Adaptation and testing of instruments to measure cervical cancer screening factors among Vietnamese immigrant women.

PURPOSE: Vietnamese American women diagnosed with cervical cancer are more likely to have advanced cancer than non-Hispanic White women. We sought to (a) develop a culturally sensitive Vietnamese translation of the Revised Susceptibility, Benefits, and Barriers Scale; Cultural Barriers to Screening Inventory; Confidentiality Issues Scale; and Quality of Care from the Health Care System Scale and (b) examine the psychometric properties. DESIGN: Cross-sectional study with 201 Vietnamese immigrant women from the Portland, Oregon, metropolitan area. METHOD: We used a community-based participatory research approach and the U.S. Census Bureau's team approach to translation. RESULTS: Cronbach's alpha ranged from .57 to .91. The incremental fit index ranged from .83 to .88. DISCUSSION AND CONCLUSIONS: The instruments demonstrated moderate to strong subscale internal consistency. Further research to assess structural validity is needed. IMPLICATIONS FOR PRACTICE: Our approaches to translation and psychometric examination support use of the instruments in Vietnamese immigrant women.

Contributing factors to colorectal cancer and hepatitis B screening among Vietnamese Americans.

PURPOSE/OBJECTIVES: To identify factors associated with screening for colorectal cancer (CRC) and hepatitis B, because hepatitis B can increase the risk of liver cancer. DATA SOURCES: MEDLINE®, CINAHL®, and PsycINFO databases from January 1998 to April 2012. DATA SYNTHESIS: The 23 reviewed studies included 15 descriptive, 2 intervention, 3 qualitative, 2 chart or medical record review, and 1 mixed method. Most studies used an investigator-developed instrument with no reported reliability. Inconsistent operational definitions for contributing factors to screening made it challenging to make comparisons. CONCLUSIONS: CRC and hepatitis B screening are consistently low among Vietnamese Americans. Contributing factors included sociodemographics, knowledge, cultural beliefs, and external factors. External factors such as having a regular place of care and a healthcare provider were crucial because they influenced adherence to screening recommendations. Use of a public media education plus healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appeared to be promising for improving CRC screening. Additional intervention studies are needed to increase screening. IMPLICATIONS FOR NURSING: Vietnamese is a fast-growing subgroup within the Asian American Pacific Islander (AAPI) group that may require targeted approaches to screening for disease. Future studies should focus on immigrants or those who were born in the United States (men and women) as disaggregated subgroups. Such research can inform culturally sensitive and appropriate interventions that may improve cancer screening rates. KNOWLEDGE TRANSLATION: Although Vietnamese is the fourth largest racial-ethnic subgroup within the AAPI group, the literature about contributing factors to CRC and hepatitis B screening is limited among this subgroup. CRC and hepatitis B screening are consistently low among Vietnamese Americans. Use of public media education plus a healthcare provider model and a culturally tailored intervention using Vietnamese lay advisors appears promising for improving CRC screening.

A community-based participatory research approach to understanding pap testing adherence among Vietnamese American immigrants.

OBJECTIVE: To explore factors potentially influencing Pap testing practices among Vietnamese American immigrant women (VIW, foreign-born) and describe their awareness of cervical cancer screening resources in their community. DESIGN: Descriptive study guided by the ecological model and community-based participatory research principles. SETTING: Portland, Oregon, metropolitan area. PARTICIPANTS: Vietnamese American immigrant women (211) who were age 21 and older. METHODS: We used descriptive statistics and logistic regression analyses to analyze a self-administered questionnaire that was pretested and translated using a team approach. RESULTS: Approximately 74% of VIW who completed the survey reported at least one Pap test, and 69% reported Pap testing history adherent to national guidelines. The factor most strongly associated with Pap testing receipt was suggestion from a friend, followed by longer residency in the United States, lower perceived common barriers, and lower perceived cultural barriers, for example, lack of family support and use of Eastern/Asian medicine. The factor most strongly associated with guideline adherence was having health insurance, followed by a recommendation from a physician or nurse practitioner. Only 11% of VIW knew where to obtain a free or low-cost Pap tests. CONCLUSION: Nurses can influence rates of Pap testing among VIW by providing health education through outreach programs targeted at lay health workers and their social networks, identifying at-risk patients such as recently immigrated women, reducing perceived common and cultural barriers to Pap testing, and helping women seek alternative payment options if they lack health insurance. Primary health care providers should be reminded of their essential role in increasing Pap testing adherence.

Nocturnal sleep-wake parameters of adolescents at home following cancer chemotherapy.

PURPOSE: The purpose of this descriptive, longitudinal study was to describe objective nocturnal sleep-wake parameters of adolescents at home after receiving chemotherapy in the hospital or outpatient clinic and explore differences in sleep variables by age, gender, and corticosteroid use. METHODS: We collected 7 days of wrist actigraphy and sleep diary data from 48 adolescents (10-19 years) who were receiving cancer chemotherapy for a primary or secondary cancer or a relapse. The actigraphic sleep variables included rest interval (i.e., time in bed), sleep onset, sleep offset, sleep duration, total sleep time (TST), wake after sleep onset (WASO), and %WASO. RESULTS: Of the 48 adolescents, 38 had at least five nights of scored actigraphy and were included in analyses. Older (13-18 years) adolescents went to bed later and had fewer minutes of TST than younger adolescents (10-12 years). Exploratory analyses revealed no differences between adolescents who were taking oral corticosteroids (i.e., prednisone, dexamethasone) and those who were not or between males and females. CONCLUSION: These adolescents had sleep durations that met or exceeded the recommended sleep duration for their age groups but experienced significant WASO. Further research is needed to estimate sleep needs of adolescents during chemotherapy and determine factors that contribute to nocturnal wake-time so that targeted interventions can be designed to improve sleep quality.

Sleep-wake patterns of school-age children and adolescents before diagnosis and during induction chemotherapy for acute lymphocytic leukemia.

Sleep disturbances are commonly reported by children receiving chemotherapy for leukemia. Sleep patterns before diagnosis and during induction chemotherapy were evaluated in 38 children (7 to 18 years old). Child Sleep Assessment (CSA) was used to evaluate sleep patterns prior to diagnosis. Sleep diaries and actigraphy were used during chemotherapy. Adolescents went to bed later and awakened later than school-age children before diagnosis and during chemotherapy. During chemotherapy, children averaged 60 minutes of nighttime wake time. The early recognition of sleep problems associated with disease, treatment, and age is important for school-age children and adolescents with leukemia.

Sleep quality and sleep hygiene behaviors of adolescents during chemotherapy.

STUDY OBJECTIVES: Describe the self-reported sleep quality and sleep hygiene behaviors of adolescents before diagnosis and during chemotherapy (CTX), compare their sleep quality and sleep hygiene behaviors with published normative data for healthy adolescents and adolescents with chronic pain, and explore factors that predict sleep quality. METHODS: Subjects were 51 adolescents (10 to 19 years) receiving CTX for cancer. A questionnaire was used to assess sleep patterns prior to the adolescent's cancer diagnosis, and a 7-day sleep diary was used to assess subjective sleep-wake activity during CTX. Sleep quality was assessed using the Adolescent Sleep Wake Scale, and sleep-facilitating and sleep-inhibiting behaviors using the Adolescent Sleep Hygiene Scale. RESULTS: Adolescents receiving CTX reported significantly worse sleep quality and sleep hygiene behaviors than healthy adolescents, and better sleep quality but similar sleep hygiene behaviors to adolescents with chronic pain. Significant interactions were found between bedtimes and wake-times on weekdays and weekends before diagnosis and during CTX. Sleep hygiene and demographic variables accounted for 24% of the variance in sleep quality. The cognitive and emotional subscales of the sleep hygiene scale and demographic variables accounted for 36% of the variance in sleep quality. CONCLUSIONS: Both the weekday and weekend sleep-wake patterns of adolescents receiving CTX resembled their weekend sleep patterns prior to diagnosis.

Differences in symptom occurrence, frequency, intensity, and distress in adolescents prior to and one week after the administration of chemotherapy.

PURPOSE/OBJECTIVES: The purpose of this study was to describe differences in occurrence, frequency, intensity, and distress of symptoms prior to (T1) and one week following (T2) the administration of intravenous chemotherapy. DESIGN: Longitudinal, descriptive. SETTINGS: Two regional children's cancer centers in the Pacific Northwest. SAMPLE: A total of 51 adolescents 10 to 19 years old receiving cancer chemotherapy. METHODS: Memorial Symptom Assessment Scale (MSAS 7-12). FINDINGS: No significant differences were found in symptom occurrence rates between T1 and T2. Fatigue was the only symptom with significantly greater frequency and intensity, and nausea was the only symptom with significantly greater distress at T2 compared with T1. CONCLUSIONS: Adolescents receiving chemotherapy experience multiple symptoms that persist over time. IMPLICATIONS FOR NURSING: In monitoring for symptoms, nurses need to be aware of the extent to which symptoms are present throughout treatment, as evidenced by these findings that symptom occurrence was significant even prior to receiving a subsequent course of chemotherapy.

Pain, sleep disturbance, and fatigue in children with leukemia and their parents: a pilot study.

PURPOSE/OBJECTIVES: To determine the feasibility of collecting symptom data at home from school-age children with acute lymphoblastic leukemia (ALL) and from their fathers and mothers and to obtain initial descriptions of pain, sleep disturbance, and fatigue experienced by the family members at home. DESIGN: Prospective and descriptive. SETTING: Children's homes in Oregon and southwestern Washington. SAMPLE: 9 children with ALL (aged 8-16 years), 6 fathers, and 7 mothers. The children received vincristine during the maintenance phase of their outpatient chemotherapy treatments. METHODS: With age-appropriate, paper-and-pencil diaries and wrist actigraphy, data were collected for three days in the families' homes. Families were reminded by telephone to complete their sleep and activity diaries. MAIN RESEARCH VARIABLES: Pain, sleep disturbance, and fatigue in school-age children and their fathers and mothers. FINDINGS: Most of the families who were approached indicated willingness to participate in the study. After receiving outpatient chemotherapy, the children reported pain, sleep disturbance, and fatigue data over three days. Fathers and mothers also reported symptoms. Actigraphy showed children waking more often during the night than mothers or fathers. CONCLUSIONS: Children's pain, sleep disturbance, and fatigue suggest that the symptoms are influencing families' quality of life. Larger studies are needed to examine the symptom patterns and health outcomes of children, fathers, and mothers over the course of chemotherapy. IMPLICATIONS FOR NURSING: Improving sleep and managing pain and fatigue after chemotherapy treatment for children with ALL may improve health outcomes for children and parents.

Mothers' management of adenoid-tonsillectomy pain in 4- to 8-year-olds: a preliminary study.

The health care system has moved towards home care, early discharge, and day procedures. Parents in the home are, therefore, far more likely to be managing their children's postoperative pain than health professionals. The purpose of this study was to describe mothers' experiences in identifying and managing their children's acute pain associated with surgery. Because little is known about family's perceptions and management of a child's pain in the home, a qualitative design and grounded theory method were used. A purposive, convenience sample of 7 mothers whose children were 4-8 years old and who had a day-surgery adenoid-tonsillectomy were interviewed in depth (2-3 interviews per mother). Four themes were found in the data: (1) mothers' descriptions of their children's overall pattern of postoperative pain indicated that pain was minimal or absent before surgery, increased following surgery, and decreased with medicine and healing; (2) mothers' assessment and evaluation of their children's pain used pain cues similar to those used by nurses and physicians; (3) all the mothers worried about drug addiction; and 4) mothers learned to manage their children's pain through 'trial and error'. This study provides beginning data for understanding family management of children's pain.