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Ta Park VM, Grill JD, Tsoh J, Meyer OL, Ameli N, Helman S, Tzuang M, Nam B, Hinton L, Kanaya A, Gallagher-Thompson D, Vuong Q, Bang J, Shin HW, Gansky SA. Asian Americans' and Pacific Islanders' preferences in recruitment strategies and messaging for participation in the CARE registry: A discrete choice experiment. Alzheimers Dement 2023; 19:5198-5208. [PMID: 37171018 DOI: 10.1002/alz.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/23/2023] [Accepted: 03/21/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION This discrete choice experiment (DCE) identified Asian American and Pacific Islander (AAPI) adults' preferences for recruitment strategies/messaging to enroll in the Collaborative Approach for AAPI Research and Education (CARE) registry for dementia-related research. METHODS DCE recruitment strategy/messaging options were developed in English, Chinese, Korean, and Vietnamese. AAPI participants 50 years and older selected (1) who, (2) what, and (3) how they would prefer hearing about CARE. Analyses utilized conditional logistic regression. RESULTS Participants self-identified as Asian Indian, Chinese, Filipino, Japanese, Korean, Samoan, or Vietnamese (N = 356). Overall, they preferred learning about CARE from the healthcare community (vs. community champions and faith-based organizations), joining CARE to advance research (vs. personal experiences), and hearing about CARE through social media/instant messaging (vs. flyer or workshop/seminar). Preferences varied by age, ethnic identity, and survey completion language. DISCUSSION DCE findings may inform tailoring recruitment strategies/messaging to engage diverse AAPI in an aging-focused research registry.
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Affiliation(s)
- Van M Ta Park
- Department of Community Health Systems, University of California, San Francisco, California, USA
- Asian American Research Center on Health (ARCH), University of California, San Francisco, California, USA
- Multiethnic Health Equity Research Center (MERC), University of California, San Francisco, California, USA
| | - Joshua D Grill
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, USA
| | - Janice Tsoh
- Asian American Research Center on Health (ARCH), University of California, San Francisco, California, USA
- Multiethnic Health Equity Research Center (MERC), University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Oanh L Meyer
- Department of Neurology, University of California Davis, Sacramento, California, USA
| | - Niloufar Ameli
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Sarit Helman
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Marian Tzuang
- Department of Community Health Systems, University of California, San Francisco, California, USA
| | - Bora Nam
- Department of Community Health Systems, University of California, San Francisco, California, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California, USA
| | - Alka Kanaya
- Asian American Research Center on Health (ARCH), University of California, San Francisco, California, USA
- Multiethnic Health Equity Research Center (MERC), University of California, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Quyen Vuong
- International Children Assistance Network (ICAN), San Jose, California, USA
| | - Joon Bang
- Iona Senior Services, Washington DC, USA
| | - Hye-Won Shin
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, California, USA
| | - Stuart A Gansky
- Multiethnic Health Equity Research Center (MERC), University of California, San Francisco, California, USA
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
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Lwi SJ, Ford BQ, Levenson RW. Cultural differences in caring for people with dementia: a pilot study of concern about losing face and loneliness in Chinese American and European American caregivers. Clin Gerontol 2023; 46:207-222. [PMID: 36309843 PMCID: PMC9928887 DOI: 10.1080/07317115.2022.2137448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Heavy demands upon dementia caregivers can lead to a number of poor health outcomes including declines in physical, mental, and brain health. Although dementia affects people from all backgrounds, research in the US has largely focused on European American caregivers. This has made providing culturally-competent care more difficult. This study begins to address this issue by empirically examining how culturally-shaped beliefs can influence loneliness in family caregivers of people with dementia. METHODS We conducted a preliminary questionnaire study with Chinese American and European American family caregivers of people with dementia (N = 72). RESULTS Chinese American caregivers were more concerned than European American caregivers about losing face, which in turn, was associated with greater loneliness. This pattern remained when accounting for caregiver gender, age, and relationship to the person with dementia. CONCLUSIONS These preliminary findings highlight the role that cultural beliefs can play in adverse caregiver outcomes, and suggest that addressing concerns about losing face may be an important way for healthcare providers to help reduce loneliness among Chinese American caregivers. CLINICAL IMPLICATIONS Understanding how cultural beliefs influence caregiver outcomes is critical as healthcare professionals work to provide culturally-competent care and design culturally-sensitive interventions.
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Affiliation(s)
- Sandy J Lwi
- VA Northern California Health Care System, Martinez, California, USA
| | - Brett Q Ford
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Robert W Levenson
- Department of Psychology, University of California, Berkeley, California, USA
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AboJabel H, Werner P. The mediating effect of social support and coping strategies on the relation between family stigma and caregiver burden among Israeli Arab family caregivers of people with Alzheimer's disease (AD). Aging Ment Health 2022; 26:1597-1603. [PMID: 33904814 DOI: 10.1080/13607863.2021.1916881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Many studies have attempted to identify the factors that are associated with caregiver burden among family caregivers of people with Alzheimer's disease (AD), because of its plethora of negative consequences. One unique factor that has been investigated recently is family stigma. However, the path leading from family stigma to caregiver burden has not been thoroughly studied. Hence, this study had two main objectives. The first was to examine whether family stigma was a predictor of caregiver burden among Israeli Arab family caregivers of a person with AD. The second was to examine the interplay of family stigma and caregiver burden with coping strategies and social support. METHODS Structured face-to-face interviews were conducted with 175 Israeli Arab family caregivers (adult children and spouses) of elderly people with AD (87.4% female; 71.4% adult children; mean age = 54.28). RESULTS Overall, the participants reported moderate levels of caregiver burden and family stigma. Additionally, as expected, family stigma made a unique - although modest - contribution to the explanation of caregiver burden. Whereas neither problem-focused coping nor emotion-focused coping played a significant role in mediating the relation between family stigma and caregiving burden, social support did mediate the relation between these variables. CONCLUSIONS Our findings reveal how social support is important as a specific way to reduce the impact of family stigma on caregiver burden.
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Affiliation(s)
- Hanan AboJabel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Vila-Castelar C, Fox-Fuller JT, Guzmán-Vélez E, Schoemaker D, Quiroz YT. A cultural approach to dementia - insights from US Latino and other minoritized groups. Nat Rev Neurol 2022; 18:307-314. [PMID: 35260817 PMCID: PMC9113534 DOI: 10.1038/s41582-022-00630-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/14/2022]
Abstract
Alzheimer disease and related dementias present considerable challenges to health-care and medical systems worldwide. In the USA, older Black and Latino individuals are more likely than older white individuals to have Alzheimer disease and related dementias. In this Perspective, we leverage our experience and expertise with older US Latino groups to review and discuss the need to integrate cultural factors into dementia research and care. We examine the importance of considering the effects of cultural factors on clinical presentation and diagnosis, dementia risk, clinical research and recruitment, and caregiving practices, with a focus on minoritized groups in the USA. We highlight critical gaps in the literature to stimulate future research aimed at improving the prevention and early detection of Alzheimer disease and related dementias and developing novel treatments and interventions across ethnoracially diverse populations. In addition, we briefly discuss some of our own initiatives to promote research and clinical care among Latino populations living in the USA.
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Affiliation(s)
- Clara Vila-Castelar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua T Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Edmarie Guzmán-Vélez
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dorothee Schoemaker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yakeel T Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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The Understanding and Experiences of Living with Dementia in Chinese New Zealanders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031280. [PMID: 35162305 PMCID: PMC8835650 DOI: 10.3390/ijerph19031280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 01/27/2023]
Abstract
Little is known about the lived experience of dementia in the New Zealand Chinese community. This study aims to explore the understanding and experiences of living with dementia in Chinese New Zealanders. Participants were recruited from a memory service and a community dementia day programme. In-depth interviews were conducted by bilingual and bicultural researchers. The recorded interviews were transcribed and thematically analysed. Sixteen people living with dementia and family carers participated in this study. The first theme revealed the lack of understanding of dementia prior to diagnosis, the commonly used term of “brain shrinkage” and that dementia is associated with getting older. The second theme covered the symptoms experienced by people with dementia and how family carers found anhedonia and apathy particularly concerning. The third theme highlighted the tension between cultural obligation and carer stress. The fourth theme is about the stigma attached to dementia. Our results provide some insight into ways to improve dementia care for Chinese New Zealanders, including targeted psychoeducation in the Chinese community to improve awareness and to reduce stigma, access to person-centred interventions, and learning about strategies for healthy ageing to live well with dementia, and emotional support and psychoeducation for family carers to reduce carer stress.
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Early Implementation and Evaluation of StepUp for Dementia Research: An Australia-Wide Dementia Research Participation and Public Engagement Platform. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111353. [PMID: 34769871 PMCID: PMC8583565 DOI: 10.3390/ijerph182111353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/16/2022]
Abstract
Recruiting participants for dementia research takes time. For those who are interested, opportunities to participate can be ad hoc. Delays in finding the right participants can result in studies taking longer to deliver, often requiring funding extensions, and ultimately increasing the cost and limiting the effectiveness of research and evaluation. To address these issues, a digital platform, StepUp for Dementia Research, was developed in 2019 and evaluated through ongoing data analytics, researcher feedback and annual volunteer surveys in 2019 and 2021. Using innovative matching technology, StepUp provides volunteers with an opt-in, secure way of registering interest in dementia studies and allows researchers to access matched volunteers in Australia. As of June 2021, 1070 volunteers registered (78% female), and 25 organizations became ‘champions’ for StepUp promotion. Of 122 registered researchers, 90 completed training. Forty studies from 17 research/health institutions recruited participants using StepUp. The evaluation demonstrated program feasibility and recruitment efficiency with a high level of satisfaction from users. Evaluation outcomes highlighted disparities in public participation in dementia research (e.g., gender, education and race/ethnicity) and provided valuable insights for further enhancements of StepUp. A concerted and strategic effort is needed by leading registries such as StepUp to ensure narrowing volunteer participation gaps in dementia research.
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Shim YS, Park KH, Chen C, Dominguez JC, Kang K, Kim HJ, Hong Z, Lin YT, Chu LW, Jung S, Kim S. Caregiving, care burden and awareness of caregivers and patients with dementia in Asian locations: a secondary analysis. BMC Geriatr 2021; 21:230. [PMID: 33827446 PMCID: PMC8028783 DOI: 10.1186/s12877-021-02178-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study investigated the differences in caregiver activity, caregiver burden, and awareness of both caregivers and patients with Alzheimer’s disease (AD) across different Asian locations. Methods This was a secondary analysis of a multi-national cohort study that aimed to assess caregiver activity and caregiver burden using the Caregiver Activity Scale (CAS) and Zarit Burden Interview (ZBI), respectively. Patients’ awareness of their dementia diagnosis was assessed by asking the following yes/no question: “Do you have dementia?” Caregivers’ awareness of the patient’s dementia diagnosis was assessed by asking the following yes/no question: “Does your patient have dementia?” Results In total, 524 caregivers of patients with AD from China, Hong Kong, South Korea, the Philippines, Singapore, Thailand, and Taiwan participated. The CAS and ZBI score were significantly different across most locations (p < 0.001 and p = 0.033, respectively). Overall, 56.6% of caregivers and 37.5% of patients had awareness of the dementia diagnosis, and the proportion of patients and caregivers with awareness were also different between each location (all, p < 0.001). Conclusions Caregiving, caregiver burden, and the awareness of caregivers and patients were different across many Asian locations. With understanding of cultural differences, further public education on dementia could help increase the awareness of patients and caregivers and reduce caregiver burden. Trial registration ClinicalTrials.gov, NCT02262975. Registered 13 October 2014,
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Affiliation(s)
- Yong S Shim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kee Hyung Park
- Department of Neurology, College of Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Christopher Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Kyunghun Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-Jin Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Zhen Hong
- Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yu-Te Lin
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Leung-Wing Chu
- Queen Mary Hospital, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - San Jung
- Department of Neurology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine & Clinical Neuroscience Center, Seoul National University Bundang Hospital, 582, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Seoul, Republic of Korea.
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Lim C, Hernandez M, Gaona L, Barrio C. Recruitment of Asian Americans with Schizophrenia Spectrum Disorder for Research Participation: Barriers, Strategies, and Outcomes. Community Ment Health J 2021; 57:490-501. [PMID: 32588227 DOI: 10.1007/s10597-020-00670-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 06/19/2020] [Indexed: 11/28/2022]
Abstract
Difficulty reaching Asian Americans with schizophrenia spectrum disorder has prompted mental health researchers to exclude this subpopulation from the sampling frame or enroll a comparatively smaller sample compared to other races and ethnicities with similar diagnoses. Understanding potential influences on research participation may facilitate efforts to increase the representation of this vulnerable yet underrepresented population in research. We detailed our experiences recruiting Asian Americans with schizophrenia spectrum disorder for participation in an observational study that evaluated their clinical outcomes. We applied the matching model of recruitment by identifying recruitment barriers encountered by or arising from the target group and researchers at the macro (community mental health center and academic institution), mediator (gatekeepers and research team), and micro (participant and interviewer) levels and then implementing a multilevel approach to overcoming identified obstacles. Our yearlong recruitment efforts yielded a diverse community sample (n = 75) recruited from six urban community mental health centers. Barriers to involving Asian Americans with schizophrenia spectrum disorder in research are complex and associated with being a member of a heterogeneous racial and ethnic minority group and having a serious psychiatric condition. Engaging Asian Americans with schizophrenia spectrum disorder in research is feasible if researchers devote time and resources to address barriers confronting the target group and challenges researchers encounter.
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Affiliation(s)
- Caroline Lim
- Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Blk AS3 Level 4, 3 Arts Link, Singapore, 117570, Singapore.
| | - Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, USA
| | - Lizbeth Gaona
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA.,College of Behavioral and Social Sciences, Calfornia Baptist University, Riverside, USA
| | - Concepción Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
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Dilworth-Anderson P, Moon H, Aranda MP. Dementia Caregiving Research: Expanding and Reframing the Lens of Diversity, Inclusivity, and Intersectionality. THE GERONTOLOGIST 2020; 60:797-805. [PMID: 32667672 DOI: 10.1093/geront/gnaa050] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 02/04/2023] Open
Abstract
This forum expands and reframes the lens of dementia caregiving research among diverse racial and ethnic groups to better understand the unique needs, stressors, and strengths of multicultural and racial-ethnic family caregivers in the United States. By providing more diverse and inclusive knowledge on caregiving to older adults in the United States, we can create a new path forward with regards to caregiving research. Throughout the article, major questions and answers are supported by critiquing some of the caregiving literature. Discussions are provided to help create inclusive ways of conceptualizing caregiving research and using methodological approaches to reflect the diversity of caregivers and care recipients in the United States. Expanding and reframing the conceptual and methodological lens of diversity, inclusivity and intersectionality can provide evidence to support effective policy, practice, and care in addressing the needs of diverse groups of caregivers and older adults living with dementia.
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Affiliation(s)
- Peggye Dilworth-Anderson
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
| | - Heehyul Moon
- Kent School of Social Work, University of Louisville, Kentucky
| | - María P Aranda
- USC Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles.,USC Alzheimer's Disease Center, University of Southern California, Los Angeles
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Graffigna G, Barello S, Morelli N, Gheduzzi E, Corbo M, Ginex V, Ferrari R, Lascioli A, Feriti C, Masella C. Place4Carers: a mixed-method study protocol for engaging family caregivers in meaningful actions for successful ageing in place. BMJ Open 2020; 10:e037570. [PMID: 32788189 PMCID: PMC7422654 DOI: 10.1136/bmjopen-2020-037570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Engaging family caregivers could be a critical asset to make the 'ageing-in-place' imperative a reality. This is particularly evident in rural and remote areas, where caregivers can fill the gaps that exist due to the fragmentation of the welfare system. However, there is little knowledge about the expectations that family caregivers have from healthcare services in rural and remote areas.Place4Carers (P4C) project aims to co-produce an innovative organisational model of social and healthcare services for family caregivers of older citizens living in Vallecamonica (Italy). The project is expected to facilitate ageing-in-place for older citizens, thus helping caregivers in their daily care activities. METHODS AND ANALYSIS P4C is a community-based participatory research project featuring five work packages (WPs). WP1 consists of a survey of unmet needs of caregivers and older people receiving services in Vallecamonica. WP2 consists of a scoping literature review to map services that provide interventions of support to caregivers living in remote areas and promote engagement. WP3 organises co-creation workshops with caregivers to co-design, co-manage, and co-assess ideas and proposals for shaping caregiver-oriented services and organisational models. WP3 enriches the results of WP1 (survey) and WP2 (scoping literature review), and aims to co-create new ideas for intervention support with and for caregivers in relation to the objectives, features and characteristics of a new service able to address the caregivers' needs and expectations. WP4 tests the service ideas co-created in WP3 through piloting an intervention based on ideas co-created with caregivers. Finally, WP5 assesses the transferability of the intervention to other similar contexts. ETHICS AND DISSEMINATION The study has been approved by the Ethics Committees of the Department of Psychology of Università Cattolica del Sacro Cuore and Politecnico of Milan. Results will be disseminated through peer-reviewed journals, scientific meetings and meetings with the general population.
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Affiliation(s)
- Guendalina Graffigna
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Serena Barello
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Niccolò Morelli
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona, Italy
- Department of Sociology and Business Law, Università di Bologna, Bologna, Italy
| | - Eleonora Gheduzzi
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milano, Italy
- Fondazione NEED Institute, Milan, Italy
| | - Valeria Ginex
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milano, Italy
- Fondazione NEED Institute, Milan, Italy
| | - Roberta Ferrari
- Azienda Territoriale per i Servizi alla Persona Vallecamonica, Breno, Italy
| | - Andrea Lascioli
- Azienda Territoriale per i Servizi alla Persona Vallecamonica, Breno, Italy
| | - Carolina Feriti
- Azienda Territoriale per i Servizi alla Persona Vallecamonica, Breno, Italy
| | - Cristina Masella
- Department of Management Engineering, Politecnico di Milano, Milano, Italy
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Salazar CR, Hoang D, Gillen DL, Grill JD. Racial and ethnic differences in older adults' willingness to be contacted about Alzheimer's disease research participation. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12023. [PMID: 32399482 PMCID: PMC7207155 DOI: 10.1002/trc2.12023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/10/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION We sought to examine the association of race/ethnicity with willingness to engage in studies that involve procedures typical of Alzheimer's disease (AD) clinical trials and determine whether any observed differences could be explained by research attitudes. METHODS We studied 2749 adults aged ≥50 years who enrolled in a community-based recruitment registry. RESULTS Compared to non-Hispanic (NH) whites (n = 2393, 87%), Hispanics (n = 191, 7%), NH Asians (n = 129, 5%) and NH blacks (n = 36, 1%) were 44%, 46%, and 64% less willing, respectively, to be contacted for studies that have requirements typical of AD prevention trials, namely: cognitive testing, brain imaging, blood draws, and investigational medications. Mediation by research attitudes was explored, but did not explain the observed differences. DISCUSSION Our findings suggest that ethnoracial minorities are less willing to engage in studies that are typical of AD prevention trials. Future work should focus on understanding the factors that drive these differences.
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Affiliation(s)
- Christian R. Salazar
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
| | - Dan Hoang
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
| | - Daniel L. Gillen
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
- Department of StatisticsUniversity of California, IrvineIrvineCaliforniaUSA
| | - Joshua D. Grill
- UC Irvine Institute for Memory Impairments and Neurological DisordersUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Psychiatry and Human BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
- Department of Neurobiology and BehaviorUniversity of California, IrvineIrvineCaliforniaUSA
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Fletcher JR. Positioning ethnicity in dementia awareness research: does the use of senility risk ascribing racialised knowledge deficits to minority groups? SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:705-723. [PMID: 31965599 DOI: 10.1111/1467-9566.13054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Over recent decades, the importance of increasing dementia awareness has been promoted by charities, researchers and governments. In response, a large body of research has emerged that evaluates the awareness of different populations. One such population are minority ethnic communities. Associated studies typically conclude that minority ethnic groups have a poor awareness of dementia and that interventions should be developed to better educate them. Operationalisations of awareness almost always reference senility - the traditional notion that dementia is a natural outcome of ageing - a widely held belief among many populations. Senility is considered incorrect knowledge in the research literature, and those participants who identify with it are deemed to have poor awareness. Despite the researchers' claims that senility is false, the scientific evidence is inconclusive, and the concept is contested. As such, a large body of research repeatedly positions minority ethnic communities as inferior and in need of re-education based on researchers' questionable assumptions. This issue is bound up with a racialised deficit-model of science communication and wider critiques of psychiatric colonialism. In response, researchers of dementia and ethnicity should reflect on their own awareness and the ways in which they position others in relation to it.
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Affiliation(s)
- James R Fletcher
- Department of Global Health and Social Medicine, King's College London, London, UK
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Lee SE, Hong M, Casado BL. Examining public stigma of Alzheimer's disease and its correlates among Korean Americans. DEMENTIA 2020; 20:952-966. [PMID: 32295415 DOI: 10.1177/1471301220918328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study examined public stigma associated with Alzheimer's disease (AD) among Korean Americans and identified factors affecting their public stigma. Data used in the study were collected using a cross-sectional survey with 268 Korean Americans. Guided by attribution theory, different domains of public stigma were assessed: pity, antipathy, and social distance. Hierarchical regression analyses were conducted to examine the effects of sociodemographic characteristics, exposure to AD, social networking, and AD knowledge on each stigma domain. The influence of emotional attributions (pity and antipathy) on behavioral attributions (social distance) in the stigma process suggested in attribution theory was also examined. Results show that pity is most prevalent followed by social distance and antipathy. Being more proficient in English, knowing fewer relatives/friends with AD, and knowing less about AD risk factors are associated with having more pity stigma. Being less socially engaged and knowing less about AD risk factors are related to having more antipathy stigma. Being younger and more proficient in English and having stronger antipathy stigma are associated with having more social distance stigma. Findings reveal multifaceted nature of public stigma associated with AD in Korean Americans and suggest that we need to work on both positive and negative sides of public stigma for stigma change. Findings of different factors associated with each public stigma domain can be considered when trying to foster and/or reduce certain stigmatic beliefs and behaviors associated with AD.
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Affiliation(s)
- Sang E Lee
- School of Social Work, San Jose State University, CA, USA
| | - Michin Hong
- School of Social Work, Indiana University, IN, USA
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Lim S, Mohaimin S, Min D, Roberts T, Sohn YJ, Wong J, Sivanesathurai R, Kwon SC, Trinh-Shevrin C. Alzheimer's Disease and its Related Dementias among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review. J Alzheimers Dis 2020; 77:523-537. [PMID: 32675416 PMCID: PMC8638681 DOI: 10.3233/jad-200509] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) aging population is rapidly growing and the burden of Alzheimer's disease and its related dementias (ADRD) will likely mirror this demographic growth. AANHPIs face significant barriers in obtaining timely ADRD diagnosis and services; yet little is known about ADRD in this population. OBJECTIVE The study objective is to conduct a systematic review on the published literature on ADRD among AANHPIs to identify gaps and priorities to inform future research and action plans. METHODS The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Co-author (TR), an experienced Medical Librarian, searched PubMed, EMBASE, PsycINFO, Cochrane Central of Clinical Trials, Ageline, and Web of Science for peer-reviewed articles describing ADRD among AANHPIs. The search was not limited by language or publication date. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. RESULTS The title/abstract and full texts of 1,447 unique articles were screened for inclusion, yielding 168 articles for analysis. Major research topics included prevalence, risk factors, comorbidities, interventions and outreach, knowledge and attitudes, caregiving, and detection tools. A limited number of studies reported on national data, on NHPI communities generally, and on efficacy of interventions targeting AANHPI communities. CONCLUSION To our knowledge, this is the first systematic review on ADRD among AANHPI populations. Our review provides a first step in mapping the extant literature on ADRD among this underserved and under-researched population and will serve as a guide for future research, policy, and intervention.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine
| | - Sadia Mohaimin
- Department of Population Health, New York University Grossman School of Medicine
| | - Deborah Min
- Department of Population Health, New York University Grossman School of Medicine
| | - Timothy Roberts
- Health Science Library, New York University Grossman School of Medicine
| | - Young-Jin Sohn
- Department of Population Health, New York University Grossman School of Medicine
| | - Jazmine Wong
- Department of Population Health, New York University Grossman School of Medicine
| | | | - Simona C. Kwon
- Department of Population Health, New York University Grossman School of Medicine
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine
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Cheung G, Appleton K, Boyd M, Cullum S. Perspectives of dementia from Asian communities living in New Zealand: A focus group of Asian health care professionals. Int J Geriatr Psychiatry 2019; 34:1758-1764. [PMID: 31389087 DOI: 10.1002/gps.5189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/05/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The number of Asian New Zealanders with dementia is growing. The objective of this study was to explore with a group of Asian health care professionals about public attitudes towards dementia in Asian communities in New Zealand, the stigma of dementia, and how best to develop culturally appropriate services for Asian people and families living with dementia. METHODS A focus group was conducted with a group of bilingual Asian health care professionals. A topic guide was developed based on the discussion at a prior meeting with the Cross Cultural Interest Group. The data were independently analysed by three researchers using the thematic qualitative methodology. RESULTS Eleven overseas-born Asian health care professionals (Chinese: n = 9, 82%) participated in the focus group. Four main themes emerged from the data: (a) cultural interpretations of dementia; (b) stigma; (c) filial piety; and (d) inequity in the availability of resources. CONCLUSION Our findings suggest that much work is needed to destigmatise dementia in New Zealand Asian communities, through psychoeducation, public awareness, and the availability of readily accessible services that can meet their cultural and language needs.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | | | - Michal Boyd
- School of Nursing and Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Avdikou K, Stefanatos C, Tsatali M, Gouva M, Tsolaki M. The Role of Gender in Shame, Hostility, and Aggression Experienced by Caregivers for Patients With Dementia. Am J Alzheimers Dis Other Demen 2019; 34:231-235. [PMID: 30295038 PMCID: PMC10852499 DOI: 10.1177/1533317518802458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the differences between male and female caregivers for patients with dementia in the way they experience various psychosocial parameters such as shame, hostility, and aggression. The sample included 55 caregivers of patients with moderate and severe dementia, whereas the average age was 51 years. Female caregivers were found to experience significantly higher levels of external shame, measured by Other As Shamer scale, than male caregivers, t (53) = 2.54, P < .01. A significant difference was also found between the female and male caregivers regarding their recorded levels of internal shame, measured by Experience of Shame Scale, with female caregivers experiencing more internal shame than their male counterparts, t (53) = 2.11, P < .01. However, no significant differences were found in hostility and aggression between males and females. These results demonstrate the existence of gender differences in the levels of shame experienced by care providers for patients with dementia.
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Affiliation(s)
| | | | | | - Mairy Gouva
- Department of Nursing, Higher Technological Educational Institution of Epirus, Epirus, Greece
| | - Magda Tsolaki
- Alzheimer Hellas, Thessaloniki, Greece
- 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Background An ageing global population will bring a significant increase in the prevalence of dementia, with the need for a collaborative international effort to combat this public health challenge being increasingly recognised. To be successful, this cooperation must be sensitive to the different cultural environments in which dementia is positioned, which shape the variety of clinical, political and social approaches to the condition worldwide. The aim of this project is to examine the social representations of dementia among people from three countries with different health care systems. More specifically, to investigate the internal structure of the social representations of dementia within the framework of the structural approach among British, American and Chinese lay-people. Methods A sample of 194 participants completed a free association task and a justification task in response to the stimulus word ‘dementia’. The data was subsequently analysed within the framework of the structural approach to social representations, using prototypical analysis. Results The American group’s unique elements were nearly exclusively concerned with physical and cognitive decline, and elements referring to care were focused on external support, namely nursing homes. In the Chinese group, there were several elements referring to behaviour, but a much greater emphasis on cognition than predicted by the literature. Elements concerning care were, as expected, focused on the family. In the British group, there was also a cognitive focus, but this was accompanied by elements which portrayed the experience of the condition from the perspective of those affected, and a reference to relative well-being in the context of care. Conclusions Social representation theory proved to be a viable method in gathering data on cross-cultural differences in how dementia is understood and approached. The current study demonstrated how the conceptualisation of the condition’s relationship with the cognitive, behavioural and affective dimensions might have an impact on the structure and form of care for those living with dementia in each culture.
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Affiliation(s)
- Clara Calia
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, UK
| | - Harry Johnson
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, UK
| | - Mioara Cristea
- Department of Psychology, School of Social Sciences, Heriot Watt University, Edinburgh, UK
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18
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Bartlett R, Milne R, Croucher R. Strategies to improve recruitment of people with dementia to research studies. DEMENTIA 2018; 18:2494-2504. [PMID: 29327604 DOI: 10.1177/1471301217748503] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Low participation in research is one of the key challenges to advancing understanding of dementia, and improving the care and treatment of those who live with this condition. Nurses and nurse researchers play a vital role in recruiting people with dementia to studies, as several countries including the United States and the United Kingdom set national targets and develop initiatives to encourage more people with dementia to take part in research. Aim To highlight the challenges to recruiting people with dementia to studies, and to identify strategies that nurses, and in particular, nurse researchers can use for overcoming them. Our focus is primarily on the role of nurses in recruiting people with dementia to dementia studies, but much of the discussion will apply to other health professionals involved in the recruitment of people with dementia to research more generally. Discussion Challenges discussed include a lack of awareness about research participation opportunities and a suitable study partner. We discuss how the nurses’ role is to ensure that recruitment practices are personalised and responsive to participants’ needs and situation, rather than target driven. The notion of responsible research is used to anchor the discussion. Conclusion Increasing the participation of people with dementia in research is a global priority. Nurses and nurse researchers play an important role in ensuring that people who take part in research have an optimal research experience. Implications for practice: Recruiting people with dementia to research studies is a national priority in many countries. With a greater understanding of the challenges involved and strategies that can be used to overcome them, nurses can have an effective role in the recruitment process and research experience.
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Willingness to Be a Brain Donor: A Survey of Research Volunteers From 4 Racial/Ethnic Groups. Alzheimer Dis Assoc Disord 2017; 31:135-140. [PMID: 27779492 DOI: 10.1097/wad.0000000000000174] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Racial and ethnic groups are under-represented among research subjects who assent to brain donation in Alzheimer disease research studies. There has been little research on this important topic. Although there are some studies that have investigated the barriers to brain donation among African American study volunteers, there is no known research on the factors that influence whether or not Asians or Latinos are willing to donate their brains for research. METHODS African American, Caucasian, Asian, and Latino research volunteers were surveyed at 15 Alzheimer Disease Centers to identify predictors of willingness to assent to brain donation. RESULTS Positive predictors included older age, Latino ethnicity, understanding of how the brain is used by researchers, and understanding of what participants need to do to ensure that their brain will be donated. Negative predictors included African/African American race, belief that the body should remain whole at burial, and concern that researchers might not be respectful of the body during autopsy. DISCUSSION The predictive factors identified in this study may be useful for researchers seeking to increase participation of diverse ethnic groups in brain donation.
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20
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Wang SC, Creswell JW, Nguyen D. Vietnamese Refugee Elderly Women and Their Experiences of Social Support: A Multiple Case Study. J Cross Cult Gerontol 2017; 32:479-496. [PMID: 29105016 DOI: 10.1007/s10823-017-9338-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study sought to address the gaps in the literature on Asian American gerontology with a multiply marginalized group in terms of gender, immigration status, and context. Guided by a multiple case study approach, we sought to explore how social support was experienced by four Vietnamese elderly refugee women residing in different living arrangements (i.e., alone, with spouse, with adult children, or in a multigenerational household). Within-case analyses were conducted to yield descriptive information about each individual. Additionally, three overarching themes emerged across each of the living arrangements: (1) Burden of care-taking, (2) Distinguishing family from nonfamily help, and (3) Ambivalence toward government-sponsored services. Our findings provide a contextualized understanding of social support to explain the inconsistencies that have been found in the literature on Asian American gerontology and family support. The benefits of living alone are described, along with the potential risks of coresidency.
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Affiliation(s)
- Sherry C Wang
- Department of Counseling Psychology, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95050-0201, USA.
| | - John W Creswell
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Dau Nguyen
- Vietnamese Community of Lincoln, Lincoln, NE, USA
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Narayan S, Jaiswal AS, Sharma R, Nawab A, Duckworth LV, Law BK, Zajac-Kaye M, George TJ, Sharma J, Sharma AK, Hromas RA. NSC30049 inhibits Chk1 pathway in 5-FU-resistant CRC bulk and stem cell populations. Oncotarget 2017; 8:57246-57264. [PMID: 28915668 PMCID: PMC5593639 DOI: 10.18632/oncotarget.19778] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/20/2017] [Indexed: 01/20/2023] Open
Abstract
The 5-fluorouracil (5-FU) treatment induces DNA damage and stalling of DNA replication forks. These stalled replication forks then collapse to form one sided double-strand breaks, leading to apoptosis. However, colorectal cancer (CRC) stem cells rapidly repair the stalled/collapsed replication forks and overcome treatment effects. Recent evidence suggests a critical role of checkpoint kinase 1 (Chk1) in preventing the replicative stress. Therefore, Chk1 kinase has been a target for developing mono or combination therapeutic agents. In the present study, we have identified a novel orphan molecule NSC30049 (NSC49L) that is effective alone, and in combination potentiates 5-FU-mediated growth inhibition of CRC heterogeneous bulk and FOLFOX-resistant cell lines in culture with minimal effect on normal colonic epithelial cells. It also inhibits the sphere forming activity of CRC stem cells, and decreases the expression levels of mRNAs of CRC stem cell marker genes. Results showed that NSC49L induces 5-FU-mediated S-phase cell cycle arrest due to increased load of DNA damage and increased γ-H2AX staining as a mechanism of cytotoxicity. The pharmacokinetic analysis showed a higher bioavailability of this compound, however, with a short plasma half-life. The drug is highly tolerated by animals with no pathological aberrations. Furthermore, NSC49L showed very potent activity in a HDTX model of CRC stem cell tumors either alone or in combination with 5-FU. Thus, NSC49L as a single agent or combined with 5-FU can be developed as a therapeutic agent by targeting the Chk1 pathway in 5-FU-resistant CRC heterogeneous bulk and CRC stem cell populations.
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Affiliation(s)
- Satya Narayan
- Department of Anatomy and Cell Biology, University of Florida, Gainesville, FL 32610, USA
| | - Aruna S. Jaiswal
- Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ritika Sharma
- Department of Anatomy and Cell Biology, University of Florida, Gainesville, FL 32610, USA
| | - Akbar Nawab
- Department of Anatomy and Cell Biology, University of Florida, Gainesville, FL 32610, USA
| | - Lizette Vila Duckworth
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Brian K. Law
- Department of Pharmacology and Experimental Therapeutics, University of Florida, Gainesville, FL 32610, USA
| | - Maria Zajac-Kaye
- Department of Anatomy and Cell Biology, University of Florida, Gainesville, FL 32610, USA
| | - Thomas J. George
- Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jay Sharma
- Celprogen, Inc., Torrance, CA 90503, USA
| | - Arun K. Sharma
- Department of Pharmacology, Penn State Cancer Institute, Penn State College of Medicine, Hershey, PA 17033, USA
| | - Robert A. Hromas
- Department of Medicine, University of Florida, Gainesville, FL 32610, USA
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22
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Boise L, Hinton L, Rosen HJ, Ruhl M. Will My Soul Go to Heaven If They Take My Brain? Beliefs and Worries About Brain Donation Among Four Ethnic Groups. THE GERONTOLOGIST 2017; 57:719-734. [PMID: 26935242 PMCID: PMC6197603 DOI: 10.1093/geront/gnv683] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 10/02/2015] [Indexed: 11/15/2022] Open
Abstract
Purpose of the Study Studying the brain through autopsy is an essential component of Alzheimer's disease research. Racial and ethnic minorities are underrepresented in Alzheimer's research generally and, in particular, in the number of completed brain autopsies. We explored beliefs about and attitudes toward brain donation among African American, Chinese, Caucasian, and Latino research subjects and their family members through focus groups at 4 NIH-funded Alzheimer's Disease Centers. Design and Methods Eighteen focus groups were conducted with 61 research subjects and 34 family members. Because the primary purpose of the focus groups was to identify the range of considerations that may influence the decision to participate in brain donation, data from focus groups were pooled and then analyzed. Results We found that many of the concerns, attitudes, and beliefs about brain donation were similar across the 4 ethnic groups. Concerns and attitudes fell into 3 categories: (a) concerns and misconceptions about brain research and the process of brain removal, (b) religious beliefs, and (c) the role of the family. Implications Our findings suggest that interventions to enhance enrollment in brain donation that target factors identified in this study are likely to be relevant to people from a broad range of backgrounds and ethnicities. Nonetheless, we observed some potential differences among racial/ethnic groups that may affect how research volunteers and their families approach a decision about donating their brain for research. Further study is warranted to explore these and other possible culturally distinct attitudes and beliefs about brain donation.
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Affiliation(s)
- Linda Boise
- Layton Aging & Alzheimer’s Disease Center, Oregon Health and Science University, Portland
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine
| | - Howard J. Rosen
- UCSF Memory and Aging Center, University of California, San Francisco
| | - Mary Ruhl
- Layton Aging & Alzheimer’s Disease Center, Oregon Health and Science University, Portland
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23
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Zhang H, Loi SM, Zhou S, Zhao M, Lv X, Wang J, Wang X, Lautenschlager N, Yu X, Wang H. Dementia Literacy among Community-Dwelling Older Adults in Urban China: A Cross-sectional Study. Front Public Health 2017. [PMID: 28638820 PMCID: PMC5461251 DOI: 10.3389/fpubh.2017.00124] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Delay in seeking diagnosis of dementia is common in China. Misinformation and poor knowledge about dementia may contribute to it. The study was designed to explore the nationwide dementia literacy among older adults in urban China and to investigate the factors associated with overall dementia literacy. Methods In a cross-sectional study, a convenience sample of 3,439 community-dwelling old adults aged 60 and over was recruited from 34 cities in 20 provinces between June 20 and August 20, 2014. All participants were administered the face-to-face mental health literacy questionnaire, which included the prevalence, symptoms, intention, and options for treatment of dementia. Stepwise multivariate regression analysis was used to explore factors associated with overall dementia literacy. Results The response rate was 87.4%. The overall dementia literacy was 55.5% (SD = 20.9%) among all respondents. The correct response rate was higher for questions on symptoms (58.7–89.6%), but lower for questions on the prevalence (22.2%) and choosing appropriate professional care personnel (22.2%). Being male [OR = 1.256, 95% CI (1.022–1.543)], having lower per capita annual income [OR = 1.314, 95% CI (1.064–1.623)], lower education [OR = 1.462, 95% CI (1.162–1.839)], and suspected depression [OR = 1.248, 95% CI (1.009–1.543)] were negatively associated with overall dementia literacy. Conclusion Dementia literacy among community-dwelling older adults in urban China remains very low, in particular about the impact of dementia and appropriate treatment personnel. Community educational programs aiming to close this knowledge gap are encouraged to focus on those in the population at highest risk of low dementia literacy.
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Affiliation(s)
- Haifeng Zhang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Samantha M Loi
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Aged Persons Mental Health Program, North Western Mental Health, Melbourne Health, Parkville, VIC, Australia
| | - Shu'aijun Zhou
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,Institute of Medical Education, Peking University Health Science Center, Beijing, China
| | - Mei Zhao
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiaozhen Lv
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jing Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xiao Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Nicola Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Aged Persons Mental Health Program, North Western Mental Health, Melbourne Health, Parkville, VIC, Australia
| | - Xin Yu
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Key Laboratory for Translational Research on Diagnosis and Treatment of Dementia, Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Abstract
In a Perspective, Alexandra Hillman and Joanna Latimer discuss cultural representations of dementia in the media, film, and literature.
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25
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Chang TE, Brill CD, Traeger L, Bedoya CA, Inamori A, Hagan PN, Flaherty K, Hails K, Yeung A, Trinh NH. Association of Race, Ethnicity and Language with Participation in Mental Health Research Among Adult Patients in Primary Care. J Immigr Minor Health 2017; 17:1660-9. [PMID: 25398517 DOI: 10.1007/s10903-014-0130-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Racial and ethnic minorities remain underrepresented in clinical psychiatric research, but the reasons are not fully understood and may vary widely between minority groups. We used the Z-test of independent proportions and binary logistic regression to examine the relationship between race, ethnicity or primary language and participation in screening as well as interest in further research participation among primary care patients being screened for a depression study. Minorities were less likely than non-Hispanic Whites to complete the initial screening survey. Latinos and Blacks were more likely to agree to be contacted for research than non-Hispanic Whites. Among Latinos, primary language was associated with willingness to be contacted for research. Associations between research participation and race, ethnicity and language are complex and vary across different enrollment steps. Future research should consider stages of the research enrollment process separately to better understand barriers and identify targets for intervention.
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Affiliation(s)
- Trina E Chang
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA.
| | - Charlotte D Brill
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
| | - Lara Traeger
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, MA, USA
| | - C Andres Bedoya
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, MA, USA
| | - Aya Inamori
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
| | - Patrick N Hagan
- Center for Community Health Improvement, Massachusetts General Hospital, Boston, MA, USA
| | | | - Katherine Hails
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
| | - Albert Yeung
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
| | - Nhi-Ha Trinh
- Depression Clinical and Research Program (DCRP), Massachusetts General Hospital, 1 Bowdoin Square, 6th Fl, Boston, MA, 02114, USA
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Nielsen TR, Waldemar G. Knowledge and perceptions of dementia and Alzheimer's disease in four ethnic groups in Copenhagen, Denmark. Int J Geriatr Psychiatry 2016; 31:222-30. [PMID: 26040575 DOI: 10.1002/gps.4314] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/04/2015] [Accepted: 05/08/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Older people from ethnic minorities are underrepresented in dementia care. Some of the determinants of access to care are knowledge and perceptions of dementia, which may vary between ethnic groups in the population. The aims of this study were to compare knowledge and perceptions of dementia and Alzheimer's disease (AD) among four ethnic groups in Copenhagen, Denmark, and to assess the influence of education and acculturation. METHODS Quantitative survey data from 260 participants were analyzed: 100 native Danish, and 47 Polish, 51 Turkish, and 62 Pakistani immigrants. Knowledge and perceptions of dementia and AD were assessed with the Dementia Knowledge Questionnaire (DKQ) supplemented with two questions from the Alzheimer's Disease Awareness Test (ADAT). Knowledge and perceptions of dementia and AD in the four groups were compared, and the influence of education and acculturation was assessed. RESULTS Group differences were found on the DKQ total score as well as all sub-domains. Turkish and Pakistani people were most likely to hold normalizing and stigmatizing views of AD. Level of education and acculturation had limited influence on dementia knowledge, accounting for 22% of the variance at most and had only minor influence on perceptions of AD. CONCLUSIONS Lacking knowledge and certain perceptions of dementia and AD may hamper access to services in some ethnic minority groups. Ongoing efforts to raise awareness that dementia and AD are not part of normal aging, particularly among Turkish and Pakistani communities, should be a high priority for educational outreach.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Commodore-Mensah Y, Himmelfarb CD, Agyemang C, Sumner AE. Cardiometabolic Health in African Immigrants to the United States: A Call to Re-examine Research on African-descent populations. Ethn Dis 2015; 25:373-80. [PMID: 26675140 DOI: 10.18865/ed.25.3.373] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In the 20th century, Africans in Sub-Saharan Africa had lower rates of cardiometabolic disease than Africans who migrated. However, in the 21st century, beyond infectious diseases, the triple epidemics of obesity, diabetes and hypertension have taken hold in Africa. Therefore, Africans are acquiring these chronic diseases at different rates and different intensity prior to migration. To ensure optimal care and health outcomes, the United States practice of grouping all African-descent populations into the "Black/African American" category without regard to country of origin masks socioeconomic and cultural differences and needs re-evaluation. Overall, research on African-descent populations would benefit from a shift from a racial to an ethnic perspective. To demonstrate the value of disaggregating data on African-descent populations, the epidemiologic transition, social, economic, and health characteristics of African immigrants are presented.
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Affiliation(s)
| | | | - Charles Agyemang
- 2. Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne E Sumner
- 3. Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, Maryland
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Carmody J, Traynor V, Marchetti E. Barriers to qualitative dementia research: the elephant in the room. QUALITATIVE HEALTH RESEARCH 2015; 25:1013-1019. [PMID: 25296651 DOI: 10.1177/1049732314554099] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
As our population is aging, the global prevalence of dementia is rising. Recent extensive reviews of the dementia literature highlight a clear need for additional qualitative research to address the experiences of people with dementia and their carers. To date, the vast majority of published dementia research is quantitative in nature and, perhaps not surprisingly, attracts the bulk of government funding. In contrast, qualitative dementia research is poorly resourced and less frequently published. Although a myriad of factors are responsible for this dichotomy, we propose that inadequate funding represents the "elephant in the room" of dementia research. In this article, we describe and emphasize the need for qualitative dementia research, highlight existing barriers, and outline potential solutions. Examples of barriers are provided and theoretical underpinnings are proposed.
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Affiliation(s)
- John Carmody
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Victoria Traynor
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Elena Marchetti
- University of Wollongong, Wollongong, New South Wales, Australia
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Dai B, Mao Z, Wu B, Mei YJ, Levkoff S, Wang H. Family Caregiver's Perception of Alzheimer's disease and caregiving in Chinese culture. SOCIAL WORK IN PUBLIC HEALTH 2015; 30:185-196. [PMID: 25602761 DOI: 10.1080/19371918.2014.969858] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined the perception of Alzheimer's disease (AD) and caregiving among family caregivers of individuals with mild cognitive impairment (MCI) and AD in China. In-depth semistructured interviews were conducted with 46 family caregivers of individuals with cognitive impairment in 2009 in Wuhan and Beijing, China. Participants included 38 spouses, 7 adult children, and 1 sibling, aged between 41 and 85 years old. The findings showed that all family caregivers thought the Chinese terminology of AD laonian chidai, brought discrimination to individuals with cognitive impairment. Caregivers of individuals with AD experienced burden and desired an increase of formal services. Traditional beliefs of respecting elders and caring for extended family members were held among family caregivers of individuals with cognitive impairment, and there was nearly no difference found between caregivers of AD and those of MCI. It implied that traditional culture provided positive influences on caring for elders with cognitive impairment. An alternative term for MCI may contribute to further reducing the discrimination brought by the old Chinese terminology of AD laonian chidai. Development of formal services for elders with cognitive impairment may contribute to reducing caregivers' worries about future caregiving.
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Affiliation(s)
- Baozhen Dai
- a School of Management, Jiangsu University , Zhenjiang , China
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Lee SE, Casado BL. Assessment of Alzheimer's disease symptom recognition in Korean Americans and psychometric analysis of Alzheimer's Disease Symptom Recognition Scale (ADSRS). JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2015; 58:289-305. [PMID: 25602359 DOI: 10.1080/01634372.2015.1005785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 01/06/2015] [Indexed: 06/04/2023]
Abstract
This study examined recognition of Alzheimer's disease symptoms among Korean Americans (KAs) and assessed psychometric properties of the Alzheimer's Disease Symptom Recognition Scale (ADSRS). A cross-sectional survey collected data from 209 KAs, using a self-administered questionnaire. Results show that KAs recognized symptoms related to memory and cognitive functioning well, but had very limited recognition of neuropsychiatric symptoms. Psychometric analysis of ADSRS identified 4 factors in their symptom recognition. Findings suggest a need to raise awareness of Alzheimer's symptoms over the course of the disease. Assessment using ADSRS can be incorporated in communication in the practice context and public outreach.
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Affiliation(s)
- Sang E Lee
- a School of Social Work , San Jose State University , San Jose , California , USA
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Chao SZ, Matthews BR, Yokoyama JS, Betty Lai N, Ong H, Tse M, Yuan RF, Lin A, Kramer J, Yaffe K, Miller BL, Rosen HJ, Rosen HJ. Depressive symptoms in Chinese-American subjects with cognitive impairment. Am J Geriatr Psychiatry 2014; 22:642-52. [PMID: 24021225 PMCID: PMC4309267 DOI: 10.1016/j.jagp.2012.10.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 08/22/2012] [Accepted: 10/12/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare the prevalence of depressive symptoms and frequency of antidepressant use between a group of elderly Chinese-American subjects with and without cognitive impairment and a group of matched white subjects. A secondary aim was to examine the clinical and demographic predictors of depressive symptoms across these groups. METHODS The study was conducted at an academic neurology subspecialty clinic. This was a case-control study with 140 Chinese-American subjects and 140 demographically and cognitively matched white subjects. In each group, there were 48 cognitively normal and 92 cognitively impaired participants (49 with mild cognitive impairment, 43 with Alzheimer disease). The proportion of individuals with significant depressive symptoms, as indicated by a Geriatric Depression Scale score ≥6 of 15, and frequency of antidepressant use were compared across groups by using χ(2) analysis. Factors predicting depressive symptoms, including racial and diagnostic group, age, gender, Mini-Mental State Examination score, level of functional impairment, education level, and medical comorbidities, were assessed by using linear regression analysis. RESULTS Significant depressive symptoms were more common in cognitively impaired Chinese-American (35%) than cognitively impaired white (15%; χ(2)[1] = 9.4; p = 0.004) subjects. Chinese-American subjects with cognitive impairment were less likely to be receiving treatment for depression (12%) than white subjects with cognitive impairment (37%; χ(2)[1] = 15.6; p = 0.002). Racial and diagnostic group, age, level of functional impairment, Mini-Mental State Examination score, and education level were all statistically significant independent predictors of Geriatric Depression Scale score. CONCLUSIONS Elderly Chinese-American subjects with cognitive impairment are at increased risk for unrecognized and untreated depressive symptoms compared with elderly white subjects with cognitive impairment. Education level may contribute to this risk or it may be a surrogate marker for other factors contributing to depressive symptoms in this group.
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Affiliation(s)
- Steven Z. Chao
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California,Department of Neurology, VA Palo Alto Health Care System, Palo Alto, California
| | - Brandy R. Matthews
- Department of Neurology, Indiana University School of Medicine, Indiana Alzheimer Disease Center, Indianapolis, IN
| | - Jennifer S. Yokoyama
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Ngan Betty Lai
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Hilary Ong
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Marian Tse
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Runfen Frances Yuan
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Amy Lin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Joel Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco and Memory Disorders Clinic, San Francisco VA Medical Center
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA.
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Abstract
ABSTRACTThis article is about dementia disease in the context of transnational migration. Focusing on the example of Pakistani immigrants in Norway, the article explores response processes surrounding signs and symptoms of dementia. Particular attention is lent to understanding how Norwegian-Pakistani families ‘negotiate dementia’ in the space between their own imported, culturally defined system of cure and care, and the Norwegian health-care culture, which is characterised by an inclination towards public care and biomedical intervention. Based on field observations and in-depth interviews with Norwegian-Pakistani families and hospital professionals working with dementia, we show that the centrality of the traditional family in Norwegian-Pakistanis' identity claims has significant implications for how Norwegian-Pakistanis relate to the Norwegian health-care culture, and for how signs and symptoms of cognitive decline are read and responded to in a migratory context.
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Kally Z, Cherry DL, Howland S, Villarruel M. Asian Pacific Islander dementia care network: a model of care for underserved communities. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:710-727. [PMID: 24820019 DOI: 10.1080/01634372.2013.854856] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study presents the results of the work of the Asian Pacific Islander Dementia Care Network (APIDCN)--a collaborative model of care created to develop community capacity to deliver dementia capable services, build community awareness about Alzheimer's disease and other dementias, and offer direct services to caregivers in the API community in Los Angeles. Through trainings, mentoring, and outreach campaigns, the APIDCN expanded the availability of culturally competent services in the API community. The knowledge that was embedded within partner organizations and in the community at large assures sustainability of the services after the project ended.
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Affiliation(s)
- Zina Kally
- a Institute for Change, Partners in Care Foundation , San Fernando , California , USA
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Prorok JC, Horgan S, Seitz DP. Health care experiences of people with dementia and their caregivers: a meta-ethnographic analysis of qualitative studies. CMAJ 2013; 185:E669-80. [PMID: 24003093 PMCID: PMC3787191 DOI: 10.1503/cmaj.121795] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Understanding the health care experience of people with dementia and their caregivers is becoming increasingly important given the growing number of affected individuals. We conducted a systematic review of qualitative studies that examined aspects of the health care experience of people with dementia and their caregivers to better understand ways to improve care for this population. METHODS We searched the electronic databases MEDLINE, Embase, PsychINFO and CINAHL to identify relevant articles. We extracted key study characteristics and methods from the included studies. We also extracted direct quotes from the primary studies, along with the interpretations provided by authors of the studies. We used meta-ethnography to synthesize the extracted information into an overall framework. We evaluated the quality of the primary studies using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS In total, 46 studies met our inclusion criteria; these involved 1866 people with dementia and their caregivers. We identified 5 major themes: seeking a diagnosis; accessing supports and services; addressing information needs; disease management; and communication and attitudes of health care providers. We conceptualized the health care experience as progressing through phases of seeking understanding and information, identifying the problem, role transitions following diagnosis and living with change. INTERPRETATION The health care experience of people with dementia and their caregivers is a complex and dynamic process, which could be improved for many people. Understanding these experiences provides insight into potential gaps in existing health services. Modifying existing services or implementing new models of care to address these gaps may lead to improved outcomes for people with dementia and their caregivers.
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Affiliation(s)
- Jeanette C. Prorok
- Department of Psychiatry (Prorok, Seitz), Queen’s University; Providence Care, Mental Health Services (Prorok, Horgan, Seitz), Kingston, Ont
| | - Salinda Horgan
- Department of Psychiatry (Prorok, Seitz), Queen’s University; Providence Care, Mental Health Services (Prorok, Horgan, Seitz), Kingston, Ont
| | - Dallas P. Seitz
- Department of Psychiatry (Prorok, Seitz), Queen’s University; Providence Care, Mental Health Services (Prorok, Horgan, Seitz), Kingston, Ont
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Chang WZD, Bourgeois M. Effects of Memory Aids on the Conversations of Elderly Chinese Persons. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/136132812804731767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Shanley C, Leone D, Santalucia Y, Adams J, Ferrerosa-Rojas JE, Kourouche F, Gava S, Wu Y. Qualitative research on dementia in ethnically diverse communities: fieldwork challenges and opportunities. Am J Alzheimers Dis Other Demen 2013; 28:278-83. [PMID: 23512998 PMCID: PMC10852705 DOI: 10.1177/1533317513481099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Australia, like other ethnically diverse societies, needs to provide culturally appropriate health care to all its citizens. One way of facilitating this is to ensure that health services research adequately reflects the circumstances and needs of culturally and linguistically diverse (CALD) communities within the population. This article discusses the fieldwork phase of a qualitative research project on dementia caregiving in 4 CALD communities in south west Sydney, Australia. Rather than focusing on the study results-which have been published elsewhere-this article presents and discusses crucial fieldwork issues that arose in the conduct of the project, particularly regarding participant recruitment and facilitation of focus groups. In being transparent about some of the difficulties encountered and how these were managed, we offer suggestions for other researchers wanting to include CALD communities in a meaningful way in their research projects.
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Affiliation(s)
- Chris Shanley
- Aged Care Research Unit, Liverpool Hospital, University of New South Wales, Sydney, Australia.
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Abstract
BACKGROUND Many minority ethnic (ME) older adults face several culturally associated and systemic barriers to timely dementia diagnoses that may result in delays to dementia care-seeking. We aimed to develop and propose a model illustrating variables that influence dementia care-seeking among ME older adults. METHODS We conducted a literature review on the effects of these barriers on diagnostic delays and impairment levels at initial evaluation. We also strived to provide a basis for the Sociocultural Health Belief Model (SHBM) to guide future research and service planning pertaining to culture and dementia care-seeking. RESULTS There was consistent evidence that ME older adults with dementia tended to have greater diagnostic delays and higher levels of cognitive impairment and behavioral and psychological symptoms of dementia at initial evaluation than their non-Hispanic White counterparts. We also found several barriers to dementia care-seeking among ME groups. These barriers included lower levels of acculturation and accurate knowledge about dementia, more culturally associated beliefs about dementia, such as the perception of memory loss as normal aging and stigma associated with dementia, and health system barriers. CONCLUSIONS The SHBM provides an empirically based conceptual framework for examining cross-cultural differences in dementia care-seeking among diverse groups. We provide recommendations for future research, such as the need for research with more diverse ethnic subgroups and the examination of group-specific cultural values. We conclude with a discussion of the clinical and service implications of our review, including potential interventions aimed at facilitating timely dementia diagnoses among ME older adults.
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Dai B, Mao Z, Mei J, Levkoff S, Wang H, Pacheco M, Wu B. Caregivers in China: knowledge of mild cognitive impairment. PLoS One 2013; 8:e53928. [PMID: 23326541 PMCID: PMC3543358 DOI: 10.1371/journal.pone.0053928] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 12/07/2012] [Indexed: 11/19/2022] Open
Abstract
This study aimed to examine the experience and knowledge of mild cognitive impairment (MCI) among Chinese family caregivers of individuals with MCI. The sample was recruited from memory clinics in Zhongnan Hospital in Wuhan, China. In-depth semi-structured interviews were used. Thirteen family members of individuals diagnosed with MCI participated in the study. Data analysis revealed three themes: 1) initial recognition of cognitive decline; 2) experience of the diagnosis of MCI; 3) perception of cognitive decline as a normal part of aging. While family members recognized the serious consequences of memory loss (e.g. getting lost), they would typically not take their family members to see a doctor until something specific triggered their access to the medical care system. The Chinese traditional perception of dementia as part of normal aging may serve to lessen the stigma of individuals with MCI, while the term "laonian chidai" which literally translates to "stupid, demented elderly" may exacerbate the stigma associated with individuals with MCI. It is suggested that family members' worries may be relieved by improving their access to accurate knowledge of the disease, community-based and institutional care services, and culturally appropriately words are needed for MCI.
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Affiliation(s)
- Baozhen Dai
- School of Management, Jiangsu University, Zhenjiang, People’s Republic of China
- Research Institute for New Rural Development of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Zongfu Mao
- School of Public Health, Wuhan University, Wuhan, People’s Republic of China
| | - John Mei
- Department of Anthropology, William James Hall, Harvard University, Cambridge, Massachusetts, United States of America
| | - Sue Levkoff
- College of Social Work, University of South Carolina, DeSaussure College, Columbia, South Carolina, United States of America
| | - Huali Wang
- Dementia Care & Research Center, Peking University Institute of Mental Health, Beijing, People’s Republic of China
| | - Misty Pacheco
- University of Hawaii at Manoa, Honolulu, Hawai‘i, United States of America
| | - Bei Wu
- School of Nursing and Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Knapskog AB, Portugal MDG, Barca ML, Coutinho ESF, Laks J, Engedal K. A cross-cultural comparison of the phenotype of depression as measured by the Cornell Scale and the MADRS in two elderly outpatient populations. J Affect Disord 2013; 144:34-41. [PMID: 22858259 DOI: 10.1016/j.jad.2012.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 06/01/2012] [Accepted: 06/02/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Different cutoff points for a depressive disorder on depression scales exist in different countries. The reasons could be that the presence or the intensity of the various symptoms on the scales differ. We wanted to explore differences in scores on depression scales among patients in Brazil and Norway. METHODS The Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) were completed independently among 211 elderly outpatients in Brazil and Norway. A psychiatrist, blind to the results, diagnosed depression using the ICD-10 and DSM-IV criteria. RESULTS According to the ICD-10 criteria, 29 (33.7%) Brazilian and 51 (40.8%) Norwegian patients had depression (p=0.3). Mean CSDD score was 14.4 (SD 8.9) in Brazil and 6.8 (SD 4.9) in Norway (p<0.001). Mean MADRS score was 13.2 (SD 12.1) in Brazil and 8.4 (SD 6.8) in Norway (p=0.02). We analyzed the scores for the depressed and the non-depressed patients separately. In both groups the Brazilian patients had significantly higher scores on both scales compared to the Norwegian patients. In an adjusted linear regression analysis the variable "country" was associated with the CSDD score (beta=-0.29, p=0.01). LIMITATIONS The protocols in the two countries were not exactly the same. Only one psychiatrist evaluated the patients. CONCLUSIONS The scores on the MADRS and the CSDD were higher in patients in Brazil than in Norway. In an adjusted linear regression analysis, "country" was the only variable associated with the higher CSDD score.
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Affiliation(s)
- Anne-Brita Knapskog
- Department of Geriatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, P.B. 4950, Nydalen, 0424 Oslo, Norway.
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Chao SZ, Rosen HJ, Azor V, Ong H, Tse MM, Lai NB, Hou CE, Seeley WW, Miller BL, Matthews BR. Frontotemporal dementia in eight Chinese individuals. Neurocase 2013; 19:76-84. [PMID: 23311888 PMCID: PMC3545415 DOI: 10.1080/13554794.2011.654218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Frontotemporal dementia (FTD) has rarely been reported in Chinese populations. There are many potential reasons for this, including possible hesitancy on the part of patients or families to bring FTD-related symptoms to medical attention. Here, we present data on eight Chinese individuals, all of whom met criteria for the behavioral variant of FTD or the semantic variant of primary progressive aphasia. These patients presented for neurological evaluation at a relatively advanced stage. The mean MMSE score at initial presentation was 15. Behavioral symptoms were common and usually elicited during the medical history only after direct questioning. Delay in presentation was attributed to a variety of issues, including family disagreements about whether the symptoms represented a disease and lack of medical insurance. These cases illustrate that the symptoms of FTD in Chinese-Americans are similar to those in Caucasians but various factors, some potentially culturally relevant, may influence the likelihood and timing of clinical presentation for FTD, as well as other dementias. Additional study of FTD in diverse ethnic groups needs to address barriers to clinical presentation, including factors that may be culturally specific.
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Affiliation(s)
- Steven Z Chao
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
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Sun F, Ong R, Burnette D. The influence of ethnicity and culture on dementia caregiving: a review of empirical studies on Chinese Americans. Am J Alzheimers Dis Other Demen 2012; 27:13-22. [PMID: 22467411 PMCID: PMC10697324 DOI: 10.1177/1533317512438224] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The purpose of this article is to pinpoint the cultural and ethnic influences on dementia caregiving in Chinese American families through a systemic review and analysis of published research findings. Eighteen publications on Chinese American dementia family caregivers published in peer-reviewed journals between 1990 and early 2011 were identified. Based on a systematic database search and review process, we found that caregivers' beliefs concerning dementia and the concept of family harmony as evidenced through the practice of filial piety are permeating cultural values, which together affect attitudes toward research and help-seeking behaviors (ie, seeking information on diagnosis and using formal services). There is also evidence to suggest that these cultural beliefs impinge on key elements of the caregiving process, including caregivers' appraisal of stress, coping strategies, and informal and formal support. The study concludes with recommendations for future research and practice with the Chinese American population.
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Affiliation(s)
- Fei Sun
- School of Social Work, Arizona State University, Phoenix, AZ 85004, USA.
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42
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How do older people describe others with cognitive impairment? A multiethnic study in the United States. AGEING & SOCIETY 2012. [DOI: 10.1017/s0144686x11001255] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTWe studied how older people describe others with cognitive impairment. Forty-two focus groups represented African Americans, American Indians, Chinese Americans, Latinos, Vietnamese Americans, and Whites other than Latinos (Whites) (N = 396, ages 50+), in nine locations in the United States of America. Axial coding connected categories and identified themes. The constant comparison method compared themes across ethnic groups. African Americans, American Indians and Whites emphasised memory loss. African Americans, American Indians, Latinos and Whites stressed withdrawal, isolation and repetitive speech. African Americans, American Indians, Vietnamese Americans and Whites emphasised ‘slow thinking’. Only Whites described mood swings and personality changes. Many participants attributed dementia to stress. Terms describing others with dementia included ‘Alzheimer's’, ‘dementia’, ‘senile’ and ‘crazy’. Euphemisms were common (‘senior moment’, ‘old timer's disease’). Responses focused on memory, with limited mention of other cognitive functions. Differences among ethnic groups in descriptions of cognitive health and cognitive impairment underscore the need to tailor public health messages about cognitive health to ways that people construe its loss, and to their interest in maintaining it, so that messages and terms used are familiar, understandable and relevant to the groups for which they are designed. Health promotion efforts should develop ethnically sensitive ways to address the widely held misperception that even serious cognitive impairment is a normal characteristic of ageing and also to address stigma associated with cognitive impairment.
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Chao SZ, Lai NB, Tse MM, Ho RJ, Kong JP, Matthews BR, Miller BL, Rosen HJ. Recruitment of Chinese American elders into dementia research: the UCSF ADRC experience. THE GERONTOLOGIST 2011; 51 Suppl 1:S125-33. [PMID: 21565814 DOI: 10.1093/geront/gnr033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To describe the results of efforts to recruit Asian Americans into longitudinal research on cognitive decline in aging. DESIGN AND METHODS Recruitment strategies include clinics for assessment of cognitive impairment at the University of California, San Francisco campus and San Francisco's Chinatown, lectures to local health care providers and community members, participation in community events, and publications in mass media. RESULTS Over 200 Chinese patients were evaluated in our outreach clinic. Many were primarily Chinese speaking with low levels of education. One hundred and twenty-five participants enrolled, and annual follow-up has been 88%. Among enrollees, 36% were recruited from our clinical service; 30% via word of mouth; and the rest from community lectures and events, flyers, and mass media. Participants who enrolled were relatively highly educated, tended to be interested in learning about their cognitive abilities, and were supportive of the goals of research. IMPLICATIONS Despite the significant cultural and linguistic barriers, Chinese Americans can be successfully recruited into longitudinal studies of aging and cognitive impairment. Clinical services are a critical component of such an effort, and low education and other factors that may be associated with it are clear barriers to research participation.
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Affiliation(s)
- Steven Z Chao
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, 350 Parnassus Avenue, Box 1207, Suite 905, San Francisco, CA 94143, USA
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Woodall A, Howard L, Morgan C. Barriers to participation in mental health research: findings from the Genetics and Psychosis (GAP) Study. Int Rev Psychiatry 2011; 23:31-40. [PMID: 21338296 DOI: 10.3109/09540261.2010.546777] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to investigate why people with a first episode of psychosis choose or decline to participate in mental health research, using a qualitative study design. Participants were recruited via referrals from the Genetics and Psychosis (GAP) study. A total of 26 individuals with a first-episode of psychosis (nine of whom declined participation in the GAP study and 17 who participated) were individually interviewed and asked about their attitudes towards mental health research participation. Thematic analysis of interview transcripts was used to determine dominant themes and sub-themes on what constituted barriers and facilitators to participation. Reasons for research participation identified included a desire to help others, curiosity, and positive experiences with clinicians. Decisions to participate or not were also influenced by practical issues, including the timing of the approach, researchers' communication skills and whether individuals had concerns that it may be potentially harmful to their health. Other barriers to participation included patients' conceptualizations of mental health problems and the influence of other inpatients. Information on barriers and facilitators to recruitment in mental health research could inform recruitment strategies, thereby maximizing recruitment rates and minimizing the risk of selection biases.
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Affiliation(s)
- Anna Woodall
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK.
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Lanting S, Crossley M, Morgan D, Cammer A. Aboriginal Experiences of Aging and Dementia in a Context of Sociocultural Change: Qualitative Analysis of Key Informant Group Interviews with Aboriginal Seniors. J Cross Cult Gerontol 2011; 26:103-17. [DOI: 10.1007/s10823-010-9136-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Older adults' concerns about cognitive health: commonalities and differences among six United States ethnic groups. AGEING & SOCIETY 2011. [DOI: 10.1017/s0144686x10001273] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABSTRACTWe studied concerns about cognitive health among ethnically diverse groups of older adults. The study was grounded in theories of health behaviour and the representation of health and illness. We conducted 42 focus groups (N=396, ages 50+) in four languages, with African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos (hereafter, Whites) and Vietnamese Americans, in nine United States locations. Participants discussed concerns about keeping their memory or ability to think as they age. Audio recordings were transcribed verbatim. Constant comparison methods identified themes. In findings, all ethnic groups expressed concern and fear about memory loss, losing independence, and becoming ‘a burden’. Knowing someone with Alzheimer's disease increased concern. American Indians, Chinese Americans, Latinos and Vietnamese Americans expected memory loss. American Indians, Chinese Americans and Vietnamese Americans were concerned about stigma associated with Alzheimer's disease. Only African Americans, Chinese and Whites expressed concern about genetic risks. Only African Americans and Whites expressed concern about behaviour changes. Although we asked participants for their thoughts about their ability to think as they age, they focused almost exclusively on memory. This suggests that health education promoting cognitive health should focus on memory, but should also educate the public about the importance of maintaining all aspects of cognitive health.
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Rooney LK, Bhopal R, Halani L, Levy ML, Partridge MR, Netuveli G, Car J, Griffiths C, Atkinson J, Lindsay G, Sheikh A. Promoting recruitment of minority ethnic groups into research: qualitative study exploring the views of South Asian people with asthma. J Public Health (Oxf) 2011; 33:604-15. [PMID: 21228023 DOI: 10.1093/pubmed/fdq100] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We sought to understand the barriers and facilitators to participation in research from the perspectives of South Asian people with asthma. METHODS Eight focus groups were conducted in the preferred language of participants. Sampling was purposeful to ensure inclusion of males and females from differing ethnic, linguistic and religious backgrounds. RESULTS The forming of trusting relationships was described as pivotal to the successful recruitment of minority ethnic groups into research; personalized approaches were likely to be better received than more impersonal written approaches. Notable barriers to participation included: the stigma of being labelled with asthma; concerns surrounding participation in pharmaceutical trials; major time or travel commitments and a failure to show respect by not making information available in minority ethnic languages. Flexibility, in terms of timing, location and respecting of cultural and religious sensitivities around gender segregation, together with the offer of incentives, were highlighted as key factors to promote participation. CONCLUSIONS The barriers to recruitment are largely surmountable, but these will necessitate the use of resource intensive and more personalized approaches than are commonly employed for the White European origin population. Our proposed model to enhance recruitment is likely to have transferability beyond the field of asthma.
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Affiliation(s)
- Laura K Rooney
- Department of Health, Nursing and Midwifery, University of the West of Scotland, Paisley PA1 2BE, UK
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Dong X, Chang ES, Wong E, Wong B, Skarupski KA, Simon MA. Assessing the Health Needs of Chinese Older Adults: Findings from a Community-Based Participatory Research Study in Chicago's Chinatown. J Aging Res 2011; 2010:124246. [PMID: 21253522 PMCID: PMC3022171 DOI: 10.4061/2010/124246] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 10/24/2010] [Accepted: 12/01/2010] [Indexed: 11/20/2022] Open
Abstract
The objective of this study is to examine the cultural views of healthy aging, knowledge and barriers to services, and perception of health sciences research among community-dwelling Chinese older adults in Chicago's Chinatown. This qualitative study is guided by the Precede-Proceed conceptual model with community-based participatory research design. Data analysis is based on eight focus group interviews with Chinese older (age 60+) adults (n = 78). We used a grounded theory framework to systematically guide the thematic structure of our data. Findings show participants described cultural conception of health in terms of physical function, psychological well-being, social support, and cognitive function. The availability, affordability, and cultural barriers towards health care services were major negative enabling factors that inhibit participants from fulfilling health needs. Perception and knowledge of health sciences research were also discussed. This study has implications for the delivery of culturally appropriate health care services to the Chinese aging population.
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Affiliation(s)
- Xinqi Dong
- Department of Internal Medicine, Rush University Medical Center, 1645 West Jackson Boulevard, Suite 675, Chicago, IL 60612, USA
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Rugkåsa J, Canvin K. Researching mental health in minority ethnic communities: reflections on recruitment. QUALITATIVE HEALTH RESEARCH 2011; 21:132-43. [PMID: 20682968 DOI: 10.1177/1049732310379115] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In this article we reflect on the recruitment of research participants to two related studies of experiences of mental health problems in Black and minority ethnic communities in the United Kingdom. A total of 65 people were recruited via three main strategies: the employment of bicultural recruiters, intensive information sharing about the studies, and work through local community groups. Three main issues seemed to affect recruitment: gatekeepers' attitudes, the (non)payment of participants, and reciprocal arrangements with local community groups. The type of strategy employed resulted in recruits with differing characteristics (although our sample was too small to draw generalizable conclusions). We conclude that to ensure that research participation is accessible to all, researchers must employ flexible recruitment methods that permit adaptation to specific needs arising out of health status, level of involvement with services, culture, and socioeconomic status. Systematic research into this part of the research process is needed.
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Woodall A, Morgan C, Sloan C, Howard L. Barriers to participation in mental health research: are there specific gender, ethnicity and age related barriers? BMC Psychiatry 2010; 10:103. [PMID: 21126334 PMCID: PMC3016310 DOI: 10.1186/1471-244x-10-103] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 12/02/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is well established that the incidence, prevalence and presentation of mental disorders differ by gender, ethnicity and age, and there is evidence that there is also differential representation in mental health research by these characteristics. The aim of this paper is to a) review the current literature on the nature of barriers to participation in mental health research, with particular reference to gender, age and ethnicity; b) review the evidence on the effectiveness of strategies used to overcome these barriers. METHOD Studies published up to December 2008 were identified using MEDLINE, PsycINFO and EMBASE using relevant mesh headings and keywords. RESULTS Forty-nine papers were identified. There was evidence of a wide range of barriers including transportation difficulties, distrust and suspicion of researchers, and the stigma attached to mental illness. Strategies to overcome these barriers included the use of bilingual staff, assistance with travel, avoiding the use of stigmatising language in marketing material and a focus on education about the disorder under investigation. There were very few evaluations of such strategies, but there was evidence that ethnically matching recruiters to potential participants did not improve recruitment rates. Educational strategies were helpful and increased recruitment. CONCLUSION Mental health researchers should consider including caregivers in recruitment procedures where possible, provide clear descriptions of study aims and describe the representativeness of their sample when reporting study results. Studies that systematically investigate strategies to overcome barriers to recruitment are needed.
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Affiliation(s)
- Anna Woodall
- Section of Women's Mental Health Health Services and Population Research Department, PO31 Institute of Psychiatry, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Craig Morgan
- Section of Social Psychiatry Health Service and Population Research Department, PO33 Institute of Psychiatry, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Claire Sloan
- Section of Women's Mental Health Health Services and Population Research Department, PO31 Institute of Psychiatry, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Louise Howard
- Section of Women's Mental Health Health Services and Population Research Department, PO31 Institute of Psychiatry, King's College London, De Crespigny Park, SE5 8AF, London, UK
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