ETAC Multi-site Qualitative
Evaluation Plan Update
Andrés Maiorana and Sophia
Zamudio-Haas
Our presentation today
• Overview of qualitative evaluation
• Concepts about Latino/a identity and minority
status that will inform the evaluation
• Dialogue and critical thinking about concepts
that will shape the interventions
Objectives
• To describe the interventions and the barriers and
facilitators that affect their implementation
• To identify best practices regarding community
engagement, testing, linkage, and retention in care
• To better understand the experiences of patients
related to testing, linkage, and engagement in care
• To assess perspectives of interventionists on core
components tailored for the appropriate
transnational population
Timeline
Phase 1
Phase 2
Phase 3
Secondary Data
Key informant
interviews with staff
implementing the
interventions
Client/Patient interviews
Year 1
Years 2 and 4
Year 3
Domains to explore
• Experiences participating in the interventions,
barriers and facilitators to engagement in care
• Perceptions related to living with HIV, being
in HIV care, ongoing service needs
• Health seeking experiences (beliefs, behaviors
and structural barriers)
• Self-identity in relationship to health care:
ethnicity, gender, sexual orientation, minority
status and level of acculturation)
Transnational Framework
• Transnationalism is a conceptual theory
that explains and describes the cross-border
interconnections between people, groups
and businesses
How are the interventions grounded in self-identity,
ethnicity, and understanding of minority status for
persons of Mexican and Puerto Rican origin?
Cultural elements guiding
engagement-in-care interventions
• How do the interventions connect with persons of
Mexican and Puerto Rican origin newly diagnosed
or out of care?
• How are cultural elements operationalized to
make the interventions culturally competent?
• What cultural factors are most effective to make
the interventions relevant and effective?
Cultural elements guiding
engagement in care interventions
• Content is culturally bound
• Core values, beliefs, norms and lifestyles
• Form of delivery of intervention
– Ex. Promotore/as
• Characteristics of the interventionists
Identity
• Self-identity is the organized structure of
cognitions or thoughts that we have about
ourselves, including perceptions of our social
identities and personal qualities, and
generalizations about the self based on
experience.
• Identity is the meanings attached to the self
by one's self and others
Michener, H. Andrew, John D. DeLamater, and Daniel J. Myers. 2004.
Social Psychology. 5th ed. Belmont, CA: Wadsworth/Thompson Learning
Self-Identity
• A set of beliefs and perceptions about oneself
• Multiple layers:
– Personal identity (Not fixed and stable but mutable
and plural)
– Ethnicity
– Social identity (perceived by others)
– Identity, community and ethnic boundaries
Ethnicity
“Aspects of relationships between groups
which consider themselves, and are regarded
by others, as culturally distinct.”
Hylland Eriksen, T. “Ethnicity and Nationalism: Anthropological Perspectives”. Pluto
Press, 2002.
Latino Ethnicity
• Defined by a shared or common identity from Spanishspeaking countries of North, Central and South America,
and the Caribbean
• Shared identity expressed through a sense of belonging
and place
• Solidarity and reciprocity ties in social relationships
• Common history
• Spanish as the native language of origin
Concept of Latinidad
The concept of Latinidad is mainly defined in the context of
Latinos in the U.S. being a minority sharing historical,
political, and cultural processes, united by race and language,
and facing particular challenges such as stigma, racism, and
immigration-related issues.
Miguel, Guadalupe San. "Embracing Latinidad: Beyond Nationalism in the History of
Education." Journal of Latinos & Education 10.1 (2011): 3-22.
Price, P. L. "Cohering Culture on Calle Ocho: The Pause and Flow of Latinidad."
Globalizations 4.1 (2007): 81-99
Concept of Latinidad in U.S.
“As Latinos living in the U.S., we have a truly multicultural experience.
In this nation, through good fortune and necessity, the lines along country
of origin that normally distinguish one Latino from the other are softened
even as our common heritage is highlighted. While we still form strong
organizations based on our home country, we also form very powerful
and strategic alliances as well as deep personal relationships with a
diverse group of Latin American peers.”
“Como latinos radicados en Estados Unidos, nos desenvolvemos en un
ambiente multicultural. En este país, por fortuna y necesidad, las líneas
nacionales que nos pueden distinguir el uno del otro se hacen más suaves
a la vez que nuestra herencia común se destaca. Eso nos lleva a construir
fuertes lazos profesionales y sentimentales con personas de diversos países
latinoamericanos”
-NEXXOS, American Airlines Magazine, May, 2014
Balancing Intersecting Identities
Minority
Status
Intersecting or Overlapping
Identities
•
•
•
•
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Mexican Americans
Nuyoricans
Puerto Ricans of African descent
Indigenous migrants from Mexico
LGBT
A Queer Latinidad
• View into the life experiences of gay, bisexual, transsexual,
and queer Latino/as at the confluence of race, ethnicity, and
gender and sexual orientation.
• Localized in a time-space framework, in which the identities,
history and desire of Latino/a LGBTQ are expressed
through political, social , cultural and linguistic interactions,
including activism and HIV prevention.
Foster, D. W. El Ambiente Nuestro, Bilingual Press, Tempe, Arizona, 2006. Rodriguez, J.
M. Queer Latinidad: Identity Practices, Discursive Spaces, 2003.Lima, L., Picano, F. (ed.)
Ambientes, New Queer Latino Writing, Univ. of Wisconsin Press, 2011.
Factors that shape the experience
of first generation Latino/as
• Personal characteristics (ex.SES, agency, and
ideology)
• Reasons for living in the continental U.S.
• Language
• Length in the US
• Sending community/place of origin (urban/rural)
• Receiving community in the U.S
– Neighborhood and social and gender networks of
support
– Political climate
Language
Unifying
Element
Marker of
Culture
Spanish
Language
Protective
Factor
Marker of
Identity
Spanish Language and
Latino/as in the U.S
• Communicate in native language
• Underline a representation of the world
• Protect an identity against the acculturating and
homogenizing effects of English
Foster, D. W. El Ambiente Nuestro, Bilingual Press, Tempe, Arizona, 2006.
Language
• Ability to communicate in English reflects levels
of acculturation and easiness of functioning in
mainstream U.S. society.
• Interplay and switching between English and
Spanish an expression of two different worlds
with which they are familiar.
• Spanish used to express a nostalgia for real or
idealized roots.
Foster, D. W. El Ambiente Nuestro, Bilingual Press, Tempe, Arizona, 2006.
Latino Cultural “Ismos”
•
•
•
•
•
Machismo/Caballerismo
Familismo
Personalismo
Confianza (trust)
Marianismo
How much do they apply to a specific individual?
Other cultural elements
• Mistrust of the system and authority
• Passive aggressiveness
• “Si pero no”
How do the “Ismos” and other cultural
elements need to be considered as part of the
interventions to engage persons of Mexican
and Puerto Rican origin in care?
Minority Status
• Historical processes result in differential
power dynamics
• Economic, political and social inequities
• Dwellings in inner cities with social and
environmental ills
• Social and economic isolation
Signifiers of Ethnic Identity
and Markers of difference
• Socioeconomic Status
• Language
• Skin color
• An “ethnic” name
• Social, cultural and political factors
Markers of Difference
• Perceptions of the “foreign” as a
threat
• Perceptions of the “alien” as
outside the community of
“Americans”
• Stigma and discrimination
Markers of Difference
“My mind does not have an accent,
my speech does”
Maiorana, A.; Rebchook, G.; Curotto, A.; Galindo, G.; Susan Kegeles, S. “Adaptation
of the Mpowerment Project to YoungLatino MSM.” www.mpowerment.org
Common Structural Barriers
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•
•
•
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Lack of financial resources
Limited job opportunities
Access to health services
Legal status
Lack of insurance
How does the interplay of barriers and cultural
elements impact health care utilization and
health seeking behaviors?
Concept of Citizenship/
Concepto de Ciudadanía
• Vastly used in Latin America
• Framework of social justice
• Achievement of equal political, economic, social,
cultural, sexual rights
• Access to health services as a basic right
• Full participation in a democratic and plural
society
Dagnino, E. “Citizenship in Latin America: An Introduction.” Latin American
Perspectives 2003 30: 211
Concept of Citizenship
Legal Status
Full rights and
participation
in civic
society
Sense of
belonging
Cáceres, Frasca, Pecheny, Terto. Ciudadanía sexual en América Latina: abriendo el
debate. Lima” Perú. 2004.
To be continued
• Health seeking behaviors
• Acculturation processes
• Stigma