The Grady Nia Project: A culturally competent intervention for low-income, abused, and suicidal African American women.

Background information is provided on the link between intimate partner violence and suicidal behavior, as this association sets the stage for interventions for this population. Attention then is paid to the theoretical components of an innovative culturally competent intervention for abused and suicidal, low-income African American women, entitled Grady Nia Project. The intervention is guided by the theory of triadic influence. Cultural competence components essential to implementing an intervention with this unique population and guided by this model are articulated. The Grady Nia Project is then described in detail, focusing on the context in which the intervention is conducted, the content of the 10 sessions, and treatment satisfaction and outcome data. Implications for culturally informed practice with abused, suicidal African American women are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk and protective factors for suicidal behavior in abused African American women.

This study examined risk and protective factors that differentiate low-income, abused African American women (N=200) who attempted suicide from those who had never made a suicide attempt. Results from multivariate analyses revealed that numerous and/or severe negative life events, a history of child maltreatment, high levels of psychological distress and depression, hopelessness about the future, and alcohol and drug problems were factors associated with attempter status. Protective factors associated with nonattempter status included hopefulness, self-efficacy, coping skills, social support, and effectiveness in obtaining material resources. Culturally competent intervention approaches for abused women should target increasing their protective factors and reducing their risk factors to decrease the likelihood that these women engage in suicidal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ratings of family functioning of suicidal and nonsuicidal African American women.

This study compared ratings of family functioning between female African American suicide attempters (n?=?126) and nonattempters (n &≠?112) (aged 18-64 yrs). Attempters reported poorer family-of-creation (physical and nonphysical partner abuse, family strengths, and marital adjustment) and family-of-origin (physical, sexual, and emotional abuse and emotional neglect) functioning than did controls. In a multivariate logistic regression, only marital discord and childhood sexual abuse were risk factors for suicide attempts. A cumulative risk model was also tested and indicated that the presence of 4 or more of the risk factors increased a woman's likelihood of making a nonfatal suicide attempt more than threefold. This study offers one of the first investigations of the families of suicidal African American women and highlights the importance of focusing on family concerns when working with this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors that mediate and moderate the link between partner abuse and suicidal behavior in African American women.

Findings from a study comparing partner abuse in African American women suicide attempters (n?=?148) and nonattempters (n?=?137) revealed higher rates of physical and nonphysical partner abuse among attempters than their demographically similar nonsuicidal counterparts. The partner abuse–suicidal behavior link was mediated by psychological distress, hopelessness, and drug use and moderated by social support. Results also revealed that nonphysical partner abuse accounted for unique variance in the prediction of suicide attempt status beyond that attributable to childhood maltreatment. Implications of the findings for assessing both suicidal and abused women are discussed, and recommendations for preventive interventions for women at risk for suicidal behavior are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mediating roles of perceived social support and resources in the self-efficacy-suicide attempts relation among African American abused women.

The authors examined whether self-efficacy among African-American abused women decreased their risk of suicide through the mediating influences of perceived social support from friends, perceived social support from family, and perceived effectiveness for obtaining material resources. The sample consisted of 100 women who presented to a hospital following a suicide attempt and 100 women who presented to the same hospital for nonemergency medical problems. Results revealed that the association between self-efficacy and suicide attempt status was partially accounted for by the mediating roles of perceived social support from friends and family, and perceived effectiveness at obtaining resources. Findings suggest that interventions to increase abused women's self-efficacy should focus on increasing their capacity to obtain social and material resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidal, abused African American women's response to a culturally informed intervention.

Objective: This study examined (a) the efficacy of a manualized, culturally informed, empowerment-focused psychoeducational group intervention (Nia) designed in accord with the theory of triadic influence or treatment as usual (TAU) for reducing psychological symptomatology (suicidal ideation, depressive symptoms, posttraumatic stress symptoms, general psychological distress), and (b) the effect of Nia versus TAU on the relation between exposure to intimate partner violence (IPV) and psychological symptomatology in these women. Method: Two hundred eight low-socioeconomic-status African American women with a recent history of IPV and a suicide attempt were randomized to Nia or TAU and assessed at baseline, postintervention, and 6- and 12-month follow-up. They were assessed on their levels of IPV (Index of Spouse Abuse), suicidal ideation (Beck Scale for Suicidal Ideation), depressive symptoms (Beck Depression Inventory–II), posttraumatic stress symptoms, and general psychological distress (Brief Symptom Inventory). Results:Hierarchical linear modeling found that women receiving the culturally informed Nia intervention showed more rapid reductions in depressive symptoms and general distress initially, and the between-group difference in depressive symptoms persisted at follow-up. Following intervention, compared with women randomized to TAU, women in Nia exhibited less severe suicidal ideation when exposed to physical and nonphysical IPV. Conclusions:Findings highlight the value of incorporating Nia as an adjunctive intervention for abused, suicidal, low-income women. They underscore the ways the intervention needs to be bolstered to address more directly more mediating and moderating constructs, as well as the need to target more effectively the key outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of eating disorders among African American women.

This study was the first to establish Diagnostic and Statistical Manual of Mental Disorders (DSM—IV; American Psychiatric Association, 1994) prevalence rates for eating disorders by targeting an entire sample of African American college women. Participants were 413 African American women enrolled at a large, predominantly Caucasian public university in the midwestern United States. Participants were given the Questionnaire for Eating Disorder Diagnoses (L. B. Mintz, M. S. O'Halloran, A. M. Mulholland, & P. A. Schneider, 1997). No respondents were classified as having anorexia nervosa or bulimia nervosa, and 2% were classified as having an eating disorder not otherwise specified. Twenty-three percent were classified as symptomatic. Although there is some evidence that these prevalence rates may be underestimated, they are nevertheless in the same range as those obtained for comparative Caucasian samples. Implications for future research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Womanism: a methodologic framework for African American women

Socially anxious (N = 41) and non-anxious (N = 41) individuals participated in a getting acquainted situation that was based on the reciprocity self-disclosure paradigm. Subjects' appraisals of the situation were manipulated to be either positive or negative by highlighting the likelihood of positive or negative social outcomes. Subjects' social goals and use of safety behaviors were assessed, as were others' reaction to the subjects. As predicted, socially anxious individuals elicited significantly more negative responses from others in the negative appraisal condition, where they employed safety behaviors, than in the positive appraisal condition, where they did not. The results supported a cognitive model of social anxiety, rather than alternative explanations.     

Culturally competent health care: a challenge for nurses in Saudi Arabia

An emerging global reality is the presence of a culturally diverse workforce in health care environments. Not only are nurses delivering care to culturally diverse clients, the nurses themselves may come from different cultural and educational backgrounds. In order to provide culturally competent health care, such diversity must be molded into professional collaboration and respect. To date, health care to the citizens of Saudi Arabia has been provided largely by a foreign labor force, the vast majority of whom are non-Arabic speaking. This paper explores a number of strategies aimed at educating expatriate non-Saudi health professionals in the provision of culturally competent and culturally congruent health care. Leininger's transcultural health care theory is identified as the framework for achieving this goal. The theory has proved to be of great relevance in a hospital setting where some 40 different nationalities are represented among the work force. In such a setting, the potential for cultural conflict and stress is very real. Health professionals new to the Kingdom are introduced to the cultural dimensions of health care as it relates to patient care modes, as well as living and working together in a transcultural environment. Transcultural nursing is a major component of a professional nurse practice model which provides a visionary perspective for nursing care. Within the practice model, transcultural care principles are used to guide education, clinical practice and nursing research. Furthermore, Leininger's theory serves to grasp a comprehensive view of generic (folk) and professional health systems and to identify ethical issues confronted by nurses in the transcultural setting.     

Preventive health practices of African American women

Preventive health practices of African American women (AAW) have been little studied. This study explores the participation of middle-income AAW in health promotion/disease prevention behavior. In-depth, audiotape, and semi-structured interviews were held with 36 AAW between the ages of 26 and 75 years. Results indicated that the majority of the women participated in diet control behavior for health purposes. Participation in weight management and exercise behavior was less extensive. The women were involved in other types of preventive health practices to keep healthy. The findings reveal the need for increased educational efforts in the areas of weight management, exercise behavior, mammography, and in the practice of breast self-examination. Results of the study have implications for researchers, educators, and clinicians.     

Nursing case management and its role in perinatal risk reduction: development, implementation, and evaluation of a culturally competent model for African American women

The authors outline the need for comprehensive perinatal services management for African American pregnant women, based on social/environmental stressors, and propose a workable model for delivery of services based on case management principles. The implications of case management as an intervention to ameliorate these stressors are discussed. Data from 5 years of comprehensive case management are included to support the effectiveness of case management as an intervention among high-risk women. Steps utilized to develop, implement, and evaluate case management are also discussed.     

The mediating role of empowerment for African American women experiencing intimate partner violence.

Intimate partner violence (IPV) is a significant societal problem associated with posttraumatic stress disorder (PTSD) and depression, which in turn can cause impairment in a variety of areas. Previous research suggests that African American women experience more frequent and severe IPV than White women, yet report fewer PTSD symptoms related to their abuse. One proposed explanation for this relationship is that African American women are more resilient due to internal coping methods such as empowerment; however, this relationship has yet to be empirically tested. The current study investigates the role of empowerment in mediating IPV-related psychological distress in a sample of African American and White battered women (N = 204). As hypothesized, personal empowerment mediated the relationships between race and PTSD and race and depression, suggesting that empowered African American women may demonstrate greater resiliency when faced with IPV. Results are discussed in terms of their implication for developing culturally sensitive empowerment-based interventions for battered women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting mammography and breast self-examination in African American women

In the past ten years four sportsmen with a traumatic perilymphatic fistula were treated. Three of these four patients were surgically treated: two of them underwent a labyrinthectomy and with one of them, the oval window was grafted. After the analysis of these cases, we have made a study of the literature. Careful attention to the patient history and accurate review of the recurrent vestibulocochlear symptomatology isolate a clinical "audiovestibular syndrome of perilymphatic fistule". There is lack of precise preoperatoire diagnostic test. Nevertheless, entire positionnal audiometric test is a reliable and easy to perform test. The medical management is based on bed rest during a reasonable period. Only patients with significant suggestive symptomatology are surgically explored . They sometimes need destruction of vestibular function without preservation of hearing.     

Discrimination and unfair treatment: Relationship to cardiovascular reactivity among African American and European American women.

This study examined the relationship of cardiovascular reactivity to both interpersonal mistreatment and discrimination in a community-based sample of African American and European American women (N?=?363) in midlife. Subtle mistreatment related positively to diastolic blood pressure (DBP) reactivity for African American participants but not their European American counterparts. Moreover, among the African American participants, those who attributed mistreatment to racial discrimination exhibited greater average DBP reactivity. In particular, these women demonstrated greater DBP reactivity to the speech task, which bore similarities to an encounter with racial prejudice but not to a nonsocial mirror tracing task. These findings are consistent with the hypothesis that racial discrimination is a chronic stressor that can negatively impact the cardiovascular health of African Americans through pathogenic processes associated with physiologic reactivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger of African American women in the south

In this existential-phenomenological investigation middle-class African American women (n = 9) in the Southern United States were interviewed about their experience of anger in daily life. The purpose of the study was to examine what African American women's anger is about, what it means, and how it is experienced. Transcribed interviews were analyzed using a hermeneutic process. The thematic structure of African American women's anger comprises three main elements that stand out as figural: power, control, and respect. These figural elements can be understood only when seen against the ground of a racist Southern culture that produces pervasive mistrust. These findings are of importance to clinicians, who cannot deliver culturally competent interventions to African American female clients without a clear understanding of the complexity and meaning of their anger experience.     

Staging of dietary patterns among African American women

This article describes the development of a behavioral staging algorithm for use in the Eat Well, Live Well Nutrition Program, a peer-delivered community-based program for African American women (N = 301). The authors examined whether increased frequency in performing low-fat eating behaviors and lower percentage calories from fat intake resulted as a participant moved through five stages of readiness to change each of five low-fat dietary patterns. Frequency of performing low-fat dietary behaviors was significantly different (p<.05) between four stages for the pattern of avoid fried foods, three stages for modify meats, and two stages for the patterns of substitution, avoid fat as seasoning, replacement. Percentage calories from fat were significantly different (p<.05) between four stages for the pattern of replacement, three stages for avoid fried foods and modify meats, and two stages for substitution and avoid fat as seasoning. Implications of these findings for the tailoring of community-based dietary programs are presented.     

Treatment approaches for obese and overweight African American women: A consideration of cultural dimensions.

It is important to understand how individual factors interact with environmental and sociocultural factors for a client in treatment. The purpose of this article is to acknowledge the utility of an Afrocentric systems approach to treating obese or overweight African American women. It is suggested that a treatment program should address and integrate the strengths and supports of the culture into the development of interventions. African American beliefs about psychotherapy and family, cognitive and coping styles, religiousness and spirituality, and body satisfaction and body image, as well as current approaches to treating obesity and overweight, are considered. This literature is used to frame guidelines for helping African American women with eating problems, body dissatisfaction, or weight management in ways that do not dismiss the experience of multiple oppressions (i.e., racism, sexism, and the stigma of obesity and overweight). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perception of others’ body size influences weight loss and regain for European American but not African American women.

Objective: The authors investigated whether European American (EA) and African American (AA) women took longer to lose weight, and were less likely to maintain weight loss if they perceived others to be overweight. Design: Overweight EA and AA women completed a Figure Rating Scale and the Three-Factor Eating Questionnaire prior to a weight loss intervention. Body composition was assessed by dual energy X-ray absorptiometry prior to and following weight loss. Main Outcome Measures: rate of weight loss, % body fat at follow-up. Results: For EA, but not AA women, perception of others’ body size was inversely associated with rate of weight loss and cognitive restraint, and positively associated with body fat gain following intervention. In linear regression modeling, EA, but not AA, women who perceived others as large, subsequently had greater percent body fat 1 year after weight loss than did those who perceived others as lean, independent of age, baseline body fat, and body size deemed “acceptable.” Inclusion of cognitive restraint in the model weakened this effect. Conclusion: Among EA but not AA women, perception of others’ body size influenced weight loss and maintenance. This effect may have been mediated by cognitive restraint. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Context framing to enhance HIV-antibody-testing messages targeted to African American women.

African American women (N?=?100) recruited from an urban clinic were randomly assigned to view 1 of 3 experimental videotapes promoting HIV testing: (a) an ethnicity-matched information control videotape; (b) the same ethnicity-matched videotape presented by an African American woman (gender-ethnicity-matched control condition), or (c) an experimental videotape with a culturally relevant context that embedded HIV-testing information within a frame of reference emphasizing personal loss. Consistent with D. Kahneman and A. Tversky's (1979) prospect theory, women who viewed the context-framing videotape were most likely to have been tested during a 2-wk follow-up interval. Among women who expressed intentions to get tested after viewing the videotapes, 63% of those in the message-framing condition were tested for HIV during a 2-wk period compared with 23% in the gender-ethnicity-matched condition, and none in the ethnicity matched condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally competent teaching strategies for Asian nursing students for whom English is a second language

Abdominal aortic aneurysm (AAA) is a common condition that vascular nurses see daily in their practice. Ruptured AAA is the thirteenth leading cause of death in the United States. Increasingly, vascular surgeons are facing older patients with severe comorbid conditions and an AAA. These factors have led to the development of less invasive techniques for repairing AAAs. Endovascular grafting is a technique currently being performed on selected patients. Benefits of this procedure include a small femoral incision, fewer cardiopulmonary risks than the traditional surgery, rapid recovery, short hospital stay, and a decrease in overall cost. Nurses are responsible for patient education, assessment, and evaluation of patients undergoing this procedure.