Health beliefs: a cultural division?

The Concepts of Health and Preventive Health Practices of Chinese Australian Women in Relation to Cancer Screening

Despite an emphasis on mammographic screening in Australia, Chinese Australian women have low participation rates. This qualitative study investigated how concepts of health and health promotion influence Chinese Australian women's decisions to participate in cancer screening, which is an important issue for nurses who work with multicultural populations. In-depth interviews were conducted with 20 Chinese Australian women. Using thematic data analysis, the findings showed that health and illness are taken-for-granted experiences of everyday life. When they were asymptomatic, most informants saw no reason to suspect that they may have diseases. Consistent with these health beliefs, the women focused on preserving and promoting health and overall well-being in everyday life rather than attempting to detect hidden disease by screening. These ideas and practices influenced behavior in relation to cancer diagnosis and in particular toward mammography.

The relationship between audience mentality and attitudes towards healthy lifestyle promotion in the mass media

Health promoters who use the mass media to encourage people to change their health behaviours usually underestimate the importance of audience's mental predispositions, which may determine their susceptibility to such influences. This paper presents research findings that show how some elements of an audience's mentality are related to their attitudes towards healthy lifestyle promotion in the mass media (HLPMM). The research project, undertaken between 2007 and 2009, comprised: a qualitative study using in-depth interviews (N=30); a self-administered survey on a purposive sample (N=237) and a computer-assisted personal interview or interviewing (CAPI) survey on a representative sample of Polish adult population (N=934). The findings from the first two studies were used to construct a scale to investigate the attitude towards HLPMM. This scale was applied in a nation wide survey and, as a result, four dimensions of the attitude were identified: (1) appraisal of the idea of HLPMM; (2) appraisal of HLPMM practice; (3) propensity to receive media messages promoting healthy lifestyle and (4) propensity to avoid such messages. Moreover, the survey results confirmed the hypotheses whereby a higher degree of individualism, a higher degree of authoritarianism, a weaker demanding orientation and generalised trust are related to a more positive attitude towards HLPMM. The aforementioned relationships indicate that producers of media messages promoting a healthy lifestyle need to take account of their audience's mentality, since knowledge of mental predispositions of the target audience may help them make the message more suitable for specific recipients.

Using intervention mapping to develop a culturally appropriate intervention to prevent childhood obesity: the HAPPY (Healthy and Active Parenting Programme for Early Years) study

Introduction

Interventions that make extensive use of theory tend to have larger effects on behaviour. The Intervention Mapping (IM) framework incorporates theory into intervention design, implementation and evaluation, and was applied to the development of a community-based childhood obesity prevention intervention for a multi-ethnic population.

Methods

IM was applied as follows: 1) Needs assessment of the community and culture; consideration of evidence-base, policy and practice; 2) Identification of desired outcomes and change objectives following identification of barriers to behaviour change mapped alongside psychological determinants (e.g. knowledge, self-efficacy, intention); 3) Selection of theory-based methods and practical applications to address barriers to behaviour change (e.g., strategies for responsive feeding); 4) Design of the intervention by developing evidence-based interactive activities and resources (e.g., visual aids to show babies stomach size). The activities were integrated into an existing parenting programme; 5) Adoption and implementation: parenting practitioners were trained by healthcare professionals to deliver the programme within Children Centres.

Results

HAPPY (Healthy and Active Parenting Programme for Early Years) is aimed at overweight and obese pregnant women (BMI > 25); consists of 12 × 2.5 hr. sessions (6 ante-natal from 24 weeks; 6 postnatal up to 9 months); it addresses mother’s diet and physical activity, breast or bottle feeding, infant diet and parental feeding practices, and infant physical activity.

Conclusion

We have demonstrated that IM is a feasible and helpful method for providing an evidence based and theoretical structure to a complex health behaviour change intervention. The next stage will be to assess the impact of the intervention on behaviour change and clinical factors associated with childhood obesity. The HAPPY programme is currently being tested as part of a randomised controlled feasibility trial.

Heath beliefs of UK South Asians related to lifestyle diseases: a review of qualitative literature

OBJECTIVE

To review available qualitative evidence in the literature for health beliefs and perceptions specific to UK South Asian adults. Exploring available insight into the social and cultural constructs underlying perceptions related to health behaviours and lifestyle-related disease.

METHODS

A search of central databases and ethnic minority research groups was augmented by hand-searching of reference lists. For included studies, quality was assessed using a predetermined checklist followed by metaethnography to synthesise the findings, using both reciprocal translation and line-of-argument synthesis to look at factors impacting uptake of health behaviours.

RESULTS

A total of 10 papers varying in design and of good quality were included in the review. Cultural and social norms strongly influenced physical activity incidence and motivation as well as the ability to engage in healthy eating practices.

CONCLUSIONS

These qualitative studies provide insight into approaches to health among UK South Asians in view of their social and cultural norms. Acknowledgement of their approach to lifestyle behaviours may assist acceptability of interventions and delivery of lifestyle advice by health professionals.

Health promotion lifestyle profile-II: Chinese version short form

AIM

This paper is a report of an examination of the validity and reliability of the Chinese version of the Health Promoting Lifestyle Profile.

BACKGROUND

The Health Promotion Lifestyle Profile, a well-known instrument measuring health promotion lifestyle behaviours and developed by Walker in 1987 and later refined, has been translated into several languages. The original Chinese translated version, based on Walker's 48-item 1987 version, detected six dimensions of health promotion lifestyle behaviours. The 52-item revised Health Promotion Lifestyle Profile-II has not been tested for Mandarin-speakers.

METHOD

After the English version of the Health Promotion Lifestyle Profile-II was translated into Chinese using established forward-backward translation procedures, the psychometric properties of the translated version were determined with 331 Taiwanese Mandarin-speaking adults. Data were collected from August 2007 to July 2008 at outpatient clinics for health screening in Southern Taiwan. The psychometric properties of the instrument were evaluated, including the internal consistency, test-retest reliability, item analysis and factor analysis.

RESULTS

Neither Walker's original 6-factor model nor a forced 6-factor solution of the 52 items of the Health Promotion Lifestyle Profile-II was supported. Parallel analysis suggested that five factors be retained, with the 5-factor solution statistically and conceptually satisfactory. The 5-factor Chinese version of the Health Promoting Lifestyle Profile explained 53% of the variance in healthy lifestyles. Thirty items were retained for the Chinese version of the Health Promoting Lifestyle Profile.

DISCUSSION

Deletion of 22 items from the Health Promotion Lifestyle Profile-II did not impair the ability of the Chinese version of the Health Promoting Lifestyle Profile to measure a healthy lifestyle among a sample of Taiwanese adults. The data support the fact that lifestyle is influenced by culture.

Chinese health beliefs of older Chinese in Canada

Objectives. This study examines the cultural health beliefs held by older Chinese in Canada. Methods. Chinese surnames are randomly selected from the local Chinese telephone directories. Telephone screening is then conducted to identify eligible Chinese people 55 years of age or older to take part in a face-to-face interview to complete a structured survey questionnaire. Results. The results of exploratory factor analysis indicate that the health beliefs of the older Chinese are loaded onto three factors related to beliefs about traditional health practices, beliefs about traditional Chinese medicine, and beliefs about preventive diet. Education, religion, country of origin, length of residency in Canada, and city of residency are the major correlates of the various Chinese health beliefs scales. Discussion. The findings support the previous prescriptive knowledge about Chinese health beliefs and illustrate the intragroup sociocultural diversity that health practitioners should acknowledge in their practice.

Turkish adaptation of the parental health beliefs scale

AIM

This paper reports an adaptation of the English version of the Parental Health Beliefs Scale for use with Turkish parents and an evaluation of its psychometric properties.

BACKGROUND

As a profession, nurses are particularly concerned with cross-cultural influences that affect the health beliefs of populations. Although the international literature describes questionnaires and specific scales in health promotion and health beliefs, adequate Turkish-language instruments are scarce. Therefore, suitable instruments need to be developed or adapted for the Turkish parents.

METHOD

This was a psychometric study. A convenience sample (n=257) was recruited in 2003 from parents who attended a primary healthcare centre in Erzurum, Turkey. Translation and back-translation of the original English instrument and content validation by an expert panel were the first two steps. The third step was psychometric testing of the adapted instrument to establish internal consistency, inter-item correlation and construct validity. Data were collected using the Parental Health Beliefs Scale. Socio-demographic data were also collected. The investigators visited the centre every workday, and interviewed the samples. The parents read and self-completed the questionnaire.

FINDINGS

Content validity procedure resulted in a final scale that consisted of 20 items. Cronbach's alpha was 0 x 75. Factor analysis yielded three factors related to chance, internality and powerful others.

CONCLUSION

Although acceptable levels of reliability and validity of the Turkish version of the Parental Health Beliefs Scale for parents were reached, cultural factors appeared to play a role in the applicability of the scale. Further validation research is therefore needed before the scale can be recommended for use in nursing research and practice.

Effective heart disease prevention: lessons from a qualitative study of user perspectives in Bangladeshi, Indian and Pakistani communities

OBJECTIVES

Coronary heart disease (CHD) has a high mortality, incidence and prevalence among Indian, Pakistani and Bangladeshi communities in the UK, indicating the need for effective heart disease prevention initiatives for these communities. This paper considers how service user perspectives can be used to develop effective, culturally focused CHD prevention interventions for these target groups by addressing identified barriers, including deeply held cultural beliefs.

STUDY DESIGN

A qualitative research study, using a longitudinal action research approach.

METHODS

This was a community-based study in Edinburgh. Six focus group discussions--two for each community--were organized with participants from these communities at the beginning of the project. A further six focus group discussions for the same communities were organized six months later.

RESULTS

Over the period examined, participants reported varying changes in levels of knowledge relating to the nature, causes and symptoms of CHD. Some participants reported taking slight to significant steps to reduce or prevent heart disease, while others did not. The project was viewed as helpful in increasing knowledge about CHD and preventive measures and encouraging healthier lifestyles. However, persistent barriers to change were also identified, requiring changes to the project that involved not only matching intervention materials and messages to observable, superficial characteristics of the target population, but more fundamental changes that address the cultural, social, historical, environmental and psychological forces that influence health behaviour.

CONCLUSION

CHD prevention initiatives need to identify and respond to deep-rooted influences on health-behaviour in 'at-risk' groups, in addition to superficial characteristics of the target populations. It is important for specific prevention initiatives to be linked into wider CHD frameworks to ensure transferability of learning and integration within wider service provision.

Cultural Dissimilarities in General Practice: Development and Validation of a Patient’s Cultural Background Scale

Due to increased migration physicians encounter more communication difficulties due to poor language proficiency and different culturally defined views about illness. This study aimed to develop and validate a 'patient's cultural background scale' in order to classify patients based on culturally conditioned norms instead of on ethnicity. A total of 986 patients from 38 multi-ethnic general practices were included. From a list of 36 questions, non-contributing and non-consistent questions were deleted and from the remaining questions the scale was constructed by principal component analysis. Comparing the scale with two other methods of construction assessed internal validity. Comparing the found dimensions with known dimensions from literature assessed the construct validity. Criterion validity was determined by comparing the patient's score with criteria assumed or known to have relationship with cultural background. Criterion validity was reasonably good but poor for income. A valid patient's cultural background scale was developed, for use in large-scale quantitative studies.

Comparison of health-promoting behavior between Taiwanese and American adolescents: a cross-sectional questionnaire survey

OBJECTIVES

The main aim of this study was to compare the health promotion practices of Taiwanese (n=265) and American (n=285) adolescents, using the revised Adolescent Health Promoting scale.

METHODS

A comparative and descriptive design was used. Categorical data analysis was applied to explore the association of culture differences and adolescent health-promoting behaviors.

RESULTS

Findings indicated significant differences between Taiwanese and American adolescents in some demographic characteristics: American participants had higher self-perceived health status (p<0.001), parental educational level (p<0.001), overweight percentage (p<0.001), and rate of living only with the mother (p<0.001) than the Taiwanese participants. Taiwanese adolescents had a higher frequency of health-promoting behavior than Americans in terms of healthy diet behavior, stress management, health responsibility, and social support (p<0.01), but less frequently engaged in exercise and life appreciation (p<0.001). Because many of the demographic characteristics between the two countries, such as the parent's educational level, differ significantly, a comparison can be difficult. However, healthy behavior is an important measure of demand for preventive health services.

CONCLUSIONS

The findings should sound an alarm for all public health professionals to take heed of what is happening to our youth based on culture differences. School and family health promotion counseling should be encouraged for adolescents to improve their lifestyle habits. Based on the findings, school health promotion programs should focus on factors for which there may be significant local ethnic differences. For the locales in this study, Taiwanese adolescents need encouragement to improve their exercise and life appreciation behaviors. For American adolescents, healthy diet, stress management, health responsibility, and social support should be emphasized.

Hong Kong families and breast cancer: Beliefs and adaptation strategies

In Chinese society the family not the individual is the basic structural and functional unit. Family beliefs significantly determine the impact of the illness, choice of coping patterns and ultimately the physical and behavioral reactions of both the women and their family members. The purpose of this study was to identify the family beliefs about breast cancer and how the beliefs influenced family functioning. Twenty Hong Kong Chinese families where the woman had breast cancer (N=59) were interviewed using a minimally structured schedule. Interpretive phenomenology was the qualitative methodology used in the study. Gadamer's philosophical hermeneutics related to the process of understanding, application and interpretation was used to guide the analysis. Patterns of disharmony related to stress and emotion, diet, exercise, genetics and fate were evident in the family beliefs about the causes of breast cancer and guided the cognitive, emotional and behavioral strategies they adopted to negotiate the illness experience.

The Lindsay Leg Club Model: a model for evidence-based leg ulcer management

Leg Club is a unique model of community-based leg ulcer care. By providing nursing care in a non-medical, social environment, the model has several benefits: it removes the stigma associated with leg ulcers and helps isolated older people reintegrate into their communities, which in turn improves concordance and has a positive impact on healing and recurrence rates. In an atmosphere of de-stigmatisation, empathy and peer support, positive health beliefs are promoted and patients take ownership of their treatment. The Leg Club model creates a framework in which nurses, patients and local community can collaborate as partners in the provision of holistic care. The model also provides an environment for appropriate supportive education, advice and information.

Understanding different religions when caring for diabetes patients

A significant and accelerating worldwide increase in the incidence of diabetes, coupled with growing population mobility, will lead to an urgent need for all nurses to develop a greater understanding of the role of different cultural and religious beliefs in diabetes control and care. In this article, the author presents a brief overview of the five major religions practised in the UK and the associated beliefs, customs and lifestyle factors that may affect the person with diabetes and his/her compliance with current advice and education with the aim of promoting culturally competent health care.

Ratings of contracting infectious diseases and of the risk of sexual HIV transmission by health care students from Germany, Lithuania, and Namibia

In Germany, Lithuania, and Namibia different types of the HIV epidemic are present. HIV testing of health care students and their ratings of the risk of sexually acquired HIV infections and factors influencing the risk of contracting infectious diseases were analyzed. 182 German medical and dental students, 176 Lithuanian medical students, and 135 Namibian student nurses participated by completing anonymous questionnaires. The Namibian student nurses rated sexual HIV transmission risks higher than the Lithuanian and German medical students did. In general, the Lithuanian medical students rated risks of HIV transmission lowest, compared to the students in the other two samples. Risk behavior and environmental factors were most emphasized by the three student samples as having an influence on the risk of contracting infectious diseases. Thus, national prevalence of HIV influences ratings of sexual HIV transmission risks, while rating of factors influencing the risk of contracting infectious diseases are similar.

A Comparison of Health Practices of Canadian and Jordanian Nursing Students

The purpose of this study was to compare health-promoting practices of Canadian (n = 49) and Jordanian (n = 44) first-year nursing students using the revised Health-Promoting Lifestyle Profile II. Results indicated significant differences between the groups on three subscales: health responsibility, physical activity, and interpersonal relations; however, both groups had similarly low scores. Implications for nurse educators are discussed from both curricular and cross-cultural perspective that focuses on health-promotion activities and programs.

Cervical screening: population-based comparisons between self-reported survey and registry-derived Pap test rates

OBJECTIVE

To compare self-reported cervical screening rates, as recorded in the 1998 NSW Health Survey, with registry-based cervical screening rates for NSW for the same period; and to examine factors associated with over-estimates of cervical screening rates by self-report.

METHODS

Self-reported cervical screening data was extracted from the 1998 NSW Health Survey, biennial screening rates estimated and compared with biennial cervical screening rates for 1997-98, as recorded on the NSW Pap Test Register (PTR). Rates and differences were related to socio-demographic characteristics of the 17 Area Health Services of NSW.

RESULTS

According to the 1998 NSW Health Survey, 74% of women reported having a Pap test during the previous two years. The equivalent rate recorded on the NSW PTR for 1997-98 was 62% (p<0.0001). Among the 17 Area Health Services of NSW these differences ranged from nine to 19 percentage points. Area-specific differences between self-reported and registry-based screening rates were negatively correlated with the registry-based screening rate. Age-specific differences between self-reported and registry-based screening rates were positively correlated with registry-based screening rates. No SES, regional or migrant population characteristics were predictive of differences between recorded and surveyed screening rates.

CONCLUSION

Cervical screening rates in NSW derived from self-reported survey data exceed the rate recorded by the NSW Pap Test Register by 12 percentage points (equivalent to 19% inflation).

IMPLICATIONS

The data in this paper can be used indicatively where necessary to adjust for over-reporting in cervical cancer screening surveys.

Heart health-associated health beliefs and behaviours of adolescents of African and African Caribbean descent in two cities in the United Kingdom

The following paper presents the findings of an exploratory ethnography, the purpose of which was to identify and describe heart health associated beliefs and behaviours of year seven (Y7) and year 10 (Y10) secondary school young people of African and African Caribbean descent in two UK cities. Data were collected by the data collection technique of focus groups. However, eight focus groups were conducted involving 47 Y7 young people and 29 Y10 pupils, 76 pupils in total. The data were analysed utilizing ATLAS/ti qualitative data analysis software. This software is informed by grounded theory. Data from the study formed six themes. The findings informed the development of an interactive health promotion website which can be found at http://www.shef.ac.uk/web/uni/projects/mshhp. The paper argues that in order to provide meaningful programmes of health promotion to be developed by health care providers including school nurses and health visitors, it is essential that interventions are informed by an understanding of the health beliefs and behaviours of African and African Caribbean young people.

An analysis of the concept of risk

The meaning of the word "risk" has changed throughout history. Once a neutral term, risk has come to represent a combination of probability and something adverse or dangerous. Phenomena that were previously referred to as hazards, dangers, or uncertainties are now labeled as risks. Although risk touches every aspect of health and human welfare, the dimensions of risk as conceptualized in the fields of epidemiology, nursing science, medical science, and lay health are qualitatively different. Risk has not been examined as a concept in nursing literature or research, although risk and related terms are defined in a few nursing textbooks. Using the evolutionary method of concept analysis, risk is examined as a concept. This analysis was undertaken to define and clarify the concept and dimensions of risk as they relate to risk for disease. A sound understanding of risk as a concept is critical for developing an empirical knowledge base in nursing and directing nursing research examining issues related to risk for developing diseases such as cancer.

Beliefs about health and illness essential for self-care practice: a comparison of migrant Yugoslavian and Swedish diabetic females

In a multicultural society the frequency of contact with migrant diabetic individuals will increase, as well as the need for knowledge about their beliefs about health and illness, which have rarely been studied. The aim of the present study was to explore beliefs about health and illness among migrant Yugoslavian and Swedish diabetic subjects that might affect their self-reported self-care practices and care-seeking behaviours. The study design was explorative, and a purposive sampling procedure was used. Fifteen females born in Sweden and 13 in former Yugoslavia, aged 33-73 years, with previously known diabetes mellitus were recruited from primary health care centres in southern Sweden. Median time of residence in Sweden was 5 years (range 2-30 years). Eight of the Yugoslavians had their diabetes diagnosed in Sweden. Focus-group interviews including scenarios of common problems related to diabetes mellitus were held. Yugoslavian females in general gave less tangible examples concerning beliefs about health and illness. Yugoslavians were orientated towards feelings related to their migratory experiences, enjoyed life by making deviations from dietary advice and retaining former traditions, and were less inclined towards self-monitoring and preventive foot care. They also expressed a passive role, depending on health care personnel, and discussed the influence of supernatural forces. Swedes expressed themselves in terms of medicine and a healthy lifestyle, took active part in their self-care and let self-monitoring guide their actions. Self-care was mainly practised to restore health when ill in both groups, and when help was needed it was sought in the professional sector (nurse or physician). Yugoslavians expressed higher confidence in physicians and used more natural cure medicine, side by side with biomedicine, while Swedes more frequently used alternative medicine. Demonstrated dissimilarities illustrate that beliefs about health and illness differ between migrant Yugoslavian and Swedish diabetic individuals, and are essential for self-care practice and care-seeking behaviour and must be considered when planning diabetes care.

The individual, the family, and genetic testing

Genetics plays a role in every disease, yet few health care providers understand basic genetic principles or the science underlying the genetic testing process. An understanding of the science behind genetic advances is necessary, and it is equally important for health professionals to have an understanding of the complex nature of genetic testing for individuals and their families. Much of the debate about the psychological effects of genetic testing has occurred in the absence of empirical data on diseases for which predictive testing has only recently emerged. This article will review selected literature on genetic testing and its implications for the individual and the family. The responses of families and individuals to the diagnosis of a genetic disease will be reviewed, and Huntington disease will be used as the paradigm for examining issues related to genetic testing for adult-onset cancers. Literature addressing the response to genetic susceptibility for adult-onset cancers and the implications of testing children also will be explored. Finally, identification of emerging issues relevant to genetic screening will provide a framework for identifying needed nursing research in genetic testing for adult-onset cancer risk.

Pakistani moslems with Type 2 diabetes mellitus: effect of sex, literacy skills, known diabetic complications and place of care on diabetic knowledge, reported self-monitoring management and glycaemic control

AIMS

To study factors such as sex, educational status and place of care, which might influence knowledge and self-management of diabetes, and glycaemic control in a Pakistani moslem diabetic population attending primary care general practices (GP) and secondary care clinics at the Manchester Diabetes Centre (MDC).

METHODS

Patients with Type 2 diabetes mellitus took part in a one-to-one semi-structured interview and gave blood for haemoglobin A1c levels.

RESULTS

Two hundred and one patients entered the study. Knowledge about diabetic diets was good (average scores 72%), and patients claimed to perform regular glucose measurements (66%), but they were not good at applying their knowledge to problems in daily life. Only 24% knew how to manage persistent hyperglycaemia. Women were worse than men at this (19 vs. 31% (chi2 = 3.8, P = 0.05)), were less likely to understand why glucose levels should be monitored, and had poorer glycaemic control overall (HbA1c 8.8 vs. 8.1%, P = 0.04). Fifty-four patients were completely illiterate. They had similar knowledge scores to readers but were less able to handle problem scenarios. Forty-five of these patients were women, and multiple regression analysis showed they were more likely to have the poorest glycaemic control. No major differences were found between general practitioner and hospital attenders, or between patients with and without known complications, except that hospital attenders were more likely to have complications and poorer control.

CONCLUSIONS

Women who cannot read in this population are likely to have poorer glycaemic control and may be finding it more difficult to learn how to apply their knowledge to daily life. This subgroup may need more intensive, culturally appropriate, health education and support.

Meanings and practices of health among married Thai immigrant women in Sweden

The aim of this qualitative study was to explore and explain the meanings and practices of health among Thai immigrant women in Sweden with Swedish husbands. In agreement with Leininger's theory of cultural care, data were collected through observation-participation and ethnographic interviews with 10 key informants and 16 general informants living in Uppsala. The principal meanings of health of the Thai immigrant women were abstracted from the raw data using structural analysis. They were found to be (a) state of well-being, (b) absence of illness, (c) ability to perform daily role activities, and (d) adaptation to their new life situation. The principal factors for the promotion of health among these women were (a) mental support from family, (b) nutrition, (c) physical exercise, (d) no smoking, and (e) modest drinking. Knowledge among health care professionals of meanings and practices of health, such as those found here, is vital for the provision of culturally congruent care in a multicultural society such as Sweden.

Influence of health locus of control and parental health perceptions on follow-through with school nurse referral

The health perceptions and health locus of control of 50 parents of students in a school district in New Jersey were investigated in this comparative descriptive study. The study was based on the Health Belief Model and Roger's Science of Unitary Human Beings. Subjects were categorized into two groups, depending on whether or not they followed through with school nurse referrals for their children. Data were collected from each subject to measure levels of health locus of control and health perceptions. The hypothesis stated that parents who do not follow up on health referrals for their children will score lower on health perceptions and health locus of control than parents who schedule referrals for their children. Results revealed no significant differences between compliant and noncompliant parents in health perceptions and health locus of control. Chi-square analyses were used to determine the relationships between sample characteristics and participants' responses to the Health Locus of Control scale and the Health Perceptions Questionnaire.

Collecting ethnic group data for inpatients: is it useful?

Since April last year British hospitals have had to collect data on the ethnic group of every patient. Patients must categorise their own ethnic group using the categories of the 1991 census. Claire Hilton argues that such data collection is unhelpful and will not meet its stated aim of helping to provide equitable access to NHS services for all ethnic groups. Self categorisation is unreliable, and the number of ethnic groups available is inadequate, in particular for the white population. Additional data on the size of each ethnic group in the local population and on rates of illness in particular groups are necessary to assess whether services are being provided equitably. Moreover, ethnicity is a multidimensional concept, and information on patients' language and cultural and religious practices, as well as their place of origin, is necessary if services are to be culturally sensitive.

Health beliefs and early detection among Chinese women

Little is known about the knowledge and practices regarding early detection of cancer for Chinese women either living in their homelands or worldwide. The purpose of this exploratory study is to describe how cultural beliefs and understandings may influence participation in early detection programs for the increasing numbers of Chinese women who live in the United States. The Health Belief Model (HBM) emerged as a useful framework for categorizing data obtained in Mandarin from a qualitative study of married, educated Chinese women (n = 23; mean age 30.4 years) who attended a university clinic. Cultural beliefs about modesty, husband's involvement, self-care, relationship between health and body functions, and use of preventive health behaviors in the absence of illness influenced women's participation and supported the HBM. Early detection was not a clear concept for these women: 80% believed performing monthly breast self-examinations and 70% believed receiving annual Papanicolaou smears would prevent cancer.

Perception and social consequences of tuberculosis: a focus group study of tuberculosis patients in Sialkot, Pakistan

Treatment defaulting is one of the major causes of the failure of TB control programs. In Bethania Hospital, Sialkot, defaulting rates are high: 72% for the standard 12 months course and 56% for the 8 months course. Attrition is especially important in the first weeks of treatment: < 70% of the patients start the 10th week of treatment. A focus group discussion study has been carried out to gain a better understanding of the impact of social stigmatization, treatment cost and pregnancy on defaulting. The study population consisted of 3 male and 3 female groups each with 8 hospitalized TB patients. The study shows that TB is perceived as a very dangerous, infectious and incurable disease. This perception has many social consequences: stigmatization and social isolation of TB patients and their families: diminished marriage prospects for young TB patients, and even for their family members: TB in one of the partners may lead to divorce. Due to fear patients often deny the diagnosis and reject the treatment. While both male and female TB patients face many social and economical problems, female patients are more affected. Divorce and broken engagements seem to occur more often in female patients. Females are usually economically dependent on their husbands and family in law, and need their cooperation to avail of treatment. The belief that pregnancy enhances the risk for relapse decreases their marriage prospects. Pregnancy is also a reason for stopping TB treatment as both are considered as incompatible. The findings of this study reveal the urgent need for a health education campaign to convince the general population that tuberculosis is curable. All health care providers should act as destigmatizers.

Concept analysis of family+health = a new definition of family health

In this article, the authors explore references to family and health in the nursing literature and compare them with their own perceptions to propose a new definition of family health. Focusing on connectedness, energy, and hope for the future, this definition and its conceptual model can help nurses care for families in the rehabilitation setting.