Victoria Sánchez

Expressions of Machismo in Colorectal Cancer Screening Among New Mexico Hispanic Subpopulations

Although national colorectal cancer (CRC) incidence rates have steadily decreased, the rate for New Mexico Hispanics has been increasing, and screening rates are low. We conducted an exploratory qualitative study to determine barriers to CRC screening for New Mexico Hispanics. We found that machismo served as a dynamic influence on men’s health-seeking behaviors; however, it was conceptualized differently by two distinct Hispanic subpopulations, and therefore appeared to play a different role in shaping their screening attitudes and behaviors. Machismo emerged as more of an influence for Mexican men, who expressed concern over colonoscopies being potentially transformative and/or stigmatizing, but was not as salient for Hispanos, who viewed the colonoscopy as “strictly medical,” and were more concerned with discomfort and pain. Findings from the study highlight the importance of identifying varying characteristics among subpopulations to better understand screening barriers and provide optimal CRC screening counseling in primary care settings.

School Wellness Policy Implementation: Insights and Recommendations From Two Rural School Districts

Although school wellness policies have the potential to transform school environments, relatively little has been written about postadoption policy implementation and evaluation (policy to practice). The authors report results of a research study that examined the implementation of school wellness policies in two school districts in northern New Mexico. Through nine key informant interviews with administrators and two focus groups with students, they found that physical activity and nutrition policies were implemented inconsistently in both districts. Study participants identified facilitating factors (e.g., champions, grant funding) and barriers (e.g., competitive food sales, lack of clarity about responsibility for policy enforcement) to policy implementation. Participants also provided recommendations to improve policy implementation, including wellness policy training for school personnel and parents, improving the taste, nutritional value of, and choices in cafeteria food; and involving the community health council to promote community understanding and support of the policies. This study underscores the need to identify and address factors involved in the successful implementation of school wellness policies, looking at schools in the larger context of their communities. It also serves as an example of the potential for communities, schools, and others to work together to address a locally identified health priority.

Process Evaluation of a Promotora de Salud Intervention for Improving Hypertension Outcomes for Latinos Living in a Rural U.S.-Mexico Border Region

Hypertension is a growing public health problem for U.S.–Mexico border Latinos, who commonly experience low levels of awareness, treatment, and control. We report on a process evaluation that assessed the delivery of Corazón por la Vida, a 9-week promotora de salud–led curriculum to help Latinos manage and reduce hypertension risks in two rural/frontier counties in the New Mexico border region. Ninety-six adults participated in the program, delivered in three waves and in three communities. We assessed program delivery and quality, adherence, exposure, and participant responsiveness. Participant outcome measures included self-reported eating and physical activities and assessment of community resources. Findings suggest that the program was fully delivered (99%) and that most participants (81.7%) were very satisfied with the educational sessions. The average participant attendance for educational sessions was 77.47%. We found significant differences in self-reported behavioral changes depending on the number of sessions completed: The higher the dose of sessions, the better the self-reported outcomes. These findings suggest that a promotora-led curriculum may be useful for promoting self-management of chronic disease in rural/frontier border Latino populations. Future evaluation should focus on training and implementation adaptations within evidence-based chronic disease programs for diverse Latino communities.

Reflections on Community Coalition Staff: Research Directions from Practice

E stablishing coalitions to build partnerships for collaborative decision making between health agencies and communities holds a dominant place in health promotion efforts that address public health problems embedded within the social-political context of communities. In addition, coalitions often strive to increase the capacity of local citizens groups to advocate for shared power and leadership with local health organizations and academic institutions that have traditionally held power. A major interest of mine over the past few years has been to understand the roles and functions of community health educators (as staff) in building coalitions, with a particular emphasis on their role in community capacity building. I have pursued this interest through both research and practice. It has been my observation that for public health practitioners and especially those trained in health behavior/health education, working with and for coalitions and helping to build community capacity are essential to community health practice. In this commentary, I share my reflections on the pivotal, yet at times invisible, roles and functions of coalition staff. These reflections are based on my research with four county coalitions of the North Carolina CommunityBased Public Health (NC CBPH) initiative (19921996), the coalition literature, and observations from my experience in community-based public health practice.

Veterans transitioning from isolation to integration: a look at veteran/service dog partnerships

Abstract Background: This study explored the dynamics of veteran/service dog partnerships by gathering the perspectives of veterans with a history of post-traumatic stress disorder and/or traumatic brain injury. Methods: Exploratory qualitative methods (focus groups and individual interviews) were used to investigate veteran/service dog relationships related to community involvement, family and friend relationships, self-care, work, and leisure. Nine male veterans, Paws, and Stripes program graduates participated. Data were audio recorded and transcribed by two research team members who used qualitative analytic software to manage and code the data. The full research team discussed themes and reached consensus on the themes that emerged from analysis. Results: Five themes emerged about the perceived benefit of veteran/service dog relationship: Secluded but Seeking Society (moving from isolation to reconnection); Opening Opportunities (navigating daily life); Bridging the Gap (facilitating social opportunities); and Reclaiming Life (transforming sense of worth and purpose). An overarching theme, Calming Catalyst, connected the other four themes. Conclusions: Veterans in this study reported that their goal was to reclaim and develop key aspects of their lives and they perceived service dogs as a support in their transition from isolation to reintegration. This study found that service dogs supported the veterans to meet their goal. Implications for rehabilitation There are a significant number of veterans with post-traumatic stress disorder and/or traumatic brain injury who are facing life challenges including self-care, securing work, participating in leisure activities, and integrating into the community. Service dogs are an emerging intervention used to assist veterans with reintegration into civilian life. There is a need for professionals to be aware of potential benefits of service dog/veteran partnerships. Based on our findings, veterans could benefit from being paired with a service dog to facilitate their successful return to community life.

Using a participatory evaluation design to create an online data collection and monitoring system for New Mexico's Community Health Councils

We present the collaborative development of a web-based data collection and monitoring plan for thirty-two county councils within New Mexicos health council system. The monitoring plan, a key component in our multiyear participatory statewide evaluation process, was co-developed with the end users: representatives of the health councils. Guided by the Institute of Medicines Community, Health Improvement Process framework, we first developed a logic model that delineated processes and intermediate systems-level outcomes in council development, planning, and community action. Through the online system, health councils reported data on intermediate outcomes, including policy changes and funds leveraged. The system captured data that were common across the health council system, yet was also flexible so that councils could report their unique accomplishments at the county level. A main benefit of the online system was that it provided the ability to assess intermediate, outcomes across the health council system. Developing the system was not without challenges, including creating processes to ensure participation across a large rural state; creating shared understanding of intermediate outcomes and indicators; and overcoming technological issues. Even through the challenges, however, the benefits of committing to using participatory processes far outweighed the challenges.

The Influence of a Mexican Cultural Immersion Experience on Personal and Professional Healthcare Practices.

The purpose of this study was to understand the influence of a cultural immersion experience on personal and professional healthcare practices of occupational therapists. The experience, a 10-day course in Oaxaca, Mexico, exposed participants to alternative and complementary medicine through interactive sessions with Mexican indigenous traditional healers. The literature indicates that cultural immersion experiences can increase the perceived cultural effectiveness of healthcare professionals. Three focus groups were conducted with eight occupational therapists and two occupational therapy fieldwork students who had participated in the course. Themes were coded based on responses to each question by two graduate students and a qualitative researcher. Four major themes emerged regarding the influence of a cultural immersion experience on personal and professional healthcare practices of occupational therapists: (1) Natural Remedies; (2) Mind, Body, Spirit Connection; (3) Increased Openness; and (4) Challenges of Integrating Traditional and Western Medicine. The themes derived from this study confirmed the advantages of a cultural immersion experience on both the personal and professional views and practices of occupational therapists. Cultural immersion courses can assist occupational therapists to better understand different cultural views of health, disability and healing in order to provide quality occupational therapy care in a multicultural society. Copyright

How Service Dogs Enhance Veterans’ Occupational Performance in the Home: A Qualitative Perspective

Background: This qualitative study explored the lives of veterans diagnosed with posttraumatic stress disorder (PTSD) and/or traumatic brain injury (TBI) and how the partnerships with their service dogs supported improved occupational performance in their homes. Method: Semi-structured individual interviews were conducted with six veterans with PTSD and/or TBI who graduated and received their service dogs from the Paws and Stripes Program in Albuquerque, NM. Home activities of daily living (self-care, household tasks, leisure activities, and family and friend relationships) guided the interview questions. The individual interviews were audio recorded, transcribed, and coded using qualitative data analysis software. Preliminary themes were independently developed by two graduate research assistants. Final themes and subthemes were generated by team consensus. Results: The overarching theme was veteran and service dog partnerships improved occupational performance in the home. Four primary themes arose that supported the overarching theme: (a) providing physical safety and peace of mind; (b) supporting healthy behaviors; (c) my service dog, my hero; and (d) influencing family and friend relationships. Discussion: Findings from this study support that veteran and service dog partnerships improved the veterans’ occupational performance in their homes. The service dogs assisted the veterans on physical and emotional levels and improved their healthy behaviors. Comments Stephanie Barger reports that as the director of programs for Paws and Stripes, she has significant knowledge about the individuals studied in this program and did not take part in the collection or analysis of the data. The service dog vest is patent-pending.

Moving Away from the Tip of the Pyramid: Screening and Brief Intervention for Risky Alcohol and Opioid Use in Underserved Patients

Purpose: Rates of risky substance use and substance use disorders are high in primary-care practices, yet the adoption of universal screening and brief intervention (SBI) has been slow and uneven. This study aimed to describe SBI-related attitudes, practices, and perspectives regarding practice change among medical providers in a minority-majority state. Methods: We conducted a cross-sectional, on-line survey of a practice-based research network of medical providers serving predominantly Hispanic/Latinx and Native American patients in rural and urban settings. The main variables were clinician 1) perspectives on the need to address substance use problems in primary care, 2) current screening and intervention practices, and 3) satisfaction with and willingness to make changes to their practices. Results: Although providers endorsed alcohol and opiate misuse to be significant problems in their practices, only 25% conducted universal screening. Providers reported focusing most of their screening efforts on those with substance use dependence. In general, providers rated importance of and ability to make practice changes moderately high. There was high interest in practice coordination with the community followed by interest in a collaborative care approach. Conclusions: Providers mainly focus efforts on the relatively few patients at the tip of the pyramid (substance use dependence) rather than on the majority of patients who comprise the middle of the pyramid (risky substance use). Practice change strategies are needed to increase universal screening with a focus on risky substance use, particularly in practices serving racial/ethnic communities.

The Mental Health of the Organic Farmer: Psychosocial and Contextual Actors:

Despite the large body of research and literature on the health and mental health of farmers, we should not assume that research findings necessarily apply to the organic farmer. The limited literature on the mental health of the organic farmer points to potential differences. Research has found that workers on organic farms may be happier than their counterparts; others have identified added sources of stress related to the perceived need of organic farmers to embrace concepts linked to the organic movement. However, further research is needed to identify both risk and protective factors for mental health among organic farmers. The purpose of this qualitative descriptive study was to explore the psychosocial and contextual factors that may relate to the mental health of the organic farmer. Key informant interviews were conducted with 10 farm producers and 20 farm workers. The findings indicated that respondents recognized mental health as influential in the workplace and the future of organic practices (e.g., the mental, financial, physical stress). Some of the risk factors mentioned by participants reflected those experienced by conventional, nonorganic farmers. Participants also reported contentment with farming as an occupation, the benefits of being connected to the land, feelings of social and environmental responsibility, and engagement in social activities that may promote human and social capital. These feelings and activities ultimately benefit the farmer, contribute to social cohesion, and may have positive implications for mental health. Results suggest that there may be protective mental health factors unique to the organic farmer.