Locating Culturally Safe Care in Narratives of Historical Trauma and Health in Guam: A Third-Space Model of CHamoru Health.

We sought to understand contemporary health beliefs and practices of the CHamorus of Guam in the context of their perceptions of historical trauma. Narrative analysis of 20 story-eliciting interviews with 10 CHamoru adults identified stories of health and illness and living in-betweenness, wherein participants described navigation between health practices of Traditional and Western cultures in the centuries-long involvement with the colonizing culture. Those connections pointed to a conceptual third-space, informed by Homi Bhabha, in which historical trauma and the in-betweenness of Traditional and Western health open new possibilities of what culturally safe health care might look like for CHamorus.

A phenomenological reflection on women's lived experience of giving in circumstances of material scarcity.

There is a robust body of research that examines problems women with criminal-legal system involvement face, the support they need, how they get it, from whom, and how they use it. Rarely do we pause to consider what resources such women already have, the support they give, or what those experiences teach us about how to support them. In this study, my purpose was to reflect on the phenomenon of giving as experienced by women who have few material resources and whose lives have been disrupted by repeat incarcerations. I analyzed four lived experience descriptions of giving from interviews conducted in 2016-2017 with 10 women who had significant histories of criminal-legal system involvement, unstable housing, and little or no income. Using concepts from hermeneutic phenomenology and the practice of phenomenological study described by Max Van Manen, I analyzed giving wholistically, selectively, and in detail. I discerned that the women's experience of giving was relationally structured as exchange, with both past and future aspects. In selective and detailed analysis, themes of "taking in" and "being there" and a gem or essential feature of automaticity/personhood presented themselves. Women found meaning, value, and a sense of belonging in giving to others even when they struggled to meet their own needs. The findings suggest potential directions for nursing practice, research, and advocacy, including work to recognize, build on, and remunerate women's affiliative care-giving and support-while also putting pressure on community health and social services delivery systems to better serve those in need.

SystemCHANGE™ Solutions to Improve Medication Adherence in Kidney Transplant Recipients: A Secondary Data Analysis.

The SystemCHANGE™ intervention has led to great improvements in medication adherence, which is a challenge for nearly one-third of kidney transplant recipients. This secondary data analysis sought to measure the frequency of individual solutions utilized by participants in a previously conducted randomized controlled trial of the SystemCHANGE™ intervention and to determine which classes of solutions had greatest impact on improved medication adherence. Solutions that were significant predictors of improving medication adherence to the 85% or higher level included alarm cues (p ≤ 0.0001), time cues (p = 0.006), restructuring the physical environment (p = 0.048), and social support (p = 0.023). Alarm and time cues, restructuring the environment, and social support were successful solutions largely influenced by personal routine and environment consideration that might be prioritized in future studies when implementing SystemCHANGE™.

Freirean Conscientization With Critical Care Nurses to Reduce Moral Distress and Increase Perceived Empowerment: A Pilot Study.

Moral distress in nursing has been linked to a relative lack of power in the workplace. We designed and piloted a Freirean-based conscientization intervention to raise awareness and address disempowerment with 13 critical care nurses in the US Midwest who recently experienced moral distress. A transformative, mixed-methods, pre/post design was used with convergence of qualitative and quantitative data. Results showed improved moral distress and mixed results in perceived personal and group empowerment. Further study is warranted to test conscientization-based interventions that give nurses opportunity collectively to develop empowered responses to situations that lead to moral distress.

Effectiveness of a Kansas City, Jail-Based Intervention to Improve Cervical Health Literacy and Screening, One-Year Post-Intervention.

PURPOSE: To assess effectiveness, 1-year post-intervention, of a program delivered in jails with women to improve cervical health literacy (CHL) and up-to-date Papanicolaou (Pap) screening. DESIGN: Pre-post design to evaluate Pap screening and CHL effects 1 year after our original randomized wait-list control study. SETTING: Surveys conducted in Kansas City, 2015 to 2017 (baseline in 2014). PARTICIPANTS: Adult women (n = 133). INTERVENTION: One-week (10-contact-hour), small-group, CHL program. MEASURES: Surveys to assess CHL components and up-to-date Pap screening. ANALYSIS: χ2 and t tests, followed by best-subsets logistic regression using sociodemographic and CHL components to fit an optimal model for up-to-date screening 1-year post-intervention. RESULTS: 73% (133/182) women retained at 1-year. From pre-intervention, 6 of 8 CHL components improved (.01 > P > .001). Up-to-date Pap screenings increased over pre-intervention (72%-82%, P < .05). Best-subset model to predict up-to-date screening included age; public benefits; medical insurance; 5 CHL components (knowledge, benefits, barriers, seriousness, susceptibility). CONCLUSION: A brief intervention to promote cervical health literacy, delivered with women during a jail detention, can lead to sustained improvements in CHL and prevention practices.

Feminism and Bourdieusian Social Theory in a Sexual Health Empowerment Project with Incarcerated and Recently Released Women.

Theory is often downplayed or omitted in the research and scholarly literature around public health interventions in carceral settings. Our Sexual Health Empowerment (SHE) project was an education intervention and ethnographic study that aimed to reduce cervical cancer risk among women with histories of incarceration. In this article, we describe our application of concepts from feminist theory and bourdieusian social theory to the design, planning, and delivery of SHE. We outline how theory-driven practice both underscored and helped us meet challenges in implementation in three urban jails over a two-year period, 2014-2016. Our approach provides a model for others who wish to bring critical theory and research practice together in health interventions with populations that are marginalized in multiple ways.

Education level as a predictor of condom use in jail-incarcerated women, with fundamental cause analysis.

OBJECTIVE: To model condom usage by jail-incarcerated women incarcerated in US local jails and understand results in terms of fundamental cause theory. DESIGN, SAMPLE, MEASUREMENTS: We surveyed 102 women in an urban jail in the Midwest United States. Chi-square tests and generalized linear modeling were used to identify factors of significance for women who used condoms during last sex compared with women who did not. Stepwise multiple logistic regression was conducted to estimate the relation between the outcome variable and variables linked to condom use in the literature. RESULTS: Logistic regression showed that for women who completed high school odds of reporting condom use during last sex were 2.78 times higher (p = .043) than the odds for women with less than a high school education. Among women who responded no to ever having had a sexually transmitted infection, odds of using a condom during last sex were 2.597 times (p = .03) higher than odds for women who responded that they had had a sexually transmitted infection. CONCLUSIONS: Education is a fundamental cause of reproductive health risk among incarcerated women. We recommend interventions that creatively target distal over proximal factors.

Strategizing and Fatalizing: Self and Other in the Trauma Narratives of Justice-Involved Women.

Jail admissions in the United States number nearly 1 million women annually. Many have limited access to public support and must seek assistance from family, friends, and strangers to maintain health and safety after release. This study sought to learn more about how women with a history of interpersonal trauma and criminal justice involvement perceive and manage social relationships. In-depth, story-eliciting interviews were conducted over 12 months with 10 participants who were selected from the convenience sample of an ongoing parent study in a Midwestern urban jail. Embedded trauma narratives were analyzed for self-presentation, form, and theme. The trauma narratives registered a continuum of agency, anchored at either end by patterns of strategizing talk and fatalizing talk. Providers and advocates can improve support for justice-involved women post incarceration by becoming familiar with and responding to patterns of strategizing and fatalizing in their personal narratives.

Theories and assumptions that inform trauma-specific interventions for incarcerated women.

The field of interventional outcomes research in programs designed to treat trauma in correctionally involved women involves contributions from researchers in a variety of disciplines. In this review, we asked how recent interventional studies addressed 3 theoretical touchstones-relational cultural theory, trauma theory, and addiction theory. We found that few outcomes studies engaged theory directly on any of these points and concluded that the opportunity for field-defining debate may risk getting lost in a quest for numbers or outcomes. We recommended that researchers more explicitly position their work, especially with respect to key theories and points of debate.