Ellen D. S. Lopez

Quality-of-Life Concerns of African American Breast Cancer Survivors Within Rural North Carolina: Blending the Techniques of Photovoice and Grounded Theory

Social norms imposing a prevailing silence around breast cancer in rural African American communities have made it difficult for survivors to express their quality-of-life (QOL) concerns. In this article, the authors describe how they blended the photovoice method (providing participants with cameras so they can record, discuss, and relate the realities of their lives) with grounded theory techniques to assist 13 African American breast cancer survivors from rural eastern North Carolina in (a) exploring how they perceive and address their QOL within their own social context and (b) developing a conceptual framework of survivorship QOL. The framework that emerged reveals that three social forces (racism, stigmas regarding cancer, and cultural expectations of African American women) drive four QOL concerns (seeking safe sources of support, adjusting to the role of cancer survivor, feeling comfortable about the future, and serving as role models) and that survivors address these concerns by relying on spiritual faith and devising strategies to maintain social standing.

The Potential of Survivorship Care Plans in Primary Care Follow-up of Minority Breast Cancer Patients

ABSTRACTBACKGROUNDWhen the clinical care of minority breast cancer survivors is transferred from oncology settings to primary care, quality of care may be compromised if their primary care providers do not have adequate cancer treatment records and follow-up care guidelines. Survivorship care plans (SCPs) given to survivors before they transition to primary care settings are designed to improve the transfer of this information. This study examined these issues in a sample of minority breast cancer survivors.DESIGNDuring four focus groups with minority breast cancer survivors, data were collected about the types of information survivors remember receiving from their oncologists about follow-up health care needs. Survivors were also asked their opinions on the value and content of a survivorship care plan.RESULTSMinority breast cancer survivors received variable amounts of information about their cancer treatments. They were dissatisfied with the amount of information they received on cancer-related side-effects, including race-specific information. The American Society of Clinical Oncology’s breast cancer survivorship care plan was viewed as important, but too highly technical and limited in information on side-effects and self-care approaches.CONCLUSIONSSurvivorship care plans may help increase information transfer from oncologists to patients and primary care providers, but the content of care plans needs to be adapted to minority patients’ concerns. Primary care physicians may be challenged by survivors to explain recommended surveillance guidelines and to respond to untreated physical and psychosocial problems.

Breast Cancer Fatalism: The Role of Women's Perceptions of the Health Care System

Cancer fatalism, which can be understood as the belief that cancer is a death sentence, has been found to be a deterrent to preventive cancer screening participation. This study examines factors associated with breast cancer fatalism among women. We analyzed data from a 2003 survey of women 40 years of age. The survey collected information about respondents’ knowledge and attitudes regarding breast health. Analyses compared the characteristics of women who reported and those who did not report a fatalistic attitude. Women with a fatalistic attitude were more likely to be African American, to have a family history of breast cancer, to rate their quality of care as fair or poor, to believe that not much could be done to prevent breast cancer, to believe that breast cancer could not be cured if found early, and to believe that treatment could be worse than the disease.

Mixed Methods Approach Explaining Process of an Older Driver Safety Systematic Literature Review

In this article, we drew from a recently completed etiological systematic literature review (SLR) using a mixed methods approach (1) to explain the process for analyzing and synthesizing the results of 201 sources and (2) to comment on the use of Creswell et als criteria for mixed methods approaches. We provided a detailed process description of the steps involved in this SLR, and demonstrated that a mixed methods approach, traditionally not associated with a SLR, can be used, comprehensively and explicitly, to plan, collect, analyze, synthesize, and interpret data. We offered guidelines for rehabilitation professionals who are considering performing similar studies.

Systematic Literature Review and Model for Older Driver Safety

Using the Precede-Proceed Model of Health Promotion (PPMHP) and an etiological systematic literature review, we examined the risk/protective factors of older driver safety in the United States. We described key features of this literature review and developed a structural model illustrating the prevalence of risk/protective factors in the health domain (63%) and in other PPMHP domains (environment 20%; behavior and lifestyle 10%; predisposing 1%; reinforcing 3%, enabling 2%; health education 2%). This model, a first step in synopsizing and quantifying these risk/protective factors, informs rehabilitation professionals of their etiology and prevalence, affords opportunities for multidisciplinary research, and lays the foundation for intervention planning.

Drawing From Freirian Empowerment Methods to Develop and Use Innovative Learning Maps: Increasing Enrollment of Uninsured Children on Detroit's Eastside

In 2001, virtually every child on Detroits eastside was eligible for health coverage, yet approximately 3,000 children remained uninsured. The primary aim of the Eastside Access Partnership (EAP), a community-based participatory research collaboration, was to increase enrollment of uninsured children in state programs. To achieve this aim, one of the approaches that EAP is using is the innovative Learning Map© titled Choosing the Healthy Path, which was developed in collaboration with Root Learning, Inc. Although Learning Maps were originally developed to assist corporations in implementing strategic change, their integration of visualization and interactive dialogue incorporates Freirian principles of empowerment education, making them a viable option for providing meaningful learning opportunities for community residents. This article presents the collaborative process involving the University of Michigan, local community-based organizations, community members, and Root Learning consultants to develop a visual map that enables community residents to understand and overcome the barriers that prevent them from obtaining health insurance for their children.