Richard H. Steeves

Culturally Tailored Intervention for Rural African Americans With Type 2 Diabetes

Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study. Methods Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included story-telling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period. Results Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME. Conclusions The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

“Working Hard With It”: Self-management of Type 2 Diabetes by Rural African Americans

The specific aims of this study were to describe the experience of self-managing type 2 diabetes among rural dwelling African Americans, to identify facilitators and barriers to self-management, to describe the use of prescribed and alternative therapies, and to elicit recommendations for programs of diabetes care. Ten focus groups were held in 3 rural communities. Men and women were in separate groups with facilitators matched by race and gender. Seventy-three participants attended the focus groups to discuss the management of diabetes. Group sessions were tape-recorded and transcribed; field notes were also taken. Data were analyzed using Folio Views software and were reviewed by the multidisciplinary team. Results indicate both unique and common themes from this population.

The significance of suffering in cancer care

Understanding suffering as a possible meaning of cancer for patients and families is a necessary part of cancer nursing care. This article presents a discussion of suffering as a possible meaning of cancer for patients and family members. Suffering is addressed in the context of its definition as an experience of the whole person. First, to illustrate suffering, a narrative of a young man treated for leukemia with bone marrow transplantation is presented. The narrative focuses on the mans suffering as he struggles to make meaning of what has happened to him, a struggle that ends with his death. The second part of the article presents eight aphorisms or succinct principles of suffering. Each aphorism is discussed with examples from the case narrative and related literature.

Talking With Death at a Diner: Young Women's Online Narratives of Cancer

PURPOSE/OBJECTIVES To gain a unique perspective of the experiences of young women with cancer (age 20-39 years at diagnosis) through analysis of their online illness blogs. DESIGN A qualitative analysis of online narratives based on hermeneutic phenomenology. SETTING Online illness blogs found through young adult cancer Web sites and social media sites such Twitter. SAMPLE 16 women, aged 20-39 years, who self-identified as being diagnosed with cancer and who initiated and maintained an illness blog based on their cancer experience. METHODS Ethnographic immersion in online culture, thematic analysis based on line-by-line coding, and construction of themes and meanings. MAIN RESEARCH VARIABLES Transitions from diagnosis, through treatment, to long-term survivorship. FINDINGS Themes were identified as the women processed their diagnosis: living in the middle, new normal, urgency, and transition into the abyss. CONCLUSIONS The narratives shared on illness blogs offer an online place for expression of emotion, information exchange, and online social support. Emotional catharsis in the young womens narrative elucidated the experiences of transition through diagnosis, treatment, and survivorship that allow a better understanding of their emotional and psychosocial needs. IMPLICATIONS FOR NURSING Illness narratives are a naturalistic form of inquiry that allow nurses to understand the experience of the patient beyond the traditional clinic setting. This initial study provides a point for understanding the content of online narratives and has vast implications for nursing-based interventions.

Blogging through cancer: young women's persistent problems shared online.

Background: Many young women have turned to illness blogs to describe their lived experience with cancer. Blogs represent an untapped source of knowledge for researchers and clinicians. Objective: The purpose of this qualitative, exploratory study was to describe the life disruptions caused by cancer among young women, as well as to understand the facilitators and barriers in accessing healthcare services during and after active treatment. Methods: Sixteen Internet illness blogs were analyzed among women, aged between 20 and 39 years, diagnosed with cancer. These blogs were analyzed based on phenomenological qualitative methods and thematic analysis. Results: There were 4 dimensions of persistent problems that were articulated in the narratives of the young women without any relief. They included pain and fatigue, insurance and financial barriers, concerns related to fertility, and symptoms of posttraumatic stress and anxiety. Conclusion: The young women’s narratives capture fear, uncertainty, anger, and the debilitating nature of these persistent issues. Many of the women expressed their lingering physical, psychosocial, and emotional problems. Implications for Practice: Online illness narratives are a naturalistic form of inquiry that allows nurses to understand the experience of the patient through their own words and accounts. This study provides a foundation for nursing-based interventions that transcend traditional clinic experiences.

Strategies for recruiting African American men into prostate cancer screening studies.

Background:Recruitment for research and clinical trials continues to be challenging. Prostate cancer is the most commonly diagnosed cancer in men and disproportionately affects African American men; thus, effective recruitment strategies are essential for this population. Objectives:The aim of this study was to focus on innovative and effective recruitment strategies for research on prostate cancer with minorities. Methods:A systematic description is provided of the recruitment efforts for a hermeneutic phenomenological qualitative study of African American mens experiences in decision making on whether to have a prostate cancer screening. Results:Seventeen African American men were enrolled from rural Central Virginia. Recruiting strategies were targeted on places where African American men usually are found but that are rarely used for recruitment: barbershops, community health centers, and churches. Word of mouth was also used, and most of the participants (n = 11) were reached through this method. Discussion:Recruitment efforts have been noted to be particularly challenging among minorities, for numerous reasons. Making minority recruitment a priority in any research or clinical trial is essential in gaining a representative sample. Word of mouth is a powerful tool that is often forgotten but should be looked at in further detail.

How African American Men decide Whether or Not to Get Prostate Cancer Screening

Prostate cancer is the most commonly diagnosed cancer in men in the United States and affects African Americans disproportionately when compared to other ethnic groups. There are unclear reasons for this disparity, but several factors may include race, nutrition, family history of cancer, and screening. With early detection of prostate cancer, survival is much better; thus, screening may be helpful, especially for high-risk individuals. Prostate cancer screening continues to be controversial. A paucity of data exists on what prostate cancer screening means to African Americans, particularly in rural areas, and how they make the decision whether or not to undergo prostate cancer screening. This study interviewed 17 African American men to explore how and when they decided about prostate cancer screening. Most of the men (n = 9) said that they had prostate cancer screening. Three themes emerged from the data: (1) these men had information on prostate cancer; (2) family and friends played an important role in the mens decision-making process; and (3) for screening, it was necessary for the men to have a trusting relationship with their healthcare provider. These findings confirm that the decision-making process is not a simple process. The studys results can help healthcare providers understand some of the important decision-making factors in prostate cancer screening for African American men.

Plenty of Sickness : Descriptions by African Americans living in rural areas with type 2 diabetes

Purpose The purposes of this study were to (1) describe facilitators and barriers to self-care for African Americans with type 2 diabetes living in a rural community, (2) compare experiences of men and women, and (3) solicit recommendations for programs of care. Methods Focus groups with small numbers of men and women (n = 7) were held to explore facilitators and barriers to self-management. Groups were led by moderators of the same gender and race as participants. Data from these information-rich cases were analyzed thematically using Folio Views ® and Inspiration ®software. Results Final categories included “being diagnosed,” “diabetes as betrayal by the body,” “provider-individual-family relationship,” “self-management,” and “difficulty getting help.” Although limited by sample size and methodology, results indicate differences by gender that require additional investigation. Conclusions Knowledge of self-care patterns is foundational to designing culturally appropriate interventions and programs of care for rural African Americans living with diabetes.

The rhythms of bereavement.

This research was conducted to add to the understanding of the experiences of elderly, bereaved spouses in the rural South. During this study, data were gathered from 29 informants, many of whom were interviewed multiple times over several months. Data in the form of field notes and transcribed interviews were treated as texts and were subjected to hermeneutic analysis. The results explore the rhythm of grief as it is experienced in three stages over the months after a death; the rhythmic waves of grief, the cycles of sleeping and wakefulness, and the stages of sleep itself; how bereavement is spaced through the life span; and the way informants experienced and talked about the duration of their bereavement.

Ethical considerations in research with bereaved families.

This article describes a research project aimed at delivering an intervention to bereaved family members living in the community. The issues covered are access to subjects, recruitment and retention of subjects, and random assignment to control and experimental groups.