Tami L. Thomas

Overcoming the triad of rural health disparities: How local culture, lack of economic opportunity, and geographic location instigate health disparities

Objective: To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas. Methods: We critically profile each component of the deterministic triad in shaping current health-related disparities in rural areas; evaluate the uniquely composed intersections of these disparities in relation to Human Papillomavirus (HPV)-related cancer prevention in three isolated rural Georgia counties; and develop implications for future leadership in rural healthcare research, policy, and practice. Results: The deterministic triad of culture, economy, and geographical location is unique to a rural community, and even if two rural communities experience the same health disparity, each community is likely to have a discretely different composition of cultural, economic, and geographic determinants. Conclusion: The deterministic triad presents a challenge for health policymakers, researchers, and practitioners trying to develop health-related interventions that are equitable, efficacious, and practical in low-resource rural communities. The situation is worsened by the limited opportunities for employment, which leads to greater disparities and creates propagating cultural norms that further reduce access to healthcare and opportunities for sustainable health promotion.

Cultural Values Influencing Immigrant Haitian Mothers' Attitudes Toward Human Papillomavirus Vaccination for Daughters.

Although research has shown that mothers significantly influence daughters’ willingness to be vaccinated against the human papillomavirus (HPV), cultural factors influencing immigrant Haitian mothers’ willingness to have adolescent daughters to be vaccinated are unknown. This is of concern as this population experiences disproportionately higher rates of HPV infection and related cervical cancers. This study identifies cultural beliefs influencing 31 immigrant Haitian mothers’ willingness to vaccinate their daughters against HPV using semistructured interviews. Mothers had low levels of HPV and HPV vaccine knowledge, and desired more information. Concerns centered on cultural values regarding adolescent sexuality and HIV/AIDS stigmas specific to Haitian communities. If vaccination were recommended by a physician, mothers are more likely to have their daughters vaccinated. HPV vaccination uptake efforts targeting Haitian months should emphasize physician involvement and incorporate culturally relevant health concerns.

Initial evaluation of the Robert Wood Johnson Foundation Nurse Faculty Scholars program

BACKGROUND The Robert Wood Johnson Foundation Nurse Faculty Scholars (RWJF NFS) program was developed to enhance the career trajectory of young nursing faculty and to train the next generation of nurse scholars. Although there are publications that describe the RWJF NFS, no evaluative reports have been published. The purpose of this study was to evaluate the first three cohorts (n = 42 scholars) of the RWJF NFS program. METHODS A descriptive research design was used. Data were derived from quarterly and annual reports, and a questionnaire (seven open-ended questions) was administered via Survey Monkey Inc. (Palo Alto, CA, USA). RESULTS During their tenure, scholars had on average six to seven articles published, were teaching/mentoring at the graduate level (93%), and holding leadership positions at their academic institutions (100%). Eleven scholars (26%) achieved fellowship in the American Academy of Nursing, one of the highest nursing honors. The average ratings on a Likert scale of 1 (not at all supportive) to 10 (extremely supportive) of whether or not RWJF had helped scholars achieve their goals in teaching, service, research, and leadership were 7.7, 8.0, 9.4, and 9.5, respectively. The majority of scholars reported a positive, supportive relationship with their primary nursing and research mentors; although, several scholars noted challenges in connecting for meetings or telephone calls with their national nursing mentors. CONCLUSIONS These initial results of the RWJF NFS program highlight the success of the program in meeting its overall goal-preparing the next generation of nursing academic scholars for leadership in the profession.

The Robert Wood Johnson Foundation Nurse Faculty Scholars Program: An opportunity for junior nurse faculty

The Robert Wood Johnson Foundation Nurse Faculty Scholars program provides promising junior faculty extramural funding, expert mentoring, and the training needed to be successful in the academic role. The Nurse Faculty Scholars program, which admitted its first cohort in 2008, is designed to address the nursing faculty shortage by enhancing leadership, educational, and research skills in junior nursing faculty. This article provides an overview of the program, its purpose, and its eligibility requirements. The authors give strategies for selecting mentors, developing the written application, and preparing for an oral interview. Finally, the authors provide an analysis of funded institutions, research design and methods from current and recently funded projects, and rank and positions held by nursing mentors.

Parental Human Papillomavirus Vaccine Survey (PHPVS): Nurse-Led Instrument Development and Psychometric Testing for Use in Research and Primary Care Screening

Background and Purpose: Human papillomavirus (HPV) vaccine was approved for girls aged 9–24 years in 2006 to prevent HPV infection and cervical cancer. The Parental Human Papillomavirus Survey (PHPVS) was framed on theoretical constructs of the health belief model (HBM) and developed to survey parents regarding their HPV knowledge, attitudes, and intent to vaccinate. Methods: We evaluated the psychometric properties of the PHPVS using classical item analysis and exploratory factor analysis (EFA) among a sample of 200 parents/caregivers. Results: The EFA yielded a 4-factor unidimensional model that explained between 62% and 68% of the total variance depending on the extraction method used. The estimated Cronbach’s alpha for the PHPVS was .96. Conclusions: The PHPVS is a reliable measure of HPV knowledge, attitudes, and intent to vaccinate.

Cardiac e-learning: Development of a web-based implantable cardioverter defibrillator educational system.

OBJECTIVE The objective of this study was to design a Web-based implantable cardioverter defibrillator (ICD) module that would allow greater access to learning which could occur at an individuals convenience outside the fast-paced clinical environment. MATERIALS AND METHODS A Web-based ICD software educational program was developed to provide general knowledge of the function of the ICD and the interpretation of the stored electrocardiograms. This learning tool could be accessed at any time via the Columbia University Internet server, using a unique, password protected login. A series of basic and advanced ICD terms were presented using actual ICD screenshots and videos that simulated scenarios the practitioner would most commonly encounter in the fast-paced clinical setting. To determine the usefulness of the site and improve the module, practitioners were asked to complete a brief (less than 5 min) online survey at the end of the module. RESULTS Twenty-six practitioners have logged into our Web site: 20 nurses/nurse practitioners, four cardiac fellows, and two other practitioners. The majority of respondents rated the program as easy to use and useful. CONCLUSION The success of this module has led to it becoming part of the training for student nurse practitioners before a clinical electrophysiology rotation, and the module is accessed by our cardiac entry level fellows before a rotation in the intensive care unit or electrophysiology service. Remote electronic arrhythmia learning is a successful example of the melding of technology and education to enhance clinical learning.

Young Hispanic Men and Human Papillomavirus Vaccination Choices

This exploratory descriptive study examined perceived vulnerabilities to human papillomavirus (HPV) and the correlation to factors influencing vaccine beliefs and vaccine decision making in young Hispanic males attending a large public urban university. Only 24% of participants believed that the HPV vaccine could prevent future problems, and 53% said they would not be vaccinated. The best predictors of HPV vaccination in young Hispanic men were agreement with doctor recommendations and belief in the vaccine’s efficacy. Machismo cultural norms influence young Hispanic men’s HPV-related decision making, their perceptions of the vaccine, and how they attitudinally act on what little HPV information they have access to. This study provides culturally relevant information for the development of targeted health education strategies aimed at increasing HPV vaccination in young Hispanic men.

Stigma Scale for Receiving Psychological Help (SSRPH) An Examination Among Adolescent Girls

Stigma is one of the greatest obstacles to care and impedes recovery. The Stigma Scale for Receiving Professional Psychological Help (SSRPH), a measure of public stigma, has been used in young adults and has limited psychometric data in adolescents. This article reports the reliability and validity of the SSRPH in adolescent girls (N = 156, age = 13-17). Discriminant validity was supported, but concurrent validity was not. The confirmatory factor analysis revealed excellent model fit and serves as beginning evidence for construct validity. Cronbach’s alpha for the SSRPH was .65. The SSRPH was stable over 8 weeks. Findings suggest that the SSRPH can serve as a foundation for further instrument development. Future studies may explore enhancing the reliability and validity of the SSRPH and use advanced analytic techniques to examine the overall global construct of stigma, the latent constructs of public and private stigma, and associations of individual items to these constructs.

Hispanic Women's Expectations of Campus-Based Health Clinics Addressing Sexual Health Concerns

Although the number of Hispanic women attending postsecondary institutions has significantly increased in the past decade, knowledge about their use of campus health services to address sexuality-related issues remains low. Increased information about this population is crucial given that sexual health indicators have shown Hispanic women in college to be at a greater risk for negative sexual health outcomes compared with their white counterparts. In this study, we conducted individual interviews with Hispanic women to explore their sexual health concerns and identify the roles they see campus-based health clinics playing in addressing these issues. Study findings suggest a need for health providers to provide sexual health skills that empower Hispanic women, the importance of creating a sense of comfort and trust with the health provider, and illustrating respect for cultural values. Campus health centers can play an important role in providing culturally appropriate sexual health information to Hispanic and other ethnic/racial minority students.

Cross-Cultural Differences and Sexual Risk Behavior of Emerging Adults

Purpose: The authors examined population-specific risk factors that increase emerging adults’ risk of acquiring sexually transmitted infections (STIs), including the human papillomavirus (HPV). Design and Method: A cross-sectional sample of 335 diverse, emerging adults ages 18 to 24 years was recruited from a health center at a large university in the Southeastern United States. The mean age was 20.6 ± 1.9 years, majority were females (74.0%), and 61.0% were Hispanic. Results: Findings revealed inconsistent condom use, reasons for not using condoms, and a need for more culturally specific intervention strategies. Discussion and Conclusions: Healthcare providers should identify culturally specific reasons for inconsistent condom use, examine cultural and geographic differences in sexual risk behaviors among groups and communities, and modify communication, educational programs, and interventions accordingly. Implications for Practice: By adopting a multicultural approach to the control of STIs, nurses can address specific cultural attitudes and behaviors that may influence exposure to STIs, including HPV.