A small grants program to involve communities in research.

A key tenet of community-based participatory research is that communities be involved in all facets of research, from defining the problem to identifying solutions, to assisting in the research, and to participating in the publication of results. In this study, we instituted a small grants program for community participation. A Request for Applications (RFA) was developed and circulated widely throughout the Valley. The RFA sought proposals to address health disparities in cancer education, prevention, and treatment among Hispanics living in the Valley. Funds available were $2,500.00-3,500.00 for 1 year's worth of work. To help evaluate the progress of the RFA community projects according to the perspectives of the Community Advisory Board (CAB), an open-ended, semi-structured interview was created and administered by a former staff member to CAB members. In 4 years, ten small grants proposed by community members were funded. Funds allocated totaled approximately $25,000. Interviews with CAB members indicated that the RFA program was perceived positively, but there were concerns about sustainability. Our community grants program resulted in the implementation of several novel cancer prevention programs conducted by a variety of community organizations in the Lower Yakima Valley.

A qualitative investigation of cancer survivorship experiences among rural Hispanics.

Cancer survivorship experiences were explored among Hispanic men and women with cancer and family members of cancer survivors, recruited from two rural Washington communities in the Lower Yakima Valley. Five focus groups were conducted from February 2006 to October 2007 with 31 women and 10 men. Disbelief, fear, sadness, strength, courage, faith, and hope were common reactions to diagnosis. Concerns about family/children, losing medical coupons, and feelings of depression/isolation were identified as challenges faced after diagnosis. Participants identified smoking and environmental exposures as causes of cancer, but many believed operating on tumors caused cancer to spread. Participants used conventional treatments but identified herbal/natural remedies as cures. Most participants reported negative experiences with physicians and believed their community would benefit from language-appropriate information regarding prevention and treatment. The importance of linking survivors through support groups was emphasized and information elicited from sessions has been used to organize survivor support groups in these two communities.

Type 2 diabetes among rural Hispanics in Washington State: perspectives from community stakeholders.

During February-March 2006, elicitation interviews were conducted with 23 community stakeholders in the Yakima Valley, Washington State, to examine concerns about diabetes and to obtain recommendations for how to address concerns among Hispanics in this rural community. Using a snowball approach, stakeholders were identified from organizations providing care and outreach for Hispanics with diabetes. Interviews were guided by a social ecology approach and were conducted as part of a larger parent study using principles of community-based participatory research. Audiotaped interviews were transcribed and then coded by three staff members who identified common themes independently before meeting to reach consensus. Stakeholders represented health care delivery or social service organizations, churches, or local radio stations. Diabetes was perceived as an important problem among community members, who often underwent delayed diagnosis of the disease. Lack of disease knowledge, access to appropriate information or services, health insurance, and personal responsibility were perceived as barriers. Stakeholders recommended using exiting organizations and businesses as intervention channels, promoting cultural sensitivity of health professionals and volunteers, creating and distributing appropriate information, and organizing activities to promote awareness and disease management. Recommendations have informed the design of community interventions to lessen the impact of diabetes in the Yakima Valley.

Sociodemographic factors and self-management practices related to type 2 diabetes among Hispanics and non-Hispanic whites in a rural setting.

CONTEXT: Hispanics in the United States have a higher prevalence of non-insulin-dependent diabetes mellitus (type 2 diabetes) and experience more complications for the disease than non-Hispanic whites. Differences in medical management or self-management practices may, in part, explain the relative high risk for diabetes complications among Hispanics. PURPOSE: Using data from a community-randomized intervention study on cancer prevention, we examined the medical management and self-management practices of Hispanics and non-Hispanic whites who have diabetes. METHODS: Locally hired bilingual personnel conducted in-person interviews of a random selection of 1,863 adults in 20 communities in the Yakima Valley of eastern Washington State. FINDINGS: A total of 70 Hispanics (11% age-adjusted prevalence) and 87 non-Hispanic whites (7.3% age-adjusted prevalence) reported having type 2 diabetes. Hispanics with a high level of acculturation were slightly more likely to have diabetes, compared to those with a low level of acculturation, though the association was nonsignificant. Hispanics were significantly less likely than non-Hispanic whites to treat their diabetes with diet and exercise (36% vs 61.3%; P < or = .001). Annual eye examinations were less commonly reported among Hispanics (48.9%) than among non-Hispanic whites (72.7%). CONCLUSIONS: Our data indicate that Hispanics engage less frequently in self-management practices to control diabetes than non-Hispanic whites.

Attitudes and beliefs about colorectal cancer among Mexican Americans in communities along the US-Mexico border.

PURPOSE: The purpose of this study was to examine Mexican American knowledge, attitudes, and beliefs about colorectal cancer and barriers to receiving colorectal cancer screening exams. DESIGN: We developed an open-topic focus group schedule that addressed knowledge, attitudes, and beliefs about screening for colorectal cancer and identified cultural issues to be considered when developing educational interventions to increase screening participation. Focus groups were used to elicit participant responses. SETTING: Two small communities (colonias) along the US-Mexico border. SUBJECTS: Mexican Americans ages > or = 50 years. RESULTS: A total of 43 individuals (20 men and 23 women) participated in the focus groups, each of which lasted approximately 90 minutes. Few focus group participants had ever heard of colorectal cancer or specific screening exams to detect early forms of cancer. Participants identified cost of medical care and embarrassment about receiving colorectal exams as barriers to screening participation. Respondents commonly expressed fatalistic attitudes about their chances of recovering from cancer, some preferred not to know if they had cancer or believed that they would refuse treatment if diagnosed with cancer. Nevertheless, many participants noted that strong support from family and friends or a strong will would allow one to survive cancer. CONCLUSION: Interventions to improve participation in screening services for colorectal cancer should focus on reducing the influences of cost and embarrassment and improving levels of knowledge about colorectal cancer and the need for screening.

Attitudes and beliefs among Mexican Americans about type 2 diabetes.

Hispanics in the United States have a disproportionately high risk for non-insulin-dependent diabetes mellitus (type 2 diabetes) compared with non-Hispanic whites. Little is known of the attitudes and beliefs about diabetes in this group. Using data from six focus groups of 42 Mexican Americans (14 men and 28 women), we characterized perceptions about the causes of and treatments for type 2 diabetes. Many participants believed diabetes is caused by having a family history of the disease, eating a diet high in fat or sugar, and engaging in minimal exercise. Experiencing strong emotions such as fright (susto), intense anger (coraje), or sadness and depression (tristeza) was also thought to precipitate diabetes. Nearly all participants expressed the belief that it is important to follow doctors' recommendations for diet and exercise, oral medication or insulin; many also cited herbal therapies, such as prickly pear cactus (nopal) and aloe vera (savila) as effective treatments. These findings may be useful in designing interventions to reduce the burden of diabetes in Hispanic populations.

Anthropological and psychological merge: design of a stress measure for Mexican farmworkers.

This study implements qualitative and quantitative methodologies in the development of a culturally appropriate instrument of stress for Mexican immigrant farmworkers. Focus groups were used to uncover culturally based perspectives on life stressors, definitions of stress, and stress mediators. Qualitative data were analyzed using QSR NVivo and then used to develop a 23-item stress scale. The scale was tested for reliability and validity in an independent sample and demonstrates excellent reliability (alpha = 0.9123). Test-retest coefficients of the stress scale are also strong (r = 0.8344, p = 0.0000). Qualitative analyses indicated three major sources of stress: work, family, and community. Emotional aspects of stress also emerged, demonstrating a cultural perspective of stress closely related to feelings of despair and not being able to find a way out of despairing situations. This paper reveals themes gathered from the qualitative data and identifies reliability and validity constructs associated with the scale. The stress scale developed as part of this investigation is a reliable and culturally appropriate instrument for assessing stress among Mexican immigrant farmworkers.