James Butler

Knowledge, Attitudes, and Beliefs about End-of-life Care among Inner-City African Americans and Latinos

OBJECTIVEnThis project explored end-of-life care preferences and barriers among low-income, urban African Americans and Latino/Hispanic Americans (Latinos) to uncover factors that may influence hospice utilization.nnnMETHODSnFocus groups were conducted separately for African Americans (4 groups, n = 26) and Latinos (4 groups, n = 27). Transcripts were coded and analyzed using consensus and triangulation to identify primary themes.nnnRESULTSnFour preference themes and four barriers were identified. Results were largely similar across the two groups. Both preferred having families provide care for loved ones but expressed desire to reduce caretaker burden. Groups emphasized spirituality as the primary means of coping and valued the holistic well-being of the patient and family. Barriers reported were closely tied to access to care. Participants reported low hospice utilization because of lack of awareness of hospice and the prohibitive cost of health care. Latinos were more likely to report language barriers, while African Americans were more likely to report mistrust of the system.nnnCONCLUSIONSnAfrican Americans and Latinos in this study were highly receptive to end-of-life care that would provide relief for patients and caregivers and emphasize spirituality and family consensus. Improving awareness of hospice services would likely increase utilization.

Low-income fathers' and mothers' perceptions of the father role: A qualitative study in four early head start communities

Une enquete quantitative dans quatre sites de Recherche sur les Programmes dAide Precoca a lEnfance Defavorisee (aux Etats-Unis) a explore la maniere dont les meres et peres de milieux pauvres et defavorises concoivent le role des peres dans leurs familles. Les perceptions de role ont ete recueillies a partir dun total de 56 parents de nourrissons ou enfants en bas age dans les quatre sites, en utilisant des methodes de recueil de donnees diverses, comprenant des groupes de mise au point, des entretiens ouverts, et une etude de cas. Les donnees ont ete analysees pour identifier les themes communs a tous les sites. Les participants ont identifie des roles qui incluaient: offrir un soutien financier, etre la, soccuper de lenfant, sorties et jeu, lenseignement et la discipline, donner de lamour, et la protection. Les implications de ces resultats qualitatifs ont discutees a legard de leurs relations aux structures theoriques actuelles sur les roles du pere. De plus, ces resultats aident a mieux comprendre la question selon laquelle les familles de milieux pauvres et defavorises concoivent les roles de parentage comme etant relativement discrets (cest-a-dire des fonctions separees ou traditionnelles des meres et des peres) ou sils voient leur role dans une perspective plus fondue mettant laccent sur le co-parentage.

How does food security impact residents of a food desert and a food oasis

This study explored how factors that influence food buying practices make it harder for food secure and food insecure households to eat healthy. Twenty-five men and women participated in the concept mapping process, a mixed methods approach that allows participants to identify, sort, and rate ideas according to their perceptions. Participants identified 121 unique statements and sorted them into 12 clusters that represented their perceptions. Cluster ratings were higher among food-insecure participants compared to food-secure participants. A secondary aim was to explore how food security and food desert statuses are perceived to hinder healthy eating. Food secure participants in a food desert perceived clusters as more important to hindering healthy eating than food-secure participants in a food oasis. Similar perceptions were noted among food-insecure residents in either a food desert or a food oasis. Findings contribute to our understanding of how perceptions differ by food desert and food security statuses.

Reconceptualizing access: a cultural competence approach to improving the mental health of African American women.

SUMMARY Despite the prevalence of mental illness among African American women, only a limited number of them seek or accept help from mental health service delivery systems. An extensive review of the literature revealed that (1) racism and discrimination, (2) socioeconomic status, (3) stress and well being, and (4) housing and neighborhood conditions must be considered in an assessment of the mental health status of African American women. These factors negatively affect their mental health and should be addressed in eliminating disparities in access to and utilization of mental health services. We recommend a process by which mental health providers reconceptualize access to mental health services using a socio-cultural framework. The knowledge gained in this process will result in increased provider cultural competence. This developmental process would be facilitated by the use of a socio-cultural conceptual model for treatment engagement. The model takes into consideration the barriers to mental health treatment services that, in part, have to be eliminated by mental health providers in order to decrease disparities and enhance both access to and utilization of mental health services by African American women.

The 6-Step Model for Community Empowerment: Revisited in Public Housing Communities for Low-Income Senior Citizens

The 6-step community empowerment model was replicated in communities with different geographical, racial, and age backgrounds from the original application. Resident groups of Blue Ribbon Health Panels (BRHPs) in federally funded senior housing in Pennsylvania followed the 6 steps to identify community health issues, to develop strategies to address priority issues, and to implement the strategies in collaboration with partner agencies. The 6-step model served as an operationalization strategy of community empowerment by facilitating quick accomplishments of communities desired outcomes, legitimizing and motivating BRHP efforts. Community capacities to actively participate and collaborate influenced the models progress in this replication study, as did partner agencies capacities to adhere to the community-based participatory and collaborative orientation of the project. Community capacity development and partnership facilitation would be important for a community empowerment project, as well as consistent and clear communication among everyone involved in the process.

Perspectives on a community-based course for public health students.

In recent years, there has been an increase in collaborations between universities and local community agencies. During the 2005-2006 academic year, the Department of Behavioral and Community Health Sciences at the University of Pittsburgh Graduate School of Public Health began a community—university partnership with Hosanna House Inc., a local community service center. The initial phase of this partnership included holding a departmental community development course at the community service center. Information from student journals, course evaluations, and key informant interviews were used to describe the attitudes and perspectives of the students, course instructor, and key informants toward this experience. Overall, this experience positively affected the personal and professional development of the students and was well received by faculty and staff within the academic department and community service center. The authors anticipate that this information will promote and serve as a reference for similar community—university partnerships at other schools of public health.

Using an Expert Panel to Develop Social Support Program Sequencing for Young Adults With Type 1 Diabetes

Background. Young adults living with type 1 diabetes (T1DM) often encounter poor health outcomes, such as uncontrolled blood glucose levels. Social support programs can be a helpful method to support T1DM self-management. Effectively planning and tailoring social support programs for young adults living with T1DM are crucial for improving these programs and associated outcomes. Objectives. This study convened an expert panel primarily composed of young adults living with T1DM to generate ideas and key components for sequential inclusion in social support programs prioritizing them. Method. Exploratory expert panel meetings consisting of four individuals living with T1DM were held where Nominal Group Technique and Ideawriting exercises were used to develop themes and discussion points. Results. Six themes emerged from the meetings representing areas of difficulty for young adults living with T1DM. Topics such as following self-care recommendations, nutrition, handling stress, coping with social situations, and navigating the health care system were identified as important issues facing young adults. Conclusions. By incorporating this approach into new or existing support group improved program discussions for young adults can be achieved and pertinent issues addressed, thus leading to improved health care outcomes.