Vicki Hines-Martin

Barriers to mental health care access in an African American population.

Emphasis has been placed on understanding the mental health disparities that exist within minority populations in the United States. Disparities are of particular importance when examining access to services. This paper reports findings from a NINR-funded qualitative study that examined the barriers to mental health care service use in an African American low-income population. Barriers were identified at three levels--Individual, Environmental, and Institutional. Fourteen barrier categories were identified within those levels with three categories common to the majority of participants. The identified categories provide insight into the process of seeking services within this population and provide direction for future investigation.

An environmental intervention aimed at increasing physical activity levels in low-income women.

Background: Regular physical activity is a health promotion and disease prevention behavior. Of all demographic groups, low-income women report the lowest levels of physical activity. Research Objective: The purpose of this study was to test an intervention aimed at reducing community environmental barriers to physical activity in low-income women. Methods: The research design was mixed methodology: (1) quantitative (quasi-experimental, pretest-posttest, cohort design in which no treatment partitioning was possible) and (2) qualitative (focus groups). The setting was a church-sponsored community center centrally located in a low-income urban neighborhood. The comparison group was recruited first followed by the intervention group to control for setting. The sample consisted of 104 women (comparison group, n = 53; intervention group, n = 51) between the ages of 18 and 63 years who were residents of neighborhoods served by the community center. Results: No between-group differences were found for physical activity behavior. Significant between-group differences in cholesterol (P = .007) and perception of physical activity (P = .033) were observed. Significant intervention group increases from pretest to posttest were found related to advanced registered nurse practitioner support, friend support, and more positive physical activity environment at the community center. Qualitative data supported and enriched the quantitative data. Conclusions: Physical activity levels were not significantly different between the groups. In a sample of low-income women who have multiple barriers, improving attitudes, expanding their knowledge of community resources, and providing physical activity opportunities in their neighborhoods are important intermediate steps toward initiation and maintenance of regular physical activity.

Supervision as professional development for psychiatric mental health nurses.

Clinical supervision is an essential element in the professional development of advanced practice psychiatric mental health nurses, and many interpersonal approaches exist to facilitate this process. This article discusses the issues underlying supervision, the key elements of the supervision process, and the current literature focused on the development of best practices in the conduct of clinical supervision. Recommendations for the implementation of supervision are identified.

Addressing Gaps in Mental Health Needs of Diverse, At-Risk, Underserved, and Disenfranchised Populations: A Call for Nursing Action

Psychiatric nurses have an essential role in meeting the mental health needs of diverse, at-risk, underserved, and disenfranchised populations across the lifespan. This paper summarizes the needs of individuals especially at-risk for mental health disorders, acknowledging that such vulnerability is contextual, age-specific, and influenced by biological, behavioral, socio-demographic and cultural factors. With its longstanding commitment to cultural sensitivity and social justice, its pivotal role in healthcare, and its broad educational base, psychiatric nursing is well-positioned for leadership in addressing the gaps in mental health prevention and treatment services for vulnerable and underserved populations. This paper describes these issues, presents psychiatric nursing exemplars that address the problems, and makes strong recommendations to psychiatric nurse leaders, policy makers and mental health advocates to help achieve change.

Understanding systems and rhythms for minority recruitment in intervention research.

We describe one approach for recruitment and retention of minority individuals in intervention research using a systematic environmental perspective based on Bronfenbrenners ecological systems (BES) model and the construct of temporality. An exemplar in a physical activity intervention study with low-income and primarily African American women is presented. The exemplar illustrates application of BES and temporality to enhance recruitment and retention in research focused on understanding and accommodating environmental influences. Using this theory based approach resulted in successful recruitment and a high level of participant retention.

Barriers to depression treatment in low-income, unmarried, adolescent mothers in a southern, urban area of the United States.

This study explored barriers to depression treatment in low-income, unmarried, adolescent mothers in a southern, urban area of the United States. The authors utilized a phenomenological approach and focus group methodology. Participants (n = 9) were enrolled in a teen parent program, an option of the public school system. The metaphor of a merry-go-round emerged from the data and represented the ups and downs that the adolescent mothers experience as they struggle to adjust to the role of mother. Their knowledge of postpartum depression and depression treatment occurred in the context of their demographics and their desire to create a family for their baby, their fears, and surprise at the reality of mothering. Childbirth education for adolescent mothers should include information on depression and the process of depression treatment.

African American consumers: What should we know to meet their mental health needs?☆

National health care organizations have placed greater emphasis on meeting the mental care needs of minority clients in the United States. Disparities in mental health care use among various populations have been clearly demonstrated. This article discusses what is known about mental health care use among African Americans and the need for new knowledge to address current and future needs. Strategies for examining and addressing mental health disparities in this population are addressed, and implications for nurse clinicians and researchers are presented.

Authoritarianism and Attitudes Toward Mental Health Services

Right-wing authoritarians have been shown to resist change and to demonstrate hostility toward out-groups and social movements that may advocate change from traditional and conventional beliefs. Using data from the Louisville Metropolitan Survey, an omnibus survey of 771 adults interviewed by telephone, the authors investigated the relationship between right-wing authoritarianism (RWA) and attitudes toward mental health services. The findings of the bivariate and regression analyses indicated that high scorers on a version of B. Altemeyers (1988) RWA index were more likely to hold negative attitudes on mental health services. In particular, the Submissive Authoritarianism scale predicted negative attitudes toward mental health services; however, scores on the Conventionality subscale were not related to attitudes toward mental health services.

Exploring the Providers Perspective of Health and Social Service Availability for Immigrants and Refugees in a Southern Urban Community

Abstract As the foreign-born population continues to grow and increasingly expand into inland U.S. cities, they experience insufficient resources and facilities to support their unique health and social needs. The purpose of this study was to describe provider perspectives on health and social services for immigrants and refugees in a southern metropolitan city with a rapidly increasing foreign-born population. Ten health and social service providers participated in an ethnographic study using surveys, in-depth interviews, participant observation, and document review methods. Providers identified the greatest need for immigrants and refugees was access to urgent health services and management of chronic illnesses. Barriers and facilitators to service were related to accessibility, availability, affordability, and acceptability factors. Findings indicate that despite the establishment of population specific service organizations, immigrants and refugees continue to experience unmet health and social needs associated with sociocultural, economic, and political contextual factors.

Comorbid Diabetes and Depression in African Americans: Implications for the Health Care Provider

Health care providers (HCPs) face many obstacles as they undertake efforts to meet the challenges of caring for African American patients with comorbid diabetes and depression. This review article discusses the incidence of comorbid diabetes and depression in African Americans, cultural factors affecting diabetes self-management, and clinical practice implications for the HCP. The role of patient-centered care, engagement, and best-practice strategies are discussed to provide the HCP with guidelines regarding the minimal standards that support improved health care outcomes for African Americans with comorbid diabetes and depression.