UOSC PAD3034 Intervention Tailoring for Minorities Article Paper

UOSC PAD3034 Intervention Tailoring for Minorities Article Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON UOSC PAD3034 Intervention Tailoring for Minorities Article Paper You must then choose 1 of these articles to read and interpret. Interpreting the article means that you are clearly and succinctly communicating the findings of the article as well as the methods used. This is not an article summary, an article critique, or an article review. This is an article interpretation, so you must interpret the findings of the article as if you were communicating this information to an individual for whom you worked. This assignment must be 400–500 words and be formatted in current Turabian style, including a citation at the beginning (on the top of the first page of text rather than at the end in a bibliography). No sources other than the article, itself, are required for this assignment. UOSC PAD3034 Intervention Tailoring for Minorities Article Paper article.pdf A Qualitative Case Study Examining Intervention Tailoring for Minorities Nelda Mier, PhD; Marcia G. Ory, PhD; Deborah J. Toobert, PhD; Matthew Lee Smith, PhD, MPH, CHES, CPP; Diego Osuna, MD, MPH; James R. McKay, PhD; Edna K. Villarreal, MPH; Ralph J. DiClemente, PhD; Barbara K. Rimer, DrPH Objectives: To explore issues of intervention tailoring for ethnic minorities based on information and experiences shared by researchers affiliated with the Health Maintenance Consortium (HMC). Methods: A qualitative case study methodology was used with the administration of a survey (n=17 principal investigators) and follow-up telephone interviews. Descriptive and content analyses were conducted, and a synthesis of the findings was developed. Results: A majority of the HMC projects used individual tailoring strategies regardless of the ethnic background of participants. Followup interview findings indicated that T here is evidence that the overall health of the US population has improved1-3 with social and behavioral interventions playing a crucial role in the key considerations in the process of intervention tailoring for minorities included formative research; individually oriented adaptations; and intervention components that were congruent with participants’ demographics, cultural norms, and social context. Conclusions: Future research should examine the extent to which culturally tailoring long-term maintenance interventions for ethnic minorities is efficacious and should be pursued as an effective methodology to reduce health disparities. Key words: cultural, tailoring, ethnic minorities, disparities Am J Health Behav. 2010;34(6):822-832 process.4,5 The Institute of Medicine (IOM) (2006), however, has noted that ethnic minorities experience higher mortality and morbidity rates than do nonminorities. Nelda Mier, Associate Professor and Edna K. Villarreal, Graduate Research Assistant both from the Department of Social and Behavioral Health, School of Rural Public Health, McAllen Campus, Texas A&M Health Science, McAllen, TX. Marcia G. Ory, Regents’ Professor and Matthew Lee Smith, Research Associate both from Department of Social and Behavioral Health, School of Rural Public Health, A&M Health Science Center, College Station, TX. Deborah Toobert, Senior Research Scientist, Oregon Research Institute, Eugene, OR. Diego Osuna, Clinician Researcher, Kaiser Permanente Colorado Institute for Health Research, Denver, CO. James McKay, Professor of Psychology in Psychiatry, University of Pennsylvania Center on the Continuum of Care in the Addictions, and Philadelphia VAMC, Philadelphia, PA. Ralph J. DiClemente, Chandler Professor, Emory University School of Public Health, Atlanta, GA. Barbara K. Rimer, Dean, Alumni Distinguished Professor, NC Gillings School of Global Public Health, Chapel Hill, NC. Address correspondence to Dr Mier, Department of Social and Behavioral Health, School of Rural Public Health, McAllen Campus, Texas A&M Health Science Center, 2101 S McColl Rd McAllen, TX 78572. UOSC PAD3034 Intervention Tailoring for Minorities Article Paper Email: [email protected] 822 Mier et al Hispanics and African Americans experience more age-adjusted years of potential life lost before age 75 than do non-Hispanic whites due to stroke, chronic liver disease and cirrhosis, diabetes, and homicide. 6,7 Both Hispanics and African Americans have higher rates of obesity and report lower levels of physical activity than those of non-Hispanic whites.6-8 Asian populations suffer a higher incidence of tuberculosis, certain types of cancer, and Hepatitis B than do non-Hispanic whites.9 Native Americans are more likely to report poorer health outcomes than any other ethnic group.10 In addition, disparities exist in access to health care and are associated with higher mortality rates among ethnic minority groups.1 The increasing diversification of the United States underlines the need to address ethnic health disparities and weigh the significance of using a cultural sensitivity paradigm in the design and dissemination of health interventions targeting minorities. Whereas ethnic minorities currently constitute about one third of the US population, it is expected that by 2050 minorities will become the majority and represent 54% of the national population. It is also estimated that by 2050, the Hispanic population will grow almost 3-fold (from 49 million to 132.8 million); the Asian group will more than double from 14.4 million to 34.4 million; and the African American population will increase almost 43% (to become 56.9 million).11 If ethnic minorities continue to experience health disparities,1,2,6-10 the estimated population growth of these groups may exacerbate the negative impact of these disparities. Responding to both the IOM recommendation to eliminate disparities and the NIH mandate for a more systematic inclusion of ethnic minorities in research12,13 to reflect national demographic trends will require, among other public health strategies, the diffusion of effective health interventions that are culturally sensitive to ethnic minorities. This paper through a case study approach aimed to explore ways in which the Health Maintenance Consortium (HMC) (a collective of 21 NIH-sponsored research projects) addressed issues of cultural tailoring explicitly for ethnic minority participants. We wanted to understand to what extent, and what types of, culturally sensitive strategies were used by the consortium for tailoring mainAm J Health Behav.? ? 2010;34(6):822-832 tenance health interventions that were inclusive of ethnic minority participants. This case study is based on information and experiences shared by researchers who participated in the HMC. Consortium researchers were funded by NIH to conduct studies to test different theoretical models for achieving long-term behavioral change. Intervention outcomes in these studies included lifestyle behaviors associated to chronic disease (ie, eating behaviors, physical activity, cigarette smoking, and alcohol consumption), more risky behaviors (ie, suicide, drug abuse, and HIV-related sexual behaviors), and preventive practices (ie, mammography and mental health screening). Cultural Sensitivity Paradigm The cultural sensitivity paradigm guiding the process of intervention tailoring or adaptation for diverse groups in public health and behavioral research has emerged from multiple disciplines, including health communication,14,15 psychology,16 substance abuse prevention,17-23 HIV research,24,25 and health care systems. UOSC PAD3034 Intervention Tailoring for Minorities Article Paper 26-30 The paradigm is not only consistent with the movements of patient-centered care and the chronic care model,31 but its relevance is also underscored within the health-disparity literature addressing ethnic disparities.2,28,30,32 The concept of cultural sensitivity has been used interchangeably as cultural competence, cultural appropriateness, or cultural consistency. Although there is not a single theoretical framework or a standard definition in reference to the cultural sensitivity paradigm, we defined the concept as “the extent to which ethnic and cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of a target population, and relevant historical, environmental, and social forces” (p493) are taken into account in intervention design, implementation, and assessment.33 The application and impact of the cultural sensitivity paradigm has also been investigated. Considerable research supports the notion that addressing the individual needs and sociocultural context of ethnic minorities in behavioral interventions results in statistically significant health-outcome modifications among participants.34-39 Despite the emergence of cultural frameworks and the evidence showing that cul- 823 Tailoring for Minorities Table 1 Survey Instrument Items and Interview Themes Survey instrument items related to cultural sensitivity (the list of possible responses is not shown): · In what ways have the treatment strategies that are being used in your study been adapted to be culturally sensitive (cultural sensitivity refers to the extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of target populations are incorporated in the design, delivery, and evaluation of your intervention materials . This might involve for example using different recruitment strategies for different ethnic groups)? · To what extent has the content of your intervention strategies been adapted to be culturally sensitive? · In what language(s) are the intervention materials provided? · What formats/considerations were used to address issues regarding literacy in these materials?· Are your interventionists required to speak a language other than English? · Are your interventionists required to meet specific criteria regarding age, gender, race/ethnicity, and/or other? Theme guide with open-ended questions used in follow-up interviews: · What minority groups did you target? · How did you tailor the intervention to be culturally sensitive for this group? · What formative research activities did you conduct to tailor the intervention? · What are the main components that made your intervention culturally sensitive? · What lessons did you learn from tailoring your intervention to minority participants? · What worked and what did not? What would you do differently in future studies? turally tailored interventions are effective in improving, in the short term, the health status of ethnic minorities,34-39 there is paucity of studies examining cultural sensitivity applications in long-term maintenance of behavior change in minority health research. This case study, therefore, was proposed as an instructive exercise to gain insights on culturally sensitive issues as addressed by HMC researchers. UOSC PAD3034 Intervention Tailoring for Minorities Article Paper Background of the Health Maintenance Consortium The case study consortium was established in 2004 with funding from the National Institutes of Health (NIH). The HMC is a collective of 21 behavioral research projects focused on understanding the long-term maintenance of behavior change as well as identifying intervention components for achieving sustainable health promotion and disease prevention. Coordinated by the NIH Office of Behavioral and Social Sciences Research, the HMC comprised NIH administrators, 21 research investigators in the United States, and the HMC Resource Center program staff and advisors. METHODS A qualitative case study methodology 824 was used for the study. The data collection process consisted of 2 phases: a descriptive analysis of data from a survey administered to 17 HMC principal investigators (PIs) and telephone interviews with 4 HMC PIs to follow up on issues of cultural sensitivity specifically related to ethnic minority participants. Survey Using a community-based participatory approach, a task force was established as part of the HMC activities to investigate the role that different intervention strategies played in the longterm maintenance of behavior change. The task force comprised 9 HMC members, including HMC PIs, advisors, and staff and NIH administrators. We all participated on a voluntary basis. The goal of the task force was to compile an inventory of interventions for projects affiliated with the HMC and to identify intervention components. Using a consensus process, the task force designed a structured 52item questionnaire to be administered to HMC PIs conducting studies that tested the effects of long-term interventions. The task force also established the content validity of the questionnaire. The survey instrument was then pilot tested to assure it met the group’s aim and to Mier et al Table 2 Studies Included in the Interview Data Analysis Study 1 HIV Prevention Maintenance for African American Teens. Aim: To determine the efficacy of an HIV maintenance prevention intervention to sustain condom-protected sexual intercourse among African American females aged 14-20 years, over an 18-month follow-up period. Study 2 !Viva Bien! This project was a cultural adaptation for Latinas of the Mediterranean Lifestyle Program (MLP) (affiliated with HMC). Aim of the MLP and !Viva Bien!: To improve multiple health behaviors in postmenopausal women with type 2 diabetes Study 3 Finding the M.I.N.C. for Mammography Maintenance. Aim: To identify the minimum intervention needed for change for annual mammography use and maintenance among women of diverse occupations and backgrounds. Study 4 Weight Loss Maintenance in Primary Care. Aim: To evaluate 2 interventions for weight loss maintenance in primary care patients recruited by their physicians. test its readability and comprehension. The instrument was administered via email to 21 PIs. A total of 17 PIs responded. The survey queried the PIs about the characteristics of their interventions, including topics related to ways in which the intervention was tailored to be culturally sensitive. For purposes of this case study, we examined data obtained from responses to only 6 close-ended items included in the instrument survey. These 6 items were related to cultural sensitivity (as shown in Table 1). The data were analyzed using descriptive statistics. UOSC PAD3034 Intervention Tailoring for Minorities Article Paper After written consent was obtained, interviews with the 4 PIs were conducted by telephone and recorded. All interviews were transcribed verbatim. For Study 2, the PI and a research team member were interviewed, but both interviews were treated as one set of data or transcript. Transcripts were reviewed independently. Then, using a focused coding process in which concepts that emerged throughout the data were identified, transcript findings were combined into larger, overreaching themes.40 This study was approved by the Texas A&M University Institutional Review Board. Follow-up Interviews In addition to analyzing the survey data collected by the task force, authors of this paper also conducted telephone interviews with 4 HMC PIs to expand on issues of cultural-tailoring processes applied to ethnic minority groups. The interviews were based on a theme guide (Table 1). Principal investigators who responded to the survey (n=17) were asked to state via e-mail whether or not they tailored their interventions to make them culturally sensitive for ethnic minority participants. Of the 17 PIs who replied to the email inquiry, 4 responded affirmatively. One of the interviews was related to an intervention not affiliated to HMC, but was nevertheless considered because the PI culturally adapted the HMC-related intervention to an ethnic minority group. A description of the 4 studies is shown in Table 2. RESULTS Survey Instrument Data The descriptive analysis of survey responses revealed that the most frequent tailoring strategy was matching intervention schedules with participants’ availability (76.5%). Another prevailing strategy was delivering the intervention in accessible locations to participants or meeting their transportation needs (64.7%). Half of the HMC projects tailored the interventions based on formative research. In addition, 8 studies (47%) reported that their interventions were delivered by individuals who were knowledgeable of the cultural views and values of participants (it is worth noting that the descriptive data did not capture details or examples of such cultural views and values; Table 3). Almost 2 thirds of the HMC studies Am J Health Behav.? ? 2010;34(6):822-832 825 Tailoring for Minorities Table 3 Percentage of HMC Projects (n=17 ) by Intervention Tailoring Strategy Intervention tailoring strategiesa %b The design of the treatment strategies was based on formative research experiences, norms, beliefs, values, behavioral patterns, socioeconomic level, or other cultural characteristics of participants. 58.8 Recruitment staff are from the participants’ community. 11.8 The treatment strategies include activities that involve family and friends of participants. 29.4 The intervention delivery setting was selected to make it accessible to, or meet the transportation needs of, participants (eg, community setting, church, neighborhood). 64.7 The delivery of the intervention is facilitated by individuals or organizations from the participants’ community (eg, community health workers, community leaders). 11.8 The intervention delivery schedules were adapted to match the participants’ availability. 76.5 The treatment strategies address trust issues related to research participation. 23.5 The interventionists are knowledgeable of cultural views and values of participants. UOSC PAD3034 Intervention Tailoring for Minorities Article Paper 47.1 The interventionists’ racial/ethnic background is matched to the participants. 11.8 The interventionists’ age is matched to the participants. 5.9 The interventionists’ gender is matched to the participants. Recruitment was done in minority newspapers, churches, and community events. 17.6 5.9 Intervention content was based on the socioeconomic status of the participants. 35.3 Intervention content was developed to match the participants’ cultural views and values. 23.5 Intervention content was developed to match the participants’ literacy level. 58.8 Intervention content was developed in the preferred language of the participants. 23.5 Notes. a This is the list of statements as presented in the survey instrument. Survey respondents were asked to check each statement that applied to their study. b Percentage of respondents that checked the corresponding item box developed intervention contents that met the literacy level of the target population (Table 3). All interventions were delivered in English, and only one reported having an interpreter in the intervention classes. All 17 projects included some ethnic minority participants. The average percentage of ethnic minority inclusion was 826 40.18%, and the range was from 6% to 100%, with only one study having all participants from an ethnic minority group (Figure 1). Follow-up Interview Data Three major themes emerged from data obtained through the follow-up interviews: the importance of formative research in Mier et al Figure 1 Percentage of Ethnic Minority Participants by Study (n=17) cultural tailoring, intervention cultural components, and main lessons learned. Formative Research The intervention tailoring process in 3 projects was informed by formative research including literature searches, focus groups, interviews, theatrical testing, and pilot testing: You can read the literature, but unfortunately, even the African American community is not homogeneous. So if you were dealing with Caribbean Americans, African Americans, or Africans, people who have lived in the North versus the South, there really are some differences that need to be taken into account. The only way to really get at those nuanced differences is by doing some in depth formative work. (Study 1) Study 2 began the formative process by searching the literature for “some insights into things that we should consider changing from the parent program [The Mediterranean Lifestyle Program]. There could be some factors unique to Latinas Am J Health Behav.? ? 2010;34(6):822-832 that would make a difference in terms of learning self- management procedures. In that literature we frankly didn’t find anything that was very profound.” Study 2 also conducted focus groups, but again “we were left with the sense that the overall format in the parent program was feasible for implementation with Latinas. Childcare and transportation were 2 of the areas the participants thought we should be sensitive to because they thought the intervention would be rather demanding.” Study 1 conducted 2 pilots assessing the feasibility and cultural appropriateness of the program: “The pilot studies were sort of a dress rehearsal. We went through all the procedures, including randomization, and we delivered our intervention, and at the end of each intervention session, that’s when we requested specific informa … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10