Sherry Garrett Hendrickson

Reaching an underserved population with a randomly assigned home safety intervention.

Objective: To access an underserved, mobile segment of a monolingual Spanish speaking population and to improve maternal self efficacy for home safety behaviors using a culturally appropriate intervention. Design: A pre- and post-test experimental design tested differences in maternal childhood injury health beliefs (MCIHB) and controllable safety hazards (CHS). Participants were randomly assigned to experimental and control groups. Baseline data assessed demographic and study variables comparability. The intervention included counseling, assessment of maternal safety practices, and provision of safety items. Setting: A non-urban area in Texas where low income, largely migrant Hispanics represent the majority of residents. Participants: Eighty two mothers of 1–4 year old children. Results: The 95% retention rate of an itinerant, hard to reach population suggests that minority participants may be receptive to culturally appropriate home visits. The intervention group demonstrated improved self efficacy for home safety behaviors (F (2, 77)  = 7.50, p = 0.01). Mothers with stronger self efficacy and fewer perceived barriers had fewer accessible in-home hazards. Observed home hazard predictors were: (a) never being married; (b) poor home repair, (c) lower self efficacy for safety behaviors; and (d) control group status. Conclusions: Safety items coupled with a home visit tailored to child age and maternal culture was an effective intervention in a hard to reach population. This study contributes to designing research for a monolingual population with limited local language proficiency and community residency. Injuries represent a major source of health disparities in these neglected populations.

IMPACT OF A THEORY BASED INTERVENTION TO INCREASE BICYCLE HELMET USE IN LOW INCOME CHILDREN

Objective—While community interventions to increase bicycle helmet use have increased markedly, few of these studies are theoretically based. The purpose of this study was to determine relationships among PRECEDE model predictors and self reported helmet use among 407 fourth graders from nine low income, non-urban schools. Setting—Low income schools, with high minority populations in eight non-metropolitan Central Texas counties were chosen. Methods—Schools were randomly assigned in a repeated measures design to either classroom only, parent-child, or control groups. School nurses were educated by the researchers to present a head injury prevention program in all but the experimental schools. Researchers made contact by phone with the parents of children in the parent-child group. Results and conclusions—Participation in either of the educational interventions, followed by belief that helmets protect your head (a predisposing factor), and participation in the parent intervention condition, added significant unique variance to the prediction of helmet use after helmet ownership is accounted. These four variables, taken together, account for 72% of the variance in predicting bicycle helmet use.

Beyond Translation... Cultural Fit

Reaching non-English-speaking families, the economically disadvantaged, and those who are disproportionately represented in disease and injury statistics is challenging. This article describes the process of making a questionnaire developed in English, culturally appropriate for low-income, monolingual, Mexican and Mexican American mothers. The questionnaire, guided by the Health Belief Model, assesses maternal childhood injury health beliefs and was originally used with a 96% African American, English-speaking sample in the Eastern United States. Two research assistants from the target population worked with the non-Hispanic, bilingual investigator to redesign the questionnaire’s language and presentation and to collect data. Sixty monolingual Latina mothers participated in the study to determine the internal consistency of the 42-item Spanish language Maternal Childhood Injury Health Belief Questionnaire (MCIHB). Cronbach’s alpha coefficients ranged from .76 (Benefits subscale) to .90 (Consequences subscale).

Time Series Analysis of Physiological Response During ICU Visitation

Time series analysis (TSA) is an important statistical procedure for clinical nursing research. The current paucity of nursing research reports using TSA may be due to unfamiliarity with this technique. In this article, TSA is compared with the ordinary least squares regression model; validity concerns of time series designs are discussed; and concomitant and interrupted TSA of data collected on the effects of family visitation on intracranial pressure (ICP), heart rate, and blood pressure of patients in ICUs are presented. The concomitant TSA of the effect offamily on ICP suggested thatfamily presence tended to be associated with decreased ICR Interrupted TSA indicated the effect offamily on heart rate and blood pressure was not as consistent: The overall effect on blood pressure appeared to be negligible, and heart rate may increase overall. Restrictive visiting policies, once typical of intensive care units, should be reconsidered.

Video Recruitment of Non-English-Speaking Participants

Recruitment of underserved participants begins to close the disparity gap evident within disadvantaged communities, and innovative approaches to recruitment support this effort. Literacy, communication, and credibility barriers distance potential research participants. The literature search from 1975 to 2005 included the Cochrane Review, MEDLINE, EBSCO, PsycINFO, Google Scholar, and CINAHL for the terms video recruitment, videotaped, minority recruitment, and research subject recruitment with no documented use of videotape recruitment of non-English-speaking (NES) participants. Based on this review, an innovative recruitment video was developed and targeted to monolingual Hispanic mothers to explain a study using home safety visits. Community assistants collaborated on the script. In 4 minutes, potential participants, some illiterate, saw what they could not read, and also whom they should expect at their door if they decided to participate. A total of 82 women were recruited, and with a retention rate of 95%. Classic minority recruitment barriers are reducible with this approach.

Focusing on the “T” in LGBT: An Online Survey of Related Content in Texas Nursing Programs

BACKGROUND As nurses, we advocate for the most vulnerable and underserved, who, within the lesbian, gay, bisexual, and transgender (LGBT) community, are transgender individuals. Yet, the existence of LGBT education in nursing schools has not been examined. METHOD After approval by the university institutional review board, 113 nursing programs in Texas were surveyed between November 2013 and January 2014, with a 12-question, Web-based questionnaire. A Verisign certificate and 128-bit encryption program supported compliance with the Health Insurance Portability and Accountability Act of 1996. RESULTS Nineteen percent of the surveys were returned. Ten (47.62%) of 21 respondents addressed transgender or transsexual individuals. Fifteen (71.43%) of 21 answered a free-text question to estimate the number of hours spent addressing LGBT content, reporting an average of 1.6 hours. CONCLUSION Our study suggests that, in Texas, nursing students may not be receiving sufficient content, nor do they understand transgender health needs or how to best deliver competent, compassionate care to this population.

Maternal Worries, Home Safety Behaviors, and Perceived Difficulties

PURPOSE The aim of the study was to explore the worries, safety behaviors, and perceived difficulties in keeping children safe at home in a purposive sample of low-income, predominantly non-English speaking mothers as a foundation for later nursing interventions. DESIGN This study was a qualitative, descriptive design with content analysis to identify maternal concerns, behaviors, and perceptions of home safety as part of a larger study. METHODS Eighty-two mothers, 64% of whom were monolingual Spanish-speakers, responded in writing to three semistructured interview questions. When mothers were unable to read and write the researcher wrote the responses, then read the content aloud for verification. A standardized probe for each question was posed to obtain richer responses. Data management included use of the software program NUD*IST and coding analyses following the Miles and Huberman guidelines (1994). Interpretations were translated into English for this report. FINDINGS The major worries were falling, health, kidnapping, and being hit by a car. The leading maternal behaviors were coded as being physically, verbally, and environmentally preventive. Mothers said that it was their role to provide safety, and that this role could be wearisome, such that constant supervision was difficult. CONCLUSIONS Low-income mothers described their worries for their 1 to 4 year-old children, explored their behaviors for preventing injury, and discussed what made keeping children from harm difficult. Understanding how mothers keep children safe, the barriers to home safety, and effective safety behaviors are important to the health of children. CLINICAL RELEVANCE The clinical relevance of this study includes building trust as clinicians plan assessment, intervention and evaluation of home safety to encourage dialog about concerns, safety behaviors, and barriers to keeping children from injury.

Translation Cost, Quality, and Adequacy

PURPOSE Although the inclusion of non-native-speaking participants in nursing research is important in every country where nursing research takes place, the literature contains little on the method of achieving quality translation while simultaneously addressing cost containment. We describe a process for evaluating translation adequacy and demonstrate its use in comparing procedures for translating data from non-native-speaking interviews. ORGANIZING CONSTRUCT This work demonstrates a process for establishing, evaluating, and achieving translation adequacy when conducting qualitative research for cross-cultural comparisons. METHODS In an ethnographic investigation of disability in Mexican American women, we describe a process for obtaining translation adequacy, defined here as the methodological goal whereby the quality of the translated text meets the needs of the specified study. Using a subset of responses transcribed from Spanish audiotapes into Spanish text, the text was subjected to two separate translation processes, which were compared for adequacy based on error rates and accuracy of meaning, as well as for cost. FINDINGS The process for discriminating translation adequacy was sensitive to differences in certified versus noncertified translators. While the noncertified translation initially appeared to be seven times less expensive than the certified process, auditing and correcting errors in noncertified translations substantially increased cost. No errors were found with the certified translations. CONCLUSIONS The level of translation adequacy needed for any qualitative study should be considered before beginning the study itself. Based on a predetermined level, translation choices can be assessed using specified methods, which can also lead to greater transparency in the research process. CLINICAL RELEVANCE An ongoing process to verify translation outcomes including cost, a component minimally discussed in the current literature, is relevant to nurses worldwide. Awareness of expense and quality issues makes greater methodological transparency possible in the design of translation projects and research studies.

Development and evaluation of a mother-centered toolkit for postpartum behavioral and psychosocial health

The well-being of mothers and infants is influenced by mothers’ behavioral and psychosocial health (B&PH), yet it is often neglected during healthcare visits. To address this gap, this study aimed to develop and evaluate acceptability of a postpartum toolkit (screening questionnaire, feedback template, and decision aid) to promote B&PH. Using a decision-making model and participatory design (N = 24), a B&PH screening questionnaire was refined, and prototypes of feedback templates and decision aids for selecting health goals were developed. Most mothers in this multi-ethnic sample rated the resulting toolkit as easy to understand/use and useful, and reported they were likely to act on their health goals. Toolkit ease of use and usefulness ratings were largely unrelated to education, ethnicity, and acculturation. In conclusion, findings support the toolkit’s acceptability and applicability to women of diverse backgrounds. The toolkit is a promising strategy to engage mothers in setting goals to promote B&PH.

The pain and suffering of a Mexican American woman with mobility impairment.

There is a dearth of literature examining how adversity shapes the experiences of pain and/or suffering in middle-aged Mexican American women. The purpose of this qualitative descriptive study was to understand pain and suffering from a life course perspective as described by a Mexican American woman aging with early-onset mobility impairment. This Hispanic woman experienced episodes of abuse and rejection over the life course, which may have significantly influenced her pain and suffering experience in adulthood. This adds to the literature on how adversity influences later life pain experience and provides insight on why pharmacological treatment alone may not be as successful as a holistic intervention.