Research Proposal: Reducing Risky Behavior for African-American

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[. . .] The disproportionately high HIV incidence among African-American female teens convincingly defines the term 'health disparity.' A possible intervention has been explored by Aronowitz and Agbeshie (2012) and Aronowitz and Eche (2013) using qualitative study designs. Working under the assumption that mothers are the primary sex educators for daughters, they investigated the interactions that took place between inner-city African-American mother-daughter dyads during discussions about intimate sexual issues. The goal of these studies were to define the main communication and parenting strategies employed, thereby providing valuable, culturally-sensitive information that could help clinicians reduce health disparities for African-American female youth.

Aronowitze and Agbeshie (2012) used a focus group strategy within a grounded theory study design. They limited the daughter's age to between 11- and 14-years of age, under the assumption that initiating discussion about sex before sexual debut is the most effective way to delay the age of sexual debut and related risky behaviors. The age range of the mothers was between 32- and 78-years of age, since a few daughters were being raised by their grandmothers. The main themes that emerged from these focus group sessions were level of disclosure, mixed messages, emotional tone, and knowing. The level of disclosure pertains to the amount of intimate information that the daughter and mother are willing to discuss, while mixed messages are the domain of how mothers communicate the topic of sex to their daughters. The emotional tone describes the extent to which discussions about sex are mostly reactive and therefore unproductive. Knowing describes how confident the daughter or mother is in understanding the non-verbal communications that take place during discussions about sex.

The findings from the study by Aronowitz and Agbeshie (2012) apparently informed a follow-up study examining the parenting styles used by African-American inner-city mothers during discussions of sex with their daughters (Aronowitz and Eche, 2013). Of the four parenting styles extensively covered in the research literature, including laissez-faire and permissive, authoritarian and authoritative parenting styles dominated. The researchers discovered that authoritarian mothers tended to rely on psychological control methods, such as scaring, to control the social behavior of their daughters. By comparison, authoritative mothers tended to rely more heavily on setting rules for behavior, monitoring the whereabouts of the daughter through social connections, communicating unconditional love, and fostering an ethnic identity. The daughters almost uniformly agreed that scare tactics and intrusive monitoring techniques tended to be counterproductive, even to the point that it might have the opposite effect on a daughters social choices concerning sex.

Aronowitz and Eche (2013) discussed their findings from the perspective of nursing interventions. A nurse could encourage mothers who tend to rely on an authoritarian parenting style to increase the amount of time spent communicating unconditional love and fostering a positive ethnic identity. With time, the mother may also become convinced that scare tactics may be counterproductive and that better approaches to controlling her daughter's social choices concerning sex are available.

Theoretical Framework

The theoretical framework for the proposed study is based on the work of Peplau (Coury, Martsolf, Drauker, & Strickland, 2008), Gonzalez-Guarda et al. (2011), Aronowitz and Agbeshie (2012), and Aronowitz and Eche (2013), in addition to the substantial policy shift that has taken place in the United States by federal health agencies (Office of Minority Health, 2013) and professional medical organizations (Douglas et al., 2009) in support of cultural competency training for health care providers. Currently, very little empirical support exists for the efficacy of cultural competency training for reducing health disparities. Best practice recommendations have been published by a number of organizations, but evidence-based practice recommendations are almost non-existent. Peplau's interpersonal theory of nursing seems to support such an intervention, since care efficacy would depend on transcultural knowledge and communication skills. There is thus a great need to begin the process of investigating the efficacy of cultural competency training in relation to health disparities.

Based on the findings and interpretations of Gonzalez-Guarda et al. (2011) the syndemic factor 'acculturation to American society' contributes to risky behavior in sexually-active Hispanic women between the ages of 18 and 50 living in South Florida. The main categories of risky behavior examined were substance abuse, exposure to violence, condom use, sexually-transmitted infections (STIs), and partner risky behavior. An additional, related category of depressive symptoms was also correlated with length of time spent in America.

It seems to naturally follow from these findings that the sexual choices being made by African-American female teens could be modified significantly by syndemic factors. The work of Aronowitz and Agbeshie (2012) and Aronowitz and Eche (2013) suggest that the parenting style of mothers of these teens could represent a syndemic factor, in part because mothers tend to be the primary sex educator for children. The findings of Aronowitz and Eche (2013) suggest that an authoritative parenting style, compared to an authoritarian parenting style, would more likely result in better health outcomes for daughters in terms of risky behavior.

Based on this theoretical framework, cultural competency training for providers would be predicted to improve the health outcomes of inner-city African-American female adolescents because of the positive impact the intervention would have on the mother's parenting styles.

Methods

Sample and Setting -- Nurse practitioners (NPs) meeting the inclusion criteria of primary care provider, inner-city practice setting, non-African-American identity, and African-American clients will be identified by cross-referencing contact information obtained from the American Association of Nurse Practitioners with low-income (SBA, n.d.)/African-American neighborhoods (SSDAN, n.d.). The NPs thus identified will be contacted by mail and asked to participate. All interested NPs responding within the first 30 days will be placed in a pool and 20 selected randomly for participation in either the experimental or control group. The NPs who offer to participate may not be a representative sample of all providers meeting the inclusion criteria, simply because of their willingness and ability to participate. This would probably introduce a selection bias that could reduce the generalizability of the findings.

Selected NPs will be asked to invite all African-American mother-daughter dyads on their client list to participate in the study. The inclusion criteria for mother-daughter dyads are (1) residing in the same home and (2) daughter age between 11 and 15 years. To attain a confidence interval of 10 with an ? Of 0.05, the sample size would have to be at least 96 mother-daughter dyads. Assuming a high dropout rate of 20%, at least 115 mother-daughter dyads will need to be enrolled in the study. The number of NPs enrolled in the study beyond the initial 20 will therefore depend on reaching the goal of 115 mother-daughter dyads.

The overall sampling strategy is probability sampling because providers, and thus their clients, will be randomized into an experimental or control group. The control NPs and their mother-daughter dyads will also be blinded to the intervention, because the pretest will not reveal that the intervention is cultural competency training for providers.

The ethical concerns are minimal because provider cultural competency training, as an intervention, has not been empirically proven to reduce risky behavior among African-American female teens. The possible negative consequences of study participation could be creating tension between mother-daughter dyads due to filling out the questionnaires, but the expectation is that any discord would be minimal and transient. No ethical issues concerning participating NPs have been identified.

All study subjects, including providers, will be required to sign an informed consent form before they will be included in the study. This form will describe the sexual nature of the survey questions, but will not reveal the intervention. The readability scores determined by Microsoft Word for the consent form is a Flesch-Kincaid Grade Level of 13.2 and Flesch Reading Ease score of 34.5.

Research Design -- Given the qualitative findings by Aronowitz and Eche (2013) the next logical step is to test the theory that a provider intervention that modifies parenting style will influence teen risky behavior patterns using a quantitative study design. The research design chosen is randomized-controlled trial (RCT) because providers will be randomly assigned to either the experimental or control group. The intervention will be provider cultural competency training and the outcome measure teen risky behavior.

The pretest-posttest design will allow a comparison between the experimental and control group baseline data, so that any difference between the posttest data can be attributed to the intervention. There is a chance that the pretest will sensitize the experimental group to the intervention, which represents the main threat to internal validity, but the intervention impacts the providers, not the mother-daughter dyads; therefore, all mother-daughter dyads should be theoretically blinded to the intervention. In addition, the Cronbach's alpha coefficient will be used to test for internal consistency.

Intervention -- The intervention will be cultural competency training for nurse practitioners providing primary care services in low-income communities with a significant African-American client base. The intervention will be the online continuing education course offered by the Office of Minority Health (n.d.). The course is free and a passing score… [END OF PREVIEW]

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Reducing Risky Behavior for African-American.  (2014, February 4).  Retrieved April 20, 2019, from https://www.essaytown.com/subjects/paper/reducing-risky-behavior-african-american/3427398

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"Reducing Risky Behavior for African-American."  Essaytown.com.  February 4, 2014.  Accessed April 20, 2019.
https://www.essaytown.com/subjects/paper/reducing-risky-behavior-african-american/3427398.