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Ethnic minority midlife women frequently do not recognize cardiovascular symptoms that they experience during the menopausal transition. Racial/ethnic differences in cardiovascular symptoms are postulated as a plausible reason for their lack of knowledge and recognition of the symptoms. The purpose of this study was to explore racial/ethnic differences in midlife women's cardiovascular symptoms and to determine the factors related to these symptoms in each racial/ethnic group. This was a secondary analysis of the data from a larger study among 466 participants, collected from 2006 to 2011. The instruments included questions on background characteristics, health and menopausal status, and the Cardiovascular Symptom Index for Midlife Women. The data were analyzed using inferential statistics, including Poisson regression and logistic regression analyses. Significant racial/ethnic differences were observed in the total numbers and total severity scores of cardiovascular symptoms (p < .01). Non-Hispanic Asians had significantly lower total numbers and total severity scores compared to other racial/ethnic groups (p < .05). The demographic and health factors associated with cardiovascular symptoms were somewhat different in each racial/ethnic group. Further studies are needed about possible reasons for the racial/ethnic differences and the factors associated with cardiovascular symptoms in each racial/ethnic group.

The purposes of the study were to develop a theoretical model to explain the relationships between immigration transition and midlife women's physical activity and test the relationships among the major variables of the model. A theoretical model, which was developed based on transitions theory and the midlife women's attitudes toward physical activity theory, consists of 4 major variables, including length of stay in the United States, country of birth, level of acculturation, and midlife women's physical activity. To test the theoretical model, a secondary analysis with data from 127 Hispanic women and 123 non-Hispanic (NH) Asian women in a national Internet study was used. Among the major variables of the model, length of stay in the United States was negatively associated with physical activity in Hispanic women. Level of acculturation in NH Asian women was positively correlated with women's physical activity. Country of birth and level of acculturation were significant factors that influenced physical activity in both Hispanic and NH Asian women. The findings support the theoretical model that was developed to examine relationships between immigration transition and physical activity; it shows that immigration transition can play an essential role in influencing health behaviors of immigrant populations in the United States. The NH theoretical model can be widely used in nursing practice and research that focus on immigrant women and their health behaviors. Health care providers need to consider the influences of immigration transition to promote immigrant women's physical activity.

Introduction: Women's racial/ethnic-specific attitudes toward physical activity have been pointed out as a plausible reason for their low participation rates in physical activity. However, very little is actually known about racial/ethnic commonalities and differences in midlife women's attitudes toward physical activity. The purpose of this study was to explore commonalities and differences in midlife women's attitudes toward physical activity among 4 major racial/ethnic groups in the United States (whites, Hispanics, African Americans, and Asians)., Methods: This was a secondary analysis of the qualitative data from a larger study that explored midlife women's attitudes toward physical activity. Qualitative data from 4 racial/ethnic-specific online forums among 90 midlife women were used for this study. The data were analyzed using thematic analysis, and themes reflecting commonalties and differences in the women's attitudes toward physical activity across the racial/ethnic groups were extracted., Results: The themes reflecting the commonalities were: 1) physical activity is good for health, 2) not as active as I could be, 3) physical activity was not encouraged, 4) inherited diseases motivated participation in physical activity, and 5) lack of accessibility to physical activity. The themes reflecting the differences were: 1) physical activity as necessity or luxury, 2) organized versus natural physical activity, 3) individual versus family-oriented physical activity, and 4) beauty ideal or culturally accepted physical appearance., Discussion: Developing an intervention that could change the social influences and environmental factors and address the women's racial/ethnic-specific attitudes would be a priority in increasing physical activity of racial/ethnic minority midlife women., (© 2013 by the American College of Nurse-Midwives.)

Objectives: To explore Asian American midlife women's attitudes toward physical activity using a feminist perspective., Design: A qualitative online forum study., Settings: Internet communities/groups for midlife women and ethnic minorities., Participants: A total of 17 Asian American women recruited through the Internet using a convenience sampling method., Methods: A 6-month qualitative online forum was conducted using 17 online forum topics. The data were analyzed using thematic analysis., Results: Three major themes related to Asian American midlife women's attitudes toward physical activity were extracted from the data: keeping traditions, not a priority, and not for Asian girls. Because Asian American midlife women were busy in keeping their cultural traditions, they rarely found time for physical activity. The women gave the highest priority to their children, and physical activity was the lowest priority in their busy lives. Also, the women were rarely encouraged to participate in physical activity during their childhoods, and they perceived that their weak and small bodies were not appropriate for physical activity., Conclusions: Several implications for future development of physical activity promotion programs for this specific population have been suggested based on the findings., (© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Background: Despite an increasing number of studies of midlife women's physical activity, little is known about how attitudes toward physical activity of midlife women from diverse ethnic groups influence the women's physical activity., Objectives: To explore ethnic differences in midlife women's attitudes toward physical activity and determine the relationships between the attitudes and their actual participation in physical activity while considering other influencing factors., Methods: The Midlife Women's Attitudes Toward Physical Activity model was used to guide the study. This was a cross-sectional Internet survey study of 542 midlife women. The instruments included questions on background characteristics and health and menopausal status; the Physical Activity Assessment Inventory; a modified Barriers to Health Activities Scale; the Questions on Attitudes Toward Physical Activity, Subjective Norm, Perceived Behavioral Control, and Behavioral Intention; and the Kaiser Physical Activity Survey. The data were analyzed using ANOVA, correlation, hierarchical multiple regression, and path analyses., Results: There were significant ethnic differences in the attitude scores (F = 2.58, p < .05), but no ethnic differences in the physical activity scores. Interestingly, there were significant ethnic differences in the occupational physical activity scores (F = 5.68, p < .01). Attitude scores accounted for 5% of total variances of the physical activity scores (F(ch) = 43.52, p < .01). The direct paths from the attitude scores (p < .01), the self-efficacy scores (p < .01), and the barrier scores (p < .05) to the physical activity scores were statistically significant., Discussion: Ethnic differences in the women's attitudes toward physical activity need to be considered in promoting physical activity of midlife women.

The purpose of this study was to explore African American midlife women's attitudes toward physical activity. Using a feminist perspective, a 6-month online forum was conducted with 21 African American midlife women recruited on the Internet. The data were analyzed using thematic analysis. Four themes emerged: (a) culturally acceptable body, (b) missed opportunity to learn, (c) physical activity as a luxury, and (d) want to do by myself. The women had positive body images regardless of their actual weight. The women considered physical activity "a luxury" in their busy lives and thought that they had already missed opportunities to learn. The women wanted to participate in physical activities alone because of their bad childhood experiences and hesitance to go out in public with sweaty, messy hair. The findings suggested that unique programs that promote physical activity should be developed that consider the women's ethnic-specific attitudes.

Our purpose in this study was to identify differences in menopausal symptom management among four major ethnic groups in the United States. 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 United States 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.

Objective: To explore attitudes toward physical activity of White midlife women in the United States using a feminist perspective., Design: A cross-sectional qualitative study using a thematic analysis., Setting: Internet communities for midlife women., Participants: Twenty-nine White midlife women in the United States recruited using a convenience sampling method., Methods: 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., Results: 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., Conclusion: 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., (© 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

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 a 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.

Objective: To describe the experience of menopausal symptoms of midlife Black women in the United States., Design: Qualitative online forum using a feminist perspective., Setting: Internet communities for midlife women and Blacks., Participants: Twenty midlife Black women recruited using a quota sampling method., Methods: A 6-month online forum was conducted with seven discussion topics on menopausal symptoms. The discussion topics were posted sequentially on the forum site, and the women posted messages at their convenience over 6 months. The data were analyzed using thematic analysis., Results: The identified themes were raised to be strong, accepting a natural aging process, silent and without knowledge, and our own experience. The women tried to be strong during their menopausal transitions while dealing with other important family matters. The women did not report their menopausal symptoms and were silent about or downplayed their symptoms, but many emphasized the importance of education about menopausal symptoms and highlighted their own lack of knowledge. These women generally did not talk about their symptoms because they believed that nobody except other Black midlife women could understand their menopausal experience., Conclusion: Health care providers need to develop a mechanism to deliver the necessary knowledge about menopausal symptoms and management strategies to Black midlife women in their health care practices.

Purpose: To compare the menopausal symptom experiences of subethnic groups of Asian American midlife women., Design: 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., Findings: The most frequently reported and the most severe symptoms differed by subethnicity. The total number of symptoms differed by subethnicity, as did total severity scores for the symptoms., Discussion: Researchers and clinicians should be aware of subethnic differences.

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 linked easily 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., (Copyright 2010 Mosby, Inc. All rights reserved.)

Using a feminist approach, we examined the menopausal symptom experience of Hispanic midlife women in the United States This was a qualitative online forum study among 27 Hispanic midlife women in the United States. 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.

My purpose in this study was to explore ethnic differences in symptoms experienced during the menopausal transition among four major ethnic groups in the United States 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 (MSI). 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.

Studies have indicated the need for theories that explain and target ethnic-specific cancer pain experiences, including those of Asian Americans. In this article, I present a situation-specific theory that explains the unique cancer pain experience of Asian Americans. Unlike other existing theories, this situation-specific theory was developed on the basis of evidence, including a systematic literature review and research findings, making it comprehensive and highly applicable to research and practice with Asian American patients with cancer. Thus, this theory would strengthen the interconnections among theory, evidence, and practice in pain management for Asian American cancer patients.

Background: Although a number of studies have reported different domains of cancer patients' needs for help, very little is known about gender and ethnic differences in those needs. Gender differences have been implicitly assumed in most studies, and specific ethnic groups have been focused on rather than comparing several ethnic groups., Objectives: The purpose of this pilot study was to explore cancer patients' needs for help among four major ethnic groups in the US, to determine gender and ethnic differences in needs, and to provide direction for future studies., Design: This was a descriptive and comparative pilot study using a feminist perspective., Settings and Participants: A total of 110 self-identified cancer patients were recruited through both Internet and community settings using a convenience sampling method., Methods: The instruments included sociodemographic questions, the Cancer Needs Questionnaire-Short Form, and the Supportive Care Needs Survey. The data were analyzed using descriptive statistics and inferential statistics including the Mann-Whitney U tests and Kruskal-Wallis tests., Results: The findings indicated that there was no significant gender difference in all domains of needs for help. There were significant ethnic differences in all domains of needs except communication and sexual needs. Asians reported the lowest scores in most domains of needs for help while Hispanics reported the highest scores in most domains of needs for help., Conclusions: The findings indicated certain ethnic differences in cancer patients' needs for help and suggest further in-depth qualitative investigations on cultural beliefs and attitudes that may influence needs, with a careful examination of gender sensitivity and cultural competence of the instruments measuring cancer patients' needs for help.

Purpose/objectives: To explore gender and ethnic differences in needs for help among patients with cancer., Research Approach: Qualitative., Setting: Internet and community settings., Participants: 16 self-identified patients with cancer aged at least 18 years who could read and write English., Methodologic Approach: Using six discussion topics on needs for help, an online forum was administered for one month. Data were analyzed with thematic analysis., Main Research Variables: Need for help., Findings: 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 United States society. Women tended to report double burden and stress as patients with cancer resulting from their gender. Ethnic minorities tended to be hesitant to talk about cancer or seek help because of the stigmatized nature of cancer. Ethnic minority patients perceived cancer as a family disease that they needed to go through as a family, and they tended to mistrust healthcare providers., Conclusions: The overriding theme was a marginalized experience for ethnic minority patients with cancer., Interpretation: Researchers should include cultural needs as a separate category of needs and consider contextual factors influencing the needs of patients with cancer in their daily lives.

Aim: The aim of the study was to explore the menopausal symptom experience of White midlife women., Background: Recent cross-cultural investigations have indicated important ethnic differences in menopausal symptoms and have challenged the universality of these symptoms. Currently available cultural knowledge on menopausal experience, however, is inadequate to guide appropriate and adequate care even for White women in the menopausal transition., Method: A cross-sectional qualitative online forum study was conducted in 2007 with 23 midlife women who self-identified as non-Hispanic Whites using convenience sampling. Seven topics related to menopausal symptom experience were used to guide the online forum for 6 months. The data were analysed using thematic analysis., Results: The experiences of menopause caused women to redefine themselves within their busy daily life schedules. They were optimistic about their symptoms, and tried to laugh at the experience to boost their inner strength and motivate themselves to persevere. Many thought that both generational and life-style differences were much more important than ethnic differences in menopausal symptom experiences. In seeking assistance with the symptoms of menopause, women were not satisfied with the guidance of their physicians., Conclusion: Nurses need to listen carefully to what women themselves say about their own experiences with menopausal symptoms and avoid imposing predetermined symptom management strategies. Further studies of women's perceptions of life-style influences are needed to guide symptom management. In addition, studies of generational changes in menopausal symptom experience are needed.

Recent studies have indicated that Internet Cancer Support Groups (ICSGs) tend to serve highly educated, high-income Whites at an early stage of cancer. Why do very few ethnic minority cancer patients, especially ethnic minority women, participate in ICSGs? In this article, the possible answers to this question are explored through a literature review from a feminist perspective. The potential reasons identified through the review include (a) gender and ethnic differences in attitudes toward ICSGs, (b) gender and ethnic differences in need for help, and (c) gender- and ethnic-specific contexts. Based on the discussion, implications for future research are proposed.

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. About 317 general and 233 ethnic-specific Internet Cancer Support Groups and 1588 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.

Purpose/objectives: To explore patients' attitudes toward Internet cancer support groups (ICSGs) through an online forum., Research Approach: Qualitative study using a feminist perspective., Setting: Internet and real settings., Participants: 16 patients with cancer., Methodologic Approach: An online forum was held for one month with six discussion topics. The data were analyzed using thematic analysis., Main Research Variables: Attitudes toward ICSGs., Findings: Through the data-analysis process, four themes were found related to patients' attitudes toward ICSGs. First, the participants universalized patients' needs for and attitudes toward ICSGs. Second, most of the participants wanted to use ICSGs for emotional support, information, and interactions. Third, many of the participants used ICSGs because they could reach out to other patients with cancer without traveling and without interrupting their busy schedules. Finally, many participants were concerned about the security of interactions on ICSGs, so they wanted ICSGs that could ensure privacy and safeguard the anonymity and confidentiality of what they shared online., Conclusions: Patients view ICSGs positively. Additional studies should examine gender-specific and multilanguage ICSGs by recruiting more ethnic minority patients., Interpretation: Despite concerns about the security of Internet interactions, ICSGs would be an excellent source of social support that is acceptable to patients with cancer.

Our purpose in this article is to review theories critically that have been used to explain immigrant women's health based on 4 case studies of Korean immigrant women's experiences in the United States and suggest directions for future development of theories on immigrant women's health. First, 3 existing theories on immigration and health (selective migration, negative effect of immigration, and acculturation) are concisely described. Then, the daily experiences of 4 low-income Korean immigrant women are described in a narrative mode, and the 3 existing theories are critiqued in terms of how they can explain the women's narratives. Finally, implications for future theory development on immigrant women's health experience are proposed based on the discussion.

Infant feeding decisions depend on knowledge and attitudes toward breastfeeding. The purpose of this study was to explore Korean university students' knowledge and attitudes toward breastfeeding by gender and major. This was a cross-sectional comparative study among 341 university students. The instrument was a modified self-administered breastfeeding knowledge and attitudes questionnaire. Female students were slightly more knowledgeable and had somewhat more positive attitudes compared to male students. Students in health-related fields showed more knowledge than students in other disciplines, but their attitudes did not differ in majority. A significant correlation was found between the students' knowledge and their attitudes.

The purpose of this Internet study was to describe menopausal symptoms, perceived causes of the symptoms, and management strategies for the symptoms among five ethnic groups of Asian American women. Sixty-two university faculty and/or staff members aged 40 to 60 years who self-reported as Asian Americans and could read and write English were recruited through the Internet. An Internet survey was conducted, and the data were analyzed using descriptive statistics. The most prevalent symptoms were "worrying about body," "aches in back of neck and skull," and "weight gain." Most of the women perceived "aging" as the main cause of their symptoms and chose not to manage their symptoms. The findings strongly suggest that women's own explanation of their symptoms is frequently different from that of health care providers.

In this study attitudes toward physical activity of three groups of Korean women were explored using a feminist qualitative research design. Seventeen healthy Korean women, 11 Korean women at risk of muscular atrophy, and 16 Korean immigrant women were recruited using a purposive sampling method. In-depth interviews using an interview guide were audiotaped and transcribed. Data were analyzed using thematic analysis. The findings indicate that the women viewed physical activity holistically, that death was viewed as the opposite of physical activity, that exercise was differentiated from physical activity, that exercise was connected to health, and that the women rarely participated in exercise because of their busy lives. The findings confirm the importance of considering the psychosocial contexts of attitudes toward health behavior., (Copyright 2003 Wiley Periodicals, Inc.)

The purpose of the study was to explore women's own needs for and attitudes toward physical activity among Korean immigrant women in the US using feminist approach and transition theory. This was a cross-sectional study consisting of quantitative and qualitative phases. Using convenience sampling methods, 54 Korean immigrant women were recruited for the quantitative phase, and 15 women among them were recruited for the qualitative phase. Questionnaires and semi-structured interviews were used to collect data. The data were analyzed using descriptive and inferential statistics and thematic analysis. The findings indicated that the women's needs for and attitudes toward physical activity were influenced by the contexts of their culture and immigration, and deeply associated with the women's daily experiences. Some implications for future research and nursing practice are proposed based on the findings.

Purpose: To extend the previous model of transitions by including the experiences of low-income Korean immigrant women in the United States during their menopausal transition. The extension results in a situation-specific theory of Korean immigrant women's menopausal transition., Design: Findings from a study of menopausal transition among Korean immigrant women were used as a main source for modification of the conceptual properties of transitions, conditions shaping the transitions, and indicators of healthy transitions. The study was cross-sectional with methodologic triangulation. Quantitative analysis was based on data from 119 first-generation Korean immigrant women who engaged in low-status or low-income work outside their homes; qualitative study using theoretical sampling method included 21 women., Methods: Analyses included descriptive and inferential statistics and thematic analysis. Integrative conceptual analysis using deductive and inductive reasoning was conducted to determine modifications in theory based on the descriptions of menopausal transition of Korean immigrant women., Findings: Three main themes were identified: (a) the women gave their menopausal transition far less attention than they did to their immigrant and work transition; (b) menopause was a hidden experience in cultural background; and (c) the women "normalized," ignored, and endured symptoms. The findings indicated additions of the following concepts: (a) number, seriousness, and priority of transitions; (b) socioeconomic status; (c) gender; (d) context; (e) attitudes toward health and illness; (f) interrelationships among all conditions shaping transitions; and (g) symptom management., Conclusions: The proposed situation-specific model is limited in scope. However, it provides understanding of the menopausal transition of Korean immigrant women in context, and is a guide for nursing interventions for immigrant women experiencing transition.

The menopausal transition needs to be understood in terms of the multiple mediating factors within the context in which women experience it. For immigrant women especially, the menopausal experience is complicated by multiple transitions and social marginality, so it cannot be adequately explained without considering this complexity. In this paper we review the literature on the menopausal transition of a group of vulnerable immigrant women in two ways: describing the transitions themselves (menopause, immigration, and housewife to employee), and describing factors that mediate the menopausal transition experience (family norms, meaning of menopause and women's work, and health practices). We emphasize the context and suggest areas of needed research.