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Cortés DE, Zack RM, Odayar V, Moyer M, Kumar A, Maia JL, Bronico JVR, Granick J. The Impact of the COVID-19 Pandemic on Food Access: Insights from First-Person Accounts in a Safety-Net Health Care System. J Health Care Poor Underserved 2024; 35:37-54. [PMID: 38661858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The COVID-19 pandemic disproportionately affected populations that were already facing socioeconomic disadvantages and limited access to health care services. The livelihood of millions was further compromised when strict shelter-in-place measures forced them out of their jobs. The way that individuals accessed food during the early stages of the COVID-19 pandemic drastically changed as a result of declines in household income, food chain supply disruptions, and social distance measures. This qualitative study examined the food access experiences of participants enrolled in a safety-net health care system-based, free, monthly fruit and vegetable market in the Metro Boston area during the first six months of the COVID-19 pandemic. The findings offer rich qualitative information to understand the financial repercussions of the pandemic on food access.
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Zack RM, Rodríguez Bronico JV, Babbin M, Nguyen T, Weil R, Granick J, Fiechtner L, Mulugeta W, Odayar V, Cortés DE. Facilitators and Barriers to Patient Attendance at a Free Health Center Produce Market. Am J Prev Med 2022; 63:S131-S143. [PMID: 35987525 PMCID: PMC10680439 DOI: 10.1016/j.amepre.2022.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patient participation in healthcare system‒sponsored efforts to address food insecurity varies widely. This mixed-methods study sought to understand the patient sociodemographic factors associated with and barriers and facilitators to the use of a monthly produce market held at Cambridge Health Alliance in partnership with The Greater Boston Food Bank. METHODS Baseline surveys (N=715) were conducted from February 2019 to March 2020 before market attendance, followed by 1-year follow-up surveys (n=514) and qualitative interviews (n=45). Robust Poisson regression estimated associations between sociodemographic characteristics and market attendance. Analyses were conducted from 2021 to 2022. RESULTS A total of 37.1% attended the market ≥1 time. Market attendance was associated with being aged 30-49 years (Risk Ratio (RR)=1.36, 95% CI=1.00, 1.86), having a monthly household income <$1,000 (RR=1.73, 95% CI=1.29, 2.32), identifying as Asian (RR=2.48, 95% CI=1.58, 3.89), having a preferred language for medical care other than English (RR=1.35, 95% CI=1.03, 1.76), being retired (RR=1.90, 95% CI=1.17, 3.08), and living in the city of the market's location (RR=1.36, 95% CI=1.12, 1.63). Barriers included limited time (28%), work conflict (23%), forgetfulness (23%), and not knowing market location/date (22%). Interviews revealed that accessibility barriers (e.g., limited market hours, transportation issues, competing demands, medical conditions, long lines) were obstacles to attendance, whereas access to novel, healthy foods motivated attendance. CONCLUSIONS Healthcare-based food distributions have the potential to reach patients with unmet food needs who cannot or would not access other forms of food assistance. Time constraints, physical limitations, and transportation challenges impact attendance; program modifications are necessary to improve accessibility.
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Affiliation(s)
- Rachel M Zack
- The Greater Boston Food Bank, Boston, Massachusetts.
| | | | - Molly Babbin
- Community Health Improvement Department, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Tra Nguyen
- The Greater Boston Food Bank, Boston, Massachusetts
| | - Rachel Weil
- The Greater Boston Food Bank, Boston, Massachusetts
| | - Jean Granick
- Community Health Improvement Department, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Lauren Fiechtner
- The Greater Boston Food Bank, Boston, Massachusetts; Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts; Division of Gastroenterology and Nutrition, Mass General Hospital for children, Boston, Massachusetts
| | | | - Varshini Odayar
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Dharma E Cortés
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts
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Progovac AM, Tepper MC, Stephen Leff H, Cortés DE, (Cohen) Colts A, Ault-Brutus A, Hou SSY, Lu F, Banbury S, Sunder D, Cook BL. Patient and provider perception of appropriateness, acceptability, and feasibility of behavioral health home (BHH) core components based on program implementation in an urban, safety-net health system. Implement Res Pract 2021; 2:26334895211043791. [PMID: 37089996 PMCID: PMC9978621 DOI: 10.1177/26334895211043791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This manuscript evaluates patient and provider perspectives on the core components of a Behavioral Health Home (BHH) implemented in an urban, safety-net health system. The BHH integrated primary care and wellness services (e.g., on-site Nurse Practitioner and Care Manager, wellness groups and tools, population health management) into an existing outpatient clinic for people with serious mental illness (SMI). Methods As the qualitative component of a Hybrid Type I effectiveness-implementation study, semi-structured interviews were conducted with providers and patients 6 months after program implementation, and responses were analyzed using thematic analysis. Valence coding (i.e., positive vs. negative acceptability) was also used to rate interviewees' transcriptions with respect to their feedback of the appropriateness, acceptability, and feasibility/sustainability of 9 well-described and desirable Integrated Behavioral Health Core components (seven from prior literature and two additional components developed for this intervention). Themes from the thematic analysis were then mapped and organized by each of the 9 components and the degree to which these themes explain valence ratings by component. Results Responses about the team-based approach and universal screening for health conditions had the most positive valence across appropriateness, acceptability, and feasibility/sustainability by both providers and patients. Areas of especially high mismatch between perceived provider appropriateness and measures of acceptability and feasibility/sustainability included population health management and use of evidence-based clinical models to improve physical wellness where patient engagement in specific activities and tools varied. Social and peer support was highly valued by patients while incorporating patient voice was also found to be challenging. Conclusions Findings reveal component-specific challenges regarding the acceptability, feasibility, and sustainability of specific components. These findings may partly explain mixed results from BHH models studied thus far in the peer-reviewed literature and may help provide concrete data for providers to improve BHH program implementation in clinical settings. Plain language abstract Many people with serious mental illness also have medical problems, which are made worse by lack of access to primary care. The Behavioral Health Home (BHH) model seeks to address this by adding primary care access into existing interdisciplinary mental health clinics. As these models are implemented with increasing frequency nationwide and a growing body of research continues to assess their health impacts, it is crucial to examine patient and provider experiences of BHH implementation to understand how implementation factors may contribute to clinical effectiveness. This study examines provider and patient perspectives of acceptability, appropriateness, and feasibility/sustainability of BHH model components at 6-7 months after program implementation at an urban, safety-net health system. The team-based approach of the BHH was perceived to be highly acceptable and appropriate. Although providers found certain BHH components to be highly appropriate in theory (e.g., population-level health management), their acceptability of these approaches as implemented in practice was not as high, and their feedback provides suggestions for model improvements at this and other health systems. Similarly, social and peer support was found to be highly appropriate by both providers and patients, but in practice, at months 6-7, the BHH studied had not yet developed a process of engaging patients in ongoing program operations that was highly acceptable by providers and patients alike. We provide these data on each specific BHH model component, which will be useful to improving implementation in clinical settings of BHH programs that share some or all of these program components.
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Affiliation(s)
- Ana M Progovac
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - Miriam C Tepper
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - H. Stephen Leff
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dharma E Cortés
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | | | - Andrea Ault-Brutus
- Office of Health Equity, Nassau County Department of
Health, Mineola, NY, USA
| | - Sherry S-Y Hou
- Department of Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Frederick Lu
- Boston University School of
Medicine, Boston, MA, USA
| | - Sara Banbury
- University of Pennsylvania Perelman
School of Medicine, Philadelphia, PA, USA
| | | | - Benjamin L Cook
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
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Levison JH, García-Fragoso L, García García IE, Del Cueto P, Gely L, Levis MF, Valencia-Prado M, Cortés DE. 1139. Adherence to Zika virus-related Pediatric Follow-up Care in Puerto Rico. Open Forum Infect Dis 2020. [PMCID: PMC7776484 DOI: 10.1093/ofid/ofaa439.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Over three thousand children in Puerto Rico were potentially exposed to Zika virus infection during pregnancy during the 2016 Zika virus epidemic. This congenital exposure is an established risk factor for birth defects and neurodevelopmental abnormalities, which may appear after birth. Puerto Rico guidelines require consistent pediatric monitoring for early identification and intervention of children up to age five. Methods Our objective was to assess factors that influence caregiver adherence to Zika-related follow-up pediatric services in Puerto Rico. We conducted qualitative semi-structured focus groups and individual interviews with 57 individuals, including 35 caregivers (aged ≥18 years and a primary caregiver for a child with laboratory evidence of confirmed or possible Zika virus infection during pregnancy) and 22 healthcare providers or service coordinators. We explored participants’ views on barriers to Zika-related pediatric services and suggestions for improving appointment attendance. Interviews were recorded, transcribed, and translated. We developed and applied a coding scheme based on barriers and facilitators from the Andersen Model of Health Care Utilization and Katz Model for Adolescent Vaccine Adherence (a multi-step process influenced by adolescent and caregiver factors). Data were analyzed using thematic analysis. Results Three themes influencing adherence to Zika-related pediatric follow-up care were consistently reported throughout the interviews and focus groups discussions: (1) logistics of getting child to appointments based on clinic location, availability and costs associated with transportation, and physical requirements to transport child or multiple children; (2) complexity of requirements for follow-up appointments; and (3) caregiver burden including emotional, social, and time. Conclusion Barriers to Zika-related pediatric follow-up care in Puerto Rico are complex and multi-level. Core intervention targets should include caregiver burden, health system navigation, and coaching caregivers in communication with pediatric providers. Use of a caregiver-delivered manualized intervention led by community health workers seems appropriate to achieve these goals. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Julie H Levison
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Ines E García García
- University of Puerto Rico School of Medicine, San Juan, Not Applicable, Puerto Rico
| | - Paola Del Cueto
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leticia Gely
- Univeristy of Puerto Rico School of Medicine, Río Piedras, Not Applicable, Puerto Rico
| | - Maria F Levis
- Impactivo, LLC, San Juan, Not Applicable, Puerto Rico
| | | | - Dharma E Cortés
- Cambridge Health Alliance and Harvard Medical School, Boston, Massachusetts
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Progovac AM, Cortés DE, Chambers V, Delman J, Delman D, McCormick D, Lee E, De Castro S, Sánchez Román MJ, Kaushal NA, Creedon TB, Sonik RA, Quinerly CR, Rodgers CRR, Adams LB, Nakash O, Moradi A, Abolaban H, Flomenhoft T, Nabisere R, Mann Z, Hou SSY, Shaikh FN, Flores M, Jordan D, Carson NJ, Carle AC, Lu F, Tran NM, Moyer M, Cook BL. Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences. Qual Health Res 2020; 30:1833-1850. [PMID: 32713258 PMCID: PMC10797602 DOI: 10.1177/1049732320937663] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient-provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.
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Affiliation(s)
- Ana M. Progovac
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Dharma E. Cortés
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jonathan Delman
- University of Massachusetts Medical School, Worcester, USA
- Massachusetts Mental Health Center, Boston, USA
| | | | - Danny McCormick
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Esther Lee
- Cambridge Health Alliance, Massachusetts, USA
- Columbia Mailman School of Public Health, New York City, New York, USA
| | | | - María José Sánchez Román
- Cambridge Health Alliance, Massachusetts, USA
- George Washington University, District of Columbia, USA
| | | | | | - Rajan A. Sonik
- Cambridge Health Alliance, Massachusetts, USA
- AltaMed Institute for Health Equity, Los Angeles, California, USA
| | - Catherine Rodriguez Quinerly
- The Transformation Center, Roxbury, Massachusetts, USA
- Dr. Solomon Carter Fuller Mental Health Center, Boston, Massachusetts, USA
| | | | - Leslie B. Adams
- Cambridge Health Alliance, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | - Ora Nakash
- Smith College School for Social Work, Northampton, Massachusetts, USA
| | - Afsaneh Moradi
- Cambridge Health Alliance, Massachusetts, USA
- Blair Athol Medical Center, South Australia, Australia
| | - Heba Abolaban
- Cambridge Health Alliance, Massachusetts, USA
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Tali Flomenhoft
- Cambridge Health Alliance, Massachusetts, USA
- Brandeis University, Waltham, Massachusetts, USA
| | | | - Ziva Mann
- Cambridge Health Alliance, Massachusetts, USA
- Ascent Leadership Networks, New York City, New York, USA
| | - Sherry Shu-Yeu Hou
- Cambridge Health Alliance, Massachusetts, USA
- McGill University, Montreal, Quebec, Canada
| | | | | | | | - Nicholas J. Carson
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Adam C. Carle
- James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Psychology, University of Cincinnati College of Arts and Sciences, Cincinnati, OH, USA
| | - Frederick Lu
- Cambridge Health Alliance, Massachusetts, USA
- Boston University School of Medicine, Massachusetts, USA
| | | | - Margo Moyer
- Cambridge Health Alliance, Massachusetts, USA
| | - Benjamin L. Cook
- Cambridge Health Alliance, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Progovac AM, Cortés DE, Chambers V, Adams LB, Jean‐Claude S, Willison CE, Flores M, Creedon TB, Cook BL. Addressing Major Health Disparities Related to Coronavirus for People With Behavioral Health Conditions Requires Strength-Based Capacity Building and Intentional Community Partnership. World Med Health Policy 2020; 12:242-255. [PMID: 32904922 PMCID: PMC7461022 DOI: 10.1002/wmh3.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/27/2020] [Indexed: 11/07/2022]
Abstract
Far from being an equalizer, as some have claimed, the COVID‐19 pandemic has exposed just how vulnerable many of our social, health, and political systems are in the face of major public health shocks. Rapid responses by health systems to meet increased demand for hospital beds while continuing to provide health services, largely via a shift to telehealth services, are critical adaptations. However, these actions are not sufficient to mitigate the impact of coronavirus for people from marginalized communities, particularly those with behavioral health conditions, who are experiencing disproportional health, economic, and social impacts from the evolving pandemic. Helping these communities weather this storm requires partnering with existing community‐based organizations and local governments to rapidly and flexibly meet the needs of vulnerable populations.
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Lee CS, Colby SM, Rohsenow DJ, Martin R, Rosales R, McCallum TT, Falcon L, Almeida J, Cortés DE. A randomized controlled trial of motivational interviewing tailored for heavy drinking latinxs. J Consult Clin Psychol 2019; 87:815-830. [PMID: 31403817 DOI: 10.1037/ccp0000428] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This randomized controlled trial (Clinicaltrials.gov NCT [01996280]) compared the efficacy of a brief motivational interview (MI) adapted to address social stressors and cultural influences (culturally adapted MI [CAMI]) to a standard MI for heavy-drinking Latinxs. CAMI was hypothesized to reduce heavy drinking days and frequency of alcohol-related consequences more than MI. Moderators of treatment effect were explored. METHOD Latinxs (N = 296; 63% male, M age = 41 years) who reported 2+ past month heavy drinking episodes received a single-session (MI/CAMI), with assessments at baseline and 3, 6, and 12 months. RESULTS Both conditions showed significant reductions in percent heavy drinking days and frequency of alcohol-related consequences through 12-month follow-up when compared with baseline; reductions were not significantly different by condition. Acculturation moderated treatment condition effect on alcohol-related problems at 3 months (d = .22, 95% CI [.02, .41]); less acculturated individuals experienced less frequent consequences of drinking after CAMI than MI (d = .34, 95% CI [-.60, -.08]). Discrimination moderated condition effect on frequency of alcohol-related consequences at 3 months (d = .17, 95% CI [-.33, -.01]); individuals with higher levels of baseline discrimination had less frequent consequences after CAMI than MI (d = .20, 95% CI [-.39, -.01]). CONCLUSIONS Participants in both groups improved with no significant differences between groups. Moderation effects suggest that cultural adaptation has particular benefit for more vulnerable individuals and support the theory of change in this adaptation model. MI is efficacious with Latinx heavy drinkers and should be used to mitigate health disparities related to alcohol misuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Christina S Lee
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University
| | | | | | | | | | | | - Luis Falcon
- College of Fine Arts, Humanities, and Social Sciences, University of Massachusetts at Lowell
| | | | - Dharma E Cortés
- Health Equity Research Lab, Cambridge Health Alliance/Harvard Medical School
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Cerda Diez M, E. Cortés D, Trevino-Talbot M, Bangham C, Winter MR, Cabral H, Norkunas Cunningham T, M. Toledo D, J. Bowen D, K. Paasche-Orlow M, Bickmore T, Wang C. Designing and Evaluating a Digital Family Health History Tool for Spanish Speakers. Int J Environ Res Public Health 2019; 16:E4979. [PMID: 31817849 PMCID: PMC6950582 DOI: 10.3390/ijerph16244979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022]
Abstract
Digital family health history tools have been developed but few have been tested with non-English speakers and evaluated for acceptability and usability. This study describes the cultural and linguistic adaptation and evaluation of a family health history tool (VICKY: VIrtual Counselor for Knowing Your Family History) for Spanish speakers. In-depth interviews were conducted with 56 Spanish-speaking participants; a subset of 30 also participated in a qualitative component to evaluate the acceptability and usability of Spanish VICKY. Overall, agreement in family history assessment was moderate between VICKY and a genetic counselor (weighted kappa range: 0.4695 for stroke-0.6615 for heart disease), although this varied across disease subtypes. Participants felt comfortable using VICKY and noted that VICKY was very likeable and possessed human-like characteristics. They reported that VICKY was very easy to navigate, felt that the instructions were very clear, and thought that the time it took to use the tool was just right. Spanish VICKY may be useful as a tool to collect family health history and was viewed as acceptable and usable. The study results shed light on some cultural differences that may influence interactions with family history tools and inform future research aimed at designing and testing culturally and linguistically diverse digital systems.
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Affiliation(s)
- Maria Cerda Diez
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Dharma E. Cortés
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA 02141, USA;
- Department of Psychiatry, Harvard Medical School, Cambridge, MA 02139, USA
| | - Michelle Trevino-Talbot
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Candice Bangham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA 02118, USA;
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Tricia Norkunas Cunningham
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
| | - Diana M. Toledo
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA;
| | - Deborah J. Bowen
- Department of Bioethics and Humanities, School of Public Health, University of Washington, Seattle, WA 98195, USA;
| | | | - Timothy Bickmore
- College of Computer and Information Science, Northeastern University, Boston, MA 02115, USA;
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA; (M.C.D.); (M.T.-T.); (C.B.); (T.N.C.)
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Kressin NR, Elwy AR, Glickman M, Orner MB, Fix GM, Borzecki AM, Katz LA, Cortés DE, Cohn ES, Barker A, Bokhour BG. Beyond Medication Adherence: The Role of Patients' Beliefs and Life Context in Blood Pressure Control. Ethn Dis 2019; 29:567-576. [PMID: 31641324 DOI: 10.18865/ed.29.4.567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective Despite numerous interventions to address adherence to antihypertensive medications, continued high rates of uncontrolled blood pressure (BP) suggest a need to better understand patient factors beyond adherence associated with BP control. We examined how patients' BP-related beliefs, and aspects of life context affect BP control, beyond medication adherence. Methods We conducted a cross-sectional telephone survey of primary care patients with hypertension between 2010 and 2011 (N=103; 93 had complete data on all variables and were included in the regression analyses). We assessed patient sociodemographics (including race/ethnicity), medication adherence, BP-related beliefs, aspects of life context, and used clinical BP assessments. Results Regression models including sociodemographics, medication adherence, and either beliefs or context consistently predicted BP control. Adding context after beliefs added no predictive value while adding beliefs after context significantly predicted BP control. Practical Implications Results suggest that when clinicians must choose a dimension on which to intervene, focusing on beliefs would be the most fruitful approach to effecting change in BP control.
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Affiliation(s)
- Nancy R Kressin
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Section of General Internal Medicine, Boston University School of Medicine; Boston, MA
| | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University; Providence, RI
| | - Mark Glickman
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Department of Statistics, Harvard University; Boston, MA
| | - Michelle B Orner
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Boston University School of Public Health; Boston, MA
| | - Ann M Borzecki
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Section of General Internal Medicine, Boston University School of Medicine; Boston, MA.,Boston University School of Public Health; Boston, MA
| | - Lois A Katz
- VA New York Harbor Healthcare System; New, York, NY.,New York University School of Medicine; New York, NY
| | - Dharma E Cortés
- Cambridge Health Alliance; Cambridge, MA.,Harvard Medical School; Cambridge, MA
| | - Ellen S Cohn
- Boston University, Sargent College of Health and Rehabilitation Sciences; Boston, MA
| | - Anna Barker
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial Veterans Hospital; Bedford, MA.,Boston University School of Public Health; Boston, MA
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11
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Amaro H, Cortés DE, Garcia S, Duan L, Black DS. Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers. Am J Public Health 2017; 107:800-806. [PMID: 28323473 DOI: 10.2105/ajph.2017.303725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping. METHODS From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention). RESULTS Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group. CONCLUSIONS Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home.
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Affiliation(s)
- Hortensia Amaro
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - Dharma E Cortés
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - Samantha Garcia
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - Lei Duan
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - David S Black
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
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Yinusa-Nyahkoon L, Cohn ES, Tickle-Degnen L, Cortés DE, Lieu TA, Bokhour BG. Examining Routines to Understand the Ecological Context: Managing Childhood Asthma. OTJR: Occupation, Participation and Health 2016. [DOI: 10.1177/15394492070270s121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Leff HS, Chow C, Wieman DA, Ostrow L, Cortés DE, Harris T. Measurement of Perceived and Technical Quality of Care for Depression in Racially and Ethnically Diverse Groups. J Immigr Minor Health 2016; 18:810-818. [PMID: 26748509 DOI: 10.1007/s10903-015-0286-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Measurement of patient satisfaction is now considered essential for providing patient centered care and is an important tool for addressing health care disparities. However, little is known about how ethnically and racially diverse (ERD) groups differ in how they perceive quality, and widely used instruments for measuring perceived quality give little attention to cultural elements of care. This study examined the relationship between the culturally determined beliefs and expectations of four ERD groups (African Americans, Latinos, Portuguese-speakers, and Haitians, total N = 160) and the technical quality of treatment for depression provided in four "culturally-specific" primary care clinics. Using data from the Experiences of Care and Health Outcomes survey, chart reviews and focus groups, the study addressed a set of questions related to the psychometric properties of perceived care measures and the technical quality of care. The groups differed in preferred cultural elements except all preferred inclusion of religion. They did not differ in overall perceived quality. Technical quality was higher for Portuguese and Haitians than for African Americans and Latinos. Implications of group differences for measuring quality are discussed.
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Affiliation(s)
- H Stephen Leff
- Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA, USA
| | - Clifton Chow
- Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA, USA
| | - Dow A Wieman
- Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA, USA. .,Human Services Research Institute (HSRI), 2336 Massachusetts Avenue, Cambridge, MA, 02140, USA.
| | - Laysha Ostrow
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dharma E Cortés
- Mauricio Gastón Institute for Latino Community Development and Public Policy, University of Massachusetts Boston, Boston, MA, USA
| | - Treniece Harris
- Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, MA, USA
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Shao W, Guan W, Clark MA, Liu T, Santelices C, Cortés DE, Merchant RC. VARIATIONS IN RECRUITMENT YIELD, COSTS, SPEED AND PARTICIPANT DIVERSITY ACROSS INTERNET PLATFORMS IN A GLOBAL STUDY EXAMINING THE EFFICACY OF AN HIV/AIDS AND HIV TESTING ANIMATED AND LIVE-ACTION VIDEO AMONG ENGLISH- OR SPANISH-SPEAKING INTERNET OR SOCIAL MEDIA USERS. Digit Cult Educ 2015; 7:40-86. [PMID: 27330570 PMCID: PMC4912013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
For a world-wide, Internet-based study on HIV/AIDS and HIV testing knowledge, we compared the yields, speed and costs of recruitment and participant diversity across free postings on 13 Internet or social media platforms, paid advertising or postings on 3 platforms, and separate free postings and paid advertisements on Facebook. Platforms were compared by study completions (yield), time to completion, completion to enrollment ratios (CERs), and costs/ completion; and by participants' demographic characteristics, HIV testing history, and health literacy levels. Of the 482 English-speaking participants, Amazon Mechanical Turk yielded the most participants, recruited participants at the fastest rate and had the highest CER (0.78) and lowest costs / completion. Of the 335 Spanish-speaking participants, Facebook yielded the most participants and recruited participants at the fastest rate, although Amazon Mechanical Turk had the highest CER (0.72) and lowest costs/completion. Across platforms participants differed substantially according to their demographic characteristics, HIV testing history and health literay skills. The study results highlight the need for researchers to strongly consider choice of Internet or social media plaforms when conducting Internet-based research. Because of the sample specifications and cost restraints of studies, specific Internet/ social media or participant selection plaforms will be much more effective or appropriate than others.
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Affiliation(s)
| | - Wentao Guan
- Department of Biostatistics, Brown University
| | | | - Tao Liu
- Department of Biostatistics, Brown University
| | | | | | - Roland C. Merchant
- Department of Epidemiology, Brown University
- Department of Emergency Medicine, Brown University
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Merchant RC, Clark MA, Santelices CA, Liu T, Cortés DE. Efficacy of an HIV/AIDS and HIV testing video for Spanish-speaking Latinos in healthcare and non-healthcare settings. AIDS Behav 2015; 19:523-35. [PMID: 25179540 DOI: 10.1007/s10461-014-0889-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We assessed the efficacy of a Spanish-language HIV/AIDS and HIV testing video as a substitute for comparable orally-delivered information in healthcare and non-health care settings for Spanish-speakers regardless of health literacy level. In a non-inferiority clinical trial, Spanish-speaking Latinos from an emergency department, a clinic, and community-based organizations were randomly assigned to receive HIV/AIDS and HIV testing information orally or from a video. Comprehension of the information was measured using a questionnaire. Of the 150 participants, 39 % met criteria for lower health literacy and 75 % previously had been tested for HIV. Mean scores on the questionnaire for the video (20.4; 95 % CI 19.5 ~ 21.3) and the orally-delivered information arms (20.6; 95 % CI 19.7 ~ 21.5) were similar (Δ = -0.15; 95 % CI -1.4 ~ 1.1). Mean scores among lower health literacy participants also were similar (18.3 (video) vs. 19.6 (in-person); p < 0.30). This Spanish-language video is a viable substitute for orally-delivered HIV/AIDS and HIV testing information.
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Pagán-Ortiz ME, Cortés DE, Rudloff N, Weitzman P, Levkoff S. Use of an online community to provide support to caregivers of people with dementia. J Gerontol Soc Work 2014; 57:694-709. [PMID: 24689359 PMCID: PMC4127129 DOI: 10.1080/01634372.2014.901998] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
One challenge faced by many family members caring for persons with dementia is lack of information about how to take care of others and themselves. This is especially important for persons from ethnic minority groups, because linguistically and culturally appropriate information is often not available. In response to these needs, we developed a web site for Spanish-speaking caregivers. Cuidatecuidador.com provides bilingual information on dementia and caregiver issues. Content was developed and then evaluated by caregivers residing in 3 countries. Findings suggest trends that exposure to information may be related to a higher sense of mastery and a reduction of depressive symptomatology.
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Fix GM, Cohn ES, Solomon JL, Cortés DE, Mueller N, Kressin NR, Borzecki A, Katz LA, Bokhour BG. The role of comorbidities in patients' hypertension self-management. Chronic Illn 2014; 10:81-92. [PMID: 23892774 PMCID: PMC8887829 DOI: 10.1177/1742395313496591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities. METHODS We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-à-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension. RESULTS We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed. DISCUSSION Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns.
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Affiliation(s)
- Gemmae M Fix
- 1Center for Healthcare Organization and Implementation Research (CHOIR), a VA HSR&D Center of Innovation, VA Boston Healthcare System and Edith Nourse Rogers Memorial VA Medical Center, MA, USA
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Cortés DE, Millán-Ferro A, Schneider K, Vega RR, Caballero AE. Food purchasing selection among low-income, Spanish-speaking Latinos. Am J Prev Med 2013; 44:S267-73. [PMID: 23415192 DOI: 10.1016/j.amepre.2012.11.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/26/2012] [Accepted: 11/28/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND In the U.S., poverty has been linked to both obesity and disease burden. Latinos in the U.S. are disproportionately affected by poverty, and over the past 10 years, the percentage of overweight U.S. Latino youth has approximately doubled. Buying low-cost food that is calorie-dense and filling has been linked to obesity. Low-income individuals tend to favor energy-dense foods because of their low cost, and economic decisions made during food purchasing have physiologic repercussions. Diets based on energy-dense foods tend to be high in processed staples, such as refined grains, added sugars, and added fats. These diets have been linked to a higher risk of obesity, type 2 diabetes, and cardiovascular disease. PURPOSE This pilot study conducted ethnographic qualitative analyses combined with quantitative analyses to understand grocery shopping practices among 20 Spanish-speaking, low-income Latino families. The purpose was to analyze food selection practices in order to determine the effect of nutrition education on changes in shopping practices to later develop educational tools to promote selection of healthier food options. METHODS Participants received tailored, interactive, nutrition education during three to five home visits and a supermarket tour. Grocery store receipts for grocery purchases collected at baseline and at the end of the project were analyzed for each family to extract nutritional content of purchased foods. Nutritional content was measured with these factors in mind: quantity, calories, fats, carbohydrates, fiber, protein, and percentage of sugary beverages and processed food. Data were collected in 2010-2011 and analyzed in 2011-2012. RESULTS After receiving between three and five home-based nutrition education sessions and a supermarket tour over a 6-month period, many families adopted instructions on buying budget-friendly, healthier alternative foods. Findings indicate that participating families decreased the total number of calories and calories per dollar purchased from baseline to post-education (median total calories: baseline, 20,191; post-education, 15,991, p=0.008); median calories per dollar: baseline, 404; post-education, 320, p=0.008). The median grams of carbohydrates per dollar (baseline, 66, post-education, 45) and median calories from processed food (baseline, 11,000, post-education, 7845) were not reduced (p=0.06). CONCLUSIONS This pilot study demonstrated that grocery shopping practices are an important factor to address in nutrition education among Spanish-speaking, low-income individuals, and that there may be ways to encourage low-income, Latino families to purchase healthier foods. Findings challenged arguments suggesting that such an approach is not possible because of the high cost of healthier foods.
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Affiliation(s)
- Dharma E Cortés
- Mauricio Gastón Institute for Latino Community Development and Public Policy, University of Massachusetts Boston, Boston, Massachusetts 02125-3393, USA.
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Bokhour BG, Cohn ES, Cortés DE, Solomon JL, Fix GM, Elwy AR, Mueller N, Katz LA, Haidet P, Green AR, Borzecki AM, Kressin NR. The role of patients' explanatory models and daily-lived experience in hypertension self-management. J Gen Intern Med 2012; 27:1626-34. [PMID: 22821569 PMCID: PMC3509311 DOI: 10.1007/s11606-012-2141-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 04/11/2012] [Accepted: 06/05/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients' hypertension self-management have had lasting effects. Previous work has focused largely on patients' beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients' social contexts. OBJECTIVE This study aims to explore how patients' "explanatory models" of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors. DESIGN Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers. PARTICIPANTS (OR PATIENTS OR SUBJECTS): African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure. APPROACH We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients' explanatory models, social context and hypertension management behaviors. RESULTS Patients' perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients' daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management. CONCLUSIONS Designing interventions to improve patients' hypertension self-management requires consideration of patients' explanatory models and their daily-lived experience. We propose a new conceptual model - the dynamic model of hypertension self-management behavior - which incorporates these key elements of patients' experiences.
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Affiliation(s)
- Barbara G Bokhour
- Center for Health Quality, Outcomes & Economic Research, ENRM Veteran Affairs Medical Center, Bedford, MA 01730, USA.
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Gonzalez JM, Cortés DE, Reeves T, Whitley R, Lopez L, Bond GR, Velligan DI, Miller AL. Community mental health agency views of research. Community Ment Health J 2012; 48:223-31. [PMID: 21424543 DOI: 10.1007/s10597-011-9397-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 02/28/2011] [Indexed: 11/26/2022]
Abstract
We examined community mental health center staff perceptions of ongoing research within their agency. We interviewed upper management and conducted focus groups with medical staff, non-medical clinicians, and administrative staff. Participants were asked about (1) their attitudes towards research in general, agency research and towards the principal academic institution doing research with clients, (2) their perceptions of the value of research and (3) ideas for improving the collaboration. We identified 5 overarching themes: inter-agency communication, shared goals and equality in research, researchers adding knowledge to the agency, improving attitudes toward research, and agency involvement in research. Under these domains, specific suggestions are made for how to improve the collaboration across all stakeholder groups. Lack of shared values and inadequate communication processes can negatively impact community-based research collaborations. However, clear strategies, and adequate resources have great potential to improve community mental health collaborations.
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Affiliation(s)
- Jodi M Gonzalez
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
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Meléndez M, Cortés DE, Amaro H. Acceptability and Cultural Fit of Spiritual Self-Schema Therapy for Puerto Rican Women with Addiction Disorders: Qualitative Findings. Women & Therapy 2012. [DOI: 10.1080/02703149.2012.634733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Two purposive case studies illustrate the role of habits and routines in illness management and how they are addressed in the clinical encounter. We argue habits and routines are related, but distinct constructs, and that by overlooking habits and routines, providers may be missing key opportunities to influence behaviour change. Utilization of ‘habit-changing’ professionals or health coaches who have the opportunity to communicate with patients on a regular basis in their daily living environment is proposed.
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Affiliation(s)
| | | | - Gemmae Fix
- Center for Health Quality Outcome & Economics Research, ENRM Veterans Affairs Medical Center, Bedford, MA
| | - Nora Mueller
- Center for Health Quality Outcome & Economics Research, ENRM Veterans Affairs Medical Center, Bedford, MA
| | - Jeffery L. Solomon
- Center for Health Quality Outcome & Economics Research, ENRM Veterans Affairs Medical Center, Bedford, MA
| | - Barbara G. Bokhour
- Center for Health Quality Outcome & Economics Research, ENRM Veterans Affairs Medical Center, Bedford, MA
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Abstract
OBJECTIVE The objective of this study is to understand factors that influence the oral health-related behaviors of Latino children, as reported by their parents. METHODS Focus groups and in-depth interviews assessed parental perceptions, experiences, attributions, and beliefs regarding their children's oral health. Guiding questions focused on a) the participant's child dental experiences; b) the impact of dental problems on the child's daily activities, emotions, self-esteem; c) parental experiences coping with child's dental problems; and d) hygienic and dietary habits. Participants were purposively sampled from dental clinics and public schools with a high concentration of Latinos; 92 urban low-income Latino Spanish-speaking parents participated. Transcriptions of the audio files were thematically analyzed using a grounded theory approach. RESULTS Parents' explanations of their children's dental experiences were categorized under the following themes: caries and diet, access to dental care, migration experiences, and routines. CONCLUSIONS Findings revealed fundamental multilevel (i.e., individual/child, family, and community) factors that are important to consider for future interventions to reduce oral health disparities: behaviors leading to caries, parental knowledge about optimal oral health, access to sugary foods within the living environment and to fluoridated water as well as barriers to oral health care such as lack of health insurance or limited health insurance coverage, among others.
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Maxwell J, Cortés DE, Schneider KL, Graves A, Rosman B. Massachusetts’ Health Care Reform Increased Access To Care For Hispanics, But Disparities Remain. Health Aff (Millwood) 2011; 30:1451-60. [DOI: 10.1377/hlthaff.2011.0347] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James Maxwell
- JSI Research and Training Institute, Boston, Massachusetts, USA.
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Abstract
The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York?based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.e., those involved in both Puerto Rican and mainland cultures) were less risky in terms of injection- and sex-related risk behaviors and that geographic and other contextual factors, along with cultural norms, influence risk behaviors for immigrants. Both studies indicate the need to differentiate subgroup factors affecting HIV risk and prevention behaviors to develop appropriate and effective community-based interventions. The study's limitations are noted.
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Affiliation(s)
- Sherry Deren
- Center for Drug Use and HIV Research, College of Nursing, New York University, New York, New York 10003, USA.
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Amaro H, Magno-Gatmaytan C, Meléndez M, Cortés DE, Arevalo S, Margolin A. Addiction Treatment Intervention: An Uncontrolled Prospective Pilot Study of Spiritual Self-Schema Therapy with Latina Women. Subst Abus 2010; 31:117-25. [DOI: 10.1080/08897071003641602] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cortés DE, Drainoni ML, Henault LE, Paasche-Orlow MK. How to achieve informed consent for research from Spanish-speaking individuals with low literacy: a qualitative report. J Health Commun 2010; 15 Suppl 2:172-82. [PMID: 20845202 DOI: 10.1080/10810730.2010.499990] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Investigators have the responsibility to ensure that prospective participants are fully informed about a research protocol prior to consenting to participate, yet many researchers face challenges when obtaining consent, since the majority of the general population has limited or no familiarity with research studies. These challenges are further magnified when obtaining consent from individuals with low literacy levels and who speak languages other than English. In this article we present findings from a qualitative study conducted with Spanish-speaking individuals with low-literacy designed to refine the Agency for Healthcare Research and Quality's Informed Consent and Authorization Toolkit for Minimal Risk Research. Findings from this study indicate that familiarity with providing informed consent and authorization for research or the experience of being a research participant appear to play key roles in an individual's ability to understand the consent and authorization process. While the text of the consent and authorization documents can be simplified using plain language principles, comprehension of several fundamental ideas such as risk and privacy need to be safeguarded with a consent process that confirms comprehension. Recommendations are provided to address the informational needs of individuals with low literacy levels and limited or no experience with research participation.
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Affiliation(s)
- Dharma E Cortés
- Department of Psychiatry, Cambridge Hospital/Harvard Medical School, Cambridge, Massachusetts 02139, USA.
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Cohn ES, Cortés DE, Hook JM, Yinusa-Nyahkoon LS, Solomon JL, Bokhour B. A narrative of resistance: presentation of self when parenting children with asthma. Commun Med 2009; 6:27-37. [PMID: 19798833 DOI: 10.1558/cam.v6i1.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Using a social constructivist perspective and narrative analysis, the purpose of this paper is to illustrate how an understanding of self-presentation in interactions may inform health care interventions. We examine how a single African American mother, living in poverty, presents her sense of self in the context of obtaining and providing asthma care for her children. By analyzing four separate encounters--two interviews with the children's mother, the clinical encounter between the mother and her children's doctor, and an interview with the doctor, we gain an understanding of the mother's self-presentation and identity and the doctor's view of the mother. The analyses reveal the mother's consistent desire to protect her children in an unpredictable social world. By examining self-presentation, behavior that is typically construed as non-adherence is reframed as resilience, one mother's attempt to assert control. We argue that an understanding of identity production may enable practitioners and patients to create collaborative interventions. The analysis presented in this paper points to the need for a co-constructed intervention that allows for choice and control and honors the mother's sense of self.
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Affiliation(s)
- Ellen S Cohn
- Boston University, College of Health and Rehabilitation Services, Boston, MA 02215, USA.
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Abstract
Biculturality refers to two independent processes of acculturation, one to the host society's culture and another to the culture of origin. This study examined the relationship between biculturality and HIV-related risk behaviors in a sample of injecting and noninjecting Puerto Rican drug users (N = 259), recruited in New York City in 2005-2006. Biculturality was measured by two scales: involvement in (i) American culture (AMBIC) and (ii) Puerto Rican culture Biculturality (PRBIC). The majority (78%) of the participants were males, with a mean age of 42 years. About half were born in Puerto Rico, and the average length of stay in the United States was 26 years. In multiple logistic-regression analysis, AMBIC was significantly related to lower injection risk after controlling for other factors including gender, age, and MMTP enrollment, while PRBIC was a significant predictor of higher sex risk. Involvement in the host culture and the culture of origin differed in their relationship to risk behaviors, indicating that incorporating assessments of biculturality may be useful in assessing and addressing migrants' behaviors, including HIV-risk behaviors. The study's limitations have been noted.
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Affiliation(s)
- Sung-Yeon Kang
- National Development and Research Institutes, Inc., New York, New York 10010, USA.
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Smith LA, Bokhour B, Hohman KH, Miroshnik I, Kleinman KP, Cohn E, Cortés DE, Galbraith A, Rand C, Lieu TA. Modifiable risk factors for suboptimal control and controller medication underuse among children with asthma. Pediatrics 2008; 122:760-9. [PMID: 18829799 DOI: 10.1542/peds.2007-2750] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our aims were (1) to describe rates of suboptimal control and controller medication underuse in a diverse population of children with asthma and (2) to identify potentially modifiable parental behaviors and beliefs associated with these outcomes. METHODS We conducted telephone interviews with parents of 2- to 12-year-old children with persistent asthma, in a Medicaid plan and a large provider group. Suboptimal control was defined as >or=4 symptom days, >or=1 symptom night, or >or=4 albuterol use days in the previous 2 weeks. Controller medication underuse was defined as suboptimal control and parent report of <6 days/week of inhaled steroid use. Multivariate analyses identified factors that were independently associated with suboptimal control and controller medication underuse. RESULTS Of the 754 study children, 280 (37%) had suboptimal asthma control; this problem was more common in Hispanic children (51%) than in black (37%) or white (32%) children. Controller medication underuse was present for 133 children (48% of those with suboptimal asthma control and 18% overall). Controller medication underuse was more common among Hispanic (44%) and black (34%) children than white (22%) children. In multivariate analyses, suboptimal control was associated with potentially modifiable factors including low parental expectations for symptom control and high levels of worry about competing household priorities. Controller medication underuse was associated with potentially modifiable factors including parental estimation of asthma control that was discordant with national guidelines and no set time to administer asthma medications. CONCLUSIONS Deficiencies in asthma control and controller medication use are associated with potentially modifiable parental beliefs, which seem to mediate racial/ethnic and socioeconomic disparities in suboptimal control and controller medication underuse.
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Affiliation(s)
- Lauren A Smith
- Department of Pediatrics, School of Medicine, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA.
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Bokhour BG, Cohn ES, Cortés DE, Yinusa-Nyahkoon LS, Hook JM, Smith LA, Rand CS, Lieu TA. Patterns of concordance and non-concordance with clinician recommendations and parents' explanatory models in children with asthma. Patient Educ Couns 2008; 70:376-85. [PMID: 18162357 PMCID: PMC2376053 DOI: 10.1016/j.pec.2007.11.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 10/23/2007] [Accepted: 11/05/2007] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Many children with asthma do not take medications as prescribed. We studied parents of children with asthma to define patterns of non-concordance between families' use of asthma controller medications and clinicians' recommendations, examine parents' explanatory models (EMs) of asthma, and describe relationships between patterns of non-concordance and EM. METHODS Qualitative study using semi-structured interviews with parents of children with persistent asthma. Grounded theory analysis identified recurrent themes and relationships between reported medication use, EMs, and other factors. RESULTS Twelve of the 37 parents reported non-concordance with providers' recommendations. Three types of non-concordance were identified: unintentional--parents believed they were following recommendations; unplanned--parents reported intending to give controller medications but could not; and intentional--parents stated giving medication was the wrong course of action. Analysis revealed two EMs of asthma: chronic--parents believed their child always has asthma; and intermittent--parents believed asthma was a problem their child sometimes developed. CONCLUSIONS Concordance or non-concordance with recommended use of medications were related to EM's and family context and took on three different patterns associated with medication underuse. PRACTICE IMPLICATIONS Efforts to reduce medication underuse in children with asthma may be optimized by identifying different types of non-concordance and tailoring interventions accordingly.
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Affiliation(s)
- Barbara G Bokhour
- Center for Health Quality, Outcomes and Economic Research, ENRM Veterans Affairs Medical Center,Bedford, MA 01742, United States.
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Cortés DE, Gerena M, Canino G, Aguilar-Gaxiola S, Febo V, Magaña C, Soto J, Eisen SV. Translation and cultural adaptation of a mental health outcome measure: the BASIS-R(c). Cult Med Psychiatry 2007; 31:25-49. [PMID: 17219078 DOI: 10.1007/s11013-006-9043-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Culturally and linguistically appropriate outcome measures are needed to address the needs of Latino consumers of mental health services. The revised Behavior and Symptom Identification Scale (BASIS-R(c)) is an English-language consumer self-report measure designed to assess outcome of behavioral health or substance abuse treatment. This study sought to develop a culturally and linguistically appropriate version of the BASIS-R(c) for Spanish-speaking Latinos. To achieve this goal, the English instrument was translated and adapted into Spanish by an international bilingual committee and tested in four focus groups and 45 cognitive interviews with Puerto Ricans, Dominicans, and Mexicans living in the United States and Puerto Rico. Focus groups and cognitive interviews provided qualitative and quantitative information about the instrument's content and format, and respondents' understanding of the instructions, questionnaire items, time frame, and response options. Respondents' ratings of the clarity and importance of each item were also obtained. Analyses of focus group and cognitive interview data identified items that were confusing or difficult for participants. Findings suggest that the Spanish version of the BASIS-R(c) incorporated the cultural diversity of the three groups of Latinos in this study without compromising the validity of the English version of the BASIS.
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Affiliation(s)
- Dharma E Cortés
- Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02139, USA.
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Cortés DE, Deren S, Andía J, Colón H, Robles R, Kang SY. The use of the Puerto Rican Biculturality Scale with Puerto Rican drug users in New York and Puerto Rico. J Psychoactive Drugs 2003; 35:197-207. [PMID: 12924742 DOI: 10.1080/02791072.2003.10400001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examines the psychometric properties of an acculturation scale specifically developed for Puerto Ricans with a sample of substance abusers residing in Puerto Rico and New York. In line with current conceptual models of acculturation, this instrument departs from a mutually exclusive or zero-sum conceptualization of acculturation by assessing involvement in both American and Puerto Rican cultures independently of each other. Findings from this study permitted comparisons of acculturation as experienced by Puerto Rican injection drug users in Puerto Rico and New York. Results supported the notion of independence of individuals' involvement in American and Puerto Rican cultures, thus confirming the complex nature of biculturalism. This article also examines the relevance of the study of acculturation scales that can assist in identifying the influences of the cultures of origin and destination on substance abuse and HIV risk behaviors.
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Affiliation(s)
- Dharma E Cortés
- Harvard Medical School and Cambridge Hospital, Department of Psychiatry, Cambridge, Massachusetts 02139, USA
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Abstract
Identified the concept of acculturation as a cornerstone of immigration research, while questioning assumptions about zero-sum cultural change in acculturation scales and in procedures assessing biculturality. Involvements in the host society culture and the culture of origin should be assessed separately in order to reflect the complexities of the cultural interactions immigrants and their offspring experience. To evaluate this prescription, we convened focus groups of Puerto Rican adults to discuss their cultural experiences in Puerto Rico and in the United States. Discussions were content analyzed to develop acculturation items. Factor analysis of the responses of 403 first- and second-generation adults yielded two general factors, involvement in American culture and involvement in Puerto Rican culture, which demonstrated modest reliability, relative independence, and moderate correlations with traditional acculturation scale validators. Results of the study challenge the assumption of mutual cultural exclusivity in acculturative change; enable the measurement of degree of biculturality; and provide future directions for the assessment of acculturation in domains other than language usage. The concept of acculturation is integrated with recent formulations in community psychology which advocate a deeper and more extensive commitment to studying the implications of cultural phenomena and greater focus on the growing cultural diversity in the United States.
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Affiliation(s)
- D E Cortés
- Hispanic Research Center, Fordham University, Bronx, New York 10458, USA
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