The subjective burden that occurs in family caregivers of patients diagnosed with chronic obstructive pulmonary disease (COPD) may be related to specific caregiver attributes. In a sample of 138 family caregivers of 138 patients diagnosed with COPD, Black caregivers experienced less burden than did their White counterparts, and caregivers younger than 55 years of age experienced more burden than did older caregivers. Similar levels of burden occurred in male versus female and spouse versus nonspouse caregivers. In addition, the subjective burden did not differ by caregiver education, perceived financial adequacy, or employment status. Clinicians cognizant of the relationship between contextual factors, such as caregiver age and caregiver burden, are better prepared to provide appropriate care that may optimize family caregiver and, indirectly, chronic care patients' outcomes.Improved technology has increased life expectancy and led to a greater prevalence of chronic illnesses, particularly during later life

This pilot study used a quasi-experimental pretest-posttest design to examine if participation in a chronic disease self-management program (CDSMP) improved self-efficacy, self-efficacy health, and self-management behaviors in an underserved, poor, rural population. The sample, recruited from two clinics in a south central state, consisted of 48 adults (59.70 +/- 11.22 years) and was 79.2% Caucasian (n = 38) and 20.8% (n = 10) African American. Trained lay leaders with chronic illnesses directed the interactive CDSMP based on Bandura's self-efficacy theory that included strategies for personal exercise program development, cognitive symptom management, problem solving, and communication skills. Program-specific paper-and-pencil instruments were completed prior to and immediately after completion of the 6-week program. Significant improvements (p<.10) in self-efficacy, self-efficacy health, and self-management behaviors occurred. Results underscore the need to evaluate intervention programs for specific populations and for a new paradigm that focuses on patient-provider partnerships that can improve health outcomes in underserved, poor, rural populations.

Intervention studies with urban adolescents and families affected by asthma are critical to improving the disproportionate morbidity in this population. Community-based recruitment and retention strategies in a multi-site longitudinal project evaluating an asthma self-management intervention for adolescents are presented. Successful recruitment strategies depended on the geographic and cultural characteristics of each study site. Partnering with providers and groups known to the target population and in-person contact with target population were found effective. Flexibility accommodating modified and new approaches, securing multiple contacts and repeating mailings as well as capitalizing on the benefits of subject payment was critical to achieving long-term subject engagement of 85% in the study. Ongoing monitoring and adjustment of recruitment and retention strategies is recommended.

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Although transplantation dramatically improves QoL, some segments of the patient population, namely African-Americans and women, do not benefit to the same extent as others. Nurses need to recognize sociocultural differences in patients and how these differences affect care requirements.