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Ingram M, Dueñas KR, Castro I, Vázquez L, Crocker RM, Larson EK, Guernsey de Zapien J, Torres E, Carvajal SC. The Use of Qualitative Methods to Guide the Development of the Border Resilience Scale in a Participatory Research Study. Int J Environ Res Public Health 2023; 20:ijerph20095703. [PMID: 37174221 PMCID: PMC10177960 DOI: 10.3390/ijerph20095703] [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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
U.S.-Mexico border residents experience pervasive social and ecological stressors that contribute to a high burden of chronic disease. However, the border region is primarily composed of high-density Mexican-origin neighborhoods, a characteristic that is most commonly health-promoting. Understanding factors that contribute to border stress and resilience is essential to informing the effective design of community-level health promotion strategies. La Vida en La Frontera is a mixed-methods, participatory study designed to understand factors that may contribute to border resilience in San Luis, Arizona. The study's initial qualitative phase included interviews with 30 Mexican-origin adults exploring community perceptions of the border environment, cross-border ties, and health-related concepts. Border residents described the border as a Mexican enclave characterized by individuals with a common language and shared cultural values and perspectives. Positive characteristics related to living in proximity to Mexico included close extended family relationships, access to Mexican food and products, and access to more affordable health care and other services. Based on these findings, we co-designed the 9-item Border Resilience Scale that measures agreement with the psychosocial benefits of these border attributes. Pilot data with 60 residents suggest there are positive sociocultural attributes associated with living in border communities. Further research should test if they mitigate environmental stressors and contribute to a health-promoting environment for residents.
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Affiliation(s)
- Maia Ingram
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Karina R Dueñas
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | | | - Luis Vázquez
- Campesinos Sin Fronteras, Somerton, AZ 85350, USA
| | - Rebecca M Crocker
- Cancer Center, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Emily K Larson
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Jill Guernsey de Zapien
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Emma Torres
- Campesinos Sin Fronteras, Somerton, AZ 85350, USA
| | - Scott C Carvajal
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
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Villavicencio EA, Maldonado A, Crocker RM, Guan Y, Stallman C, Garcia DO. Communicating PNPLA3 genetic risk status for NAFLD among Mexican-origin men. Front Public Health 2023; 10:1090101. [PMID: 36684893 PMCID: PMC9846364 DOI: 10.3389/fpubh.2022.1090101] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The burden of non-alcoholic fatty liver disease (NAFLD) continues to disproportionately impact under-resourced communities in the U.S., particularly Mexican-origin populations. Genetic polymorphisms such as the rs738409 C/G variant in patatin-like phospholipase domain-containing 3 (PNPLA3) have been associated with higher prevalence of and progression along the NAFLD spectrum. This qualitative study conducted in the U.S. Southwest aimed to assess Mexican-origin men's experience receiving genetic testing for PNPLA3 risk carrier status. Methods Semi-structured interviews were conducted with 17 Mexican-origin men whose NAFLD status and genetic predisposition were determined as part of a previous cross-sectional study. The interview guide included questions exploring participants' insights on how genetic risk status was delivered, how the information influenced their motivation for lifestyle modification to reduce NAFLD risk, and any knowledge sharing that occurred with family members after learning of their PNPLA3 risk status. Interviews were conducted and audio recorded in English (n = 6) and Spanish (n = 11) and uploaded into NVivo software for data analysis and interpretation. Guided by the Health Belief Model, a thematic analysis approach was used to identify primary themes. Results Results highlighted men's preference for receiving this type of genetic risk information through a letter sent to their homes. General comprehension of PNPLA3 risk status was deemed high and most men stated sharing their genetic predisposition to NAFLD with their immediate family members. Participants also indicated that family and awareness of this genetic risk acted as primary motivators for implementing behavior changes (e.g., diet, physical activity) toward the prevention of more severe liver conditions. Discussion Findings from this qualitative study suggest the feasibility of communicating genetic risk for NAFLD among Mexican-origin men. Future strategies for the dissemination of genetic risk results among Mexican-origin individuals should consider familial and cultural appropriate strategies.
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Affiliation(s)
- Edgar A. Villavicencio
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Adriana Maldonado
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Rebecca M. Crocker
- Center for Border Health Disparities, Health Sciences, University of Arizona, Tucson, AZ, United States
| | - Yue Guan
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Chris Stallman
- Genetic Counseling Graduate Program, University of Arizona, Tucson, AZ, United States
| | - David O. Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Palmer KNB, Crocker RM, Marrero DG, Tan TW. A vicious cycle: employment challenges associated with diabetes foot ulcers in an economically marginalized Southwest US sample. Front Clin Diabetes Healthc 2023; 4:1027578. [PMID: 37124466 PMCID: PMC10140327 DOI: 10.3389/fcdhc.2023.1027578] [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] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/24/2023] [Indexed: 05/02/2023]
Abstract
Aim To describe patients' reported employment challenges associated with diabetic foot ulcers (DFUs). Methods Fifteen patients from under-resourced communities in Southern Arizona, with a history of DFUs and/or amputations, were recruited from a tertiary referral center from June 2020 to February 2021. Participants consented to an audio-recorded semi-structured phone interview. Interviews were transcribed and thematically analyzed using the Dedoose data analysis platform. Results Participants shared a common theme around the cyclic challenges of DFU prevention/management and employment. Those employed in manual labor-intensive jobs or jobs requiring them to be on their feet for long durations of time believed working conditions contributed to the development of their DFUs. Patients reported work incapacity due to declines in mobility and the need to offload for DFU management. Many expressed frustration and emotional distress related to these challenges noting that DFUs resulted in lower remuneration as medical expenses increased. Consequently, loss of income and/or medical insurance often hindered participants' ability to manage DFUs and subsequent complications. Conclusion These data illuminate the vicious cycle of DFU and employment challenges that must be addressed through patient-centered prevention strategies. Healthcare providers should consider a person's contextual factors such as employment type to tailor treatment approaches. Employers should establish inclusive policies that support patients with DFUs returning to work through flexible working hours and adapted work tasks as needed. Policymakers can also mitigate employment challenges by implementing social programs that provide resources for employees who are unable to return to work in their former capacity.
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Affiliation(s)
- Kelly N. B. Palmer
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Center for Health Disparities Research, University of Arizona Health Sciences, Tucson, AZ, United States
- *Correspondence: Kelly N.B. Palmer,
| | - Rebecca M. Crocker
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Center for Health Disparities Research, University of Arizona Health Sciences, Tucson, AZ, United States
| | - David G. Marrero
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- Center for Health Disparities Research, University of Arizona Health Sciences, Tucson, AZ, United States
| | - Tze-Woei Tan
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, United States
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Duenas KR, Ingram M, Crocker RM, Pace TWW, de Zapien JG, Torres E, Carvajal SC. La vida en la frontera: protocol for a prospective study exploring stress and health resiliencies among Mexican-origin individuals living in a US-Mexico border community. BMC Public Health 2022; 22:2442. [PMID: 36575410 PMCID: PMC9794409 DOI: 10.1186/s12889-022-14826-x] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/06/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mexican-origin adults living near the U.S.-Mexico border experience unique and pervasive social and ecological stressors, including poverty, perceived discrimination, and environmental hazards, potentially contributing to the high burden of chronic disease. However, there is also evidence that residents in high-density Mexican-origin neighborhoods exhibit lower prevalence rates of disease and related mortality than those living in other areas. Understanding the factors that contribute to health resiliencies at the community scale is essential to informing the effective design of health promotion strategies. METHODS La Vida en la Frontera is a mixed-methods participatory study linking a multi-disciplinary University of Arizona research team with Campesinos Sin Fronteras, a community-based organization founded by community health workers in San Luis, Arizona. This paper describes the current protocol for aims 2 and 3 of this multi-faceted investigation. In aim 2 a cohort of N≈300 will be recruited using door-to-door sampling of neighborhoods in San Luis and Somerton, AZ. Participants will be surveyed and undergo biomarker assessments for indicators of health and chronic stress at three time points across a year length. A subset of this cohort will be invited to participate in aim 3 where they will be interviewed to further understand mechanisms of resilience and wellbeing. DISCUSSION This study examines objective and subjective mechanisms of the relationship between stress and health in an ecologically diverse rural community over an extended timeframe and illuminates health disparities affecting residents of this medically underserved community. Findings from this investigation directly impact the participants and community through deepening our understanding of the linkages between individual and community level stress and chronic disease risk. This innovative study utilizes a comprehensive methodology to investigate pathways of stress and chronic disease risk present at individual and community levels. We address multiple public health issues including chronic disease and mental illness risk, health related disparities among Mexican-origin people, and health protective mechanisms and behaviors.
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Affiliation(s)
- Karina R. Duenas
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Arizona Prevention Research Center Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. Tucson, Tucson, AZ 85724 USA
| | - Maia Ingram
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Arizona Prevention Research Center Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. Tucson, Tucson, AZ 85724 USA
| | - Rebecca M. Crocker
- grid.134563.60000 0001 2168 186XHealth Sciences, University of Arizona, Tucson, USA
| | - Thaddeus W. W. Pace
- grid.134563.60000 0001 2168 186XCollege of Nursing, Department of Psychiatry, College of Medicine, University of Arizona, Tucson, USA ,grid.134563.60000 0001 2168 186XDepartment of Psychology, College of Science, University of Arizona, Tucson, USA
| | - Jill Guernsey de Zapien
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Arizona Prevention Research Center Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. Tucson, Tucson, AZ 85724 USA
| | | | - Scott C. Carvajal
- grid.134563.60000 0001 2168 186XDepartment of Health Promotion Sciences, Arizona Prevention Research Center Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. Tucson, Tucson, AZ 85724 USA
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Tan TW, Crocker RM, Palmer KNB, Gomez C, Armstrong DG, Marrero DG. A qualitative study of barriers to care-seeking for diabetic foot ulceration across multiple levels of the healthcare system. J Foot Ankle Res 2022; 15:56. [PMID: 35932076 PMCID: PMC9356391 DOI: 10.1186/s13047-022-00561-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The mechanisms for the observed disparities in diabetes-related amputation are poorly understood and could be related to access for diabetic foot ulceration (DFU) care. This qualitative study aimed to understand patients’ personal experiences navigating the healthcare system and the barriers they faced. Methods Fifteen semi-structured interviews were conducted over the phone between June 2020 to February 2021. Participants with DFUs were recruited from a tertiary referral center in Southern Arizona. The interviews were audio-recorded and analyzed according to the NIMHD Research Framework, focusing on the health care system domain. Results Among the 15 participants included in the study, the mean age was 52.4 years (66.7% male), 66.7% was from minority racial groups, and 73.3% was Medicaid or Indian Health Service beneficiaries. Participants frequently reported barriers at various levels of the healthcare system. On the individual level, themes that arose included health literacy and inadequate insurance coverage resulting in financial strain. On the interpersonal level, participants complained of fragmented relationships with providers and experienced challenges in making follow-up appointments. On the community level, participants reported struggles with medical equipment. On the societal level, participants also noted insufficient preventative foot care and education before DFU onset, and many respondents experienced initial misdiagnoses and delays in receiving care. Conclusions Patients with DFUs face significant barriers in accessing medical care at many levels in the healthcare system and beyond. These data highlight opportunities to address the effects of diabetic foot complications and the inequitable burden of inadequately managed diabetic foot care.
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Affiliation(s)
- Tze-Woei Tan
- Southwestern Academic Limb Salvage Alliance (SALSA), Los Angeles, Tucson, USA. .,Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Ste 4300, Los Angeles, CA, 90033, USA.
| | - Rebecca M Crocker
- Center for Health Disparities Research (CHDR), University of Arizona Health Sciences, Tucson, AZ, USA
| | - Kelly N B Palmer
- Center for Health Disparities Research (CHDR), University of Arizona Health Sciences, Tucson, AZ, USA
| | - Chris Gomez
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Los Angeles, Tucson, USA.,Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Ste 4300, Los Angeles, CA, 90033, USA
| | - David G Marrero
- Center for Health Disparities Research (CHDR), University of Arizona Health Sciences, Tucson, AZ, USA
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Crocker RM, Duenas K, Vázquez L, Ingram M, Cordova-Marks FM, Torres E, Carvajal S. "Es Muy Tranquilo Aquí": Perceptions of Safety and Calm among Binationally Mobile Mexican Immigrants in a Rural Border Community. Int J Environ Res Public Health 2022; 19:ijerph19148399. [PMID: 35886251 PMCID: PMC9323766 DOI: 10.3390/ijerph19148399] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
Perceptions of community can play an important role in determining health and well-being. We know little, however, about residents’ perceptions of community safety in the Southwestern borderlands, an area frequently portrayed as plagued by disorder. The qualitative aim of this community-based participatory research study was to explore the perceptions of Mexican-origin border residents about their communities in southern Yuma County, Arizona. Our team of University of Arizona researchers and staff from Campesinos Sin Fronteras, a grassroots farmworker support agency in Yuma County, Arizona, developed a bilingual interview guide and recruited participants through radio adds, flyers, and cold calls among existing agency clientele. Thirty individual interviews with participants of Mexican origin who live in and/or work in rural Yuma County were conducted remotely in 2021. Participants overwhelmingly perceived their communities as both calm and safe. While some participants mentioned safety concerns, the vast majority described high levels of personal security and credited both neighbors and police for ensuring local safety. These perceptions were stated in direct contrast to those across the border, where participants had positive familial and cultural ties but negative perceptions regarding widespread violence. In conclusion, we argue that to understand environmental factors affecting health and well-being in Mexican immigrant populations, it is critical to examine the role of binational external referents that color community perceptions.
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Affiliation(s)
- Rebecca M. Crocker
- Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (K.D.); (F.M.C.-M.)
- Correspondence:
| | - Karina Duenas
- Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (K.D.); (F.M.C.-M.)
| | - Luis Vázquez
- Campesinos Sin Fronteras, Somerton, AZ 85350, USA; (L.V.); (E.T.)
| | - Maia Ingram
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (M.I.); (S.C.)
| | - Felina M. Cordova-Marks
- Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (K.D.); (F.M.C.-M.)
| | - Emma Torres
- Campesinos Sin Fronteras, Somerton, AZ 85350, USA; (L.V.); (E.T.)
| | - Scott Carvajal
- Arizona Prevention Research Center, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA; (M.I.); (S.C.)
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Crocker RM, Morrill KE, Villavicencio EA, Garcia DO. How Mexicans' Emotional Responses to Non-Alcoholic Fatty Liver Disease Can Help Inform Culturally Congruent Health Care. J Transcult Nurs 2022; 33:615-623. [PMID: 35684997 DOI: 10.1177/10436596221101923] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION This article aims to increase understanding of how Mexican immigrants respond to learning about non-alcoholic fatty liver disease (NAFLD), a spectrum disease with a heavy burden among Mexican-origin people. METHODOLOGY This article presents findings from qualitative interviews (n = 26) that formed part of a mixed-methods study of foreign-born Mexican immigrants carried out in 2019 to 2020 in southern Arizona to assess NAFLD awareness. RESULTS We documented common experiences of surprise, fear, and hope during study participation, all of which motivated research participants to reduce their NAFLD risk by seeking additional information, sharing it with others, and making lifestyle changes. DISCUSSION Understanding how these emotional experiences are tied to cultural and historical factors-including Mexico's high rates of liver disease, participant's limited access to health care, and the ability to address the NAFLD risk with lifestyle changes-may promote the development of more effective and culturally congruent care in this population.
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Affiliation(s)
- Rebecca M Crocker
- Department of Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | | | - Edgar A Villavicencio
- Department of Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Abstract
Mexicans living in the United States frequently rely upon popular healing to address a broad spectrum of physical, psychological, and spiritual ailments. They practice Mesoamerican healing ways including using herbal remedies, employing nutritional health promotion and illness remediation, over the counter pharmaceuticals, prayer and religion, and visiting expert healers. In this article, we utilize Brigitte Jordan's theory of "authoritative knowledge," to show how Mexican immigrants' ancestral and ecological-based healing knowledge travels with them through migration. Based on original ethnographic research in the Southwest borderlands, we expand an understanding of the factors that support the continuity of authoritative knowledge spatially and temporally. Mexicans' healing knowledge persisted north of the border because it (1) incorporated a wide array of healing techniques and materials that remained accessible post-migration, (2) enabled immigrants to heal according to Mesoamerican worldviews that privileged natural modalities and a holistic approach to body, mind, and spirit, and (3) remained relevant by allowing immigrants to remedy daily health stressors inherent to Mexican migration, including the border crossing, detention and deportation, and daily fear provoked by undocumented status. While lay practices have often been interpreted as problematic by medical professionals, we conclude that Mexicans' authoritative healing knowledge serves as a survival mechanism during the challenging circumstances of binational migration.
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Affiliation(s)
- Rebecca M Crocker
- Health Sciences Center for Border Health Disparities, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85721, USA.
| | - Patrisia Gonzales
- Department of Mexican-American Studies, University of Arizona, Tucson, AZ, USA
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Crocker RM, Tan T, Palmer KNB, Marrero DG. The patient's perspective of diabetic foot ulceration: A phenomenological exploration of causes, detection and
care seeking. J Adv Nurs 2022; 78:2482-2494. [PMID: 35285035 PMCID: PMC9283226 DOI: 10.1111/jan.15192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/29/2021] [Accepted: 02/09/2022] [Indexed: 01/13/2023]
Abstract
AIMS Diabetic foot ulceration can contribute to lowered life expectancy and quality of life for people with diabetes, and yet, scant attention has been given to improving preventive and educational measures. This article uses a phenomenological approach to explore individuals' lived experiences of diabetic foot ulcerations to explore factors that can be harnessed to achieve improved outcomes. DESIGN This was a qualitative study using semi-structured interviews grounded in a phenomenological framework to explore how patients perceive and understand their foot problems. METHODS Study participants were recruited from February 2020 to February 2021 from a tertiary referral centre that treats foot problems in persons with diabetes. A total of 15 Hispanic, Native American and White patients participated in the study. We conducted in-depth semi-structured interviews which were audio recorded with the participant's consent. Interview data were transcribed and analysed with Dedoose data management software. RESULTS Analysis revealed findings in two primary domains: (1) how patients perceive foot ulceration, with themes around limited understandings of foot ulceration, close sensory observation of foot problems and barriers to ulcer perception and (2) how patients experience the timing of foot ulceration, with themes on how time perceptions shifted as foot problems became more serious, which correlated closely to how patients responded to their foot problems. CONCLUSION Despite the close sensory observation of their feet, people with diabetes face an array of barriers to recognizing and understanding the implications of diabetic foot ulceration, which can lead to delayed care seeking. Nurses can play a critical role in promoting patient education and improving patient self-management of foot ulcers. IMPACT This phenomenological study offers important lessons to guide nurses and other providers in enhancing patient self-management of DFUs and improving care outcomes by expanding an understanding of DFU early warning signs, the imperative to seek medical care quickly, and addressing possible barriers.
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Affiliation(s)
- Rebecca M. Crocker
- Center for Border Health Disparities University of Arizona Health Sciences Tucson Arizona USA
| | - Tze‐Woei Tan
- Division of Vascular and Endovascular Surgery University of Arizona College of Medicine‐ Tucson, Southern Arizona Limb Salvage Alliances (SALSA) Tucson Arizona USA
| | - Kelly N. B. Palmer
- Center for Border Health Disparities University of Arizona Health Sciences Tucson Arizona USA
| | - David G. Marrero
- Center for Border Health Disparities University of Arizona Health Sciences Tucson Arizona USA
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Villavicencio EA, Crocker RM, Garcia DO. A Qualitative Analysis of Mexican-Origin Men's Knowledge and Cultural Attitudes Toward Non-Alcoholic Fatty Liver Disease and Interest in Risk Reduction. Am J Mens Health 2021; 15:15579883211063335. [PMID: 34872379 PMCID: PMC8655456 DOI: 10.1177/15579883211063335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Mexican-origin men are at increased risk of developing non-alcoholic fatty liver disease (NAFLD). The purpose of this qualitative research was to assess Mexican-origin men’s knowledge and cultural attitudes toward NAFLD and their interest in risk reduction. Semi-structured interviews were conducted with 11 Spanish-speaking Mexican-origin men who were considered high-risk of having NAFLD according to transient elastography (FibroScan®) continuous attenuation parameter (CAP) scores (≥280). Audio recordings of these interviews were transcribed and interpreted in their respective language to facilitate data analysis using NVivo 12. A thematic codebook was developed, from which the research team identified emerging themes. Findings demonstrated limited knowledge about NAFLD and in general chronic liver disease among Mexican-origin men. Cultural attitudes appeared to both enhance and mitigate their perceived risk for NAFLD. Interviews also revealed high interest levels for reducing NAFLD risk, with family and loved ones acting as the main motivators for engagement in healthier behaviors. Inclination toward family-based interventions was reported as a subject of interest for this high-risk population. This qualitative study suggests that the development of a NAFLD-specific intervention approach for Mexican-origin men may be feasible and should consider a familial and cultural context centered in improving lifestyle health behaviors.
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Affiliation(s)
- Edgar A Villavicencio
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Rebecca M Crocker
- Center for Border Health Disparities, Health Sciences, The University of Arizona, Tucson, AZ, USA
| | - David O Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
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Morrill KE, Crocker RM, Hingle MD, Thomson CA, Garcia DO. Awareness, Knowledge, and Misperceptions Related to Nonalcoholic Fatty Liver Disease in a Community Sample of Mexican-Origin Women: A Mixed Methods Study. Front Public Health 2021; 9:626428. [PMID: 34485209 PMCID: PMC8415027 DOI: 10.3389/fpubh.2021.626428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 07/16/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction: Mexican-origin women suffer disproportionate rates of nonalcoholic fatty liver disease (NAFLD) and research on how to tailor NAFLD treatment interventions for this population is lacking. Objectives: The purpose of this study was to assess awareness, knowledge, perceptions, and information sources related to NAFLD in a community-based sample of Mexican-origin women. Methods: This study employed a convergent parallel mixed-methods approach and consisted of a brief questionnaire (n = 194) and interviews (n = 26) among Mexican-origin women recruited from community-based settings including health fairs, churches, and community events. Participants were eligible if they identified as Mexican-origin, had a BMI ≥ 25 kg/m2, were 18-64 years of age, had the ability to speak, read, and write in English and/or Spanish, and provided informed consent. A purposeful sampling approach was used to recruit a subset of women (n = 26) with confirmed liver steatosis indicative of NAFLD (controlled attenuation parameter ≥280 dB/m) who completed the questionnaire. The twenty-six participants then completed one on one, in-depth semi-structured interviews to ascertain their knowledge and understanding of NAFLD. Results: Qualitative findings revealed low awareness of risk factors for liver disease, NAFLD specifically. Knowledge of liver disease tended to center around cirrhosis, a condition many participants reported was prevalent in their families. Quantitative and qualitative findings both found information sources for NAFLD and liver disease to be predominantly friends, family, and media. Interviews revealed a misperception related to NAFLD risk that liver disease was only caused by high alcohol intake. Conclusion: Low levels of NAFLD awareness and knowledge warrant the need for greater efforts to educate the general population, perhaps by integrating NAFLD education into existing type 2 diabetes educational campaigns and prevention interventions. Additionally, further elicitation research conducted in Mexican-origin adults is needed to elucidate key factors within behavioral-theory constructs that can be targeted in future interventions tailored to this unique population.
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Affiliation(s)
- Kristin E Morrill
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Rebecca M Crocker
- Center for Border Health Disparities, Health Sciences, University of Arizona, Tucson, AZ, United States
| | - Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - David O Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Crocker RM, Palmer KNB, Marrero DG, Tan TW. Patient perspectives on the physical, psycho-social, and financial impacts of diabetic foot ulceration and amputation. J Diabetes Complications 2021; 35:107960. [PMID: 34059410 PMCID: PMC8316286 DOI: 10.1016/j.jdiacomp.2021.107960] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 04/20/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/22/2023]
Abstract
AIMS Diabetic foot ulcers (DFUs) and ulceration are complex and lifelong problems for patients with diabetes which dramatically increase mortality rates. This qualitative study sought to capture detailed personal accounts and insights from patients with a clinical history of DFUs and amputations to better understand patient experiences. METHODS Fifteen patients from a tertiary referral center that treats diabetic foot problems were approached for participation. Inclusion criteria included having at least one DFU and being of white, Native American, or Hispanic background. Interviews were conducted by telephone by study staff trained in qualitative data gathering and audio recorded. RESULTS The main themes that emerged around impacts included the heavy burden of managing care, significant loss of ambulatory function, economic stress due to medical care costs and job loss, and emotional suffering tied to these stressors. CONCLUSIONS These data illuminate common social and personal impacts of diabetic foot problems across an ethnically and racially diverse and predominantly low-income US sample that expand our understanding of related declines in well-being. Our results indicate a need for proactive mental health assessment post DFUs diagnosis and the diversification of hospital and community-based support systems.
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Affiliation(s)
- Rebecca M Crocker
- Center for Border Health Disparities, University of Arizona Health Sciences, 1295 N Martin Ave., PO Box 210202, Tucson, AZ 85719, United States of America.
| | - Kelly N B Palmer
- Center for Border Health Disparities, University of Arizona Health Sciences, United States of America
| | - David G Marrero
- Center for Border Health Disparities, University of Arizona Health Sciences, United States of America
| | - Tze-Woei Tan
- Division of Vascular and Endovascular Surgery, University of Arizona College of Medicine-Tucson, Southern Arizona Limb Salvage Alliances (SALSA), United States of America
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Abstract
Barriers to health care access faced by Mexican immigrants in the United States have been well-documented, including lack of insurance, fear of deportation, and language barriers. However, little is known about this population's care-seeking experiences before migration. In this article, I use a life-course approach to explore binational isolation from health care and the ways in which early-life experiences pattern Mexicans' care-seeking practices in the United States. This ethnographic research project took place in Tucson, Arizona, between 2013 and 2014 and used semistructured interviews with service providers and first-generation Mexican immigrants. The majority of participants faced significant barriers to medical care in Mexico, which resulted in low rates of care utilization and heavy reliance on lay modalities. Immigrants faced an even broader array of barriers to care in the United States, and their lack of prior health care access further discouraged care utilization and compromised their medical care experiences after migration.
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14
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Crocker RM, Reineke RC, Ramos Tovar ME. Ambiguous Loss and Embodied Grief Related to Mexican Migrant Disappearances. Med Anthropol 2021; 40:598-611. [PMID: 33544654 DOI: 10.1080/01459740.2020.1860962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Since the 1990s, thousands of Latin Americans have died or disappeared along the US-Mexico border, following the funneling of migration through remote desert regions. The families of missing migrants face long-term "ambiguous loss," a lived experience in which a loved one is physically absent but psychologically present. Mexican relatives of the missing in Arizona and Sonora report that these losses produce deep emotional suffering along a timeline - worrying about the crossing, learning of the disappearance, beginning to search, and finally, coping with the long-term impacts of unknowing. Close relatives experience embodied health effects including headaches, insomnia, anxiety, depression, and chronic disease.
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Abstract
This article explores the intersection of two growing health concerns: the rising incidence of loneliness and the negative health impacts of migration and displacement. To better evaluate loneliness across diverse populations, we emphasize the cultural shaping of expectations for social lives and the ways in which structural vulnerability and violence can undermine these expectations. We draw on ethnographic research with two groups of migrants: Mexican immigrants living in southern Arizona and Turkana pastoralists of Kenya who experience displacement and unpredictable mobility as a result of low intensity violence. For Mexican immigrants, feelings of loneliness intertwine with the emotions of fear, trauma, and sadness, all closely associated with social isolation. The Turkana describe loneliness associated with the loss of their animals, or the shifting social landscapes they must traverse to keep their families safe. The culturally salient experiences described by these two communities highlight the complexity of defining loneliness. Given the pace of global migration and the number of refugees and displaced persons, closer scrutiny of how cultural expectations and structural violence interact to produce feelings of loneliness seems overdue.
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Affiliation(s)
- Ivy L Pike
- School of Anthropology, University of Arizona, Tucson, AZ 85721, USA
| | - Rebecca M Crocker
- Center for Border Health Disparities, University of Arizona Health Sciences, Tucson, USA
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