Reaching the unheard: overcoming challenges in health research with hard-to-reach populations.

PURPOSE: Addressing obstacles such as logistical complexities, social stigma, and the impact of historical traumas is essential for the successful inclusion of underrepresented groups in health research. METHODS: This article reviews engagement and interview techniques used to ethically engage recently settled Afghan refugees in Oklahoma and rural Mexican-born women in Illinois in research. The paper concludes with a reflective discussion on the challenges and lessons learned. RESULTS: Creative strategies to engage hard-to-reach populations in research included considering the participants' socioeconomic and cultural contexts in their interactions and developing community partnerships to establish trust and obtain reliable data. Other engagement strategies were communicating in the participants' preferred language, providing assistance with reading and responding to study questions for those with low literacy, employing research staff from the population of interest, and recruiting in specific locations where the populations of interest live. CONCLUSIONS: Community engagement is essential at all stages of research for building trust in hard-to-reach populations, achieving inclusivity in health research, and ensuring that interventions are culturally sensitive and effective.

Contextualizing acculturative stress among Latino immigrants in the United States: a systematic review.

Purpose: This systematic review of the literature informed of (a) the relationship between acculturation and acculturative stress, (b) examined the determinants of acculturative stress among Latino immigrants in the U.S., and (c) provided a conceptual framework that can be used to specify the interactive effect of various factors on acculturative stress. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), this review synthesized the results of thirty studies published between 2000 and 2015 that investigated the influence of several socio-demographic and cultural contexts on acculturative stress among Latino immigrants categorized using Family Stress Management (FSM) theory as a framework. Results: Studied highlighted several protectors from and risks to acculturative stress. Historical context protective factors included having a choice over the decision to migrate and social support; risks included discrimination, family left abroad, and fear of deportation. Economic context protective factors included higher income. The development context protective factors included English skills, years in the U.S., and being married; risks included being female. Cultural context protective factors included being culturally competent and acculturation; risks included family-cultural conflict and ethnic enclave pressures. Internal context protectors included post-immigration religious coping, church attendance, and family values. Implications: The results highlighted incorporating cultural aspects (i.e. family values and social support) in mental health practice with Latino immigrants. A less stressful integration experience can be achieved if age-related stressors and experiences of discrimination are acknowledged and the need for social support and harmonious family dynamics was prioritized in service plans.

Perceptions of Cancer Risk/Efficacy and Cancer-Related Risk Behaviors: Results From the HCHS/SOL Sociocultural Ancillary Study.

This study evaluated the associations among perceived risk, perceived efficacy, and engagement in six cancer-related risk behaviors in a population-based Hispanic/Latino sample. Interviews were conducted with 5,313 Hispanic/Latino adults as part of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. Participants were recruited from the study's four field centers (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA) between February 2010 and June 2011. Perceived risk and perceived efficacy were assessed with questions drawn from the Health Interview National Trends Survey. More than half of the sample endorsed perceived risk of cancer associated with the six evaluated behaviors, as well as general perceived efficacy for preventing cancer. Adjusted logistic regression analyses demonstrated significant differences across Hispanic/Latino background groups for perceived risk associated with high consumption of alcohol and saturated fat, low consumption of fruits and vegetables, and insufficient exercise but not with smoking or low consumption of fiber. Differences were also found for the belief, "It seems like everything causes cancer" but not for other perceived efficacy items. Perceived cancer risk and perceived efficacy for preventing cancer were neither independently nor interactively associated with engagement in cancer-related risk behaviors after controlling for sociodemographic covariates. Results suggest that perceptions of risk and efficacy with regard to cancer vary across Hispanic/Latino background groups, and therefore background group differences should be considered in prevention efforts. Perceived risk and perceived efficacy were not related to cancer-related risk behaviors among Hispanics/Latinos. Further work is needed to evaluate determinants of cancer-related risk in this population.

Is there a link between wealth and cardiovascular disease risk factors among Hispanic/Latinos? Results from the HCHS/SOL sociocultural ancillary study.

OBJECTIVE: To examine the relationship between wealth and cardiovascular disease risk factors among Hispanic/Latinos of diverse backgrounds. DESIGN: This cross-sectional study used data from 4971 Hispanic/Latinos, 18-74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) baseline exam and the HCHS/SOL Sociocultural Ancillary Study. Three objectively measured cardiovascular disease risk factors (hypertension, hypercholesterolemia, and obesity) were included. Wealth was measured using an adapted version of the Home Affluence Scale, which included questions regarding the ownership of a home, cars, computers, and recent vacations. RESULTS: After adjusting for traditional socioeconomic indicators (income, employment, education), and other covariates, we found that wealth was not associated with hypertension, hypercholesterolemia or obesity. Analyses by sex showed that middle-wealth women were less likely to have hypercholesterolemia or obesity. Analyses by Hispanic/Latino background groups showed that while wealthier Central Americans were less likely to have obesity, wealthier Puerto Ricans were more likely to have obesity. CONCLUSION: This is the first study to explore the relationship between wealth and health among Hispanic/Latinos of diverse backgrounds, finding only partial evidence of this association. Future studies should utilize more robust measures of wealth, and address mechanisms by which wealth may impact health status among Hispanic/Latinos of diverse backgrounds in longitudinal designs.

Puerto Rican-Born Women in the United States: Contextual Approach to Immigration Challenges.

This study focused on how acculturative stress and psychological distress affect Puerto Rican-born women residing in the United States. Mediation path analysis was used to estimate relationships between contextual factors, acculturative stress, and psychological distress. The fit of the data to the final model was adequate as estimated using chi-square analysis, comparative fit index, Tucker-Lewis Index, and root-mean-square error of approximation. Racial discrimination (b = 0.38, p = .01), difficulties visiting family abroad (b = 0.26, p = .03), and age at immigration (b = 0.19, p = .03) were positively associated with acculturative stress. The factor English skills (b = -0.31, p = .02) was negatively associated with acculturative stress. Racial discrimination had the strongest effect on acculturative stress, followed by English skills, difficulties visiting family abroad, and age at immigration. Racial discrimination (b = 0.39, p = .01) and financial constraints (b = 0.30, p = .01) were positively associated with psychological distress. Racial discrimination affected the women's psychological distress the most, followed by economic contexts (financial constraints). This study informs practitioners in considering the significant contextual factors relevant to the psychological distress of Puerto Rican-born women.

Psychological distress among low-income U.S.- and foreign-born women of Mexican descent: impact of acculturation.

PURPOSE: After testing the capacity of Kessler's psychological distress (K6) scale to measure equally across low-income Mexican-born women (n=881) and U.S.-born women of Mexican descent (n=317), this study assesses the impact of acculturation on this group's psychological distress. METHODS: We employ descriptive and confirmatory factor analyses to test the cross-cultural equivalence of K6. Multivariate and logistic regression is used to test the association between acculturation and psychological distress among low-income, Mexican-American women. RESULTS: The cross-cultural equivalence analysis shows that some of the scale's items have the capacity to measure psychological distress equally among participants. Regression results indicate that the more acculturated these women become, the greater their psychological distress is. CONCLUSION: The study recommends that researchers emphasize the cross-cultural equivalence of their measures and suggests a heightened awareness among practitioners of the multidimensional impact of acculturation on clients of Mexican descent.

Contextual Approach to Acculturative Stress Among Latina Immigrants in the U.S.

Based on Family Stress Management theory, we explored the contextual influence on acculturative stress and psychological distress. We included 639 Latinas from the National Latino Asian American Survey. We hypothesized that (a) impact of acculturative stress on psychological distress depends on specific contexts; (b) U.S. climate (i.e., perceived discrimination, happiness with U.S. move, years in the U.S.) impacts acculturative stress and psychological distress the most, and (c) contextual factors interact in impacting acculturative stress. Acculturative stress did not always lead to psychological distress. Perceived discrimination and difficulty visiting family abroad were positively associated with acculturative stress. Years in the U.S. and happiness with the U.S. move were negatively associated with acculturative stress. Years in the U.S. and perceived discrimination interacted in predicting acculturative stress. These results can aid formulation of effective interventions that target contexts likely to impact acculturative stress and psychological distress among Latinas.

When a mother has cancer: pathways to relational growth for mothers and daughters coping with cancer.

BACKGROUND: Most research on daughters of women with cancer have focused on the daughters' adjustment to the cancer with little attention given to the impact of the cancer on the relationships between mothers and daughters. METHODS: Guided by the feminist relational-cultural theory, this study examines mothers' perceptions of their cancer experience on their relationships with daughters, focusing on their emotional connections, ruptures or disconnections in the relationships, and relational competencies. By using the grounded theory, 29 in-depth interviews of mothers with cancer were analyzed. RESULTS: Although most of the participants reported closer relationships with their daughters as a result of the cancer experience, emotions such as fear, anger, or guilt were frequently cited. Mothers were able to work through these emotions with their daughters through four relational competencies: (a) anticipatory empathy (sensitivity about the impact of cancer on each other); (b) authenticity (full presence without fear of abandonment); (c) mutual empathy (caring and emotional support); and (d)mutual empowerment (capacity to empower one another). CONCLUSION: The concept of post-traumatic relational growth is introduced to describe how mothers transformed the stressful experience of cancer into an experience in which they grew emotionally in relationship with their daughters.

Dodecaphony: enacting support brokerage in the twelve cash & counseling expansion states.

Support brokers are entities that provide information and assistance to self-directed clients in Medicaid waiver programs. Although all Cash & Counseling programs have support brokerage, each state has a great deal of liberty in determining how those functions are carried out, who provides those activities, which functions are emphasized and how responsibility for support broker tasks coordinates with other support activities. In this article, we map out the various ways in which states have operationalized the support brokerage concept. Differences in title, qualifications, training, hiring preferences, and caseload are described and further directions for research are suggested.

Exploring patterns of service utilization among persons with disabilities in a consumer-directed care program.

Empirical evidence on the role financial institutions and home and community-based interventions play in influencing asset building among persons with disabilities is scarce. This article contributes to this effort directed at understanding such effects by exploring patterns of and barriers to use of banking services offered by the credit union that has enrolled persons with disabilities in Iowa under a home and community-based services waivers program. It is suggested that although banking services are not used by the majority of program participants, the credit union model has appeal. It provides an opportunity for people with disabilities to build savings for the purchase of goods and services that enhance their independence and productivity.