The development of a feasible community-specific cardiovascular disease prevention program: triangulation of methods and sources

Understanding Youth: Using Qualitative Methods to Verify Quantitative Community Indicators

Community- and individual-level data were collected from interviews with 1,294 boys and girls, 13 to 19 years old, in three impoverished urban communities of Beirut. Univariate analyses of variables provide quantitative indicators of adolescents' lives and communities. Researchers including the authors, interested in using these indicators to plan for community interventions with youth in the Palestinian refugee camp, discuss the pertinent results with youth from the camp in six focus groups. The authors find that many indicators misrepresent the situation of youth in the camp. For example, adolescents may have underreported cigarette and argileh (water pipe) smoking (8.3% and 22.4%, respectively) because of the lack of social desirability of these behaviors; other questions may have been misunderstood, such as perceived health and health compared to others. Also, important issues for them such as drug abuse, violence, and school problems were not asked. Implications for intervention research are discussed.

Perspectives on barriers and facilitators to self-care in Lebanese cardiac patients: A qualitative descriptive study

BACKGROUND

Cardiovascular disease is the leading cause of mortality worldwide. Cardiac self-care practices are essential for managing cardiac illness and improving quality of life. However, these practices may be affected by factors that may hinder or facilitate self-care especially in countries that experience political and economic instabilities.

OBJECTIVES

The purpose of this study was to explore self-care practices among Lebanese cardiac patients. Another aim was to reveal factors that might influence these self-care practices.

DESIGN

This is a qualitative descriptive study.

SETTING

Participants were recruited from a referral medical center in Beirut, Lebanon and interviews took place in their homes.

PARTICIPANTS

Purposive sample of 15 adult participants, seven females and eight males, diagnosed with coronary artery disease at least a year ago and not in critical condition recruited from the cardiology clinics of the medical center.

METHODS

Data were collected through semi-structured audio-recorded interviews that took place in their places of residents.

RESULTS

Three themes emerged from the data: I. The behaviors of cardiac patients demonstrated selected self-care practices; II. Patients identified barriers to self-care reflective of the Lebanese political and socio-economic situation; and, III. Patients described facilitators to self-care consistent with the Lebanese socio-cultural values and norms. The most common self-care practices included taking medications and eating properly. Participants emphasized avoiding stress and being upset as a self-protective measure for cardiac health. Health care costs, family responsibilities, psychological factors and the country's political situation impeded self-care practices whereas family support facilitated them.

CONCLUSION

Lebanese patients reported select self-care practices in dealing with their cardiac illness. Barriers and facilitators to their self-care behaviors reflected the Lebanese context and culture. Thus health care providers must assess their patients' practices within their sociocultural context so that interventions to promote self-care are tailored accordingly.

Explaining nutritional habits and behaviors of low socioeconomic status women in Sanandaj: a qualitative content analysis

INTRODUCTION

Health and behavior are closely related subjects because disease is typically rooted in individuals' unhealthy behaviors and habits. This study aims to identify women's nutritional habits and behaviors in order to design interventions to promote nutritional literacy.

METHODS

This qualitative research is part of a mixed method (quantitative-qualitative) study, conducted based on content analysis. Data were collected using semistructured interviews, group discussions, and in-depth interviews with married women, aged 18-50 years, who were referred to four health care centers in Sanandaj in 2013-2014.

RESULTS

Nutritional habits and behaviors of participants were classified into two categories: representation of nutritional behavior based on consumption pattern and representation of nutritional behavior based on consumption method. For the former, eight consumption pattern subcategories were formed: meat, dairy, fast food, local foods, fruits and vegetables, soft drinks, and oils. The latter (representation of nutritional behavior based on consumption method), included two subcategories: consumption method in line with health and consumption method inconsistent with health.

CONCLUSION

Results of this qualitative study provide a solid foundation for development and designing interventions to nutritional literacy promotion based on needs. The designed intervention to healthy nutritional behavior should be based on empowering women and providing facilitator factors of a healthy diet. While designing this study, with a holistic perspective, individual and social aspects of a healthy diet should be taken into account.

The Cultural Meaning of Cardiac Illness and Self-Care Among Lebanese Patients With Coronary Artery Disease

BACKGROUND

Cardiac disease is the leading cause of death in Lebanon, accounting for 22% to 26% of total deaths in the country. A thorough understanding of perceptions of cardiac illness and related self-care management is critical to the development of secondary prevention programs that are specific to the Lebanese culture.

PURPOSE

To explore the cultural perceptions of cardiac illness and the associated meaning of self-care among Lebanese patients.

DESIGN

Using a qualitative descriptive method, semistructured interviews were conducted with a purposive sample of 15 Lebanese cardiac patients recruited from a medical center in Beirut, Lebanon.

FINDINGS

The qualitative descriptive analysis yielded one overarching and two other themes describing perceptions of cardiac illness and self-care within the Lebanese cultural context. The overarching cultural theme was, "Lebanese cardiac patients were unfamiliar with the term concept and meaning of self-care." Lebanese cardiac patients thanked God and accepted their fate (Theme I). The participants considered their cardiac incident a life or death warning (Theme II).

IMPLICATIONS FOR PRACTICE

Health care providers need to consider patients' cultural perception of illness while planning and evaluating cardiac self-care programs.

Environmental determinants of cardiovascular diseases risk factors: a qualitative directed content analysis

Background:

Cardiovascular diseases (CVDs) are the number one cause of death in the world. In most analyses of health problems, environment plays a significant and modifiable role in causing the problem either directly or indirectly through behavior.

Objectives:

This study aims to understand the patients and healthcare providers’ experiences about the environmental determinants of CVD risk factors based on the Precede Model.

Patients and Methods:

This qualitative study conducted over six months in 2012 at Diabetes Units of Health Centers associated with Alborz University of Medical Sciences and Health Services which is located in Karaj, Iran. The data were collected based on individual semi-structured interviews with 50 patients and 12 healthcare providers. Data analysis was performed simultaneous with data collection using the content analysis directed method.

Results:

Lack of behaviors like stress control, healthy eating and physical activity were the roots of the risk factors for CVD. The environmental factor is one of the barriers for conducting these behaviors. The environmental barriers included of structural environment including “availability and accessibility of health resources”, “new skills”, and “law and policies” which are located in enabling category and social environment including “social support”, “motivation to comply” and “consequences of behavior” which are located in reinforcing category. The most barriers to performing health behaviors were often structural.

Conclusions:

The environmental factors were barriers for doing healthy behaviors. These factors need to be considered to design health promotion interventions. Policymakers should not only focus on patients’ education but also should provide specific facilities to enhance economic, social and cultural status.

Study protocol--Indigenous Australian social networks and the impact on smoking policy and programs in Australia: protocol for a mixed-method prospective study

BACKGROUND

Tobacco use is the most preventable cause of morbidity and mortality in Australia. Comprehensive tobacco control has reduced smoking rates in Australia from approximately 34 per cent in 1980 to 15 per cent in 2010. However, 46 per cent of Aboriginal and Torres Strait Islander people (Indigenous Australians) smoke on a daily basis, more than double the rate of non-Indigenous Australians. The evidence of effective tobacco control strategies for Indigenous Australians is relatively scarce. The aim of this study is to (i) explore the influences of smoking in Indigenous Australian people and to (ii) help inform and evaluate a multi-component tobacco control strategy. The study aims to answer the following questions:--do individuals' social networks influence smoking behaviours;--is there an association between various social and cultural factors and being a smoker or non-smoker; and--does a multi-component tobacco control program impact positively on tobacco behaviours, attitudes and beliefs in Indigenous Australians.

METHODS AND DESIGN

Our prospective study will use a mixed-method approach (qualitative and quantitative), including a pre- and post-test evaluation of a tobacco control initiative. The study will explore the social and cultural context underlying Indigenous Australian tobacco use and associated factors which influence smoking behaviour. Primary data will be collected via a panel survey, interviews and focus groups. Secondary data will include de-identified PBS items related to smoking and also data collected from the Quitlines call service. Network analysis will be used to assess whether social networks influence smoking behaviours. For the survey, baseline differences will be tested using chi(2) statistics for the categorical and dichotomous variables and t-tests for the continuous variables, where appropriate. Grounded theory will be used to analyse the interviews and focus groups. Local Aboriginal community controlled organisations will partner in the study.

DISCUSSION

Our study will explore the key factors, including the influence of social networks, that impact on tobacco use and the extent to which smoking behaviours transcend networks within the Indigenous Australian community in the ACT. This will add to the evidence-base, identifying influential factors to tobacco use and the effectiveness and influence of a multi-component tobacco control strategy.

Combining women's preferences and expert advice to design a tailored smoking cessation program

We designed a patient-centered smoking cessation program for women in 2004/2005, incorporating women's preferences and expert opinion. Our four-step process included: (1) concept-development focus groups; (2) an expert panel; (3) concept-testing focus groups, and (4) a pilot study. Data analyses occurred in 2004-2007. The new program offered options: the traditional Veterans Health Administration (VA) male-dominated program was the least selected option in the pilot study. Patients can be effectively involved in program development. The study's implications and limitations are noted. This research (conducted in Los Angeles, California) was funded by the American Legacy Foundation with additional VA support.

Listen to the consumer: designing a tailored smoking-cessation program for women

We used a consumer-driven approach to develop a model smoking-cessation program for women. Four focus groups (N = 23 [5-7/group]), each lasting 2 hours, were led by a professional moderator and audiotaped in 2004. Researchers reviewed transcripts; key themes were identified using scrutiny techniques (Ryan and Bernard, 2003). Necessary elements of a smoking-cessation program for women included support and choice (i.e., control over the program components), suggesting the need for an individualized program. Identifying appropriate components is a critical step in the development of efficacious programs that target substance-abusing populations; focus group methodology is useful in this endeavor. The study's implications and limitations are noted.

“Una Mujer Trabaja Doble Aquí”: Vignette-Based Focus Groups on Stress and Work for Latina Blue-Collar Women in Eastern North Carolina

Latina women are a growing percentage of the working population, and very little is known about their health needs and interests. The purpose of this article is to share qualitative research results gathered from Latina women with a particular focus on exploring stress and health. This project was a substudy of Health Works in the Community, a 5-year CDC-funded multiple risk-factor reduction trial using participatory action research approaches to address smoking, healthy eating, stress, and physical activity among blue-collar women from 12 manufacturing work sites in rural, eastern North Carolina. Five focus groups were conducted with trained, bilingual facilitators using a vignettebased moderator guide that appeared particularly effective with this population. Results from the focus groups are used to make recommendations for future research with Latinas and for developing effective work-site-based interventions to address issues of stress and health within this population.

Developing and implementing a triangulation protocol for qualitative health research

In this article, the authors present an empirical example of triangulation in qualitative health research. The Canadian Heart Health Dissemination Project (CHHDP) involves a national examination of capacity building and dissemination undertaken within a series of provincial dissemination projects. The Project's focus is on the context, processes, and impacts of health promotion capacity building and dissemination. The authors collected qualitative data within a parallel-case study design using key informant interviews as well as document analysis. Given the range of qualitative data sets used, it is essential to triangulate the data to address completeness, convergence, and dissonance of key themes. Although one finds no shortage of admonitions in the literature that it must be done, there is little guidance with respect to operationalizing a triangulation process. Consequently, the authors are feeling their way through the process, using this opportunity to develop, implement, and reflect on a triangulation protocol.

The prevalence of hypertension and its association with other cardiovascular disease risk factors in a representative sample of the Lebanese population

Hypertension is a well-known major risk factor for cardiovascular diseases. This study has been designed to assess the prevalence of hypertension, its co-occurrence with other cardiovascular risk factors and its association with cardiovascular diseases in a representative sample of Lebanese population. A pretested questionnaire was administered to 2125 adults aged equal or above 30 years old from all regions in Lebanon and proportionate with the respective population density. Data revealed that 23.1% of the respondents admitted being hypertensive, with no statistically significant difference between male and female patients. Prevalence of hypertension increased with age (P < 0.01) and hypertension tended to occur more in the less educated and the unemployed (P < 0.01). Only 45.7% of hypertensive patients followed a low fat diet while 14.7% exercised daily. The prevalence of hypertension increased significantly with an increase in body mass index particularly in female patients. Among the hypertensive respondents, 23.9% were diabetic, 38.1% were hyperlipidaemic and 9.1% were both diabetic and hyperlipidaemic. Co-occurrence of hypertension with diabetes, hyperlipidaemia or both was more common in female patients compared to male patients. In addition, stroke, myocardial infarction (MI) and atherothrombosis occurred in hypertensive respondents at rates of 2.4, 4.3 and 9.5%, respectively. Hypertensive female patients reported more stroke and atherothrombotic episodes compared to male patients, whereas hypertensive male patients had more MIs. Based on these results it is very important to address the issue of lifestyle modification for the prevention and treatment of hypertension and awareness campaigns should stress the fact that cardiovascular diseases are not only restricted to men.