Perceived barriers and facilitators to diet and physical activity among adults diagnosed with type 2 diabetes in Malawi.

Diet and physical activity are crucial to Type 2 diabetes mellitus (T2DM) self-management. However, socio-environmental, and cultural factors can impede lifestyle behaviours, and hence T2DM management. This study aimed to identify barriers, facilitators and support for diet and physical activity among adults with T2DM in Malawi selected from a larger clinical assessment study, conducted in urban and semi-urban public hospitals. Four focus group discussions were conducted, and audio-recorded, transcribed verbatim, coded, then organised and analysed using thematic analysis. Emergent themes included: family, friends, and health worker ties that facilitated both diet and physical activity as socio-support systems. Diabetes peer groups occurred more often in urban than semi-urban areas. Dietary barriers to self-management of T2DM included: cost and access to food; lack of knowledge on what and how much to eat; challenges of separate preparation and purchase of food; dilemmas of what to eat during functions and travel; and conflicting dietary information from different sources. Comorbidities and fear of public ridicule were key perceived barriers to participants being physically active. Therefore, socio-environmental factors should be considered by nutritionists, dietitians, and health workers when developing and providing nutrition and physical activity education to adults with T2DM in Malawi.

Promoting Healthy Eating and Regular Physical Activity in Low-Income Families Through Family-Centered Programs: Implications for Practice.

Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.

Risk and Protective Factors Associated with Childhood Obesity in a Sample of Low-Income, Single Female, Parent/Guardian Households: Implications for Family Therapists.

The United States is in the midst of a childhood obesity epidemic that disproportionately impacts underserved and diverse populations. In this study, in-depth qualitative interviews were conducted with 16 low-income, single, female, parent/guardians of an overweight or obese 3- to 8-year-old from socioeconomically disadvantaged backgrounds. Following the tenets of the thematic analysis approach, interviews focused on identifying risk and protective factors influencing parental and child health behaviors associated with child weight status. Results from the interviews are organized according to the Socioecological Framework to help identify risk and protective factors at various system levels. Findings from this investigation have relevance for family therapists as they can inform clinical and advocacy-focused interventions with disadvantaged families affected by childhood obesity.

Estados Unidos está en medio de una epidemia de obesidad infantil que afecta desproporcionadamente a poblaciones diversas y marginadas. En este estudio, se realizaron entrevistas cualitativas detalladas con 16 madres/tutoras solteras de bajos recursos de un niño de entre 3 y 8 años obeso o con sobrepeso de origen socioeconómicamente desfavorecido. Siguiendo los principios del enfoque del análisis temático, las entrevistas se centraron en reconocer los factores de riesgo y de protección que afectan las conductas de salud de los padres y de los niños asociadas con el peso del niño. Los resultados de las entrevistas están organizados de acuerdo con el marco socioecológico para contribuir a identificar los factores de riesgo y de protección en diferentes niveles del sistema. Los resultados de esta investigación tienen relevancia para los terapeutas familiares, ya que pueden explicar las intervenciones clínicas y centradas en el apoyo con familias marginadas afectadas por la obesidad infantil.

African American Women's Perceptions on Access to Food and Water in Flint, Michigan.

OBJECTIVE: To explore the perceptions of food access by African American women in Flint, MI. METHODS: Using womanist theory, in which African American women's experiential knowledge centered the analysis, 8 focus groups were conducted during fall/spring, 2014-2015. Seventeen mothers aged 21-50 years with children aged <18 years and 13 women aged >60 years comprised the groups. RESULTS: The high cost of water, poor availability of healthy foods in inner-city stores, and limited transportation were barriers to accessing healthy food. Conversely, receiving food from food giveaways, friends, and family, as well as access to transportation facilitated food access. These women also reported discriminatory experiences and diet-related health concerns. Participants were keenly aware of available free community resources and gender, racial, and income barriers to accessing them. CONCLUSION AND IMPLICATIONS: Understanding these barriers and facilitators provides information to aid local food policy assistance decisions and inform community-based interventions, especially given the lead contamination of water and the purported importance of a healthy diet to sequester lead.

Acculturation and Self-Management Perceptions Among Mexican American Adults With Type 2 Diabetes.

Because type 2 diabetes (T2DM) is disproportionately high among Mexican Americans in the United States, this study examined how acculturation influences T2DM self-management, a critical component for disease outcome. Qualitative interviews of 24 low-income Mexican American patients with T2DM were matched to their biomedical and dietary data and degree of acculturation. Greater acculturation to the United States was associated with less favorable diabetes control, fiber density, leisure-time physical activity, and more physical disability. Health care professionals can improve their cultural competence by learning culturally appropriate foods and fostering a warm, caring manner with Mexican Americans to enhance their sense of well-being and compliance with T2DM recommendations.

Miscarriage at advanced maternal age and the search for meaning.

Although it has been documented that miscarriage is a common pregnancy outcome and more likely to happen among women aged 35 years and older, there is very little research on the quality of such a lived experience. This study features phenomenological interviews of 10 women aged 35 years and older. Theoretical frameworks of ambiguous loss and feminism guide the design and analysis. The salient themes suggest that women experience miscarriage from a physical, emotional, temporal, and social context that includes intense loss and grief, having a sense of otherness, a continuous search for meaning, and feelings of regret and self-blame.

Resilience in low-income African American women living and aging with HIV.

Women are living with HIV into middle and older age and are likely to face multiple comorbidities and stressors as they age. This study focused on understanding how women who experience multiple forms of oppression and ongoing adversity are still able to adapt and stand strong. Using a theoretical framework of resilience and a feminist research ideology, interviews of eight middle-aged and older African American women living with HIV were analyzed. Despite experiences of HIV-related discrimination, trauma, and violence, these women demonstrated a remarkable ability to adapt and maintain support. Implications for research and practice are discussed.

What couples say about their recovery of sexual intimacy after prostatectomy: toward the development of a conceptual model of couples' sexual recovery after surgery for prostate cancer.

INTRODUCTION: Interventions designed to help couples recover sexual intimacy after prostatectomy have not been guided by a comprehensive conceptual model. AIM: We examined a proposed biopsychosocial conceptual model of couples' sexual recovery that included functional, psychological, and relational aspects of sexuality, surgery-related sexual losses, and grief and mourning as recovery process. METHODS: We interviewed 20 couples preoperatively and 3 months postoperatively. between 2010 and 2012. Interviews were analyzed with Analytic Induction qualitative methodology, using NVivo software. Paired t-tests described functional assessment data. Study findings led to a revised conceptual model. MAIN OUTCOME MEASURES: Couples' experiences were assessed through semi-structured interviews; male participants' sexual function was assessed with the Expanded Prostate Cancer Index Composite and female participants' sexual function with the Female Sexual Function Index. RESULTS: Preoperatively, 30% of men had erectile dysfunction (ED) and 84% of partners were postmenopausal. All valued sexual recovery, but worried about cancer spread and surgery side effects. Faith in themselves and their surgeons led 90% of couples to overestimate erectile recovery. Postoperatively, most men had ED and lost confidence. Couples' sexual activity decreased. Couples reported feeling loss and grief: cancer diagnosis was the first loss, followed by surgery-related sexual losses. Couples' engagement in intentional sex, patients' acceptance of erectile aids, and partners' interest in sex aided the recovery of couples' sexual intimacy recovery. Unselfconscious sex, not returning to erectile function baseline, was seen as the end point. Survey findings documented participants' sexual function losses, confirming qualitative findings. CONCLUSIONS: Couples' sexual recovery requires addressing sexual function, feelings about losses, and relationship simultaneously. Perioperative education should emphasize the roles of nerve damage in ED and grief and mourning in sexual recovery.

Exploring the role of the partner in couples' sexual recovery after surgery for prostate cancer.

BACKGROUND: Prostate cancer survivors' post-surgery sexual problems are well documented and long lasting. Partners' distress in this context leads to psychological morbidity which is poorly understood. Given the prevalence of prostate cancer diagnoses in older men, partners' distress represents a public health concern. This study elucidates an important aspect of partners' distress which has hitherto been undocumented. It can lead to further research and health-care provisions that will support couples in prostate cancer survivorship towards improved mental health and health outcomes. PURPOSE: Partner sexual function has been viewed as a factor in men's erectile function recovery after prostatectomy for prostate cancer. However, patients' and partners' perceptions on the role of the partner in couples' sexual recovery has not been studied. We wanted to understand those perceptions and to see whether their perceptions were congruent. METHODS: Men and partners were recruited from a previous study and interviewed separately about the role of the partner. Interview transcripts were analyzed using grounded theory with the help of NVivo software. RESULTS: Ten men and nine partners participated; most were more than 1 year past surgery. Men were 62, and partners were 58 years old on average. Nine men had erectile dysfunction. Six female partners were post-menopausal, and a participating male partner had post-prostatectomy erectile dysfunction. Men and partners agreed that partners provide emotional and logistical support. Both perceived the partner's own sexual interest, not function, as critical to the couple's sexual recovery. Some men felt pressured by partners' initiative, feeling insecure about sexual performance. Men were unaware of partners' sexual needs or needs for support. Partners expressed those needs but were unsure of what kind of support they needed. CONCLUSION: Partners' sexual and support needs during couples' sexual recovery after prostatectomy should be acknowledged and addressed as a legitimate aspect of research and care for men recovering from prostatectomy.

Maternal psychological absence and toddlers' social-emotional development: interpretations from the perspective of boundary ambiguity theory.

The current study tests a novel latent construct reflecting psychological absence and examines its relations with maternal depression, mother-toddler interactions, and toddlers' social-emotional outcomes in a low-income sample (N = 2,632). Structural equation modeling confirmed a psychological absence construct and revealed that psychological absence, measured at the child's 36-month birthday-related assessment, is a significant predictor of children's social-emotional development at 36 months, mediated by mother-child interaction. Results are interpreted within a boundary ambiguity framework.

A place to be: the role of clubhouses in facilitating social support.

OBJECTIVE: Intentional recovery communities, such as clubhouse programs, aim to foster social connections among individuals at risk for isolation as a result of living with a serious mental illness to engage and become active participants in the community. The objective of the study was to gather information on the nature of clubhouse support as it pertains to social network support and social relationships. METHODS: The personal story/narrative approach was utilized and involved a naturalistic inquiry approach that allowed stories of clubhouse experiences to come forth with little interference or interjection as possible. RESULTS: Personal narratives revealed that staff, members and the overall clubhouse structure emerged as the center of social interaction and comfort for participants and a central sustaining means of social support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It appears that the clubhouse provides an intentional environment that creates a sense of community and a place to belong. The clubhouse as a place to be where one can meet individuals in like situations has been identified as very helpful in achieving recovery by providing the opportunity to rebuild one's shattered social network and offering contact with others in similar contexts.

The longitudinal effects of cancer treatment on sexuality in individuals with lung cancer.

PURPOSE/OBJECTIVES: To examine changes in sexual functioning during treatment for lung cancer and the extent to which age, gender, social support, and mood status affect sexual dysfunction. DESIGN: Prospective, exploratory. SETTING: Outpatient cancer clinic. SAMPLE: 59 of 84 eligible patients diagnosed with small cell or non-small cell lung cancer. METHODS: The Derogatis Interview for Sexual Function, Self-Report, to measure sexual functioning; the Social Provisions Scale to measure social support; and the Derogatis Affects Balance Scale to measure mood status were administered at diagnosis and at two and four months during treatment. MAIN RESEARCH VARIABLES: Level of sexual function, treatment, age, gender, social support, and mood status. FINDINGS: Results indicate a decrease in sexual function but no significant change in sexual function between the two treatment groups. Age was a significant factor affecting sexual function. Gender significantly affected sexual function at time 2 only. Between times 1 and 2, mood status had a significant relationship with sexual function. Social support did not affect sexual function directly; social support was found to significantly affect mood status. CONCLUSIONS: Most patients reported below-normal sexual function at baseline. Sexual function worsened over time. Further research is warranted to examine time, place, and type of intervention needed. IMPLICATIONS FOR NURSING: New data encourage assessment, intervention, and research related to the sexual function of patients with lung cancer.