Catherine A. Marshall

Considerations of culture and social class for families facing cancer: the need for a new model for health promotion and psychosocial intervention.

Cancer is a family experience, and family members often have as much, or more, difficulty in coping with cancer as does the person diagnosed with cancer. Using both family systems and sociocultural frameworks, we call for a new model of health promotion and psychosocial intervention that builds on the current understanding that family members, as well as the individuals diagnosed with cancer, are themselves survivors of cancer. We argue that considering culture, or the values, beliefs, and customs of the family, including their choice of language, is necessary to understand fully a familys response to cancer. Likewise, acknowledging social class is necessary to understand how access to, and understanding of, otherwise available interventions for families facing cancer can be limited. Components of the model as conceptualized are discussed and provide guidance for psychosocial cancer health disparities research and the development of family-focused, strength-based, interventions.

Un Abrazo Para La Familia: providing low-income Hispanics with education and skills in coping with breast cancer and caregiving.

Un Abrazo Para La Familia (A Hug for the Family) is an intervention designed to increase the accessibility of cancer information to low‐income and medically underserved co‐survivors of cancer. Co‐survivors are family members or friends of an individual diagnosed with cancer. Our goal was to increase socio‐emotional support for these co‐survivors and improve skills in coping with cancer. The purpose of our pilot study was to explore the effectiveness of the intervention in increasing cancer knowledge and self‐efficacy among co‐survivors.

like a mexican wedding: Psychosocial intervention needs of predominately hispanic low-income female co-survivors of cancer

Although recent work has recognized that the influence and consequences of cancer extend beyond the individual receiving the diagnosis, no studies have focused on the specific psychosocial intervention needs of female co-survivors in low-income populations. In this qualitative study, the co-survivors, 16 women, representing 10 low-income families and predominately Hispanic, were interviewed about their experience of having someone in their family diagnosed with cancer. Several themes emerged from the data, including family stress, lack of skill in coping with the effects of cancer (e.g., depression of their loved one), a need for financial help, a willingness to share with others, and reliance on faith to see them through the cancer experience. Whereas no agreement existed as to where and how to provide an intervention, participants reported that tailoring an intervention to family needs and delivering it in a way that was accessible to them was important.

Differences in Transitional Care Provided to Mexican American and Non-Hispanic White Older Adults.

Background:Transitional care, assisting patients to move safely through multiple health care settings, may be insufficient for older Hispanic patients. Purpose: Describe home health care services referral rates for Hispanic and non-Hispanic White (NHW) patients and factors that influence case managers’ (CMs’) discharge planning processes. Design: Organized by the Ethno-Cultural Gerontological Nursing Model, health records were reviewed (n = 33,597 cases) and supplemented with qualitative description (n = 8 CMs). Findings: Controlling for gender, insurance type, age, and hospital length of stay, NHW older adults received more home health care services referrals (odds ratio = 1.23). Insurance coverage was the most frequent determinant of CMs’ post–hospital care choices, rather than patients’ being Hispanic. NHW older adults were more likely to have insurance than Hispanic older adults. Implications: Insurance coverage being CMs’ primary consideration in determining patients’ dispositions is a form of systems-level discrimination for Hispanic vulnerable groups, which combined with other hospital-level constraints, should be addressed with policy-level interventions.

Family-Focused Preventive Interventions With Cancer Cosurvivors: A Call to Action

Health promotion and preventive action in the context of public health interventions for highly prevalent, long-term conditions such as cancer are rarely geared toward the family as a whole. Yet family members, as cancer cosurvivors, must manage their own substantial stress and multiple caregiving responsibilities and often constitute a critical nexus between individual patients and clinicians. We drew on 2 examples of cancer cosurvivorship from 2 different health service contexts, the United States and Finland. A systemic approach in public health is needed to support family members who not only have to confront the meaning of long-term conditions such as cancer but also may have to manage concurrent social life challenges and stressors such as economic hardship.

Un Abrazo Para La Familia: An Evidenced-Based Rehabilitation Approach in Providing Cancer Education to Low-SES Hispanic Co-Survivors

We discuss Un Abrazo Para La Familia as an effective, rehabilitation-informed evidence-based model of education, information-sharing, and skill teaching for use with low-income Hispanic co-survivors of cancer. Over 2xa0years, 120 co-survivors participated in the intervention. The majority of participants (96xa0%) were women and all but one reported being Hispanic. Both in years 1 and 2, we followed the same pre- and post-intervention evaluation design. Based on pre- and post-intervention assessments of cancer-related knowledge and self-efficacy, the percentage of questions answered correctly about cancer significantly increased for co-survivors. Self-efficacy significantly increased as well. Using item analysis, we explored skill teaching as a mechanism for the effective delivery of Un Abrazo and recommend the use of promotoras in providing the intervention. Of the 12 cancer knowledge items resulting in statistically significant increases of cancer knowledge, 5 were taught via interactive skill teaching. Given the projected rise in the incidence of cancer in Hispanic populations, coupled with the fact that people from low-income backgrounds face unique challenges in cancer prevention and management, implications of the Un Abrazo model for future research and policy regarding cancer and families are considered.

Information and support for co-survivors during or after cancer treatment: Consideration of Un Abrazo Para la Familia as a model for family-focused intervention in cancer rehabilitation

OBJECTIVEnThe development and evaluation of Un Abrazo Para La Familia, [A Hug for the Family] is described. Un Abrazo is discussed as an effective model of education, information-sharing, and skill-building for use with low-income co-survivors of cancer.nnnPARTICIPANTSnSixty co-survivors participated. The majority were women and all reported being Hispanic.nnnMETHODSnUsing quantitative data (N=60), the needs, concerns, and characteristics of the co-survivor population served through Un Abrazo are presented. Further, we offer three qualitative case studies (with one co-survivor, one survivor, and one non-participant) to illustrate the model and its impact.nnnRESULTSnThe median level of education level of co-survivors was 12 years. The majority were unemployed and/or identified as homemakers, and indicated receipt of services indicating low-income status. Half reported not having health insurance. The top four cancer-related needs or concerns were: Information, Concern for another person, Cost/health insurance, and Fears.nnnCONCLUSIONSnRecognizing the centrality of the family in addressing cancer allows for a wider view of the disease and the needs that arise during and after treatment. Key rehabilitation strategies appropriate for intervening with co-survivors of cancer include assessing and building upon strengths and abilities and making culturally-respectful cancer-related information and support accessible.

Oregon's Familias en Acción replicates benefits for underserved cancer co-survivors through Un Abrazo Para la Familia

Our goal in this study was to determine if we could replicate initial findings when providing the intervention, Un Abrazo Para La Familia (“Abrazo”). Abrazo is a community‐focused psychoeducational preventive intervention addressing the cancer information and coping needs of low‐income, underserved family members of cancer survivors, developed and first implemented in Tucson, Arizona.

I’ll Paint you a Picture and You’ll Hear my Story: Broadening the Scope of Narrative Research for Arts-Based Service Learning

This chapter explores “reflective multimodal narrative” research as a methodology in arts-based service learning (ABSL). The chapter builds on the notion that imposing written or spoken data creation, which is currently dominant in Western research methods, limits the extent to which diverse student and community ABSL participants can narrate their experiences “in and on their own terms” in a research context. We assert that researchers need to be flexible and responsive to ABSL participants’ diverse cultural and personal preferences and abilities in gathering stories (data) to be interpreted and analysed when evaluating ABSL projects. Reflective multimodal storytelling is one way of supporting and documenting the dynamic, reciprocal intercultural learning that ideally takes place in ABSL programs.