MHealth provides a new way of promoting hypertension self-management behaviors. However, the acceptance, feasibility, and effectiveness of interventions incorporating mHealth technology have been understudied in African-Americans with hypertension. This study aimed to explore participants' (n = 30) experiences using a community and technology-based intervention to self-manage their hypertension (COACHMAN). Focus groups were conducted with African-Americans living with hypertension. Focus groups were audio-recorded, and the data were transcribed verbatim and analyzed qualitatively using thematic analysis. Regarding the use of mHealth-enabled self-management hypertension interventions to support hypertension control among African-Americans, the thematic analysis produced the following five barrier themes: (a) lack of knowledge regarding how to use technology, (b) resistance to learning new technology, (c) lack of access to technology, (d) privacy and security concerns, and (e) issues with the medication management support features. Facilitator themes that emerged from the thematic analysis were all related to the intervention components, which were: (a) reminders, (b) rewards, and (c) education modules. This study focused on mHealth barriers and facilitators as described by African-Americans living with hypertension. Results provide a starting point for developing a mHealth intervention for African-Americans that incorporates a self-management program.
The purpose of this study was to encourage African-Americans to become active participants in advanced care planning through increased education and awareness. A quasi-experimental design was used in two local churches in Leon County. Thirty participants (N = 30) were African-Americans, 18 years of age and older, English speaking, from all socioeconomical levels, and from all educational backgrounds. The annotated 2003 Minnesota Survey was used to develop pre-survey and post-survey questions regarding advanced care planning. A paired t test was used to analyze the pre-survey and post-survey responses. The significant value was < 0.05, thus demonstrating a statistically significant difference in pre- and post-survey responses. The educational intervention on advanced directives indicated that all 30 participants would consider completing some form of advanced directive or discussing end-of-life care planning with either another person, a healthcare provider, or they would seek legal advice. African-Americans are more prone to chronic diseases. However, a systemic literature review describes how African-Americans were less likely to participate in advanced care planning and were less likely to receive end-of-life care than other ethnic groups. The 30-minute educational intervention encouraged African-Americans to participate in advanced care planning. Because the sample size was small, results cannot be generalized to all African-Americans. With increased educational opportunities, African-Americans may be encouraged to become active participants in advanced care planning. Advanced practice registered nurse providers should provide advanced care planning information to all patients, but especially to African-Americans. This study should be replicated in a wide variety of settings with larger numbers of participants. Further research is needed to discover additional methods of providing advanced care planning education to African-Americans.
African-Americans bear a disproportionate burden of HIV infections in the United States and African-American women make up 64% of new HIV infections. Therefore, this study aimed to explore the predictors of those who are more likely to use Pre-Exposure Prophylaxis (PrEP) among women reporting IPV, depression, and partner risk. This study used secondary data analysis to explore IPV, depression, and increased partner risk as predictors of PrEP use among 768 women (506 African-American women and 262 White women in the United States) who responded to survey questions regarding potential PrEP use and barriers to uptake. The parent data had been collected at Emory University Rollins School of Public Health. Results of the data analysis of the sample (N = 768) indicated that women who reported high levels of partner risk (p < 0.05), depression (p < 0.01), and/or experienced IPV (p < 0.01), were more likely to use PrEP. In addition, younger women aged 20-35 were more likely to use PrEP, compared to women older than 36 years. Furthermore, college educated African-American women were more likely to use PrEP than White women. Despite limitations, findings indicated that IPV, depression, and partner risk are predictors of PrEP use. There is need for a multi-modal approach in addressing these predictors of PrEP use among African-American women in the United States.
This study describes a conceptual model about empowering self-care. Such a model is important because of its potential for influencing health outcomes in chronic conditions, a leading cause of illness and disability. A defining characteristic of chronic illness is the need for effective self-care management. Therefore, a self-care management plan that is collaboratively developed and considers the patient's goals, resources, culture, and lifestyle was proposed. The philosophical perspective of oppression and story theory provided the theoretical lenses used to define the concept empowering self-care. Identified are qualities of empowerment, which stress a non-hierarchical relationship that promote authentic dialoguing and valuing of each individual's contribution. Story theory structures ideas around the nurse-person intentional dialogue. It is especially useful when the nurse is attempting to understand what matters most to someone living with a health challenge. The story was gathered using the story path method to structure the dialogue. A synthesized definition of empowering self-care was created through the lens of Freire (2005) and the story of what matters to a person living with the health challenge of a chronic condition. Empowering self-care can promote increased patient accountability and responsibility for self-care management leading to improved patient outcomes. Health outcomes may improve when nurses actively support patients' efforts to achieve their own goals.
Mentoring can enhance retention of academically at-risk students. The purpose of this project was to determine the feasibility of technology-enhanced faculty mentorship use in retention of minority undergraduate nursing students. The project consisted of a unique, blended (face-to-face and tablet-based) mentoring approach. Eight faculty mentors and 29 nursing student mentees participated across two cohorts. We used descriptive statistics instead of inferential statistics; therefore our findings are observational instead of inferential. We observed that after participation, the semester passing rate of the students was 100% in the first cohort and 90.5% in the second cohort. Another observation was that the overall program retention rate was improved compared to the preceding year, and that mentee satisfaction ranged from 90.9% to 100%.
Global warming and environmental heat stress are public health concerns. Urban heat islands, metropolitan areas with higher temperatures compared to their surrounding rural areas, compound the effects of increased environmental heat. In addition to acute heat-related illness, increased environmental heat is linked to exacerbation of chronic diseases. The purpose of this narrative review is to provide an overview of heat islands and how the effects of heat stress intersect with chronic diseases in the African American (AA) community. Across the United States, AAs are more likely to reside in heat islands, resulting in greater exposure to environmental heat. Unfortunately, chronic diseases exacerbated by increased environmental heat disproportionately impact the AA community. Due to the intersection of these disparities, heat-related health risks are likely higher for the AAs. The increased health risks posed by urban heat island exposure on AAs have significant implications for nursing practice, research, and policy.
Roughly 88 million adults have prediabetes and over 84% are unaware that they even have prediabetes. African-Americans have an increased risk of being diagnosed with prediabetes. Faith-based organizations have a history of serving as a primary source of social support for African-Americans. Parishioners with prediabetes from four African-American churches participated in free, evidence-based group coaching to learn how to manage and control risk factors associated with type 2 diabetes. The weekly group coaching sessions took place at a local church and they were co-facilitated by two trained professionals: a lifestyle coach and a nurse practitioner. At the conclusion of the 16-week group coaching sessions, participants had a decrease in hemoglobin A1C levels, an increase in minutes of physical activity per week, and an improvement in knowledge and behavior.
Healthcare providers face certain barriers to fully assessing different social needs and referring patients to community resources appropriately, perpetuating healthcare disparities. The purpose of this quality improvement study was to create an intervention to increase assessment of social determinants of health (SDOH) and referrals. A module incorporating concepts of SDOH was developed and delivered during two training sessions. This module focused on: Partnership, Acceptance, Compassion, and Evocation (PACE). It was found that the public health providers at a local public health center were able to appropriately refer 55% of all new and annual patients screened with specific SDOH needs after the educational module was implemented. An overall increase in SDOH understanding and referrals was also found. SDOH training and ongoing social needs screenings could be incorporated in public health centers to decrease healthcare inequities present among minorities and individuals who live in poverty.
This qualitative research study highlights medical mistrust as a significant barrier to quality health care for Black women. Unraveling mistrust is essential for reducing health disparities and improving well-being for women and their families. Three research sites were included: Florida, Ohio, and the U.S. Virgin Islands. Three 90-minute focus groups were convened with 10 women in each of them. The discussions were recorded. Five themes will be discussed through the voices of women from each of the sites. Mistrust of healthcare professionals was associated with fears about being rejected, embarrassed, and misunderstood during the clinical encounter. Others reported that providers who were reluctant to make physical contact with them during the clinical visits provoked feelings that the color of their skin might seem "dirty." Finally, this research will help to inform discussions about COVID-19 vaccine hesitancy, which remains a critical health concern among Black women and healthcare providers.
Across the world, suicidal behaviors are responsible for more than one million deaths each year. In Haiti, suicidal behaviors were found to be related to intimate partner violence (IPV) against women. This study was conducted after the 2010 earthquake in Haiti and women were asked about IPV before and after that event. A sample of women between 18 and 44 years of age responded to a questionnaire about physical, psychological, or sexual abuse by an intimate or non-intimate partner. The women were divided into two groups: (a) women who were abused by partners (n = 133) and (b) women who were not abused (n = 75). Those who were abused had 2.2 times higher odds for suicidal thoughts and 1.9 times higher odds for suicidal attempts and were significantly more likely to suffer from depression and PTSD. For each 1-unit increase in a measured PTSD score, the odds of being abused increased by 105.7%. For each 1-unit increase in the measured depression score, the odds of being abused increased by 14.9%.
In Immokalee, Florida, farmworkers returning for the fall harvest season and students returning to school for in-person classes combined to create fertile ground for a new outbreak of COVID-19 (ciw-online, 2020). In response to this situation, the goal of this service-learning experience was to provide health screenings and health education to migrant workers and their families in Immokalee, a rural medically underserved community. In the first immersion, RN-BSN students provided educational programs in three churches, at Boys & Girls Club and Pace Center for Girls, reaching 984 migrant workers and their families. In the second immersion, students served 820 migrant workers and their families. Interviews were conducted on 50 students and transcribed. Twenty-five (25) were then selected for content analysis with some key statements presented as results. The students improved their ability to provide culturally competent care to migrant workers.
The COVID-19 pandemic exposed the inequity and injustice that African-Americans and those in minority communities face when it comes to their fundamental health rights. The prejudice they see in social situations, politics, and finances has resulted in unfair, organized, and socially manufactured health inequities, especially in those minority communities in New York City. These disparities result in a mistrust of the healthcare system and, ultimately, hesitancy toward COVID-19 vaccines. To combat these issues, healthcare leaders such as those from the Greater New York City Black Nurses Association have partnered with community organizations to combat racism in our healthcare system and establish and successfully operate vaccination sites in these communities. These efforts led to the inoculation of over 22,000 people with COVID-19 vaccines. This shows that African-American nurse leaders are best suited to address the healthcare disparities that African-Americans face, especially during public health emergencies, and guide the conversation on racial equity in healthcare.
Cervical cancer, one of the most common gynecological cancers in the United States, is highly preventable due to the papanicoloau (Pap) test with human papillomavirus (HPV) co-screening. However, there is increasing evidence of low adherence to screening guidelines by health care providers (HCP). The purpose of this study was to identify and improve health care providers' attitudes, beliefs, and knowledge of the most updated screening guidelines and to provide them with an evidence-based educational intervention to increase their confidence in the updated guidelines, improve their attitudes and beliefs, and screen their patients more appropriately. Before being presented with an intervention consisting of an educational session that detailed the most recent U.S. Preventative Services Task Force (USPSTF) cervical cancer screening guidelines, the HCPs were surveyed for knowledge and at 2 months post-intervention, they were surveyed again. When the survey was scored pre- and post-intervention, two-thirds of the HCPs improved their score. An important barrier (67% post-intervention) to extending the interval included concerns about the patients losing contact with the medical system (50% at baseline). An educational intervention, including the updated screening guidelines, improved the HCPs' attitudes, beliefs, and knowledge of screening guidelines.
Dr. Gloria Smith's 1975 message "From Invisibility to Blackness: The Story of the National Black Nurses Association," still resonates today and in some instances, resonates even more. The need to promote the visibility of Black nurses in improving the health and well-being of Black communities and advancing the profession has never wavered. Dr. Gloria Smith's 1975 message still resonates today and in some instances, resonates even more. The need to promote the visibility of Black nurses in improving the health and well-being of Black communities and advancing the profession has never wavered.I believe Dr. Smith would take note that we have moved from Invisibility to Influence since her earlier message. Clearly, we have more work to do. However, we can take pride in what Black nurses have accomplished since NBNA was established.
The purpose of this study was to explore student nurses' awareness of implicit biases that may exist related to caring for individuals of different races. To further explore this subject, several student nurses were asked to analyze their Implicit Association Test (IAT) results and reconcile their findings with their lived experiences. The students' responses and assessments are reported in this study. Although several health disciplines are looking at those biases, there is a need for additional data to address those biases, specifically in nursing. A constructive, pedagogical approach is needed to rectify any remnant of culturally insensitive practices.
As a result of severe acute respiratory syndrome coronavirus 2, there has been a surge in the prevalence and severity of non-syndromic pediatric overweight (NSPO) in the United States. Prevention interventions such as engagement in regular moderate-to-vigorous physical activity have been consistently shown to mitigate the development and maintenance of NSPO. Yet, African-American adolescent females, a subgroup of the population disparately impacted by NSPO, are less likely to engage in regular physical activity. Although multidimensional global self-concept has been identified as a possible predictor of physical activity engagement, dimensional linkage with physical activity engagement among members of this subgroup has yet to be established. This secondary analysis of data from N = 312 urban dwelling African-American adolescent females sought to evaluate the contribution that selected dimensions of global self-concept had on engagement in vigorous physical activity. Findings from a 3-Model hierarchical regression analysis found that in addition to socioeconomic position, several social desirability and competence dimensions of global self-concept were significant predictive contributors to physical activity engagement among members of the study cohort. Specifically, these were the dimensions of physical appearance, romantic appeal, close friendship, social acceptance, and scholastic competence. Although more research is needed, results from this study have important implications for population health.
This study considers why selected information behaviors such as health information seeking, understanding communicated risks, and therapeutic misconceptions contribute to the decision not to participate in a clinical trial despite the possible benefit to the subject. Topics also presented include background regarding the nature of clinical trials in the United States, ethical and regulatory constraints facing researchers, and a consideration of why the history of medical experimentation on the African-American community may be a reason why members of this group decline participation in clinical trials.
