Gary J. Burkholder

Mixed Methods in Intervention Research: Theory to Adaptation

The purpose of this article is to demonstrate the application of mixed methods research designs to multiyear programmatic research and development projects whose goals include integration of cultural specificity when generating or translating evidence-based practices. The authors propose a set of five mixed methods designs related to different phases of program development research: (a) formative research, Qual →/+ Quan; (b) theory development or modification and testing, Qual → Quan →/+ Qual → Quan ... Qual → Quan; (c) instrument development and validation, Qual → Quan; (d) program development and evaluation, Qual →/+ Quan →/+ Qual →/+ Quan ... Qual →/+ Quan, or Qual →← Quan; and (e) evaluation research, Qual + Quan. We illustrate the application of these designs to creating and validating ethnographically informed psychological assessment measures and developing and evaluating culturally specific intervention programs within a multiyear research program conducted in the country of Sri Lanka.

Rising and surviving: A conceptual model of active coping among Black lesbians.

This study tested a conceptual model of active coping among a predominantly middle-class sample (N = 92) of Black lesbians (ages 18 to 68) attending a Black lesbian retreat. F. B. Tylers (1978) active coping dimension of psychosocial competence and L. P. Anderson, C. L. Eaddy, and E. A. Williamss (1990) psychosocial competence model for Black Americans emphasizing the role of individual and environmental factors provided the theoretical framework for the study. A theoretical model was developed to examine whether internal (self-esteem, race and lesbian identification) and external (social support, perceived available lesbian, gay, bisexual, and transgendered resources) factors predicted active coping. Results confirmed that the model of internal and external factors was a statistically significant predictor of active coping.

Racial discrimination, social support, and sexual HIV risk among Black heterosexual men

Numerous studies document the adverse impact of racial discrimination on African Americans’ health outcomes, but few have focused on HIV risk. We examined the relationship between racial discrimination and sexual risk in a sample of 526 Black heterosexual men and tested the hypothesis that social support would moderate this relationship. Participants in the predominantly low-income urban sample ranged in age from 18 to 45. High social support had a buffering impact on the relationship between racial discrimination and sexual risk. Among men reporting high racial discrimination, those with more social support reported less sexual risk than men with low social support. Men who reported high racial discrimination and low social support reported more sexual risk than men in any of the other groups. The study highlights social support as an important but understudied protective factor that may reduce sexual risk for Black heterosexual men who report high levels of racial discrimination.ResumenNumerosos estudios documentan los efectos negativos de la discriminación racial en la salud de los afroamericanos, pero pocos se han centrado en el riesgo de VIH. Examinamos la relación entre la discriminación racial y el riesgo sexual en una muestra de 526 hombres negros heterosexuales para probar la hipótesis que el apoyo social mitigaria esta relación. Los participantes en una muestra predominantemente urbana de bajos ingresos tenían edades comprendidas entre 18 a 45. Alto apoyo social tuvo un impacto amortiguador sobre la relación entre la discriminación racial y el riesgo sexual. Entre los hombres que reportaron una alta discriminación racial, aquellos con más apoyo social indicaron tener menos riesgos sexuales que los con bajo apoyo social. Hombres que reportaron una alta discriminación racial y bajo apoyo social reportaron más riesgos sexuales que aquellos en cualquiera de los otros grupos. El estudio pone de manifiesto el apoyo social como un factor de protección importante poco estudiado que puede reducir el riesgo sexual para hombres negros heterosexuales que reportan altos niveles de discriminación racial.

Assessing Adolescents' Understanding of and Reactions to Stress in Different Cultures Results of a Mixed-Methods Approach

This article expands on an emerging mixed-method approach for validating culturally-specific constructs (see Hitchcock et al., 2005). Previous work established an approach for dealing with cultural impacts when assessing psychological constructs and the current article extends these efforts into studying stress reactions among adolescents in Sri Lanka. Ethnographic data collection and analysis techniques were used to construct scenarios that are stressful to Sri Lankan youth, along with survey items that assess their related coping mechanisms. The data were factor analysed, results were triangulated with qualitative findings, and reliability estimates of resulting scales were obtained. This in turn generated a pilot assessment approach that can be used to measure stress and coping reactions in a distinct culture. Use of the procedures described here could be replicated to generate culturally-specific instruments in international contexts, or when working with ethnic minorities within a given nation. This should in turn generate information needed to develop culturally relevant intervention work.

Validating Culture- and Gender-Specific Constructs: A Mixed-Method Approach to Advance Assessment Procedures in Cross-Cultural Settings

SUMMARY Despite on-going calls for developing cultural competency among mental health practitioners, few assessment instruments consider cultural variation in psychological constructs. To meet the challenge of developing measures for minority and international students, it is necessary to account for the influence culture may have on the latent constructs that form a given instrument. What complicates matters further is that individual factors (e.g., gender) within a culture necessitate additional refinement of factor structures on which such instruments are based. The current work endeavors to address these concerns by demonstrating a mixed-methods approach utilized to assess construct validation within a specific culture; and in turn develop culturally-specific instruments. Qualitative methods were used to inform the development of a structured self-report by gaining detailed knowledge of the target culture and creating items grounded in interview and observational data. Factor analysis techniques and triangulation with qualitative analyses validated these findings. Previous work (Sarkar, 2003) suggested a number of gender-specific perceptions of mental health constructs within the target culture and these were investigated using additional mixed-method analyses. This article demonstrates an emerging mixed-method technique for developing culturally sound assessment tools, offers guidance on how to incorporate the overall approach in assessment, and provides a basis for thinking critically about the use of existing instruments when working with diverse populations.

Vulnerability, Social Networks, Sites, and Selling as Predictors of Drug use among Urban African American and Puerto Rican Emerging Adults

This paper reviews the results of research conducted with African American and Puerto Rican emerging adults between the ages of 18 and 25 whose life experiences increase vulnerability to drug use and pose some significant challenges in achieving milestones widely recognized as important in achieving adult status. Literature on drug use in adolescence suggests that personal vulnerability accounts for most experimental and problem drug use. Included in the vulnerability construct are religiosity, perceived risk, social influence, drug access, social norms, and social risk defined primarily as exposure to various forms of violence. This study shows that personal vulnerability explains only some of the variance in use and predicts variance differently with respect to different specific drugs and polydrug use. Further, it argues that additional contextual factors including social networks, party and club attendance, and drug selling activities, all typical of emerging adulthood and urban lifestyle, are also important factors in enhancing potential for accelerated drug use during this developmental period. Finally, it notes that the consequences of these activities have implications for further economic and social marginalization of urban, multiethnic low income emerging adults.

HIV-positive parents, HIV-positive children, and HIV-negative children’s perspectives on disclosure of a parent’s and child’s illness in Kenya

HIV disclosure from parent to child is complex and challenging to HIV-positive parents and healthcare professionals. The purpose of the study was to understand the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. Sixteen HIV-positive parents, seven HIV-positive children, and five HIV-negative children completed semistructured, in-depth interviews. Data were analyzed using the Van Kaam method; NVivo 8 software was used to assist data analysis. We present data on the process of disclosure based on how participants recommended full disclosure be approached to HIV-positive and negative children. Participants recommended disclosure as a process starting at five years with full disclosure delivered at 10 years when the child was capable of understanding the illness, or by 14 years when the child was mature enough to receive the news if full disclosure had not been conducted earlier. Important considerations at the time of full disclosure included the parent’s and/or child’s health statuses, number of infected family members’ illnesses to be disclosed to the child, child’s maturity and understanding level, and the person best suited to deliver full disclosure to the child. The results also revealed it was important to address important life events such as taking a national school examination during disclosure planning and delivery. Recommendations are made for inclusion into HIV disclosure guidelines, manuals, and programs in resource-poor nations with high HIV prevalence.

Racial discrimination and posttraumatic stress symptoms as pathways to sexual HIV risk behaviors among urban Black heterosexual men

In light of evidence that racial discrimination and posttraumatic stress symptoms (PTSS) are neither rare nor extraordinary for many Black urban men, we examined the relationship between everyday racial discrimination and sexual HIV risk behaviors in a predominantly low-income sample of 526 urban Black heterosexually identified men; 64% of whom were unemployed and 55% of whom reported a history of incarceration. We tested the hypothesis that PTSS would mediate the relationship between everyday racial discrimination and sexual risk. Participants in the predominantly low-income urban sample ranged in age from 18 to 45 (M = 28.80, SD = 7.57). Three multiple regression models were used to test the studys mediational model. As hypothesized, PTSS mediated the relationship between everyday racial discrimination and sexual risk behaviors. Most participants (97%) reported experiences with everyday racial discrimination. Results empirically support the notion of racial discrimination-based traumatic stress as a pathway to Black heterosexual mens increased sexual risk behaviors. Results also highlighted key demographic differences with older men reporting fewer PTSS and sexual risk behaviors compared with younger men. Incarceration was related to both PTSS and sexual risk, underscoring the role that incarceration may play in Black heterosexual mens adverse health outcomes. Our study highlights the need for more qualitative and quantitative research to understand the nature of PTSS in Black heterosexual men and mechanisms such as substance use that may link traumatic experiences and sexual risk. Future research could also assess experiences with childhood sexual abuse, violence, and incarceration to gain a more in-depth understanding of the sources of traumatic stress in Black heterosexual mens lives. We advocate for the development of community-based individual and structural-level interventions to help Black heterosexual men in urban areas develop effective strategies to cope with racial discrimination-based traumatic stress to reduce sexual HIV risk behaviors in Black communities.

A Model for HIV Disclosure of a Parent's And/Or a Child's Illness

HIV prevalence in Kenya remains steady at 5.6% for adults 15 years and older, and 0.9% among children aged below 14 years. Parents and children are known to practice unprotected sex, which has implications for continued HIV spread within the country. Additionally, due to increased accessibility of antiretroviral therapy, more HIV-positive persons are living longer. Therefore, the need for HIV disclosure of a parent’s and/or a child’s HIV status within the country will continue for years to come. We conducted a qualitative phenomenological study to understand the entire process of disclosure from the time of initial HIV diagnosis of an index person within an HIV-affected family, to the time of full disclosure of a parent’s and/or a child’s HIV status to one or more HIV-positive, negative, or untested children within these households. Participants were purposively selected and included 16 HIV-positive parents, seven HIV-positive children, six healthcare professionals (physician, clinical officer, psychologist, registered nurse, social worker, and a peer educator), and five HIV-negative children. All participants underwent an in-depth individualized semistructured interview that was digitally recorded. Interviews were transcribed and analyzed in NVivo 8 using the modified Van Kaam method. Six themes emerged from the data indicating that factors such as HIV testing, living with HIV, evolution of disclosure, questions, emotions, benefits, and consequences of disclosure interact with each other and either impede or facilitate the HIV disclosure process. Kenya currently does not have guidelines for HIV disclosure of a parent’s and/or a child’s HIV status. HIV disclosure is a process that may result in poor outcomes in both parents and children. Therefore, understanding how these factors affect the disclosure process is key to achieving optimal disclosure outcomes in both parents and children. To this end, we propose an HIV disclosure model incorporating these six themes that is geared at helping healthcare professionals provide routine, clinic-based, targeted, disclosure-related counseling/advice and services to HIV-positive parents and their HIV-positive, HIV-negative, and untested children during the HIV disclosure process. The model should help improve HIV disclosure levels within HIV-affected households. Future researchers should test the utility and viability of our HIV disclosure model in different settings and cultures.

A Mixed Methods Examination of the Influence of Dimensions of Support on Training Transfer

The purpose of this mixed methods sequential explanatory study was to explore how specific dimensions of supervisor support (mentoring, coaching, social support, and task support) influence the transfer of learned knowledge and skills to the job. Quantitative data were collected from employees (N = 48) who develop curriculum at an educational organization and analyzed using multiple regression analysis; this was followed by in-depth interviews (n = 10) that focused on participants’ lived experiences of supervisor support, transfer motivation, and training transfer. Findings suggest that mentoring, coaching, social support, and task support directly and/or indirectly facilitate training transfer and provide greater insight into the underlying mechanisms that account for how and why supervisor support influences training transfer.