Arab American Adolescents' Perceived Stress and Bullying Experiences: A Qualitative Study.

In 2012, 20% of high school students were bullied in the United States. Bullying is more prevalent among minority populations. Arab American adolescents receive little research attention and are described as the invisible population. This descriptive qualitative study was conducted with 10 Arab American adolescent bullying victims to describe their bullying experiences and related stress. In addition to being bullied because of health problems or social disadvantages, Arab American adolescents reported that they were bullied because of their ethnic/racial background and religious affiliation. Victims described high stress levels and anxiety which compromised their ability to function. They reported feeling sad, angry, overwhelmed, helpless, and hurt when they were bullied. They also lost control over their lives and self-confidence. Family and friends were sources of support but school administrators and teachers were not supportive. Implications for practice and future research were discussed.

Cyberbullying: a 21st Century Health Care Phenomenon.

This study examined bullying and cyberbullying prevalence among 367 adolescents 10 to 18 years of age who were attending schools and community organizations in suburban and urban neighborhoods in the Midwest United States. The correlational design investigated adolescents' daily use of technology that could be used to cyberbully peers, such as cell phones, computers, email, and the Internet. Results showed that 30% of participants had been bullied during school, and 17% had been cyberbullied, with online social networking sites the most common media employed (68%). The majority of participants owned or had access to computers (92%), email accounts (88%), social networking accounts (e.g., Facebook or MySpace) (82%), and cell phones (79%). Daily technology use included an average of two hours on a computer and a median of 71 text messages per day. Logistic regression analysis revealed no significant differences in bullying or cyberbullying prevalence based on location (urban or suburban) or demographic characteristics. Given the substantial presence of cyberbullying and the increase in technology use among adolescents in the 21st century, nurses need knowledge of the phenomenon to plan assessments in clinical practice. Early identification and assessment of cyberbullying victims and perpetrators, and development and implementation of effective interventions are needed to reduce this form of bullying among adolescents.

An examination of eating behaviors, physical activity, and obesity in african american adolescents: gender, socioeconomic status, and residential status differences.

BACKGROUND: African American adolescents experience higher rates of obesity and have an increased risk of obesity-related diseases than do White American adolescents. Despite culturally sensitive obesity preventive interventions, obesity rates are increasing within the African American adolescent population. Current obesity interventions do not usually address the heterogeneity (e.g., socioeconomic status [SES], gender, and residential status differences) within the African American adolescent community that can affect the efficacy of these interventions. PURPOSE: To examine the gender, SES, and residential status differences related to obesity and weight behaviors in African American adolescents. METHODS: A descriptive correlational study was conducted with 15- to 17-year-old African American adolescents (n = 145) from community clinics, youth organizations, churches, and social networks in metropolitan and inner-city Detroit. Data were collected through use of survey methods and analyzed with use of descriptive statistics, independent sample t tests, and multiple regression equations. RESULTS: Female adolescents consumed foods higher in fat and calories (t = -2.36, p = .019) and had more body fat (t = -9.37, p = .000) than did males. Adolescents of lower SES consumed food higher in fat and calories (t = -2.23, p = .027) and had higher body mass (t = -2.57, p = .011) than did adolescents of higher SES. Inner-city African American adolescents had higher levels of physical activity (t = -2.39, p = .018) and higher body mass (t = 2.24, p = .027) than did suburban African American adolescent counterparts. Gender, SES, and residential status were statistically significant predictors of eating behaviors, physical activity, body mass index, and body fat. CONCLUSIONS: The initial findings from the study will assist in better understanding the obesity epidemic that affects African American adolescents in disparate proportions. IMPLICATIONS: Further examination of the study variables is essential to serve as a basis for developmentally appropriate and culturally relevant targeted interventions with this population. Health care providers and obesity researchers who work with youth can use the initial findings from this study to advocate for healthy lifestyles while reducing the obesity disparity within the African American adolescent population.

Psychometric Properties and Construct Validity of the Knowledge Information Profile-Coumadin.

Background: Oral anticoagulation therapy using Coumadin (warfarin) requires significant patient involvement. Limited validated instruments exist to test patient knowledge of Coumadin, and low health literacy may impede patient self-management. Objective: This article reports the psychometric testing of the Knowledge Information Profile-Coumadin (KIP-C20) to determine (a) minimum number of items and dimensions, (b) reliability, and (c) construct validity. Methods: Participants (N = 192) were recruited from outpatient pharmacist-directed anticoagulation clinics associated with an urban teaching hospital in the Midwest United States. Instruments were the Animal Naming test (AN), Rapid Estimate of Adult Literacy in Medicine (REALM), and KIP-C20. Multidimensional item response theory modeling and exploratory factor analyses were used to determine the best fitting model. Results: The final instrument, renamed KIP-C14, with 3 factors and 14 items, had a good fit to data (M2 = 96.49, P < .0001; root mean square error of approximation = .04), and all factor loadings were .3 or larger. Internal consistency reliability was .65; test-retest correlation was .67. The KIP-C14 correlated positively, as expected, with years of Coumadin treatment. Subscales were differentially correlated with sociodemographic variables. Conclusions: The KIP-C14 had nearly identical, slightly higher reliability than the KIP-C20. Still, reliability was lower than expected, indicating a promising clinical assessment scale in need of further refinement.

Providing culturally competent care in home infusion nursing.

All health care providers, and particularly nurses who are on the front lines of patient care, must be skilled in providing culturally appropriate and competent care. Cultural competence needs to be guided by a philosophical framework. This article was written to describe cultural care in the context of home infusion nursing using the Process of Cultural Competence in the Delivery of Healthcare Services model. The model is used to provide structural reference in order to offer nursing care to members of diverse cultures. The 5-part model gives an overarching conceptual orientation to assist the nurse in providing quality care that is culturally sensitive.

Using the teach-back method to increase maternal immunization literacy among low-income pregnant women in Jamaica: a pilot study.

The purpose of this pilot study was to assess maternal health literacy of pregnant women in Jamaica and evaluate their ability to communicate the benefits, risks, and safety of the Bacillus Calmette-Guerin (BCG) and Hepatitis B (hep B) vaccines after using the teach back method. REALM scores were moderately, positively correlated with identification of the BCG vaccine risks (r = .43, p = .01) and with hep B vaccine benefits (r = .34, p = .05) and risks (r = .42, p = .01). Women who gave incorrect responses about the benefits or risks of the vaccines had lower REALM scores than women who gave completely correct or partially correct responses.

Evaluating nutrition risk factors and other determinants of use of an urban congregate meal program by older African Americans.

Rapid growth in both the number of older U.S. adults and diversity in the population suggests increased and disparate demands for nutrition services. Funded by the Older Americans Act (OAA), the primary purpose of congregate meal services is to keep older Americans nutritionally secure and living independently in the community. Understanding characteristics that influence older African Americans' use of congregate meal services is important for development of culturally sensitive networks and program policies. With a sample of 151 community-dwelling older African Americans, a descriptive exploratory design was used to explore predisposing, enabling, and need characteristics that influence use of a congregate meal service and to examine the relationship between nutritional risk and service use. Provider-oriented structural enablers (awareness and transportation) that promote or impinge on elderly persons' use of a congregate meal service were also examined. Multivariate analysis indicated that among program participants, nutrition risk and living arrangement had significant influence on service use. Additionally, nutrition risk was higher among respondents who did not participate in congregate meal service compared to their participant counterparts.

The influence of easy-to-read pamphlets about self-care management of radiation side effects on patients' knowledge.

PURPOSE/OBJECTIVES: To test patients' knowledge of side effects after they review six easy-to-read pamphlets on radiation side effects. DESIGN: Nonexperimental. SETTING: Urban radiation oncology clinic. SAMPLE: 47 patients receiving radiation treatment. METHODS: The Knowledge of Radiation Side Effects Test was administered. MAIN RESEARCH VARIABLES: Patient literacy and knowledge level. FINDINGS: The self-report of highest grade completed in school was 10th grade; however, the actual reading level was 4th-6th grade. Scores for each knowledge test increased with literacy level, with statistically significant correlations for pamphlets on fatigue, skin problems for women, and skin problems for men. Participants who read at the 4th-6th-grade level scored higher than expected. CONCLUSIONS: Although the pamphlets were deemed easy to read, patients who had the lowest reading levels still had difficulty understanding them. IMPLICATIONS FOR NURSING: In addition to written patient information, oncology nurses should use innovative teaching strategies to improve patient understanding and self-care behaviors. A need exists for continued nursing inquiry that will focus on self-care behaviors to manage radiation side effects, particularly for patients with low literacy.

The effect of low literacy on the self-care behaviors of men receiving radiation therapy.

Using Orem's theory as the framework, two purposes guided the study: (a) to test the effectiveness of an audio-visual education program and behavioral contracting to promote self-care behaviors in managing radiation side effects and (b) to determine the extent to which low literacy affects self-care abilities. Seventy men diagnosed with prostate cancer participated in this experimental study. The nursing interventions of education and behavioral contracting significantly increased the self-care behaviors of men in managing radiation side effects. An increase in self-care behaviors was especially shown in men with low-literacy skills.

Using the teach-back and Orem's Self-care Deficit Nursing theory to increase childhood immunization communication among low-income mothers.

Guided by Orem's Self-care Deficit Nursing theory, the purpose of the pilot study was to assess the relationship between maternal health literacy and the mother's ability to comprehend and communicate information about childhood immunizations. Communication is the key to positive health results, particularly for patients with low literacy skills, yet few studies have examined patients' ability to converse about health information taught to them by providers. The study was conducted in an urban walk-in immunization clinic. A quantitative-qualitative research design was used. Convenience sampling was applied to obtain 15 mothers with one child (M1) and 15 mothers with more than one child (M>1). The Rapid Estimate of Adult Literacy (REALM) was used to assess literacy level. Vaccine information statements on inactive poliovirus (IPV) and pneumococcal conjugate vaccine (PCV) were instructional materials used in the teach- back procedure. Although the results of the study were mixed, patterns and trends were noted. Mothers with higher literacy levels provided more correct responses for the benefits of the polio vaccine than did those mothers with lower literacy levels (F(2,25)=4.70, p= .02). For both IPV and PCV vaccines, more mothers gave correct answers for risks and benefits, but more mothers gave incorrect answers for safety. There also was some relationship between mother's age and correctness of responses regarding risk of pneumonia vaccination (F(2,24)=3.79, p= .04). The inconsistency of the mothers' responses to communicate critical immunization information about vaccines indicates the need to further assess how best to increase parents' vaccine knowledge and communication skills.

Mothers' knowledge and information needs relating to childhood immunizations.

The purpose of this pilot study was to determine mothers' literacy level and knowledge, information needs, and information-seeking behaviors related to the vaccine(s) their children were receiving. A convenience sample of 15 mothers with one child and 15 mothers with two or more children was recruited at a free, urban, walk-in immunization clinic in Detroit. Participants completed the REALM test and a demographic form. Structured interviews were conducted to assess a mother's knowledge, information needs, and information-seeking behavior relating to the vaccines. The average reading skills were at the 7th- to 8th-grade level. Only four mothers knew the name and purpose of the vaccine their child was receiving. Information needs of the 26 mothers who did not know the name or purpose of the vaccine were categorized as immediate or deferred according to Krikelas's model of information seeking. More mothers with one child had immediate information needs, while more mothers with two or more children had deferred information needs. Primary sources of vaccine information were physicians and nurses. More research needs to be done to determine which nursing interventions work best to satisfy a mother's information needs.

Disordered eating and food cravings among urban obese African American women.

OBJECTIVE: The prevalence of night eating syndrome (NES), binge eating disorder (BED), and bulimia nervosa (BN) and the general experience of food cravings were examined in 88 obese urban African American women. METHOD: Participants were administered The Questionnaire on Eating and Weight Patterns-R, the Night Eating Syndrome Questionnaire, and the State and Trait Food Cravings Questionnaire, Trait version (FCQ-T). RESULTS: Twenty-eight percent reported symptoms of eating disorders (18.9% NES, 6.4% recurrent binge eating, 2.2% both NES and recurrent binge eating). Those reporting disordered eating had significantly higher total FCQ-T scores than those not reporting disordered eating. Persons endorsing recurrent binge eating had the highest mean score, followed by those reporting NES. Those who identified themselves as binge eaters and night eaters were not significantly different from each other, but both groups were significantly different than the no eating disorder symptoms group on various subscales of the FCQ-T. DISCUSSION: Obese African American women report significant levels of NES and binge eating which may contribute to the development and/ or maintenance of obesity.

Can easy-to-read immunization information increase knowledge in urban low-income mothers?

This article describes a pilot study that (1) assessed the self-report of highest grade completed in school and the actual reading and comprehension skills of low-income mothers whose children receive immunizations in urban public clinics and (2) tested the effectiveness of a nursing intervention on immunization knowledge using revised easy-to-read written education materials. Thirty-seven mothers were randomized either to a control group (asked to read the standard vaccine information sheets) or to an experimental group (asked to read the revised immunization pamphlets). Although there was a modest increase in immunization knowledge for both groups, it was not significant. Thus, simplifying information alone may not increase parental knowledge.

An exploratory study of the health problems, stigmatization, life satisfaction, and literacy skills of urban, street-level sex workers.

An exploratory study of 26 female urban, street-level sex workers was conducted to gather information about their health problems, feelings of stigmatizations, satisfaction with life, and literacy skills. Each woman completed the health questionnaire, Stigmatization Scale, Satisfaction with Life Scale, and the Rapid Estimate of Adult Literacy in Medicine. Twenty-one women had acute or chronic health problems; only eleven sought health care. Literacy scores revealed 7th to 8th grade reading levels. Feelings of stigmatization varied from low to high and all the women were found to be dissatisfied with their lives. Further research needs to address how these factors affect their use of health care and outreach services.

Assessing the readability of skin care and pressure ulcer patient education materials.

OBJECTIVE: The purpose of this study was to evaluate the readability of written patient education materials used to teach patients about the prevention and care of skin and pressure ulcers. Other design characteristics of the materials including organization, writing style, appearance, and appeal also were assessed. DESIGN: This study used a nonexperimental, descriptive design. Setting and Stimulus Materials: Ten pamphlets and brochures commonly used in urban hospitals, home care agencies, and public clinics in the Midwest were evaluated. INSTRUMENTS: The study used 2 instruments: The Area Health Education Center (AHEC) checklist and the Simple Measure of Gobbledygook (SMOG) readability formula. METHODS: The investigator used the SMOG readability formula to analyze patient education materials. The AHEC checklist was used to evaluate the design characteristics of the materials, including organization, writing style, appeal, and appearance. RESULTS: The overall readability level of the written materials was 10th grade. At least half of the materials were written at 8th-grade level or below, which is considered acceptable for the general public. Some pamphlets used words such as "seborrheic keratosis" or "actinic keratosis," making the materials difficult to read. An incidental finding was that none of the materials addressed skin care or pressure ulcer experiences of different cultural groups. CONCLUSION: None of the materials was determined to be appropriate teaching tools for low-literacy patients, as measured by the AHEC checklist. Although half the materials were written at the 8th-grade level and below, that level may be too high for many patients.

Evaluation of education materials using Orem's self-care deficit theory.

This article presents Orem's self-care deficit nursing theory as the conceptual framework in the development, design, selection, and evaluation of appropriate written patient education materials for patients with low literacy skills. The model, which includes essential evaluation factors used in literacy research, offers nurses and other professionals a more comprehensive means to judge the suitability of health information and instructional materials. Nurses have a critical role in educating consumers and their families and for providing patients with useful information that will influence their decision-making and participation in care.

Literacy, readability and cultural barriers: critical factors to consider when educating older African Americans about anticoagulation therapy.

The number of patients on anticoagulation therapy has increased dramatically over the past two decades. Yet, few studies have examined the psychosocial barriers of low literacy, culture and inappropriate patient education materials used to teach older African Americans about their anticoagulation therapy. The aims of this study were to investigate literacy levels among older patients, and evaluate the readability and determine the cultural sensitivity of written information used in an anticoagulation management clinic. A descriptive, correlational design was used. Patients' (n = 62) knowledge levels and the readability and cultural sensitivity of written materials were examined. The Rapid Estimate of Adult Literacy in Medicine (REALM) was used to measure reading skills of patients, while the SMOG formula (a formula for assessing readability) was used to test the readability of written educational materials used in an Anticoagulation Management Clinic. A Knowledge Information Profile, developed for this study by one of the authors (Wilson), was used to measure patient knowledge about warfarin, medication side-effects and food sources of vitamin K. A modified, culturally sensitive and easy-to-read pamphlet was used as an alternative teaching tool in the study. The results of the study revealed the average self-reported for highest grade completed in school was twelfth grade; however, the actual mean reading skills were between seventh and eighth grade. The readability of the written information was three to four grades higher than patients' reading abilities. None of the patient education materials were culturally sensitive. This study underscores the importance of having information that is understandable and culturally relevant to prevent the outcome of internal bleeding. Nurses have a vital role in educating patients and ensuring that teaching materials are appropriate for the target population.