Developing Culturally Tailored Mobile Web App Education to Promote Breast Cancer Screening: Knowledge, Barriers, and Needs Among American Indian Women.

American Indian (AI) women face disproportionate rates of breast cancer mortality and cancer disparities. This study conducted qualitative research to assess perspectives of AI women towards breast cancer screening, knowledge, barriers, and needs about mobile web app-based education to promote breast cancer screening. This study, in collaboration with the Yankton Sioux Tribe (YST), followed a community-based participatory research approach and conducted two focus groups with a total of 22 YST women aged 40-70 years living on reservation in rural South Dakota. Each group consisted of 11 local professionals working in healthcare and social services and community members. A grounded theory was used for the qualitative analysis. A large portion of participants reported having prior knowledge about breast cancer and screening methods, yet lacked awareness of the detailed procedure and recommended guidelines. Competing priorities and cost of mammograms were noted as major barriers to screening. Participants wanted to learn-in a convenient and easy-to-understand manner-more about breast cancer and prevention from a credible source. Both groups were favorable toward novel educational tools, such as the mobile web app education, and cited potential health benefits, particularly for women aged 40s to 60s. Our findings highlighted the importance of creating effective, culturally tailored educational interventions built into programs specific to AIs to increase understanding about breast cancer screening and promote screening behaviors among AI women. Particular attention to how AIs' culture, beliefs, and barriers are implicated in screening behaviors could help with developing culturally tailored health education tools for this population.

American Indian women cancer survivors' perceptions and experiences with conventional and non-conventional mental health care for depressive symptoms.

Background: Despite cancer and depression being disproportionately high for American Indian and Alaska Native (AI/AN) women, such cancer survivors' help-seeking practices and perceptions related to depression are absent in extant research. A broader context of historical oppression has set the stage for unequal health outcomes and access to quality services. The purpose of this article was to explore AI women cancer survivors' experiences with conventional mental health services and informal and tribally-based assistance, as well as barriers related to mental health service utilization.Methods: A qualitative descriptive study methodology, with qualitative content analysis, was used to examine the experiences of AI women cancer survivors as they related to help-seeking experiences for depressive symptoms. The sample included 43 AI women cancer survivors (n = 14 breast cancer, n = 14 cervical cancer, and n = 15 colon and other types of cancer survivors).Results: Since receiving a cancer diagnosis, 26 (62%) participants indicated they had feelings of depression. Some participants (n = 13) described mixed perceptions of the mental health service system. Generally, participants viewed families and informal support systems as primary forms of assistance, whereas conventional services were reported as a supplementary or 'as needed' forms of support, particularly when the informal support system was lacking. Participants received help in the forms of psychotropic medications and psychotherapy, as well as help from family and AI-specific healing modalities (e.g. sweat lodges and healing ceremonies). Stigma and confidentiality concerns were primary barriers to utilizing conventional services as described by 12 (29%) participants.Discussion: Participants' help primarily came from family and tribally-based entities, with conventional mental health care being more salient when informal supports were lacking. The mixed perceptions espoused by participants may be related to a broader context of historical oppression; family and social support and tribally-based services may be protective factors for cancer survivors with depression.

The Resilience of Indigenous Women of the U.S. Who Experience Cancer: Transcending Adversity.

Almost no research specifically explores resilience among Indigenous women of the U.S. who experience cancer. A qualitative descriptive study included a sample of 43 Indigenous women from the Northern Plains region of the U.S. Almost 90% (88%, n=37) of participants indicated personal growth in response to having cancer, indicating they valued relationships (n=3), had a stronger faith (n=5), were grateful and living in moment (n=21), were healthier (n=5), and helped others (n=6) in response to their cancer experience. Results indicate that factors that promote and facilitate resilience are critical for culturally responsive practice with Indigenous women.

Family: The Bedrock of Support for American Indian Women Cancer Survivors.

Cancer disparities among American Indian (AI) women are alarming, yet a dearth of research focuses on the role of family support for such women. The purpose of this research was to examine the composition of AI women cancer survivors' family support networks and the types of support that they provided. We used a qualitative descriptive methodology with 43 AI women cancer survivors and qualitative content analysis, which indicated that 38 participants (approximately 90%) reported that their families provided integral and varied forms of support, especially instrumental support throughout cancer experiences. Families were the bedrock of support for AI women cancer survivors.

American Indian Women Cancer Survivors' Spiritual and Religious Coping Practices.

Despite AI women's cancer disparities being a public health concern, a dearth of research on this populations' spiritual coping poses a barrier to redressing such disparities. The purpose of this article was to explore AI women cancer survivors' spiritual and religious coping. This qualitative descriptive study included a sample of 43 AI women cancer survivors. Qualitative content analysis revealed that 93% of AI women cancer survivors used a variety of AI spiritual coping, religious coping, and/or a mixture of the two. Results reveal the prevalence of AI spiritual coping, with traditional AI spiritual practices being particularly common.

Multilevel Analysis of Child and Adolescent Subjective Well-Being Across 14 Countries: Child- and Country-Level Predictors.

This study tests an ecological, relationship-based model of children's subjective well-being with 9- to 14-year-old children (n = 25,906) from 14 countries across Africa, Asia, Europe, North America, and South America. Children completed the Children's Worlds survey, a self-report measure of contextual and well-being indicators. Multilevel modeling was used to predict children's well-being (life satisfaction and self-image) at two levels, child (age, gender, home context, family relationships, peer relationships, school context, teacher relationships, and neighborhood quality), and country (gross domestic product and income inequality). Findings indicated that intercepts varied significantly across countries. The majority of variance in children's well-being was attributed to child-level rather than country-level factors. Country-level factors did not strongly predict well-being but marginally improved model fit.

Identifying risk and protective factors related to depressive symptoms among Northern Plains American Indian women cancer survivors.

Cancer is the leading cause of death among American Indian and Alaska Native (AIAN) women, and depressive symptoms have been linked to higher mortality, but research on depressive symptoms among AIAN cancer patients has been scant. The purpose of this exploratory study was, using the Framework of Historical Oppression, Resilience, and Transcendence, to examine risk and protective factors related to depressive symptoms in American Indian (AI) women cancer survivors. We examined the relationships of adverse childhood experiences (ACE), perceived health status, resilience, and social support with depressive symptoms in Northern Plains AI women cancer survivors. We used a cross-sectional design with purposive sampling of 73 female cancer survivors (aged 18 years or older) between June 2014 and February 2015. Hierarchical multiple regression was used to test three sets of variables in relation to depressive symptoms: (1) sociodemographics, (2) risk factors (ACE and perceived health), and (3) protective factors (psychological resilience and social support). Approximately 47 percent of participants had probable depressive symptoms. Depressive symptoms were inversely associated with perceived health, psychological resilience, and social support. These results support bolstering existing social support among AI cancer patients and survivors as well as prevention and intervention efforts that strengthen resilience.

American Indian women cancer survivors' coping with depressive symptoms.

OBJECTIVE: Depressive symptoms have been identified as a primary predictor of quality of life among cancer patients. Depression and cancer are co-occurring and disproportionately elevated for American Indian and Alaska Native (AI/AN) women. The purpose of this article is to examine American Indian (AI) women cancer survivors' coping mechanisms for depressive symptoms. RESEARCH APPROACH: The methodology included a qualitative descriptive approach with conventional content analysis to examine the coping strategies of AI women cancer survivors associated with depressive symptoms. The interview guide was semi-structured and developed in collaboration with a community advisory board (CAB). Data-derived qualitative analysis was used to generate codes inductively from the data. PARTICIPANTS: A sample of 43 AI women cancer survivors (n = 14 cervical cancer, n = 14 breast cancer, and n = 15 other cancers) from the Northern Plains region, in the state of South Dakota were interviewed. Data were collected from June 2014 to February 2015. Methodological approach: Qualitative content analysis was used for data analysis, which allowed themes to emerge inductively from the data. Analysis revealed 430 preliminary codes. After de-briefing, validation, and discussion among coauthors, these were then sorted into 67 codes. Member checks with all available participants were conducted to minimize misinterpretation. FINDINGS: A total of 26 participants (62%) indicated they had feelings of depression since their cancer diagnosis. Women coped with depressive feelings by (a) participating in faith traditions; (b) seeking creative and positive outlets; (c) martialing family and social support; and (d) keeping busy with other life activities. INTERPRETATION: AI women experienced depressive symptoms following a cancer diagnosis and used a variety of positive coping mechanisms to create personal meaning. Implications for Psychosocial Providers or Policy: AI women may need unique support following a cancer diagnosis, and interventions should incorporate AI beliefs and traditions, such as storytelling and talking with family and community members.

American Indian Women Cancer Survivor's Needs and Preferences: Community Support for Cancer Experiences.

Cancer (the focus of this inquiry) is the leading cause of death among American Indian and Alaska Native women. The purpose of this study was to identify American Indian women cancer survivors' needs and preferences related to community supports for their cancer experience. This qualitative study examined female American Indian cancer survivors' needs and preferences about community support. The sample included 43 American Indian women cancer survivors (the types of cancer survivors included cervical cancer: n = 14; breast cancer: n = 14; and colon and other types: n = 15) residing in the Northern Plains region, in the state of South Dakota. Data were analyzed using qualitative content analysis and were collected between June of 2014 and February of 2015. When asked about their needs and preferences, 82% of participants (n = 35) of female American Indian cancer survivors reported at least one of the following most commonly reported themes: cancer support groups (n = 31, 72%), infrastructure for community support (n = 17, 40%), and cancer education (n = 11, 26%). In addition to the aforementioned themes, 33% of participants (n = 14) indicated the need for an improved healthcare system, with 11% (n = 5) of participants expressly desiring the integration of spirituality and holistic healing options. The majority of American Indian women cancer survivor participants of this study identified a need for more community-based support systems and infrastructures to aid with the cancer survivor experience. Results warrant a community approach to raise awareness, education, and support for American Indian cancer survivors.

Childhood Sexual Abuse and Depression among American Indians in Adulthood.

The present study investigated distal and proximal factors associated with depression among a sample of 479 American Indian (AI) adults in the Midwest. Distal factors included histories of childhood sexual abuse (CSA) and other childhood adversities. Proximal factors included levels of health self-efficacy and treatment for alcohol problems. The study also examined the moderating effect of treatment for alcohol problems on the relationship between CSA and depression. In model 1, results indicate that CSA was positively related to depression after controlling for demographic and background variables. In model 2, childhood adversities and treatment for alcohol problems were associated with increased depression in AI adults; CSA became nonsignificant. As a protective factor, level of health self-efficacy was negatively associated with depression. In model 3, treatment for alcohol problems magnified the effect of CSA on depression. These findings suggest that early traumatic experiences may have persistent, harmful effects on depression among AIs; one mechanism exacerbating the impact of CSA on depression is treatment for alcohol problems. Targeted interventions are needed to mitigate the long-term negative health effects of childhood trauma in this population and to strengthen proximal protective factors, such as health self-efficacy.

Healthcare barriers and supports for American Indian women with cancer.

Although American Indian (AI) women continue to experience cancer at higher rates and have not seen the same decline in cancer prevalence as the general U.S. population, little research examines how interactions with health care providers may influence and exacerbate these health disparities. The purpose of the study was to understand the experiences of AI women who receive cancer treatment, which is integral for eradication of AI cancer disparities among women. A qualitative descriptive methodology was used with a sample of 43 AI women with breast, cervical, colon, and other types of cancer from the Northern Plains region of South Dakota. Interviews were conducted from June 2014 to February 2015. Qualitative content analysis revealed that women experienced: (a) health concerns being ignored or overlooked; (b) lack of consistent and qualified providers; (c) inadequate healthcare infrastructure; (d) sub-optimal patient-healthcare provider relationships; (e) positive experiences with healthcare providers; and (f) pressure and misinformation about treatment. Results indicate the types of support AI women may need when accessing healthcare. Culturally informed trainings for healthcare professionals may be needed to provide high-quality and sensitive care for AI women who have cancer, and to support those providers already providing proper care.

Breast cancer literacy and health beliefs related to breast cancer screening among American Indian women.

The purpose of this article is to examine the health beliefs and literacy about breast cancer and their relationship with breast cancer screening among American Indian (AI) women. Using the Health Belief Model (HBM) and hierarchical logistic regression with data from a sample of 286 AI female adults residing in the Northern Plains, we found that greater awareness of breast cancer screening was linked to breast cancer screening practices. However, perceived barriers, one of the HBM constructs, prevented such screening practices. This study suggested that culturally relevant HBM factors should be targeted when developing culturally sensitive breast cancer prevention efforts.

The Role of Religiousness/Spirituality and Social Networks in Predicting Depressive Symptoms among Older Korean Americans.

This study (1) examined the effects of religiousness/spirituality and social networks as predictors of depressive symptoms in older Korean Americans and (2) compared the best predictors of depressive symptoms. A cross-sectional survey was conducted with 200 older Korean Americans residing in the New York City area in 2009. Best-subsets regression analyses were used to evaluate the best predictors of depressive symptoms. Nearly 30% of older Korean participants reported mild or severe depressive symptoms. The best model fit for depressive symptoms involved four predictors: physical health status, religious/spiritual coping skills, social networks, and annual household income. Social networks and religious/spiritual coping skills contributed significantly to the variance of depressive symptoms. Adding additional variables to the model did not enhance predictive and descriptive power. Religiousness/spirituality and social networks are important for coping with life stress and may be useful in developing effective health care strategies in the management of depression among older Korean Americans. Health education and intervention could be framed in ways that strengthen such coping resources for this population. Future research is needed to best guide prevention and intervention strategies.

Risk and Protective Factors for Depressive Symptoms Among Indigenous Older Adults: Intimate Partner Violence (IPV) and Social Support.

Research on depression and intimate partner violence (IPV) experienced by Indigenous older adults is virtually nonexistent. Given the associations between IPV and depression and their disproportionately high rates among Indigenous peoples in a context of historical oppression, the purpose of this inquiry is to examine how IPV and social support are associated with depressive symptoms for Indigenous older adults. We expand the knowledge base on IPV in later life, which primarily focuses on female samples, by including older men. We predicted: (a) IPV will be positively associated with depressive symptoms and (b) levels of social support will be negatively associated with depressive symptoms. Hierarchical regression analyses of data from a sample of Indigenous older adults (N = 233) in the Upper Midwest indicated that physical aggression (but not psychological aggression, sexual coercion, injury, or negotiation) was positively associated with depressive symptoms, whereas social support was negatively associated with depressive symptoms.

Risk and protective factors for depressive symptoms among American Indian older adults: adverse childhood experiences and social support.

OBJECTIVES: Despite efforts to promote health equity, many American Indian and Alaska Native (AI/AN) populations, including older adults, experience elevated levels of depression. Although adverse childhood experiences (ACE) and social support are well-documented risk and protective factors for depression in the general population, little is known about AI/AN populations, especially older adults. The purpose of this study was to examine factors related to depression among a sample of AI older adults in the midwest. METHOD: Data were collected using a self-administered survey completed by 233 AIs over the age of 50. The survey included standardized measures such as the Geriatric Depression Scale-Short Form, ACE Questionnaire, and the Multidimensional Scale of Perceived Social Support. Hierarchical multivariate regression analyses were conducted to evaluate the main hypotheses of the study. RESULTS: Two dimensions of ACE (i.e., childhood neglect, household dysfunction) were positively associated with depressive symptoms; social support was negatively associated with depressive symptoms. Perceived health and living alone were also significant predictors. CONCLUSION: ACE may play a significant role in depression among AI/AN across the life course and into old age. Social support offers a promising mechanism to bolster resilience among AI/AN older adults.

Socio-demographic and Health Behavioral Correlates of Depressive Symptoms among Korean Americans.

This study identifies the associations between socio-demographic characteristics and help seeking behaviors for depressive symptoms among adult Korean Americans (KAs). Using survey data from 230 residents of the New York City, Teaneck, New Jersey, and Philadelphia areas, simple and multiple logistic regression analyses were performed to assess the association between depressive symptoms and the covariates. Women were at much lower risk of depressive symptoms than were men, even after adjusting other covariates (OR 0.45, 95% CI 0.21-0.96). Having no health insurance (OR 4.02, 95% CI 1.28-12.61) and having experience in seeking professional help for mental health problems during the last year were significantly associated with depressive symptoms (OR 2.96, 95% CI 1.29-6.80). The findings suggest more attention to the risk of depression of KA men and further efforts on understanding the unique contribution of socio-demographic factors and health-related behaviors on depressive symptoms among KAs.

Attitudes Toward Mental Health Services Among American Indians by Two Age Groups.

This study examined determinants of attitudes toward mental health services with a sample of American Indian younger-old-adults (aged 50-64, n = 158) and American Indian older-old adults (aged 65 and older, n = 69). Adapting Andersen's behavioral model of healthcare utilization, predisposing factors, mental health needs, and enabling factors were considered as potential predictors. Female and those with higher levels of social support tend to report more positive attitudes toward mental health services. Culture-influenced personal belief was associated with negative attitudes toward mental health services among American Indian younger-old -adults. Age and higher chronic medical conditions were significantly related to negative attitudes toward mental health services. Health insurance was positively associated with positive attitudes toward mental health services in the American Indian older-old adults. Findings indicate that practitioners should engage how culture, social support, and chronic conditions influence the response to mental health needs when working with older American Indians.

Typology of religiosity/spirituality in relation to perceived health, depression, and life satisfaction among older Korean immigrants.

OBJECTIVES: The objectives of this study were (1) to identify distinct subtypes of older Korean immigrants based on their levels of religiosity/spirituality (R/S) and (2) to determine if the identified subtypes differed by demographic characteristics, perceived health, depression, and life satisfaction. METHOD: Factor mixture models were evaluated with a nonprobability sample of older Korean immigrants (N=200) residing in the New York City area in 2009 to classify typologies of R/S. Multiple regression was used to test the associations between the R/S subtypes and outcomes (perceived health, depression, and life satisfaction) while controlling for demographics. RESULTS: Two substantively distinct latent profiles were identified: normally religious/spiritual ('average R/S') and minimally religious/spiritual ('low R/S'). The average R/S subgroup (74.4%) showed higher means than those in the low R/S subgroup (25.6%) on all six R/S class indicators. Subtypes did not differ on age, education, income, marital status, living arrangements, or years in the USA. However, males were more likely than females to be 'average R/S.' The 'average R/S' subtype had significantly greater life satisfaction than their 'low R/S' counterpart. No differences between the two subtypes were found on perceived health or depression. CONCLUSION: Findings highlight the importance of the classifications of R/S for mental health outcomes, and they indicate that relationships among R/S, various demographic characteristics, and physical/mental health are complex. Future research should validate and refine this classification of R/S in order to help identify particular sources of health risks/behaviors, relevant treatments, and health-promoting interventions within homogenous subtypes of older Korean immigrants.

Depression Literacy and Depressive Symptoms: The Mediating Role of Self-Rated Mental Health Among Korean Americans.

OBJECTIVE: Depression literacy (DL) is increasingly recognized as an important predictor of mental health outcomes, but there remains a noticeable lack of scientific inquiry focusing on Korean Americans in this area. In addition, women are known to be more susceptible to depression, potentially affecting their DL and depressive symptoms differently than men. This study aimed to explore two primary objectives: (1) the potential role of self-rated mental health (SRMH) in mediating the association between DL and depressive symptoms in this population, and (2) whether gender differences exist in the presence and magnitudes of these mediation effects. METHOD: Data were drawn from a survey with 693 Korean Americans aged 18 and older residing in New York and New Jersey. The PROCESS macro was used to test the mediation effect of self-rated mental health on the relationship between depression literacy and depressive symptoms in men and women. RESULTS: Self-rated mental health was found to mediate the relation between depression literacy and depressive symptoms in women but not in men. CONCLUSIONS: Providing evidence-informed, culturally tailored and gender specific depression literacy education and programs for the KA communities may be an important strategy to reduce depressive symptoms in this group.

Cognitive Impairment and Social Determinants of Health Among Indigenous Women.

BACKGROUND AND OBJECTIVES: Cognitive impairment and Alzheimer's disease and related dementias (ADRD) pose significant challenges for Indigenous populations, necessitating urgent research. Limited evidence suggests that high rates of ADRD among Indigenous peoples are associated with social determinants of health (SDOH), such as education, income, health literacy, religion, and social engagement. RESEARCH DESIGN AND METHODS: Collaborating with a Northern Plains tribe, participants were recruited 123 self-identified Indigenous women aged 40-70 through a comprehensive recruitment strategy. Employing the SDOH framework, the research assessed cognitive impairment and Alzheimer's disease knowledge (ADK), utilizing the Ascertain Dementia 8 and Alzheimer's disease knowledge scales (ADK-30). The investigation examined the relationships between selected SDOH variables and cognitive impairment status. RESULTS: More than half of the participants showed signs of cognitive impairment, which correlated with lower income and education levels. Increased knowledge about Alzheimer's disease, particularly in terms of treatment management and its life impact subscales, was associated with lower odds of cognitive impairment. Conversely, higher levels of depressive symptoms and participation in religious activities were linked to increased odds of cognitive impairment. DISCUSSION AND IMPLICATIONS: The findings underscore the importance of culturally grounded tools and SDOH frameworks tailored to Indigenous contexts in addressing ADRD disparities. Future research should integrate historical and cultural factors to advance health equity within Indigenous communities, ultimately mitigating the impact of ADRD and promoting overall well-being.