Donelle M. Barnes

An Analysis of the Grounded Theory Method and the Concept of Culture

Researchers increasingly include multicultural respondents in qualitative research studies. The grounded theory method, a currently popular qualitative methodology, seeks to interpret data for theory development. However, analysis of respondents from a culture(s) significantly different from the researchers culture requires special attention to methodological issues. Requirements for conducting a grounded theory analysis with respondents from varying cultural orientations include personal or professional experience in the respondents culture, professional literature of the respondents culture around the phenomenon of interest, data analysis conducted in the language of the respondents, and a constant comparison of emerging concepts from the cultural perspective of the respondents. Only by attending to the cultures of the respondents and of the researchers can the social sciences create sufficiently rich inductively derived grounded theory.

Refugees’ Perceptions of Healthy Behaviors

This descriptive study explored refugees’ knowledge and perceptions of nutrition, physical activity and smoking behaviors using the Health Promotion and Transtheoretical Models. A one-time interview used both closed- and open-ended questions. The sample included 31 adults from Bosnia, Iran, and Cuba. Refugees had some knowledge of a healthy diet and physical activity, and were aware of both benefits and barriers for health behaviors. They had a realistic perception of their weight (55% overweight), and none thought obesity was a positive characteristic. Changes in diet, physical activity and smoking since arrival in the US have been positive for some and negative for others. For all categories discussed, refugees were in the pre-contemplation stage of change. There is a need to study refugees’ health behaviors over time after arrival. Health behavior interventions must be specific to ethnicity in order to accurately document progress and to be culturally appropriate.

Voices of Mexican American caregivers for family members with cancer: on becoming stronger.

This grounded theory study report describes the experience of 34 Mexican American (MA) female caregivers who provided care to a family member with cancer. Caregivers identified a process of “Becoming Stronger” as a result of their caregiver role. The emerging theoretical model of female MA cancer caregiving offers evidence to change current cancer care approaches from patient-focused to family-focused care for this ethnic group. Findings suggest that changes most responsive to cultural values and likely to provide accessible and quality cancer care for MA families are those that involve active partnering with MA caregivers to prioritize the patients cancer care.

Health Risk and Promotion Behaviors in Refugee Populations

Refugees resettling in the U.S. are generally low-income and underserved by health promotion interventions. To begin to address refugee health promotion issues, this study describes health behaviors of newly arrived (less than 90 days) adult refugees in the U.S. The methods used were retrospective description of clients from one refugee health screening program. The sample consisted of adult refugees (n=591), men and women, from Cuba, Bosnia, Vietnam, Kosovo, Iran, Iraq, and other countries. Rates of overweight were highest among Bosnians and lowest among Vietnamese. Cubans reported the most physical activity and Kosovars the least. Rates of smoking were highest among Bosnians and lowest among Cubans. Older refugees were more overweight and reported less physical activity and more smoking than younger adults. In some cases, different refugee groups have similar health promotion needs, while in others needs differ. This baseline descriptive data supports calls for further health promotion research and interventions in refugee populations.

Refugee Women's Reproductive Health in Early Resettlement

OBJECTIVE To describe reproductive health needs and screening rates for breast and cervical cancer for newly arrived (less than 90 days) refugee women in the United States. DESIGN A retrospective study of existing medical charts from 1996 to 2000. SETTING Refugee health screening clinic, central Texas. PATIENTS Refugee women (n = 283) newly arrived in the United States from Cuba (31.1%), Bosnia (26.1%), Vietnam (24.7%), and other countries (18.0%); age range = 18 to 74 years, mean age = 34.4 years. MAIN OUTCOME MEASURES Frequency of reproductive health problems and breast and cervical cancer screening rates. RESULTS Twenty-five percent of women in the sample were pregnant or had a reproductive health problem. A significant percentage older than 40 (86%) had never had a mammogram when compared to American women of the same age (33%). Only 24% reported having had a Pap test within the previous 3 years. CONCLUSIONS The risk of not receiving adequate reproductive health care is higher among newly arrived refugee women compared to nonrefugee women in the United States. For refugee women to enjoy optimum health, their individual needs and health care system issues must be addressed.

Mexican Immigrants’ and Mexican Americans’ Perceptions of Hypertension

Although the rate of hypertension (HTN) is no higher for Mexican-origin clients than for non-Hispanic Whites, their rate of blood pressure (BP) control is lower. To effectively assist clients with their BP, health care providers must first understand barriers and facilitators to BP control from the clients’ perspectives. The purpose of this study was to describe the experience of living with HTN for Mexican immigrants and Mexican Americans. A phenomenological method was appropriate to describe their lived experience. We conducted one-time interviews with 26 adults who self-identified as Mexican-origin. Some participants did not know what caused HTN and others believed in causes they could control. Many believed HTN was of short duration. Some participants forgot to take medication or were not able to afford it. Mexican-origin clients need more assistance with BP control, and need it in both English and Spanish.

An ethnography of chronic pain in veteran enlisted women

Enlisted women are an essential subpopulation within the United States (U.S.) Armed Services, yet little is known about their chronic pain experiences. The purpose of this study was to describe veteran enlisted womens chronic pain experiences, both while on active duty and since active duty ended. A total of 15 enlisted women were interviewed. This ethnographic approach produced stories of their beliefs, attitudes, and behaviors regarding their chronic pain and the care they have received both while serving and after discharge or retirement. The findings show that U.S. military culture and training have a major impact on enlisted womens chronic pain experiences. Enlisted women learn to ignore or deny acute pain because it would hamper their ability to complete their military mission. Even when they admit to themselves that they are in pain, they may mask the pain from others for fear of being called weak or fear of discrimination and ostracism. When the pain can no longer be ignored and they seek health care, they are frustrated when their pain reports are not believed by supervisors and health care providers. Chronic pain eventually leads to discharge or retirement when they can no longer do their job. Health care providers must understand both U.S. military culture and enlisted womens strategies concerning pain if they are to accurately diagnose and sufficiently treat enlisted women in pain.

Readability and Suitability of Spanish Language Hypertension and Diabetes Patient Education Materials

ABSTRACT Hispanics who speak Spanish are at risk for low health literacy. We evaluated Spanish language hypertension (HTN) and diabetes mellitus (DM) patient education materials from U.S. federal agency public sector sources using the Suitability of Assessment (SAM) instrument. Mean readability for HTN materials was grade 7.9 and for DM materials was grade 6.6. Mean SAM score for HTN materials was 43.9 and for DM materials was 63.2. SAM scores were significantly better for DM than for HTN materials in overall score, content, graphics, layout, stimulation/motivation, and cultural appropriateness (p < .05). Clinicians should evaluate suitability of Spanish language HTN and DM materials that they use in patient teaching.

Social Support and Adherence for Military Veterans With Hepatitis C.

Purpose/Objectives: The aim of this study was to describe military veterans’ experiences of support and how those experiences influence their decisions to be adherent, during hepatitis C virus (HCV) treatment. Design: A qualitative phenomenological design was used. Inclusion criteria were veterans 18 years or older, receiving standard treatment for HCV, able to read, write, and communicate in English. Setting: A US Veterans Administration facility in Texas. Sample: Convenience sampling was used to obtain a final sample of 21 veterans. Methods: Data collection consisted of 1-time, in-depth interviews with analysis occurring simultaneously. Follow-up phone calls with participants verified that the themes were accurate reflections of their lived experience. Results: Because of the fear of stigma, veterans make choices about to whom they tell their diagnosis. This limits the circle of friends and coworkers who could provide support. For some veterans, family members provide emotional and practical support, but family can also be a burden. In order to cope with family and treatment demands, some veterans hibernate, whereas others socialize with friends and coworkers. Some veterans found providers to be supportive, but others did not. Conclusions: Veterans experience both supportive and unsupportive reactions from family, friends, and healthcare providers while receiving HCV treatment. Those reactions either support or frustrate efforts to be adherent to treatment. Implications: In order to support treatment adherence, healthcare providers need to assess sources of support, or burden, experienced by military veterans during HCV treatment. When veterans do not have a supportive network, they need to be encouraged to attend a support group or seek counseling. Support services need to be funded by the Veterans Administration. Providers need to practice empathy and caring in order to support adherence during treatment. Further research is needed on how military veterans manage their health after hepatitis C treatment, contrasting successful versus unsuccessful treatment outcomes.

Self-Determination Theory With Application to Employee Health Settings:

Occupational health nurses motivate employees to engage in healthy behaviors. Both clinicians and researchers need strong theories on which to base decisions for health programs (e.g., healthy diet) and experimental interventions (e.g., workplace walking). The self-determination theory could be useful as it includes concepts of individual autonomy, competence to perform healthy behaviors, and relationships as predictors of health behaviors and outcomes. In this article, the self-determination theory is described and evaluated using Walker and Avant’s criteria. The theory is applied to a population of federal employees who smoke. By increasing employees’ ability to autonomously choose smoking cessation programs, support their competence to stop smoking, and improve their relationships with both others who smoke and employee health services, smoking cessation should increase.