Andrea Meier

After Hurricane Floyd passed: investigating the social determinants of disaster preparedness and recovery.

In September 1999, Hurricane Floyd struck eastern North Carolina. Investigators from the health promotion study “Health Works for Women/Health Works in the Community” responded by initiating a focused research study, “Health Works After the Flood.” Participatory research involving a multilevel design and qualitative methods was applied to investigate how community preparedness, response, and recovery are affected by social factors such as social capital, social cohesion, and collective efficacy. This article presents evidence from qualitative research conducted for “Health Works After the Flood” and links these findings to observations regarding current conceptualizations of social capital and related concepts.

Disaster Down East: Using Participatory Action Research to Explore Intimate Partner Violence in Eastern North Carolina:

In the aftermath of Hurricane Floyd in 1999, a Community Advisory Committee requested assistance from its university partners (University of North Carolina) to address stress and increased risk for intimate partner violence (IPV). Collected from 12 study work sites, baseline data indicated that IPV rates were higher among blue-collar women in eastern North Carolina than national population-based rates suggest. IPV victims reported higher levels of perceived stress, psychological distress, somatic complaints, and post-traumatic stress disorder (PTSD) symptoms than did nonvictimized coworkers. As for the relationship of the flood to IPV, no significant increase in IPV incidence occurred after the flood. Regardless of their flood experience, however, IPV victims consistently reported greater stress, PTSD symptoms, and somatic and psychological problems. Moreover, IPV victims may be at higher risk for stress-mediated chronic illnesses and for using negative coping behaviors. This study uses an established trusting relationship between researchers and community members to explore community needs and inform intervention design.

Offering social support via the Internet: a case study of an online support group for social workers

SUMMARY Human service professionals have begun to explore the Internets potential as a therapeutic medium for individuals, families and groups, but we still know very little about the ways that Internet-mediated communication affects interventions. This paper uses examples from a recent study of a short-term, listserv-based support group that helps social workers cope with job stress to discuss issues related to the use of online support groups.

Evaluating the implementation of peer counseling in a church-based dietary intervention for African Americans

OBJECTIVE Body & Soul, an evidence-based nutrition program for African Americans churches, is currently being disseminated nationally and free of charge by the National Cancer Institute. For dissemination feasibility, the peer counseling training is done via DVD rather than by live trainers. We describe implementation and process evaluation of the peer counseling component under real world conditions. METHODS The study sample included 11 churches (6 early intervention, 5 delayed intervention) in 6 states. Data sources included training observations, post-training debriefing sessions, coordinator interviews, and church participant surveys. Survey data analysis examined associations between exposure to peer counseling and change in dietary intake. Qualitative data were analyzed using the constant comparative method. RESULTS Eight of 11 churches initiated the peer counseling program. Recall of talking with a peer counselor was associated with significantly (p<.02) greater fruit and vegetable intake. Data indicate sub-optimal program execution after peer counselor training. CONCLUSION Inconsistent implementation of the peer counseling intervention is likely to dilute program effectiveness in changing nutrition behaviors. PRACTICE IMPLICATIONS Disseminating evidence-based programs may require added resources, training, quality control, and technical assistance for improving program uptake. Similar to earlier research phases, systematic efforts at the dissemination phase are needed for program success.

Parents and Health Care Professionals Working Together to Improve Adolescent Health: The Perspectives of Parents

One proposed strategy to improve adolescent health and health care is to create working partnerships among adolescent health care professionals (HCPs) and families. In this pilot qualitative study we interviewed 17 mothers to explore their perceptions of the role of parents, HCPs, and parent-HCP partnerships in addressing adolescent health issues.

Individuals’ responses to global CHD risk: A focus group study

OBJECTIVE To explore how individuals respond to global coronary heart disease (CHD) risk and use it in combination with treatment information to make decisions to initiate and maintain risk reducing strategies. METHODS We conducted four focus groups of individuals at risk for CHD (n=29), purposively sampling individuals with each of several risk factors. Two reviewers coded verbatim transcripts and arbitrated differences, using ATLAS.ti 5.2 to facilitate analysis. RESULTS Participants generally regarded the concept of global CHD risk as useful and motivating, although had questions about its precision and comprehensiveness. They identified several additional influential factors in decision-making (e.g. achievable risk, the quickness and self-evidence of results) and generally preferred lifestyle changes to medications (although most would accept medications under certain circumstances). They also noted the importance of participating in decision-making. CONCLUSION Our results underscore the motivating potential of global CHD risk and the importance of patient participation in decision-making. PRACTICE IMPLICATIONS Global CHD risk is a useful adjunct to CHD prevention and can be presented in ways, and with information, that might improve CHD outcomes.

“Una Mujer Trabaja Doble Aquí”: Vignette-Based Focus Groups on Stress and Work for Latina Blue-Collar Women in Eastern North Carolina

Latina women are a growing percentage of the working population, and very little is known about their health needs and interests. The purpose of this article is to share qualitative research results gathered from Latina women with a particular focus on exploring stress and health. This project was a substudy of Health Works in the Community, a 5-year CDC-funded multiple risk-factor reduction trial using participatory action research approaches to address smoking, healthy eating, stress, and physical activity among blue-collar women from 12 manufacturing work sites in rural, eastern North Carolina. Five focus groups were conducted with trained, bilingual facilitators using a vignettebased moderator guide that appeared particularly effective with this population. Results from the focus groups are used to make recommendations for future research with Latinas and for developing effective work-site-based interventions to address issues of stress and health within this population.

Methodological Tips for Overcoming Formative Evaluation Challenges The Case of the Arthritis Foundation Walk With Ease Program

Formative evaluation is an effective first step in guiding program improvement by identifying participant preferences and yielding information pertinent to making program decisions. As program evaluators working with service providers are increasingly encouraged to adopt evidence-based health promotion programs, a discrete set of real-world recommendations may help extend the use of this methodology to respond to community-specific contexts and improve health impact. This article describes the authors’ step-by-step process of conducting a formative evaluation of the Arthritis Foundation Walk With Ease (WWE) program. Data collection targets (leaders, coordinators, and participants in the original program and leaders and participants in the revised piloted program) as well as methods (written surveys, focus groups, structured telephone interviews, and expert reviews) were triangulated. The authors describe the challenges they faced and conclude with practical methodological recommendations about managing time and resources, communications with respondents, and accountability systems for organizing triangulated data.

Growing www.parentsofsuicide: A Case Study of an Online Support Community

Worldwide, people can now come together in online support communities (e-communities) to share common concerns. Although myriad e-communities now exist, few researchers have investigated their leadership, infrastructure, and developmental processes. Because these e-communities are often founded without professional oversight by people confronted with life crises, social workers have expressed concern about their safety and effectiveness for vulnerable populations. This article presents findings from a case study of an e-community, www.parentsofsuicide, for parents who have lost a child to suicide, and the leadership and organizational development factors contributing to its organizational durability and effectiveness as a source of social support.