Marylyn Morris McEwen

The validity and reliability of a Spanish version of the summary of diabetes self-care activities questionnaire

Background: Translation of data collection instruments, paying careful attention to equivalency between the source and the target language, is important to obtain valid data collection instruments. Objective: To translate the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire (English) into Spanish and to evaluate the reliability and validity of the Spanish version. Methods: Translation and back-translation were used to develop the Spanish version of the SDSCA. The Spanish version of the SDSCA was reviewed by an expert panel for conceptual and content equivalence to the English version. Psychometric properties were assessed further by combining data from three studies that used the Spanish version as a data collection instrument. Results: Correlation of each item of the Spanish and English version of the SDSCA instrument ranged from .78 to 1.00, with no variability in the responses of 2 of the 12 items. Test-retest correlations for the SDSCA ranged from .51 to 1.00. Internal consistency (Cronbachs alpha) for the Spanish version was .68. Items loaded on three factors, with the factors accounting for 61% of the variance in SDSCA. Discussion: The findings for the psychometric properties of the Spanish version of the SDSCA questionnaire suggest that it has conceptual and content equivalency with the original English version and is valid and reliable. However, further testing with larger samples is required.

Health-illness transition experiences among Mexican immigrant women with diabetes.

Multiple and complex health–illness transitions are required for successful diabetes self-management. Diabetes health–illness transitions influence the daily lives and interactions of Mexican immigrant women with diabetes. This article reports the findings from an intervention study designed to facilitate the health–illness transition in Mexican immigrant women with type 2 diabetes who reside in the Arizona-Sonora region of the US–Mexico border. There was a significant (P < 0.001) increase from preintervention to postintervention in diabetes knowledge and diabetes self-efficacy and a significant decrease (P ≤ 0.001) in psychosocial and health-related behavior problems.

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.

Mexican immigrants' explanatory model of latent tuberculosis infection.

This article reveals how the multiple and disparate explanations of latent tuberculosis infection (LTBI) from the U.S. and Mexico professional health sectors and the popular sector are used to inform the explanatory model (EM) of LTBI for Mexican immigrants residing in the U.S.-Mexico border region. Fourteen immigrants, nine diagnosed with LTBI (n = 9) and their spouses (n = 5) participated in this critical ethnographic study. Because care seeking and treatment decisions are influenced by EMs, the results indicate that it is imperative that interventions for Mexican immigrants with LTBI are built on an understanding of their illness experience and are contextually meaningful.

United States-Mexico Border Crossing: Experiences and Risk Perceptions of Undocumented Male Immigrants

Undocumented immigrants crossing the US–Mexico border face many hazards as they attempt to enter the United States, including heat and cold injury, dehydration, and wild animal encounters. In the Tucson sector of the US–Mexico border, there are over 100 deaths a year from heat-related injuries alone. Public awareness campaigns have been undertaken to disseminate information on the dangers inherent in crossing. Little is known, however, about the ways in which undocumented immigrants actually receive information regarding the risks of crossing the border, how such information impacts their preparation for crossing or how the journey itself effects their motivation to cross again in the future. A qualitative descriptive method was used to describe and analyze information from adult males who had attempted to illegally cross the US–Mexico Border and had recently been returned to Mexico. Semi-structured interviews were conducted, and responses were classified into several broad themes. Interviews were conducted and analyzed iteratively until thematic saturation was achieved. The responses validated the established risks as being commonplace. A total of eight (8) male undocumented immigrants participated in the interviews. Individuals sought information prior to crossing from the media, their families and friends, and acquaintances in border towns. They did not appear to value any particular information source over any other. New areas of risk were identified, such as traveling with others who might have new or existing medical problems. There was also substantial concern for the family unit as both a source of inspiration and motivation. The family emerged as an additional at-risk unit due to the destabilization and financial strain of having one of its members leave to attempt to immigrate to the US for work. While many planned to cross again, the majority of the men in our sample had no intention of seeking permanent residence in the US, instead planning to work and then return to their families in Mexico. This preliminary study found that individuals crossing the US–Mexico border appear willing to put themselves and their families at substantial perceived risk in order to seek economic opportunity. Future public awareness campaigns may choose to shift focus solely from the individual risk of the crossing to the additional risks to family and community.

The Effects of a Community-Based, Culturally Tailored Diabetes Prevention Intervention for High-Risk Adults of Mexican Descent

Purpose This article reports the results of a community-based, culturally tailored diabetes prevention program for overweight Mexican American adults on weight loss, waist circumference, diet and physical activity self-efficacy, and diet behaviors. Methods The intervention used content from the Diabetes Prevention Program but culturally tailored the delivery methods into a community-based program for Spanish-speaking adults of Mexican descent. The design was a randomized controlled trial (N = 58) comparing the effects of a 5-month educational intervention with an attention control group. The primary study outcome was weight loss. Secondary outcomes included change in waist circumference, body mass index, diet self-efficacy, and physical activity self-efficacy. Results There were significant intervention effects for weight, waist circumference, body mass index, and diet self-efficacy, with the intervention group doing better than the control group. These effects did not change over time. Conclusions Findings support the conclusion that a community-based, culturally tailored intervention is effective in reducing diabetes risk factors in a 5-month program.

The impact and implications of undocumented immigration on individual and collective health in the United States

A nation of immigrants, the United States currently has more foreign-born residents than any other country; approximately 28% of these foreign-born residents are undocumented immigrants--individuals who either entered or are currently residing in the country without valid immigration or residency documents. The complex and constantly changing social, political, and economic context of undocumented migration has profound effects on individuals, families, and communities. The lack of demographic and epidemiologic data on undocumented immigrants is a major public health challenge. In this article, we identify multiple dimensions of vulnerability among undocumented persons; examine how undocumentedness impacts health and health care access and utilization; and consider the professional, practice, and policy issues and implications for nurses.

Resistance, Health, and Latent Tuberculosis Infection: Mexican Immigrants at the U.S.-Mexico Border

Mexican immigrants living in the U.S.-Mexico border region are confronted with different national explanations about latent tuberculosis infection (LTBI) and preventive treatment. The purpose of this study was to explore how a group of Mexican immigrant women (N = 8) at risk of LTBI treatment failure interpreted and ultimately resisted LTBI preventive treatment. A critical ethnographic methodology, grounded in asymmetrical power relations that are historically embedded within the U.S.-Mexico border culture, was used to examine the encounters between the participants and the health care provider. The study findings are discussed from the perspective of women who experienced oppression and resistance in the U.S.-Mexico border region, providing an account of how Mexican immigrant women become entangled in U.S.-Mexico TB health policies and through resistance manage to assert control over health care choices. In the context of the U.S.-Mexico border region, health care professionals must be skilled at minimizing asymmetrical power relations and use methods that elicit immigrant voices in reconciling differences in health beliefs and practices.

Challenges and Success of Recruiting and Retention for a Culturally Tailored Diabetes Prevention Program for Adults of Mexican Descent

Purpose The purpose of this article is to describe methods used to recruit and retain high-risk, Spanish-speaking adults of Mexican origin in a randomized clinical trial that adapts Diabetes Prevention Program (DPP) content into a community-based, culturally tailored intervention. Methods Multiple passive and active recruitment strategies were analyzed for effectiveness in reaching the recruitment goal. Of 91 potential participants assessed for eligibility, 58 participated in the study, with 38 in the intervention and 20 in the attention control group. The American Diabetes Association Risk Assessment Questionnaire, body mass index, and casual capillary blood glucose measures were used to determine eligibility. Results The recruitment goal of 50 individuals was met. Healthy living diabetes prevention presentations conducted at churches were the most successful recruiting strategy. The retention goal of 20 individuals was met for the intervention group. Weekly reminder calls were made by the promotora to each intervention participant, and homework assignments were successful in facilitating participant engagement. Conclusions A community advisory board made significant and crucial contributions to the recruitment strategies and refinement of the intervention. Results support the feasibility of adapting the DPP into a community-based intervention for reaching adults of Mexican origin at high risk for developing diabetes.

Saying "no" to professional recommendations: Client values, beliefs, and evidence-based practice

PurposeThe purpose of this article is to explore the phenomenon of saying “no” to secondary prevention recommended by healthcare providers. Data sourcesExtracted findings from two qualitative studies in which participants have said “no” to provider recommendations for secondary prevention, specifically screening mammograms or treatment for latent tuberculosis infection, are discussed. ConclusionsAlthough these two studies focus on different aspects of secondary prevention, both studies emphasize how client values and beliefs impact health decisions. In evidence-based practice (EBP), both scientific evidence and client values and beliefs must be considered. Nurse practitioners (NPs) have the skill set and are in a position to assist clients to mediate between their values and beliefs and current scientific evidence. Implications for practiceSeveral findings from the two qualitative studies are relevant for practice: qualitative studies provide information about values and beliefs for EBP, and findings from these particular qualitative studies demonstrated that women were protective about their health even though their values and beliefs did not align with current scientific evidence. Through client narratives, NPs can facilitate clients aligning personal values and beliefs with current scientific evidence in relationship to caring for self.