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Objective The process of reflexivity is used to critically examine the experience of conducting qualitative research with functionally diverse older adults in a post disaster context. Methods The design of the study began with an interpretative phenomenological framework, using in-depth interviews. Fifteen individuals with functional and access needs living in Puerto Rico were interviewed regarding their experiences after Hurricane María of 2017. Findings In the field, it was necessary to expand the initial design, and adjust to participants’ preferences and needs, as well as situational characteristics, without compromising ethical standards of practice. The methodology transformed because of the need for flexibility requiring humility from the researchers. A more relational form of inquiry was warranted, which acknowledged the intersubjectivity of human experience. This entailed adapting to community involvement, building rapport with community leaders functioning as gatekeepers, and integrating family or friends in interviews. Discussion The reflexive approach allowed for a better understanding of the researcher’s positionalities and how they influence the ability or inability to develop trust (e.g. insider/ outsider status, Puerto Rican/ US, with functional and access needs/ without functional and access needs). Conclusions Given the shift toward relational inquiry and due to the challenges faced while carrying out the study, we suggest that post-disaster qualitative research would benefit from further including principles of indigenous decolonizing methodologies, which can be incorporated into studies using interpretative phenomenological analysis.

Persistent drug shortages introduce challenges to clinicians and health care systems. We describe an exploratory qualitative study of key informants' perspectives, discourse, and experiences in confronting drug shortages. Semi-structured interviews were conducted with pharmacy directors and bedside clinicians at urban academic medical centers and surrounding community hospitals. Focused coding, reflexive review, and thematic analyses informed by constructionist grounded theory were employed. For some participants, the unpredictability of drug shortages created a siege mentality. Recognition of potentially related patient safety deficits also led to moral distress. Participants were often unprepared to make explicit allocation decisions nor openly discuss drug substitutions with patients. Despite these struggles; participants displayed resilience, and inter-professional teamwork, which eclipsed role constraints and medical hierarchical authority. Varied perspectives and responses are described.

Background Discrimination and social inequity increase risk for alcohol use disorders among Latinxs. An alcohol intervention trial that led to significant reductions in alcohol-related consequences also produced significant reductions in mental health symptoms for Latinx heavy drinkers. In the current qualitative study, we explore this trial's mental health effect by examining participants' perspectives on the social context of immigration, i.e., structural barriers, and associations among the immigrant experience, stigma, depressive/anxiety symptomatology, and alcohol consumption. Methods Study participants were eligible if they completed the clinical trial, exhibited levels of depressive and anxiety symptoms that exceeded the range for clinical depression (≥18, CES-D) and anxiety (≥12, BAI) at baseline, and demonstrated significant declines in depression and anxiety symptoms 12 months following their completion of the trial. The study coded 24 participant transcripts using ATLAS.ti and thematic analysis. Results Participants reported their responses to structural barriers (e.g., a lack of educational supports, difficulties accessing safety net programs). Reported experiences of exclusion and discrimination were associated with depressive and anxiety symptoms. Stigmatization processes included feeling isolated and contributed to poor mental health. Participants reported drinking to cope with low mood. Conclusions Structural barriers are exclusionary because they limit full participation and communicate who does/does not belong along race/ethnic lines, i.e., structural racism. Feeling stigmatized for being different was associated with feelings of anxiety and depression among our immigrant participants. Future interventions must focus on stressors associated with the constraints of being an immigrant. Understanding how structural barriers and structural racism impact health behavior can enrich the design and impact of interventions for socially disadvantaged Latinx individuals.

The special issue on Women’s Reproductive Health in Cultural Context covers multiple dimensions of women’s reproductive health and how it might be shaped by cultural meanings, social and gender inequities, and power differentials, employing a variety of methodological approaches. On the one hand, it aims to bring to the forefront the conversation about how women’s health is uniquely experienced and constructed in local settings, and on the other hand, it aims to draw broader conclusions from a perspective of interconnectedness of women and the shared issues that they face. The special issue was initiated through a call for submissions and includes ten articles on the topic of women’s reproductive health in cultural context. The articles provide many insights into how the context in which they live can disadvantage women and endanger their health, as well as offer perspectives on women’s resistance to disempowering and stigmatizing discourses and practices. It aims to be of interest to scholars in behavioral medicine, psychology, and other social sciences

This study addresses criminal victimization and contact with police among older Puerto Ricans living in Northeastern United States. Framing their experiences within the context of immigration, we assess the role that acculturation and perceived stress play on Puerto Rican crime and victimization. Data from the Boston Puerto Rican Health Study (BPRHS; N = 1,504) were analyzed using multiple logistic regressions. The experience of criminal victimization by Puerto Ricans is associated with higher educational attainment, increased perceived stress, and also with psychological acculturation. Contact with police is associated with linguistic, but not psychological, acculturation. Our findings give strength to the argument that exposure to crime and the criminal justice system increases with acculturation and that this argument is relevant to Puerto Ricans. Thus, the association between acculturation, criminal victimization, and police contact depends on the conceptualization of acculturation used. The relationship between stress, acculturation, and crime among Latinos is complex and warrants further assessment.

Puerto Rican adults in the United States mainland live with socioeconomic and health disparities. To understand their contextual experience of aging, we interviewed participants in the Boston Puerto Rican Health Study. Through a Thematic Analysis we identify themes and tensions: normalization and acceptance of aging; gratitude; the importance of aging within social networks; longing to return to Puerto Rico at older age. We address the tensions between ‘acceptance’ and fatalismo as a cultural belief, and a function of structural barriers. The experience of aging is discussed in the context of Puerto Rico’s history and continued dependence on the United States.

This article aims to initiate a critical reconstruction of theory and research on reasoning and personal epistemology prompted by socio-philosophical critiques of rationalism and by a theoretical perspective according to which both discourses of knowledge and modes of thought are constituted in a power-infused sociocultural order structured materially and discursively by gender, ‘race,’ and socioeconomic class. A new qualitative methodology is introduced, particularizing participants in terms of their social location and modes of thought while also formulating cross-sectional analytical constructs. New analytical constructs for characterizing epistemic resources ostensibly brought into reasoning are interpretively induced from data through a quasi-inductive process informed by critical philosophical perspectives on knowledge. Theoretical implications point to the functional interplay of dominant and subversive discourses of knowledge in the constitution of thought, the complex assemblage of discursive resources flexibly deployed in reasoning, and the social constitution and biographical particularity of reasoners as epistemic agents.

Self-rated health (SRH) is an important indicator of overall health, predicting morbidity and mortality. This paper investigates what individuals incorporate into their self-assessments of health and how acculturation plays a part in this assessment. The relationship of acculturation to SRH and whether it moderates the association between indicators of health and SRH is also examined.The paper is based on data from adults in the Boston Puerto Rican Health Study, living in the greater Boston area (n=1357) mean age 57.2 (SD = 7.6). We used multiple regression analysis and testing for moderation effects.The strongest predictors of poor SRH were the number of existing medical conditions, functional problems, allostatic load and depressive symptoms. Poor SRH was also associated with being female, fewer years of education, heavy alcohol use, smoking, poverty, and low emotional support. More acculturated Puerto Rican adults rated their health more positively, which corresponded to better indicators of physical and psychological health. Additionally, acculturation moderated the association between some indicators of morbidity (functional status and depressive symptoms) and SRH.Self-assessments of overall health integrate diverse indicators, including psychological symptoms, functional status and objective health indicators such as chronic conditions and allostatic load. However, adults' assessments of overall health differed by acculturation, which moderated the association between health indicators and SRH. The data suggest that when in poor health, those less acculturated may understate the severity of their health problems when rating their overall health, thus SRH might thus conceal disparities. Using SRH can have implications for assessing health disparities in this population.

The incidence of cervical cancer in Eastern Europe has been on the rise, in contrast to the reduction in incidence in most countries of Western Europe. The objectives of the paper are to delineate the inequalities in cervical cancer screening in Romania and Bulgaria and identify explanations for these inequalities.Representative samples of women - 1,099 in Bulgaria and 1,053 in Romania, were interviewed through a structured questionnaire.We found multiple dimensions of inequalities in cervical cancer prevalence and prevention, including disparities in comparison to other countries, disparities due to socioeconomic status, education, residency and ethnicity, as well as differential barriers faced by women in access to screening and in relationships with providers. We identified mediators of the effects of socio-economic status on screening history.The study concludes that the effect of SES on screening is mediated mainly by the structural barriers in accessing the healthcare system, as well as women's perceptions of the multiple costs of the smear. These conclusions are relevant to the development of national screening programs and health promotion in the two countries.

The current rise of immigration to the United States is being accompanied by a dramatic increase of newly arrived immigrant children to American schools. Therefore, there is a clear need to gain an understanding of the way in which the children themselves conceptualize achievement and how they attribute success and failure in their new unfamiliar surroundings. We examined immigrant children's narratives elicited by a modified version of the Thematic Apperception Test (TAT) (C. Suarez-Orozco & Suarez-Orozco) collected in two separate studies. The first study, Transformations: Immigration, Family Life, and Achievement Motivation Among Latino Adolescents (C. Suarez-Orozco & Suarez-Orozco, 1995) is archived in the Murray Research Archive, Harvard–MIT Data Center, Harvard University. The second study from which we drew data is the Longitudinal Immigrant Student Adaptation Study (LISA) (C. Suarez-Orozco, Suarez-Orozco, & Todorova, in press). In this combination of current and archival data, we applied a unified...

This introductory chapter uses a detailed case study to illustrate the interconnection of multiple social influences on one particular youth's path of migration. It further identifies some of the major influences on immigrant youth development, including the stresses of migration, separations and reunifications, changing networks of relations, poverty and segregation, and identity formation.

The article discusses the way in which culturally available discourses of the expected transition to motherhood are negotiated in women's narratives of living with involuntary childlessness in Bulgaria. We follow the meanings that the situation holds for the women and the ways in which they creatively appropriate, transform, and resist culturally available discourses in the process of constructing their narratives and identities. For the purpose of this analysis, we use the Listening Guide Method of interviewing and interpretation of interview transcripts. For the women we interviewed in Bulgaria, both subtle and explicit forms of resistance were evident. They protest stigma and mistreatment through voicing their anger, and they also appeal to social change through organized action. Childless women in Bulgaria are slowly changing the available cultural images of infertility, as well as the models of womanhood, introducing more societal options.

The Human Papilloma Virus (HPV) is the most common sexually transmitted infection (STI) and can cause cervical cancer. Two vaccines are available to protect against the most common strands of the virus. Vaccination programs differ across Europe but most neglect young adults, who are the group with the highest risk of contracting STIs. Our aim was to explore the views of young women from four European countries-Scotland, Spain, Serbia, and Bulgaria - about the HPV vaccine communication strategy. These countries are characterized by different cervical cancer prevalence and vaccine implementation policies. We conducted focus group discussions with young women (aged 18-26) with various vaccination histories in a purposive sample. We subjected the data to thematic analysis with the purpose of identifying themes related to communication about the HPV vaccine. We recorded the information sources mentioned by participants. Participants discussed numerous sources of vaccine-related information. They approached information critically rather than naively and questioned the sources’ trustworthiness and motives. Participants desired transparent information about the risks of the virus and the risks and benefits of the vaccine. These risks and benefits were individualized in view of personal and external factors. Particular aspects of the vaccine and the way information was communicated resulted in feelings of uncertainty. There were notable cross-cultural differences in experiences with HPV vaccine communication. Our results suggest that transparent risk communication about the HPV vaccine is valued by young women. In addition, both individual and culturally-dependent factors influenced experiences with, and preference for information.

The need to improve quality of care represents a major goal of all health care systems. The objective of this series is to illuminate how the contextual factors of hospitals from eight European countries, and the well-being of their healthcare professionals, contribute to either construct or degrade quality of care. The studiesreported here provide an important bottom-up perspective on quality of care, andthe way that burnout and organizational culture are intertwined within it. Overall, thecollected studies represent an in-depth examination through focus groups of theexperiences of 153 physicians, 133 nurses, and 46 patients from Greece, Portugal,Bulgaria, Romania, Ireland, Turkey, Croatia, and the Republic of Macedonia. Eachpaper makes a unique contribution to the understanding of how institutionalcontexts, organizational management, and job characteristics impose constrains, bothon the capacity of health workers for better treatment decisions and choices, butalso on their day-to-day professional satisfaction and quality of life. Taken as a whole,the papers make an even greater contribution, by pointing out the underlyingsimilarities and differences across these eight European countries.