Adaptation of a Multimedia Chemotherapy Educational Intervention for Latinos: Letting Patient Narratives Speak for Themselves.

This study aims to adapt a video-based, multimedia chemotherapy educational intervention to meet the needs of US Latinos with advanced gastrointestinal malignancies. A five-step hybrid adaptation process involved (1) creating a multidisciplinary team with diverse Latino subject experts, (2) appraising the parent intervention, (3) identifying key cultural considerations from a systematic literature review and semi-structured Latino patient/caregiver interviews, (4) revising the intervention, highlighting culturally relevant themes through video interviews with Latino cancer patients, and (5) target population review with responsive revisions. We developed a suite of videos, booklets, and websites available in English and Spanish, which convey the risks and benefits of common chemotherapy regimens. After revising the English materials, we translated them into Spanish using a multi-step process. The intervention centers upon conversations with 12 Latino patients about their treatment experiences; video clips highlight culturally relevant themes (personalismo, familismo, faith, communication gaps, prognostic information preferences) identified during the third adaptation step. The adapted intervention materials included a new section on coping, and one titled "how to feel the best you can feel," which reviews principles of side effect management, self-advocacy, proactive communication, and palliative care. Ten Latinos with advanced malignancies reviewed the intervention and found it to be easily understandable, relatable, and helpful. A five-step hybrid model was successful in adapting a chemotherapy educational intervention for Latinos. Incorporation of video interviews with Latino patients enabled the authentic representation of salient cultural themes. Use of authentic patient narratives can be useful for cross-cultural intervention adaptations.

"Too Much to Ask, Too Much to Handle": Women's Coping in Times of Zika.

Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences for pregnancies have made governments and both national and international agencies issue advice and recommendations to women. This study was designed to understand the impacts of Zika on women who were less directly affected and less vulnerable to Zika. Women were recruited from various locations in Brazil, Puerto Rico, and the United States. Data were collected through semi-structured interviews and analyzed using thematic analysis. Women perceived that public health systems placed an unfair responsibility for preventing health complications from Zika onto women who had limited ability to do so. They also stated that the measures recommended to them were invasive, while creating the perception that women were the sole determinant of whether they contracted Zika. The results indicate that women with higher levels of education understood the limitations of the information, government actions, and medical care they received, which ended up producing higher levels of anguish and worry. Gender inequality and discrimination must be recognized and rendered visible in the public health emergency response. The social effects of the epidemic affected women more than had been thought before and at deeper emotional levels.

"I don't know if I have the courage": reproductive choices in times of Zika

In this transnational study, we aimed at providing insights into women's views and attitudes towards their reproductive rights during the Zika epidemic. Women of distinct nationalities and ethnicities were recruited from various locations in Brazil, Puerto Rico, and the United States. We conducted semi-structured interviews that suggest that participants reproductive decisions were intimately related to personal convictions and cultural beliefs, and their actions and thoughts were embedded in their sociocultural norms. The majority of women interviewed communicated that it takes courage to make the extreme, emotional, and overwhelming decision to have an abortion. The findings of this study suggest that women from different countries and regions, and with different levels of social capital, faced the same conflicts concerning reproductive decisions. Thus, we argue for the importance of considering cultural beliefs and behaviors when implementing health prevention or protection measures to control epidemics. This epidemic may be yet another opportunity for the improvement of women's health by strengthening culturally sensitive family planning services, and a broad spectrum of public health interventions.

Neste estudo transnacional, pretendemos fornecer informações sobre as opiniões e atitudes das mulheres em relação aos seus direitos reprodutivos durante a epidemia do Zika. Mulheres de diferentes nacionalidades e etnias foram recrutadas em vários locais do Brasil, Porto Rico e Estados Unidos. Foram realizadas entrevistas semiestruturadas que sugerem que as decisões reprodutivas dos participantes estavam intimamente relacionadas às convicções pessoais e crenças culturais, e suas ações e pensamentos foram incorporados em suas normas socioculturais. A maioria das mulheres entrevistadas comunicou que é preciso coragem para tomar a decisão extrema, emocional e esmagadora de fazer um aborto. Os achados deste estudo sugerem que mulheres de diferentes países e regiões, e com diferentes níveis de capital social, enfrentam os mesmos conflitos relativos às decisões reprodutivas. Assim, defendemos a importância de considerar crenças e comportamentos culturais ao implementar medidas de prevenção ou proteção à saúde para controlar epidemias. Esta epidemia pode ser mais uma oportunidade para melhorar a saúde das mulheres, fortalecendo serviços de planejamento familiar culturalmente sensíveis e um amplo espectro de intervenções de saúde pública.