Five Dimensions of Needs for Help: The Efficacy of a Technology-Based Intervention Among Asian American Breast Cancer Survivors.

Cancer survivors including Asian American breast cancer survivors have reported their high needs for help during their survivorship process. With the COVID-19 pandemic, the necessity of technology-based programs to address their needs for help without face-to-face interactions has been highlighted. The purpose of this randomized intervention study was to determine the efficacy of a technology-based program in reducing various types of needs for help among this specific population. This was a randomized clinical trial with repeated measures. A total of 199 participants were included in the data analysis. The recruitment settings included both online and offline communities/groups for Asian Americans. The needs for help were assessed using the Support Care Needs Survey-34 Short Form (SCNS) subscales measuring psychological, information, physical, support, and communication needs. Data analysis was conducted through an intent-to-treat approach. In the mixed effect models, psychological needs, information needs, physical needs, and communication needs decreased over time (P < .001). However, there were no significant group * time effects. Social support significantly mediated the effects of a technology-based intervention on psychological, information, and support needs at the pre-test and the post-1 month. This study supported significant decreases in the needs for help of Asian American breast cancer survivors by a technology-based intervention. Further studies are needed with other racial/ethnic groups of cancer survivors to confirm the efficacy of a technology-based intervention in reducing cancer survivors' needs for help during their survivorship process.

Community sharing: Contextualizing Western research notions of contamination within an Indigenous research paradigm.

Báa nnilah is a chronic illness self-management program designed by and for the Apsáalooke (Crow) community. Arising from a collaboration between an Indigenous nonprofit organization and a university-based research team, Báa nnilah's development, implementation, and evaluation have been influenced by both Indigenous and Western research paradigms (WRPs). Báa nnilah was evaluated using a randomized wait-list control group design. In a WRP, contamination, or intervention information shared by the intervention group with the control group, is actively discouraged as it makes ascertaining causality difficult, if not impossible. This approach is not consonant with Apsáalooke cultural values that include the encouragement of sharing helpful information with others, supporting an Indigenous research paradigm's (IRP) goal of benefiting the community. The purpose of this paper is to address contamination and sharing as an area of tension between WRP and IRP. We describe how the concepts of contamination and sharing within Báa nnilah's implementation and evaluation are interpreted differently when viewed from these contrasting paradigms, and set forth a call for greater exploration of Indigenous research approaches for developing, implementing, and evaluating intervention programs in Indigenous communities. (Improving Chronic Illness Management with the Apsáalooke Nation: The Báa nnilah Project.: NCT03036189), ClinicalTrials. gov: NCT03036189).

Current Trends in Nursing Research Across Five Locations: The United States, South Korea, Taiwan, Japan, and Hong Kong.

PURPOSE: Despite the importance of research in the discipline of nursing, current trends in nursing research have rarely been discussed across countries. The purpose of this article was to identify current trends in nursing research across five countries, including the United States, South Korea, Taiwan, Japan, and Hong Kong, in order to provide directions for future global nursing research. ORGANIZING CONSTRUCT: A discussion article. METHODS: To identify the current trends, seven leaders from the five countries had discussions through a series of workshops and conference presentations. After the most recent conference, all the leaders reflected for a month on their presentations and compiled the exemplars and cases from their experience and the existing literature in individual countries into a table. The tables and supporting references were collected at the completion of the reflection period. Then, the PowerPoint (Microsoft Corporation, Redmond, WA, USA) slideshows of the conference presentations by the leaders and the collected tables were analyzed using a content analysis. FINDINGS: Six themes reflecting the current trends in nursing research were extracted: (a) demographic alterations; (b) increasing diversities and globalization; (c) technology innovation; (d) individualized or personal care and population health initiatives; (e) health policies and regulations; and (f) nursing workforce changes. CONCLUSIONS: Future directions for nursing research across the countries were proposed: (a) cost-effectiveness research; (b) implementation science; (c) data science; (d) training of the future generation of nurse researchers; (e) population health; and (f) team science. CLINICAL RELEVANCE: This topic could be applied to any clinical settings.

The Use of Mobile Health to Assist Self-management and Access to Services in a Rural Community.

The purpose of this study was to explore the barriers to and needs for using mobile health technology to assist low-income Asian American and Pacific Islander participants living in rural Hawaii in their healthcare. Three focus groups consisting of patients, family support/significant others, and providers (N = 19) were conducted to assess the unique needs of low-income Asian American and Pacific Islander patients in rural Hawaii. The electronic health literacy scale was also used among participants in the patients and family support/significant other groups. The total electronic health literacy means were 23.57 (SD = 9.71) among participants in the patient group, 34.50 (SD = 7.78) in the family support/significant others group, and 35.67 (SD = 4.56) in the providers group. The qualitative analysis yielded categories with three main themes: value of mobile health, stumbling blocks to mobile health, and mobile health wish list and subthemes. Practice implications include uses of these findings to integrate future versions of mobile health that will promote effective communication and information specifically to diverse low-income populations.

Recruitment of Asians and Pacific Islanders with Type 2 Diabetes into a Clinical Research Trial of Enhancing Diabetes Self-Management.

The objective of the study was to evaluate strategies and barriers to recruiting Asians and Pacific Islanders (API) with type 2 diabetes, into clinical trials. Descriptive statistics and content analysis were utilized to analyze reasons for non-participation. A "talk story" interview method was employed to recruit participants and uncover reasons for non-participation. A total of 1891 potential participants were identified and 340 declined participation. Eighty who declined were randomly selected to provide their reasons for non-participation. Socioeconomic issues faced by this population, such as earning wages to meet basic needs and care giving took precedence over altruistic participation in research.

Lifestyle intervention for Filipino Americans at risk for diabetes.

The aims of this study were to determine recruitment and retention feasibility, changes in self-efficacy for diet and exercise, and weight and fasting insulin level change after a lifestyle intervention in a community park. A randomized wait-list control design was used to recruit 50 Filipino American participants into a flexible eight-week curriculum. The retention rate was 88%. A weight loss of 1.52 kg (p < .05) and a waist reduction of 5.46 cm (p < .05) were found in the intervention group. Significant predictors for weight loss were gender and marital status. The intervention showed promise for this community program.

The Báa nnilah Program: Results of a Chronic-Illness Self-Management Cluster Randomized Trial with the Apsáalooke Nation.

Indigenous people in Montana are disproportionately affected by chronic illness (CI), a legacy of settler colonialism. Existing programs addressing CI self-management are not appropriate because they are not consonant with Indigenous cultures in general and the Apsáalooke culture specifically. A research partnership between the Apsáalooke (Crow Nation) non-profit organization Messengers for Health and Montana State University co-developed, implemented, and evaluated a CI self-management program for community members. This article examines qualitative and quantitative program impacts using a pragmatic cluster randomized clinical trial design with intervention and waitlist control arms. The quantitative and qualitative data resulted in different stories on the impact of the Báa nnilah program. Neither of the quantitative hypotheses were supported with one exception. The qualitative data showed substantial positive outcomes across multiple areas. We examine why the data sets led to two very different stories, and provide study strengths and limitations, recommendations, and future directions.

Depression and chronic illness: Asian/Pacific Islander adults in Hawaii.

Asian/Pacific Islanders (APIs) are comprised of many subgroups, such as Filipinos, Hawaiians, Japanese, Chinese, Koreans, and Samoans. They are often portrayed as the model minority for health, though they rarely seek help for depression. Few studies have reported findings for each of the subgroups separately. Because depression has been related to health care and outcomes of people with chronic illness, this study, utilizing previously collected data, compared the prevalence of mild, moderate, moderately severe and severe depression and self-reported chronic illnesses among several API groups. Understanding subgroup cultural differences in the prevalence of depression may contribute to better assessment of early signs of depression for this population. A descriptive statistical analysis found Pacific Islanders were three times more likely to have severe or moderately severe depression compared to Asians (4.8% vs. 1.5%). Other characteristics related to these findings include: cigarette use, employment status, emotional support, life satisfaction, and health care access.

A randomized controlled trial testing a virtual program for Asian American women breast cancer survivors.

A culturally tailored virtual program could meet the survivorship needs of Asian American women breast cancer survivors (AABC). This study aims to determine the efficacy of a culturally tailored virtual information and coaching/support program (TICAA) in improving AABC's survivorship experience. A randomized clinical trial (NCT02803593) was conducted from January 2017 to June 2020 among 199 AABC. The intervention group utilized TICAA and the American Cancer Society [ACS] website while the control group used only ACS website for 12 weeks. The outcomes were measured using the SCNS-34SF (needs; primary), the MSAS-SF (symptoms; secondary), and the FACT-B (quality of life; secondary). The data were analyzed using an intent-to-treat approach. The intervention group showed significant reductions in their needs from the baseline (T0) to post 4 weeks (T1) and to post 12 weeks (T2). Although the changes were not statistically significant, the intervention group had decreased symptoms from T0 to T2 while the control group had an increase in their symptoms. The intervention group had a significant increase in their quality of life from T0 to T2. A culturally tailored virtual program could therefore improve quality of life in AABC patients. Trial Registration: To Enhance Breast Cancer Survivorship of Asian Americans (TICAA), NCT02803593, https://clinicaltrials.gov/ct2/show/NCT02803593?titles=TICAA&draw=2&rank=1.

Improving Chronic Illness Self-Management with the Apsáalooke Nation: The Báa nnilah Project, a cluster randomized trial protocol.

Chronic illness (CI) is a major cause of morbidity and mortality for Indigenous people. In Montana, Indigenous communities disproportionately experience CI, a legacy of settler colonialism. For over two decades, Messengers for Health, an Apsáalooke (Crow Indian) non-profit, and Montana State University have partnered to improve community health using a community-based participatory research (CBPR) approach. We developed Báa nnilah, an intervention utilizing community strengths, to improve CI self-management. This manuscript describes the protocol for a cluster randomized trial with two arms: an intervention group and a wait list control group, who both participated in the Báa nnilah program. Enrollment occurred through family/clan networks and community outreach and attended to limitations of existing CI self-management interventions by using an approach and content that were culturally consonant. Participants received program materials, attended seven gatherings focused on improving CI management, and received and shared health information through storytelling based on a conceptual framework from the Apsáalooke culture and incorporating CI self-management strategies. Participant support occurred within partnership dyads during and between gatherings, from community mentors, and by program staff. The study used mixed methods to evaluate the intervention, with qualitative measures including the Short Form Health Survey (SF-12), Patient Health Questionnaire (PHQ-9), Patient Activation Measure (PAM), and a suite of PROMIS measures, various physical tests and qualitative survey responses, semi-structured interviews, and outcomes shared by participants with program staff. We hypothesized that Báa nnilah would significantly improve participant health outcome measures across multiple dimensions with quality of life (QoL) as the primary outcome. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03036189. Registered on 30 January 2017. (From https://clinicaltrials.gov/ct2/show/NCT03036189).

Perceptions related to diet and exercise among Asians and Pacific Islanders with diabetes.

The purpose of this study was to explore the perceptions of Asians and Pacific Islanders (API) with Type 2 diabetes related to diet and exercise. A descriptive content analysis was conducted on verbalized responses from 15 participants in focus groups who were asked "What role does your culture play in what, when, and how much you eat?" and "If and/or how much you exercise and what type of exercise you do?" The participants recorded responses were transcribed verbatim and analyzed for themes utilizing the social ecological framework.The families, environment, and the local culture in Hawai'i greatly affect the dietary and physical activities of the participants. Psychosocial themes related to diet included depression, denial, and lack of self control. Physical activities were impacted by motivation and awareness of complications of diabetes. Family upbringing, social events, food portions and variety, and reciprocity contributed to eating behaviors of the participants. Family values in sports and role expectations of gender influenced physical activities.This study identified social ecological influences on health behavior among Asians and Pacific Islanders. The findings suggest various efforts for physicians and other health care providers to assist API in taking care of their diabetes.

A center for self-management of chronic illnesses in diverse groups.

Prevention and successful treatment of chronic disease require a scientific understanding of the impacts and interactions of ethnicity, culture, and illness on self-management interventions. This article presents one approach to developing effective methods to address the needs of ethnic minorities living with chronic illnesses. Described is the University of Hawaii Center for Ohana Self-Management of Chronic Illnesses (COSMCI) located in the School of Nursing & Dental Hygiene and funded by the National Institute of Nursing Research (Award Number P20NR010671). The interdisciplinary center focuses on family and community self-management interventions in ethnically diverse populations with chronic illnesses. Areas discussed are: 1) the operational structure for creating an environment conducive to interdisciplinary ohana self-management chronic illness research in ethnically diverse populations; and 2) the development of sustainable interdisciplinary, biobehavioral research capacity. The COSMCI uses a social cognitive theory framework to guide the application of established self-management interventions to Asian and Pacific Island populations (API) through three conceptually linked research projects on HIV infection, type 2 diabetes, and chronic obstructive pulmonary disease. COSMI addresses the feasibility of sharing of lessons learned among the approaches taken. The interdisciplinary nature of COSMCI increases the potential success of the intervention efforts.

Feasibility of Using Mobile Technology to Improve Physical Activity Among People Living with Diabetes in Asia.

Background: Chronic conditions such as diabetes (DM) and cardiovascular disease are associated with disability and poor quality of life. Asians are 30% more likely than non-Hispanic Whites to develop type 2 DM. The important roles of wearable technological applications or devices in maintaining individuals' motivation to attain their physical activity (PA) goal have been reported. However, evidence of the feasibility and impact of the mobile technology on the PA in Thailand is limited. This study aims to examine the feasibility and the impact of the immediate performance feedback feature of the wearable device on PA. Methods: This pilot study recruited persons aged 18 or older with diabetes from two diabetes clinics in Chiang Mai, Thailand. Participants were randomly assigned into three groups: the aware group (AW: can see the step count on the device screen), the unaware group (UW: the device screen was completely covered), and the control group (usual care). Participants in the AW and UW groups were asked to wear the device for 2 full days while the usual care group did not wear the device. All participants completed a questionnaire package at their first study visit. Data analysis of univariate and multivariate general linear models were conducted using SAS version 9.4 (SAS Institute Inc., Cary, NC). All significance levels were set at 5%. Results: One hundred and fourteen participants age ranged from 39 to 75 years old were included in this analysis. The majority were female (n = 86, 69%) and married (n = 103, 82%). No adverse events were reported among device users. Within 2 days, there were less than 10% missing data and more than 70% of participants liked the devices mainly because they could see the step count. More than 63% of participants who wore the device had an average of steps greater than 10,000 per day. Although the number of steps and sleep hours were not significantly different between the AW and UW groups, 68% of the AW participants found that the device help them with their exercise. Discussion: The results demonstrate the feasibility of the use of the wearable device among people living with chronic conditions. Participants found that the step count screen provided immediate physical performance feedback that was helpful with their exercise. The behavioral changes, however, could not be examined due to the short duration of the usage. Future studies that require longer device usage in larger sample sizes are needed.

Partnership to build research capacity.

Today's nursing leaders are setting the stage for the next evolution--bringing together skilled clinicians and administrators with peers in education to create new approaches to leading the profession forward. Partnerships share goals, common purpose, mutual respect, willingness to negotiate and compromise, informed participation, information giving, and shared decision making. The shared practice academia effort between a public university and a private health care system situated in the island state of Hawai'i is described. The medical center and school of nursing pursued individual strategic efforts to build research capacity and used the opportunity to fund academic practice research projects. The mutual need and recognition of the high stakes involved, in concert with stable, committed leaders at all levels, were key to the early success of their efforts. Through the formal research partnership mechanism, a discrete focus was created for efforts and used to move to tactical, operational, and interpersonal integration in this relationship.

The Refined Middle-Range Theory on Women's Leadership in Asian Culture.

Introduction: Because virtually no theories were available to explain unique characteristics of Asian women's leadership in nursing, a middle-range theory on women's leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women's leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women's Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women's leadership in nursing across the globe.

Improving chronic illness self-management with the Apsáalooke Nation: Development of the Báa nnilah program.

RATIONALE: Since 1996, members of the Apsáalooke (Crow) Nation and faculty and students at Montana State University have worked in a successful community-based participatory research (CBPR) partnership, leading to increased trust and improvements in health awareness, knowledge, and behaviors. As major barriers to health and healthy behaviors have caused inequities in morbidity and mortality rates for multiple chronic diseases among the Apsáalooke people, community members chose to focus the next phase of research on improving chronic illness management. OBJECTIVE: Existing chronic illness self-management programs include aspects inconsonant with Apsáalooke culture and neglect local factors seen as vital to community members managing their health conditions. The aim of this study was to use CBPR methods grounded in Apsáalooke cultural values to develop an intervention for improving chronic illness self-management. METHOD: Community members shared stories about what it is like to manage their chronic illness, including facilitators and barriers to chronic illness management. A culturally consonant data analysis method was used to develop a locally-based conceptual framework for understanding chronic illness management and an intervention grounded in the local culture. RESULTS: Components of the intervention approach and intervention content are detailed and similarities and differences from other chronic illness management programs are described. CONCLUSIONS: Our collaborative process and product may be helpful for other communities interested in using story data to develop research projects, deepen their understanding of health, and increase health equity.

Factors influencing osteoporosis preventive behaviours: testing a path model.

AIM: This paper is a report of a study to test a model of certain factors influencing people engaging in osteoporosis preventive behaviours, and to estimate the direct and indirect effects of personal and social factors on whether people engage in those behaviours. BACKGROUND: Osteoporosis preventive behaviours, including exercise and calcium intake, help decreasing the risk of developing osteoporosis. Reasons for engaging in osteoporosis preventive behaviours are complex and influenced by personal and social factors. Years of education, self-efficacy, knowledge of osteoporosis, social support and social capital have been indicated to increase people engaging in osteoporosis preventive behaviours; but age has been shown to decrease those behaviours. METHODS: The proposed model was developed using Social Cognitive Theory and a conceptual framework for addressing the social context of health behaviour. A correlational cross-sectional study was carried out in 2005, using questionnaires and a convenience sample of 243 participants. Data analysis included descriptive statistics, correlation techniques and path analysis. RESULTS: Self-efficacy was a better predictor of engaging in osteoporosis preventive behaviours than were the other variables. Social capital had a statistically significant direct and indirect effect on osteoporosis preventive behaviours. The modified path model showed good fit with the data. CONCLUSION: The associations between personal and social factors extend our knowledge from previous studies and increase our understanding of the complex relationships among the study variables. The model provides guidance for future nursing practice, research, and education programs related to osteoporosis prevention.

Japanese American Nursing Education Leadership.

Why are there so few Japanese-American Nursing Education leaders in the United States when Asians in general are considered the "model minority"? Several reasons point to the cultural and value differences of an Eastern versus Western perspective. Many who have addressed this issue in other professional fields explain this phenomenon as the bamboo ceiling. This article provides the experiences of two Japanese American Nurse Leaders framed through a theoretical framework proposed by Bolman and Deal (1991), which seems to relate to their "human resource leadership" style and the strong belief and empowerment of others. These leadership types develop symbols and cultures to shape human behavior with the shared mission and identity of the organization in mind which is in concert with the Japanese American cultural values of collectivism. Explanation and recommendations for future leaders are provided along with examples by two nurse leaders which may provide better insight into an answer to the question of "Why so few?"

An Emerging Integrated Middle-Range Theory on Asian Women's Leadership in Nursing.

INTRODUCTION: Asian cultures reflect patriarchal cultural values and attitudes, which likely have influenced women leaders in their countries differently from women in Western cultures. However, virtually no leadership theories have been developed to reflect the experiences and development of nursing leaders from Asian cultures. The purpose of this article is to present an emerging integrated middle-range theory on Asian women's leadership in nursing. METHODOLOGY: Using an integrative approach, the theory was developed based on three major sources: the leadership frames of Bolman and Deal, literature reviews, and exemplars/cases from five different countries. RESULTS: The theory includes two main domains (leadership frames and leadership contexts). The domain of leadership frames includes human resources/networks, structure/organization, national/international politics, and symbols. The domain of leadership contexts includes cultural contexts, sociopolitical contexts, and gendered contexts. DISCUSSION: This theory will help understand nursing leadership in Asian cultures and provide directions for future nurse leaders in this ever-changing globalized world.

A Systematic Review of Adolescent Self-Management and Weight Loss.

INTRODUCTION: The aim of this review is to evaluate self-management interventions among overweight and obese adolescents to direct future research and practice. METHODS: Studies published between 2008 and 2014 were identified by electronic database searches. The Jadad Scoring of Quality Reports of Randomized Clinical Trials was used to evaluate the quality of the studies with subsequent reviews. RESULTS: Out of 69 studies, 10 randomized controlled trials were reviewed after all inclusion and exclusion criteria were met. Quality scores ranged from 7 to 11 out of 13 (M = 9.2, SD = 1.13). For the majority of studies, self-management strategies for weight loss were found to be significant for a mix of behavioral, psychological, anthropometric, and metabolic outcomes. DISCUSSION: Findings indicated that interventions were most successful when incorporating family members. Self-management interventions that include a combination of appropriate diet, physical activity, and behavioral strategies with a family component are recommended.