Strategies African-American Cancer Survivors Use to Overcome Fears and Fatalistic Attitudes.

This qualitative study explored strategies African-American cancer survivors use to overcome their fears and fatalistic attitudes toward cancer at the point of diagnosis through completion of treatment. Thirty-one African-American cancer survivors who had completed or nearly completed treatment were recruited through criterion purposeful sampling. In-depth, open-ended interviews were used to collect data. The data were analyzed using thematic analysis. Of the 31 survivors interviewed, 26 reported being fearful of cancer and believed that cancer would result in death. These cancer survivors were particularly fearful of having a cancer had spread, of being isolated, and performing less effectively at work. Strategies used to overcome these fears included increasing their own awareness about cancer, using positive self-talk, and avoiding negative people. The findings suggest that past experiences continue to influence fears and fatalistic perspectives about cancer and that educational resources to inform the public about cancer may be ignored until there is a confirmed diagnosis of cancer. Televised news broadcasts of high-profile personalities who had died from cancer were also anxiety provoking, particularly if the cancer survivor died of a recurrence from cancer. Prevalent sources of information and support for these survivors were family members or close friends they trusted with personal information, perceived as strong, or experienced in the care of other cancer survivors.

African-American Cancer Survivors' Use of Religious Beliefs to Positively Influence the Utilization of Cancer Care.

Among African-Americans, religion impacts health-seeking behaviors. This qualitative study used criterion purposeful sampling and thematic analysis in analysis of data from 31 African-American cancer patients to understand the influence of religion on the utilization of cancer care services. Our findings suggest that religious beliefs and practices positively influenced attitudes toward their illness and ability to endure treatment. God's ability to heal and cure, God's control over survival, God's will over their lives, and God's promise for health and prosperity were examples of survivor's religious beliefs. Religious practices such as prayer promoted a trusting relationship with healthcare providers and were a source of strength and encouragement.

Perceptions of mailed HPV self-testing among women at higher risk for cervical cancer.

Whether human papillomavirus (HPV) self-testing can expand access to cervical cancer screening will depend on making the test accessible and acceptable to higher-risk women. To evaluate a novel delivery mode, we mailed HPV self-test kits to low-income, under-screened women and assessed their perceptions of self-testing and cervical cancer prevention. We conducted a telephone survey of 199 women in North Carolina. Eligibility criteria included not having had a Pap test in 4 years and reporting 1 or more indicators of economic hardship, such as being uninsured. Over half (55 %) of women in the diverse sample were non-Hispanic black, and almost three-quarters (74 %) reported annual household incomes of $20,000 or less. Trust in HPV self-testing was moderate to high, with almost all women (98 %) agreeing the mailed test was safe. A few women (6 %) preferred HPV self-testing to Pap testing for protecting health, but most (75 %) had no preference. Trust in or preference for mailed self-testing did not vary by race or income. However, compared to white women, black women had lower HPV-related knowledge (OR 0.46, 95 % CI 0.23-0.92) and perceived lower cervical cancer risk in the absence of screening (OR 0.44, 95 % CI 0.22-0.86). We found similar patterns of disparities for women with very low (<$10,000) versus relatively higher incomes. Our findings suggest that, across racial and economic subgroups, under-screened women generally trust HPV self-tests delivered by mail. To succeed, programs for HPV self-testing must overcome disparities in knowledge and perceptions related to cervical cancer screening.

Longitudinal predictors of human papillomavirus vaccination among a national sample of adolescent males.

OBJECTIVES: We conducted a longitudinal study to examine human papillomavirus (HPV) vaccine uptake among male adolescents and to identify vaccination predictors. METHODS: In fall 2010 and 2011, a national sample of parents with sons aged 11 to 17 years (n = 327) and their sons (n = 228) completed online surveys. We used logistic regression to identify predictors of HPV vaccination that occurred between baseline and follow-up. RESULTS: Only 2% of sons had received any doses of HPV vaccine at baseline, with an increase to 8% by follow-up. About 55% of parents who had ever received a doctor's recommendation to get their sons HPV vaccine did vaccinate between baseline and follow-up, compared with only 1% of parents without a recommendation. Fathers (odds ratio = 0.29; 95% confidence interval = 0.09, 0.80) and non-Hispanic White parents (odds ratio = 0.29; 95% confidence interval = 0.11, 0.76) were less likely to have vaccinated sons. Willingness to get sons HPV vaccine decreased from baseline to follow-up among parents (P < .001) and sons (P = .003). CONCLUSIONS: Vaccination against HPV remained low in our study and willingness to vaccinate may be decreasing. Physician recommendation and education about HPV vaccine for males may be key strategies for improving vaccination.

Parental acceptance and uptake of the HPV vaccine among African-Americans and Latinos in the United States: A literature review.

BACKGROUND: African-Americans and Latinos suffer the highest cervical cancer burden compared to other populations and have sub-optimal HPV vaccination rates. OBJECTIVE: To condense research findings of studies conducted with African-Americans and Latinos on factors associated with HPV vaccine acceptability and uptake. METHODS: Standards for conducting an integrative review were used. PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases were searched. RESULTS: Awareness about HPV and the HPV vaccine varied by demographics of parents. For Latino parents, acculturation and awareness were associated. However, findings were mixed regarding the association between acculturation and knowledge. Among African-Americans, higher socioeconomic status (SES) and awareness were associated. Sexuality-related concerns, concerns about safety and low perceived risk of daughter's acquiring HPV emerged as barriers to vaccination among Latinos and African-Americans. Among Latinos, vaccine acceptability was associated with the vaccine's cancer prevention benefits and a provider's recommendation. Among African-Americans, acceptability was associated with awareness, perceived risk of acquiring HPV, religion, and a provider's recommendation. Few interventions have been developed to increase HPV vaccine acceptance. Importantly, few studies assessed the influence of culture on vaccine acceptance and uptake. CONCLUSIONS: Future research should be informed by culture-centered theories as this is the first step to inform the development of culturally-grounded interventions.

Underrepresented students' perspectives on institutional climate during the application and admission process to nursing school.

BACKGROUND: A growing body of literature has focused on issues related to recruitment and retention to enhance diversity in nursing. This study was designed to identify barriers and supports encountered by underrepresented students when applying to nursing school. METHOD: Twenty-two underrepresented baccalaureate nursing students participated in two focus groups. Applied thematic analysis was used to organize the data and identify major themes. RESULTS: Students expressed the importance of having (a) navigators in the offices of admissions and student affairs to provide encouragement, support, and information during the application process; (b) tailored programming for underrepresented students; (c) financial aid guidance; (d) timely feedback about admissions decisions; (e) a clear and easily navigated Web site; and (f) negotiation and acculturation to know the right things to do and say during the application and admissions process. CONCLUSION: Findings provide direction for developing programming and collaborations to enhance the institutional climate for underrepresented nursing applicants. [J Nurs Educ. 2015;54(5):261-269.].

Psychosocial predictors of depression among older African American patients with cancer.

PURPOSE/OBJECTIVES: To determine whether psychosocial factors predict depression among older African American patients with cancer. DESIGN: A descriptive correlational study. SETTING: Outpatient oncology clinic of a National Cancer Institute-designated cancer center in the southeastern United States. SAMPLE: African American patients with cancer aged 50-88 years. METHODS: Fisher's exact and Wilcoxon rank-sum tests were used to evaluate differences between patients who were possibly depressed (Geriatric Depression Scale) or not. Multivariate linear regression statistics were used to identify the psychosocial factors that predicted higher depression scores. Education and gender were included as covariates. MAIN RESEARCH VARIABLES: Religiosity, emotional support, collectivism, perceived stigma, and depression. FINDINGS: Participants (N = 77) had a mean age of 61 years (SD = 8.4), and a majority were well-educated, insured, religiously affiliated, and currently in treatment. Participants who were in the lowest income category, not married, or male had higher depression scores. The multivariable model consisting of organized religion, emotional support, collectivism, education, and gender explained 52% (adjusted R2) of the variation in depression scores. Stigma became insignificant in the multivariable model. CONCLUSIONS: Psychosocial factors are important predictors of depression. Emotional support and organized religious activities may represent protective factors against depression, whereas collectivism may increase their risk. IMPLICATIONS FOR NURSING: Nurses need to be particularly aware of the potential psychological strain for patients with collectivist values, experienced stigma, disruptions in church attendance, and lack of emotional support. In addition, the treatment plans for these patients should ensure that family members are knowledgeable about cancer, its treatment, and side effects so they are empowered to meet support needs. KNOWLEDGE TRANSLATION: Among older African American patients with cancer, emotional support and reassurance from family and friends that they will not abandon them decreases the likelihood of depressive symptoms and minimizes the impact of stigmatizing responses, but the perception that the illness is placing a strain on the family increases the likelihood of such symptoms. Emotional support likely is a stronger predictor of depressive symptoms than religious service attendance.