Ivora Hinton

Parental Influences on Academic Performance in African-American Students

We investigated the relationship between parental influences and academic outcomes for African-American students. Secondary data analysis was conducted on the National Survey of Family and Household data set. Multiple regression analysis showed that parenting style (nurture and control) and parental involvement significantly predicted academic outcomes. Research has traditionally focused on the reasons for the failure of African-American students to succeed in school. This study focused on factors that determine success. The problem of negative school outcomes may be alleviated by studying what works to promote school success rather than what does not work for African-American students.

Culturally Tailored Intervention for Rural African Americans With Type 2 Diabetes

Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study. Methods Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included story-telling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period. Results Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME. Conclusions The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

Flexibility and sharing of childcare duties in black families

With the increasing number of Black mothers participating in the labor force, rearing children without fathers present, and relying on extended family for support the question of the nature of role-flexibility and sharing in the family is raised. Sixty-four families participated in an examination of the relative influence of one- and two-parent Black families and the proximity of the grandmother on self-report measures of (a) household maintenance duties, (b) childcare duties, and (c) parental punishment behaviors. Parents, grandmothers, and at least one child between the ages of 7 and 14 years completed three types of self-report measures. Although the results indicated that mothers, fathers, and grandmothers were nominated as consistently participating in childcare and household maintenance duties, mothers were nominated for more than 60% of the childcare and household tasks. Moreover mothers and not fathers used the full range of discipline practices including corporal punishment. The hypothesis regarding role-sharing in Black household was not supported. Black mothers, like mothers in general, are primarily responsible for the maintenance of the house and the care of children.

“Working Hard With It”: Self-management of Type 2 Diabetes by Rural African Americans

The specific aims of this study were to describe the experience of self-managing type 2 diabetes among rural dwelling African Americans, to identify facilitators and barriers to self-management, to describe the use of prescribed and alternative therapies, and to elicit recommendations for programs of diabetes care. Ten focus groups were held in 3 rural communities. Men and women were in separate groups with facilitators matched by race and gender. Seventy-three participants attended the focus groups to discuss the management of diabetes. Group sessions were tape-recorded and transcribed; field notes were also taken. Data were analyzed using Folio Views software and were reviewed by the multidisciplinary team. Results indicate both unique and common themes from this population.

Shared Decision Making in Mental Health Treatment: Qualitative Findings from Stakeholder Focus Groups

PURPOSE This article reports on findings from seven stakeholder focus groups conducted in exploring shared decision making (SDM) between provider and consumer in mental health (MH) treatment in public MH. BASIC PROCEDURES Seven focus groups were conducted with stakeholders-consumers, family members, prescribers, MH clinicians, and rural providers. Each of the focus groups was recorded digitally, transcribed into text, and analyzed qualitatively for recurring themes. MAIN FINDINGS Provider barriers to SDM include history of the medical model, MH crises, lack of system support, and time. Consumer-related barriers included consumer competency, fears, insight, literacy, and trauma from past experiences. Information-exchange issues include consumer passivity, whether consumers could be viewed as experts, and importance of adequate history information. New skills needed to practice SDM included providers knowledge about alternative treatments, mastery of person-first language, and listening skills; consumers ability to articulate their expert information; and computer skills for both providers and consumers. Outcomes expected from practice of SDM include greater sharing of power between provider and consumer, greater follow-through with treatment plans, greater self-management on the part of consumers, and improved therapeutic alliances. PRINCIPAL CONCLUSIONS Implementing SDM in public MH will impact consumers and their families, providers, prescribers, and administrators. More SDM trials in public MH are needed to answer some of the many questions that remain.

Enhancing Diabetes Self-care Among Rural African Americans With Diabetes Results of a Two-year Culturally Tailored Intervention

Purpose The purpose of this study is to test the feasibility of conducting a community-based randomized controlled trial evaluating a culturally tailored community-based group diabetes self-management education (DSME) program among rural African Americans. Methods Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study designed to test the effectiveness of the “Taking Care of Sugar” DSME program for the 2-year follow-up. Participants were selected from rural central Virginia. Primary outcomes variables included average blood sugar levels, cardiovascular risk factors, and general physical and mental health. These outcomes were assessed at baseline, 3 months, 6 months, and 12 months post baseline. Results From baseline to 3-month follow-up assessment, participants exhibited significant improvement on several physiological and behavioral measures. Given the small sample size, hypothesis testing was limited. Results show change from baseline over time, illustrating that the primary outcome of A1C decreased, although not significant. Additionally, participants reported more knowledge about diabetes self-management and personal care skills (ie, exercise and foot care) that persisted over time. The feasibility of the culturally tailored DSME was established, and participation with the program was high. Conclusions A community-based group DSME program using storytelling is feasible. This research will help to inform clinicians and health policymakers as to the types of interventions that are feasible in a larger rural population. If such a program is carried out, we can improve knowledge, reduce complications, and improve quality of life among rural African Americans.

Culture Brokerage Strategies in Diabetes Education

The purpose of this article is to describe the elements of culture brokerage as applied in a recent educational pilot study among rural African Americans with type 2 diabetes mellitus. Culture Brokerage is a nursing intervention consisting of mediation between the traditional health beliefs and practices of a patients culture and the health care system. The intervention of Culture Brokerage holds particular relevance for clinicians who work with chronically ill patients, including those with diabetes. Diabetes prevalence rates continue to rise with alarming swiftness, affecting people of all age groups and ethnicities. The burden of disease, however, disproportionately falls on ethnic minority groups, including African Americans. Notable health disparities in the prevalence and long-term complications of diabetes warrant the attention of health care professionals. One way in which public health nurses can address these disparities is to apply strategies of culture brokerage.

A Substance Use Decision Aid for Medically at-Risk Adolescents Results of a Randomized Controlled Trial for Cancer-Surviving Adolescents

Background: Adolescent survivors of childhood cancer engage in risky behaviors. Objective: This study tested a decision aid for cancer-surviving adolescents aimed at difficult decisions related to engaging in substance use behaviors. Methods: This randomized controlled trial recruited 243 teen survivors at 3 cancer centers. The cognitive-behavioral skills program focused on decision making and substance use within the context of past treatment. Effects at 6 and 12 months were examined for decision making, risk motivation, and substance use behaviors using linear regression models. Results: The majority of the teen cancer survivors (90%) rated the program as positive. There was an intermediate effect at 6 months for change in risk motivation for low riskers, but this effect was not sustained at 12 months. For quality decision making, there was no significant effect between treatment groups for either time point. Conclusions: The overall program effects were modest. Once teen survivors are in the program and learn what quality decision making is, their written reports indicated adjustment in their perception of their decision-making ability; thus, a more diagnostic baseline decision-making measure and a more intensive intervention are needed in the last 6 months. With 2 of 3 teen participants dealing with cognitive difficulties, the data suggest that this type of intervention will continue to be challenging, especially when 90% of their household members and 56% of their close friends model substance use. Implications for Practice: This effectiveness trial using late-effects clinics provides recommendations for further program development for medically at-risk adolescents, particularly ones with cognitive difficulties.

Mother-Daughter Communication: A Protective Factor for Nonsmoking Among Rural Adolescents

&NA; Rural adolescent females are at‐risk for smoking at rates nearly equal to those of boys, and girls are at increased risk for smoking related diseases, reproductive, and pregnancy problems. The purpose of this study was to investigate protective factors related to nonsmoking in African American (AA) and Caucasian American (CA) female adolescents residing in rural tobacco‐producing counties in Virginia. This qualitative study targeted rural female adolescent nonsmokers and their parents because of the importance of promoting tobacco‐free, healthy lifestyles into adulthood. Participants were 18 adolescent female nonsmokers 16–17 years of age (6 AA and 12 CA) and 10 mothers (5 AA and 5 CA). Semi‐structured questionnaires based on a health behavior framework and communication theory guided four in‐depth group interviews of female adolescents and two group interviews of mothers. Protective factors identified by youth and parent groups were: frequent and open communication about smoking dangers and risks, mothers’ intentionality in messages about nonsmoking; repeated patterns of oversight of daughters activities and friends; mothers’ pride in their daughters; close knit family of support; and daughters explicit desire not to disappoint their parents. Directions for future research include the nature and type of female adolescents’ communication with parents and a parallel study of protective factors of tobacco‐free rural male adolescents to design parent‐child communication interventions for tobacco prevention.

Racial/Ethnic Perspectives on the Quality of Hospice Care

Diversity in the US population is increasing, and evaluating the quality of culturally sensitive hospice care is important. A survey design was used to collect data from 743 patients enrolled in hospice or their family members or caregivers. Race/ethnicity was not significantly associated with any of the hospice interventions or outcomes. Patients were less likely to be satisfied with the overall hospice care (OR = 0.23, 95% CI = 0.065-0.796, P = .021) compared to other type of respondents. Satisfaction with emotional support was substantially associated with the increased likelihood of satisfaction with pain management (OR = 3.82, 95% CI = 1.66-8.83, P = .002), satisfaction with other symptom management (OR = 6.17, 95% CI = 2.80-13.64, P < .001), and of overall satisfaction with hospice care (OR = 20.22, 95% CI = 8.64-47.35, P < .001).