Perceived Mental Healthcare Barriers and Health-seeking Behavior of African-American Caregivers of Adolescents with Mental Health Disorders.

African-American adolescents with mental health disorders are more likely to experience higher rates of depressive moods but are less likely to utilize mental health resources. Mental healthcare providers inform caregivers of adolescents with mental health issues about appropriate resources to facilitate appropriate treatment decisions. Although we understand rates of utilization of services, little understanding exists concerning socio-ecological barriers African-American caregivers experience when seeking mental health care for their adolescents. This study explores African-American caregiver perceptions of barriers to mental health care for adolescents with mental health disorders. We sought to understand how these perceptions influence African-American caregiver mental health-seeking behavior. This qualitative study utilized semi-structured interviews using a grounded theory approach to identify common themes describing experiences of African-American caregivers accessing mental health care for their adolescents. Previous caregiver experiences with mental illness, perceptions of social support, early intervention by educators and extrinsic behavior requiring medication compliance affected caregiver decision-making. Stigma associated with mental illness was a potential barrier to access to mental health care. Financial barriers that prevent access to care and an overall belief that mental health may not be as important as other issues was not identified as affecting health-seeking behaviors for mental health care. Caregivers who struggled with mental health issues themselves recognized these in adolescents and sought mental healthcare services. Caregiver previous experiences with mental healthcare services influenced their decision-making. Healthcare provider ability to engage adolescents, caregivers, and support systems increases the possibilities for positive experiences and continuation of treatment.

Summative Content Analysis for Understanding of Romantic Relationships Among Rural Mexican American Adolescent Women.

An understanding of romantic relationships among adolescent Mexican-American females is lacking yet needed to provide culturally appropriate sexual health interventions. Although explored among other populations, romantic relationships among adolescents in rural settings is under-studied. This study explores romantic relationships for rural Mexican American female adolescents as a component of sexual health promotion. Rural Mexican-American adolescent females (n = 82) aged 14-18 years were recruited via convenience sampling at a rural health clinic. They completed open-ended individual interviews describing romantic relationships. Responses to open-ended questions were analyzed using summative content analysis. The majority reported sexual activity (62.2%) of which 23.5% had been pregnant. Summative content analyses identified personal characteristics and relationship characteristics as main categories with eight additional subcategories from responses. Sex was reported as what men wanted from women while physical attractiveness was perceived as important for both genders in development of romantic relationships. They prioritized other relational and personal characteristic such as integrity, and partner treatment of self and others. More obesity was present among those reportedly in romantic relationships. Description of parental roles as a component of romantic relationships was not present. Addressing adolescent romantic relationship with an emphasis on what male and female adolescents want or perceive as expected from relationships, long-term outcomes of relationships and on parental roles may enhance sexual health among rural Mexican-American adolescent populations. This study addresses a gap in literature by exploring romantic relationships for rural Mexican American female adolescents. This understanding of romantic relationships augments existing sexual health programing for these adolescents.

Attachment and associated sexual health behaviors of heterosexual Mexican housewives.

Sexually transmitted infections including human immunodeficiency virus are international public health concerns. Heterosexual women who are in steady relationships have been described as a particularly vulnerable population at risk for sexually transmitted infections acquired from their male partners. In this pilot study, we describe associations identified via cross-sectional survey among demographic variables, attachment style, and condom use in Mexican heterosexual women (ages 20-44 years, n  =  50) who self-reported current steady partner relationships. Descriptive, bivariate, and correlation analyses were conducted. Secure attachment and condom use were positively correlated with education level. Limited sexual risk prevention knowledge and contraception use, low risk perception within male partner relationships and misconception about proper condom use were identified as sources of elevated risk for sexually transmitted infections via male partners. Implications of findings include sexual health intervention modification to include dialogue concerning the context of steady relationship and sexual risk among Mexican heterosexual women.

Toward an understanding of the context of anal sex behavior in ethnic minority adolescent women.

Understanding the context of anal sex behavior among ethnic minority adolescent women has public health implications for behavioral sexual health promotion and risk reduction interventions. African-American (n = 94) and Mexican-American (n = 465) women (14-18 years of age) enrolled in a clinical trial completed semi-structured interviews to assess psychosocial and situational factors and relationships to sexual risk behavior, substance use, sexually transmitted infection/HIV acquisition, and violence. Bivariate analyses with comparisons by anal sex experiences identified differences by ethnicity and higher self-reported histories of sexual risk behaviors, substance use, violence, and stressful psychosocial and situational factors among adolescent women experiencing anal sex. Predictors of anal sex identified through logistic regression included Mexican-American ethnicity, ecstasy use, methamphetamine use, childhood sexual molestation, oral sex, and sex with friends for benefits.

Sexual risk behavior and STI health literacy among ethnic minority adolescent women.

Although information is available for prevention of sexually transmitted infection (STI/HIV), adolescents continue to engage in high risk sexual behavior particularly ethnic minority adolescent women with histories of STI or abuse. A description therefore of STI/HIV knowledge and sexual risk behavior among these women is indicated for modification of prevention efforts for sexual health promotion. African-American (n=94) and Mexican-American (n=465) adolescent women 14-18 years of age were included in the study. Assessments of sexual risk behavior and STI/HIV knowledge among these adolescent women described Mexican-American women as at higher risk of STI, pregnancy, substance use and abuse with lower levels of STI/HIV knowledge, previous HIV testing and perceptions of risk than African-American women. A focus on Mexican-American adolescent women with histories of STI and abuse is indicated for translation of community-based health promotion interventions for amelioration of potential adverse sexual health outcomes among ethnic minority adolescent women.

Mexican-American adolescents' perceptions about causes of perinatal depression, self-help strategies, and how to obtain mental health information.

PROBLEM: Perinatal depression is a public health concern as it is associated with adverse pregnancy outcomes. Previous studies have recommended further examination of perinatal depression among Mexican-American adolescents. Thus, the purpose of this study was to understand pregnant and postpartum Mexican-American adolescents' knowledge and beliefs concerning perinatal depression. METHODS: This qualitative descriptive study examined perceptions about the causes of perinatal depression, self-help strategies, and how to obtain mental health information. Data were analyzed using deductive and inductive qualitative content analysis. A convenience sample, consisiting of 20 pregnant and postpartum adolescents, self-identified as Mexican-Americans, between the ages of 15 and 19 years was interviewed. FINDINGS: The quality of relationships with their family and significant other and difficulties in transitioning to motherhood were described as potential causes for depression. Journaling, exercising, and spending time with friends and family were identified as self-help strategies. Healthcare providers, the internet, and mothers who have experienced depression were stated as helpful sources of mental health information. CONCLUSION: An assessment of their psychosocial environment is indicated to identify risk or protective factors for perinatal depression. Its consideration and inclusion in interventions may optimize mental health among perinatal adolescents.

Motivators of HIV Risk-Taking Behavior of Young Gay Latino Men.

BACKGROUND: Latinos have been disproportionately affected by HIV, placing young Latino men who have sex with men (MSM) at increased risk within this ethnic community. OBJECTIVES: The study explored the lived experience of growing up as a young Latino MSM and motivators to HIV risk behaviors. DESIGN: Five young Latino MSM ages 18 to 25 years were enrolled in a qualitative, phenomenological study using semistructured interviews followed by a HIV risk-taking behavior survey. RESULTS: A relationship was identified between patterns of belonging and self-acceptance of sexual orientation and motivators of HIV sexual risk-taking behavior. La familia, machismo, hiding, and guilt were themes related to belonging and self-acceptance. CONCLUSIONS: The need to belong and be accepted by the family and self-acceptance of sexual orientation are related to the HIV sexual risk-taking behavior of young Latino MSM. J Am Psychiatr Nurses Assoc, 2008; 14(4), 310-316. DOI: 10.1177/1078390308321926.

Características psicométricas del cuestionario de abuso en contra de la mujer, versión en español: su uso en investigación y práctica clínica / Psycometric characteristic of the women abuse screen, spanish versión: it uses in research and practice

Este artículo describe el proceso de traducción y adaptación del inglés-español del instrumento "Woman Abuse Screen" para uso en investigación. El cuestionario original fue traducido al español por dos traductores e intérpretes bilingües, y posteriormente se condujo una revisión de contenido por expertos asegurándose que incluía elementos relevantes del concepto "violencia". El instrumento traducido "Cuestionario de Abuso en contra de la Mujer" (CACM) fue puesto a prueba con 217 mujeres que iniciaron su control prenatal en clínicas en Monterrey, México. El análisis factorial exploratorio con rotación Varimax agrupó nueve reactivos en tres factores (violencia sexual, física y psicológica) con varianza explicada de 79.8 por ciento. El coeficiente de confiabilidad obtenido fue 0.86 (Alfa de Cronbach). Se concluye que CACM es un instrumento fácil de contestar y que entrega información sobre el tipo de violencia que está siendo víctima la mujer en el presente o el pasado. CACM puede ser utilizado en investigación y/o práctica clínica.

This paper describes the process of English-Spanish translation and adaptation of the "Woman Abuse Screen" for use in research. The original screen was initially translated into Spanish by two bilingual translators-interpreters, followed by a content review conducted by experts to ensure that the screen included relevant aspects of the conceptualization of violence. The Spanish translation "Cuestionario de Abuso en contra de la Mujer" (CACM) was tested with 217 pregnant women initiating prenatal care in outpatient clinics in Monterrey, Mexico. Exploratory factor analysis with Varimax rotation grouped the nine items on three factors (sexual, physical and psychological violence) with an explained variance of 79.8 percent. A reliability coefficient of 0.86 was obtained (Cronbach Alpha). It is concluded that CACM is easy to answer and provides information on previous and present violence experienced by the women. CACM may be utilized in practice and research for screening of interpersonal violence.

Traducción y validación del Cuestionario de Beneficios y Barreras del Control Prenatal en embarazadas de México / Translation and Validation of the “Cuestionario de Beneficios y Barreras del Control Prenatal” in Mexican pregnant women

Objetivo: El propósito principal del presente artículo es describir el proceso de adaptación y validación del Questionnaire of Barriers, Motivators and Facilitators of Prenatal Care Utilization al Modelo de Promoción en Salud (MPS) y a población Mexicana. Metodología: El cuestionario original fue inicialmente traducido al español. Se realizó una revisión minuciosa del contenido del instrumento para asegurar validez y congruencia con el MPS. Los reactivos fueron agrupados por subescalas de acuerdo al modelo. El instrumento en español “Cuestionario de Beneficios y Barreras del Control Prenatal” fue puesto a prueba con 253 mujeres embarazadas que asistían a la Consulta de Obstetricia en el Área Metropolitana de Monterrey, México. Se realizó análisis factorial exploratorio para identificar los grupos o conglomerados de variables relacionadas. Se obtuvieron los coeficientes de confiabilidad Alfa de Cronbach para cada una de las subescalas. Resultados: La subescala de beneficios reveló un solo factor con varianza explicada de 41%; Barreras reveló siete factores con varianza explicada de 68%; y Actitud hacia el embarazo reveló tres factores con varianza explicada de 58%. Todos los factores por subescala mantuvieron Valores Característicos (eigenvalues) por arriba de 1.0. Conclusión: Se concluye que el Cuestionario de Beneficios y Barreras del Control Prenatal obtuvo validez de sus constructos, con base en el MPS. Las subescalas obtuvieron coeficientes de confiabilidad sobre .70 lo que es aceptable para nuevas escalas psicosociales, confirmándose que las mediciones mantienen una congruencia interna y una homogeneidad integrada de sus reactivos

Objective: The main purpose of the present article is to describe the adaptation and validation process of the questionnaire of “Barriers, Motivators and Facilitators of Prenatal Care Utilization" to the Health Promotion Model (HPM) and to Mexican population. Methods: The original questionnaire was initially translated into Spanish. A meticulous content review of the translated instrument was conducted to ensure validity and coherence with the HPM. Items were grouped by subscales in congruence with the model. The Spanish translation, “Cuestionario de Beneficios y Barreras del Control Prenatal” was tested with 253 pregnant women receiving prenatal care in outpatient clinics in Monterrey, Mexico. Exploratory factorial analysis was performed to identify the groups or conglomerates of related variables. Reliability testing utilizing Cronbach’s Alpha coefficient was conducted for each subscale. Results: Subscale of Benefits revealed a single factor with explained variance of 41%; Barriers revealed seven factors with explained variance of 68%; and Attitude toward pregnancy revealed three factors with explained variance of 58%. All factors from the subscales maintained Eigenvalues above 1.0. Conclusions: The Cuestionario de Beneficios y Barreras del Control Prenatal obtained construct validity based on the HPM. The subscales obtained reliability coefficients over .70, considered acceptable for new psychosocial scales, confirming that the measurements maintained an internal coherence and integrated homogeneity of their items