Are Psychosocial Interventions Targeting Older African American Cancer Survivors Culturally Appropriate? A Review of the Literature
School of Nursing, University of North Carolina, Chapel Hill, North Carolina 27599-7460, USA. Cancer nursing
(Impact Factor: 1.97).
06/2011; 35(2):E12-23. DOI: 10.1097/NCC.0b013e31821e0b11
The alleviation of cancer health disparities makes it necessary to understand and apply the knowledge about cultural behaviors in the design of interventions deemed culturally appropriate.
This review aimed to provide an overview of the ways in which strategies were used to facilitate the cultural appropriateness of psychosocial interventions delivered to African American cancer survivors.
An electronic and hand search of 5 major databases was performed to identify intervention studies that targeted African American cancer patients/survivors 50 years or older. We review researchers' efforts to achieve culturally appropriate intervention research by evaluating whether peripheral, evidential, linguistic, constituent-involving, or sociocultural strategies were used.
Only 6 intervention studies met the criteria for inclusion in this review, with each study using 1 or more strategies to achieve cultural appropriateness. However, few studies incorporated sociocultural factors in the intervention design.
Strategies to achieve cultural appropriateness in psychosocial interventions targeting older African Americans have focused more on enhancing recruitment and retention and less on the inclusion of sociocultural concepts into the content of the intervention.
Intervention studies delivered to older African American cancer patients/survivors should aim to incorporate those concepts of relevance to the population and likely to facilitate healthcare outcomes.
Available from: Abbas Tavakoli
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ABSTRACT: The effects of a therapeutic group by teleconference for African American women with breast cancer have not been documented, although the benefits of therapeutic groups for European women are well established. African American women with breast cancer may experience social disconnection, a sense of being cut off from partners, family, and friends because of side effects of treatment and fatalistic beliefs about cancer. A therapeutic group by teleconference may counteract these problems and improve social connection.
A randomized trial design stratified by treatment type was used. Data were collected at baseline, at the end of the intervention, and 16 weeks from baseline. Repeated-measures, fixed-factor analyses of covariance were used for each outcome. The between-subject factors were group and replicate set, and the within-subject factor was time. Physical well being and educational level differed significantly between the 2 groups at baseline and were used as covariates.
The mixed-model analysis of the outcome variables revealed significant changes over time for knowledge (P ≤ .001), with higher scores on knowledge observed for the control group. Group-by-time interactions were observed for fatalism (P = .0276), fear (P = .0163), and social connection (P = .0174) as measured by the Social Well Being subscale from the Functional Assessment of Cancer Treatment-Breast Cancer Version. No group-by-time interaction was observed for social connection as measured by the Social Support Questionnaire. Social connection measured with the Social Well Being subscale improved significantly in the intervention group, whereas fatalism and fear significantly decreased.
In this study, the authors documented the benefits of a therapeutic group by teleconference, a novel way to provide support for African American women with breast cancer. Further research should include a behavioral outcome, such as treatment adherence.
Available from: Deborah J Toobert
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ABSTRACT: Objective: To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research. Method: Influential literature from the past decade was examined to identify points of consensus. Results: There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions. Conclusions: Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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ABSTRACT: The purpose of this study was to determine if a particular set of health behaviors of health care providers and African American men (AAM) influence patient satisfaction from the AAM's perspective. This descriptive, correlational study consisted of 505 AAM in North Carolina diagnosed with prostate cancer and enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP). Analyses consisted of bivariate analyses and multiple regression. Patient-to-provider communication, interpersonal treatment, and provider-to-patient communication accounted for 45% (p ≤ .0001) of the variability in patient satisfaction. Interpersonal treatment (provider focusing on the patient) explained the greatest amount (F = 313.53, R² = .39) of patient satisfaction. Since interpersonal treatment focuses on the patient and demonstrated to be the strongest predictor in patient satisfaction, it is noteworthy to consider the emphasis that should be placed on patient-centered care. In addition, knowing important variables positively affecting patient satisfaction provides useful information for developing appropriate interventions to improve AAM health care experiences.
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