Jeannine Coreil

Group interview methods in community health research

Scholarly development of group interview techniques within the social sciences has lagged behind the rapid popularization of this method. This article offers conceptual clarification regarding different types of group interviews and analyzes case examples to highlight important methodologic issues in the application of group interviews to community health research. Selected problem areas and desirable future directions in the refinement of group interview methods are discussed. An appendix traces the historical development of focus group interviews in social science research.

Cultural Models of Illness and Recovery in Breast Cancer Support Groups

In an ethnographic study of breast cancer support groups for white women, the authors describe the cultural model of illness and recovery espoused by the groups and examine contested areas that might influence participation. Through analysis of interviews, observation at meetings, and program documents, they develop a model of group culture that includes five components: recovery narrative, group metaphors, perceived benefits, group processes, and contested domains. The recovery narrative focuses on optimism and personal growth, and members invoke metaphors of family and sisterhood to describe their relationship to the group. Linkages are made between perceived benefits and group processes. Contested domains challenge dominant features of the recovery narrative. The authors discuss the value of cultural studies of illness support groups for understanding member-group fit.

Filarial elephantiasis among Haitian women: social context and behavioural factors in treatment

Few studies have addressed the social and behavioural aspects of lymphatic filariasis. The research reported here investigated the ethnographic context of filarial elephantiasis among women in Léogane, Haiti, and focused on explanatory models of the illness, the impact of the disease on womens lives, and the difficulties patients experienced in following a therapeutic regimen provided at a local hospital. Qualitative data were collected through focus group and individual interviews and direct observation of patients enrolled in the treatment programme. Results indicate that traditional understanding and treatment for the disease are prevalent in the community, although biomedical explanations are gaining credence as a consequence of long‐term filariasis control activities in this area. Womens lives are substantially burdened both socially and economically by the physical impairment of elephantiasis, most notably in the loss of income due to restrictions on mobility. The degree of social discrimination encountered varies by the timing of onset of symptoms in the life course. Difficulties encountered with the physical therapy regimen included maintenance of the compressive bandage and availability of suitable foot wear. Similarities between these findings and those reported for other parts of the world are noted. Recommendations from the study cite the need for community education and peer support activities to provide a knowledge base and support structure for current and future intervention programmes.

Cultural Feasibility Assessment of Tuberculosis Prevention Among Persons of Haitian Origin in South Florida

A cultural feasibility study was conducted among persons of Haitian origin in South Florida to identify factors which might influence utilization of screening and treatment services for latent tuberculosis infection in this population. Five focus group interviews conducted among men and women explored cultural beliefs and practices related to TB, barriers and incentives to screening, and approaches to increasing treatment adherence. Key findings include the influence of social stigma and fears related to confidentiality of medical status as disincentives to screening. Cultural sensitivity to being labeled as a high risk group for these infections also emerged as a critical variable. Community-based approaches to health education for this population are described. Study recommendations include the planning of programs based on a service delivery model that stresses respect and personal attention to clients, improved interpersonal skills of health center staff, and coordination of services between private doctors and public health agencies.

Ethnicity and cultural models of recovery from breast cancer

Objective. Recovery narratives describe the culturally shared understandings about the ideal or desirable way to recover from an illness experience. This paper examines ethnic differences in recovery narratives among women participating in breast cancer support groups in Central Florida, USA. It compares groups serving African-American, Latina, and European American women, with the objective of better understanding the appeal of ethnic-specific illness support groups for culturally diverse populations. Design. A mixed-method study design combined qualitative and quantitative measures, including in-depth interviews, participant observation at support group meetings, collection of printed documents, and a structured survey. Results. Core elements of the recovery narrative drew from the dominant societal cancer discourse of optimism and personal transformation through adversity; however, important ethnic differences were evident in the meaning assigned to these themes. Groups gave distinctive salience to themes of faith and spirituality, empowerment through the migration experience, and becoming a better person through the journey of recovery. Conclusion. The findings suggest that ethnic cancer support groups draw upon dominant societal discourses about cancer, but they espouse distinctive recovery narratives that are consonant with the groups’ cultural models of illness. Similarity between ethnic members’ individual recovery narratives and that of the group may contribute to the appeal of ethnic illness support groups for culturally diverse populations.

Recognition and Management of Teething Diarrhea Among Florida Pediatricians

According to current medical opinion, teething diarrhea (TD) is a myth; yet cross-cultural data document a worldwide distribution of popular belief in the association of frequent, loose stools with tooth eruption. A mail survey in 1990 of 215 pediatricians practicing in Florida investigated beliefs and practices related to TD. Thirty-five percent of respondents believed there is a real association between diarrhea and tooth eruption. When compared with pediatricians who do not believe in TD, these respondents were more likely to be more recent graduates of medical school, to be in general pediatric practice, to be female, to see more patients per week, and to practice in metropolitan areas. The most common explanations for the link between dentition and diarrhea were changes in eating habits, increased salivation, and stress. Respondents reported that both they and the parents of their patients tended to view TD as less serious than other types of diarrhea, and both managed it accordingly. When compared with earlier studies, our findings indicate that belief in TD among pediatricians may have increased since the 1970s. The results suggest a need for more empirical research on the effects of tooth eruption on bowel function.

Health Behavior in Developing Countries

The distinction between developed and developing countries has become increasingly blurred as many less developed countries make important strides in social conditions as well as economic development. While it long has been recognized that the nations of the world do not fall neatly into two categories of “more” and “less” developed, but instead extend across a wide continuum of socioeconomic diversity, only recently have observers noted that health and quality of life indicators can be quite variable within countries traditionally considered underdeveloped (Pillai & Shannon, 1995). Some very poor countries have made remarkable improvements in the health of their populations, while comparatively wealthier nations have not fared so well (Caldwell, 1990). It is common to find a fourfold typology by which nations are classified as least developed, less developed, newly industrialized, and developed.

Anticipated tuberculosis stigma among health professionals and Haitian patients in South Florida.

This paper compares tuberculosis-related stigma perceptions of health professionals with that of local patient populations, and examines these in relation to other measures of anticipated distress. Comparison groups were service providers and Haitian American patients diagnosed with latent TB (LTBI). Providers consistently rated LTBI higher on anticipated stigma than patients both overall and for internal perceptions and emotions, external perceptions and actions, and Haitian identity. Health professionals were almost five times more likely than patients to report the possibility of other types of psychosocial distress. The findings are consistent with previous studies reporting a higher degree of perceived stigma among unaffected populations compared with people diagnosed with a medical condition. Results suggest that providers may overestimate the likelihood that patients with a stigmatized condition will experience negative consequences. This may negatively affect adherence to TB testing guidelines because of confidentiality concerns. The implications for achieving national TB elimination goals are discussed.

Social Science Contributions to Public Health: Overview

Social science contributions to public health have roots in nineteenth-century discourse on social medicine and health conditions of the poor. Development of the field accelerated beginning in the mid-twentieth century, bolstered by the emergence of chronic diseases as major health challenges. Significant theoretical and methodologic developments have enhanced the study and control of public health problems. Research and practice have emphasized individual health promotion through behavior change methodologies, along with increasing attention to social contextual influences. Interest in macro-level determinants of health has grown in recent decades, including the critical analysis of public health policy and practice.