =.235)], and self-efficacy (ß = .457, t = 15.178, p = .001) significantly predicted nursing students' HPB. CONCLUSION: The differences between racial/ethnic groups noted in this study indicate nursing faculty need to render culturally sensitive interventions to promote self-efficacy and HPB among undergraduate nursing students. [J Nurs Educ. 2021;60(9):500-508.].

African American women's perceptions of the meaning of support groups for improving adherence to hypertension treatment: a conceptual model.

AIM: To investigate the meaning of support groups and the features of these groups that African American (AA) women view as improving adherence to high blood pressure (HBP) treatment. The study generated a conceptual model to illuminate features of these groups that influence adherence of AA women to HBP treatment. DESIGN: Qualitative research. METHODS: Used focus groups and open-ended questions to obtain the views of 26 eligible AA women, recruited from South Los Angeles. Line-by-line review and coding of interview transcripts were done. The feedback was used to specify a conceptual model depicting the meaning of support groups. The Consolidated Criteria for the Reporting of Qualitative Research guidelines were used. RESULTS: The conceptual model depicts the meaning of support groups as information giving/knowledge sharing, emotional or psychological support, instrumental support and coaching, and facilitators and barriers to joining support groups and factors for consideration in forming these groups.

The Facilitators of and Barriers to Adherence to Hypertension Treatment Scale.

BACKGROUND: Lack of adherence to recommended regimens is a major cause of uncontrolled blood pressure (BP) among African/Black American (AA) women. The national initiative to increase BP control among AAs by 50% makes clear the need for culturally appropriate instruments to assess facilitators of adherence to treatment of hypertension (high BP [HBP]). OBJECTIVE: The aim of this study was to develop a culturally sensitive measure of facilitators of and barriers to adherence to hypertension treatment regimens for AA women. METHODS: We developed the Facilitators of and Barriers to Adherence to Hypertension Treatment Scale (FATS) with input from focus groups with 20 AA women. A total of 147 AA women from a federally funded inner-city clinic in Los Angeles were enrolled in the study and 70 (48%) completed the survey. Internal consistency reliability was estimated using Cronbach's α. RESULTS: Coefficient α for the 18-item FATS was 78. In a multivariate regression model, controlling for BP stage, the FATS was significantly associated with the Hill-Bone High Blood Pressure Compliance Scale (standardized ß = .35; P = .0014), the Enhancing Recovery From Coronary Heart Disease Social Support Inventory (ß = .42; P = .001), the and CAGE (cut down on your drinking, annoyed by being criticized for your drinking, guilty about drinking, and eye-opener drink in the morning) alcohol screening instrument (ß = -.24; P = .05). DISCUSSION: The FATS is a culturally sensitive measure for assessing adherence to treatment regimens of HBP in AA women. Further study in other samples of AA women is needed to confirm that the FATS adequately assesses facilitators of adherence to regimens for HBP in AA women.

Differential item functioning by survey language among older Hispanics enrolled in Medicare managed care: a new method for anchor item selection.

OBJECTIVE: To propose a permutation-based approach of anchor item detection and evaluate differential item functioning (DIF) related to language of administration (English vs. Spanish) for 9 questions assessing patients' perceptions of their providers from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare 2.0 survey. METHOD AND STUDY DESIGN: CAHPS 2.0 health plan survey data collected from 703 Hispanics who completed the survey in Spanish were matched on personal characteristics to 703 Hispanics that completed the survey in English. Steps to be followed for the detection of anchor items using the permutation tests are proposed and these tests in conjunction with item response theory were used for the identification of anchor items and DIF detection. RESULTS: Of the questions studied, 4 were selected as anchor items and 3 of the remaining questions were found to have DIF (P < 0.05). The 3 questions with DIF asked about seeing the doctor within 15 minutes of the appointment time, respect for what patients had to say, and provider spending enough time with patients. CONCLUSIONS: Failure to account for language differences in CAHPS survey items may result in misleading conclusions about disparities in health care experiences between Spanish and English speakers. Statistical adjustments are needed when using the items with DIF.

Readability estimates for commonly used health-related quality of life surveys.

PURPOSE: To estimate readability of seven commonly used health-related quality of life instruments: SF-36, HUI, EQ-5D, QWB-SA, HALex, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the NEI-VFQ-25. METHODS: The Flesch-Kincaid (F-K) and Flesch Reading Ease (FRE) formulae were used to estimate readability for every item in each measure. RESULTS: The percentage of items that require more than 5 years of formal schooling according to F-K was 50 for the EQ-5D, 53 for the SF-36, 80 for the VFQ-25, 85 for the QWB-SA, 100 for the HUI, HALex, and the MLHFQ. The percentage of items deemed harder than "easy" according to FRE was 50 for the SF-36, 67 for the EQ-5D, 79 for the QWB-SA, 80 for the VFQ-25, 100 for the HUI, HALex, and the MLHFQ. CONCLUSIONS: All seven surveys have a substantial number of items with high readability levels that may not be appropriate for the general population.

Reports and ratings of care: black and white Medicare enrollees.

PURPOSE: This study compared African American/Black and White Medicare enrollees' perceptions of care. DESIGN AND METHODS: Analyses of the 2002 Consumer Assessment of Healthcare Providers and Systems (CAHPS) 3.0 survey of 101,189 (White) and 8,791 (Black) Medicare enrollees (82% response rate) randomly sampled from 321 health plans, with data collected via mail (84%) and telephone (16%). Multivariate linear regression models were conducted with the CAHPS composites and global ratings as dependent variables, controlling for case-mix variables. RESULTS: Blacks reported significantly (p< or =.0001, p < or =.05) worse experiences with getting care quickly, office staff helpfulness, getting needed care, health plan customer service, rating of specialist care, and rating of the health plan (effect sizes ranging from 0.02 to 0.21). However, they reported better provider communication and rated their personal doctors/nurses and health care more positively (effect sizes ranging from 0.02 to 0.09).

Adherence treatment factors in hypertensive African American women.

BACKGROUND: Hypertension among African American women is of epidemic proportions. Nonadherence to treatment contributes to uncontrolled blood pressure in this population. Factors associated with adherence to treatment in African American women are unknown. The purpose of this study was to identify factors associated with adherence to hypertension treatment in African American women. METHODS: Five audio-taped focus groups were conducted with hypertensive African American women, 35 years and older receiving treatment for hypertension from an inner-city free clinic. All transcripts from the tapes were analyzed for content describing adherence to treatment factors. FINDINGS: factors associated with adherence to treatment in hypertensive african american women were in three main categories including: beliefs about hypertension, facilitators of adherence to treatment, and barriers to adherence to treatment. IMPLICATIONS: The study supports the need for education on managing hypertension and medication side effects, early screening for depression in hypertensive African Americans, development of culturally sensitive hypertension educational material, and formation of support groups for promoting adherence to treatment among African American women with hypertension.

Language and regional differences in evaluations of Medicare managed care by Hispanics.

OBJECTIVES: This study uses the Consumer Assessments of Healthcare Providers and Systems (CAHPS((R))) survey to examine the experiences of Hispanics enrolled in Medicare managed care. Evaluations of care are examined in relationship to primary language (English or Spanish) and region of the country. DATA SOURCES: CAHPS 3.0 Medicare managed care survey data collected in 2002. STUDY DESIGN: The dependent variables consist of five CAHPS multi-item scales measuring timeliness of care, provider communication, office staff helpfulness, getting needed care, and health plan customer service. The main independent variables are Hispanic primary language (English or Spanish) and region (California, Florida, New York/New Jersey, and other states). Ordinary least squares regression is used to model the effect of Hispanic primary language and region on CAHPS scales, controlling for age, gender, education, and self-rated health. DATA COLLECTION/EXTRACTION METHODS: The analytic sample consists of 125,369 respondents (82 percent response rate) enrolled in 181 Medicare managed care plans across the U.S. Of the 125,369 respondents, 8,463 (7 percent) were self-identified as Hispanic. The survey was made available in English and Spanish, and 1,353 Hispanics completed one in Spanish. PRINCIPAL FINDINGS: Hispanic English speakers had less favorable reports of care than whites for all dimensions of care except provider communication. Hispanic Spanish speakers reported more negative experiences than whites with timeliness of care, provider communication, and office staff helpfulness, but better reports of care for getting needed care. Spanish speakers in all regions except Florida had less favorable scores than English-speaking Hispanics for provider communication and office staff helpfulness, but more positive assessments for getting needed care. There were greater regional variations in CAHPS scores among Hispanic Spanish speakers than among Hispanic English speakers. Spanish speakers in Florida had more positive experiences than Spanish speakers in other regions for most dimensions of care. CONCLUSIONS: Hispanics in Medicare managed care face barriers to care; however, their experiences with care vary by language and region. Spanish speakers (except FL) have less favorable experiences with provider communication and office staff helpfulness than their English-speaking counterparts, suggesting language barriers in the clinical encounter. On the other hand, Spanish speakers reported more favorable experiences than their English-speaking counterparts with the managed care aspects of their care (getting needed care and plan customer service). Medicare managed care plans need to address the observed disparities in patient experiences among Hispanics as part of their quality improvement efforts. Plans can work with their network providers to address issues related to timeliness of care and office staff helpfulness. In addition, plans can provide incentives for language services, which have the potential to improve communication with providers and staff among Spanish speakers. Finally, health plans can reduce the access barriers faced by Hispanics, especially among English speakers.

Quality indicator themes among African Americans, Latinos, and Whites.

Elimination of racial/ethnic disparities requires cross-cultural knowledge about quality of care among vulnerable populations. This study used 3 existing data sets to identify quality indicator themes relating to healthcare concerns of African Americans, Latinos, and whites. Using a quality-of-care framework to organize and compare the themes across racial/ethnic groups, we found several unique and 9 common themes. The at-a-glance grid is useful in facilitating culturally competent caring processes in clinical practice.

Psychometric characteristics of a patient satisfaction instrument tailored to the concerns of African Americans.

The national initiative to eliminate health disparities by 2010 makes clear the need for culturally appropriate patient-reported outcome measures. The objective of the study was to refine and augment an existing comprehensive patient satisfaction instrument, the Group Health Association of America (GHAA) survey, to capture the health care concerns of African Americans from diverse socioeconomic backgrounds. Modifications of GHAA items included splitting, rewording, substituting, and adding items. The result was a 21-domain instrument. Three new domains included respect, health education, and discrimination/stereotyping. A cross sectional survey of 600 African Americans and Whites yielded 237 usable surveys with 214 self-identified as African American (n=100) or White (n=114). Item-scale correlations were examined to evaluate the extent to which items correlated more highly with the scale they were intended to represent than they did with other scales. Support was found for 15 of 19 hypothesized multi-item scales. This study yields a survey that can be used to evaluate care delivered to African Americans and Whites. The survey needs to be evaluated in other samples to determine if it adequately reflects cultural issues from other ethnic minorities.

Comparison of data quality for reports and ratings of ambulatory care by African American and White Medicare managed care enrollees.

OBJECTIVE: Compare missing data and reliability of health care evaluations between African Americans and Whites in Medicare managed care health plans. METHOD: Consumer Assessment of Healthcare Providers and Systems (CAHPS) 3.0 health plan survey data collected from 109,980 Medicare managed care enrollees (101,189 Whites, 8,791 African Americans) in 321 plans. Participants self-administered the survey and four single-item global ratings of care. RESULTS: Missing data rates were significantly higher for African Americans than Whites on all CAHPS items (p < .0001). Internal consistency reliability estimates for the CAHPS scales did not differ significantly between African Americans and Whites, but plan-level reliability estimates for the scales and global rating items were significantly lower for African Americans than Whites. DISCUSSION: Higher missing data rates and lower plan-level reliability estimates for African American Medicare managed care enrollees suggest caution in making race/ethnicity comparisons. Future efforts are needed to enhance the quality of data collected from older African Americans.

Adherence to treatment factors in hypertensive African American women.

Hypertension (HTN) is a major public health problem in African American women. The disproportionate rate of HTN in African American women makes it a high-priority national health objective. Lack of access to a regular continuous source of care may be particularly significant among African American women because such a source of care is a prerequisite to early diagnosis and successful treatment. Understanding the factors that influence access to care for HTN in African American women will provide the information needed to improve the use of healthcare services and enhance adherence to treatment. Despite the known importance of adherence to successful HTN treatment, few attempts have been made to incorporate the indicators of adherence to HTN treatment into a theoretical model that can be used to guide research and practice with African American women. The adapted Hill-Levine model offers an appropriate framework for studying these phenomena in African American women because factors frequently associated with seeking and using healthcare services are organized in three dimensions, including predisposing, enabling, and reinforcing factors. This article discusses the magnitude of the problem presented by HTN and lack of HTN control in African American women, identifies from the literature the factors related to adherence to treatment in HTN management, in general, and in African American women, specifically, and uses the adapted Hill-Levine model to organize the identified predisposing, enabling, and reinforcing factors associated with adherence to HTN treatment recommendations among African American women.

The effectiveness of an advance notice letter on the recruitment of African Americans and Whites for a mailed patient satisfaction survey.

OBJECTIVE: Evaluate an advance notice letter for enhancing patient satisfaction survey response rates in African Americans and Whites. METHODS: Randomized trial of an advance notice letter (versus no letter) mailed two weeks prior to a mail satisfaction survey in a random sample of 600 African American and White patients ages 50 and older, stratified by ethnicity, sex, and age. RESULTS: The advance letter was independently associated with a completed survey in Whites (odds ratio = 2.73; 95% confidence interval [CI] 1.66, 4.50), but not in African Americans (odds ratio = 1.24; 95% CI 0.76, 2.02). Being male was independently associated with returning a survey in Whites (odds ratio = 1.86; 95% CI 1.13, 3.06). Younger age (odds ratio = 0.98; 95% CI 0.96, 0.99) was independently associated with a completed survey in African Americans. DISCUSSION: An advance letter prior to a satisfaction survey is associated with increased response rates in Whites, but not in African Americans.

International health care perspectives: the Cameroon example.

The purpose of this article is to describe the health care system in the West African country of Cameroon and to make recommendations for quality improvement. The Cameroon health care system, used here as an example of the type of system often encountered in developing countries, is described in terms of factors influencing its operation with subsequent health outcomes. International assistance and collaboration with developed countries to improve the Cameroon health care system and health status of the Cameroon people are recommended.

Overview of themes identified from African American discourse on quality of care.

The article reports on an exploratory descriptive study conducted to establish quality-of-care dimensions from African Americans' perspective, using a combined focus group interview and modified Delphi process. Descriptors of quality, which were identified using participants' vocabulary and thinking patterns, were used to establish quality-of-care dimensions; they were then examined in terms of an adapted quality-of-care framework. Themes and issues related to quality of care also were identified. The article analyzes the qualitative themes abstracted from that discourse and relates focus group interview guide questions to the emerging quality-of-care issues. An interpersonal processes-of-care framework is used to examine the quality-of-care themes, and the quality-of-care issues are discussed using a systems theoretical perspective.