Heather Becker

Measuring Cultural Awareness in Nursing Students

Recognizing the need for a valid and reliable way to measure outcomes of a program to promote multicultural awareness among nursing faculty and students, the authors developed a cultural awareness scale. In the first phase of the study, a scale consisting of 37 items was generated from a literature review on cultural awareness, sensitivity, and competence in nursing. A Cronbachs alpha reliability coefficient of .91 was obtained from a sample of 72 student nurses. In the second phase, the items were presented to a panel of experts in nursing and culture to determine content validity. A content validity index of .88 was calculated, and the total number of items on the scale was reduced to 36. The scale then was administered to 118 nursing students. Data from the two samples then were combined, and factor analysis was conducted to support construct validity. Cronbachs alpha for the combined samples was .82.

Development of a scale to measure barriers to health promotion activities among persons with disabilities.

Subjectively-defined barriers to engaging in health promoting activities are one of the most important, yet least well operationalized, components in our models of health promotion. This article describes the development of a tool to measure barriers to health promotion among persons with disabilities. The Barriers to Health Activities among Disabled Persons scale (BHADP) is comprised of 16 items reflecting barriers to taking care of ones health identified from previous barriers literature and interviews with disabled persons. In a study of 135 disabled adults living in two southwestern cities, the BHADP yielded a Cronbach Alpha of .82 as a measure of internal consistency reliability. In addition, t-test analyses demonstrated a significant difference in scores between the disabled sample and a comparison group of 144 nondisabled adults, suggesting the BHADP discriminate between these groups. The BHADP may be useful in sensitizing health care providers to the wide range of barriers experienced by persons with disabilities, thereby enabling them to work more effectively with this special population.

The Expect Respect Project: Creating a Positive Elementary School Climate

The Expect Respect Project, a violence prevention program, was developed to reduce the incidence of bullying and sexual harassment by creating a positive school climate in which inappropriate behaviors are not tolerated and staff members respond consistently to incidents. The project implemented an educational intervention for students, parents, and staff members on expecting respect in student relationships and strategies for responding to inappropriate student behaviors. This article describes the educational intervention and evaluation of the project. Findings from the project showed a significant increase in awareness of bullying following the educational intervention. Bullying was reported to have occurred in areas with less adult super-vision such as the playground, cafeteria, hallway, and buses. Students thought staff would respond to inappropriate behaviors by telling students to ignore verbal bullying or sexual harassment. In contrast, staff at the elementary schools thought adults would respond to inappropriate behaviors by telling the bully to stop, calling his or her parents, or giving a specific punishment.

A randomized controlled trial of a cognitive rehabilitation intervention for persons with multiple sclerosis

Objective: To explore the feasibility and effects of a computer-assisted cognitive rehabilitation intervention – Memory, Attention, and Problem Solving Skills for Persons with Multiple Sclerosis (MAPSS-MS) – for persons with multiple sclerosis on cognitive performance, memory strategy use, self-efficacy for control of symptoms and neuropsychological competence in activities of daily living (ADL). Design: A randomized controlled single-blinded trial with treatment and wait list control groups. Setting: Southwestern United States. Subjects: Convenience sample of 61 persons (34 treatment, 27 wait list control) with multiple sclerosis (mean age 47.9 years, SD 8.8). Intervention: The eight-week MAPSS-MS intervention program included two components: (a) eight weekly group sessions focused on building efficacy for use of cognitive compensatory strategies and (b) a computer-assisted cognitive rehabilitation program with home-based training. Outcome measures: A neuropsychological battery of performance tests comprising the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) and self-report instruments (use of memory strategies, self-efficacy for control of multiple sclerosis and neuropsychological competence in ADL) were completed at baseline, two months (after classes), and at five months. Results: Both groups improved significantly (P < 0.05) over time on most measures in the MACFIMS battery as well as the measures of strategy use and neuropsychological competence in ADL. There was a significant group-by-time interaction for scores on the measures of verbal memory and the use of compensatory strategies. Conclusions: The MAPSS-MS intervention was feasible and well-accepted by participants. Given the large relative increase in use of compensatory strategies by the intervention group, it holds promise for enhancing cognitive function in persons with multiple sclerosis.

Recruiting People With Disabilities as Research Participants: Challenges and Strategies to Address Them

As service professionals strive to become morefocused on the needs and aspirations of people withdisabilities, soliciting information directly from in-dividuals about their perceptions of their lives hasbecome increasingly important (Freedman, 2001;Rapley, 2003; Schalock, 1994; Sigelman, Budd,Spanhel, & Schoenrock, 1981; Sigelman et al.,1980). People with disabilities are taking a largerand more primary role in the planning, evaluation,and delivery of services. Consequently, the natureof research efforts has been evolving from one inwhich investigators treat people with disabilities assubjects to one that includes these ‘‘subjects’’ in thedesign and implementation of the research. Con-ducting such studies requires careful planning onthe part of researchers. In this paper we reflect onthe challenges of surveying people with disabilitiesand discuss possible strategies to address these chal-lenges.Our experience is based upon a face-to-face in-terview study of adults with disabilities conductedover a 2-year period in two cities within a largesouthwestern state. Project Asking Consumers toIndicate Their Own Needs and Strengths (AC-TIONS) was designed to enable researchers to gath-er information about the perceptions of people witha wide range of disabling conditions about their life.The state’s Council on Developmental Disabilities,which funded the study, planned to use this infor-mation in their planning process.Project ACTIONS’ advisory group decidedthat those individuals we recruited should have thecapacity to consent to participation, operationallydefined as individuals who did not have a legalguardian. The recruitment plan included surveyingindividuals with a range of disabling conditions, in-cluding physical/mobility impairments, whethercongenital or the result of trauma; developmentaldisabilities, including cognitive impairments (in themild to moderate range); and other disabling con-ditions. Both males and females were recruited intothis multi-ethnic sample.

Promoting wellness for women with multiple sclerosis.

There is increasing interest in wellness programs among health care providers and consumers. A unique intervention program was developed to promote wellness for women with multiple sclerosis (MS). Key processes include: provision of accurate knowledge that is specific to health promotion within the context of MS; enhancement of self-efficacy for health behaviors and individualized goal setting and monitoring. Participants have reported positive changes as a result of this two-phase (knowledge/skill building classes and telephone follow-up) intervention.

Complementary and Alternative Medicine Use for Vasomotor Symptoms Among Women Who Have Discontinued Hormone Therapy

OBJECTIVES To explore the use and perceived usefulness of complementary and alternative medicine therapies and nonhormonal conventional medicine alternatives to treat vasomotor symptoms occurring after withdrawal from hormone therapy. DESIGN Retrospective, single cross sectional descriptive study. SETTING Study volunteers were recruited via a direct mailed questionnaire sent to a sample of women throughout the United States. Additional respondents were recruited through flyers and postcards advertising the study placed with permission at several health care provider offices and other locations. PARTICIPANTS A sample of 563 menopausal women who had discontinued the use of hormone therapy completed a questionnaire describing their experiences with the use of complementary and alternative medicine. MAIN OUTCOME MEASURES Responses to an investigator developed survey. RESULTS Nearly half of the women surveyed used complementary and alternative medicine. The most common choices of complementary and alternative medicine were (a) multivitamins and calcium, (b) black cohosh, (c) soy supplements and food, (d) antidepressants, (e) meditation and relaxation, (f) evening primrose oil, (g) antihypertensives, and (h) homeopathy. Of the alternative therapies that were used by at least 5% of the sample, antidepressants were perceived as the most useful. CONCLUSIONS With the increased adoption of complementary and alternative medicine, it is important for health care providers to be familiar with the various methods so they are comfortable discussing the benefits and risks with their patients to assist them in making informed decisions.

The use of individualized goal setting to facilitate behavior change in women with multiple sclerosis.

&NA; Setting goals is a useful strategy for changing behavior. The purpose of this study was to examine the effectiveness of a wellness intervention for women with multiple sclerosis (MS) on achieving health‐related goals set individually by each participant in the experimental group (N = 57) using goal attainment scaling. The two‐phase intervention included lifestyle‐change classes over 8 weeks, then telephone follow‐up over 3 months. Participants were followed over an 8‐month period. Goal achievement was assessed at baseline, 2 months (following class), 3 1/2 months (6 weeks after class). 5 months (following 3 months of telephone follow‐up), and at 8 months. The majority of the women met or exceeded all their individualized goals for changing behavior at the 6‐week postclass assessment. Achievement and maintenance of individual goals remained high (59%‐84%) over the 5 months after class follow‐ups. These data support the positive effects of wellness interventions for helping women with MS to meet their own individualized health goals. Setting goals with incremental steps helped participants to articulate their individual goals and monitor achievement over time.

Marriage, impairment, and acceptance in persons with multiple sclerosis.

The purpose of this study was to investigate the relationship between marital status, marital concern, perceived impairment, health-promoting behaviors, and acceptance of disability using cross-sectional and longitudinal data from a sample of persons with multiple sclerosis (MS). We hypothesized that the quality and stability of the marital relationship would influence people’s ability to accept their disability and protect from accumulation of impairment over time. Furthermore, men and women would receive dissimilar benefits from marriage. These hypotheses were considered with repeated measures analysis, Pearson correlations, and independent sample t tests of data obtained from a longitudinal study of persons with MS. The findings indicate that acceptance of disability and perceived impairment increase significantly over time for men and women. For men, being married was associated with a greater acceptance of disability and less perceived impairment. Men were more concerned than the women about how MS affected their sexual relationships.

IMPACT OF A THEORY BASED INTERVENTION TO INCREASE BICYCLE HELMET USE IN LOW INCOME CHILDREN

Objective—While community interventions to increase bicycle helmet use have increased markedly, few of these studies are theoretically based. The purpose of this study was to determine relationships among PRECEDE model predictors and self reported helmet use among 407 fourth graders from nine low income, non-urban schools. Setting—Low income schools, with high minority populations in eight non-metropolitan Central Texas counties were chosen. Methods—Schools were randomly assigned in a repeated measures design to either classroom only, parent-child, or control groups. School nurses were educated by the researchers to present a head injury prevention program in all but the experimental schools. Researchers made contact by phone with the parents of children in the parent-child group. Results and conclusions—Participation in either of the educational interventions, followed by belief that helmets protect your head (a predisposing factor), and participation in the parent intervention condition, added significant unique variance to the prediction of helmet use after helmet ownership is accounted. These four variables, taken together, account for 72% of the variance in predicting bicycle helmet use.