Assurance of transcript accuracy and quality in interview-based qualitative research is foundatio... more Assurance of transcript accuracy and quality in interview-based qualitative research is foundational for data accuracy and study validity. Based on our experience in a cross-cultural ethnographic study of women’s pelvic organ prolapse, we provide practical guidance to set up step-by-step interview transcription and translation protocols for team-based research on sensitive topics. Beginning with team decisions about level of detail in transcription, completeness, and accuracy, we operationalize the process of securing vendors to deliver the required quality of transcription and translation. We also share rubrics for assessing transcript quality and the team protocol for managing transcripts (assuring consistency of format, insertion of metadata, anonymization, and file labeling conventions) and procuring an acceptable initial translation of Spanish-language interviews. Accurate, complete, and systematically constructed transcripts in both source and target languages respond to the c...
International journal of environmental research and public health, Jan 23, 2017
Pesticide exposure is associated with deleterious health effects. Prior studies suggest Latino fa... more Pesticide exposure is associated with deleterious health effects. Prior studies suggest Latino farmworkers perceive little control over their occupational health. Using the Health Belief Model as a theoretical guide, we explored the perceptions of Latino farmworkers working in tobacco in North Carolina (n = 72) about benefits and facilitators of pesticide protective behaviors as well as barriers, and strategies to overcome barriers to their use. Interviews were conducted with participants at farmworker housing during non-work time. Qualitative data were analyzed using ATLAS.ti. Farmworkers recognized pesticide protective behaviors as helping them to not get sick and stay healthy. Farmworkers perceived work experience as facilitating protective behaviors. Wetness in the field was the most commonly cited barrier to protective behavior use. To overcome this barrier, farmworkers suggested use of water-resistant outerwear, as well as packing a change of clothes for mid-day, with space an...
The purpose of this study was to assess the knowledge and beliefs of 72 Latino farmworkers in Nor... more The purpose of this study was to assess the knowledge and beliefs of 72 Latino farmworkers in North Carolina about the threat of health effects of pesticides, including cancer. It sought to explore relationships between threat perceptions and pesticide protective behaviors observed in the field. Utilizing stepwise multiple regression, the authors found that years worked in agriculture in the United States was associated with decreased use of protective clothing. Pesticide protective behaviors in the field may be improved by utilizing moderately experienced farmworkers (<10 years) as lay advisors to reinforce training.
Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary ... more Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal d...
Agricultural pesticide exposure has potential adverse health effects for farmworkers that may be ... more Agricultural pesticide exposure has potential adverse health effects for farmworkers that may be reduced by pesticide protective behaviors (PPBs). The Environmental Protection Agency's (EPA) Worker Protection Standard (WPS) requires PPBs be taught to farmworkers prior to field work. Studies to date have not utilized observational methods to evaluate the degree to which PPBs are practiced by Latino migrant and seasonal farmworkers in the United States. The purpose of this study was to describe, compare, and contrast observed and self-reported PPBs used by Latino farmworkers; both PPBs that the WPS requires be taught and other PPBs were included. Observed and self-reported data were collected from 71 Latino farmworkers during the 2014 tobacco growing season in North Carolina. Participants were consistent in reporting and using long pants and closed shoes in the field most of the time. In addition, gloves, hats/bandanas, and water-resistant outerwear were frequently observed, altho...
Female Pelvic Medicine & Reconstructive Surgery, 2014
The aim of this study was to describe how women experience vaginal mesh complications after optim... more The aim of this study was to describe how women experience vaginal mesh complications after optimized tertiary care level treatment. Methods: We conducted telephone interviews in 2012 with women at least 6 months after presentation to our tertiary care clinic between 2006 and 2011 for complications related to vaginal mesh and transcribed verbatim responses to 2 open-ended questions about their experiences surrounding vaginal mesh complications. We analyzed data using qualitative description with low-inference interpretation in a team-based setting followed by consensus meetings to arrive at descriptive trajectories of their experiences. Results: Of 111 women, we successfully contacted 88, and 84 agreed to the interview. The mean duration from index mesh surgery to interview was 4.5 years, and the mean duration from presentation to our clinic for complications to the interview was 2.3 years. The effects of mesh complications caused both physical and emotional pain, in addition to the discomfort of the original pelvic floor dysfunction. The women's experiences followed 1 of 3 recovery trajectories. In ''cascading health problems,'' the women experienced a spiral of health problems, anxiety, and desperation. In ''settling for a new normal,'' the women who once considered themselves healthy now believed that they are unhealthy and worked to adjust to their degraded health status. In ''returning to health,'' the women described a return to health. The women still symptomatic discharged from tertiary care clinic expressed hopelessness and abandonment. Conclusions: Concomitant with ongoing research to improve the safety of vaginal mesh procedures, there must be dedicated efforts to develop and study a range of therapies for holistically treating women with mesh complications.
ABSTRACTObjectiveIndividuals in the menopausal transition often seek healthcare in the United Sta... more ABSTRACTObjectiveIndividuals in the menopausal transition often seek healthcare in the United States. However, many individuals who seek healthcare do not receive treatments for their symptoms. And, some lack access to providers of both medical care and evidence-based integrative health interventions such as acupuncture, acupressure, or massage. A potential solution to this problem is medical group visits. Medical group visits are when multiple patients are seen by one provider. The present study gathered the opinions of diverse midlife women about interest in and desired design elements of medical group visits for menopause-related symptoms and concerns.MethodsWe conducted one focus group with ethnically diverse midlife women to learn about their experiences in the menopausal transition, specifically their symptom experience, barriers, and facilitators to accessing medical and integrative health providers, and their interest in and suggestions for the design of an integrative medic...
MCN: The American Journal of Maternal/Child Nursing, 2009
To evaluate the qualitative aspects of the Hispanic Labor Friends Initiative. Methods: "Hispanic ... more To evaluate the qualitative aspects of the Hispanic Labor Friends Initiative. Methods: "Hispanic Labor Friends," bilingual Hispanic community women who were themselves mothers, were recruited by clinic and hospital personnel. Women who agreed were educated, received translation certification, and were oriented to the initiative. Pregnant Hispanic immigrant women seen in the health center who met criteria set by the multidisciplinary health care team were assigned a Hispanic Labor Friend by 32 weeks' gestation. Hispanic Labor Friends assisted women with communication with healthcare providers and provided social support. Qualitative evaluation of the program consisted of interviews with several groups: (1) Hispanic immigrant women who had a Hispanic Labor Friend, (2) Hispanic immigrant women who were not in the Hispanic Labor Friends program, (3) Hispanic Labor Friends, (4) healthcare providers for Hispanic women. Data saturation was reached, and data were analyzed by the research team using descriptive qualitative inquiry. Results: The Hispanic immigrant women described positive outcomes from being involved in the Hispanic Labor Friends program, including feeling supported and comforted. "I felt as though my family were at my side." One woman who had standard care said, "It is hard for me to communicate. When I gave birth, the nurses asked me things, and I didn't understand anything. I stayed quiet." One of the nurses who was interviewed said: "I think they [the HLF patients] get better care. Sometimes we think we can communicate with them with their little bit of English and our little bit of Spanish. But you get an HLF and it's a totally different story. We can more adequately tell what's going on with them...They end up getting better care." One Hispanic Labor Friend said, "The women are very appreciative that I was there to help them through a critical time." Women who participated in the study identified the need to have a continuing association with Hispanic Labor Friends in the early postpartum period. Clinical Implications: The provision of culturally appropriate social support is critical in the care of Hispanic immigrant childbearing women. Programs such as the Hispanic Labor Friends Initiative can help improve support and promote positive outcomes in these vulnerable and disadvantaged women.
Journal of the American Academy of Nurse Practitioners, 2012
Purpose: To determine the prevalence of postpartum depression (PPD) among Hispanic immigrant wome... more Purpose: To determine the prevalence of postpartum depression (PPD) among Hispanic immigrant women seeking healthcare services at a community health clinic. Data sources: Of the 116 Hispanic immigrant women recruited, 96 comprised the final sample. Using the Beck PDSS-Spanish version, participants were screened for symptoms of PPD. Conclusions: The prevalence of significant symptoms of PPD was 54.2% for the entire sample. Nearly 66% of women who screened positive for symptoms of PPD scored above the listed cutoff score for suicidal thoughts. Women were divided into four postpartum age groups from 2 to 48 weeks; rates of symptoms of PPD ranged from 50% to 60.9% among the groups. There were no statistically significant demographic predictors for PPD. Implications for practice: Given that a large number of Hispanic women do not return for postpartum appointments, along with the high rates of PPD symptoms, it is strongly recommended that healthcare providers implement universal screening for all Hispanic women in pregnancy and across the first postpartum year to ensure prompt diagnosis and culturally appropriate treatment. Further research is needed to assess the cultural components of PPD and to determine if the prevalence is consistent in other community settings.
For low-risk childbearing women, fewer technological interventions are associated with better phy... more For low-risk childbearing women, fewer technological interventions are associated with better physical and psychosocial outcomes; yet, the number of unmedicated physiologic births is decreasing. As a result, fewer undergraduate nursing students experience caring for women who choose physiologic birth, which presents a challenge for nurse educators and implications for preparing students to provide appropriate care for all childbearing women after the students graduate. This exploratory descriptive qualitative study was conducted among 150 randomly selected undergraduate nursing programs in the United States to explore the challenges of educating nursing students about low-intervention birth. Four themes described current challenges: lack of placement opportunities, education versus clinical practice, evidence-based support of physiologic birth, and the need for more research on pedagogical strategies that effectively educate future nurses to advocate for minimal intervention birth o...
The Journal of Perinatal & Neonatal Nursing, 2002
Despite several sociocultural factors associated with increased risk for low birth weight and inf... more Despite several sociocultural factors associated with increased risk for low birth weight and infant mortality, the rate for infants born to first-generation and less acculturated Mexican immigrant women is the same as that of non-Hispanic whites, and half that of African Americans with similar risks. It appears that sociocultural rather than genetic variables are the primary factors associated with this phenomenon. Higher levels of acculturation to North American values and lifestyle in Mexican American childbearing women have been correlated with poor perinatal outcomes, including low birth weight. Acculturation is emerging as an important variable that should be considered when providing health care to Mexican immigrant childbearing women and their families.
According to many reports, time in the United States negatively affects the health of Hispanic im... more According to many reports, time in the United States negatively affects the health of Hispanic immigrants. However, little is known about the role of traditional health beliefs and practices in immigrants' underutilization of the US health care system. This descriptive, qualitative study utilized narrative interviews with 20 foreign-born Hispanic women of childbearing age to gain a better understanding of their existing health beliefs, health promotion practices, past health care experiences, and transition into a new society and health care system. Demographic data and scores on the short acculturation scale for Hispanics were also analyzed. Results highlight the importance of female social support for Hispanic women in making health care decisions; their dual use of US medical intervention and home and herbal remedies; and perceived racial discrimination on their health-care seeking behaviors and adherence to treatment modalities. Recommendations are included for professionals who provide health care to immigrant Hispanic women and their families.
Assurance of transcript accuracy and quality in interview-based qualitative research is foundatio... more Assurance of transcript accuracy and quality in interview-based qualitative research is foundational for data accuracy and study validity. Based on our experience in a cross-cultural ethnographic study of women’s pelvic organ prolapse, we provide practical guidance to set up step-by-step interview transcription and translation protocols for team-based research on sensitive topics. Beginning with team decisions about level of detail in transcription, completeness, and accuracy, we operationalize the process of securing vendors to deliver the required quality of transcription and translation. We also share rubrics for assessing transcript quality and the team protocol for managing transcripts (assuring consistency of format, insertion of metadata, anonymization, and file labeling conventions) and procuring an acceptable initial translation of Spanish-language interviews. Accurate, complete, and systematically constructed transcripts in both source and target languages respond to the c...
International journal of environmental research and public health, Jan 23, 2017
Pesticide exposure is associated with deleterious health effects. Prior studies suggest Latino fa... more Pesticide exposure is associated with deleterious health effects. Prior studies suggest Latino farmworkers perceive little control over their occupational health. Using the Health Belief Model as a theoretical guide, we explored the perceptions of Latino farmworkers working in tobacco in North Carolina (n = 72) about benefits and facilitators of pesticide protective behaviors as well as barriers, and strategies to overcome barriers to their use. Interviews were conducted with participants at farmworker housing during non-work time. Qualitative data were analyzed using ATLAS.ti. Farmworkers recognized pesticide protective behaviors as helping them to not get sick and stay healthy. Farmworkers perceived work experience as facilitating protective behaviors. Wetness in the field was the most commonly cited barrier to protective behavior use. To overcome this barrier, farmworkers suggested use of water-resistant outerwear, as well as packing a change of clothes for mid-day, with space an...
The purpose of this study was to assess the knowledge and beliefs of 72 Latino farmworkers in Nor... more The purpose of this study was to assess the knowledge and beliefs of 72 Latino farmworkers in North Carolina about the threat of health effects of pesticides, including cancer. It sought to explore relationships between threat perceptions and pesticide protective behaviors observed in the field. Utilizing stepwise multiple regression, the authors found that years worked in agriculture in the United States was associated with decreased use of protective clothing. Pesticide protective behaviors in the field may be improved by utilizing moderately experienced farmworkers (<10 years) as lay advisors to reinforce training.
Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary ... more Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, 'Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery', uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal d...
Agricultural pesticide exposure has potential adverse health effects for farmworkers that may be ... more Agricultural pesticide exposure has potential adverse health effects for farmworkers that may be reduced by pesticide protective behaviors (PPBs). The Environmental Protection Agency's (EPA) Worker Protection Standard (WPS) requires PPBs be taught to farmworkers prior to field work. Studies to date have not utilized observational methods to evaluate the degree to which PPBs are practiced by Latino migrant and seasonal farmworkers in the United States. The purpose of this study was to describe, compare, and contrast observed and self-reported PPBs used by Latino farmworkers; both PPBs that the WPS requires be taught and other PPBs were included. Observed and self-reported data were collected from 71 Latino farmworkers during the 2014 tobacco growing season in North Carolina. Participants were consistent in reporting and using long pants and closed shoes in the field most of the time. In addition, gloves, hats/bandanas, and water-resistant outerwear were frequently observed, altho...
Female Pelvic Medicine & Reconstructive Surgery, 2014
The aim of this study was to describe how women experience vaginal mesh complications after optim... more The aim of this study was to describe how women experience vaginal mesh complications after optimized tertiary care level treatment. Methods: We conducted telephone interviews in 2012 with women at least 6 months after presentation to our tertiary care clinic between 2006 and 2011 for complications related to vaginal mesh and transcribed verbatim responses to 2 open-ended questions about their experiences surrounding vaginal mesh complications. We analyzed data using qualitative description with low-inference interpretation in a team-based setting followed by consensus meetings to arrive at descriptive trajectories of their experiences. Results: Of 111 women, we successfully contacted 88, and 84 agreed to the interview. The mean duration from index mesh surgery to interview was 4.5 years, and the mean duration from presentation to our clinic for complications to the interview was 2.3 years. The effects of mesh complications caused both physical and emotional pain, in addition to the discomfort of the original pelvic floor dysfunction. The women's experiences followed 1 of 3 recovery trajectories. In ''cascading health problems,'' the women experienced a spiral of health problems, anxiety, and desperation. In ''settling for a new normal,'' the women who once considered themselves healthy now believed that they are unhealthy and worked to adjust to their degraded health status. In ''returning to health,'' the women described a return to health. The women still symptomatic discharged from tertiary care clinic expressed hopelessness and abandonment. Conclusions: Concomitant with ongoing research to improve the safety of vaginal mesh procedures, there must be dedicated efforts to develop and study a range of therapies for holistically treating women with mesh complications.
ABSTRACTObjectiveIndividuals in the menopausal transition often seek healthcare in the United Sta... more ABSTRACTObjectiveIndividuals in the menopausal transition often seek healthcare in the United States. However, many individuals who seek healthcare do not receive treatments for their symptoms. And, some lack access to providers of both medical care and evidence-based integrative health interventions such as acupuncture, acupressure, or massage. A potential solution to this problem is medical group visits. Medical group visits are when multiple patients are seen by one provider. The present study gathered the opinions of diverse midlife women about interest in and desired design elements of medical group visits for menopause-related symptoms and concerns.MethodsWe conducted one focus group with ethnically diverse midlife women to learn about their experiences in the menopausal transition, specifically their symptom experience, barriers, and facilitators to accessing medical and integrative health providers, and their interest in and suggestions for the design of an integrative medic...
MCN: The American Journal of Maternal/Child Nursing, 2009
To evaluate the qualitative aspects of the Hispanic Labor Friends Initiative. Methods: "Hispanic ... more To evaluate the qualitative aspects of the Hispanic Labor Friends Initiative. Methods: "Hispanic Labor Friends," bilingual Hispanic community women who were themselves mothers, were recruited by clinic and hospital personnel. Women who agreed were educated, received translation certification, and were oriented to the initiative. Pregnant Hispanic immigrant women seen in the health center who met criteria set by the multidisciplinary health care team were assigned a Hispanic Labor Friend by 32 weeks' gestation. Hispanic Labor Friends assisted women with communication with healthcare providers and provided social support. Qualitative evaluation of the program consisted of interviews with several groups: (1) Hispanic immigrant women who had a Hispanic Labor Friend, (2) Hispanic immigrant women who were not in the Hispanic Labor Friends program, (3) Hispanic Labor Friends, (4) healthcare providers for Hispanic women. Data saturation was reached, and data were analyzed by the research team using descriptive qualitative inquiry. Results: The Hispanic immigrant women described positive outcomes from being involved in the Hispanic Labor Friends program, including feeling supported and comforted. "I felt as though my family were at my side." One woman who had standard care said, "It is hard for me to communicate. When I gave birth, the nurses asked me things, and I didn't understand anything. I stayed quiet." One of the nurses who was interviewed said: "I think they [the HLF patients] get better care. Sometimes we think we can communicate with them with their little bit of English and our little bit of Spanish. But you get an HLF and it's a totally different story. We can more adequately tell what's going on with them...They end up getting better care." One Hispanic Labor Friend said, "The women are very appreciative that I was there to help them through a critical time." Women who participated in the study identified the need to have a continuing association with Hispanic Labor Friends in the early postpartum period. Clinical Implications: The provision of culturally appropriate social support is critical in the care of Hispanic immigrant childbearing women. Programs such as the Hispanic Labor Friends Initiative can help improve support and promote positive outcomes in these vulnerable and disadvantaged women.
Journal of the American Academy of Nurse Practitioners, 2012
Purpose: To determine the prevalence of postpartum depression (PPD) among Hispanic immigrant wome... more Purpose: To determine the prevalence of postpartum depression (PPD) among Hispanic immigrant women seeking healthcare services at a community health clinic. Data sources: Of the 116 Hispanic immigrant women recruited, 96 comprised the final sample. Using the Beck PDSS-Spanish version, participants were screened for symptoms of PPD. Conclusions: The prevalence of significant symptoms of PPD was 54.2% for the entire sample. Nearly 66% of women who screened positive for symptoms of PPD scored above the listed cutoff score for suicidal thoughts. Women were divided into four postpartum age groups from 2 to 48 weeks; rates of symptoms of PPD ranged from 50% to 60.9% among the groups. There were no statistically significant demographic predictors for PPD. Implications for practice: Given that a large number of Hispanic women do not return for postpartum appointments, along with the high rates of PPD symptoms, it is strongly recommended that healthcare providers implement universal screening for all Hispanic women in pregnancy and across the first postpartum year to ensure prompt diagnosis and culturally appropriate treatment. Further research is needed to assess the cultural components of PPD and to determine if the prevalence is consistent in other community settings.
For low-risk childbearing women, fewer technological interventions are associated with better phy... more For low-risk childbearing women, fewer technological interventions are associated with better physical and psychosocial outcomes; yet, the number of unmedicated physiologic births is decreasing. As a result, fewer undergraduate nursing students experience caring for women who choose physiologic birth, which presents a challenge for nurse educators and implications for preparing students to provide appropriate care for all childbearing women after the students graduate. This exploratory descriptive qualitative study was conducted among 150 randomly selected undergraduate nursing programs in the United States to explore the challenges of educating nursing students about low-intervention birth. Four themes described current challenges: lack of placement opportunities, education versus clinical practice, evidence-based support of physiologic birth, and the need for more research on pedagogical strategies that effectively educate future nurses to advocate for minimal intervention birth o...
The Journal of Perinatal & Neonatal Nursing, 2002
Despite several sociocultural factors associated with increased risk for low birth weight and inf... more Despite several sociocultural factors associated with increased risk for low birth weight and infant mortality, the rate for infants born to first-generation and less acculturated Mexican immigrant women is the same as that of non-Hispanic whites, and half that of African Americans with similar risks. It appears that sociocultural rather than genetic variables are the primary factors associated with this phenomenon. Higher levels of acculturation to North American values and lifestyle in Mexican American childbearing women have been correlated with poor perinatal outcomes, including low birth weight. Acculturation is emerging as an important variable that should be considered when providing health care to Mexican immigrant childbearing women and their families.
According to many reports, time in the United States negatively affects the health of Hispanic im... more According to many reports, time in the United States negatively affects the health of Hispanic immigrants. However, little is known about the role of traditional health beliefs and practices in immigrants' underutilization of the US health care system. This descriptive, qualitative study utilized narrative interviews with 20 foreign-born Hispanic women of childbearing age to gain a better understanding of their existing health beliefs, health promotion practices, past health care experiences, and transition into a new society and health care system. Demographic data and scores on the short acculturation scale for Hispanics were also analyzed. Results highlight the importance of female social support for Hispanic women in making health care decisions; their dual use of US medical intervention and home and herbal remedies; and perceived racial discrimination on their health-care seeking behaviors and adherence to treatment modalities. Recommendations are included for professionals who provide health care to immigrant Hispanic women and their families.
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Papers by Ana Birkhead