Our purpose in this study was to identify differences in menopausal symptom management among four major ethnic groups in the U.S. This was a secondary analysis of the qualitative data from a larger Internet-based study. We analyzed data from 90 middle-aged women in the U.S using thematic analysis. We extracted four themes during the data analysis process: (a) “seeking formal or informal advice,” (b) “medication as the first or final choice,” (c) “symptom-specific or holistic,” and (d) “avoiding or pursuing specific foods.” Health care providers need to develop menopausal symptom management programs while considering ethnic differences in menopausal symptom management.
The purpose of the study was to explore ethnic differences in symptoms experienced during the menopausal transition among four major ethnic groups in the U.S. This study was done via a cross-sectional Internet survey among 512 midlife women recruited using a convenience sampling. The instruments included: questions on background characteristics, health, and menopausal status, and the Midlife Women’s Symptom Index. The data was analyzed using descriptive and inferential statistics. Significant ethnic differences in the total number and severity of the symptoms were found. The most frequently reported symptoms and predictors of the total number and severity of the symptoms differed by ethnic identity. More in-depth cultural studies are needed to understand the reasons for the ethnic differences in menopausal symptom experience.
Ethnicity; Menopausal Symptom; Midlife Women
Despite positive reports about Internet cancer support groups (ICSGs), ethnic minorities, including Asian Americans, have been reported to be less likely to use ICSGs. Unique cultural values, beliefs, and attitudes have been considered reasons for the low usage rate of ICSGs among Asian Americans. However, studies have rarely looked at this issue.
The purpose of this study was to explore (a) how Asian Americans living with cancer who participated in ICSGs viewed ICSGs, (b) what facilitated or inhibited their participation in ICSGs, and (c) what cultural values and beliefs influenced their participation in ICSGs.
The study was a one-month qualitative online forum among 18 Asian American cancer patients recruited through a convenience sampling method. Nine topics on the use of ICSGs organized the forum discussion, and the data were analyzed using thematic analysis.
Four themes emerged from the data analysis process: (a) “more than just my family,” (b) “part of my family,” (c) “anonymous me,” and (d) “shielded from the real world.”
The overarching theme was Asian Americans’ marginalized experience in the use of Internet cancer support groups.
Implications for Practice
Offering the most current information on cancer and cancer treatment is essential for nursing practice in developing a culturally competent ICSG for Asian Americans. Also, emotional familiarity should be incorporated into the design of the ICSG, and the ICSG needs to be based on non-judgmental and non-discriminative interactions.
To compare the menopausal symptom experiences of sub-ethnic groups of Asian American midlife women.
A cross-sectional study among 91 Asian American women online. Questions about background characteristics, ethnic identity, and health and menopausal status, and the Midlife Women’s Symptom Index were used. The data were analyzed using descriptive and inferential statistics.
The most frequently reported and the most severe symptoms differed by sub-ethnicity. The total number of symptoms differed by sub-ethnicity, as did total severity scores for the symptoms.
Discussion, Conclusion, and Implications for Practice
Researchers and clinicians should be aware of sub-ethnic differences.
Asian; Menopausal Symptom; Experience; Culture
In this paper, a situation-specific theory that explains the menopausal symptom experiences of Asian immigrant women in the U.S. is presented. Using an integrative approach, the theory was developed based on the transition theory, a review of the relevant literature, and a study on Asian immigrant women’s menopausal symptom experiences in the U.S. The proposed theory includes transition conditions, patterns of response, and nursing therapeutics as major concepts and explains the relationships among these major concepts. This theory should be further validated and developed in intervention studies and nursing practice with this specific population.
Situation-specific theory; midlife women; Asian; immigrant; menopausal symptom experience
This paper presents a situation specific theory—the Midlife Women's Attitudes toward Physical Activity (MAPA) theory—that explains how women's attitudes toward physical activity influence their participation in physical activity. Using the integrative approach of Im, the theory was developed based on the Attitude, Social Influence, and Self Efficacy Model, a review of the related literature, and a study of women's attitudes toward physical activity. As a situation-specific theory, the MAPA theory can be easily linked to nursing practice and research projects related to physical activity in midlife women, especially interventions aimed at increasing midlife women's participation in physical activity.
Situation-specific theory; midlife women; attitudes toward physical activity
Using a feminist perspective, the relationship between acculturation and cancer pain experience was explored.
This was a cross-sectional, correlational Internet study among 104 Hispanic and 114 Asian cancer patients. The instruments included both unidimensional and multidimensional cancer pain measures.
There were significant differences in cancer pain scores by country of birth. Yet, there was no significant association of acculturation to cancer pain scores.
Discussion and Conclusions:
This study indicated inconsistent findings.
Implications for Practice:
To provide directions for adequate cancer pain management, further studies with a larger number of diverse groups of immigrant cancer patients are needed.
Acculturation; Cancer Pain; Asian; Hispanic
Our purpose in this study was to explore ethnic differences in symptoms experienced during the menopausal transition among four major ethnic groups in the U.S. using a feminist perspective. This was a cross-sectional correlational study among 158 midlife women. The instruments included are: questions on sociodemographic characteristics, health, and menopausal status, and the Midlife Women’s Symptom Index. The data were analyzed using descriptive and inferential statistics. Significant ethnic differences in the total number of symptoms (p<.01) were found. The most frequently reported symptoms differed by ethnicity. The symptoms experienced during the menopausal transition were significantly associated with some contextual factors.
Ethnicity; Menopause; Symptoms; Midlife; Women
The purpose of this paper is to provide future directions for the usage of Internet communities (ICs) for recruitment of research participants based on issues raised in an Internet survey among 132 cancer patients. 317 general and 233 ethnic-specific Internet Cancer Support Groups and 1,588 ethnic-specific ICs were contacted to recruit cancer patients. Research staff recorded issues and wrote memos during the recruitment process. The written memos and records were later analyzed using content analysis. The issues included: (a) difficulty in identifying appropriate ICs and potential participants, (b) meta-tags, (c) dominant white and women groups, (d) dynamics inside ICs, (e) difficulty in trust building, and (f) potential selection bias. The findings suggest that researchers thoroughly review the ICs’ information, be recognizant of potential gender and ethnic issues and current trends in Internet interaction, and consider potential selection bias.
Internet Communities; Cancer Patients; Recruitment; Internet Research
Several plausible reasons for inadequate cancer pain management among Hispanic patients with cancer in the U.S. have been postulated; however, this issue is understudied.
The purpose of the study was to explore Hispanic patients' cancer pain experience from a feminist perspective in order to find explanations for inadequate pain management for Hispanic patients with cancer.
A qualitative online forum study.
Both Internet and community settings.
15 Hispanic patients with cancer recruited using a convenience sampling method.
A 6-month online forum was conducted using nine discussion topics, and the data were processed using a thematic analysis.
Phenomenon of Interest:
Cancer Pain Experience
Four major themes emerged: lack of communication with health care providers regarding undermedication; because of traditional gender roles guiding their behaviors, both women and men were enduring pain; participants placed the highest priority on family during the diagnosis and treatment process, thus setting aside their needs for pain management; finally, participants were enduring inconvenience and unfair treatment in the U.S. health care system while simultaneously appreciating what treatment they had been given.
Because of cultural factors and marginalized status in the U.S. as Hispanics and as immigrants, most of the participants could not adequately describe and manage their pain.
Findings suggest a need for further investigation of the influences of multiple factors, including financial issues, cultural norms, and gender stereotypes, on cancer pain experience among diverse subgroups of Hispanic patients with cancer.
Because of their Hispanic identity or immigrant status in the U.S., financial difficulties, language barriers, and cultural values placing family as the highest priority, most of the Hispanic participants of this study could not adequately describe and manage their pain.
Because of traditional gender roles emphasizing machismo, Hispanic men rarely complained about their pain.
Due to cultural traditions emphasizing women's obedience and obligation to sacrifice for their families, Hispanic women were also enduring pain while fulfilling their multiple roles and responsibilities.
Because of familism, Hispanic patients with cancer placed the highest priority on family while managing cancer pain.
Hispanic; Cancer; Pain Experience
Not considering cancer patients’ own views and experience with pain, especially gender and ethnic differences in their cancer pain experience, was reported to be a major contributor to the miscommunication that frequently results in inadequate cancer pain management. The purpose of this study was to explore white cancer patients’ perception of gender and ethnic differences in pain experience through an online forum. This was a descriptive qualitative study among 29 white cancer patients based on a feminist approach. Nine topics related to cancer pain experience were used. The data were analyzed using thematic analysis: 5 themes were identified. First, the participants perceived that pain accompanies cancer throughout the diagnosis and treatment process. Second, the specific characteristics of the participants’ individual culture and its view of pain and cancer could result in different cancer pain experience even among white cancer patients. Third, the participants complained that women’s pain was not taken seriously by health care providers. Fourth, the participants reported highly individualized pain experience with emotional pain. Finally, the participants wanted to have a control of their own pain management process. Based on the findings, implications for nursing research and practice are proposed.
Cancer; Pain; White; Culture; Ethnicity; Gender
Despite positive aspects of online forums as a qualitative research method, very little is known about practical issues involved in using online forums for data collection, especially for a qualitative research project.
The purpose of this paper is to describe the practical issues that the researchers encountered in implementing an online forum as a qualitative component of a larger study on cancer pain experience.
Throughout the study process, the research staff recorded issues ranged from minor technical problems to serious ethical dilemmas as they arose and wrote memos about them. The memos and written records of discussions were reviewed and analyzed using the content analysis suggested by Weber.
Two practical issues related to credibility were identified: a high response and retention rate and automatic transcripts. An issue related to dependability was the participants’ easy forgetfulness. The issues related to confirmability were difficulties in theoretical saturation and unstandardized computer and Internet jargon. A security issue related to hacking attempts was noted as well.
The analysis of these issues suggests several implications for future researchers who want to use online forums as a qualitative data collection method.
Issues; Online Forums; Cancer Patients; Qualitative Research
Internet Cancer Support Groups (ICSGs) are an emerging form of support group on Internet specifically for cancer patients. Previous studies have indicated the effectiveness of ICSGs as a research setting or a data-collection method. Yet recent studies have also indicated that ICSGs tend to serve highly educated, high-income White males who tend to be at an early stage of cancer. In this article, a total of 317 general ICSGs and 229 ethnic-specific ICSGs searched through Google.com, Yahoo.com, http://Msn.com, AOL.com, and ACOR.org are analyzed from a feminist perspective. The written records of group discussions and written memos by the research staff members were also analyzed using content analysis. The idea categories that emerged about these groups include (a) authenticity issues; (b) ethnicity and gender issues; (c) intersubjectivity issues; and (d) potential ethical issues. The findings suggest that (a) researchers adopt multiple recruitment strategies through various Internet sites and/or real settings; (b) researchers raise their own awareness of the potential influences of the health-related resources provided by ICSGs and regularly update their knowledge related to the federal and state standards and/or policies related to ICSGs; and (c) researchers consider adopting a quota-sampling method.
Analysis; Cancer; Feminist; Internet; Support groups
To explore attitudes toward physical activity of White midlife women in the United States using a feminist perspective.
A cross-sectional qualitative study using a thematic analysis.
Internet communities for midlife women.
Twenty-nine White midlife women in the United States recruited using a convenience sampling method.
We used 17 topics on attitudes toward physical activity and ethnic-specific contexts to administer an online forum. We analyzed the data using thematic analysis.
We found three themes: “thinking without action”; “gendered and sedentary culture”; and “motivating myself.” The women knew and understood the necessity of physical activity for their physical and mental health but in most cases had not been able to take action to increase their physical activities. Although the culture that circumscribed the women's physical activity was sedentary in nature, the women tried to motivate themselves to increase their physical activities through several creative strategies.
The findings strongly suggest that although women were doing their best, American culture itself needs to be changed to help women increase physical activity in their daily lives.
physical activity; attitudes; midlife; women; online forum
Despite a lack of studies on Hispanic midlife women's physical activity, the existing studies have indicated that Hispanics' ethnic-specific attitudes toward physical activity contributed to their lack of physical activity. However, little is still clearly known about Hispanic midlife women's attitudes toward physical activity. The purpose of this study was to explore Hispanic midlife women's attitudes toward physical activity using a feminist perspective. The study was a 6-month qualitative online forum among 23 Hispanic women who were recruited through Internet communities/groups. The data were collected using 17 online forum topics on attitudes toward physical activity and ethnic-specific contexts. The data were analyzed using thematic analysis. Three major themes emerged from the data analysis process: (a) “family first, no time for myself,” (b) “little exercise, but naturally healthy,” and (c) “dad died of heart attack.” Although some of the women perceived the importance of physical activity due to their family history of chronic diseases, the study participants thought that physical activity would be a waste of time in their busy daily schedules. These findings provided directions for future health care practice and research to increase physical activity among Hispanic midlife women.
physical activity; attitudes; midlife; women; online forum
The Midlife Women’s Symptom Index (MSI) was designed to measure menopausal symptoms specifically in a multiethnic sample of midlife women. This study is a psychometric property test to evaluate MSI among 512 multiethnic groups of midlife women (White, Hispanic, African American, and Asian American). Across the ethnic groups, MSI had an adequate internal consistency in all subdomains except psychosomatic symptoms. The item-to-total correlation coefficients of “lost weight” and “nosebleeds” were less than 0.20 among all ethnic groups. The discriminant validity was confirmed among all ethnic groups except Asian Americans. Overall, MSI may work better for Whites and not as well for Asian Americans, compared with other ethnic groups. Additional studies with diverse groups of multiethnic midlife women are needed, however, to confirm MSI psychometric properties.
psychometric property; reliability; validity; menopausal symptom; ethnicity
Although the Kaiser Physical Activity Survey (KPAS) was a potential instrument for cross cultural research of midlife women, little information is available on its reliability and validity among multi-ethnic groups of midlife women. The purpose of the study was to evaluate the reliability and validity of the KPAS in estimating physical activity among 341 diverse ethnic women. Internal consistency was adequate for all ethnic groups except N-H African Americans. The construct validity was identified through group comparisons and factor analysis. In group comparisons, physical activity differences among diverse ethnic groups were similar to results of previous studies using the KPAS. Eight factors were extracted among all ethnic groups except N-H Asian Americans. In the convergent validity test, N-H African Americans and N-H Asian Americans showed particular patterns. Overall, the KPAS was a reliable instrument and was reasonably accurate in assessing physical activities for any multi-ethnic groups of midlife women. However, cultural sensitivity among N-H African Americans and N-H Asian Americans need to be further examined.
Internal consistency; construct validity; convergent validity; physical activity; ethnicity; midlife; women
Little is known about how culture influences menopausal symptom experience, and few comparative qualitative studies have been conducted among multiethnic groups of midlife women in the United States.
To explore commonalities and differences in menopausal symptom experience among four major ethnic groups in the US (Whites, Hispanics, African Americans, and Asians).
This was a secondary analysis of qualitative data from a larger national Internet-based study. The qualitative data from 90 middle-aged women in the US who attended four ethnic-specific online forums of the larger study were examined using thematic analysis.
The themes reflecting commonalities across the ethnic groups were: just a part of life, trying to be optimistic, getting support, and more information needed. The themes reflecting the differences among the ethnic groups were: open and closed, universal and unique, and controlling and minimizing. Overall, the findings indicated positive changes in women’s menopausal symptom experience, and supported the existence of cultural influences on women’s menopausal symptom experience across the ethnic groups.
Systematic efforts need to be made to empower midlife women in their management of menopausal symptoms.
ethnicity; menopause; symptoms; midlife; women
Using a feminist approach, we examined the menopausal symptom experience of Hispanic midlife women in the U.S. This was a qualitative online forum study among 27 Hispanic midlife women in the U.S. Seven topics related to menopausal symptom experience were used to administer the 6-month online forum. The data were analyzed using thematic analysis. Four themes were identified: (a) “Cambio de vida (change of life),” (b) “being silent about menopause,” (c) “trying to be optimistic,” and (d) “getting support.” More in-depth studies with diverse groups of Hispanic women are needed while considering family as a contextual factor.
Hispanic; Midlife Women; Menopause; Symptoms
Cultural values and beliefs related to cancer and pain have been used to explain ethnic differences in cancer pain experience. Yet, very little is known about similarities and differences in cancer pain experience among different ethnic groups.
To explore similarities and differences in cancer pain experience among four major ethnic groups in the United States.
A feminist approach by Hall and Stevens was used. This was a cross-sectional qualitative study among 22 White, 15 Hispanic, 11 African American, and 27 Asian cancer patients recruited through both Internet and community settings. Four ethnic-specific online forums were conducted for 6 months. Nine topics related to cancer pain experience were used to guide the online forums. The collected data were analyzed using thematic analysis involving line-by-line coding, categorization, and thematic extraction.
All participants across ethnic groups reported “communication breakdowns” with their health care providers and experienced “changes in perspectives.” All of them reported that their cancer pain experience was “gendered experience.” White patients focused on how to control their pain and treatment selection process, while ethnic minority patients tried to control pain by minimizing and normalizing it. White patients sought out diverse strategies of pain management; ethnic minority patients tried to maintain normal lives and use natural modalities for pain management. Finally, the cancer pain experience of White patients was highly individualistic and independent, while that of ethnic minority patients was family-oriented.
These findings suggest that nurses need to use culturally competent approaches to cancer pain management for different ethnic groups. Also, the findings suggest further in-depth cultural studies on the pain experience of multiethnic groups of cancer patients.
cancer; ethnic minority; experience; pain
Inconsistent findings on ethnic differences in cancer pain experience suggest the need for further studies on this topic for adequate cancer pain management.
The purpose of this study was to determine ethnic differences in cancer pain experience of 4 ethnic groups in the U.S.
A feminist perspective provided the theoretical basis. This was a survey of a multiethnic sample of 480 cancer patients asking questions on sociodemographic characteristics and health/illness status, 3 unidimensional cancer pain scales, 2 multidimensional cancer pain scales, the Memorial Symptom Assessment Scale, and the Functional Assessment of Cancer Therapy Scale. The data were analyzed using descriptive and inferential statistics including ANOVA and hierarchical multiple regression analyses.
The results indicated certain ethnic differences in types of pain and symptoms that patients experienced. Also, the results demonstrated significant ethnic differences in cancer pain and functional status. The VDS, VAS, FS, MPQ, and BPI scores of Non-Hispanic (N-H) Asian participants were significantly lower than those of Hispanic and N-H White participants (p<.01). The VAS and MPQ scores of N-H African American participants were significantly lower than those of Hispanic and N-H White participants (p<.01). The FACT-G scores of N-H Asian participants were significantly lower than Hispanic participants (p<.01). The findings also indicated that being N-H Asian or not was a significant predictor of the VDS, FS, and BPI scores.
The findings suggest further in-depth qualitative exploration on cultural values and beliefs related to cancer pain in each ethnic group and national-scope studies with a larger number of ethnic minorities on this topic.
The purpose of this study was to qualitatively explore gender and ethnic differences in cancer patients’ needs for help. A feminist perspective guided the research process theoretically.
This was a qualitative online forum study.
Both Internet and real settings.
Sixteen self-identified online cancer patients aged at least 18 years who could read and write English.
Using six discussion topics on cancer patients' needs for help, the online forum was administered for one month. Then, the data were analyzed using thematic analysis.
Four major themes emerged: (a) from side effects to racism; (b) same or double stress; (c) cultural hesitance and God; and (d) a family disease with mistrust. Depending on gender and ethnicity, the participants' concerns were various and ranged from a simple physical need to a social need for elimination of racism in the U.S. society. Women tended to report double burden and stress as cancer patients due to their gender. Ethnic minorities tended to be hesitant to talk about cancer and seek for help due to stigmatized nature of cancer. Ethnic minority cancer patients perceived cancer as a family disease that they needed to go through as a family, and they tended to mistrust health care providers.
The overriding theme was ethnic minority cancer patients' marginalized experience.
Researchers need to include cultural needs as a separate category of needs, and consider contextual factors influencing cancer patients' needs in their daily lives.
Cancer; Needs; Culture; Ethnicity; Gender
The purpose of this study was to explore demographic characteristics of a specific online population, midlife women recruited through Internet communities (ICs) or groups, and to provide future direction for Internet research among midlife women. Using a feminist perspective, the study focused on ethnic variations in the characteristics of the midlife women. A total of 192 midlife women were recruited through ICs. The Internet survey included questions on sociodemographic characteristics and health/illness status. The data were analyzed using descriptive and inferential statistics. The findings indicated that midlife women recruited through ICs tended to be Caucasian, young, married, and affluent. The findings also indicated significant ethnic differences in sociodemographic characteristics. The findings suggest that researchers need to consider that midlife women recruited from ICs tend to be a specific group of midlife women.
Internet Communities; Midlife Women; Recruitment; Internet Research
The purpose of this study was to describe characteristics of cancer patients who were attending Internet Cancer Support Groups (ICSGs) and to provide direction for future research. A total of 204 cancer patients were recruited through ICSGs by posting the study announcement on the websites of the ICSGs. The participants were asked to fill out Internet survey questionnaires on sociodemographic characteristics and health/disease status. The data were analyzed using descriptive and inferential statistics including t-tests, ANOVA, and chi-square tests. Findings indicate that cancer patients recruited through the ICSGs tended to be middle-aged, well-educated, female and middle class. The findings also indicate that there were significant differences in some characteristics according to gender and ethnicity. Based on the findings, some implications are suggested for future research using and developing the ICSGs.
Internet Cancer Support Groups; Cancer Patients; Sociodemographic Characteristics