Jennifer L. Hunter

Cervical cancer educational pamphlets: Do they miss the mark for Mexican immigrant women's needs?

The rate of invasive cervical cancer in US Hispanic women is nearly doubled that of non-Hispanics. Using in-depth interviews and content/grade level analysis of educational materials, this study explores the relevance of cervical cancer education materials to the needs of Mexican immigrant women. It also addresses health literacy issues that create barriers to learning. Findings show aspects of language, content, reading level, structure, and visual images in 22 cervical cancer pamphlets from 11 health care sites in a Midwest city were not relevant to the learning needs or health literacy levels of local Mexican immigrant women. Further research is recommended to establish an evidence base regarding optimal presentation of key elements of the cervical cancer educational message for Mexican immigrant women.

Cervical cancer in Iquitos, Peru: local realities to guide prevention planning

Cervical cancer is a major public health problem in Latin America, and in much of the underdeveloped world. This issue has not historically been addressed as a health priority, but in recent years is receiving increased attention and funding. This ethnographic study on the experience of cervical cancer was conducted in Iquitos, Peru, between August 1998 and May 1999. Research methodologies included: (1) observation and household interviews to obtain background knowledge about the region, medical systems, and local cultural understanding of illness; (2) cancer experience interviews; and (3) case studies of women in various stages of cervical cancer or diagnosis. Findings are presented related to local knowledge and experience of Pap smears and cervical cancer and the ineffectiveness of a recently initiated cervical cancer screening program. The findings guide recommendations for interventions in the region in relation to: (1) needed changes in health education, (2) screening frequency and age, (3) sites for screening and treatment, (4) type and availability of treatment, (5) payment issues, (6) documentation of care, and (7) the potential of herbal remedies.

An intervention to address interpersonal violence among low-income midwestern Hispanic-American teens.

This paper reports pilot testing of “Familias En Nuestra Escuela”, an in-school interpersonal violence prevention intervention targeting Hispanic-American teens. The intervention, based on the hypothesis that the preservation and reinforcement of Hispanic cultural values can serve as a protective factor against violence, focused on the enhancement of ethnic pride. Researchers formed a partnership with a midwestern Hispanic community to test the feasibility, receptivity and preliminary impact of the intervention in a pre/post test, no control group design. Participants were low-income, predominantly first-generation Hispanic-American freshmen and sophomore students from one Hispanic-serving high school. Findings revealed a statistically significant increase in the intervention’s mediator, ethic pride. Changes in the desired direction occurred on measures of perceptions of self-efficacy for self-control, couple violence, and gender attitudes. The incidence of physical fighting and dating violence behaviors decreased over the course of an academic school year. Results provide preliminary evidence for the use of interventions based on ethnic and cultural pride as a violence prevention strategy among Hispanic-American teens, especially those who are first generation Americans.

Emelda's story: applying ethnographic insights to cultural assessment and cervical cancer control.

This article builds a bridge between cultural research and clinical practice by applying insights from an ethnographic study of cervical cancer in Iquitos, Peru, to a cervical cancer focused cultural assessment tool and teaching guide for use with immigrant patients. This application is grounded in Campinha-Bacote’s model of cultural competency. Ethnographic research is recommended as a source of knowledge from which insights can be drawn to build assessment skill in cross-cultural clinical encounters—insights into asking the right questions.

Better Late Than Never: Reflections on the Delayed Prioritization of Cervical Cancer in International Health

Cervical cancer has disproportionately affected the worlds most vulnerable women for generations, yet only recently has the disease become an international health priority. Using ethnographic evidence from a study in Iquitos, Peru, I identify three factors that have contributed to a historic blind spot regarding cervical cancer in underdeveloped regions: (a) transition theories predicting the emergence of cancer with increasing societal development, (b) chronic vs. infectious disease categories that miss the significance of infectious-associated cancers, and (c) dependence on epidemiologic statistics from underdeveloped regions for determining health care priorities. Implications for theory and education are discussed.

Challenges to Pap Smear Follow-up among Women in the Criminal Justice System

Women involved in the United States criminal justice system face a variety of challenges in maintaining their health. Histories of sexual abuse, early initiation of sex, and substance abuse are reflected in more negative reproductive health outcomes, including cervical cancer, than those found among non-incarcerated women. Little is known about how to close this health gap. The present study assessed what incarcerated women perceived to be facilitators and inhibitors of obtaining recommended follow-up for abnormal Pap tests. In-depth individual interviews were conducted with 44 women in an urban county jail about experiences with Pap tests and how they followed-up on abnormal results. We analyzed data using the process of thematic content analysis. Four themes were found, Pap test abnormality as an all-inclusive phrase for women’s health problems,unstable lives, the structural challenges of money, and competing demands. Women with criminal justice histories have numerous and complex challenges in following-up abnormal Pap test results, as well as other health problems. Understanding the context around the follow-up for abnormal Pap tests in this population may increase providers’ ability to help women effectively obtain cancer prevention care that can be life-saving, as well as to more effectively provide care for other health problems.

Resilience in Families of Children With Autism and Sleep Problems Using Mixed Methods

Purpose About 80% of children with autism spectrum disorder (ASD) have sleep problems that may disrupt optimal family functioning. We explored the impact of sleep problems on families’ resilience. Design and Methods An explanatory sequential mixed methods design was used to discern whether resilience differed between families whose children with ASD have or do not have sleep problems, to seek predictors for family hardiness/resilience, and to determine whether narrative findings support, expand, or conflict quantitative findings. Results Seventy complete surveys were returned from parents of children with ASD to compare sleep and family functioning. Fifty‐seven children had sleep problems and six interviews regarding eight of these children were conducted. Parents of children with ASD and sleep problems had lower levels of resilience than those who slept well. Predictors of hardiness were social support, coping‐coherence (stress management), and lower strain scores. Qualitative content analysis revealed a journey analogy with themes: finding the trailhead, dual pathways, crossing paths and choosing travel companions, forging new paths, resting along the way, and seeing the vistas. Conclusions Qualitative findings supported quantitative findings regarding the impact of sleep problems but also expanded them by illustrating how families’ resilience and childrens socialization improved over time. Social support predicted family hardiness. Parents revealed that sleep issues contributed to family strains and described their progression to resilience and embracing their child. Practice Implications Findings support the need for community and provider advocacy and implicates a need for development of sleep interventions on behalf of families and children with ASD. HighlightsBuilding resilience is difficult in families of children with ASD and insomnia.Social (community) support predicts better resilience.Journey toward resilience includes diagnosis, travel companions, sleep improvements.Sequential mixed methods corroborated and expanded findings.

Spirituality, Spiritual Well-Being, and Spiritual Coping in Advanced Heart Failure: Review of the Literature:

Heart failure is a chronic and terminal disease that affects a significant portion of the U.S. population. It is marked by considerable suffering, for which palliative care has been recommended. Palliative care standards require the inclusion of spiritual care, but there is a paucity of literature supporting effective spiritual interventions for the heart failure population. A literature search resulted in 30 articles meeting the criteria for review of spirituality and spiritual coping in the heart failure population. Findings within this body of literature include descriptive evidence of the uniqueness of spirituality in this population, quantitative and qualitative approaches to inquiry, theoretical models of spiritual coping, and proposed interventions. The article concludes with implications for future research and practice.

The influence of cognitive decline on rural identity: perspectives of older women.

Purpose: The purpose of this study was to examine the perspectives of community-dwelling rural, older women concerning the meaning of cognitive decline and to ascertain how cognitive decline affects their lives and the lives of those around them. Design: An ethnographic design guided 1 year of cultural immersion in a rural, farming county in Nebraska. Method: Four life history interviews, participant observations, field notes, and cultural artifacts were collected for case-focused analysis. Findings: Cognitive decline was believed to threaten one’s social identity as a “good woman” because of three strongly held beliefs that (1) the rural lifestyle protected health, (2) demands of the farm were more important than personal health needs, and (3) mainstream health care services were unnatural and insensitive, and therefore best avoided. Using mainstream health care also resulted in the loss of informal social support, which existed as a protective social silence and helped sustain older women’s rural identity. The older women feared developing cognitive decline and believed the loss of one’s life purpose would be the outcome of the condition. Conclusions: Holistic nursing actions that preserve older women’s rural identity and social support may increase the likelihood that women accept rural health care aimed at treating cognitive decline.