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African Americans are twice as likely as Caucasian Americans to choose aggressive hospital treatment when death is imminent. Repeat hospitalizations are traumatic for patients and drain patient and health system resources. Hospice care is a specialized alternative that vastly improves patient quality of life at end-of-life. This study was conducted to determine if hospices partnering with African American churches to disseminate hospice education materials could increase utilization of hospice services by African Americans. Members of two African American churches (N = 34) participated in focus group discussions to elicit beliefs about hospice care. Focus group transcripts were coded and comments were grouped according to theme. Six themes were identified. Lack of knowledge about hospice services and spiritual beliefs emerged as the top two contributing factors for underutilization of hospice services. Study findings support partnerships between hospices and African American churches to provide hospice education to the African American community., (© The Author(s) 2015.)

Purpose: Nondisclosure of terminal prognosis in the context of intercultural interactions can cause moral distress among health care providers guided exclusively by informed consent. However, cultural humility can show that revealing and withholding prognostic information are two equally valid paths to the goal of protecting the patient from harm., Design: Assumptions and history giving rise to the preference for truth telling in the United States(US) are examined. Principles of biomedical ethics are described within the context of US, Chinese, and Latin American cultures. The process of cultural competence in the delivery of health care services is explained and introduces the concept of cultural humility., Implications for Practice: By focusing more on biases and assumptions brought forth from the dominant culture, health care providers may experience less moral distress and convey increased caring in the context of intercultural interactions and nondisclosure of prognosis of a terminal illness., (© The Author(s) 2015.)

Unique drug responses that may result in adverse events are among the ethnocultural differences described by the Agency for Healthcare Research and Quality. These differences, often attributed to a lack of adherence on the part of the older adult, may be linked to genetic variations that influence drug responses in different ethnic groups. The paucity of research coupled with a lack of knowledge among health care providers compound the problem, contributing to further disparities, especially in this era of personalized medicine and pharmacogenomics. This article examines how age-related changes and genetic differences influence variations in drug responses among older adults in unique ethnocultural groups. The article starts with an overview of age-related changes and ethnopharmacology, moves to describing genetic differences that affect drug responses, with a focus on medications commonly prescribed for older adults, and ends with application of these issues to culturally congruent health care., (© The Author(s) 2015.)

Purpose: This was a descriptive-correlational study designed to determine factors associated with the healthy lifestyle behaviors of high school students in Turkey., Design: The study sample consisted of 812 high school adolescents. The Adolescent Lifestyle Profile scale was used to identify the healthy lifestyle behaviors of adolescents., Results: The total Adolescent Lifestyle Profile mean score of 2.75 ± 0.33 and the mean score on the Interpersonal relations subscale were found to be the highest scores while the mean score on the Health responsibility subscale was found to be the lowest. Significant predictors of healthy lifestyle behaviors of adolescents were good relationships with family and friends, having a father who was a college graduate, and good health perception., Conclusions: The study revealed similar results among adolescents of different cultures., Implications for Practice: These findings can be used as a guide in developing an adolescent health promotion program for school nurses., (© The Author(s) 2015.)

The Bolivian indigenous Ayoreo ethnic people are vulnerable to sexually transmitted infections and HIV. Ayoreo women who also work in sex trades belong to an extremely high-risk group, and prevention programs are not delivering effective outcomes for them. The aim of our study was to explore, describe, and understand behavioral and cultural patterns related to sexual and reproductive health in Ayoreo sex workers. A qualitative-ethnographic study was designed; data were collected through participant observation and in-depth interviews with sex workers and key informants. Two fundamental themes contributing to HIV risk for female Ayoreo sex workers in Bolivia emerged: reproductive/sexual freedom and sociocultural risk determinants. We concluded that the in-depth examination of the sexual-reproductive culture amongst the Ayoreo has provided useful information, which might contribute to the cultural adaptation and design of future policies and prevention programs for sexually transmitted infections and HIV in this group., (Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

Cultural competence is a mainstay in health care and nursing education. With the expansion in the number of distance-based nursing programs across the country, innovative teaching methods for distance learning faculty are required to instill cultural competence in students. Faculty must be deliberate when planning distance-based learning activities that incorporate cultural experiences. This article describes several such strategies including the creative use of blogging, recorded lectures, the online synchronous classroom, social media, and cultural immersion projects. These methods capitalize on existing information technologies and offer distance-based students the opportunity to connect with one another, as well as develop the awareness, sensitivity, and respect that is required when providing culturally competent care. These teaching methods are modifiable to meet the teaching and learning needs of the faculty and the students, thereby allowing educators to support the integration of cultural competence into patient care for distance students., (© The Author(s) 2014.)

The purpose of this study was to evaluate the psychometric properties of the Appraisal of Diabetes Scale (ADS) in Korean patients with Type 2 diabetes. The English-language version of the ADS was translated into Korean using a forward-and-backward translation technique. The Korean version of the ADS (ADS-K) was administered to 250 patients who were recruited from two university hospitals. The data were analyzed using principal-component analysis, Cronbach's alpha, analysis of variance, t test, and Pearson's correlation. Six of seven items were meaningfully clustered into a two-factor structure by principal-component analysis, these factors accounting for 63.75% of the total variance. The underlying structure was consistent regardless of either gender or the presence of complications. The Cronbach's alpha of the subscales ranged from .71 to .79, indicating an acceptable internal consistency reliability. As hypothesized, the ADS-K score was moderately correlated with the diabetes-specific quality of life and had satisfactory convergent validity. The known-groups validity of the ADS-K was established using depression groups and HbA1c control status. The ADS-K demonstrated good psychometric properties. In addition, it possessed satisfactory practical properties, such as acceptability and feasibility. Therefore, the ADS-K appears to be suitable for use in both clinical research and clinical practice., (© The Author(s) 2014.)

Purpose: This article evaluates the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) questionnaire, a measure of essential knowledge for type 2 diabetes self-management, after it was modified for English- and Spanish-speaking Mexican Americans., Method: We collected surveys (SKILLD, demographic, acculturation) and blood for A1C analysis from 72 community-recruited participants to analyze the SKILLD's internal consistency, interrater reliability, item analysis, and construct validity. Clinical experts evaluated content validity., Results: The SKILLD demonstrated low internal consistency but high interrater reliability and content and construct validity. There were significant correlations in expected directions between SKILLD scores and acculturation, education, and A1C and significant differences in SKILLD scores between and within groups after an educational intervention and between high- and low-acculturated participants., Conclusion/implications: The SKILLD generates useful information about Mexican Americans' diabetes knowledge. Lower SKILLD scores suggest less diabetes knowledge, lower health literacy, and participants' difficulties understanding items. Further modifications should improve use with low-acculturated Mexican Americans., (© The Author(s) 2014.)

The current Ebola crisis has sparked worldwide reaction of panic and disbelief in its wake as it decimated communities in West Africa, particularly in Guinea, Liberia, and Sierra Leone, including its health care workers. This article affirms the crucial role nurses play in maintaining health and preventing diseases, connects the devastating havoc of the Ebola virus disease to another issue of nursing shortage in underdeveloped countries, and asserts the key leadership nurses play in protecting the communities they serve while maintaining their safety and those of other health care workers. Nurses must actively seek a place at the table, as echoed by the American Academy of Nursing and American Nurses Association and the American Nurses Association, when decisions are being made regarding Ebola virus disease: at care settings, in the board room, and at federal, state, and local levels., (© The Author(s) 2015.)

Addressing the health care needs of a 21st-century nation that is experiencing increased diversity and disparity will require new models of educating future providers. The cultural competence and confidence model was the guiding framework in a study evaluating the influence of cultural educational offerings on the transcultural self-efficacy (TSE) perceptions in baccalaureate nursing students. The Transcultural Self-Efficacy Tool was used to measure perceived TSE in a pretest (N = 260), posttest (N = 236) study over an academic year. Significant changes were demonstrated in overall self-efficacy and on the cognitive, practical, and affective subscales. A classification and regression tree analysis identified social orientation as the demographic variable most predictive of the TSE level. This study supports previous research where positive changes were found in students' TSE based on the inclusion of cultural interventions in the nursing curriculum., (© The Author(s) 2014.)

Successful aging is gaining increasing attention given the growth in the older adult population. Criteria and definitions within multiple disciplines vary greatly in Western literature, with no consensus on its meaning. Sociocultural, economic, and political differences between the Western view of successful aging and its view in China add to the confusion. Similarities and differences in the meaning of successful aging in the United States and China are examined, and potential for a common definition useful to nursing in both countries is explored. Using concept analysis, shared criteria for successful aging were the following: decreased incidence of disease and disability, life satisfaction, meaning and purpose in life, and ability to cope effectively to achieve goals based on personal values and priorities. A comprehensive, multidimensional definition of successful aging for nursing and a midrange nursing theory of successful aging were identified that may be useful to guide nursing research, practice, and policy., (© The Author(s) 2014.)

Introduction: American Indian and Alaska Native (AIAN) women have relatively high breast cancer mortality rates despite the availability of free or low-cost screening., Purpose: This qualitative study explored issues that influence the participation of older AIAN women in mammography screening through tribally directed National Breast and Cervical Cancer Early Detection Programs (NBCCEDPs)., Methods: We interviewed staff (n = 12) representing five tribal NBCCEDPs and conducted four focus groups with AIAN women ages 50 to 80 years (n = 33)., Results: Our analysis identified four main areas of factors that predispose, enable, or reinforce decisions around mammography: financial issues and personal investments, program characteristics including direct services and education, access issues such as transportation, and comfort zone topics that include cultural or community-wide norms regarding cancer prevention., Conclusion: This study has implications for nurse education and training on delivering effective mammography services and preventive cancer outreach and education programs in AIAN communities., (© The Author(s) 2014.)

Purpose: Native Hawaiian and other Pacific Islanders (NHOPIs) have the highest prevalence of overweight and obesity in the world. We identified the proportion of our NHOPI sample in each body mass index (BMI) category and explored relationships between BMI and demographic characteristics., Design/method: Our descriptive correlational study included 364 NHOPI caregiver adults in Utah (n = 155) and Hawaii (n = 209). We gathered demographic information with a questionnaire. Height and weight were measured for BMI calculations., Results: According to the Centers for Disease Control and Prevention's BMI categories, 84.3% of our sample was overweight or obese. Participants in Utah had significantly higher BMIs than participants in Hawaii. Educational attainment was inversely related with BMI; however, age, gender, and income were not significantly related with BMI., Discussion: NHOPIs on the U.S. mainland may be at greater risk for obesity than those in Hawaii; food price differences between locations may help explain this. NHOPIs in early adulthood had high BMIs; overtime this situation could worsen without intervention., Implications for Practice: NHOPIs with low education levels or in areas of low food prices are at increased risk for obesity. Future research should focus on culturally sensitive interventions to reduce NHOPI obesity and associated risks., (© The Author(s) 2014.)

The aim of this study was to assess the coronary heart disease risk factors in the Asian Indian community living in a large city in Australia. A cross-sectional survey was conducted at the Australia India Friendship Fair in 2010. All people of Asian Indian descent who attended the Fair and visited the health promotion stall were eligible to participate in the study if they self-identified as of Asian Indian origin, were aged between 18 and 80 years, and were able to speak English. Blood pressure, blood glucose, waist circumference, height, and weight were measured by a health professional. Smoking, cholesterol levels, and physical activity status were obtained through self-reports. Data were analyzed for 169 participants. More than a third of the participants under the age of 65 years had high blood pressure. Prevalence of diabetes (16%) and obesity (61%) was significantly higher compared with the national average. Ten women identified themselves as smokers. Physical activity patterns were similar to that of the wider Australian population. The study has provided a platform for raising awareness among nurses and promoting advocacy on the cardiovascular risk among Asian Indians. Strategies involving Asian Indian nurses and other Asian Indian health professionals as well as support from the private and public sectors can assist in the reduction of the coronary heart disease risk factors among this extremely susceptible population., (© The Author(s) 2014.)

Purpose: The purpose of this synthesis is to explore the experience of the transition from cancer patient to survivor in African Americans with breast cancer, addressing the risk/ protective factors that have an influence on successful transition using the social ecological model., Methods: The investigator searched CINAHL, PubMed, and PsycInfo databases. Articles were assessed for content addressing risk and protective factors of transition in African American breast cancer survivorship. Eleven research articles were obtained and synthesized., Results: Risk and protective factors exist at all levels of the social ecological model. Emotional issues are prevalent after the cessation of cancer treatment, enhanced by the lack of social support in this population. Spirituality was shown to be present in many levels as a protective factor during this period., Conclusions and Implications for Practice: The entrance to survivorship represents a time of increased stressors and subsequent coping. Through careful identification of influencing factors, health care providers can develop strategies to attenuate the emotional distress and negative complications of the transition specific to this vulnerable population. Illuminating the experiences of African American women during this transition period provides insight into the interventional needs during and after the cessation of breast cancer treatment., (© The Author(s) 2014.)

Purpose: To explore Australian nursing students' perceptions of spirituality, religiosity, and personal belief., Background: Spiritual and religious literature support the benefits to patients' physical and mental health. Nurses have an ethical obligation to understand and incorporate patient's spiritual beliefs and values into the care plan., Method: A cross-sectional survey was conducted using the 32-item WHO-QOL-SRPB questionnaire., Sample: The sample consisted of 483 undergraduate nursing students in Sydney, Australia., Results: There were 21% male and 79% female students; age ranged from 18 to 56 years, with a mean age of 26.53 (SD = 7.32). There were no significant difference between male and female nursing students, but there were difference in SRPB scores between first-, second-, and third-year students and between religious affiliations., Conclusions and Implications: Spirituality is multidimensional and multilevel and is interconnected with religiosity and personal belief. Nurses need to understand their own spirituality before they can incorporate spirituality in their patient care., (© The Author(s) 2014.)

Many challenges exist when providing international education to those who care for people at the end of life. Though issues related to culture and language may vary, the one commonality that crosses all nations is that its people die. In general, societies seek to provide the best care they are trained to give. Many have few resources to provide this care well. Traditions of the past influence norms and dictate policies and procedures of the present. Since its inception in 2000, the End-of-Life Nursing Education Consortium Project has provided palliative care education to nurses and other members of the interdisciplinary team in six of the seven continents. This article describes the efforts of this project to improve education around the globe, with the goal of providing excellent, compassionate palliative care, irrespective of location, financial status, political views, religion, race, and/or ethnicity., (© The Author(s) 2014.)

As HIV incidence rises globally, Asian and Pacific Islander communities are increasingly affected. While often overlooked, Asian and Pacific Islander American women have shown the greatest percentage increase in HIV diagnosis rates. The development of a multilevel and multistrategy approach to HIV/AIDS education, prevention, and treatment among Asian and Pacific Islander females requires health care providers to identify personal and cultural barriers to prevention and treatment and implement culturally sensitive and specific measures. The purpose of this article is to illuminate barriers to HIV-related prevention, treatment, and care among Asian and Pacific Islander American females and provide practical application-based suggestions for providers, which may enhance Asian and Pacific Islander female inclusion in comprehensive HIV prevention., (© The Author(s) 2014.)

The Swahili of Lamu, Kenya, understand illness as the result of a spiritual imbalance caused by personal transgression or an attack by harmful forces directed by an envious person. Another underlying component of the Swahili concept of illness is that each person's physical body operates in conjunction with personal attributes that are fixed at birth and determine moral character, behavior, and predisposition to ailments. When physical symptoms occur, the Swahili focus on identifying the human or supernatural entity that caused the illness in consultation with a range of healers who specialize in a variety of curing strategies. Two case studies illustrate how culturally congruent nursing care can be achieved when health care providers understand the Swahili framework of diagnosing and treating illness., (© The Author(s) 2013.)

Purpose: This article seeks to review and discuss the evidence linking depression, coronary heart disease (CHD), and culture., Method: PsychInfo, CINAHL, PubMed, and Google were searched for pertinent evidence linking depression, culture, and CHD, and retrieved articles were analyzed using thematic content analysis., Findings: Identified themes were the followings: depression is a factor in development and prognosis of CHD and affects the capacity to self-manage and adhere to treatment recommendations; culture mediates mental health/illness representations and treatment-seeking behaviors; screening and assessment of depression can be affected by cultural factors; and there is a need for culturally appropriate screening and therapeutic strategies., Discussion and Conclusions: As depression is a predictor and moderating variable in the genesis and progression of CHD, understanding how factors such as culture affect screening and management of the disease is important to inform the development of culturally and linguistically competent strategies that ensure accurate screening, detection, and treatment of depression in cardiac patients in clinical practice., (© The Author(s) 2014.)

If we limit our gaze to epidemiologic or medicalized discourse about health disparities, we risk losing sight of the person living in a health disparity context. We may erase or make invisible the person from a health disparity group; pathologize difference at the population level and, by extension, stigmatize the individual; eliminate the upstream context or causes of disparities; and obscure the human story. For the continued viability of our ideas about health disparities, it is crucial that we maintain cognitive flexibility. The unconscious bedrock of trusted ideas about "culture" and "disparities" can be enriched through a humanized view of the person in the health disparities story. Transcultural nursing research complements the biomedical gaze, placing the patient at the center of a cultural context where health problems are embodied, place based, and socially constituted. Humanizing our practice depends on dialogues with those who experience health disparity conditions.

Purpose: Cognitive behavioral (CB) group therapy is an effective therapeutic intervention to treat war-related trauma. The aim of this pilot study was to describe the effects of conducting CB group therapy in a civilian population exposed to war in southern Lebanon., Method: Participants presenting with psychiatric symptoms attended an 8-week CB group therapy intervention adapted to the Lebanese culture. Observations from therapists' field notes were reviewed and grouped into commonalities., Findings: A majority of the total participants (N = 10) reported satisfaction with the CB therapy and a decrease in symptoms. Field notes revealed positive group interactions (i.e., sharing information, cohesiveness), therapeutic benefits (i.e., symptom identification, destigmatizing mental illness, learning coping strategies), and barriers to attendance (i.e., stigma, personal constraints)., Conclusion and Implications: CB group therapy is a promising intervention for civilian survivors of war trauma. Challenges to conducting such interventions in a war-conflict area are discussed. Future research and intervention planning should address challenges faced during this study to better meet mental health needs.

Purpose: The purpose of the study was to investigate the experiences of Japanese nurses and their adaptation to their work environment in Australia. Using a qualitative research method and semistructured interviews, the study aimed to discover, describe, and analyze the experiences of 14 Japanese nurses participating in the study., Design: A qualitative study., Method: Fourteen Japanese registered nurses working in Australian hospitals participated in the study. Individual semistructured interviews were conducted from April to June in 2008. Thematic analysis was used to identify themes within the data., Results: Analysis of qualitative open-ended questions revealed the participants' adaptation process. It consists of three themes or phases: seeking (S), acclimatizing (A), and settling (S), subsequently named the S.A.S. model., Discussion: The conceptual model of the adaptation processes of 14 Japanese nurses working in Australia includes the seeking, acclimatizing, and settling phases. Although these phases are not mutually exclusive and the process is not necessarily uniformly linear, all participants in this study passed through this S.A.S. model in order to adapt to their new environment., Implications for Practice: The S.A.S. model of adaptation helps to describe the experiences of Japanese overseas qualified nurses working in Australian hospitals. Future research is needed to examine whether this model can be applied to nurses from other countries and in other settings outside Australia.

This study assessed personal beliefs about the causes and meaning of having diabetes among the members of the Lumbee Indian tribe living in rural southeastern North Carolina. The sample included 20 males (50%) and 20 females (50%); the mean duration of having diabetes was 9.82 years. The average body mass index (BMI) for females was 34.76 (range, 24.21-55.44), whereas the average BMI for males was 35.10 (range, 22.71-59.71). Ninety percent reported a family history of diabetes. The majority of participants held beliefs that diabetes was a serious and chronic condition and that the disease was amenable to personal control. Participants perceived that diabetic medications were an essential and effective part of their treatment regimen, and they reported greater comfort in adhering to prescribed medication regimens than making long-term lifestyle changes. This study highlights the high prevalence of diabetes among Lumbee Indians and also the need for future studies in this area.

Hispanic men who have sex with men (MSM) experience a number of health disparities including high rates of HIV infection from high-risk sex, substance abuse, and intimate partner violence. Although some research is available to document the relationships of these health disparities in the literature, few studies have explored the intersection of these disparities and the factors that influence them. The purpose of this study was to explore the experiences that Hispanic MSM residing in South Florida have with high-risk sex, substance abuse, and intimate partner violence. Focus groups were conducted and analyzed using grounded theory methodology until data saturation was reached (n = 20). Two core categories with subcategories emerged from the data: The Roots of Risk (Los raices del riesgo) and The Tangled Branches (Las Ramas Enredadas). The results of the study provided some important clinical implications as well as directions for future research with Hispanic MSM.

Study Purpose: Describe practices of traditional birth attendants (TBAs) in assisting women in childbirth and the perceptions of TBAs by mothers and health professionals familiar with their work., Methodology: Qualitative design using focus groups conducted in urban and rural settings in Sierra Leone. Separate audiotaped focus groups conducted for each group of participants lasting between 45 and 90 minutes., Participants: Purposive sample of 20 TBAs, 20 mothers, and 10 health professionals who met the following criteria: (a) at least 18 years of age, (b) TBAs currently practicing, (c) mothers who delivered at least one child assisted by a TBA, and (d) health professionals currently practicing in the hospital and familiar with TBA practices., Findings: TBAs are valued by mothers, health professionals, and the community because they provide accessible and affordable care to mothers who may otherwise have no access to health services. TBAs need training, supervision, and resources for effective referral of mothers. Systemic problems in the health care system create enormous barriers to effective care for mothers and children independent of TBA practices that contribute to high maternal and infant mortality rates. The study findings have implications on broad public policy in improving maternal and child health in the country.

Study Purpose: Describe the comparative birthing experiences of Pakistani immigrant women in Pakistan and the United States., Conceptual Framework: The framework was drawn from Berry's cultural adaptation, Glick-Schiller et al.'s transnationalism and Berkman's social network., Methodology: Qualitative, Design: Women experienced difficulties associated with inability to observe cultural traditions and loss of extended, gendered kin support. Adaptive strategies were evident through development of social networks of weak ties with non-kin groups in the United States, maintenance of transnational ties with kin back in Pakistan, and assimilation of less gender-defined roles by women and their spouses.

Spain has seen a significant increase of the immigrant population in the past two decades. There are 5.6 million registered immigrants in this country, and 63% of them range in age between 16 and 41 years; 47% of the immigrant population are women. This situation requires additional health care, particularly as it pertains to the sexual and reproductive health of female immigrants. The objective of our study was to determine if there were differences between women of Spanish origin and immigrant women in terms of obstetric outcomes (obstetric history, gestational age at end of gestation, and at delivery) and various psychological variables during the immediate postpartum period. This was a cross-sectional study-we evaluated 30 women of Spanish origin and 30 immigrant women during the immediate postpartum period. During the 4 months after delivery, we proceeded to gather perinatal data for the study participants from their health records, partograms, and nursing assessment notes. Additionally, and following the immediate postpartum period, participants filled out the Stress Perception and Stress Vulnerability Questionnaires, as well as the Optimism Scale. Immigrant women have greater perception of stress (p = .00) and vulnerability to stress (p = .001) than do Spanish women. However, no group differences were found in obstetric variables.

Several states in the United States have been experiencing an influx of migrants from an area of the world that most people have only heard of when learning about the atomic bomb and World War II. This area is the former U.S. Trust Territory of Pacific Islands now called the Freely Associated States. At the end of World War II, the United States took possession of many of these islands and in 1948, the United States formally took over administration of the Marshalls, the Carolines, Palau, and the Northern Marianas islands. Collectively this area is known as Micronesia. Micronesians come from areas that have high prevalence of several communicable diseases and there is growing concern that Micronesian immigrants may enable the spread of infectious disease to the United States from Asia. Data concerning Hansen's disease and tuberculosis support this claim. According to data from the Hawai'i State Department of Health, a 5-year trend examining new cases of tuberculosis in Hawai'i identified that 65 out of 77 new cases came from the Freely Associated States of Micronesia. Presented is an overview of the health concerns and health status of the people from the Federated States of Micronesia.

Given the high morbidity and mortality rate of Hispanic immigrants to the United States, a study of the Hispanic Health Protection Model (HHPM) was replicated with 109 residents in Mexico who were newly diagnosed with diabetes. People with diabetes from rural clinics in Tlaxcala underwent a three-phase interview process with laboratory and weight follow-up over 4 to 6 months following a confirmed diagnosis of diabetes. This predictive, correlational study replicated the HHPM and the previous U.S. findings, including relationships between lifestyle profile, health beliefs, professional and social support, self-efficacy, diabetes knowledge, quality of life (self-satisfaction and impact of diabetes), and changes in HbA1c and body mass index. The study found that participants frequently followed good lifestyle practices while continuing to adhere to culturally based treatment and attribution beliefs. There were moderate perceptions of diabetes self-care efficacy, low ratings of support, very poor understanding of diabetes, continued obesity, acceptable quality of life ratings, and near-normal HbA1c levels.

Purpose: Participatory formative research guided the creation of a culturally tailored educational brochure about human papillomavirus (HPV) at an American Indian women's clinic., Method: A review of existing educational materials and in-depth interviews were conducted. Nine steps for creating health communications messages that were patterned after National Cancer Institute guidelines guided the brochure development process., Results: Of 95 women tested for HPV, 41% were positive, 32 (34%) agreed to the in-depth interview, and 9 agreed to the pretesting interview. Mean age was 41 years. Interviews revealed key themes concerning emotional reactions to abnormal Pap test results and HPV; need for basic information about HPV, Pap tests, and results; concerns about HPV stigma, sexual transmission, and communication with sexual partner; and the preferred source and format for HPV educational materials. A literature review revealed 12 areas of basic HPV content., Conclusions: A participatory process successfully engaged nursing staff and patients in creating culturally appropriate brochures for clinic use., Implications: This article provides specific steps for creating culturally tailored patient education materials.

Each year, more than two million people die from diarrhea-associated diseases. Although there is a global need for safe drinking water, culturally appropriate health teaching is essential to behavior change. This study evaluated the impact of a health education program in a small rural community in Cameroon. Flash cards and a modified version of the CDC-KPC 2000 survey were used to collect data in 57 homes. Children who lived in households with working Manz BioSand filters were less likely to have had diarrhea in the 2 weeks prior to the evaluation. There remained a gap between health knowledge and healthy behaviors for hand hygiene and malaria prevention. This gap was significant in the diarrheal treatment (McNemar's test, p < .000). The interdisciplinary program and 7-year time frame were crucial to sustainability. Faculty and students learned the importance of pairing service learning and research that respect local cultures in fostering a healthier global community.

This grounded theory study in California, United States was an inquiry into the perceptions of health of Cambodian women in resettlement. The sequelae of significant life trauma on the health of women who escaped political conflict have received little attention in the nursing literature. Thirty-nine Cambodian women were recruited through a social service organization and verbal referrals. Open-ended questions and a conversational approach to dialogue and data gathering facilitated the interview process. Women were interviewed at home or the local temple. Seeking life balance emerged as the core perspective of this study. The relationships between thematic categories of seeking life balance, patterns of knowing, and caring for self were salient. Outcomes of these interrelationships further moved women's health toward disharmony or harmony. The findings of this study are limited by sampling participants in a tightly networked community and may serve as a pilot for future research.