The purpose of this study was to examine the influence of family members on immigrant South Asian women’s health and health-seeking behavior. This qualitative study was part of a larger study that examined the health-seeking practices of immigrant South Asian women living in the Lower Mainland of British Columbia, Canada. Using ethnographic methods, data were collected through face-to-face interviews with women who had lived in Canada for 10 months to 31 years. Analysis of translated and transcribed data revealed that women made decisions about their health in consultation with family members. Overall, family members were perceived to be supportive and provided direct and indirect assistance to women in ways that influenced their health. Expected roles and responsibilities often had detrimental influences on women’s health. Health care for immigrant South Asian women needs to take into account women’s relationships with family members and the influence of family on women’s health.

Since the late 1980s, several HIV-specific quality of life instruments have been developed; however, little testing has been done in terms of their validity and reliability for HIV-infected women. The purpose of this study was to test the content validity, concurrent validity, internal consistency, and test–retest reliability of the Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQOL-HIV) in a sample of 85 HIV-infected women. The MQOL-HIV is a 40-item scale comprised of 10 dimensions. Most of the items and all of the domains were determined content valid but revision of some of the items and domains is recommended. Concurrent validity was measured between the MQOL-HIV and the MOS-HIV and ranged from 0.51–0.81 between similar domains. 7 Of the 10 domains and the entire instrument, had a Cronbach's α over 0.70 (range 0.43–0.92). Eight domains and the entire instrument achieved test–retest correlation coefficients over 0.70 (range 0.60–0.96). Although some revision may make the scale more content-valid for HIV-infected women, given due care in the interpretation of results, the MQOL-HIV can be used with female populations in its current form.

Othering is a process that identifies those that are thought to be different from oneself or the mainstream, and it can reinforce and reproduce positions of domination and subordination. Although there are theoretical and conceptual treatments of othering in the literature, researchers lack sufficient examples of othering practices that influence the interactions between patients and health care providers. The purpose of this study was to explore the interactions between health care providers and South Asian immigrant women to describe othering practices and their effects. Ethnographic methods were used involving in-depth interviews and focus group discussions. The analysis entailed identifying uses of othering and exploring the dynamics through which this process took place. Women shared stories of how discriminatory treatment was experienced. The interviews with health care professionals provided examples of how views of South Asian women shaped the way health care services were provided. Three forms of othering were found in informants' descriptions of their problematic health care encounters: essentializing explanations, culturalist explanations, and racializing explanations. Women's stories illustrated ways of coping and managing othering experiences. The analysis also revealed how individual interactions are influenced by the social and institutional contexts that create conditions for othering practices. To foster safe and effective health care interactions, those in power must continue to unmask othering practices and transform health care environments to support truly equitable health care.

OBJECTIVE:To compare students who were immunized or not immunized during the 1997 Simon Fraser University measles outbreak in British Columbia.METHODS:Descriptive comparative study using the Health Belief Model as a theoretical framework. A self-administered questionnaire was mailed to a stratified random sample of 400 immunized and 400 non-immunized SFU students.RESULTS:Perceived susceptibility, severity, barriers, cues to action, threat and student age were significantly related to being immunized. Logistic regression analysis achieved an overall correct prediction rate of 84.7% by including the contribution of the four variables of susceptibility, barriers, cues to action, and health motivation. Content analysis of the non-immunized students' descriptions of what it would have taken for them to be immunized indicated the influence of these four variables.DISCUSSION:The Immunization Health Belief Model Scale is a valuable tool for ascertaining attitudes and beliefs relating to immunization decision-making. Interventions targeted to significant beliefs may increase immunization coverage levels and result in improved disease prevention.

Little research has examined children's perceptions of what it was like when their mother was diagnosed and treated with chemotherapy for breast cancer. This research aimed to describe the children's perspectives and to suggest interventions to assist children to manage the experience with less stress. Qualitative naturalistic inquiry methods were used. Purposive sampling was used to recruit children whose mothers had chemotherapy for breast cancer in the prior two years. Eleven children were interviewed individually or with siblings. Children were between seven to 21 years of age. The major theme that emerged was Shielding and Being Shielded. Shielding refers to how children protected themselves from their thoughts and feelings and protected themselves from others. Being Shielded refers to what others did to protect the children. Shielding and Being Shielded each had components reflective of knowing/understanding, acknowledging/feeling, sharing, and shifting/helping. Recommendations directed towards assisting children, parents, and nurses and other health care professionals are suggested.

Peu de recherches ont examiné les perceptions des enfants sur leur vécu lorsque leur mère était diagnostiquée d’un cancer du sein et suivait un traitement de chimiothérapie. Ce projet de recherche avait pour but de décrire les perspectives des enfants et de suggérer des interventions qui aideraient ces derniers à gérer l’expérience d’une manière moins stressante. On a fait appel à des méthodes d’enquête naturalistes qualitatives. On a utilisé un échantillonnage raisonné pour recruter des enfants dont la mère avait subi une chimiothérapie pour un cancer du sein au cours des deux années précédentes. On a ainsi interviewé onze enfants soit individuellement soit avec leurs frères et/ou soeurs. Les enfants avaient entre sept et 21 ans. Le principal thème qui est ressorti de l’étude est l’autoprotection et la protection émotionnelles. Par “autoprotection émotionnelle”, on entend la manière dont les enfants se protégeaient de leurs pensées et sentiments et dont ils se protégeaient vis-à-vis d’autrui. Le terme “protection émotionnelle”, lui, se rapporte à ce que les autres faisaient pour protéger émotivement les enfants. L’autoprotection et la protection émotionnelles renfermaient toutes deux des éléments concernant les domaines Conscience/Compréhension, Reconnaissance/Sentiments, Partage, et enfin, Changement/Aide. On propose des recommandations visant à aider les enfants, les parents, les infirmières et d’autres professionnels de la santé.

This concise volume of slightly more than 100 pages is directed primarily to practicing nurses. It focuses on understanding and applying research in the clinical setting. The six chapters, written by colleagues primarily from the University of Sheffield, link well and build on concepts in a logical manner. The content is applicable anywhere, but the reader should be aware that some of the information is focused on the British health care system. Although the editor says the book will focus on health care professionals, the first two chapters are geared to nurses and nursing practice. The other four chapters incorporate basic information for raising awareness and knowledge about research and research use. Thewriters try to bring the content down to basics and to help the reader by providing “action points.” Action points are a series of reflective questions posed throughout the chapters that help the reader reflect on the content and its application. The book could have benefited from each author outlining at the beginning of each chapter what will follow. This would have simplified the organization of material for the reader. Many excellent examples are provided throughout the book that assist the reader in clarifying the application of content. It would have been even more informative if additional nursing examples were included. For example, when referring to clinical audits and quality assurance mechanisms, the author refers to a study in which nurses in one trust claimed to always give beta-blockers post-myocardial infarction, but on examination through an audit trail, only 78% of patients received the drug. This was portrayed as a nursing example, however, is it the nurses’ prerogative to determine when beta-blockers are given? In the chapter on methods, the author provides a short overview of qualitative and quantitative methods and then very briefly describes methods within each of those paradigms. Good examples are given for clarification. It might have been helpful if a table were provided that reflected types of qualitative and quantitative designs. This

Cross-cultural influences affect perceptions and health practices, which are 2 areas of nursing concern. Culturally sensitive assessment instruments are needed, but many challenges exist in obtaining valid and reliable measurement. Translating questionnaires for cross-cultural research is fraught with methodological pitfalls related to colloquial phrases, jargon, idiomatic expressions, word clarity, and word meanings. It cannot be assumed that a particular concept has the same relevance across cultures. Simply translating an English version word-for-word into another language is not adequate to account for linguistic and cultural differences. Ideally, the perspectives of people from the culture about the concept of interest should be studied first, but often a practical alternative is to find and translate a tool developed in another culture. The purpose of this article is to describe important considerations in conducting translation for equivalence, types of equivalence, and strategies to translate instruments that promote equivalence and how to test the translated version for equivalence. These concepts and strategies are illustrated by describing the translation process of Hilton's Uncertainty Stress Scale into French and the use and testing of the French version with a French Canadian sample in Skrutkowski's study of perceived uncertainty in adult survivors of cancer.

AIM:To provide a comprehensive review of the literature on harm reduction theories and strategies related primarily to licit and illicit drug use.BACKGROUND:Although human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) disease transmission is well understood, it continues to spread, particularly among injection drug users (IDUs). Despite early indications that HIV would be contained within the IDU community, it is spreading to non-IDU sexual partners and to children of IDUs, threatening a more widespread epidemic.METHODS:An examination of research studies and theoretical writings including reviews and policy papers published in English between 1990 and 2000.RESULTS:Harm reduction does not seek to eliminate drug use; it focuses on minimizing the personal and social harms and costs associated with drug use and spread of HIV. It seeks to ameliorate conditions surrounding drug use responsible for the spread of HIV in the IDU community: unequal access to health services; sharing of infected needles; racial and social discrimination; poverty; exposure to street violence; inadequate housing; lack of employment; poor general or mental health and other demographic and social determinants. Some controversial harm reduction strategies are described: methadone maintenance programmes, illegal drugs dispensing under controlled conditions, needle exchanges, HIV testing, vein maintenance, safe-sex and would-care programmes.CONCLUSION:The main challenge is to get IDUs to protect themselves against HIV when suffering physical and social privations and addiction needs. Diverse perspectives on harm reduction are problematic with consequences for success of drug use initiatives. Practical, ethical and theoretical complexities exist but further research is needed to build support for a harm-reduction orientation in practice and policy formulation.

The AIDS Prevention Street Nurse Program in Vancouver, Canada focuses on HIV and sexually transmitted diseases (STD) prevention within a context of harm reduction and health promotion targeted at marginalized, hard to reach, high-risk populations. As part of a large evaluation project that included interviews with street nurses, clients, and other service providers together with document analysis, the nature of the street nurses' work and its fit within the provision of health care were described. The street nurses' work reflected the following themes: reaching the marginalized high-risk populations for HIV/STDs; building and maintaining trust, respect, and acceptance; doing HIV/AIDS and STD prevention, early detection, and treatment work; helping clients connect with and negotiate the health care system; and influencing the system and colleagues to be responsive. The findings and their implications for community health nursing practice are examined.

A Nursing Centre in Canada was initiated to demonstrate nursing practice in a primary health care context, unencumbered by conventional health care agency parameters. As one part of a multimethod evaluation, a 5 instrument client questionnaire was designed. The main instrument was developed by the researchers to measure the impact of the Centre and nurses' work from the perspective of clients. No established instrument could be found that was appropriate for the Centre's diverse client population and nature and variation in outcomes. To guide the development of the new instrument, minimally structured client interviews were conducted with 15 clients. To assess the validity and reliability of other selected instruments for the population, clients were asked to comment on the appropriateness of items. Based on findings, the Nurses' Work and Client Outcomes Questionnaire (NWCOQ) was developed, the Client Satisfaction Questionnaire and demographic questions modified, and a Cantril Self-Anchoring ladder to assess health status was supported for use. An open section was added to invite further description of clients' experiences, in particular, the unexpected, contrary or outstanding. Further pilot work was done and the refined five instrument questionnaire then was used to survey all clients who used the Centre during a seven month period. Findings from the NWCOQ revealed the nature of the nurses' work and the degree change occurred for clients on multiple health dimensions: physical, emotional, managing their situation, and group and community involvement. Clients were highly satisfied with the Centre and experienced many positive outcomes. The quantitative instruments and results were examined in relation to results from other data collection approaches and data sources. The NWCOQ has evidence of content validity and internal consistency reliability. The use of qualitative methods to develop and refine quantitative instruments for assessment of health outcomes for diverse client populations is highly recommended. This strategy is feasible even when outcome measurement timeframes are short.

Although many South Asian immigrants have made their homes in Canada, little research has examined health behaviors in this population and fewer studies have examined the use of traditional health practices. As part of a larger study on health-seeking patterns of South Asian women living in Western Canada, an analysis was done on the use of traditional health practices. Using critical ethnographic methods, data were collected through face-to-face individual interviews (n = 50), focus group discussions (n = 12), and community meetings with a cross section of women in the South Asian community. Interviews were conducted in the language of each participant's choice. Thematic analysis was done on the transcribed interviews. Women's descriptions of traditional health practices varied and consisted of home remedies, dietary regimens, prayers, rituals, and consultation with hakims, veds, babajis, pundits, homeopaths, and jyotshis. Choosing to use traditional health practices was influenced by family members, the nature and severity of problems, beliefs and prior experiences, and the feasibility of using these practices. Traditional health practices were used on a daily or episodic basis. Women rarely used traditional health practices exclusively. Traditional health practices were used for small problems or when conventional medicines did not work. For women to meet their health needs, health care providers must be culturally sensitive and respect women's choices to use traditional health practices.

Health care concerns, health issues, and illness are defined within a social, cultural, political, and economic context.1 When health care practitioners and patients share a common culture, it is not always necessary to negotiate an understanding of the health problem. The distinctive ways that health problems are discussed and treated are often taken for granted when cultures are shared.2 Immigrants to North America may bring a set of beliefs and expectations to health care interactions that differ from those held by Western health care providers trained in biomedicine. Differences in explanatory models between professionals and their patients have the potential to create mismatches that can lead to problems, including misunderstandings and unmet expectations and needs. Explicating explanatory models in health care interactions can provide an effective device for identifying the sources of clinical miscommunications and misrecognitions.3 The concept of explanatory models is based on a distinction between illness (the patient's perceptions of symptoms and disability) and disease (the biomedical practitioner's perspective). While authors such as Kleinman have extensively explored the nature of these explanatory models, Kleinman has cautioned that they are easily misapplied when a patient's perceptions and beliefs are treated as distinct entities to be identified and recorded.4

This article reports the pretransplant findings of the first phase of a three-phase, longitudinal study examining relationships among personality traits and self-care abilities and behaviors of Ontario adults pre-and post-renal transplant. A consortium of Ontario nurse researchers representing three of Ontario’s five renal transplant centers conducted this research. All adults on the cadaver transplant lists of 15 Ontario dialysis centers were invited to participate. One hundred ninety-eight adults awaiting renal transplant were enrolled in the study, representing a 70% response rate. A cross-sectional, correlational design was used for the pretransplant phase. Self-report measures with known psychometric properties were used; validity and reliability of the measures were supported by the sample. Data were analyzed using descriptive approaches, correlational analyses, multiple regression, and path analysis. Relationships were supported among selected personality traits, health state and self-care abilities and behaviors. Further research to examine personality traits and health state in relation to adult self-care is warranted.

Little research has examined the impact of cancer and chemotherapy treatment for breast cancer from men's perspectives as partners, fathers, and caregivers. This research, part of a larger study describing women's, partners', and children's perspectives, aims to describe men's perspectives on their experiences and how their wives' breast cancer and chemotherapy impacted them and their families, to describe what facilitated and hindered their coping, and to suggest interventions to assist men and their families to manage the experience with less stress. This participatory action study used qualitative naturalistic inquiry methods. Semistructured interviews were conducted with 11 male partners. Two major themes were identified: focusing on a wife's illness and care, and focusing on the family to keep life going. Nine sub-themes cut across the major themes: being there, relying on health care professionals, being informed and contributing to decision making, trying to keep patterns normal and family life going, helping out and relying on others, being positive, putting self on hold, adapting work life, and managing finances.

The AIDS Prevention Street Nurse Program uses specially prepared community health nurses to focus on HIV and STD prevention with marginalized, hard-to-reach and high-risk clients within a broader context of harm reduction and health promotion. Street nurses (n=17), service providers (n=30), representatives of other HIV/STD programs in the province of British Columbia, Canada (n=5), and clients (n=32) were interviewed during an evaluation for the purpose of describing the nurses' work, the challenges the nurses' face, the fit of the program with other services, and the impact of the nurses' work.This article describes the impact of the nurses' work on clients. Impact/outcome changes reflected a progression from knowledge to behavioural levels and to major indicators of health/illness. Impact on clients included: knowing more about HIV/AIDS, their own situation, and options; receiving essential supplies to reduce harm and promote health; changing behaviour to reduce disease transmission, improve resistance, and promote health; connecting with help; feeling better about themselves and others; feeling supported; influencing others; receiving earlier attention for problems; being healthier with or without HIV; making major changes in drug use; and likely decreasing morbidity and mortality. The program was found to be clearly effective in making a positive impact on clients.

Breast cancer is an important women's health issue in all communities. To detect breast cancer early, all women should practise monthly breast self-examination, have regular clinical breast examinations and attend mammography screening at suggested intervals. Participation in these breast health practices is influenced by a wide variety of factors, including how women define health and health practices, priorities in women's lives and their explanations of the causes of diseases such as cancer.

Using ethnoscience methods, interviews with 50 South Asian women living in Western Canada were conducted and analyzed to explore explanations and images of breast cancer. Embedded in the women's stories of breast cancer were distinctive, often vivid and fear-provoking images of abnormal growth. Explanations about the causes of breast cancer involved five domains of belief. The first domain was of a physical nature and centred on damage to the breast. A second domain of explanations, `can catch it,' focused on the way this disease could be spread to others. Other women attributed breast cancer to the ways women could `bring it upon yourself,' often linking a negative lifestyle with the development of cancer. Many women attributed cancer to being `in the hands of others,' explaining the cancer was caused by careless words, curses or divine power. Finally, breast cancer was seen as something that could be passed down in the family. The taxonomy developed in this study provides a useful framework for understanding the explanations that might underlie women's health-seeking behaviours and for developing culturally suitable counseling strategies.