Jacquelyn H. Flaskerud

Conceptualizing vulnerable populations health-related research.

BACKGROUND A conceptual model for vulnerable populations research relates resource availability and relative risk to health status. The model has a population-based focus that places responsibility for the collective health status of its citizens with the community. Vulnerable populations are social groups who experience limited resources and consequent high relative risk for morbidity and premature mortality. There is considerable research evidence to support the major relationships in the model. Conceptual links that need additional research are identified. CONCLUSIONS The implications for research include a variety of methodological problems related to recruiting and retaining participants, instrumentation, and data collection. Research designs are needed that move beyond descriptive and epidemiological approaches to interventional and outcome studies. Ethical considerations take on special significance with vulnerable populations.

The effects of culture-compatible intervention on the utilization of mental health services by minority clients

This study examined the relationship between a culture-compatible approach to mental health service and utilization as measured by dropout and total number of outpatient visits. The sample (N=300) was 23.5% Mexican, 22.8% White, 18.1% Black, 17.1% Vietnamese, 16.8% Pilipino, and 1.7% Other ethnic group. A culture-compatible approach was found to be effective in increasing utilization. Three culture-compatibility components were the best predictors of dropout status: language match of therapists and clients, ethinic/racial match of therapists and clients, and agency location in the ethnic/racial community. Pharmacotherapy, education, previous treatment and a diagnosis of psychosis were significantly related to remaining in therapy.This study examined the relationship between a culture-compatible approach to mental health service and utilization as measured by dropout and total number of outpatient visits. The sample (N=300) was 23.5% Mexican, 22.8% White, 18.1% Black, 17.1% Vietnamese, 16.8% Pilipino, and 1.7% Other ethnic group. A culture-compatible approach was found to be effective in increasing utilization. Three culture-compatibility components were the best predictors of dropout status: language match of therapists and clients, ethinic/racial match of therapists and clients, and agency location in the ethnic/racial community. Pharmacotherapy, education, previous treatment and a diagnosis of psychosis were significantly related to remaining in therapy.

AIDS-related knowledge, perceptions, and behaviors among impoverished minority women.

OBJECTIVES The aims of this study were to (1) describe AIDS-related knowledge, perceptions, and risky behaviors of impoverished African-American and high- and low-acculturated Latina women; (2) delineate relationships involving high-risk behaviors; and (3) determine whether risky behaviors differ by race and levels of acculturation. METHODS Survey instruments were administered to 1173 impoverished women of color residing in homeless shelters and drug recovery programs. RESULTS Differences based on ethnicity and level of acculturation were found in AIDS-related knowledge, perceived risk of acquiring AIDS, and risky behaviors. Low-acculturated Latinas reported low perceived risk and were least likely to engage in illegal drug use and sexual activity with multiple partners. Intravenous drug use was most prevalent among high-acculturated Latinas, whereas nonintravenous drug use and high-risk sexual activity was most prevalent among African-American women. CONCLUSIONS The data indicate the need for culturally sensitive AIDS prevention programs for women that deal with general issues of drug use and unprotected sex, and that include separate sessions for women of different ethnic backgrounds and acculturation levels to address specialized areas of concern.

Effects of an Asian Client-Therapist Language, Ethnicity and Gender Match on Utilization and Outcome of Therapy

The purpose of this study was to examine the relationship of Asian client-therapist ethnicity, language and gender match on two measures of utilization: number of sessions with primary therapist and dropout from therapy; and one measure of client outcome: admission-discharge difference in Global Assessment Scale (GAS) scores. The sample consisted of 1746 Asian client episodes in Los Angeles County mental health facilities between January 1983 and August 1988. Various types of multiple regression analyses were used to investigate the relationship of language, ethnicity, and gender match to the three dependent variables and to eight sociodemographic variables.Either client-therapist language match or ethnic match significantly increased the number of client sessions with the primary therapist. However, only ethnicity match had a significant effect on dropout rate. Gain in GAS admission-discharge score was not affected by either a client-therapist ethnicity or language match. Gender match had no consistent effect on the dependent variables. Of the covariates examined, only therapist discipline (social worker) had a consistent effect on the dependent variables.It was concluded that both client-therapist language and ethnicity match are important variables affecting the utilization of treatment. Further research will be needed to separate the effects of language and ethnicity on therapy utilization.

Mental Health Beliefs, Practices, and Knowledge of Chinese American Immigrant Women

The purpose of this study was to describe the mental health beliefs and practices of Chinese American immigrant women. A two-part design using both qualitative and quantitative techniques was employed. The first step utilized focus group (n = 14) and key informant (n = 2) interviews to discover the beliefs, practices, and knowledge about mental health of this population. Content analysis was used to examine and condense the qualitative data. After completion of the qualitative component, 72 women were recruited to complete a set of questionnaires, which included a demographic questionnaire, culture and work subscale, and the mental health portion of the Health Behavior Scale of the Survey of Chinese American Mental Health (NRCAAMH, 1993). Pearson product-moment correlations and regression analysis were used to analyze the quantitative data. Content analysis found that the cultural value placed on the avoidance of shame, pragmatism that results in the use of both Western and traditional Chinese practitioners and treatments, and the inadequacy of Western-type services to meet the needs of the Chinese American immigrant population act as barriers to utilization of these services. These results are cross-validated by the quantitative findings. The importance of culture in determining the pathway to care was supported by the finding that higher levels of acculturation are related to greater use of mental health services.

Health Disparities Among Vulnerable Populations: Evolution of Knowledge Over Five Decades in nursing Research Publications

BackgroundConsiderable attention has been focused recently on conducting research on the health disparities experienced by some Americans as the result of poverty, ethnicity, and/or marginalized social status. Nursing research has a major role to play in developing this body of knowledge. PurposeThe purpose of this paper is to review the contributions that Nursing Research made through its publications over the last five decades in developing the body of tested knowledge about health disparities in vulnerable groups and to analyze the progress made. MethodsCriteria for reviewing the literature were established. All Nursing Research publications between 1952 and 2000 were searched manually, indexes of each year’s bound volumes were reviewed, and computer searches were conducted. Included in the review were research reports, research briefs, and methodology articles. ResultsSeventy-nine papers were found that met basic criteria for inclusion. The number of relevant publications increased each decade, with a sizable increase in numbers since 1990, and may be related to the social, political, and economic climate of each decade. The research questions asked and the methods used became more complex over time. ConclusionsNursing Research has made a significant contribution in disseminating the body of tested knowledge related to the health disparities experienced by vulnerable populations and the methodologies associated with vulnerable populations research. Areas for future research are community-based studies, intervention studies that provide tangible resources, and methodologic approaches that involve participants in the research process.

Use of vignettes to elicit responses toward broad concepts.

Use of vignettes in a measuring instrument is a valid and desirable method of eliciting responses toward broad concepts. Ambiguities of any type should be given considered attention in the establishing of validity.

Aids and Traditional Health Beliefs and Practices of Black Women

This study examines whether traditional health beliefs and practices of black Americans reported in the literature were consistent with those of a target population of low-income black women in Low Angeles Country and describes how these traditional classifications of illness and healing practices were related to their understanding of acquired immunodeficiency syndrome (AIDS). A qualitative approach was used to gathwer the data in unstructured interviews. Content analysis was used to classify data. Sources of illness and remedies identified by the women were divided into two categories: natural and supernatural. Natural sources included cold, impurities, diet, weakness, lack of moderation, and stress. Supernatural sources included illnesses allowed by God, witchcraft, and evil influences. Remedies included antidotes, food, medicines, prayer, and healing. Analysis of the relationship of AIDS to traditional beliefs revealed that AIDS had been integrated into the traditional conceptualization of illness, health practies, and healing, and was attributed to both natural and supernatural causes. Prevention, prayer, and spiritual healing were recommended as remedies. Implications were that AIDS education, prevention, and treatment programs be within the context of the traditonal belief system.

HIV-risk behaviors and mental health characteristics among homeless or drug-recovering women and their closest sources of social support.

This article describes risky drug and sexual behavior and mental health characteristics in a sample of 240 homeless or drug-recovering women and their most immediate sources of social support. Women and their closest support sources both reported a great deal of recent noninjection drug use (56% and 52%, respectively) and lesser, though similar amounts of recent injection drug use (12% and 14%, respectively). More than one third of both groups reported a history of sexually transmitted disease and sexual activity with multiple partners. Fifty-one percent of the women and 31% of their support sources had Center for Epidemiological Studies Depression Scale (CES-D) scores of 27 or greater, suggesting a high level of depressive disorders in both samples. Similarly, 76% of the women and 59% of their support sources had psychological well-being scores below a standard clinical cutoff point. These data suggest that homeless and impoverished women turn to individuals who are themselves at high risk for emotional distress and risky behaviors as their main sources of support.

Matching Client and Therapist Ethnicity, Language, and Gender: A Review of Research

The purpose of this article is to examine whether therapy process and outcome are influenced by a client-therapist ethnicity, language, or gender match. A review of research in this area does not demonstrate support for a client-therapist match on any of these variables. The methodological problems and unresolved conceptual issues involved in this research may limit the findings. The ethical and political context of the research and the implications for mental health nursing are explored.