Ayisyen an Sante - Haitiens en Sante - Healthy Haitians - RESEARCH

Association between Longevity and Internet User Rate

Mon, 30 Oct 2017 07:00:00 GMT

A research study on low and lower-middle-income countries found a significantly positive association between longevity and the following socio-ecological determinants: Gross national income, physician density and mean years of schooling [1]. In a more recent study [2], internet user rate was also positively and statistically significantly associated with life expectancy in more than 178 countries. The countries where the average number of people lived longer had the highest frequency of people with access to internet-based health information.

Comparatively, although smartphone ownership and internet usage has been increasing worldwide, particularly in low and lower-middle-income countries [3], access to health information was found to be restricted [4, 5] and less prevalent [6] among certain users.

As Napoli and Obar (2014) [4] indicated,

Memory, storage capacity, and speed. The internet performance tends to be faster when using a Personal Computer (PC) than a handheld device (e.g., mobile phone).

Content availability. Limited information is sometimes available through a handheld device in comparison to a PC. Some websites can only be viewed on a PC due to the lack of an existing mobile version. Furthermore, “a focus-group study of nearly 100 early adopters of mobile devices in Kenya found that users had very little access to locally produced mobile-ready content. As a result, the users studied tended to spend the bulk of their time with international platforms such as Facebook, Wikipedia, and YouTube (Souter 2011). Thus, even as users in developing nations gain access to the Internet via mobile devices, they still suffer from a relative lack of mobile-ready content that directly addresses their specific needs and interests.”

Information seeking. Mobile devices are typically used for leisure and entertaining activities.

Skill Sets Across Platforms. Generally speaking, individuals who first learned how to use a PC are more likely to take full advantage of their mobile devices. Whereas, the majority of new internet users who first learned how to use a mobile device do not take full access of the available internet services that could benefit their well-being and future.

As it stands, health information is widely available on the web, but not to all internet users. More and more people are first-time users of handheld devices with many advantages and disadvantages compared to Personal Computers (PCs). Improving population health will entail reaching out strategically to this segment of the population with limited health information access and literacy and facilitating their use of the internet and social media for health information consumption.

References

1. Mondal, M. N. I., & Shitan, M. (2014). Relative importance of demographic, socioeconomic and health factors on life expectancy in low-and lower-middle-income countries. Journal of Epidemiology, 24(2), 117-124. doi: 10.2188/jea.JE20130059

2. Kim, J. I., & Kim, G. (2016). Country-level socioeconomic indicators associated with healthy life expectancy: Income, urbanization, schooling, and internet users: 2000–2012. Social Indicators Research, 129(1), 391-402. doi: doi.org/10.1007/s1120

3. Poushter, J. (2016). Smartphone ownership and internet usage continues to climb in emerging economies. Pew Research Center, 22. Retrieved from http://s1.pulso.cl/wp-content/uploads/2016/02/2258581.pdf

4. Napoli, P. M., & Obar, J. A. (2014). The emerging mobile Internet underclass: A critique of mobile Internet access. The Information Society, 30(5), 323-334. doi.org/10.1080/01972243.2014.944726

5. Pearce, K. E., & Rice, R. E. (2013). Digital divides from access to activities: Comparing mobile and personal computer Internet users. Journal of Communication, 63(4), 721-744. doi: 10.1111/jcom.12045

6. Sey, A., & Ortoleva, P. (2014). All work and no play? Judging the uses of mobile phones in developing countries. Information Technologies & International Development, 10(3), 1-17. Retrieved from http://itidjournal.org/index.php/itid/article/view/1280

Promoting Behavior Change in Healthy Individuals

Fri, 01 Sep 2017 07:00:00 GMT

Early education, a well built environment, access to quality and affordable preventive care, social support, and policy changes and implementation are some of the upstream health factors that impact human behavior [1]. Behavioral changes can become manifest in the home environment, in the school setting, inside organizations, and at the community level. The expectations are such that, at the macro level, they will be reflected in the population health.

In a recently updated systematic review for the U.S. Preventive Services Task Force, the authors compiled the data on several studies that investigated the benefits and potential negative consequences of early health and behavioral education as a preventive clinical strategy for reducing the incidence of precursors of cardiovascular conditions among healthy people [2].

Out of the 88 studies included in this meta-analysis (of the compiled data), 86 research studies revealed the impacts of behavioral interventions on dietary regimen, sedentary lifestyle, and physical activity.

A) Dietary Regimen: Interventions lasted 6 months or more and resulted in an average loss of 500 kcal per day. Consumption of fruits and vegetables increased by 2.2 servings per day.

B) Sedentary Lifestyle: Self-reported sitting time periods decreased significantly.

C) Physical Activity: Interventions were of 6 to 12 months duration and on average led to a weekly accumulation of 35 minutes of physical activity. The study participants who received behavioral interventions were 1.32 times (95% CI, 1,12 to 11.56) more likely to have met the recommended 150 minutes of physical activity per week.

A total of 34 of the research studies (n = 88) reported on the clinical impacts of behavioral education through the increase in levels of physical activity and or adoption of a healthy eating regimen.

A) Blood Pressure: Non-negligible decrease at 6 months or later in systolic and diastolic blood pressures as calculated respectively for all 22 and 23 selected studies. The average decrease in systolic and diastolic blood pressure was respectively 1.26 mmHg (95% CI, -1.77 to -0.75) and 0.49 mmHg (95% CI, -1.77 to -0.75).

B) Cholesterol: Noteworthy reduction occurred in low-density lipoprotein cholesterol (LDL-C or bad cholesterol) and total cholesterol levels among participants at 6 months or more. The average reduction of LDL was 2.58 mg/dl (95% CI, -4.30 to -0.85) and of cholesterol was 2.85 mg/dl (95% CI, -4.95 to -0.75) in groups of participants who received behavioral education or counseling compared to the groups of participants who did not.

C) Adiposity: The level of adiposity (fat) appreciably went down at 6 months and up for the groups of participants in the behavioral intervention. Accordingly, the average body mass index (BMI) reduction was 0.41 (95% CI, 0.62 to -0.19).

Overall, early behavioral health education or counseling is a crucial determinant of behavior change necessary for the maintenance of good clinical outcomes in healthy individuals, excluding the potentially rare "adverse events" [e.g., fractures] related to the interventions" [2].

References

1. Havranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., ... &
Rosal, M. (2015). Social determinants of risk and outcomes for cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 132(9), 873-898. doi: 10.1161/CIR.0000000000000228

2. Patnode, C., Evans, C., Senger, A. C., Redmond, N., Lin, J. S. (20017). Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors. Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 318(2), 175-193. doi: 10.1001/jama.2017.3303

Lifestyle Requirements in the U.S. for Men (and Women)

Mon, 26 Jun 2017 07:00:00 GMT

Micronutrients are fundamental components of healthy foods that are necessary for the prevention and good management of chronic conditions in the world population. In a recent study [1] involving Haitian-Americans, African-Americans, and Cuban-Americans, the researchers explored if any differences existed in the level of nutrients intake between the participants who were not diabetic and those who were. The level of adequacy of nutrient intake was also analyzed between the members of these three ethnic groups.

A total of 868 people, including the Haitian-Americans (n = 258), the African-Americans (n = 249), and the Cuban-Americans (n = 361), were involved in this study. These study participants were randomly recruited through mailing, except for the Haitian-Americans who were recruited through local community stakeholders’ referrals and advertising. All participants had to meet certain criteria for inclusion in the study (e.g., being 35 years of age or older and not having other chronic conditions). The following assessments were performed: Diabetes testing, physical activity level using the modifiable activity questionnaire (MAQ), dietary intake using the semi-quantitative food-frequency questionnaire (FFQ), and micronutrient intakes based on the recommended daily allowances (RDA).

The data were analyzed using a variety of statistical methods. Regardless of ethnicity, males living with diabetes were “significantly less active than those without diabetes”. Overall, “half of each racial/ethnic minority in this study had type 2 diabetes”. The determination was made of the likelihood that micronutrient deficiency was found either among the Haitian-Americans, African-Americans, or the Cuban-Americans living with or without diabetes.

Among the African-Americans who were born in the U.S. (98%), Haitian-American immigrants (100 %), and Cuban-American immigrants (98%), a reported 40% of them had “insufficient intakes of vitamins D and E, and calcium”. The researchers noted that “Haitian-Americans were more likely to have insufficiencies in iron, B-vitamins, vitamin D, and vitamin E and less likely to have inadequate intake of saturated fat as compared to Cuban-Americans. Vitamin D insufficiency was more likely for Haitian-Americans as compared to African-Americans”. Additionally, “Haitian-Americans with no diabetes were more likely to be insufficient in calcium”. Haitian-Americans were less prone to consuming foods that were rich in fiber compared to the Cuban-Americans.

Reflecting on these findings and based on the literature, the low intake of micronutrients among the Haitian-Americans who participated in this study could be due to their diet, which is primarily rich in carbohydrate. These Haitian-Americans could have been experiencing a lack of access to fruits and vegetables and high-fiber foods, due to financial hardships, lack of proximity to (healthy) grocery stores, and low literacy level. The selection process of the study participants and errors made by the participants in their questionnaire responses could have also influenced the results of this study.

Nevertheless, “prekosyon pa kapon”, a saying in creole that literally means "precaution is not cowardice”. A diet rich in fruits, vegetables and fiber, besides adequate exercising, hygienic sleeping habits, and adherence to a lifestyle without (bad) stress, can help prevent and manage chronic conditions such as diabetes, hypertension, and cancer. Fruits and vegetables consumed regularly provide the daily recommended amount of micronutrients (vitamins and minerals). As the latest research reminds us, vitamin and mineral supplements are still not the best sources of micronutrients to prevent chronic diseases such as diabetes, hypertension, stroke, and cancer [2].

References

1. Huffman, F. G., Vaccaro, J. A., Zarini, G. G., Biller, D., & Dixon, Z. (2012). Inadequacy of micronutrients, fat, and fiber consumption in the diets of Haitian-, African-and Cuban-Americans with and without type 2 diabetes. Int J Vitam Nutr Res, 82(4), 275-287. doi.org/10.1024/0300-9831/a000120

2. Fortmann, S. P., Burda, B. U., Senger, C. A., Lin, J. S., & Whitlock, E. P. (2013). Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: An updated systematic evidence review for the US Preventive Services Task Force. Annals of Internal Medicine, 159(12), 824-834. doi: 10.7326/0003-4819-159-12-201312170-00729

Lifestyle Changes among U.S. Immigrant Women

Tue, 16 May 2017 00:30:23 GMT

In times past, obesity was oftentimes synonymous with well-being and riches. However, decades of research revealed to us the detrimental impacts of this health condition on individuals and society. Following the dramatic changes in food production and population migration, this heath condition has become more widespread affecting all levels of society in the U.S. and many other countries in the world.

In the northeast region of the U.S., a group of recent immigrant women were interviewed on some of the socio-ecological determinants of obesity [1].

These women, speaking Haitian Creole (n = 11), Spanish (n = 11) and Portuguese (n = 3) were mothers who have been living for only 3-12 years in the U.S. In the focus group sessions, these immigrant women shared their opinions on these following topics:

Food Quality: They estimated the foods from their own country, which they sometimes used to grow, to be minimally processed, have fewer chemicals, and contain fewer preservatives. However, the foods sold/purchased in the U.S. were considered more "diverse", "hygienic" and "safer" [1].

Food Access: Meal preparation in the U.S. was a major obstacle due to lack of time, erratic work hours, and non-available social support for child care. Consequently, they resorted to “eating more convenient and fast foods” [1].

Physical Activity: Engagement for these women and their children was an issue particularly during winter time.

Sleep Quality and Quantity: Affected by high levels of stress, constant changes in work schedules, and unavailable family and social support.

Stress: Was due to the nature of their work, “financial obligations”, and “school-related activities” [1].

“School-related activities” were particularly a major concern for all Haitian mothers interviewed. They felt inadequately prepared to get involved in the educational upbringing of their children here in the U.S. because of the language barriers and the many requirements from these schools for parents. Additionally, for these Haitian women, their sleep patterns were more adequate in Haiti as they could avail themselves of the opportunity to reach out for assistance in times of need within their social support network.

Considering that immigrants will comprise 25% of the U.S. population at the end of the next three decades [1], the increased likelihood of obesity among U.S. immigrants [2, 3], and the continued high burden of obesity on society [4], theses perceptions should inform the strategies used to promote healthier behaviors among immigrants in the U.S. - Empowering Mothers.

References

1. Tovar, A., Must, A., Metayer, N., Gute, D. M., Pirie, A., Hyatt, R. R., & Economos, C. D. (2013). Immigrating to the US: What Brazilian, Latin American and Haitian women have to say about changes to their lifestyle that may be associated with obesity. Journal of Immigrant and Minority Health, 15(2), 357-364. doi: 10.1007/s10903-012-9665-8

2. Delavari, M., Sønderlund, A. L., Swinburn, B., Mellor, D., & Renzaho, A. (2013). Acculturation and obesity among migrant populations in high income countries – A systematic review. BMC Public Health, 13(1), 458. doi: 10.1186/1471-2458-13-458

3. Mehta, N. K., Elo, I. T., Ford, N. D., & Siegel, K. R. (2015). Obesity among US-and foreign-born blacks by region of birth. American Journal of Preventive Medicine, 49(2), 269-273. doi: 10.1016/j.amepre.2015.02.014

4. Uzogara, S. G. (2017). Obesity epidemic, medical and quality of life consequences: A review. International Journal of Public Health Research, 5(1), 1. Retrieved from www.openscienceonline.com/journal/archive2?journalId=718&paperId=3643

Storytelling: Is it Effective in Patient Care?

Tue, 28 Feb 2017 08:00:00 GMT

In all cultures, stories have played a vital role in the sharing of ideas, memories, and wisdom among community members. In infancy, childhood and adulthood, humans have always been fascinated by stories that resonate with them and create these feelings that are likely to have either a short or long-lasting impact on their lives.

Thus, several researchers teamed up to explore the usefulness of storytelling to influence the level of knowledge, attitude, and behavior of patients in regards to their lifestyle managements.

In a research study, 299 African-Americans patients, aged on average 53-54 years old, in majority females (73%), with a high school or graduate education (81.63%), and on at least 1 antihypertensive medication, were assigned randomly to two different groups. One group of 147 patients (also called intervention group) was exposed to storytelling DVDs. These DVDs “featured 3 storytellers who described living with hypertension, gave lessons they had learned about how to best interact with their physicians, and offered strategies to increase medication adherence”, provided information on blood pressure, shared methods on how viewers could “express their concerns and questions to their physicians”; and educated them on how to identify “hidden sodium” as well as “getting adequate exercise” [1]. In the second group or control group, there were 152 patients who were not exposed to these videos. Then, within these two groups the patients were subdivided at random into smaller groups depending on how well they were managing their blood pressure (i.e., controlled and uncontrolled hypertension).

Comparing the patients who were still involved in the study at the 3rd and 6-9th months, the researchers discovered that the patients who viewed the storytelling DVDs subsequently experienced a drop in their blood pressure (systolic and diastolic) in the 3rd month; which was statistically significant (p < 0.012) in the subgroup of patients who could not control their blood pressure very well. At 6-9 months, visualizing the storytelling DVDs produced the same scenario among the patients who could not adequately control their blood pressure before participating in the study.

These results eventually led the researchers to conclude that culturally appropriate storytelling is a potentially impactful tool to educate patients on blood pressure management in the African-American population. Can storytelling yield similar impacts in the Haitian-American community? Will using this method work well for diabetes management? The potentials exist. Further research will certainly tell us the story.

Reference

1. Houston, T. K., Allison, J. J., Sussman, M., Horn, W., Holt, C. L., Trobaugh, J.,... & Person, S. D. (2011). Culturally appropriate storytelling to improve blood pressure: A randomized trial. Annals of Internal Medicine, 154(2), 77-84. doi: 10.7326/0003-4819-154-2-201101180-00004

Changing & Adapting to the Home Environment to Stay Healthy

Tue, 03 Jan 2017 08:00:00 GMT

The home environment can promote or discourage individuals from adopting healthy habits. In a study conducted by Kegler et al. (2016), we learn about the importance of structuring one’s living environment and the benefits of individual coaching for engaging in the recommended 150 minutes of moderate intensity and muscle-strengthening physical activity per week.

A total of 349 African-American women aged on average more than 50 years old, mostly overweight or obese, participated in this study (p. 148). Their homes were first evaluated to determine how any available space could be used for exercising using the “social cognitively based home environment assessment profiles” (p. 144). Based on these evaluations, about half of these patients benefited from the services of local coaches who helped each one of them organize an area in their “home or yard” for exercising, while promising to “using it at least once a week” (p. 144). The local coaches made “3 home visits and 4 coaching calls over 16 weeks” (p. 144).

In the homes of the women who benefited from these services, there was a significant increase in “exercise equipment in a visible location” (p = .006) at 6 months and at 12 months (p. 149). More spaces were created for exercise in their homes and yards (p. 149). These women engaged more frequently in physical activity (p. 149). More significantly, the time they spent being physically active and controlling the quality and amount of food they were ingesting helped them lose some unnecessary weight (p. 148). On average, they lost 9.1 pounds at 6 months and slightly less pounds 12th months later (P = .03) (p. 148).

In sum, the home environment matters when it comes to your health! Make the changes by yourself or find help in adapting the space where you live for getting more physical activity to stay healthy. If you have any ideas, please share them with us in the comments section.

Reference

1. Kegler, M. C., Haardörfer, R., Alcantara, I. C., Gazmararian, J. A., Veluswamy, J. K., Hodge, T. L., ... & Hotz, J. A. (2016). Impact of improving home environments on energy intake and physical activity: A randomized controlled trial. American Journal of Public Health, 106(1), 143-152. doi: 10.2105/AJPH.2015. 302942

Connections between Faith in God, Sacred Body Belief, and Behavior Lifestyle

Tue, 11 Oct 2016 07:00:00 GMT

Does believing in God influence people’s view of their body as sacred, and condition them to lead a certain lifestyle?

In a newly published study, Krause et al. (2016) demonstrated in scientific terms that having a weak or strong faith in God, as a helper in times of needs, influenced people’s perception about the sacredness of their bodies [1]. Based on perception, some people were more likely to engage in healthy behaviors, while others were not.

Representing the U.S. population, 3010 individuals were interviewed using a validated (with acceptable low percentage of error) questionnaire. Among these individuals (43.2% men and 56.2% women), 45.4% were married and had 13.4 years of schooling.

A total of 734 individuals (27.4%) shared that they strongly relied on God to achieve their goals in life and viewed their body as temple of God. As a result of their faith and body perception, they were more likely to participate in physical activities (15 mn or more per day), strenuous exercises (15mn or more per day), eat fruits and vegetables (5 servings or more per day), sleep better, and adopt a healthy lifestyle practicing all four previous behaviors.

A comparative analysis of these scientific findings with the scriptures may help us understand these results. As written in the Scriptures, we find YHWH (God) declaring to Humans the rules that they need to follow (willingly):

Hear, O Yisrael, the laws and right-rulings which I speak in your hearing today. And you shall learn them, and guard to do them [Deut 5:1].

In this passage, it is clear to the hearer(s) of God’s words that, although faith is an absolute requirement from the believer in God [Deut 5:7], he or she is also expected to play an active part in the learning and application process of divine recommendations. These recommendations or divine orders include instructions on how to become and stay healthy. For example, Dietary principles for proper nutrition [Genesis 1:29]; Rest principle for body recuperation [Deut 5:12-14]; Self-control principle for good eating habits [Proverb 25:16]; Dietary principles for prevention of zoonotic, parasitic, viral, bacterial, and cancerous diseases [Deut 14]; Financial and community principles of helping each other [Deut 15:7-11]. These are some of the pre-requirements for individuals to become and remain a sacred population, as prescribed by God. Thus, by faith in God’s wisdom and accepting the view that one’s body is to remain holy, the empowered believer is compelled to evidence their belief and body perception by adopting a healthy lifestyle. As anticipated, based on God’s promises (Deut 28), they consequently reap many blessings that are well documented benefits of a healthy lifestyle in the scientific literature [2]: Longer and more enjoyable life in a just and prosperous society.

As suggested by the authors of this study, public/community health education and promotion has the capacity to empower church members to adopt healthier lifestyles. Wisdom calls for scriptural principles to be widely used for enabling church members to better relate to public/community health education and promotion program contents and activities.

NB: Biblical references can be found in all versions of the Holy Scriptures.

References

1. Krause, N., Hill, P. C., Emmons, R., Pargament, K. I., & Ironson, G. (2016). Assessing the Relationship Between Religious Involvement and Health Behaviors. Health Education & Behavior, doi: 10.1177/1090198116655314

2. Loef, M., & Walach, H. (2012). The combined effects of healthy lifestyle behaviors on all cause mortality: A systematic review and meta-analysis. Preventive medicine, 55(3), 163-170. doi: 10.1016/j.ypmed.2012.06.017

Nationwide Expansion of the Diabetes Prevention Program to include more people with health coverage

Fri, 02 Sep 2016 07:00:00 GMT

Too many people in the U.S. population are still unable to enjoy the universal right to quality health care. One determinant of this obstacle is the inadequacy of health care management in undeserved populations.

The Affordable Care Act is a major legislative act that aims to address this issue by increasing access to affordable health insurance and behavioral care to all Americans [1]. Building on this great accomplishment, the Centers for Medicare and Medicaid Services (CMS) proposed that starting January 1, 2018, more Medicare recipients benefit from the evidence-based Diabetes Prevention Program (DPP) [2].

The Diabetes Prevention Program is a program for individuals who are at risk of becoming diabetes to go through lifestyle behavior change training that can slow down and prevent the development of diabetes. This lifestyle change program is structured so that the enrollee learns to develop culturally appropriate health habits. Individuals become empowered to change their eating patterns, enjoy more physical activities, effectively manage their stress level, and gain support within a peer group. Enrollment of individuals with pre-diabetes in the program will be based on the following national criteria:

Body mass index (BMI) of 25 or greater (a BMI of 23 or greater for Asian beneficiaries) in addition to a hemoglobin A1c test with a value of 5.7-6.4 percent, or a fasting plasma glucose of 110-125 mg/dL within the last 12 months, or 2-hour plasma glucose of 140-199 mg/dl after the 75 gram oral glucose tolerance test, and no previous diagnosis of diabetes or life-threatening conditions, mobility issues, etc. [2]

As part of the CMS requirements for providers of the program, the Diabetes Prevention Program will have to be recognized by the Centers for Disease Control and Prevention (CDC).

In sum, the Medicare Diabetes Prevention Program Expansion will offer to more Americans the opportunity to live healthier and longer in their community. It will also benefit some members of the Haitian-American community who suffer from great health disparities and inequities (see previous posts: Blood Pressure, Diabetes, Glaucoma, and late preventive care) and unfortunately receive services from medical establishments, whose star ratings tend to be low [3] and associated with increased readmission and mortality [4].

References

1. Obama, B. (2016). United States Health Care Reform: Progress to date and next steps. JAMA, E1-E8. doi: 10.1001/jama.2016.9797

2. Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program Expansion. Retrieved on August 15, 2016 from
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-07.html

3. Centers for Medicare and Medicaid Services (CMS) (n.d.). Data.Medicare.gov. Retrieved on August 15, 2016 from
https://data.medicare.gov/Hospital-Compare/Patient-survey-HCAHPS-Hospital/dgck-syfz

4. Wang, D.E., Tsugawa, Y., Figueroa, J., F., & Jha, A., K. (2016). Association between the Centers for Medicare and Medicaid Services hospital star rating and patient outcomes. JAMA Intern Med. doi: 10.1001/jamainternmed.2016.0784

Resilience among Adult Haitians: A Scale in Creole

Sun, 05 Jun 2016 22:51:27 GMT

According to a recently published study, some Haitians have been experiencing the lack of access to quality mental and medical care, affordable housing, opportunities to earn decent wages, and the anguish associated with their undocumented statuses in the U.S. [1]. In spite of these hardships, they have been able to survive, due to their extraordinary resilience. Resilience, a term used to describe the capacity of individuals to adapt to stressful and perilous circumstances, and consequently become more empowered, was never measured in Haitians using a reliable and valid questionnaire in Creole, until recently.

Following the 2010 earthquake, Cénat et al. (2015) helped develop a Creole version of the Resilience Scale (RS) [2]. The scale was administered to 1355 adults between the ages of 18 and 89 who were residing at the time of the earthquake in one of the following six municipalities in the Haitian capital: Port-au-Prince downtown, Carrefour, Delmas, Tabarre, Pétion-Ville, and Cité Soleil.

The collected data were entered into SPSS. A special test (Cronbach’s alpha test) was used to examine how error-free, the Creole version of the questions on this questionnaire were, in determining the level of resilience among the Haitians participating in the study. The results of this test demonstrated that the English version of the questions on the resilience scale were reliably translated following minor modifications, thus the Creole version of the Resilience Scale was deemed valid.

Additionally, the French version of the Social Support Questionnaire Scale (SSQ-6) and the Beck Depression Inventory (BDI-II) were administered to these Haitians in the study and analyzed for reliability. The Social Support Questionnaire Scale (SSQ-6) was adequate in measuring their “perceived availability of support” and “level of satisfaction” with the said support [2]. The Beck Depression Inventory (BDI-II) also assessed very well the level of depression in the study participants. Thereafter, the scientists compared the data from the Resilience Scale (RS) with the Beck Depression Inventory (BDI-II). There was a strong association. In other terms, the more a Haitian was found to be resilient, based on the Resilient Scale (RS), the less likely he or she was depressed, showing symptoms of depression on the Beck Depression Inventory (BDI-I). A Haitian with a higher level of resilience was more likely to document having the impression of a high and adequate level of support.

Compared to the Social Support Questionnaire Scale (SSQ-6) and the Beck Depression Inventory (BDI-II), there was no relationship between the levels of resilience in the study participants with their “high prevalence of PTSD symptoms”, as demonstrated on the French version of the Impact Event Scale Revised (IES-R) [2].

There were some limitations to this study such as the use of the French version of the scales for comparative analysis with the Resilience Scale (RS). Re-administering the Resilience Scale (RS) some years later to these same participants for a Test-Retest analysis could probably increase the reliability of this measure. Nevertheless, the authors determined that the Creole version of the Resilience Scale (RS) was a good instrument to measure the level of resilience among adult Haitians compared with adults in other studies, except in one, and to the children and adolescents assessed for resilience who were also victims of the 2010 earthquake in Haiti.

References

1. Allen, J. D., Leyva, B., Hilaire, D. M., Reich, A. J., and Martinez, L. S. 2015. “Priorities, concerns and unmet needs among Haitians in Boston after the 2010 earthquake.” Health & Social Care in the Community 1-12. doi: 10.1111/hsc.12217

2. Cénat, J. M., Derivois, D., Hébert, M., Eid, P., & Mouchenik, Y. (2015). Psychometric properties of the Haitian Creole version of the Resilience Scale with a sample of adult survivors of the 2010 earthquake. Comprehensive Psychiatry, 63, 96-104. doi: 10.1016/j.comppsych.2015.09.002

A Depression Scale in Creole: The Zanmi Lasante Depression Symptom Inventory (ZLDSI)

Fri, 27 May 2016 06:26:37 GMT

In a recent study, members of the Haitian community living in the U.S. expressed the needs for improved access to care for their psychological and physical concerns, low-income housing, work opportunities; and regulation of the immigration status of the undocumented Haitians [1]. Although strong social support exists among the Haitians, which has been playing a great role in their capacity to cope with these stressors, no assessment tool could reliably and validly capture their mental well-being in their own language. Recently, a culturally appropriate scale to screen for depression was developed.

Initially, a literature review was performed to identify the terms used in Creole that could have been used to describe the symptoms of depression. In total, the authors found 91 terms.

Following this literature search, they purposively sampled (selected) study participants based on population characteristics and the objectives of the study. During the process, they made choice of 13 authority figures from the Central Plateau and Lower Artibonite, whom community members called upon for mental health concerns. These authority figures included “six Voodoo priests/priestesses (five men, or houngan, one woman, or manbo), one herbalist (doktè fey, a man), one sacristan (a man), one primary care doctor (a man), two teachers (both men), and two respected community members (both women)” [2]. Their task was to categorize the 91 Creole terms that might define depression and provide a description of each category that they created. Each participant created their categories using their own labels. The most common three categories were about “fear and cognitive problems”, “anxiety”, and “sadness, psychomotor retardation, and loss of interest in daily activities” [2]. The third category included terms that best represented the symptoms of depression. Out of the total 91 terms found in the literature, 26 terms were selected.

These 26 terms were used to formulate the questions that made up the resulting screening tool. The screening tool was then administered to 105 community members (75 female and 25 male), aged 14-75, who were selected by convenience. Based on the DSM-IV-TR and considering the socio-cultural context of some Haitians, the site coordinators conveniently chose within each of the seven designated health clinics “8-10 depressed and 8-10 not depressed individuals” [2]. Exemplifying the importance of determining socio-ecologically the symptoms of depression, “attention was paid to questions of anhedonia, where engagement in pleasurable activities might be influenced by economic means” [2].

Upon completion of the screening tools, the authors entered the data using a software, SPSS, to evaluate the reliability of the questionnaire or its capacity to be useful for screening depression in Haitians living in other cities. Using this same software and a different measurement method (cronbach’s alpha test), they also determined if the questions were valid to detect the symptoms of depressions in individuals with varying levels of depression. During their analysis, they discovered that the participants who were screened as depressed were more likely to have documented “functional impairment (WHODAS-II scores), r = .71 (p < .001)” [2]. As a result, some questions using terms that were confusing or ambiguous, and did not respond to the criteria mentioned above were eliminated.

The resulting “13-item screening measure in Haitian Creole of depressed mood and vegetative symptoms” [2] is called the Zanmi Lasante Depression Symptom Inventory (ZLDSI). In spite of the limitations, such as the exclusion of the literature review not pertaining to the people living in the Central Plateau, the area where the study was conducted, and the non-random selection of community members for testing the screening tool, this study reveals the existence of the first reliable and valid instrument to screen for depression the Haitians in Haiti and potentially with or without adaptations those living in the U.S.

References

1. Allen, J. D., Leyva, B., Hilaire, D. M., Reich, A. J., & Martinez, L. S. (2015). “Priorities, concerns and unmet needs among Haitians in Boston after the 2010 earthquake.” Health & Social Care in the Community 1-12. doi: 10.1111/hsc.12217

2. Rasmussen, A., Eustache, E., Raviola, G., Kaiser, B., Grelotti, D. J., & Belkin, G. S. (2015). Development and validation of a Haitian Creole screening instrument for depression. Transcultural psychiatry, 52(1), 33-57. doi:10.1177/1363461514543546