Janice D. Crist

Interpretation/analysis methods in hermeneutic interpretive phenomenology.

BackgroundAlthough hermeneutical interpretive phenomenological methodology has been used in many nursing research studies, reports of findings are generally not specific regarding the analysis, or “interpretive process,” of this methodology. ApproachThe purpose of this article is to assist researchers in analyzing interviews and observations, as part of hermeneutical interpretive phenomenology. In this article the interpretive process is explained, illustrated by examples from a recent research study. ResultsOther facets of the methodology including research question development, sampling issues, and interview and observation methods are briefly reviewed. DiscussionApproaching the interpretive process as systematically as possible within a nonlinear methodology streamlines and clarifies interpretations of the interview data.

Diabetes Self-management in a Latino Social Environment

Purpose The purpose of this qualitative descriptive study was to explore the sociocultural influences and social context associated with living with type 2 diabetes among migrant Latino adults. Methods A qualitative descriptive study using grounded theory techniques was conducted. In-depth semistructured interviews were completed with 10 participants (6 female and 4 male) ranging in age from 46 to 65 years and with a duration of diabetes diagnosis ranging from 1.5 to 40 years. Results An overarching meta-theme of self-management in a social environment emerged. Every aspect of the process of self-management, as described in the 4 major themes—(1) family cohesion, (2) social stigma of disease, (3) social expectations/perception of “illness,” and (4) disease knowledge and understanding—was influenced by the social context. Conclusions The familist traditions, central to the Mexican culture, had both positive and negative consequences on diabetes management. Tailoring clinical care and developing novel education approaches, to include family and community, is central to improving the health of this population. Recognizing and acknowledging the social stigma associated with diabetes, for this population, will promote understanding and improve clinician-patient communication. The sociocultural influences that affect diabetes management practices (eg, include family, in particular the primary female caregiver, and establish community- and home-based education sessions) must be integrated into clinical practice. Future research focused on population-defined health and disease self-management, novel educational interventions, and family and community interventions focusing on the concept of social stigma of disease is indicated to further affect the health disparities of this population.

Caregiving burden, acculturation, familism, and Mexican American elders' use of home care services.

Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.

Identifying and recruiting Mexican American partners and sustaining community partnerships

In this article, how community partners were identified and recruited and how community partnerships have been sustained during a current program of study designed to eliminate health and use disparities are described. Hispanic elders use in-home community services less often than do Anglo elders. The critical social paradigm, community development theories, and participatory research methods have guided a partnership with Mexican American elders and their caregivers during five research studies. Although the process of partnering with communities evolves within specific contexts and cannot be precisely predicted, strategies can be transferred to research and transcultural nursing practice to improve preventive care and sustainability of healthful changes in vulnerable populations.

Social Relationships Among Family Caregivers: A Cross-Cultural Comparison Between Mexican Americans and Non-Hispanic White Caregivers

Sometimes, clinicians assume caregivers in cultural groups believed to have large social networks and strong social support need little intervention from health professionals. This longitudinal study tests five hypotheses about the social relationships of Mexican American compared to non-Hispanic White caregivers and whether negative changes in social support affect perceived health. The sample includes 66 Mexican American and 92 non-Hispanic White caregivers. Findings show that social networks and social support are similar at baseline and similarly stable for 1 year. Negative changes in social support are correlated with poorer health perceptions. Findings underscore the importance of designing interventions that are culturally competent based on what the caregiver is experiencing rather than cultural stereotypes.

Family caregiving of older Chinese people with dementia: testing a model.

Background:The process of taking care of older people with dementia at home is complex and influenced by cultural factors, necessitating a better understanding of the interrelationships of factors within the context of culture. Objectives:The aim of this study was to test the proposed Dementia Caregiving Model, specifying how caregiving appraisal, coping, perceived social support, and familism influence the impact of caregiving stressors on the psychological health of caregivers. Methods:A cross-sectional correlational design with a convenience sample (n = 96) from three outpatient clinics of hospitals in China was used. Questionnaires were utilized to measure the variables in the model. Path analysis was used to assess model fit and paths. Results:The original proposed model did not fit the data, butminor modifications produced a very good model fit (&khgr;2(10, n = 96) = 8.14, p = .62; goodness-of-fit index = .98, comparative fit index = 1.00, and root mean square error of approximation < .001). Care recipients’ behavioral problems had direct and indirect negative effects on caregivers’ psychological health. Perceived social support had direct and indirect positive effects on caregivers’ psychological health. Familism had indirect positive effects on caregivers’ psychological health in relation with caregiving satisfaction and coping. Caregiving appraisal and coping were mediators in the model. Conclusions:The model findings lend support that caregivers’ cognitive appraisal and coping explain some observed individual differences in stress response and outcomes. The findings broaden understanding of the effects of familism on caregivers’ psychological health. In the future, programs should include interventions for caregivers, as well as interventions for care recipients.

Mexican American elders' use of home care services

Mexican American (MA) elders are more functionally impaired at younger ages than other elders yet use home care services (HCS) less. To determine the possible reasons, nine questionnaires were completed in Spanish or English by MA elders and caregivers living in southern Arizona (N = 280). Contextual, personal, and attitudinal factors were significantly associated with the use of HCS, and cultural/ethnic factors were significantly associated with confidence in HCS. Interventions should be designed and tested to increase the use of HCS by MA elders by increasing service awareness and confidence in HCS while preserving the expectations of familism and reducing caregiving burden.

Testing of Applicability of Mutuality Scale With Mexican American Caregivers of Older Adults

By 2050, Mexican Americans (MAs) will become the largest aged minority subgroup in the United States. Although older MAs often depend on family for care, no standard instrument is available to scale the motive for filial obligation. Building on previous work, the purpose of this study is to establish psychometric properties of the bilingual Mutuality Scale (MS) for use with MA family caregivers of older adults. A methodological design with a convenience sample is used. Through Principal Axis Factoring with Oblimin© rotation, a two-factor structure emerge—interaction between the caregiving dyad and reaction from the care recipient—which accounted for 63% of the variance in MS scores. Cronbach’s alphas are .87 in both cases and test–retest estimates across three weeks are r = .93 and .94, respectively. Despite needing further refinement, the MS shows potential to measure the motive involved in older adult care, which may be useful in designing culturally relevant interventions for the MA population.

Pragmatic action research with 2 vulnerable populations: Mexican American elders and formerly incarcerated women.

Eliminating health disparities involving minority groups is a major national priority. Action research, a response to this national priority, may be derived from different theoretical models. The purposes of action research are to involve key community stakeholders in developing knowledge and taking pragmatic action to solve problems. In this article, the authors examine how the model was put into action for 2 distinct programs of research, comparing and contrasting final results, one report primarily focusing on recruitment and retention of participants and the other focusing on a community faith-based action research with formerly incarcerated women.

Perceived intrafamily melanoma risk communication

Melanoma is a skin cancer that can be deadly. Members of families with a strong history of melanoma have a high risk of melanoma occurrence or recurrence. Enhanced survival in these family members could be influenced by their knowledge of melanoma risk and by simple behaviors to decrease their risk or detect melanoma in its early, most curable, stage. Yet, there is minimal exploration on communication of risk or risk-modifying behaviors in melanoma at-risk families. In this study, we describe perceived intrafamily communication of melanoma risk. Using a qualitative descriptive approach, we examined in-depth interviews with 22 members of 8 families having 2 or more cases of melanoma. We identified 4 major themes: (1) awareness and understanding of risk, (2) families facilitate and hinder communication, (3) promoting melanoma prevention and detection in the family, and (4) an obligation to tell others. We discuss these findings in the context of extant knowledge of cancer risk communication in families at high risk for other cancers, impediments to cancer risk communication, remaining gaps in knowledge of this phenomenon, suggestions for hypothesis-driven research, and clinical implications that are applicable to these and other at-risk families.