Jo Nell Wells

Voices of Mexican American caregivers for family members with cancer: on becoming stronger.

This grounded theory study report describes the experience of 34 Mexican American (MA) female caregivers who provided care to a family member with cancer. Caregivers identified a process of “Becoming Stronger” as a result of their caregiver role. The emerging theoretical model of female MA cancer caregiving offers evidence to change current cancer care approaches from patient-focused to family-focused care for this ethnic group. Findings suggest that changes most responsive to cultural values and likely to provide accessible and quality cancer care for MA families are those that involve active partnering with MA caregivers to prioritize the patients cancer care.

Purpose-in-Life and Breast Health Behavior in Hispanic and Anglo Women

Hispanic and Anglo women differ in their practice of breast health behavior. A likely factor is differences in purpose-in-life (PIL) that influence motivation to achieve goals. To determine the relationship between PIL and breast health behavior, the PIL Test was modified and translated into Spanish, and the Breast Health Behavior Questionnaire (BHBQ) was generated. Both Spanish and English versions of the PIL Test and the BHBQ were measured in 40 Spanish and 40 Anglo women ages 20 to 49. Cronbach’s alpha for the PIL Test were .86 for the English version and .72 for the Spanish; Cronbach’s alpha for the BHBQ were .78 for the English and .70 for the Spanish version. There was a significant relationship between PIL and breast health behaviors in Anglo women but not in Hispanic women. Findings suggest further study of PIL in Hispanic women and may indicate a need for teaching the benefits of self-regulation to maintain health.

Perceived Mood, Health, and Burden in Female Mexican American Family Cancer Caregivers

Female family caregivers of various global cultures provide basic care in health, social, emotional, and financial domains for family members with cancer and may sacrifice their own health to do so. To learn about role-related mood, health status self-perceptions, and burden of one cultural group, we used qualitative and quantitative approaches to study 34 Mexican American (MA) women who provided care for an ill family member with cancer. We report quantitative data on study variables and make comparisons with caregiver qualitative reports. Implications for health planning, service delivery, and future research with underserved, minority female caregivers are presented.

Psychometric evaluation of Breast Health Behavior Questionnaire: Spanish version

&NA; The purpose of the study was to test the psychometric properties of a culturally sensitive and theory‐based instrument: the Breast Health Behavior Questionnaire. This instrument was translated into Spanish and back‐translated at a third‐ to fourth‐grade reading level. The pilot group consisted of 70 Hispanic women who attended a class at a local church. Subsequent to pilot testing, another 40 Hispanic women who attended a class at the local health department comprised the study sample. The participants responded to the 15‐item questionnaire, which is formatted as a Likert scale. Content validity of the Breast Health Behavior Questionnaire was determined by a panel of experts. A factor analysis of this instrument showed five separate dimensions accounting for 71.82% of the instruments variance. The three major components of self‐regulation theory (schema, coping, and appraisal criteria) were found clustered within the first three dimensions after three items were discarded. The Breast Health Behavior Questionnaire demonstrated an internal consistency reliability coefficient of .7172. The psychometric properties of the Spanish version of this questionnaire warrant further research. The instrument may support a better understanding of the Hispanic womans practice of breast health behavior. Eventually, the Breast Health Behavior Questionnaire may assist nurses in the formulation of culturally grounded interventions.

Preparation and participation of undergraduate students to inform culturally sensitive research

Most student work as research assistants occurs at the graduate level of nursing education, and little is known about the role of undergraduate students as research assistants (RAs) in major research projects. Based on our desire to study Mexican American (MA) cancer caregivers, we needed bilingual and bicultural RAs to serve as data collectors with women who spoke Spanish and possessed cultural beliefs that influenced their caregiving. Following successful recruitment, orientation, and mentoring based on Banduras social learning theory [Bandura, A., 2001. Social learning theory: an agentic perspective. Annual Review of Psychology 52, 1-26] and accepted teaching-learning principles, RAs engaged in various behaviors that facilitated study outcomes. Faculty researchers, RAs, and study participants benefitted greatly from the undergraduate student involvement in this project. This article describes successful student inclusion approaches, ongoing faculty-RA interactions, and lessons learned from the research team experience. Guidelines discussed support the potential for making the undergraduate RA role a useful and unique learning experience.

Healthcare Literacy: Multiple Perspectives Grounded in the Experience of Mexican American Caregivers

Cancer caregivers in Mexican American families experience role-related challenges influenced by limited healthcare literacy. The lack of functional health literacy becomes complex when Mexican Americans have limited English proficiency (LEP) and cultural beliefs that contrast with those of the American healthcare system. Three sequential studies focused on assessing the experience of Mexican American, female cancer caregivers, including their role learning needs; evaluating available community learning materials; and identifying healthcare provider perceptions of caregiver learning needs. Study findings provide direction to improve the process and content of teaching to caregivers with LEP and other caregivers facing the crisis of cancer. Practice recommendations focus on development of targeted learning materials appropriate to caregiver-identified learning needs, language, and education level. Priority learning needs include strategies to meet patient needs for home medication administration, nutrition, and psychological support. Caregiver-preferred formats for learning include videotapes in a family-assisted setting and oral exchanges with other caregivers and care providers. Bilingual clinic personnel who partner with Mexican American family caregivers to address their literacy issues support positive health outcomes in this vulnerable population. Healthcare Literacy: Multiple Perspectives Grounded in the Experience of Mexican American Caregivers

Culturally Sensitive Care: Enlisting Community Partners to Meet Mexican American Caregiver Needs

BACKGROUND: Culturally sensitive interventions are needed to assist Mexican American (MA) patients with cancer and their family members in managing their care, navigating the healthcare system, and decreasing disparities in healthcare outcomes for Hispanics with cancer. OBJECTIVES: The objectives of this study were to understand the meaning of culturally sensitive care for oncology clinic healthcare providers and to assess the usefulness and feasibility of the role of a promotora de salud to meet caregiver needs. METHODS: This study involved focus groups of 18 diverse providers who provided data for qualitative analyses. FINDINGS: The findings (themes) defined the facilitators of and barriers to culturally sensitive care and the perceived role of a promotora de salud to support the healthcare team and improve cancer care provided by MA caregivers. In addition, promotoras de salud can help reduce health costs by decreasing patient clinic visits.

Preventing Tumor Lysis Syndrome: Two Case Studies of Unexpected Outcomes

BACKGROUND Tumor lysis syndrome (TLS) is a potentially fatal complication in patients with large, rapidly proliferating tumor cell cancers that may occur after chemotherapy. Patients with TLS are complicated to treat and often have an unpredictable trajectory. OBJECTIVES The purpose of this article is to report two cases with unusual clinical manifestations and unexpected outcomes during cancer treatment and to share best practices for this situation. METHODS The authors described details from two unusual cases and outlined lessons learned. The authors described a newly developed clinical order set (protocol) to support optimal care for patients at risk for TLS. FINDINGS Implementing best practices, the order set prompts early identification of TLS risk and provides step-by-step guidance to eliminate or control TLS.

Adapting the distress thermometer for cross-cultural research: a method enhanced by Mexican American undergraduate research assistants.

Spanish-speaking Mexican Americans (MAs) need representation in cancer research studies to provide an empirical base for developing culturally relevant health care interventions. One factor that limits research with MAs is the lack of Spanish language measurement tools. Bilingual, bicultural student research assistants (RAs), working with faculty researchers and translation consultants, adapted the English version Distress Thermometer and Problem List (DT-PL) tool into the Spanish language. Additionally, RAs assessed tool feasibility with five MA women to determine its usefulness for a later study. The translation process resulted in a distress assessment instrument suitable for use in a low-literacy, Spanish-speaking population. RAs can enhance a process of adapting a measurement tool for use in research. Health care researchers should now pilot the Spanish DT-PL tool to assess its reliability and validity.