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Holman-Allgood I, Cline C, Durand C, Purvis RS, Mendoza Kabua P, Ayers BL. Providers' Perspectives of a Culturally Adapted CenteringPregnancy Intervention for Marshallese Women in Arkansas. Nurs Womens Health 2024; 28:117-127. [PMID: 38460942 PMCID: PMC10999336 DOI: 10.1016/j.nwh.2023.09.010] [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: 08/24/2023] [Revised: 09/26/2023] [Accepted: 12/07/2023] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To explore health care providers' perspectives on the successes, challenges, and suggestions for future directions regarding the implementation of CenteringPregnancy for Marshallese women in Arkansas. DESIGN A descriptive qualitative design was used as an exploratory method. SETTING/LOCAL PROBLEM This study took place in northwest Arkansas. Arkansas is home to the largest Marshallese Pacific Islander population in the United States. Marshallese Pacific Islanders residing in the United States have disproportionally high rates of poor maternal and infant health outcomes, even compared to other Pacific Islanders. PARTICIPANTS Seven CenteringPregnancy providers from the University of Arkansas for Medical Sciences Northwest. INTERVENTION/MEASUREMENTS Individual interviews were conducted from February to March of 2023. Data were managed using MAXQDA12 software. Content analysis was used to analyze the data. Initial coding was completed to identify each data segment with short summations of emergent themes. The focused thematic codes that emerged were used to identify and develop the most salient thematic categories of the data, which became the thematic codes. RESULTS Three overarching themes emerged: Implementation Successes, Challenges to Implementation, and Future Suggestions to Improve Implementation and Sustainability. Each theme had representative subthemes. CONCLUSION Findings provide insight for future implementation of CenteringPregnancy for Marshallese and other Pacific Islander individuals.
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Look MA, Maskarinec GG, de Silva M, Werner K, Mabellos T, Palakiko DM, Haumea SL, Gonsalves J, Seabury AA, Vegas JK, Solatorio C, Kaholokula JK. Developing culturally-responsive health promotion: insights from cultural experts. Health Promot Int 2023; 38:daad022. [PMID: 37067166 PMCID: PMC10108309 DOI: 10.1093/heapro/daad022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Culturally-responsive health promotion initiatives are important to the creation of health equity for Indigenous and minority populations and these initiatives are complex and time-intensive to establish. The knowledge and resources of cultural experts are often pivotal in programs, yet there is minimal research on effective collaborations. The KāHOLO Project demonstrated strong success in the management of uncontrolled hypertension in the high-risk Indigenous population through a 6-month program based on the Hawaiian cultural dance of hula. This program was developed utilizing a community-based participatory research approach and implemented by cultural experts. To better understand the effectiveness of the research endeavor and program, six experienced hula experts and educators who delivered the community-based program were interviewed. As skilled and trusted cultural experts they set a safe supportive learning environment that promoted health and cultural goals. They articulated it was important that the program maintained cultural priorities and integrity. Through the methodical establishment of mutual respect, cooperation on research protocols and requirements was achieved. The development of cultural experts as health allies offers important inroads to the inclusion of minority and Indigenous cultures in health programming.
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Affiliation(s)
- Mele A Look
- Department of Native Hawaiian Health in Honolulu, University of Hawaiʻi, John A. Burns School of Medicine, Honolulu, HI, USA
- Hālau Mōhala ʻIlima, Kāohao, HI, USA
| | | | | | - Kamuela Werner
- Department of Native Hawaiian Health, University of Hawaiʻi, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Tricia Mabellos
- Department of Native Hawaiian Health, University of Hawaiʻi, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Donna-Marie Palakiko
- University of Hawaiʻi, School of Nursing, Ke Ola Mamo, Native Hawaiian Health Care System, Honolulu, HI, USA
| | | | - Joseph Gonsalves
- Hui No ke Ola Pono, Native Hawaiian Health Care System, Waikuku, HI, USA
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Ahmed F, Liberda EN, Solomon A, Davey R, Sutherland B, Tsuji LJS. Indigenous Land-Based Approaches to Well-Being: The Niska (Goose) Harvesting Program in Subarctic Ontario, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3686. [PMID: 36834382 PMCID: PMC9958717 DOI: 10.3390/ijerph20043686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Historically, goose harvesting provided a source of culturally significant, safe, and nutritious food for the Omushkego Cree of subarctic Ontario, Canada. Disruptions stemming from colonization and climate change have led to a decrease in harvesting, resulting in higher rates of food insecurity. The aim of the Niska program was to reconnect Elders and youth to revitalize goose harvesting activities and associated Indigenous knowledge within the community. The program and evaluation were built using a two-eyed seeing (Etuaptmumk) and community-based participatory research approach. Salivary cortisol, a biomedical measure of stress, was collected before (n = 13) and after (n = 13) participation in the spring harvest. Likewise, cortisol samples were collected before (n = 12) and after (n = 12) the summer harvest. Photovoice and semi-directed interviews were employed after the spring (n = 13) and summer (n = 12) harvests to identify key elements of well-being from an Indigenous perspective. The changes observed in cortisol levels for the spring (p = 0.782) and summer (p = 0.395) harvests were not statistically significant. However, there was a noteworthy increase in the subjective well-being observed through the qualitative measures (semi-directed interviews and photovoice), highlighting the importance of using multiple perspectives when assessing well-being, especially in Indigenous peoples. Future programs should incorporate multiple perspectives when addressing complex environmental and health issues, such as food security and environmental conservation, especially in Indigenous homelands worldwide.
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Affiliation(s)
- Fatima Ahmed
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada
| | - Eric N. Liberda
- School of Occupation and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Andrew Solomon
- Fort Albany First Nation, Fort Albany, ON P0L 1H0, Canada
| | - Roger Davey
- Fort Albany First Nation, Fort Albany, ON P0L 1H0, Canada
| | - Bernard Sutherland
- Peetabeck Academy, Mundo Peetabeck Education Authority, Fort Albany, ON P0L 1H0, Canada
| | - Leonard J. S. Tsuji
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada
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Indigenous Land-Based Approaches to Well-Being: The Amisk (Beaver) Harvesting Program in Subarctic Ontario, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127335. [PMID: 35742603 PMCID: PMC9224250 DOI: 10.3390/ijerph19127335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/22/2022]
Abstract
The act of decolonizing knowledge systems involves recovering and renewing traditional, non-commodified cultural patterns, such as the sustenance of intergenerational relationships and traditional practices. A decline in beaver harvesting, which was once an integral part of the Omushkego Cree culture, has resulted in an overabundance of beavers and dams, which has negatively affected communities by increasing the local flooding events and impacting the water quality. The aim of the Amisk (beaver) program was to reconnect the Elders and youth to revitalize traditional on-the-land activities and, in the present case, beaver harvesting and associated activities within the community. The program and evaluation were built using a two-eyed seeing (Etuaptmumk) and community-based participatory research approach. Salivary cortisol, a biomedical measure of stress, was collected before and after participation in the program. Photovoice, along with semi-directed interviews, were employed to identify the key elements of well-being from a First Nations’ perspective. For the beaver harvesting activities, the changes observed in the cortisol concentrations were not statistically significant (p = 0.094). However, the act of beaver dam removal was associated with a statistically significant increase in the post-participation cortisol concentration (p = 0.021). It was noteworthy that increased stress during the removal of the beaver dams–as indicated by the elevated post-activity cortisol levels–were not reflected in a decrease in the qualitative measures (semi-directed interviews and photovoice) of well-being from an Indigenous perspective. In fact, there was a noted increase in the subjective well-being of the participants, which highlights the importance of multiple perspectives when assessing well-being, especially in Indigenous peoples. However, the cortisol findings of the present pilot project need to be interpreted with caution, due to the limited sample sizes.
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Mayes J, Castle EM, Greenwood J, Ormandy P, Howe PD, Greenwood SA. Cultural influences on physical activity and exercise beliefs in patients with chronic kidney disease: 'The Culture-CKD Study'-a qualitative study. BMJ Open 2022; 12:e046950. [PMID: 35017229 PMCID: PMC8753416 DOI: 10.1136/bmjopen-2020-046950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study used a mixed-method approach to explore cultural and ethnic influences on the perception of, and decision to engage with or not to engage with, physical activity and exercise therapy in patients with chronic kidney disease (CKD). DESIGN Qualitative research was conducted through the use of semistructured interviews and focus groups. Self-reported physical activity levels were measured using the General Practice Physical Activity Questionnaire (GPPAQ), and self-efficacy for exercise with Bandura's Self-Efficacy for Exercise Scale. SETTING This study was conducted in a non-clinical setting of a single National Health Service Hospital Trust between April 2018 and July 2019. PARTICIPANTS Participants >18 years of age with a diagnosis of CKD, from black African, black Caribbean, South Asian or white ethnicity were eligible for the study. 84 patients with a diagnosis of CKD (stages 2-5), aged 25-79 (mean age 57) were recruited. Semistructured interviews (n=20) and six single-sex, ethnic-specific focus group discussions were undertaken (n=36). OUTCOMES Primary outcome was to explore the perceptions, attitudes and values about exercise and physical activity in different ethnic groups through qualitative interviews, analysed using an inductive thematic analysis approach. Questionnaires were analysed using Pearson correlation to determine if there was a significant relationship between the self-efficacy and GPPAQ levels. RESULTS Qualitative analysis provided four primary themes: I am who I am, Change of identity, Influences to physical activity and exercise and Support and education. Quantitative analysis using Pearson correlation revealed a significant correlation between GPPAQ levels of activity and self-efficacy to regulate exercise behaviour (r=-0.40, p=0.001). CONCLUSION Understanding the cultural, attitudes and beliefs of individuals with CKD from a variety of ethnic backgrounds is complex. Understanding of patients' experiences, thoughts and beliefs may be of relevance to clinicians when designing CKD exercise services. TRIAL REGISTRATION NUMBER NCT03709212; Pre-results.
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Affiliation(s)
- Juliet Mayes
- Department of Therapies, King's College Hospital, London, UK
| | - Ellen M Castle
- Department of Therapies, King's College Hospital, London, UK
- Renal Sciences, Department of Transplantation, Immunology and Mucosal Biology, King's College London, London, UK
| | - James Greenwood
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, University College London, London, UK
| | - Paula Ormandy
- School of Health & Society, University of Salford, Manchester, UK
| | - P David Howe
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Sharlene A Greenwood
- Department of Therapies, King's College Hospital, London, UK
- Renal Sciences, Department of Transplantation, Immunology and Mucosal Biology, King's College London, London, UK
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Ades PA, Khadanga S, Savage PD, Gaalema DE. Enhancing participation in cardiac rehabilitation: Focus on underserved populations. Prog Cardiovasc Dis 2022; 70:102-110. [PMID: 35108567 PMCID: PMC9119375 DOI: 10.1016/j.pcad.2022.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 02/07/2023]
Abstract
Participation in cardiac rehabilitation (CR) significantly decreases morbidity and mortality and improves quality of life following a wide variety of cardiac diagnoses and interventions. However, participation rates and adherence with CR are still suboptimal and certain populations, such as women, minorities, and those of lower socio-economic status, are particularly unlikely to engage in and complete CR. In this paper we review the current status of CR participation rates and interventions that have been used successfully to improve CR participation. In addition, we review populations known to be less likely to engage in CR, and interventions that have been used to improve participation specifically in these underrepresented populations. Finally, we will explore how CR programs may need to expand or change to serve a greater proportion of CR-eligible populations. The best studied interventions that have successfully increased CR participation include automated referral to CR and utilization of a CR liaison person to coordinate the sometimes awkward transition from inpatient status to outpatient CR participation. Furthermore, it appears likely that maximizing secondary prevention in these at-risk populations will require a combination of increasing attendance at traditional center-based CR programs among underrepresented populations, improving and expanding upon tele- or community-based programs, and alternative strategies for improving secondary prevention in those who do not participate in CR.
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Affiliation(s)
- Philip A Ades
- Department of Medicine, Division of Cardiology, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America.
| | - Sherrie Khadanga
- Department of Medicine, Division of Cardiology, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America
| | - Patrick D Savage
- Department of Medicine, Division of Cardiology, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America
| | - Diann E Gaalema
- Department of Psychiatry, University of Vermont Larner College of Medicine, Cardiac Rehabilitation and Prevention, Burlington, VT, United States of America
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Kaholokula JK, Look M, Mabellos T, Ahn HJ, Choi SY, Sinclair KA, Wills TA, Seto TB, de Silva M. A Cultural Dance Program Improves Hypertension Control and Cardiovascular Disease Risk in Native Hawaiians: A Randomized Controlled Trial. Ann Behav Med 2021; 55:1006-1018. [PMID: 33677520 PMCID: PMC8489304 DOI: 10.1093/abm/kaaa127] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Native Hawaiians have higher hypertension (HTN) and cardiovascular disease (CVD) rates than non-Hispanic whites, calling for culturally responsive interventions to close this gap. PURPOSE We tested the effects of a 6-month behavioral intervention, a cultural dance program based on hula (the customary dance of Hawai'i), for improving blood pressure (BP) and CVD risk among Native Hawaiians with uncontrolled HTN. METHODS In a randomized controlled trial, we tested the effects of the hula-based intervention among 263 Native Hawaiians with uncontrolled HTN (systolic ≥ 140 or ≥ 130 mmHg if diabetes) and no CVD at enrollment. All participants received a brief culturally tailored heart health education before random assignment to the hula-based intervention (n = 131) or the education-only waitlist control (n = 132). Intervention received hula lessons and group-based activities for 6 months. Control received only 1-week education through 6 months. RESULTS Intervention yielded greater reductions in systolic (-15.3 mmHg) and diastolic (-6.4 mmHg) BP than control (-11.8 and -2.6 mmHg, respectively) from baseline to 6 months (p < .05). At 6 months, 43% of intervention participants compared to 21% of controls achieved a HTN stage <130/80 mmHg (p < .001). The 10-year CVD risk reduction was two times greater for the intervention group than the control group based on the Framingham Risk Score calculator. All improvements for intervention participants were maintained at 12 months. CONCLUSIONS This trial represents one of the few rigorously conducted examinations of an Indigenous practice leveraged for health promotion, with implications for other ethnic populations.
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Affiliation(s)
| | - Mele Look
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
- Hālau Mōhala 'Ilima, Ka'ōhao, HI
| | - Tricia Mabellos
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
| | - So Yung Choi
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
| | - Ka'imi A Sinclair
- Institute for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, WA
| | - Thomas A Wills
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
- Cancer Prevention in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, HI
| | - Todd B Seto
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI
- The Queen’s Medical Center, The Queen’s Health Systems, Honolulu, HI
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Lee YJ, Braun KL, Wu YY, Burrage R, Muneoka S, Browne C, Mokuau NK, Terada TM, Hossain MD. Physical Activity and Health Among Native Hawaiian and other Pacific Islander Older Adults. J Aging Health 2021; 34:120-129. [PMID: 34376094 DOI: 10.1177/08982643211032468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Native Hawaiian and other Pacific Islander (NHPI) older adults often experience social disadvantages and poor health outcomes. Physical activity has been associated with better health in other racial groups, but limited studies have examined these associations in NHPI older adults. Methods: Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n = 1,045), logistic regression models examined associations between physical activity and memory/psychological distress/self-rated health. Results: Sufficient levels of physical activity were associated with lower odds of memory problems, serious psychological distress, and poor/fair self-rated health. Unfortunately, only half of the sample reported sufficient physical activity and approximately 30% reported none. Also, 78% of the sample was estimated to be overweight/obese, and 29% had diabetes. Discussion: Culturally-appropriate interventions are recommended to increase physical activity in this population, which could also help reduce high rates of overweight/obesity and diabetes.
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Affiliation(s)
- Yeonjung J Lee
- Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Kathryn L Braun
- Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Yan Yan Wu
- Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Rachel Burrage
- Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Shelley Muneoka
- Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Colette Browne
- Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Noreen K Mokuau
- Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Tyran M Terada
- Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Mohammad D Hossain
- Thompson School of Social Work & Public Health, 3939University of Hawai'i at Mānoa, Honolulu, HI, USA
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The Impact of Land-Based Physical Activity Interventions on Self-Reported Health and Well-Being of Indigenous Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137099. [PMID: 34281031 PMCID: PMC8296996 DOI: 10.3390/ijerph18137099] [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: 05/06/2021] [Revised: 06/26/2021] [Accepted: 06/30/2021] [Indexed: 01/03/2023]
Abstract
For many Indigenous communities, decreased participation in traditional land-based activities has led to higher rates of chronic disease and a decrease in well-being. This systematic review explores how traditional land-based activities impact self-reported health and well-being of Indigenous adults, using Indigenous and Western perspectives. A search of three electronic databases (PubMed, Scopus, and Web of Science) identified nine studies which explored the experiences and perspectives of Indigenous adults taking part in land-based subsistence and ceremonial activities. A thematic analysis of these studies identified many interconnected physical, spiritual, mental, emotional, and community benefits. Community engagement throughout all stages of the interventions was an important factor in effectively addressing challenges and barriers stemming from colonization, decreased knowledge transfer, and increased use of technology. Participants reported developing more effective stress management techniques, a greater awareness of modifiable risk factors along with increased engagement with Elders. Ultimately, land-based subsistence and ceremonial activities were identified as playing an influential role in the lives of Indigenous adults. The involvement of community members allowed for the development of more culturally relevant interventions. Future community-specific research is needed to increase engagement in traditional physical-activities, improve well-being and overall reduce the risk of chronic disease.
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Vanzella LM, Oh P, Pakosh M, Ghisi GLM. Barriers to Cardiac Rehabilitation in Ethnic Minority Groups: A Scoping Review. J Immigr Minor Health 2021; 23:824-839. [DOI: 10.1007/s10903-021-01147-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 12/21/2022]
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Odonkor CA, Esparza R, Flores LE, Verduzco-Gutierrez M, Escalon MX, Solinsky R, Silver JK. Disparities in Health Care for Black Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review. PM R 2020; 13:180-203. [PMID: 33090686 DOI: 10.1002/pmrj.12509] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023]
Abstract
Racial health disparities continue to disproportionately affect Black persons in the United States. Black individuals also have increased risk of worse outcomes associated with social determinants of health including socioeconomic factors such as income, education, and employment. This narrative review included studies originally spanning a period of approximately one decade (December 2009-December 2019) from online databases and with subsequent updates though June 2020. The findings to date suggest pervasive inequities across common conditions and injuries in physical medicine and rehabilitation for this group compared to other racial/ethnic groups. We found health disparities across several domains for Black persons with stroke, traumatic brain injury, spinal cord injury, hip/knee osteoarthritis, and fractures, as well as cardiovascular and pulmonary disease. Although more research is needed, some contributing factors include low access to rehabilitation care, fewer referrals, lower utilization rates, perceived bias, and more self-reliance, even after adjusting for hospital characteristics, age, disease severity, and relevant socioeconomic variables. Some studies found that Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature. Our review highlights many gaps in the literature on racial disparities that are particularly notable in cardiac, pulmonary, and critical care rehabilitation. Clinicians, researchers, and policy makers should therefore consider race and ethnicity as important factors as we strive to optimize rehabilitation care for an increasingly diverse U.S. population.
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Affiliation(s)
- Charles A Odonkor
- Department of Orthopaedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Rachel Esparza
- Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Miguel X Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Solinsky
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Massachusetts General Hospital, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
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Ojo T, Ryan N, Birkemeier J, Appleton N, Ampomah I, Glozah F, Adongo PB, Adanu R, Boden-Albala B. Adapting a skills-based stroke prevention intervention for communities in Ghana: a qualitative study. Implement Sci Commun 2020; 1:104. [PMID: 33292870 PMCID: PMC7672911 DOI: 10.1186/s43058-020-00084-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 10/08/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Stroke is a major cause of death in Ghana. Evidence-based interventions for stroke prevention have been successful in the US; however, in low- and middle-income countries (LMICs), such interventions are scarce. The "Discharge Education Strategies for Reduction of Vascular Events" (DESERVE) intervention led to a 10-mmHg reduction in systolic blood pressure (SBP) among Hispanic survivors of mild/moderate stroke and transient ischemic attack (TIA) at 1-year follow-up. Our objectives were to capture the perceptions of a diverse set of stakeholders in an urban community in Ghana regarding (1) challenges to optimal hypertension management and (2) facilitators and barriers to implementation of an evidence-based, skills-based educational tool for hypertension management in this context. METHODS This exploratory study used purposive sampling to enroll diverse stakeholders in Accra (N = 38). To identify facilitators and barriers, we conducted three focus group discussions: one each with clinical nurses (n = 5), community health nurses (n = 20), and hypertensive adults (n = 10). To further examine structural barriers, we conducted three key informant interviews with medical leadership. All interviews were audio recorded and transcribed. Thematic analysis was carried out via deductive coding based on Proctor's implementation outcomes taxonomy, which conceptualizes constructs that shape implementation, such as acceptability, adoption, appropriateness, cost, and feasibility. RESULTS Findings highlight facilitators, such as a perceived fit (appropriateness) of the core intervention components across stakeholders. The transferable components of DESERVE include: (1) a focus on risk knowledge, medication adherence, and patient-physician communication, (2) facilitation by lay workers, (3) use of patient testimonials, (4) use of a spirituality framework, and (5) application of a community-based approach. We report potential barriers that suggest adaptations to increase appropriateness and feasibility. These include addressing spiritual etiology of disease, allaying mistrust of biomedical intervention, and tailoring for gender norms. Acceptability may be a challenge among individuals with hypertension, who perceive relative advantage of alternative therapies like herbalism. Key informant interviews highlight structural barriers (high opportunity costs) among physicians, who perceive they have neither time nor capacity to educate patients. CONCLUSIONS Findings further support the need for theory-driven, evidence-based interventions among hypertensive adults in urban, multiethnic Ghana. Findings will inform implementation strategies and future research.
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Affiliation(s)
- Temitope Ojo
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA.
| | - Nessa Ryan
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
| | - Joel Birkemeier
- Global Health Program, New York University School of Global Public Health, New York, NY, USA
| | - Noa Appleton
- Department of Population Health, New York University Langone Health, New York, NY, USA
| | | | - Franklin Glozah
- Department of Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Philip Baba Adongo
- Department of Social and Behavioral Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Bernadette Boden-Albala
- Departments of Health Society and Behavior and Epidemiology, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
- Department of Neurology, School of Medicine, University of California, Irvine, CA, USA
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Almeida V, Seto T, Banna J. Considerations for Measurement of Sodium Intake. Am J Lifestyle Med 2020; 14:585-588. [PMID: 33117098 DOI: 10.1177/1559827620946737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Current salt consumption is the major risk factor for hypertension and consequently cardiovascular disease (CVD). Accurate measurement of Na intake is an important component of developing dietary interventions to treat hypertension and lower CVD risk. Given that existing methods have a large subject burden, quick and practical ways to assess Na intake in individuals, particularly in hypertensive subjects, are needed. Such tools may be used for motivation to quantify salt intake and to set targets for lifestyle changes for prevention of CVD within a clinic setting. Patients at high risk of development of CVD may be identified and targeted for motivational interviewing. They may also be used as part of cardiac rehabilitation programs and will allow individuals to measure their own intake and to see the results of their individual action.
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Affiliation(s)
- Vanessa Almeida
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Todd Seto
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, Hawaii
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Montayre J, Neville S, Dunn I, Shrestha-Ranjit J, Wright-St Clair V. What makes community-based physical activity programs for culturally and linguistically diverse older adults effective? A systematic review. Australas J Ageing 2020; 39:331-340. [PMID: 32597566 PMCID: PMC7818171 DOI: 10.1111/ajag.12815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
Objective This integrative review aimed to determine the features of effective physical activity programs for culturally and linguistically diverse (CALD) older adults. Methods We searched for relevant articles in MEDLINE, PubMed, Google Scholar, Scopus and CINAHL. Articles were selected for evaluation if they included CALD older adults and implemented physical activity programs with culturally specific design features. Consistent with the Whittemore and Knafl integrative review methodology, we used the Downs and Black Checklist, Mixed Methods Appraisal Tool and the McMaster University appraisal tool for quantitative studies to assess the quality of included articles. Results Seven articles were included in this review. Effective community‐based exercise or physical activity programs for CALD populations commonly featured close‐to‐home delivery, native language instruction and adaptations of culturally familiar activities. Conclusion The provision of culturally appropriate community‐based physical activity programs appears to support and encourage engagement among CALD older adults.
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Affiliation(s)
- Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Stephen Neville
- Ageing and Wellbeing and Head of Nursing Department, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Ihaka Dunn
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Heil DP, Angosta AD, Zhu W, Alforque-Tan R. The Energy Expenditure of Tinikling: A Culturally Relevant Filipino Dance. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2019; 12:111-121. [PMID: 30761204 PMCID: PMC6355119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Filipino Americans have higher risks for developing cardiovascular disease than many other U.S. minority groups and Caucasians. As a precursor to developing a culturally-relevant physical activity (PA) intervention targeting high-risk Filipino Americans, this study sought to evaluate the energy cost and intensity of Tinikling, or bamboo dance, a popular type of Philippine folk dance. These energy cost values were directly compared to the moderate-to-vigorous PA (MVPA) cut-points commonly used to define the PA guidelines. Twenty-two pairs of Filipino American adults performed five minutes of continuous Tinikling dance to a three-count rhythm and standardized music. Each dancer wore a portable metabolic system to directly assess the oxygen uptake from the last two minutes of dancing. These metabolic data were then transformed to units of metabolic equivalents (METs). Mean METs for all dancers (Mean ± SD; 6.9 ± 1.4 METs; P<0.001), as well as for women (6.9 ± 1.3 METs; P<0.001) and men analyzed separately (7.0 ± 1.0 METs; P<0.001), were significantly higher than both 3.0 and 6.0 MET MVPA cut-points. These results support the use of Tinikling dance with Filipino American adults as a PA intervention tool in future studies, as well as a means to satisfy the guidelines for prescribed weekly PA.
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Affiliation(s)
- Daniel P Heil
- Department of Health and Human Development, Montana State University, Bozeman, MT USA
| | | | - Wei Zhu
- Department of Health and Human Development, Montana State University, Bozeman, MT USA
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Zhu W, Lankford DE, Reece JD, Heil DP. Characterizing the Aerobic and Anaerobic Energy Costs of Polynesian Dances. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2018; 11:1156-1172. [PMID: 30338019 PMCID: PMC6179428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study characterized both aerobic and anaerobic energy expenditure (EE) for several Polynesian dances in a group of experienced professional Polynesian dancers. Thirteen men and 17 women were tested using indirect calorimetry to assess aerobic EE (and converted to METs), and fingertip blood lactate to estimate anaerobic EE, during both resting and dancing activities. Total EE was then computed as the sum of both aerobic and anaerobic activity energy expenditure (AEE, or EE above resting). One sample t-tests compared mean MET values for each type of dance to the 3-MET and 6-MET thresholds for moderate and vigorous physical activity (MVPA), respectively. Mean MET values for all dances, except the Maori poi balls dance (Mean±SD: 3.7±1.1 METs; P=0.340), were significantly >3.0 METs (5.9±3.1 METS; P=0.005 for Maori haka; 6.5±2.4 METs for Hawaiian hula; 6.6±1.2 METs for Samoan sasa; 9.6±1.5 METs for Samoan slap; 8.3±1.8 METs for Tahitian; 6.0±2.3 METs for Tongan; 7.0±2.6 METs for Fijian; P<0.001). Mean METs for Samoan slap and Tahitian were also significantly >6.0 METs (P=0.002 and P<0.001, respectively). Aerobic and anaerobic AEE contributed an average of 83.4% and 16.6%, respectively, across all Polynesian dances, with Hawaiian hula being the most aerobic (88.7%) and Samoan slap being the least aerobic (74.2%). Thus, the Polynesian dances tested not only met the current MVPA intensity guidelines (i.e., ≥3.0 METs), each dance also had a large anaerobic EE. These data suggest that Polynesian dancing is an appropriate mode of aerobic exercise for health promotion and disease prevention.
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Affiliation(s)
- Wei Zhu
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - D Eli Lankford
- Department of Human Performance and Recreation, Brigham Young University - Idaho, Rexburg, ID, USA
| | - Joel D Reece
- Department of Exercise and Sport Science, Brigham Young University - Hawaii, LAIE, HI, USA
| | - Daniel P Heil
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
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Kaholokula JK, Ing CT, Look MA, Delafield R, Sinclair K. Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders. Ann Hum Biol 2018; 45:249-263. [PMID: 29843522 PMCID: PMC6002761 DOI: 10.1080/03014460.2018.1465593] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
CONTEXT Obesity, diabetes and cardiovascular disease (CVD) have reached epidemic proportions among Native Hawaiians/Pacific Islanders (NHPI). Culturally responsive interventions that account for their interpersonal, sociocultural and socioeconomic realities are a public health priority. OBJECTIVE To describe cultural adaptation and culturally grounded approaches to developing health interventions for NHPI and to review the culturally responsive approaches used by, and outcomes from, two long-standing community-based participatory research projects (CBPR) in Hawai'i: PILI 'Ohana and KāHOLO Projects. METHODS A literature review of 14 studies from these two projects was done to exemplify the methods applied to culturally adapting existing evidence-based interventions and to developing novel interventions from the 'ground up' to address health disparities in NHPI. Of the 14 studies reviewed, 11 were studies of the clinical and behavioural outcomes of both types of interventions. RESULTS Both culturally adapted and culturally grounded approaches using community-based assets and NHPI cultural values/practices led to establishing sustainable and scalable interventions that significantly improved clinical measures of obesity, diabetes and hypertension. CONCLUSION Several recommendations are provided based on the lessons learned from the PILI 'Ohana and KāHOLO Projects. Multidisciplinary and transdisciplinary research using CBPR approaches are needed to elucidate how human biology is impacted by societal, environmental and psychological factors that increase the risk for cardiometabolic diseases among NHPI to develop more effective health promotion interventions and public health policies.
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Affiliation(s)
| | - Claire Townsend Ing
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Mele A. Look
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Rebecca Delafield
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Ka‘imi Sinclair
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University
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Kaholokula JK, Look MA, Wills TA, de Silva M, Mabellos T, Seto TB, Ahn HJ, Sinclair KA, Buchwald D. Kā-HOLO Project: a protocol for a randomized controlled trial of a native cultural dance program for cardiovascular disease prevention in Native Hawaiians. BMC Public Health 2017; 17:321. [PMID: 28415975 PMCID: PMC5392978 DOI: 10.1186/s12889-017-4246-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 04/07/2017] [Indexed: 11/26/2022] Open
Abstract
Background As a major risk factor for cardiovascular and cerebrovascular disease (CVD), hypertension affects 33% of U.S. adults. Relative to other US races and ethnicities, Native Hawaiians have a high prevalence of hypertension and are 3 to 4 times more likely to have CVD. Effective, culturally-relevant interventions are needed to address CVD risk in this population. Investigators of the Kā-HOLO Project developed a study design to test the efficacy of an intervention that uses hula, a traditional Hawaiian dance, to increase physical activity and reduce CVD risk. Methods A 2-arm randomized controlled trial with a wait-list control design will be implemented to test a 6-month intervention based on hula to manage blood pressure and reduce CVD risk in 250 adult Native Hawaiians with diagnosed hypertension. Half of the sample will be randomized to each arm, stratified across multiple study sites. Primary outcomes are reduction in systolic blood pressure and improvement in CVD risk as measured by the Framingham Risk Score. Other psychosocial and sociocultural measures will be included to determine mediators of intervention effects on primary outcomes. Assessments will be conducted at baseline, 3 months, and 6 months for all participants, and at 12 months for intervention participants only. Discussion This trial will elucidate the efficacy of a novel hypertension management program designed to reduce CVD risk in an indigenous population by using a cultural dance form as its physical activity component. The results of this culturally-based intervention will have implications for other indigenous populations globally and will offer a sustainable, culturally-relevant means of addressing CVD disparities. Trial registration ClinicalTrials.gov: NCT02620709, registration date November 23, 2015.
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Affiliation(s)
| | - Mele A Look
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, USA.,Hālau Mōhala 'Ilima, Kailua, USA
| | | | | | - Tricia Mabellos
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, USA
| | - Todd B Seto
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, USA
| | - Hyeong Jun Ahn
- Department of Complementary and Integrative Medicine, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, USA
| | - Ka'imi A Sinclair
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, USA
| | - Dedra Buchwald
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University, Seattle, USA
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Chung-Do JJ, Look MA, Mabellos T, Trask-Batti M, Burke K, Mau MKLM. Engaging Pacific Islanders in Research: Community Recommendations. Prog Community Health Partnersh 2016; 10:63-71. [PMID: 27018355 DOI: 10.1353/cpr.2016.0002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Health disparities continue to persist among Native Hawaiian and Pacific Islander (NHPI) communities. OBJECTIVES This study sought to understand the perspectives of community organizations in the Ulu Network on how researchers can collaborate with communities to promote community wellness. METHODS Key informant interviews and small group interviews were conducted with the leadership in the Ulu Network. RESULTS Five themes were identified that highlight the importance of investing time and commitment to build authentic relationships, understanding the diversity and unique differences across Pacific communities, ensuring that communities receive direct and meaningful benefits, understanding the organizational capacity, and initiating the dialog early to ensure that community perspectives are integrated in every stage of research. CONCLUSIONS Increasing capacity of researchers, as well as community organizations, can help build toward a more equitable and meaningful partnership to enhance community wellness.
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20
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Approaches to improve cardiac rehabilitation enrollment. Int J Cardiol 2016; 206:54-5. [PMID: 26774831 DOI: 10.1016/j.ijcard.2016.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/02/2016] [Indexed: 11/22/2022]
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Gallagher R, Neubeck L, Du H, Astley C, Berry NM, Hill MN, Clark R. Facilitating or getting in the way? The effect of clinicians' knowledge, values and beliefs on referral and participation. Eur J Prev Cardiol 2016; 23:1141-50. [PMID: 26830147 DOI: 10.1177/2047487316630085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/12/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the compelling evidence of the benefits of cardiac rehabilitation (CR) on risk factor modification, quality of life and mortality reduction, a significant proportion of eligible patients are not referred or do not participate. Factors influencing CR referral and participation are complex and are likely patient, referral system and clinician-related. Little is known about clinician-related factors, which include attitudes, values and beliefs towards CR, or how these factors affect patient referral and attendance. This review examines the current evidence in the literature in relation to clinicians' attitudes, values and beliefs about CR. METHODS A review of the literature was conducted on studies in relation to clinicians' attitudes, values and beliefs toward CR. An expert consensus methodology was used to develop the concepts presented in this paper. RESULTS Besides guidelines, a range of other factors influence clinicians' view about CR. This review suggests that clinicians lacking cardiac qualifications may have limited knowledge and awareness of CR and its benefits. Low agreement among clinicians on who is more likely to benefit from CR was also identified. Clinicians' personal lifestyle and health belief, the availability and quality of local the CR programme, and the lack of a standard administrative process of referral can also hinder the referral of patients to CR. CONCLUSIONS Clinician-related factors are important to consider in relation to CR referral and participation. Education for clinicians, discussion of local services and the support of an efficacious system at programme and organisation levels are essential.
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Affiliation(s)
- Robyn Gallagher
- Sydney Nursing School, The University of Sydney, Australia Faculty of Health, University of Technology, Sydney, Australia
| | - Lis Neubeck
- Sydney Nursing School, The University of Sydney, Australia
| | - Huiyun Du
- School of Nursing and Midwifery, Flinders University, Australia
| | - Carolyn Astley
- Sydney Nursing School, The University of Sydney, Australia Faculty of Health, University of Technology, Sydney, Australia Heart Foundation SA, Flinders University, Australia
| | - Narelle M Berry
- School of Nursing and Midwifery, Flinders University, Australia
| | - Martha N Hill
- School of Nursing, The Johns Hopkins University, USA
| | - Robyn Clark
- Faculty of Health, University of Technology, Sydney, Australia School of Nursing and Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Australia Sansom Institute, University of South Australia, Australia South Australian Health and Medical Research Institute, Australia
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Cultural Dance Program Improves Hypertension Management for Native Hawaiians and Pacific Islanders: a Pilot Randomized Trial. J Racial Ethn Health Disparities 2015; 4:35-46. [PMID: 27294768 PMCID: PMC5283501 DOI: 10.1007/s40615-015-0198-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/29/2015] [Accepted: 11/27/2015] [Indexed: 02/07/2023]
Abstract
Objective Native Hawaiians and Pacific Islanders (NHPI) bear an unequal burden of hypertension and cardiovascular disease. Hula, the traditional dance of Hawaii, has shown to be a culturally meaningful form of moderate-vigorous physical activity for NHPI. A pilot study was done in Honolulu, Hawaii, to test a 12-week hula-based intervention, coupled with self-care education, on blood pressure management in NHPI with hypertension in 2013. Method NHPI with a systolic blood pressure (SBP) ≥140 mmHg were randomized to the intervention (n = 27) or a wait-list control (n = 28). Blood pressure, physical functioning, and eight aspects of health-related quality of life (HRQL) were assessed. Results The intervention resulted in a reduction in SBP compared to control (−18.3 vs. −7.6 mmHg, respectively, p ≤ 0.05) from baseline to 3-month post-intervention. Improvements in HRQL measures of bodily pain and social functioning were significantly associated with SBP improvements in both groups. Conclusion Using hula as the physical activity component of a hypertension intervention can serve as a culturally congruent strategy to blood pressure management in NHPI with hypertension. Trial registration clinicaltrials.gov Identifier: NCT01995812
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Braga HDO, Gonzáles AI, Sties SW, Carvalho GMDD, Netto AS, Campos OA, Lima DP, Carvalho TD. Protocolo de samba brasileiro para reabilitação cardíaca. REV BRAS MED ESPORTE 2015. [DOI: 10.1590/1517-869220152105136354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
RESUMO Introdução: O samba é uma dança de movimentos intensos e variados que proporcionam alegria e boa resposta cronotrópica, sendo plausível a expectativa de que beneficie o sistema cardiovascular. Objetivo: Desenvolver e avaliar um protocolo de samba brasileiro visando o treinamento físico na reabilitação cardíaca. Métodos: Quinze indivíduos com doença arterial coronariana estável, idade 60,74±5,96 anos, realizaram teste cardiopulmonar máximo com determinação da frequência cardíaca (FC) correspondente ao VO2pico e primeiro e segundo limiares ventilatórios. Durante seis sessões executaram vinte passos de samba, em três andamentos musicais, classificados por metrônomo em lento, médio ou rápido. Posteriormente, realizaram três sessões para verificar o comportamento da FC e a percepção de esforço. A análise descritiva foi utilizada na caracterização da amostra e verificação da FC, o teste t ou teste de Wilcoxon foram utilizados para comparar o comporta-mento da FC (nas diferentes sessões), com nível de significância de 5%. Resultados: Houve boa adaptação aos passos de samba, com FC situando-se entre 62% e 72% da FCpico. Durante as sessões de dança os pacientes mantiveram-se em 86 ±4,17% do tempo na zona alvo proposta para treinamento físico na reabilitação (60% a 90% da FCpico) e 77±2,26% do tempo na zona alvo considerada ideal, com a FC situada entre o primeiro e o segundo limiares ventilatórios. Durante todo o tempo os pacientes referiram percepção de esforço de leve a moderada. Conclusão: Os pacientes demonstraram boa adaptação ao protocolo de samba, que se mostrou em condições de ser adotado como proposta de treinamento na reabilitação cardíaca.
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Sentell T, Miyamura J, Ahn HJ, Chen JJ, Seto T, Juarez D. Potentially Preventable Hospitalizations for Congestive Heart Failure Among Asian Americans and Pacific Islanders in Hawai'i. J Immigr Minor Health 2015; 17:1289-97. [PMID: 25204624 PMCID: PMC4362878 DOI: 10.1007/s10903-014-0098-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Many congestive heart failure (CHF) hospitalizations are considered potentially preventable with access to high-quality primary care. Some Asian American and Pacific Islander groups have poor access to health care compared to Whites, yet CHF preventable hospitalizations are understudied in these groups. Hawai'i hospitalizations from December 2006 to December 2010 for Chinese, Japanese, Native Hawaiian, Filipino, and Whites aged 18+ years were considered (N = 245,435). CHF preventable hospitalizations were compared in multivariable models by age group (<65 vs. 65+) and gender. Native Hawaiians and Filipinos with CHF preventable hospitalizations were significantly (p < 0.001) younger than other racial/ethnic groups. In adjusted models, Native Hawaiians and Filipinos of all age and gender combinations had significantly higher CHF hospitalization rates than Whites as did Chinese women 65+. High preventable CHF hospitalization rates are seen in some Asian and Pacific Islander groups, especially Native Hawaiians and Filipinos, who have these hospitalizations at younger ages than other studied groups.
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Affiliation(s)
- Tetine Sentell
- Office of Public Health Studies, University of Hawai'i at Manoa, 1960 East-West Road, Biomed T102, Honolulu, HI, 96822, USA,
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Listening to the voices of native Hawaiian elders and ‘ohana caregivers: discussions on aging, health, and care preferences. J Cross Cult Gerontol 2015; 29:131-51. [PMID: 24659060 DOI: 10.1007/s10823-014-9227-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Native Hawaiians, the indigenous people of Hawai’i, are affected by varying social and health disparities that result in high prevalence of chronic disease, early onset of disability, and shorter life expectancy compared to other ethnic groups in Hawai’i. Six listening meetings were conducted, involving 41 community-dwelling kūpuna (Native Hawaiian elders) and ‘ohana (family) caregivers to investigate health and care preferences that offer the potential for improving well-being in later life for Native Hawaiian elders. As background, we provide three explanatory perspectives and theories—life course perspective, minority stress theory, and historical trauma—that guided the design of this study and provided the study’s context. A number of overarching themes and subthemes were identified, some of which point to universal concerns with age and caregiving (such as challenges and costs associated with growing old and caregiving) and others that are culturally specific (such as influence of culture and social stressors, including discrimination, on health needs and care preferences). Results give further support to the urgency of affordable, accessible, and acceptable programs and policies that can respond to the growing health and care needs of native elders and family caregivers.
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Maskarinec GG, Look M, Tolentino K, Trask-Batti M, Seto T, de Silva M, Kaholokula JK. Patient perspectives on the Hula Empowering Lifestyle Adaptation Study: benefits of dancing hula for cardiac rehabilitation. Health Promot Pract 2014; 16:109-14. [PMID: 24677383 DOI: 10.1177/1524839914527451] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Hula Empowering Lifestyle Adaption Study, funded by the National Institute on Minority Health and Health Disparities, was a 5-year research trial evaluating the impact of the traditional Native Hawaiian dance form, hula, as an exercise modality for cardiac rehabilitation, compared with usual care, on individuals recently hospitalized for a cardiac event or who had recently undergone coronary artery bypass surgery. METHOD AND RESULTS Seeking to learn what physical, mental, spiritual, and social effects the intervention may have had for participants, we interviewed 20 of a total of 35 patients who were enrolled in the dance arm of the study. Classical thematic triangulation analysis was used. Participants recognized that hula's coordination of body, mind, and spirit as a group activity deepened their appreciation of and connections to Hawaiian culture. This was true for those who were Native Hawaiian, connecting to their own cultural heritage, as well as for non-Native Hawaiians, who found that it improved their appreciation of the surrounding cultural traditions of the host culture where they now live. CONCLUSIONS Not only was hula a safe activity that improved functional capacity, participants also regarded its significant sociocultural aspects-even for participants who are not Native Hawaiian -as enhancing its value and meaningfulness. Learning the words of well-known Hawaiian songs provided additional long-term cues that encouraged "ownership" of the therapy and acted as practical reminders of the importance of exercise and lifestyle moderation while also offering new spiritual connections to the surrounding social environment.
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Affiliation(s)
| | - Mele Look
- University of Hawai'i, Honolulu, HI, USA Hālau Mōhala 'Ilima, Kailua, HI, USA
| | | | | | - Todd Seto
- Queens Medical Center, Honolulu, HI, USA
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Chapman R, Martin C, Smith T. Evaluation of staff cultural awareness before and after attending cultural awareness training in an Australian emergency department. Int Emerg Nurs 2013; 22:179-84. [PMID: 24412133 DOI: 10.1016/j.ienj.2013.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/31/2013] [Accepted: 11/02/2013] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Cultural awareness of emergency department staff is important to ensure delivery of appropriate health care to people from all ethnic groups. Cultural awareness training has been found to increase knowledge about other cultures and is widely used as a means of educating staff, however, debate continues as to the effectiveness of these programs. AIM To determine if an accredited cultural awareness training program affected emergency department staff knowledge, familiarity, attitude of and perception towards Australian Aboriginal and Torres Strait Islander people. METHOD One group pre-test and post-test intervention study compared the cultural awareness of 44 emergency department staff towards Aboriginal and Torres Strait Islander people before and after training. The cultural awareness training was delivered in six hours over three sessions and was taught by an accredited cultural awareness trainer. RESULTS The cultural awareness training changed perception but did not affect attitude towards Aboriginal and Torres Strait Islander people in this group. CONCLUSION Future strategies to improve staff cultural awareness need to be investigated, developed, implemented and evaluated.
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Affiliation(s)
- Rose Chapman
- Monash Health, Victoria, 135 David Street, Dandenong, Vic 3175, Australia; Australian Catholic University, 115 Victoria Parade, Fitzroy, Vic 3065, Australia.
| | - Catherine Martin
- Monash Health, Victoria, 135 David Street, Dandenong, Vic 3175, Australia; Australian Catholic University, 115 Victoria Parade, Fitzroy, Vic 3065, Australia
| | - Tammy Smith
- Monash Health, Victoria, 135 David Street, Dandenong, Vic 3175, Australia
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Usagawa T, Look M, de Silva M, Stickley C, Kaholokula JK, Seto T, Mau M. Metabolic equivalent determination in the cultural dance of hula. Int J Sports Med 2013; 35:399-402. [PMID: 24203801 DOI: 10.1055/s-0033-1353213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ethnic minorities share an unequal burden of cardiometabolic syndrome. Physical activity (PA) has been shown to be an important factor for improving the outcomes of these diseases. While metabolic equivalents (METs) have been calculated for diverse activities, most cultural activities have not been evaluated. Hula, the traditional dance of Native Hawaiians, is practiced by men and women of all ages but its MET value is unknown. To our knowledge, this is the first scientific evaluation of energy expenditure of hula. 19 competitive hula dancers performed 2 dance sets of low- and high-intensity hula. METs were measured with a portable indirect calorimetry device. Mean and standard deviations were calculated for all the variables. A 2-way ANOVA was conducted to identify differences for gender and intensity. The mean MET were 5.7 (range 3.17-9.77) and 7.55 (range 4.43-12.0) for low-intensity and high-intensity, respectively. There was a significant difference between intensities and no significant difference between genders. This study demonstrates that the energy expenditure of both low- and high-intensity hula met the recommended guidelines for moderate and vigorous intensity exercise, respectively, and that hula can be utilized as a prescribed PA.
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Affiliation(s)
- T Usagawa
- Department of Native Hawaiian Health, University of Hawaii, Honolulu, United States
| | - M Look
- Department of Native Hawaiian Health, University of Hawaii, Honolulu, United States
| | - M de Silva
- Hālau Mōhala ‛Ilima, Hālau Mōhala ‛Ilima, Kailua, United States
| | - C Stickley
- Department of Kinesiology and Rehabilitation Science, University of Hawaii, Honolulu, United States
| | - J K Kaholokula
- Department of Native Hawaiian Health, University of Hawaii, Honolulu, United States
| | - T Seto
- Department of Native Hawaiian Health, University of Hawaii, Honolulu, United States
| | - M Mau
- Department of Native Hawaiian Health, University of Hawaii, Honolulu, United States
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