Latino perceptions of and barriers to preventive healthcare maintenance in the southwest United States

Between the 1990 and 2000 Censuses, the Latino population accounted for 40% of the increase in the nation’s total population. The growing population of Latinos underscores the importance for understanding factors that influence whether and how Latinos take care of their health. According to the U.S. Department of Human Health Service’s Office of Minority Health (OMH), Latinos are at greater risk for health disparities (2003). Factors such as lack of health insurance and access to preventive care play a major role in limiting Latino use of primary health care (Institute of Medicine, 2005). Other significant barriers to preventive health care maintenance behaviors have been identified in current literature such as primary care physician interaction, self-perceived health status, and socio-cultural beliefs and traditions (Rojas-Guyler, King, Montieth and 2008; Meir, Medina, and Ory, 2007; Black, 1999). Despite these studies, there remains less information regarding interpersonal perceptions, environmental dynamics and individual and cultural attitudes relevant to utilization of healthcare (Rojas-Guyler, King, Montieth and 2008; Aguirre-Molina, Molina and Zambrana, 2001). Understanding the perceptions of Latinos and the barriers to health care could directly affect healthcare delivery. Improved healthcare utilization among Latinos could reduce the long term health consequences of many preventable and manageable diseases. The purpose of this study was to explore Latino perceptions of U.S. health care and desired changes by Latinos in the U.S. healthcare system. The study had several objectives, including to explore perceived barriers to healthcare utilization and the resulting effects on health among Latinos, to describe culturally influenced attitudes about health care and use of health care services among Latinos, and to make recommendations for reducing disparities by improving healthcare and its utilization. The current study utilized data that were collected as part of a larger study to examine multidimensional, cross-cultural issues relevant to interactions between healthcare consumers and providers. Qualitative methods were used to analyze four Spanish-language focus group transcripts to interpret cultural influences on perceptions and beliefs among Latinos. Direct coding of transcript content was carried out by two reviewers, who conducted independent reviews of each transcript. Team members developed and refined thematic categories, positive and negative cases, and example text segments for each theme and sub-theme. Incongruities of interpretations were resolved through extensive discussion. Study participants included 44 self-identified Latino adults (16 male, 28 female) between age 18 and 64 years. Thirty seven (84.1%) of the participants were immigrants. The study population comprised eight ethnic subgroups. While 31% of the participants reported being employed on a full-time basis, only 18.4% had medical insurance that was private or employee sponsored. Five major themes regarding the perceptions and healthcare utilization behaviors of Latinos were consistent across all focus groups and were identified during the analysis. These were: (1) healthcare utilization, experience, and access; (2) organizational and institutional systems; (3) communication and interpersonal interactions between healthcare provider, staff, and patient; (4) Latinos’ perception of their own health status; (5) cultural influences on healthcare utilization, which included an innovation termed culturally-bound locus of control. Healthcare utilization was directly influenced by healthcare experience, access, current health status, and cultural factors and indirectly influenced by organizational systems. There was a strong interdependence among the main themes. The ability to communicate and interact effectively with healthcare providers and navigate healthcare systems (organizational and institutional access) significantly influenced the participant’s health care experience, most often (indirectly) impacting utilization negatively. ^ Research such as this can help to identify those perceptions and attitudes held by Latinos concerning utilization or underutilization of healthcare systems. These data suggest that for healthcare utilization to improve among Latinos, healthcare systems must create more culturally competent environments by providing better language services at the organizational level and more culturally sensitive providers at the interpersonal level. Better understanding of the complex interactions between these impediments can aid intervention developments, and help health providers and researchers in determining appropriate, adequate, and effective measurers of care to better increase overall health of Latinos.^

A primeira dança : o papel da intersubjectividade na interacção mãe-bebé

Tese de doutoramento, Psicologia (Psicologia Clínica), Universidade de Lisboa, Faculdade de Psicologia, 2016

HIV Status Disclosure among Older African American Men Who Have Sex with Men and Women

Thesis (Ph.D.)--University of Washington, 2016-06

Aggressive behaviour in the high-secure forensic setting: the perceptions of patients

Twenty-seven patients undergoing treatment in a high-secure forensic facility participated in focus group interviews to elicit their perceptions of (1) the factors leading to aggressive behaviour; and (2) strategies to reduce the risk of such behaviour. The focus group interviews were audiotaped, transcribed and analysed using content analysis. The participants identified that a combination of patient, staff and environmental factors contributed to violence in the study wards. The cause of aggressive behaviour centred around five major themes: the environment; empty days; staff interactions; medication issues; and patient-centred factors. Potential strategies identified by patients to reduce aggressive behaviour included: early intervention; the provision of meaningful activities to reduce boredom; separation of acutely disturbed patients; improved staff attitudes; implementation of effective justice procedures; and a patient advocate to mediate during times of conflict. Findings suggested that social and organizational factors need to be addressed to change the punitive subculture inherent in forensic psychiatric facilities, and to ensure a balance between security and effective therapy.

Engaging game characters: Informing design with player perspectives

The behavior of characters in current computer games is generally scripted and predictable. This paper discusses some issues related to creating game characters that enhance player engagement and identifies the need for a more player-centered approach to game character design. This paper reports the results of a focus group that was carried out with experienced game players to determine what game character behaviors would enhance their engagement in a game. The four general areas of concern that came out of this discussion were consistency with context, player expectations, social interactions and consistency with the environment. This paper discusses these issues and their implication for game character design with a view to creating engaging game characters. © Springer

Kick'n'on: The design and evaluation of a group programme for young males with psychotic disorders

Young men with psychotic disorders have persistently poorer outcomes in social functioning when interventions aimed at arresting social isolation are not implemented. Recent literature has indicated that it is important to develop rehabilitation programmes that are based on areas of needs that are identified by the participants. To assist in the design of a group programme, a qualitative (focus group) investigation of the perceptions of young males concerning male roles and identity in today’s society was conducted. The participants were six young males with psychotic disorders who had been referred to an Australian regional rehabilitation service to address poor social functioning and social isolation. Three main themes emerged from the focus groups. These were role models, concept of what is a man, and societal expectations. The findings were used to develop a group programme called Kick’n’On.

MEMÓRIA TELEVISIVA COMO PRODUTO CULTURAL: um estudo de caso das telenovelas no Canal Viva

This research is aimed at studying the television memory, recovered and built by a pay-TV channel, Canal Viva, and the telenovelas from TV Globo displayed by the channel concerned, in order to verify its characteristics as a cultural product and its place in the plot of mediation and social interactions. In order to do so, the following theoretical bases are established, relating them to the concept of memory: culture, identity, imagination, history of TV and the Brazilian telenovelas, television reception (with a focus on mediation) and nostalgia. For this purpose, the methodology, as built-up, is divided into two steps: first, a bibliographic research and then a case study, on which techniques of documentary analysis are applied, guided interviews with representatives from the channel and, finally, a focus group with assiduous viewers of the Canal Viva telenovelas. The goal of this research is to contribute to studies on communication related to television memory, thus affirming its importance in social interactions.

What do students really think? Understanding postgraduate students' perception of service quality

This paper explores the components of Service Quality in HE from the Business School Postgraduate student perspective. A six-dimensional scale measuring Service Quality is developed based on focus group and survey data. Our findings highlight that postgraduate students are highly outcome oriented; the award of a reputable degree to gain employment is more important than learning for life. Whilst developing employable graduates, Business Schools must not neglect the core service; teaching & learning. In the long-term this contributes to employability rates and the reputation of institutions. However, as student satisfaction is an increasingly paramount objective, balancing the core service and factors perceived as important by postgraduate students is key.

On the periphery of Europe:an investigation of the construction of Turkish-Cypriot adolescent identities

This research study investigates the identities of a group of adolescent Turkish Cypriot (TC) students in their final year of secondary education in northern Cyprus, which it is argued, lies on the periphery of Europe. The main aim is to explore the linguistic construction of TC youth identities within school contexts but primarily the classroom in a political context in which the uniquely ambiguous status of Turkish Cypriots within the European Union (EU) continues, and where Turkish Cypriots are considered to be Europeans as individuals but not as a separate political entity. A secondary focus is upon the students’ investment in learning the English language. Identity is defined as a lifelong process of 'the social positioning of self and the other' (Bucholtz and Hall, 2005:586) which is endlessly re-created (Tabouret-Keller, 1997) and the distinction between the terms 'identity' and 'identities' is discussed. The study explores the social construction of TC students' identities using an ethnomethodological case study. By using Conversation Analysis of selected extracts from the data collected through observations of classroom interactions, focus group discussions and interviews, the thesis shows that TC students perceive and enact 'in-betweener identities' in terms of their ethnicity, societal values, age, religion, languages and Europeanness. Being on the periphery of the EU, it is argued that the Turkish Cypriots of northern Cyprus are the ‘peripheral members of the EU, remaining present yet absent. They are personally EU citizens but not as a society and cannot be represented within EU institutions. But will they ever acquire full membership, as any peripheral member would aspire to have or will they remain in between occident and orient? The possible answers to this question and the resulting ideological associations will shape how and to what extent these TC students perceive and enact their identities.

Implementation of service -learning in higher education courses: Perceptions of faculty

This study examined the motivation of college and university faculty to implement service-learning into their traditional courses. The benefits derived by faculty, as well as those issues of maintenance, including supports and/or obstacles, were also investigated in relation to their impact on motivation. The focus was on generating theory from the emerging data. ^ Data were collected from interviews with 17 faculty teaching courses that included a component of service-learning. A maximum variation sampling of participants from six South Florida colleges and universities was utilized. Faculty participants represented a wide range of academic disciplines, faculty ranks, years of experience in teaching and using service-learning as well as gender and ethnic diversity. For data triangulation, a focus group with eight additional college faculty was conducted and documents, including course syllabi and institutional service-learning handbooks, collected during the interviews were examined. The interviews were transcribed and coded using traditional methods as well as with the assistance of the computerized assisted qualitative data analysis software, Atlas.ti. The data were organized into five major categories with themes and sub-themes emerging for each. ^ While intrinsic or personal factors along with extrinsic factors all serve to influence faculty motivation, the study's findings revealed that the primary factors influencing faculty motivation to adopt service-learning were those that were intrinsic or personal in nature. These factors included: (a) past experiences, (b) personal characteristics including the value of serving, (c) involvement with community service, (d) interactions and relationships with peers, (e) benefits to students, (f) benefits to teaching, and (g) perceived career benefits. Implications and recommendations from the study encompass suggestions for administrators in higher education institutions for supporting and encouraging faculty adoption of service-learning including a well developed infrastructure as well as incentives, particularly during the initial implementation period, rewards providing recognition for the academic nature of service-learning and support for the development of peer relationships among service-learning faculty. ^

A experiência do usuário idoso no design de jogo digital para a reabilitação neural de pacientes com quadro de acidente vascular cerebral (AVC)

Stroke is nowadays one of the main causes of death in Brazil and worldwide. During the rehabilitation process, patients undergo physioterapic exercises based on repetition, which may cause them to feel little progress is being made. Focusing on themes from the areas of Human-Computer Interaction and Motor Imagery, the present work describes the development of a digital game concept aimed at motor rehabilitation to the neural rehabilitation of patients who have suffered a stroke in a playful and engaging way. The research hypothesizes that an interactive digital game based on Motor Imagery contributes to patients' raised commitment in the stroke sequel rehabilitation process. The research process entailed the investigation of 10 subjects who live with sequels caused by stroke - it was further established that subjects were over 60 years old. Using as foundation an initial survey regarding target-users' specificities, where an investigation on subjectrelated aspects was carried out through Focus Group (n=9) and Contextual Analysis (n=3), having as subjects elderly individuals, a list with the necessary requirements for the conceptualization of a digital game was fleshed out. The initial survey also enabled the establishment of preliminary interactions for the formulation of game prototypes. At first, low-resolution prototypes were used, with two distinct interaction models for the game - one with a direct approach to the Motor Imagery concept, and another using a narrative with characters and scene settings. The goal was to verify participants' receptivity regarding the addition of playful activities into game dynamics. Prototypes were analyzed while being used by five patients, through the Cooperative Evaluation technique. The tests indicated a preference for option with elements in a playful narrative. Based on these results high fidelity prototypes were created, where concepts close to the game's final version were elaborated. The High Fidelity prototype was also evaluated with four patients through the Cooperative Evaluation technique. It was concluded that elderly individuals and patients were receptive to the idea of a digital game for the rehabilitation from sequels caused by stroke; that, for the success of devices aimed at these cohorts, their contexts, needs and expectations must be respected above all; and that user-centered design is an essential approach in that regard.

The ecocultural context and child behavior problems: A qualitative analysis in rural Nepal.

Commonly used paradigms for studying child psychopathology emphasize individual-level factors and often neglect the role of context in shaping risk and protective factors among children, families, and communities. To address this gap, we evaluated influences of ecocultural contextual factors on definitions, development of, and responses to child behavior problems and examined how contextual knowledge can inform culturally responsive interventions. We drew on Super and Harkness' "developmental niche" framework to evaluate the influences of physical and social settings, childcare customs and practices, and parental ethnotheories on the definitions, development of, and responses to child behavior problems in a community in rural Nepal. Data were collected between February and October 2014 through in-depth interviews with a purposive sampling strategy targeting parents (N = 10), teachers (N = 6), and community leaders (N = 8) familiar with child-rearing. Results were supplemented by focus group discussions with children (N = 9) and teachers (N = 8), pile-sort interviews with mothers (N = 8) of school-aged children, and direct observations in homes, schools, and community spaces. Behavior problems were largely defined in light of parents' socialization goals and role expectations for children. Certain physical settings and times were seen to carry greater risk for problematic behavior when children were unsupervised. Parents and other adults attempted to mitigate behavior problems by supervising them and their social interactions, providing for their physical needs, educating them, and through a shared verbal reminding strategy (samjhaune). The findings of our study illustrate the transactional nature of behavior problem development that involves context-specific goals, roles, and concerns that are likely to affect adults' interpretations and responses to children's behavior. Ultimately, employing a developmental niche framework will elucidate setting-specific risk and protective factors for culturally compelling intervention strategies.

Preferencias, dedicación y problemáticas generadas por los videojuegos: Una perspectiva de género

Entre las actividades de ocio de los/as jóvenes, cabe mencionar las asociadas con los videojuegos. Por ello, la finalidad central de este estudio es analizar las preferencias del colectivo de adolescentes con los videojuegos, así como conocer su dedicación y problemáticas que generan, teniendo en cuenta principalmente la variable de género. El presente trabajo se encuadra en un enfoque metodológico cuantitativo-cualitativo, a partir de la recogida de datos con un cuestionario y la técnica del grupo de discusión. En el estudio han participado un total de 151 adolescentes. 124 a partir de la aplicación de un cuestionario cerrado (62 hombres y 62 mujeres) y 27 a través de la realización de 6 grupos de discusión (17 hombres y 10 mujeres). Como resultados y conclusiones, cabe destacar la existencia diferenciada en el uso de los videojuegos en función de la edad y por razón de género. A su vez, las mujeres muestran una responsabilidad mayor en esta actividad, tanto en el tiempo de dedicación como en la elección. Los chicos destinan una gran cantidad de tiempo a los videojuegos de contenido violento, mientras las chicas prefieren los de estrategia. En general, el juego con videojuegos no genera problemáticas sustanciales y controversias, aunque algunos participantes reflejan manifestaciones de mal humor. Por último, cabe indicar que las prácticas con los videojuegos en la adolescencia se ciñen al mero hecho de divertirse, desperdiciando las posibilidades educativas que esta actividad ofrece.

Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR

We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or "on waking," appeared more relevant to disease activity than asking about symptom severity "now" (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients' lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor.