Is Exercise Extra? A Mixed Methods Examination of Cultural Barriers and Enablers of Physical Activity in Management of Type 2 Diabetes in M’Bour, Senegal

Objective: This study seeks to produce culturally-attuned recommendations for disease management in individuals with type 2 diabetes in M’Bour, Senegal. Methods: The PEN-3 Cultural Model (PEN-3) framed this mixed methods study to capture a) the qualitative barriers and enablers to participating in physical activity through narrative interviews; as well as b) the quantitative extent to which participants engaged in physical activity through the International Physical Activity Questionnaire (IPAQ). Content analysis identified emergent themes from interviews and descriptive statistics summarized IPAQ responses. Results: Among 41 individuals formally diagnosed with diabetes, the mean age was 58 (SD=11.8). Results elicited from PEN-3 included several barriers and enablers to physical activity.  Barriers included prohibitive costs of gym membership and exercise equipment; limb pain; and feeling ill. Participants reported walking as their main source of exercise, with an average frequency of 4 days per week (SD=2.8). Although patients reported a lack of others with whom to exercise, familial support aided in maintaining exercise behaviors such as walking. Conclusions: Given participants’ need for exercise companions, group-based activities ​may be useful. Patients with diabetes may also benefit from complimentary home-based exercises that are gentle and pain alleviating

Cervical cancer risk and access: Utilizing three statistical tools to assess Haitian women in South Florida

Although decreasing rates of cervical cancer in the U.S. are attributable to health policy, immigrant women, particularly Haitians, experience disproportionate disease burden related to delayed detection and treatment. However, risk prediction and dynamics of access remain largely underexplored and unresolved in this population. This study seeks to assess cervical cancer risk and access of unscreened Haitian women. Extracted and merged from two studies, this sample includes n = 346 at-risk Haitian women in South Florida, the largest U.S. enclave of Haitians (ages 30–65 and unscreened in the previous three years). Three approaches (logistic regression [LR]; classification and regression trees [CART]; and random forest [RF]) were employed to assess the association between screening history and sociodemographic variables. LR results indicated women who reported US citizenship (OR = 3.22, 95% CI = 1.52–6.84), access to routine care (OR = 2.11, 95%CI = 1.04–4.30), and spent more years in the US (OR = 1.01, 95%CI = 1.00–1.03) were significantly more likely to report previous screening. CART results returned an accuracy of 0.75 with a tree initially splitting on women who were not citizens, then on 43 or fewer years in the U.S., and without access to routine care. RF model identified U.S. years, citizenship, and access to routine care as variables of highest importance indicated by greatest mean decreases in Gini index. The model was .79 accurate (95% CI = 0.74–0.84). This multi-pronged analysis identifies previously undocumented barriers to health screening for Haitian women. Recent US immigrants without citizenship or perceived access to routine care may be at higher risk for disease due to barriers in accessing U.S. health-systems

Perceptions of Practitioner Support for Patient Autonomy are Associated with Delayed Health Care Seeking among Haitian Immigrant Women in South Florida

Few empirical studies have evaluated how perceptions of the patient-provider relationship affect health care seeking among Haitian immigrants. In this cross-sectional study, we examined whether perceptions of practitioner support for patient autonomy facilitate or hinder health care seeking among Haitian women enrolled in a cervical self-sampling trial. Perceived autonomy support was measured using an adapted health care climate questionnaire. Associations between perceived autonomy support and health care seeking were modeled using logistic regression and classification and regression trees. Covariates included socioeconomic and structural access indicators. Dependent variables included receipt of any medical care in the past year and delayed health care seeking. Having a usual source of care was strongly associated with both dependent variables. Lower perceived autonomy support was associated with delayed health care seeking in regression models and classification and regression trees. Addressing the capacity of health workers to deliver autonomy-supportive care is essential for improving health services utilization in vulnerable populations

Perceptions of legal status: Associations with psychosocial experiences among undocumented Latino/a immigrants

In the present study we used a mixed-method design to examine perceptions of legal status and their association with psychosocial experiences among undocumented Latino/a immigrants in the United States Participants were asked to compare their perceived social experiences with those of documented Latinos/as in order to determine whether differences in such perceptions might emerge and whether such perceptions might differentially impact well-being. A community sample of 140 self-reported undocumented Latino/a immigrants completed questionnaires measuring perceptions of legal status, well-being (global and psychological), perceived context of reception, and experiences of discrimination. Results indicated that individuals who perceived their experiences as different from those of documented Latinos/as due to an unauthorized legal status reported less social equality as evidenced by lower well-being, increased experiences of discrimination, and a more adverse context of reception. Moreover, individuals who perceived their social experiences as different from those of documented Latinos/as due to their legal status reported issues centering on 2 domains: limited opportunity/restricted social mobility and discrimination/unfair treatment. Theoretical and practical implications are discussed in terms of advancing theory and from a multicultural counseling perspective. (PsycINFO Database Recor

Bayo Lapawol (Let Their Voices Be Heard): Haitian Women’s Barriers to and Facilitators of Cervical Cancer Prevention and Control

This study aimed to increase understanding of barriers to cervical cancer prevention and control in Haitian women using photovoice methodology. Consented participants were (1) trained to use a digital camera and encouraged to capture their screening barriers, (2) interviewed to unpack and analyze their images, and (3) invited to participate in follow-up focus groups for refined discussion and data triangulation for content analysis using NVivo software. The sample included women ( n = 25) who were on average 42 years ( SD = 9.8, range: 26–57) and born and raised in Haiti. Results highlighted multiple barriers, including gendered family responsibilities, concerns about quality of care, financial and time constraints, worries about discomfort and exam efficacy, and emotional deterrents such as frustration. Framed by the PEN-3 model’s dimensions of cultural identity, relationships and expectations, and cultural empowerment, women’s recommendations to overcome barriers spanned education, evaluation, and empowerment, respectively, across individual, interpersonal, and institutional systems. Study results call for more extensive examination of the diversity present in the groups of African origin to unearth transnational, multifaceted determinants of health by biology, beliefs, and behaviors including sociocultural and socioenvironmental access. Future interventions must include development of proactive policies, which deliberately pressure the government and global community to prioritize health infrastructure while simultaneously educating women about and dispelling fear of cervical cancer, thus empowering Haitian women to live their healthiest lives. Accordingly, this study may contribute to understanding global health equity advances and improving public health infrastructure in underresourced settings in low- and middle-income countries in the Caribbean

Exploring individual differences in the relationship between cultural identity processes and well-being

Although studies have explored how cultural identity impacts young people’s daily lives, these studies have exclusively focused on daily variability in cultural identity salience, overlooking daily variability in the underlying developmental processes. In the present study, we used a 12-day daily assessment conducted with 873 Hispanic college students to address these gaps by examining daily variability in ethnic and U.S. belonging, exploring between-person variability in the daily associations of ethnic and U.S. belonging with well-being, and identifying whether centrality predicts between-person variability in daily levels of these processes and their relation to well-being. Results indicated significant changes in ethnic and U.S belonging on a daily basis. Despite the positive average within-person associations between ethnic belonging and well-being, results indicated significant variability. Finally, centrality also significantly predicted between-person variability in the daily levels of these cultural processes and the withinperson associations. Implications for future research are discussed

Exploring individual differences in the relationship between cultural identity processes and well-being

Although studies have explored how cultural identity impacts young people’s daily lives, these studies have exclusively focused on daily variability in cultural identity salience, overlooking daily variability in the underlying developmental processes. In the present study, we used a 12-day daily assessment conducted with 873 Hispanic college students to address these gaps by examining daily variability in ethnic and U.S. belonging, exploring between-person variability in the daily associations of ethnic and U.S. belonging with well-being, and identifying whether centrality predicts between-person variability in daily levels of these processes and their relation to well-being. Results indicated significant changes in ethnic and U.S belonging on a daily basis. Despite the positive average within-person associations between ethnic belonging and well-being, results indicated significant variability. Finally, centrality also significantly predicted between-person variability in the daily levels of these cultural processes and the withinperson associations. Implications for future research are discussed

The Use of Cultural Identity in Predicting Health Lifestyle Behaviors in Latinx Immigrant Adolescents

Objectives: This study explored whether cultural identity predicts health lifestyle behaviors. Method: Participants included 302 recently immigrated (<5 years in the U.S.) Latinx adolescents (53% boys; mean age 14.51 years at baseline) from Miami and Los Angeles. Participants completed cultural identity measures at baseline and 1-year post baseline. A path analysis was used to estimate associations between cultural identities (ethnic, national, and bicultural) and health lifestyle behaviors (physical activity, diet, and sleep hygiene). Results: Ethnic identity positively predicted diet. Results also indicated a significant interaction between ethnic and national identity on sleep hygiene. Specifically, when national identity was high (+1 SD), ethnic identity positively predicted sleep hygiene. Conclusion: This study focuses on health lifestyle behaviors such as physical activity, diet, and sleep hygiene in this population. Results highlight the need to explore the protective nature of cultural identity retention in relation to health lifestyle behaviors in Latinx adolescents