PURPOSE Patterns of diet and physical activity, major drivers of morbidity and mortality, are contingent on people's feasible opportunities to pursue healthy behaviors. Our objective for this mixed methods study was to develop measures of feasible opportunities for diet and activity. METHODSThe Capability Approach framework for evaluating people's real freedoms to pursue their values guided the research. A community-based participatory model was applied to conduct focus groups of adults with obesity or diabetes mellitus from an economically disadvantaged Latino community. Focus group themes were developed into survey items that assess how individual circumstances and neighborhood contexts influence opportunities for diet and activity. The prevalence of different influences was explored in a sample of 300 patients from a primary care safety net clinic. Scales measuring different aspects of opportunity were created through principal components analysis.RESULTS Availability, convenience, safety, cost of food, and activity resources interact with individual circumstances, such as illness, depression, family and nonfamily supports, and scope of personal agency, to shape practical opportunities. Multiple vulnerabilities in availability of resources and moderators of resource use commonly occur together, intensifying challenges and creating difficult trade-offs. Only one-half of participants reported that physicians understood their difficulties pursuing activity, and just one-third for diet. CONCLUSIONSOur results suggest that practical opportunities for healthy behavior can be measured as a primary target for clinical and public health assessment and intervention. The Capability Approach holds promise as a framework for developing interventions responsive to both personal and environmental determinants. INTRODUCTIONU nhealthy diet and sedentary living cause substantial morbidity and mortality in developed societies, 1,2 taking their greatest toll on disadvantaged populations. [3][4][5][6][7][8][9] These behaviors have proved difficult to manage in both clinical 10 and public health 11 contexts because they have complex roots at the interface between individual choices and social and physical environments. [12][13][14] Given primary care's high contact rate with disadvantaged populations 15 and the importance of health behaviors in managing chronic diseases, 16 addressing behaviors is an essential function. 17,18 But its performance in this role has been mixed: a large, complex literature reports only modest success in improving diet and physical activity. 10,[19][20][21][22] Primarily, interventions have focused on increasing individuals' knowledge, motivation, and self-efficacy. 23 Much evidence shows, however, that success will be limited if social and environmental contexts are not accounted for. [24][25][26][27][28][29][30][31] Even so, the clinician's task involves more than acknowledging context; the challenge is to understand how to help a specific patient succeed in a specific environment. 47task a...
This cross-sectional survey sought to document complementary and alternative medicine (CAM) use by Texas midwives, as well as to determine whether licensed direct-entry midwives (LMs) and certified nurse-midwives (CNMs) differed significantly in their patterns of use. All respondents (n = 69) indicated that they used, recommended, or referred their clients for at least one CAM therapy during the preceding year. Ninety percent (90%) of respondents used, recommended, or referred their clients for an herbal remedy (not including homeopathic tinctures). Herbal therapies were among the top three modalities recommended for 7 of 12 (58%) clinical indications. Herbs were the most salient CAM therapy used for cervical ripening (83%), followed closely by use for nausea, vomiting, and hyperemesis (80%), and labor induction (77%). Herbal therapies also constituted 50% or more of the CAM therapies used for the following indications: anemia/iron supplementation (70%), perineal healing (66%), and anxiety/stress/fatigue (50%). LM respondents used, recommended, or referred their clients for a greater number of herbal therapies compared to CNMs. While several of the CAM modalities used or recommended by Texas midwives show potential for clinical benefit, few have been studied sufficiently to determine their efficacy or safety during pregnancy.
Local perceptions and language may not correspond to CDC/WHO clinical standards. Larger studies are needed to confirm these preliminary findings.
Knowledge of and experience with culture-bound syndromes is common among Hispanic primary care patients in South Texas. Healthcare providers ought to consider discussing these illnesses in a non-judgmental manner with patients who present with symptoms that are consistent with these syndromes. Future studies, with larger sample sizes, are warranted to elucidate the nature of culture-bound disorders and their relationships with conventional diagnostic entities and treatment-seeking behaviors.
Depressive disorders are present in a high percentage of Mexican American adolescents. Among the US Mexican American population, suicide is the fourth leading cause of death among 10- to 19-year-olds. Little research, however, has focused on Mexican American adolescents' knowledge and views about depression and seeking help for depression. Results from a qualitative study on Mexican American adolescents' attitudes about depression are investigated in this paper. Sixty-five high school and middle school students in a largely Mexican American, urban school district in San Antonio, Tex, participated in 9 semistructured, focus group interviews where participants were asked questions to elicit their understanding of depression, treatment for depression, and words used to describe it. Coding of salient words and themes from transcribed interviews were entered into Atlas. ti for qualitative analysis. Three themes emerged: (1) adolescents' definitions of depression, (2) beliefs about adolescent depression, and (3) treatment for adolescent depression. While depressive symptoms among Mexican American adolescents are common and recognized, resource and treatment knowledge is scarce. An understanding of the beliefs, attitudes, and knowledge of these adolescents can provide crucial information about the content and structure of a universal, school-based, peer-facilitated depression awareness program.
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