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PubMed1997

Living on the edge: dietary strategies of economically impoverished women in Cali, Colombia.

Economically impoverished women in Cali, Colombia, have restricted access to food in a city where food is abundant. Ethnographic observations, interviews and 2 day food records were used to better understand the coping strategies used by a group of these women (n = 85) to maintain adequate levels of energy intake. Anthropometric indicators of nutritional status were normal for the group. Interview data revealed that the ability to purchase food was a concern for 58% of the women. When faced with a restricted ability to purchase food, the women indicated they made compromises in meal composition, reduced portion sizes, and/or reduced the number of meals. They also relied on relatives, friends, neighbors, store credit, or local government programs for access to food. Changes in meal composition were identified in 17.1% of all diet records (n = 509). Low energy intake (defined as energy intake < or = 1.27 x BMR) was identified in 17.1% of all diet records. Carbohydrate consumption was significantly greater on low-energy intake days. The adequate nutritional status of this group of women suggests that their coping strategies are usually adequate to maintain energy intake, but the presence of uncertainty, the frequency of compromises in diet composition, and the frequency of low-energy intake days suggest that these women are at risk for undernutrition.

Adaptation, Psychological↗

PubMed2000

Medication compliance in older individuals with depression: gaining the views of family carers.

Documented evidence indicates that medication non-compliance for the older person is a common and poorly understood problem. This paper reports on a pilot study, which used a focus group interview to explore carers' attitudes, experiences and perceptions regarding medication compliance for their older depressed relative. It aimed to understand the problems and challenges encountered by carers in respect of their relative being non-compliant, and provide material to develop a comprehensive educational and support package to promote antidepressant compliance. A convenience sample of seven carers participated in the focus group and a qualitative analysis of the interview identified a number of key issues. Carers had little knowledge of depression, they were not well informed regarding antidepressant medication and they took an active role to ensure compliance. The focus group highlighted the need for health care professionals to promote and encourage carers to be part of the older individuals treatment programme and provide concise and unambiguous educational information in relation to antidepressants and the importance of compliance.

Caregivers↗

PubMed2005

A qualitative exploration of determinants of fruit and vegetable intake among 10- and 11-year-old schoolchildren in the low countries.

BACKGROUND: For the development of fruit and vegetable promotion interventions, insight is needed into determinants of health behaviour. This study presents results of focus group interviews held with 10- to 11-year-old schoolchildren from Ghent (Belgium-Flanders) and Rotterdam (the Netherlands) to explore personal beliefs and motivations and environmental factors related to schoolchildren's fruit and vegetable intake, to inform the Pro Children intervention development. METHODS: Twelve focus groups were held with 92 schoolchildren. The interviews were recorded and transcribed and NVivo was used to analyse the transcripts. RESULTS: Positive health beliefs, taste preferences, lack of knowledge and practical barriers were identified as personal factors related to fruit and vegetable intake. Home and school availability of fruits and vegetables, as well as parenting practices were identified as important environmental factors. CONCLUSION: A fruit and vegetable promotion intervention should aim to increase fruit and vegetable accessibility and should include educational and motivational activities tailored to these personal and environmental factors. These indications should be further evaluated in quantitative research among representative samples.

Belgium↗

PubMed2004

Learning from the experience of working with consumers in educational developments.

AIM: The aim of this paper is to report the experience of working with local parents as collaborators in an educationally focussed research study. This work subsequently led to the development of a new module aimed at professionals providing parenting support. The ensuing discussion centres on the involvement of healthcare consumers in the development of educational programmes. METHODS: Focus group interviews were held with local parents to identify their various experiences of parenting support services. In addition the interviews were used as a means of recruiting local parent volunteers willing to join the research advisory group. This group had the task of guiding both the research and development of the educational programme. FINDINGS: Involvement of the parents introduced fresh insights to both the understanding of the content of parent education module and the necessary ingredients needed for effective consumer involvement. CONCLUSION: Lecturers have gained first hand experience of working collaboratively with parents in carrying out a research study and curriculum development. Three key issues emerged from this experience. These included the identification of who the consumer is, the approaches and skills required by professionals and lastly the importance of resources to support this commitment.

Attitude of Health Personnel↗

PubMed2003

Theory-driven guidelines for practical care of older people, based on the theory of gerotranscendence.

INTRODUCTION: The theory of gerotranscendence states that human development is a process extending into old age. When optimized, this process ends in a new perspective. The developmental process towards gerotranscendence can be obstructed or accelerated by life crises and grief, but elements in the culture can also facilitate or impede the process. Similarly, the caring climate can obstruct or accelerate the process toward gerotranscendence. The view introduced by the theory may have several consequences for staff treatment of and actions towards older people, as it offers a new understanding of living into old age. AIM: The aim of the present study was to derive guidelines for practical use in the care of older people. The guidelines should be used to promote a development toward gerotranscendence and should also be of value for people who already have attained a state of gerotranscendence. METHODS: The method of deriving guidelines from the theory was focus group interviews. The theory of gerotranscendence was used as a foundation for stimulating the discussions in the focus groups as well as for organizing the proposals that emerged. FINDINGS: Concrete guidelines at three levels, focusing on the individual, activity and organization, were derived. The guidelines describe different ways to support older people in their process towards gerotranscendence. CONCLUSION: These guidelines could support staff in their practical care of older people and could be used as a supplement to enrich the present care.

Adult↗

PubMed1995

Reproducibility of responses to telephone interviews: demographic predictors of discordance in risk factor status.

The reproducibility of responses to the Behavioral Risk Factor Surveillance System questionnaire was examined across the demographic strata used by the Centers for Disease Control and Prevention and state health departments for reporting prevalence estimates (specifically age, sex, income, employment, and marital status), as well as race/ethnicity, which has been previously examined. The authors administered the questionnaire twice, 21-94 days apart, to randomly selected residents of Massachusetts (response rates: first administration, 68% of eligible households; second administration, 68% of persons who completed the first interview). Initial interviews were conducted in March and October 1992. Among 448 respondents to both interviews, group mean distributions of seven demographic characteristics and 19 risk factors were highly consistent across the two interviews. Discordance in individual risk factor status ranged from 1.2% to 21.8% (median, 7.8%) and was symmetric in direction, i.e., as many respondents were considered at increased risk on the basis of the first interview and at low risk on the basis of the second interview as the reverse. Kappas ranged from 0.30 to 0.90 (median, 0.75). Education, household income, and interval between administrations were not associated with prevalence of discordance for any risk factor. Sex, age, race/ethnicity, marital status, and employment status were each predictive of variation in discordance for one or more risk factors, but no consistent effect of any individual demographic characteristic across risk factors was observed. The questionnaire has relatively uniform and generally good reproducibility across all demographic strata used for monitoring the Health Objectives for Year 2000 and other chronic disease surveillance activities.

Adolescent↗

PubMed2004

Strengthening quality and continuity of diabetes care in rural ghana: a critical social psychological approach.

Adopting critical social psychology and community psychology perspectives, this article examines the links between shared social knowledge of diabetes, illness experience and illness action through semi-structured individual and group interviews with diabetes sufferers and lay healthy individuals in two rural Ghanaian communities. Analysis highlights that both groups make sense of diabetes and illness experience by drawing interchangeably from four shared knowledge modalities: common-sense, scientized, religious and emotional. Common-sense notions of health and illness and scientized understandings of diabetes frame illness action goals that merge with biomedical goals. These goals are compromised by structural, community/family and emotional dynamics. Findings suggest that the best immediate solutions lie in addressing availability and cost of biomedical care and quality food, with concomitant attention to community education and self-help groups as negotiators of psychosocial and economic support.

Adult↗

PubMed2002

Breastfeeding practices of working women.

Breastfeeding is the fundamental aspect of child rearing that a woman copes with. It creates a wonderful bond between mothers and their babies. The importance of breast feeding to child health is highlighted by the yearly World Breastfeeding week (Forste, Weiss & Lippincott 2001:291). Breastfeeding promotions in the Northern province like anywhere else in the country appear effective and visible enough to encourage women at all levels to breastfeed. Ironically, many women give up breastfeeding when they return to work because the thoughts of expressing their milk at work and the fiddling around with pumps and storage at work seem overwhelming (McAlpine 1998:80). Based on the assumption that breastfeeding requires commitment and determination, the researcher thought it was necessary to enquire about the experiences of working women on breastfeeding. Focus group interviews were conducted using a semi-structured format. Twenty-six women participated in three focus group discussions. The study was conducted in the suburban areas of the Northern Province, Soutpansberg region. Data was transcribed from a taped session and analysed using an open code method. Four major categories were identified: Knowledge and attitudes towards breastfeeding, lack of support at work, lack of support at home and a need for facilities and resources that promote breastfeeding at the workplace. It was perceived that women are so stressed at the end of the day that they have little or no time to nurse the baby. They appear however knowledgeable about the benefits, advantages and disadvantages of breastfeeding their babies. A concern was also raised that the time that they therefore spend with their babies is limited and affect their relationship with their babies. Women felt that they need support from their employers as well as colleagues at work to be able to balance their responsibilities.

Adult↗

PubMed1992

Child abuse as an inhibiting factor for family planning.

The aim of this study is to determine the magnitude of the problem of using children as an economic asset to the family thus, in one way increasing the prevalence of child abuse in Egypt and also hindering the family planning program. Two focus-group interviews were conducted in urban & rural areas for 10 women with the same age range and socioeconomic background. All were non-users of any contraception. Subsequently an interview was conducted for all women who attended the Ob. & Gyn. Clinic at Ain Shams University Hospital in the period from June to August 1991, their ages ranged from 30-35 years and they never used contraception. Another group of women with the same characteristics were interviewed from a rural area at Fayoum Governorate. A questionnaire was filled for each interviewed woman. The total women interviewed in urban area is 340 while in the rural area they were 400 women. Sixty percent of urban women and 80% of rural women are illiterate, 70% of the urban & 100% of rural women are housewives. Their years of marriage ranged between 10-20 years and all of them have more than five children. A percentage of 73.5% of urban women and 85% of rural women stated that children are used as an economic asset to their families, they work in urban areas as assistants in motor repairs, hair-dressers, beggars, bakeries, shops, restaurants and factories while in rural areas they work as agricultural workers.

Adult↗

PubMedDate not supplied

Gendered experiences of conflict and co-operation in heterosexual relations of Somalis in exile in Gothenburg, Sweden.

Political upheaval and poverty at home has been forcing many Somalis to immigrate. These immigrants do not only leave their physical house, families, relatives, loved ones, friends, but also familiarities, culture, customs, and often they do end up in no man's land being between their own and new home culture. Available reports suggest that there are about 15,000 Somalis in Sweden and their majority came here from late 1989 to 1996. About one third these immigrants live in and around the city of Gothenburg. This paper explores and describes gendered experiences of conflict and co-operation in heterosexual relations of Somalis in exile in Gothenburg, Sweden. A qualitative sociological in-depth interviews with 6 women and 7 men was performed during May 1999 to January 2000. A follow up focus group interviews with 10 people (2 women and 8 men) was also carried on. The results show that both the Somali culture and Muslim religion do not support the children being taught sex education in schools or the names of the sex organs being pronounced other than to be used as metaphors. The girls, unlike their age group males, experience a very painful and terrifying process during childhood in which their self-esteem is downgraded by means of serious degrading traditional active violence such as female genital mutilation and visible virginity control. The narratives tell stories in which Somali women are degraded and expected to obey in situations characterised by their man's arbitrariness. They are subject to a very extensive form of social control, which is especially pronounced on issues regarding sexuality. Their integrity as women is, consequently set aside. When Somali refugees came to Sweden some of them came to adopt much of the modern lifestyle and cultural norm systems, preferable young people and some of the females. Relating to a new culture with its new expectations on the norm obedience also created changes in self-esteem. Exile situation tends to generate horizontal conflicts, among spouses and between groups of people. It also tends to generate vertical conflicts because now generations stand up against each other and this is especially pronounced when it is about issues of sexuality and sexual relations. The young generations questions their parents authority. They are now living in new social context and perceive risks, as well as possibilities. Their new dreams and choices, however, do not fit their parents' expectations, which sometimes leads to big problems. From a traditional perspective these deviants lack of respect for traditions and the original culture. From a male perspective this means more specifically a lack of respect for male dominance and superiority.

Adult↗

PubMed2005

Public understanding of food risks in four European countries: a qualitative study.

BACKGROUND: In the wake of the 'bovine spongiform encephalopathy (BSE) crisis' there was renewed interest in how those responsible for public health could take account of public views, both to 'democratize' policy making and to increase the likelihood of information about health risks resonating with public concerns. This study explored how members of the public in four European countries (Finland, Germany, Italy and the UK) understood food risks in general, and risks arising from BSE in particular. The aims were to identify the sources of knowledge used and trusted by the public and to explore how public views could be accessed for public health information policy. METHODS: Thirty-six focus group interviews were held using a common protocol across the four countries, including people from four life-cycle stages. RESULTS: The study demonstrated the utility of using focus groups as a relatively efficient method for accessing public views, and the feasibility of cross-national qualitative research on public views. We found that public views of food risks are neither irrational nor naïve, but that they do need to be interpreted in the context of everyday food purchasing decisions, in which particular food risks are unlikely to have the same salience as they do for experts. CONCLUSIONS: Focus groups are a feasible method for accessing public knowledge on public health risks to inform information strategies.

Adolescent↗

PubMed2006

Still a difficult business? Negotiating alcohol-related problems in general practice consultations.

This paper describes general practitioners' (GPs) experiences of detecting and managing alcohol and alcohol-related problems in consultations. We undertook qualitative research in two phases in the North-East of England. Initially, qualitative interviews with 29 GPs explored their everyday work with patients with alcohol-related issues. We then undertook group interviews--two with GPs and one with a primary care team--where they discussed and challenged findings of the interviews. The GPs reported routinely discussing alcohol with patients with a range of alcohol-related problems. GPs believed that this work is important, but felt that until patients were willing to accept that their alcohol consumption was problematic they could achieve very little. They tentatively introduced alcohol as a potential problem, re-introduced the topic periodically, and then waited until the patient decided to change their behaviour. They were aware that they could identify and manage more patients. A lack of time and having to work with the multiple problems that patients brought to consultations were the main factors that stopped GPs managing more risky drinkers. Centrally, we compared the results of our study with [Thom, B., & Tellez, C. (1986). A difficult business-Detecting and managing alcohol-problems in general-practice. British Journal of Addiction, 81, 405-418] seminal study that was undertaken 20 years ago. We show how the intellectual, moral, emotional and practical difficulties that GPs currently face are quite similar to those faced by GPs from 20 years ago. As the definition of what could constitute abnormal alcohol consumption has expanded, so the range of consultations that they may have to negotiate these difficulties in has also expanded.

Alcoholism↗

PubMedDate not supplied

Qualitative responses of children to environmental noise.

Results from recent quantitative research consistently demonstrate that children are a high risk group, vulnerable to the adverse effects of noise exposure, especially effects on cognitive performance, motivation and annoyance. The aims of the two qualitative studies reported in this paper are to explore children's a) perception of noise exposure; b) perceived risk of and attitudes towards noise pollution; c) coping strategies; and d) the annoyance response. The Millennium Conference Study involved focus group interviews with an international sample (n=36) unselected by exposure. The West London Schools Study involved individual interviews, conducted with a purposively selected sample (n=18) exposed to aircraft noise. The children in the focus groups reported being most affected by neighbours' noise and road traffic noise, whereas children exposed to aircraft noise were most affected by aircraft noise. As expected, the impact of noise pollution on everyday activities (e.g. schoolwork, homework and playing) was larger for the children exposed to high levels of aircraft noise compared with the low noise exposed children and focus group samples. The range of coping strategies that children employed to combat noise exposure in their lives was dependent upon the amount of control they had over the noise source. The emotional response of children describing the annoyance reaction to noise was consistent with adult reactions and it would seem that child noise annoyance is the same construct. Future research should employ qualitative methods to supplement quantitative investigations.

Adolescent↗

PubMed2006

The experience of whanau caring for members disabled from the effects of a cerebro-vascular accident.

The study sought to understand the experience of Māori in accepting responsibility for the care of a whanau member following a cerebro-vascular accident (CVA). The importance and role of whanau, kaumatua and kuia to Māori as a distinctive ethnic entity is well known and acknowledged in coming to an understanding of Māori society. Whanau has a very large part to play in the care of the family member disabled by CVA. There is extensive literature that deals with these issues, yet there is little that deals with disability issues and in particular those issues that arise following CVA. A qualitative study was conducted examining the experience of Whanau caring for members disabled from the effects of CVA. Individual and focus group interviews were undertaken with Māori patients and their caregivers to explore this phenomenon. Data were analysed using a thematic analysis approach and highlighted three time stages of concern, namely (1) the onset of the event, (2) hospitalisation, and (3) discharge care.

Caregivers↗

PubMed2002

Nutritional considerations for bereavement and coping with grief.

PURPOSE: The purposes were 1) to examine the level of nutritional risk among recently bereaved individuals, with or without intervention for grief resolution, and those in coupled relationships and 2) to examine the dietary issues faced by the three groups. METHODS: Twenty-two individuals from the above-mentioned categories were selected. Background information was elicited using a questionnaire. Focus group interviews and the Determine Checklist were used to assess dietary issues and nutritional risk, respectively. RESULTS: Bereaved individuals, irrespective of whether they had counseling for grief resolution or not, had a moderate risk for poor nutrition (score >3). Although the level of risk was similar between the two bereaved groups, it was significantly different from those in coupled relationships, who had the lowest risk (1.43). Based on the interviews, the dietary issues included: 1) food acquisition, preparation and consumption; 2) difficult meals place and time; 3) influence of social network/spouse; and 4) food and nutrition information. The food-related issues faced by bereaved individuals were similar, but substantially different from those in coupled relationships. CONCLUSIONS: The results show that bereavement counseling does not serve as a gateway to reduced nutritional risk and highlights the need to address food issues in grief resolution interventions.

Aged↗

PubMed2004

[What kind of family makes a case difficult? Public health nurses' views on home care for the frail elderly].

OBJECTIVE: Public health nurses (PHNs) played the major role in providing care management for the frail elderly before the Long-term Care Insurance started in 2000. Although the role of care management has now shifted to care managers, PHNs are still consulted by such care managers, service providers and families of the elderly about long-term home care. The purpose of this study was to explore the factors that make a case difficult to deal with from PHNs' viewpoint. This study focuses on the factors related to family living in the same household (living-together family). SUBJECTS AND METHODS: The informants of this study were seven PHNs who worked for a city with a population of 67,000 (proportion of elderly in the whole population is 19%) in Nagano Prefecture. First, a focus group interview (about 90 minutes) with the six PHNs was conducted to extract an outline of difficult cases. Next, semi-structured interviews (about 60 minutes each) with five PHNs were conducted to obtain detailed information on difficult cases. The interviews were tape-recorded and transcribed verbatim. KJ analysis was conducted by defining characteristics, finding similar factors, and grouping these together to form categories. RESULTS: Categories of family related problems emerged for each of two major categories: family characteristics and care related problems. Firstly, existing family characteristics, including the existence of mental or psychological disorders, low motivation towards providing long-term care, conflictual familial relationships, objections to having service providers in the home, and economic difficulties contribute to problems in providing long-term care with living-together families. These characteristics can lead to a second set of problems, relating to the actual provision of care by the living-together family to frail elderly patients. These care related problems include including insufficient care, rejection of formal care services, and deviation from care directives, including to the point of physical mistreatment. CONCLUSION: This study points to the need for care providers to consider the living-together family's background and the potential for the phenomena, indicated in this study, to negatively impact on the provision of care for the frail elderly.

Aged↗

PubMedDate not supplied

Breast cancer screening in older African-American women: qualitative research findings.

PURPOSE: The purpose of this study was to gain a better understanding of the cultural meanings that shape the breast cancer screening behavior of older African-American women. DESIGN: Qualitative research methods elicited social and cultural themes related to breast cancer screening. SETTING: Focus group interviews were conducted in the natural settings (churches, etc.) of older African-American women. SUBJECTS: Interviews were conducted with 132 members from 14 social networks of older African-American women. MEASURES: A focus group guide asked about 1) perceived risk of breast cancer, 2) behavioral intentions about breast cancer screening, 3) health seeking behavior, and 4) social support. RESULTS: For older African-American women: other health concerns are of more concern than breast cancer; age is generally not recognized as a risk factor for breast cancer; fear of finding breast cancer and its social consequences are salient barriers to mammography; they tend to rely on breast self-exam rather than mammography to detect a breast problem; cost may be more an issue of competing priorities than cost per se; the tradition is to go to doctors for a problem, not prevention; and women in their own social networks are important sources of social support for health concerns. CONCLUSIONS: These data offer explanations for mammography screening in older African-American women and emphasize the strength of naturally existing sources of social support for designing interventions to increase breast cancer screening.

Black or African American↗

PubMed1999

Development of a questionnaire to investigate patient compliance with antirheumatic drug therapy.

OBJECTIVE: To develop a rheumatology oriented questionnaire that measures compliance to drug regimen and identifies factors that contribute to suboptimal compliance in patients with rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), and gout. METHODS: Thirty-two patients (16 RA, 8 PMR, 8 gout) participated in semistandardized home interviews about their attitude toward their antirheumatic medication, actual drug intake, and reasons for not taking medication. A focus group interview with 7 patients (3 RA, 2 PMR, 2 gout) was held. Following an advertisement in the rheumatology patient organization magazine (>8000 patients) 14 patients (9 RA, 5 PMR) telephoned and explained their reasons for noncompliance. All interviews were recorded on tape, transcribed, and independently reviewed by 2 investigators. Thirty-one statements were selected. After a field test, the phrasing of some items was revised. The questionnaire was then sent by mail to 117 consecutive outpatients (58 RA, 30 PMR, 29 gout). RESULTS: Twelve items were excluded because of low or high corrected item-total correlation or skew distribution of the answers. Internal consistency of the remaining 19 items was intermediate (0.71). Discriminant analyses with an overall patient self-report compliance measure showed a sensitivity of 98%, a specificity of 67%, and a Cohen's kappa of 0.71. Stepwise discriminant analyses revealed that 3 items classified 84% of all cases correctly with a sensitivity of 99%, specificity 80%, and kappa 0.78. CONCLUSION: The 19 item measure was well accepted. It is useful to detect possible barriers for optimal compliance and to predict patient compliance to drug regimen.

Aged↗