Working Against Gender-Based Violence in the American South: An Analysis of Race, Ethnicity, Gender, and Sexuality in Advocacy.

Non-profit organizations that address gender-based violence must create diverse, inclusive, and equitable workplaces for advocates so that they can adequately serve diverse survivors. Despite recent efforts, differential treatment and high turnover among minority advocates continue. Further strategies to eliminate discriminative organizational practices are needed. We interviewed 25 advocates employed by non-profit organizations in a Southeastern state to examine how race, ethnicity, gender, and sexuality shape their work experiences. Guided by constructivist grounded theory and intersectionality, data analysis yielded four major themes that covered white dominance in advocacy, essentialized womanhood and heteronormativity, serving communities of color, working in the Deep South. Patriarchal values, religious norms, and gender roles influenced how advocates' work was received by the communities. Racial/ethnic minority, and sexual and/or gender minority advocates faced discrimination, tokenism, and negative stereotypes. Transforming organizational climate and policies is necessary to support minority advocates' work engagement and ability to serve marginalized communities.

Intervention to Reduce Stigma and Improve Knowledge of HPV and Cervical Cancer in Nigeria: A Community-Based Assessment.

We compared the effectiveness of an educational intervention at reducing stigma and improving knowledge of human papillomavirus (HPV) and cervical cancer among Nigerian men and women. We used a pre-/posttest design to deliver 2 educational interventions to 266 adults. Low knowledge was observed at baseline, which improved significantly post-intervention with no difference between groups. No significant changes were observed between groups in 5 out the 6 stigma domains. Health education was effective in improving knowledge. However, the lack of positive change in stigma shows urgent need for HPV and cervical cancer stigma reduction interventions.

"The Only Way We'll Be Successful": Organizational Factors That Influence Psychosocial Well-Being and Self-Care Among Advocates Working to Address Gender-Based Violence.

Advocates who work for nonprofit organizations (NPOs) that address gender-based violence (GBV) experience a wide range of psychosocial health and well-being risks due to the emotionally demanding nature of the work they engage in. Most recommendations for advocates' self-care focus on individual-level activities, failing to hold the NPOs accountable for creating workplace cultures and practices that foster psychosocial well-being, self-care, and resilience among the advocates. The aim of this qualitative research was to further our understanding of organizational-level factors that influence psychosocial well-being and self-care practices among advocates who work for GBV-specific NPOs in a metropolitan area in the southeastern United States. We conducted in-depth interviews with 25 GBV-specific advocates. Constructivist grounded theory methods were used in coding and analyzing the data. Sixteen advocates identified as White, followed by five Black, two Hispanic, and two mixed-race/ethnicity. Mean age was 36 years. Most participants had a master's degree (n = 16). Analysis of the data resulted in three major themes: (a) Management and Leadership Style, (b) Interpersonal Relationship Dynamics, and (c) Culture of Self-Care. The ways in which leaders established relationships with other advocates to accomplish organizational goals, how advocates developed a sense of camaraderie with their coworkers, and shared norms around self-care shaped advocates' willingness and ability to engage in individual and collective self-care. Findings of this study highlight the role of GBV-specific NPOs in creating workplace cultures and practices that are conducive to engaging in self-care and developing resilience among the advocates. By fulfilling this responsibility, organizations would enable the advocates to not only survive, but thrive in their work and make even greater strides in the overall mission of GBV prevention.

Increasing Human Papillomavirus Vaccination and Cervical Cancer Screening in Nigeria: An Assessment of Community-Based Educational Interventions.

We explored the impact of two community-based educational interventions on Nigerian adults' knowledge and intention to take or encourage human papillomavirus (HPV) vaccine and cervical screenings. Face-to-face presentation and printed pamphlet intervention were delivered to 266 men and women aged 18 to 65 years in 12 locations in urban setting. At baseline, the majority (80%) had poor knowledge of HPV, and less than 12% had ever received or have a family member who had received HPV vaccine or cervical screening. Postintervention, there was significant increase (>70%) in the participants knowledge and intention to take or encourage HPV vaccination and cervical screening. In addition, more than half were willing to pay for HPV vaccine and screening even when expensive. Gender-focused and context-specific low-cost community-based educational interventions are effective in increasing HPV vaccine and cervical screening in sub-Saharan Africa.

After Ringing the Bell: Receptivity of and Preferences for Healthy Behaviors in African American Dyads Surviving Lung Cancer.

PURPOSE: To explore receptivity of and preferences for risk-reducing health behavior changes among African American survivors of early-stage lung cancer and their family members. PARTICIPANTS & SETTING: 26 African American non-small cell lung cancer survivor-family member dyads were recruited from two cancer programs in the southeastern United States. METHODOLOGIC APPROACH: Social cognitive theory principles guided the design and implementation of focus groups. Descriptive statistics were used to summarize the data, and thematic analysis was used to interpret the transcripts from the focus groups. FINDINGS: The following four themes were identified. IMPLICATIONS FOR NURSING: Participants emphasized the need for improved provider communication. Pragmatic communication interventions for providers, survivors, and family members may facilitate behavior change and improve outcomes among underserved populations.

Core strategies, social processes, and contextual influences of early phases of implementation and statewide scale-up of group prenatal care in South Carolina.

This mixed-methods process evaluation examined a state-wide, interagency collaborative in South Carolina that expanded CenteringPregnancy group prenatal care from two to five additional healthcare practices from 2012 to 2015. The evaluation focused on delineating core processes, strategies, and external contextual elements of group prenatal care implementation and scale-up. Success of this scale-up was enhanced by the effective use and creation of windows of opportunity, which allowed stakeholders to pursue actions consistent with their own values, at both state and organizational levels. Most importantly, strong political advocacy and state-level financial commitment for group prenatal care made it possible for clinics throughout South Carolina to begin providing CenteringPregnancy to their patients. Improved understanding of the processes involved in scaling-up pilot interventions may enhance the effectiveness and efficiency of future expansion efforts.

Health behavior changes in African American family members facing lung cancer: Tensions and compromises.

PURPOSE: Behavioral interventions targeting cancer survivors often fail to address the clustering of unhealthy behaviors among family members and friends, and the impact of close relationships on behavior change. The study's aim was to identify factors associated with receptivity and preferences for lifestyle behavior change among family members of African-American survivors of lung cancer. METHODS: Principles of social cognitive theory guided the design. A descriptive, qualitative study recruited 26 African-American family members of lung cancer survivors from two teaching hospitals in the southeastern United States. A 20-item Information Form collected demographic, health status, and health behavior information. Family members participated in one of three semi-structured focus group discussions. RESULTS: Four major themes emerged: family members and survivors both resisted the caregiver role; dramatic changes evoked by the diagnosis of lung cancer were facilitators and barriers to lifestyle choices; leaning on faith was the primary source of support; and these families live with a constant threat of multiple cancers. Findings emphasize the importance of meaningful conversations among health-care providers, survivors, and family members during the time of diagnosis, treatment, and recovery, so that family members are better prepared to cope with anticipated changes. CONCLUSIONS: This study highlights the stressors that affect family members and sheds light on their unique needs. The stressors limit their ability to change health behaviors. Family members need basic education, skills training, and support related to the lung cancer diagnosis and other cancers. Current methods to provide these services are limited in their accessibility, availability, and effectiveness.

An Exploratory Survey of Older Women's Post-Fall Decisions.

This research examined factors influencing older women's post-fall decision making. We surveyed 130 independent older women from continuing care retirement communities and non-institutional homes. We categorized women's post-fall decisions as medical, corrective, and social decisions, and examined the associations between post-fall decision categories, decisional conflict, number of post-fall changes, self-rated health, frequency of falls, severity of falls, health literacy, awareness and openness to long-term care institutional options, and demographics. Older women experienced greater decisional conflict when making medical decisions versus social ( p = .012) and corrective ( p = .047) decisions. Significant predictors of post-fall decisional conflict were awareness of institutional care options ( p = .001) and health literacy ( p = .001). Future educational interventions should address knowledge deficits and provide resources to enhance collaborative efforts to lower women's post-fall decisional conflict and increase satisfaction in the decisions they make after a fall.

Involvement of Family Members and Professionals in Older Women's Post-Fall Decision Making.

This exploratory, descriptive study examined involvement of family members and professionals in older women's post-fall decision making. We conducted semistructured interviews with 17 older women who had recently fallen and 11 individuals these women identified as being engaged in their post-fall decision-making processes. Qualitative data analysis involved open and axial coding and development of themes. After experiencing a fall, these older women's openness to others' opinions and advice; their assessments of types and credibility of potential information sources; and the communication practices they established with these sources influenced how they accessed, accepted, or rejected information from family members and professionals. Increased awareness of the involvement of others in post-fall decision making could enhance communication with older women who fall. Developing and implementing practical strategies to help family members and professionals initiate and engage in conversations about falls and their consequences could lead to more open decision making and improved post-fall quality of life among older women.

African American Women's Recollected Experiences of Adherence to Breast Cancer Treatment.

PURPOSE/OBJECTIVES: To explore African American women's recollected experiences of breast cancer treatment.
. RESEARCH APPROACH: Qualitative description and narrative analysis.
. SETTING: South Carolina Oncology Associates, an outpatient oncology clinic serving rural and urban populations.
. PARTICIPANTS: 16 African American women with breast cancer previously enrolled in the control arm (n = 93) of a completed randomized, controlled trial. 
. METHODOLOGIC APPROACH: Feminist narrative analysis of in-depth individual interviews.
. FINDINGS: The authors identified three themes within the African American breast cancer survivors' recollected experiences of treatment adherence. INTERPRETATION: Although little evidence was presented of shared decision making with providers, patients were committed to completing the prescribed therapies. The narratives highlighted the value of in-depth examination of patients' perspectives, particularly among minority and underserved groups. With the exception of voicing personal choice of surgical treatment, the women trusted providers' recommendations with a resolve to "just do it." Although trust may enhance treatment adherence, it may also reflect power differentials based on gender, race, education, and culture.
. IMPLICATIONS FOR NURSING: Nurses should listen to patients describe their experience with cancer treatment and compare the themes from this study with their patients' story. This comparison will help nurses support patients through various aspect of diagnosis and treatment.

Living in Limbo: Latinas' Assessment of Lower Rio Grande Valley Colonias Communities.

Community asset mapping (CAM) is the collective process of identifying local assets and strategizing processes to address public health issues and concerns and improve quality of life. Prior to implementing a community-based physical activity intervention with Latinas in the Texas Lower Rio Grande Valley, promotoras [community health workers] conducted 16 interactive sessions in 8 colonias. The analysis of the transcribed CAM recordings and on-site observational data resulted in the construction of Living in Limbo as the thematic representation of these Latinas' social isolation and marginalization associated with pervasive poverty, undocumented immigration status or lack of citizenship, their fears emanating from threats to physical and emotional safety, and the barriers created by lack of availability and access to resources.

The Cultural and Linguistic Adaptation to Brazilian Portuguese and Content Validity of the Patient Expectations and Satisfaction With Prenatal Care Instrument.

BACKGROUND: Patient satisfaction reflects how an individual's expectations, goals, and preferences are met by health care providers or services. Most research on patient expectations and satisfaction has been conducted in developed countries; there was no Portuguese language instrument to measure pregnant women's expectations and satisfaction with prenatal care. PURPOSE: To adapt and test the Patient Expectations and Satisfaction with Prenatal Care (PESPC) instrument for use in Brazil. DESIGN: We conducted a systematic cultural and linguistic adaptation of the PESPC into Brazilian Portuguese and tested the validity of the adapted instrument. RESULTS: Implementation of this rigorous methodological process resulted in a valid, reliable, culturally, and linguistically appropriate instrument. IMPLICATIONS FOR PRACTICE: We recommend further assessment of the Brazilian Portuguese PESPC with more diverse samples of Portuguese-speaking pregnant women in Brazil and other countries. Application of this structured approach to cultural and linguistic instrument adaptation is one way to further transcultural nursing research.

A conversation analysis of verbal interactions and social processes in interpreter-mediated primary care encounters.

Language asymmetry between patients with limited English proficiency and health care providers increases the complexity of patient-provider communication. In this research, we used conversation analysis to examine the content and processes of five triadic clinical communication encounters between Spanish-speaking adult patients, English-speaking nurse practitioners, and clinic-based interpreters. Data collection included audio-recordings of the triadic clinical encounters and self-administered post-encounter surveys of the nurse practitioners and interpreters. Our findings revealed communication trouble spots that, when directly addressed by the interactants, facilitated processes of negotiating relationships, and coming to a mutual understanding. Exemplars labeled Making Assumptions; Colloquialisms as Signaling Potential for Trouble; Repairing a Mis-Statement; and Turn-Taking, Silences, and Laughter illustrated how the parties identified and navigated such trouble spots. The final exemplar, Attaining Intersubjectivity, represented a successful multi-lingual triadic communication. While the role of the interpreter often is seen as a conduit of information from one language to another, in practice they also enacted roles of communication collaborators and coconstructors. Future interdisciplinary research can include closer examination of occurrences of communication trouble spots and further exploration of how interpretermediated communication is conceptualized and problematized in diverse clinical settings, to promote language interpretation policies and practices that contribute to reducing health disparities among limited-English-proficient populations.

Undocumented migration in the United States: an overview of historical and current policy contexts.

The aims of this overview are to provide a brief historical review of federal, state, and local immigration policies and to examine the historical origin and current constructions of the undocumented immigrant. We discuss how past and current policies promote, regulate, restrict, and deter immigration into the United States and access to health services and draw implications for the profession of nursing.

Undocumentedness and public policy: the impact on communities, individuals, and families along the Arizona/Sonora border.

The focus of this article is the health impact and implications of undocumentedness along the U.S.-Mexico border, particularly the Arizona/Sonora region. We describe the direct and indirect influences of immigration policies on the health of individuals, families, and communities. The Arizona border region maintains close social, cultural, and linguistic ties to Mexico, and the amplified efforts to secure the border have been dramatic on the region and on the people who live there. The 261-mile stretch across the Arizona-Sonora Desert is the most deadly corridor for immigrants crossing into the United States because they are at risk of being killed, kidnapped, and coerced into smuggling drugs or dying in the desert. Gang-related violence is pushing more Central Americans, including unaccompanied minors, to the United States. The impact on individual migrants and their families has been devastating. We examine the health implications of policy and applaud the actions of the Arizona Nurses Association and the American Academy of Nursing to address the health needs of border communities.

The impact and implications of undocumented immigration on individual and collective health in the United States.

A nation of immigrants, the United States currently has more foreign-born residents than any other country; approximately 28% of these foreign-born residents are undocumented immigrants--individuals who either entered or are currently residing in the country without valid immigration or residency documents. The complex and constantly changing social, political, and economic context of undocumented migration has profound effects on individuals, families, and communities. The lack of demographic and epidemiologic data on undocumented immigrants is a major public health challenge. In this article, we identify multiple dimensions of vulnerability among undocumented persons; examine how undocumentedness impacts health and health care access and utilization; and consider the professional, practice, and policy issues and implications for nurses.

English language proficiency and physical activity among Mexican-origin women in South Texas and South Carolina.

OBJECTIVES: To examine the relationship between English language proficiency (ELP), physical activity, and physical activity-related psychosocial measures (i.e., exercise self-efficacy, exercise social support, perceptions of environmental supports) among Mexican-origin women in South Carolina and Texas. DESIGN: Adjusted robust regression and interaction modeling to evaluate baseline questionnaire data on self-reported ELP with CHAMPS leisure-time moderate-to-vigorous physical activity (MVPA), accelerometry data, Physical Activity Self-Efficacy, Physical Activity Social Support, and Environmental Support for Physical Activity in 118 Mexican-origin women. RESULTS: The adjusted regression revealed a significant association between ELP and perceived physical activity self-efficacy (ß = 234.2, p = .004), but not with physical activity social support. In South Carolina, CHAMPS leisure-time MVPA (411.4 versus 114.3 minutes, p < .05) was significantly different between women in the high ELP quartile and those in the very low quartile. Among high ELP Mexican-origin women, participants in Texas reported significantly higher MVPA measured by accelerometry (p = .042) than those in South Carolina. CONCLUSION: Our findings indicate that ELP was associated with physical activity and that contextual factors may also play a role.

Global health diplomacy: an integrative review of the literature and implications for nursing.

The increasing interconnectedness of the world and the factors that affect health lay the foundation for the evolving practice of global health diplomacy. There has been limited discussion in the nursing literature about the concept of global health diplomacy or the role of nurses in such initiatives. A discussion of this concept is presented here by the members of a Task Force on Global Health Diplomacy of the American Academy of Nursing Expert Panel on Global Nursing and Health (AAN EPGNH). The purpose of this article is to present an integrative review of literature on the concept of global health diplomacy and to identify implications of this emerging field for nursing education, practice, and research. The steps proposed by Whittemore and Knafl (2005) were adapted and applied to the integrative review of theoretical and descriptive articles about the concept of global health diplomacy. This review included an analysis of the historical background, definition, and challenges of global health diplomacy and suggestions about the preparation of global health diplomats. The article concludes with a discussion of implications for nursing practice, education, and research. The Task Force endorses the definition of global health diplomacy proposed by Adams, Novotny, and Leslie (2008) but recommends that further dialogue and research is necessary to identify opportunities and educational requirements for nurses to contribute to the emerging field of global health diplomacy.

Program planners' perspectives of promotora roles, recruitment, and selection.

OBJECTIVE: Program planners work with promotoras (the Spanish term for female community health workers) to reduce health disparities among underserved populations. Based on the Role-Outcomes Linkage Evaluation Model for Community Health Workers (ROLES) conceptual model, we explored how program planners conceptualized the promotora role and the approaches and strategies they used to recruit, select, and sustain promotoras. DESIGN: We conducted semi-structured, in-depth interviews with a purposive convenience sample of 24 program planners, program coordinators, promotora recruiters, research principal investigators, and other individuals who worked closely with promotoras on United States-based health programs for Hispanic women (ages 18 and older). RESULTS: Planners conceptualized the promotora role based on their personal experiences and their understanding of the underlying philosophical tenets of the promotora approach. Recruitment and selection methods reflected planners' conceptualizations and experiences of promotoras as paid staff or volunteers. Participants described a variety of program planning and implementation methods. They focused on sustainability of the programs, the intended health behavior changes or activities, and the individual promotoras. CONCLUSION: To strengthen health programs employing the promotora delivery model, job descriptions should delineate role expectations and boundaries and better guide promotora evaluations. We suggest including additional components such as information on funding sources, program type and delivery, and sustainability outcomes to enhance the ROLES conceptual model. The expanded model can be used to guide program planners in the planning, implementing, and evaluating of promotora health programs.