The Social Contract Theory Of Hobbes, Locke, and Rousseau Essay

The Social Contract Theory Of Hobbes, Locke, and Rousseau - Essay Example It however states that exercising additional rights will entail bearing additional responsibilities while exercising fewer responsibilities will entail fewer rights. Authority is the power invested government or body of government officials in order to enforce laws, command, determine, judge or even exact obedience. On the other hand, legitimacy is the popular acceptance of an authority by a system of governance. Political legitimacy is considered as the main reason for governing. When excising authority a decision made by an individual who has a high rank in the political arena or social sphere, it is expected that people will abide by it irrespective of whether the decision was understood by the society members. For example, a priest has a religious authority over the congregation. Social contract is an agreement done among members of a certain organized society or a government and the governed whereby the government defines and limits the rights and duties of each member of the government. For example in our country, there is a social contract between the governed and the government whereby the governed contribute some money to a government institution in exchange for treatment of a disease or accident. Hobbes believed that the state existed in order to serve the will of the people who can choose to give power to or with hold political power. In this scenario, parties to the contract are the government and the people. Locke contradicted the ideas of Hobbes by arguing that the state was formed as a result social contract because in the state of nature, each individual judged themselves and there was no protection against those living outside the law of nature thereby suggesting that the state be guided by natural law. Rousseau states that civil society has not done anything in order to enforce the equality and individual liberty that was promised to mankind thereby suggesting that the only

Lifespan Development Essay Example | Topics and Well Written Essays - 2000 words

Lifespan Development - Essay Example Leonie Sugarman (1986) adopts the term life-span development as she tackles life-span development psychology, contributing to the field of the life-span process. Prior to the onset of the fields of social sciences, particularly psychology and sociology, understanding the development of the life course was not a popular undertaking. Now that lifespan theorists have explained systematically that a person goes through an organized process of lifespan development, studies began emphasizing its importance. Perhaps, this importance is geared towards understanding the process of change and development that occur within the course of life, alongside understanding the whys and hows of this development. A common problem with the social sciences is the idea that since they deal with aspects of human life, they tackle what is supposed to be the obvious and the already known, and their tasks are simply an elaboration of these. They use different ways on how to present the stages of growth and decline, which is but a mere rehash of the obvious facts of life. This assertion may sound true, but upon studying the lifespan development concept, it will link us to the greater truth that alters our perception of the life course. The central thinking to this assertion is that through the lifespan studies, man's thinking is influenced by lifespan development, reflecting on his own life after looking at the lives of others and being knowledgeable of the processes that he or she goes through in his or her own life course. Lifespan development models were able to develop knowledge and ideas on different ages, gender, levels of ability, race, ethnic and cultural background. In understanding the imp act of human growth and development, it is necessary that one looks at his own life course development and appreciate the importance of the key events that shape him/her as a person. Critical Assessment of Life-Span Development Models A common problem in the social sciences is the idea that since they deal with aspects of human life they deal with what in a sense is 'already' known and that as a result they are simply the elaboration of the obvious. They may use fancy words and difficult concepts but basically, everyone knows that every individual is born, then develops in a variety of ways and then experiences a period of gradual but inevitable decline. There is some truth in this assertion but truth also in the opposite view that studying life span development does actually alter our perception of how humans and thus, our individual selves develop. The central argument then is that although it is difficult if not impossible to measure the precise extent to which our thinking may have been influenced by LSD studies it is not unreasonable to suggest that it has. In addition, it is suggested that the main way in which this influence works is by individuals reflecting on their own lives after looking at the lives o f others. Due to the onset of life-span development models, a significant importance is now given to the concept of self-esteem, needs, achievement, growth, change, development, and the like, which play a significant role in the life course. It must be noted however, that unlike Freudianism, whose emphasis is only on the issues of 'growth' period associated to childhood and

Thinking Critically Simulation Review Essay Example for Free

Thinking Critically Simulation Review Essay Through the thinking critically simulation, I was able to exercise my own problem solving techniques. In the simulation, real-life business scenarios were given as examples to be resolved. It was divided into three parts: (1) Framing the problem, (2) Making the decisions, and (3) Evaluation the decision. Each phase has its own sublevels which specifically advise the decision makers on what tasks to do in order to effectively address the problem. In the first phase, I was given several possible problems and I was asked to rank them based on urgency and criticality. The detailed background information about the company helped me in analyzing the situation. However, in the end I resorted to my own techniques in coming up with the best way to rank the problems. It was easier for me to select the problem that when solve can immediately help increase the sales of the electronics store. It was just a manner of choosing the problem that would caused a major impact on the store if it is not straight away confronted. Based on the results, my efforts received a B+ grade which meant that I fairly did well in that activity. Â  Meanwhile, for the second phase, I was asked to match the best solutions for the immediate concerns of the company. It was mentioned that formulating solutions includes identifying the problem, planning alternatives and evaluating the alternatives. I followed these steps but unfortunately I was not able to get a good assessment based on the solutions that I have selected for the given problems. Probably, it would have helped if I paid more attention to details and weighed the consequences of each probable solution. I think the practicality and convenience of the solutions should also be considered in order to optimize the resources of the company without the risk of decreasing sales or losing employees. More so, I have realized that in most problems, single or the so-called best solutions are hard to find. It is easier to draft several solutions and try to implement all of them which could help in addressing all the aspects of the identified problems. In the third phase of the simulation, I was asked to evaluate the given solutions through metrics which will measure the efficiency of each resolution. It is very important that before a decision is made; all sides of the situation or the problem should have been carefully analyzed. In the end, the decision maker should always keep in mind that in making decisions, every detail no matter how small should be considered. Also, there are obvious problems and solutions that may seem as the only appropriate options for a particular situation. But a decision maker must be critical with this so as not to waste time and effort on fallacies that poses only as problems and solutions but in reality, these are just the actual scenarios.

Crytosporidia :: Essays Papers

Crytosporidia Life History: Once thought to be rare and host specific, Cryptosporidia is now believed to be one of the top three diarrheal causing pathogens in the world. Cryptosporidia muris was recognized in 1907 by E. E. Tyzer. Since then twenty (20) species of Cryptosporidium have been discovered and named although recently sixteen (16) of those twenty (20) have come under speculation due to recent cross-transmission studies. Cryptosporidia is a protozoan parasite which lives in the intestines and respiratory epitheliums of many types of animals including mammals, birds and reptiles. The disease caused by Cryptosporidia is known as Cryptosporidiosis. Cryptosporidia is found all over the world and is transmitted via fecal oral contact. Usually this is due to water contaminated by animal feces. Infected calves excrete up to 10 billion Cryptosporidium oocysts (infectious stage) per day. The infectious dose in humans is only 10-100. However, contaminated food or direct contact with feces can also cause infectio n. Microbial Characteristics: Cryptosporidia are small coccidian spore-forming protazoans. When in oocyst form they are 4-6 um in size. GRAPH Disease: Cryptosporidia are encountered and transmitted through fecal oral transmission. Once a host ingests an oocyst, sporozoites are released. The sporozoite then can enter the epithelial cells in the small intestine where it will develop into a trophozoite. Inside of a trophozoite, merozoites begin to form. When released, a merozoite can either infect another epithelial cell or it can evolve into a sexual gamete. These gametes then join to form an oocyst and will be excreted in the feces. While in the host’s body, Cryptosporidia carries out its entire life cycle in the microvilli of the small intestine. The most common symptom of Cryptosporidiosis is watery diarrhea. Other symptoms include: - Dehydration - Weight loss - Stomach cramps or pain - Fever - Nausea - Vomiting Some people with Cryptosporidiosis will have no symptoms at all. While the small intestine is the site most commonly affected, Cryptosporidium infections could possibly affect other areas of the digestive or the respiratory tract. (CDC) Symptoms usually begin 2-10 days after becoming infected and last 1-2 weeks on average. In immunocompetent individuals, Cryptosporidiosis is not life threatening.

Women as Sexsual Object

Sexism – Women as Sexual Objects Since the beginning of time, women have always been described by men as having sexual appeal. However, most of the descriptions held a negative stigma in them. In Korea’s fairytale, there exists a mythical gumiho, a nine-tailed fox who could transform into a beautiful woman so that they can seduce unsuspecting men and eat their livers. What does this tells us? Men, beware! There are beautiful women out there who are out to trick you so that she can eat your liver. This reeks of sexism where women are held in negative assumptions.Media further reinforces this view by broadcasting shows, programs or video games that exploit women’s sexual appeal. In the past, women are blamed if they could allure other women’s men; they are said to be wicked and bad (or to used the common word, a whore). If they are raped, it will always be the women’s fault; they wore revealing clothes, they were seducing him, etc. The men were never blamed, at least not directly. They are absolved of any responsibilities towards the women, even if the women that they had raped became pregnant and were the subject of ridicule among other people.Even when the men are punished for their crimes, the women will always bear a stigma; they are considered to be dirty and have lower status than a slave. I watch a lot of Korean dramas. They usually are centered on the theme of love. There usually will be two types of woman characters in the story. First and foremost is the heroine. She can be a successful woman in her career, or a naive school girl, or a woman who is facing some difficulties in her life; they will always be identifiable because they are the good girl who are kind to others or are sympathetic to other’s plight.They will always get the heroes. Then, there are the other women on the other side of spectrum. They are usually the bad girl, the one who wanted to steal the heroes. They are the scheming temptresses, are tw o-faced and are out to get the heroine. However, in the end, justice will prevail and the bad girls will get what’s coming to her. This is a type of negative stereotyping. Either the girl is kind and innocent, or the girl is a wily seductress. The girl’s sexuality is viewed as a bad thing; her weapons in tricking mankind. Woman’s sexuality is further exploited in video games.A 1998 study found that a significant amount of games portrayed women as sex objects (Dietz). There have been a lot of Japanese adult video games published recently where the goal of the games is for the player to break the wills of the women characters and seduce them until they become his faithful sex slave. An example of this game is Gibo : Stepmother’s Sins. In this game, the player’s father had just gotten married and his new wife and her daughter had moved into the player’s house. The player had a grudge against his real mother because he had walk upon his mother w hile she was cheating on his father.He transferred his hatred towards his new mother,Misaki and tried very hard to seduce her in order to prove his point that all women are depraved and couldn’t contain their sexual wanton feelings to themselves. In the course of proving his point, he groped Misaki on the crowded public train and let everyone else see her stepmother being covered in his semen (after he covered his own pant, of course). He also installed small hidden camera in the bath room so that he can take a peek of Misaki and her daughter, Shiina showering and using the toilet at a later time.He repeatedly tried to bend Misaki’s will to match to his wants and punished her psychologically when she refused. For example, Misaki wanted them to feel like a real family and asked him to call her mom. He then slyly agreed to follow her request in exchange for a kiss on the lips. When she initially refused, he cajoled her into agreeing to his terms. This happens repeatedly throughout the game, even when she repeatedly says no, until her will is broken and she became his sex slave. This game cleverly avoided using physical violence to break the women characters; instead the player had to use psychological persuasions to get what he wants.Never the less, this game still degrades women and their sexuality. Then, there are video games where the player downright raped women to break their wills. RapeLay is one of these games. In this game, the player initially attempt to grope a girl named Aoi, but was arrested when she reported it. His parents bribed his way out though, and he planned to take revenge against Aoi for busting him by raping her as well as her mother and sister. The girls will be groped until they are aroused against their will, and then they are raped. Once a girl’s will is broken, you can count on her to help you molest her relatives.If she is pregnant, which happened when you choose to ejaculate inside her while having vaginal sex, you will have to force her to abort the baby if you want to live through the game. However, the girl will commit suicide after this by taking a poison pill. You are free to rape these women as long as the game doesn’t end. Though the sex themselves are non-consensual, there was never any violence nor torture while the player is raping the women. Usually, the women will give in after a while, and they even enjoyed the sex (supposedly).As you can see, this does not bode well with women. Are we supposed to assume that a woman will enjoyed the sex while she is being raped by a stranger, even though she initially resists his intention? If this is taken as a fact, then the ‘psycho’ will took this as a legitimate reason to rape women against their will because according to the video games, the women may resists it at first but they will enjoy it after a while. This misperception is dangerous for women. If the men believed this, then women are prone to be subjected to ph ysical and emotional abuse in their relationships.A research by Apt and Hurlbert (1993) noted that women who experienced sexual abuse in their relationships expressed higher levels of sexual dissatisfaction and has negative attitudes toward sex. They also will have a tendency to avoid sex altogether compared to women who did not suffer any abuse whatsoever. This reality is a far cry from the games’ depiction that women enjoyed being raped. Even more disturbing is the possibility that women who experienced sexual violence may blame themselves for the experiences (Bennice et al. , 2003).Furthermore, in one research, college students rated female characters in video games to be more sexually provocative than the male characters (Ogletree & Drake, 2007), which shows that these students have a negative perception towards women’s sexuality. Video games that feature women as a tough chick with guns have become popular during recent years. Lara Croft is one of them. This game features Lara Croft, the protagonist, who travels around the world in the mission of searching for rare and mystical artifacts. Lara is the ultimate sex symbol.She’s sexy, she’s brainy, she’s athletic, and she kicks and kills people, literally (or at least, she does in the video game). She is a powerful woman who can fight to protect herself. This is what Toby Gard, the creator of Lara Croft, intends for Lara to be; she is sexy because she is powerful. However, other people attributed her status as a sex symbol mainly because of her physical appearance, or to be exact, her body. Play Station Magazine even listed big breast as one of her famous physical attributes. It also help that the game is in 3D mode, which makes Lara body appears realistic, even when it is not.Lara’s body in reality is an image product of a man’s fantasy. When the game is adapted to real life film, Angelina Jolie, who played her had to wear padding on her breast to add the big breast effect to Lara’s character (Lara Croft has 36D cup size while Jolie’s is 36C). She also has to gain some weight to portray Lara’s curvaceous body. Angelina Jolie has stated that personally, she is comfortable with her own body and wouldn’t want breast as big as Lara’s. However, many players, especially men, appeared to be happy with Lara’s body.They performed in-game actions to view closer camera angles of her breast, and some fans also created cheat code that would make Lara removed her clothing. Some fans also created artworks called the Nude Raider, which featured images of Lara in the nude. It has become a trend nowadays to produce movies that featured women as a tough chick who are involved in violent fights. Example of one is Kill Bill, produced by Quentin Tarantino. It tells the story of the Bride, a ninja assassin, who is on a mission to kill all of her former assassin colleagues who took part in the massacre on her wedding d ay.She was shot in the head by Bill, her former boss and lover during her wedding day. The movie justify the Bride’s actions by acknowledging that she deserved her vengeance after being wronged by her boss and his entire assassin squad. The film was filled with action and violence all the way. The Bride went on a killing spree mission, assassinating the people on her kill list, and the sight was not pleasant. There are a lot of bloods splashed, gory images of limbs parting ways with the body. And funnily enough, almost all of the assassin squad is women. The only exception was Budd, Bill’s brother.This film glorifies women as killing machines. They are the absolute femme fatale whose looks can kill (literally). The heroine herself is a powerful woman, which in turn make her hot. Women embrace this perception of female aggressive sexuality. I myself, on occasion, dreamed of being a lethal woman, who can fight her way out of trouble. It is appealing to think of myself th at way, because to me a femme fatale is both hot and sexy. I think the reason we find an aggressive women sexy is because we can protect ourselves from threats, and the notion of being able to fight is opposite to the traditional view of women’s femininity.Women has always been viewed as weak and relying on the strength of a man to protect them from harm, and the idea that we could defy that and be able to fight a man on our own are very appealing. The women are empowered by strength and the ability to handles weapons; it’s not hard to see why women are attracted to this view. Among other things, women are also affected by the ideal body portrayed in video games. In video games, the women character is busty and curvy while being thin at the same time. Of course, this is not realistically possible.It has been confirmed that young women usually compare themselves with the models they see in advertisement (Richins, 1991). And they don’t like what they see in themse lves. However, women are still obsessed with achieving what they saw as the perfect body and go on extensive diet to acquire it. In the course they neglect to take proper care of their body. And when they still couldn’t achieve it, they are depressed and ashamed because they think they are fat, and their self confidences plummet down the drain. Men who played video games also have unrealistic perceptions toward women’s body.In video games, women characters are usually shown as having small breast, thin body and small hips. There has been several researches which show that there is a positive correlation between large breast and attractiveness (Furnham, Hester ,& Weir, 1990; Kelinke & Staneski, 1980). In one study, Amy Rask surveyed the male student on which type of women’s body they think are realistic. The majority of them choose the drawing that showed a skinny woman with a large breast. This means that the male players are affected by the video games because the games altered their perceptions on realistically well-proportioned women’s body.In my Best Plan Paper, I used Utilitarian Theory to guide me in making decision that will affect people I never met. In this particular topic, I would take actions that will benefits everyone in the longer run. I think it would serve the society greater benefits if game makers start to portray the characters especially their physical appearance as realistically as possible. This way, the player will not be misinformed and have unrealistic expectations towards their own or other’s body. Violence against women should also be discouraged especially in video games and media. There should also be stricter rating system on violence.This way parents can avoid bringing their kids to the film that contains extensive violence. The available rating system on violence is too loose. For example, Kill Bill, which is a very violent film depicting gory killing scene, is granted PG-13 when it should onl y be viewed by teenage aged 18 and above only. The society should also be educated in the effect of violence and abuse on women, and if the media need to portray the violence on screen, they should be as minimal as possible and served as a reminder to educate the people on the effect this abuse will have on society’s harmony in general.Works Cited Rask, Amy. â€Å"Video Game Vixens: Shaping Men’s Perceptions of Beauty? † Paper presented at the annual meeting of the International Communication Association, TBA, San Francisco, CA, May 23, 2007 . http://www. allacademic. com/meta/p171095_index. html 5 March 2011 Rayhill, Ryan (August 2007). â€Å"Tomb Raider: Anniversary†. PlayStation Magazine (Future Publishing) (126): 82. Miller, Prairie. Angelina Jolie on Filling Lara Croft’s Shoes and D-Size Cups. NY Rock. June 2001 Web. http://www. nyrock. com/interviews/2001/jolie_int. sp 5 March 2011 Rapelay. Giant Bomb. Web. http://www. giantbomb. com/rapelay/ 61-16696/ 5 March 2011 Geddes, Dan. Kill Bill Vol. 1 (2003). The Satirist. 19 January 2004. Web. http://www. thesatirist. com/films/Killbill. html 5 March 2011 Offmann, Alia & Matherson, Kimberly. Healthy Place. The Sexual Self-Perceptions of Young Women Experiencing Abuse in Dating Relationships. 1 November 2004 Web. http://www. healthyplace. com/sex/abuse/the-sexual-self-perceptions-of-young-women-experiencing-abuse-in-dating-relationships/menu-id-66/ 5 March 2011

Emcee - 1734 Words

To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment. Ralph Waldo Emerson According to a famous philosopher, Ralph Waldo Emerson : †¢ â€Å"To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment. â€Å" There is a good reason they call these ceremonies commencement exercises. Graduation is not the end; its the beginning. A year of hard work has resulted in this moment, so join me in welcoming the candidates for graduation together with their parents, as well as the special guests and teaching staff in their processional march†¦Ã¢â‚¬ ¦.. ( candidates march with their parents and guests as well as teachers to their†¦show more content†¦Danghil Jr.- Most Behaved----------------------------------------------- Daisy Mae Wenceslao Most Polite-------------------------------------------------------- Altha May Mabini Most Energetic----------------------------------------------- Nià ±o Joseph Suson Most Neat-------------------------------------------------------- Ma. Kristine Dimple Pantoliaga Most Well-groomed--------------------------------------- Cris John D. Matbagon Most Industrious-------------------------------------------- Alpha Xhiela Maà ±ago Most Helpful-------------------------------------------------- Antonette Blosom Abata Most Creative---------------------------------------------------- Marjun Dejaà ±o Most Diligent-------------------------------------------------- Eugene Carry M. Anipan Most Obedient------------------------------------------------- Reymond C. Tubujan ⠝â€" There are also pupils who have exerted great effort in their studies, as a result, they have garnered honor for their school in the district and division level competitions and are hereby given the following special awards: GRADE II GRADE IV Waynecie Noreen R. Adolfo Jasnine Odoc - 1st place Declamation Dist. Level 5th place Sci-Dama Dist. Level - 3rd place Declamation Div. Level Jay Gaquit 3rd placeShow MoreRelatedInduction Ceremony Script Essay627 Words   |  3 PagesAir Society Induction Ceremony Script Neessen and pledges form up out of sight Emcee: Welcome to the Air Force Junior Reserve Officers Training Corps Kitty Hawk Air Society Induction Ceremony. I am Cadet (Rank and full name said) and I will be your emcee for this evening. As a courtesy for our inductees and guests we ask you to please silence your phones at this time. LONG PAUSE TO ALLOW THEM TO SILENCE CELL PHONES! Emcee: Ladies and Gentlemen, please stand, place your right hand over your heart, andRead MoreEngineering Students Farewell Party Anchoring Script1479 Words   |  6 PagesFAREWELL PARTY EMCEE SCRIPT Read online and download Farewell Party Emcee Script. Get many Ebook subject available in our online library related with Ebook Farewell Party Emcee Script PDF.... File : http://pdfebookcenter.com/file/farewell-party-emcee-script.pdf Status : Available [PDF] SAMPLE EMCEE SCRIPT FOR FAREWELL PARTY BING Read online and download Sample Emcee Script For Farewell Party Bing. Get many Ebook subject available in our online library related with Ebook Sample Emcee Script For FarewellRead MoreThe Music Of Hip Hop Essay1420 Words   |  6 Pagesflow of an emcee rocked the crowd with his/her rhythmic flow, a significant day in music history would soon influence the music industry, cultures, fashion, and make this new genre into a global phenomenon. 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By coming out with this song, â€Å"Fuck an Emcee Name,† Watsky is advancing from his typical focus on the commentary people are facing, and instead acknowledging the past from which hip-hop emerged from, all the while commenting on the idea that it is no longer necessarily required to have an emcee name in orderRead MoreClose to the Edge: the Representational Tactics of Eminem1567 Words   |  7 Pagesthree stages of cultural navigation. Beginning with appropriation, the author states that Eminem is able to adopt the hip-hop vernacular and formula required to establish himself as an innovative white rapper as opposed to just another discredited emcee. Dawkins compares his appropriation to that of The Beastie Boys, the first successful white hip-hop group. The author also points out the failure of Vanilla Ice, from which Eminem learned that creating a facade or false image would ultimately destroyRead MoreProject Plan285 8 Words   |  12 Pageswith a Italian sofa set and table. †¢ Advertisements and brochures for the boutique. †¢ Invitation card to invite people to the opening ceremony. †¢ A bottle of champagne and snacks in the opening ceremony. †¢ A well arranged opening ceremony with an emcee. †¢ A small cat walks for models to show the clothes during the opening ceremony. Milestones Find the venue and get the approvals of legal operation of the boutique ——May 22 Select the suppliers for the boutique —— June 1 The whole renovationsRead MoreIs Eminem Or His Ego Slim Shady?2234 Words   |  9 Pagesabout serious, often depressing issues in his life. 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Not too many rappers today have a good flow and good lyrics

Medication Adherence In African Americans - Free Essay Example

Sample details Pages: 17 Words: 5108 Downloads: 10 Date added: 2017/06/26 Category Ethics Essay Type Essay any type Tags: Africa Essay Did you like this example? 2. Methodology: Critically examine possible quantitative and qualitative approaches to examining medication adherence/compliance in African Americans and choose the à ¢Ã¢â€š ¬Ã‹Å"bestà ¢Ã¢â€š ¬Ã¢â€ž ¢ research method (support your choice). Denote the strengths and weaknesses of using multiple regression and logistic regression when analyzing data. When you have a dependent variable that can be continuous or dichotomous, choose which regression you would use and support your answer. What are the ethical implications of examining perceived injustice, coping, and relationship with health care provider in African Americans? Methodology Quantitative Approaches to Medication Adherence/Compliance in African Americans The purpose of the research study conducted by Thomas (2007) was to examine the relationship of components of self-concept (body sensation, body image, self-consistency, self-idea, and moral-ethical-spiritual self) and cognitive perceptions with adherence to prescribed recommended health regimes (low sodium diet, regular aerobic activity, and prescribed medications) in individual with heart failure (HF). This study used a descriptive correlational design was used to determine if relationships existed between predictor variables and medication regimes was a threat or challenge to self-concept and the outcome variable of adherence to prescribe health regime. Because of the some of the wording when describing the variables, clarity was problematic and re-reading was done several times to get an understanding of what the study was trying to measure. The research questions were written clearer than the description of the statistical analysis with the independent and dependent variabl es. A power analysis was conducted. The effect size of 0.13 was considered small and may not adequately measure the strength of the relationship between variables. Institutional Review Board (IRB) approval was obtained. The convenience sample was identified by clinic staff from two different heart failure clinics that screened for inclusion and exclusion criteria, 97 out of 134 subjects met the criteria. There was no mention of how the principal investigator trained the data collector to ensure consistency. No instruments were found that used Royà ¢Ã¢â€š ¬Ã¢â€ž ¢s Self-concept Mode Theory to investigate adherence in individual with HF, so a demographic questionnaire and three research instruments were developed using expert assistance. One of the instruments, the HF screening test (10 items) was not pilot tested prior to use. The cognitive perception of cardiovascular healthy lifestyles (57 items) was pilot tested and considered reliable. The adherence questionnaire (6 items) had low reliability scores. Validity indexes were high for all three instruments. Descriptive correlational and predictive correlation analysis using Pearson product moment correlation and stepwise multiple regression was appropriate statistical test to answer the research questions. Of the two research questions, one addressed relationships and the other addressed explaining variances. SPSS was used for data analysis. All data was collected during a regularly scheduled office visit by clinic staff. Verbal consent was obtained and implied consent was evidenced by completion of the questionnaires. Verbal and written instructions were given and confidentiality was explained. Subjects were given the questionnaires, pen, clipboard, and return envelope. Questionnaires were collected by the principal investigator, and kept in a locked, secure file until entered in the database. Returned questionnaires were 70 to 90 percent incomplete. No mechanism was developed to ensure that data col lection was complete, such as taking the subjects to a quiet comfortable setting, thoroughly explaining the need that all blanks be filled, and visually scanning the questionnaires after completion. It seems as if subjects completed the questionnaire in an office waiting room that may have had frequent interruptions. No incentive was offered to subjects and this may have affected their commitment to the research study. The most obvious challenges with this study included the instrumentation and collection of data. The reliability of the adherence questionnaire was low, so more testing and refinement may be needed. In addition, the procedure for data collection could have been improved to engage subjects more into the study, such as private area for testing and small incentives. Next, is a 12-week intervention study (Resnick, et al., 2009) was conducted to test the People Reducing Risk and Improving Strength through Exercise, Diet, and Drug Adherence (PRAISEDD) in a group of el derly African Americans who were low income. The sample resided in a senior housing site and were 65 years of age and older. IRB approval and inclusion and exclusion criteria was listed. Recruitment was completed in one meet-and-greet session at the housing site. The sample size was 22 out of 40 who had expressed interest in the study. The social ecological model was used to guide the study. The PRAISEDD method was designed to motivate, educate, and exercise subjects toward the outcome of improved self-efficacy and adherence to cardiovascular disease preventive measures such as exercise, diet, and medication. The first of the 12 weeks was an education class on preventive measures and goal setting, with advanced practice nurses and a pharmacist teaching the material. Weeks 2-12 were focused on a one hour exercise class three days per week with blood pressure and weights, motivational activities, health promotion education, and review of daily goal activities. These activities w ere lead by an experienced lay exercise trainer and the research nurse. Treatment fidelity was monitored to ensure PRAISEDD interventions were delivered as planned. A number of efficacy measurement tools were completed by the subjects: medication adherence self-efficacy scale (26 items), cardiac medication adherence outcome expectation scale (5 items), self-efficacy for health related diet (20 items), diet outcome expectations (1 item), self-efficacy for exercise (9 items), and outcome expectations for exercise (13 items). All instruments had established reliability and validity for older adults except the cardiac medication adherence outcome expectation scale, that was adapted from the osteoporosis scale and revised to address antihypertensives and lipid-lowering agents. Test-retest reliability and validity was established for this study. Instruments and baseline data was completed prior to the PRAISEDD intervention. This seemed to be a lot of instruments for this elderly popula tion. There was no mention of the time involved to administer the instruments nor if frequent breaks were given. Outcome behaviors included the Yale physical activity survey (questionnaire on physical activity), block brief food questionnaire (for recall of sodium and cholesterol intake), compliance questionnaire (self-report of medication taking), and blood pressure. All outcome measures except blood pressure were subjective and based on recall. Better objective outcome measures such as actigraphy (to monitor physical activity), pill counts (medication adherence), food diary (recall of food intake), and serum cholesterol and urine sodium (monitor food intake). Data was analyzed using descriptive statistics and a repeated-measures analysis of variance to detect changes from baseline to 4-month follow-up. The statistical software package was not mentioned. In summary, the study was well designed, but the outcome measures were a major weakness. Recruitment efforts should have been more aggressive than just one day. Objective outcome data would have made this a solid study. In addition, a control group may strengthened the study as well by providing comparison data. Although follow-up was provided a four months to post test the instruments, a periodic follow-up at weekly intervals may have helped to maintain the sustainability of health behavioral activities and goals. Don’t waste time! Our writers will create an original "Medication Adherence In African Americans" essay for you Create order Qualitative Approaches to Medication Adherence/Compliance in African Americans In a study conducted by Ogedegbe, Harrison, Robbins, Mancuso, and Allegrante (2004), the perceived barriers and facilitators to medication adherence in African Americans with hypertension was explored. An open-ended individual interview was used to gather data on subjects in two primary care practices during the course of a year. Purposeful sampling was used to recruit the best participants who could provide the useful information about medication adherence for this study. IRB approval and inclusion and exclusion criteria were listed. No incentives were provided and confidentiality was ensured. Subjects were identified from computerized medical records and appointment logs and approached during office visits or via telephone. Those who consented verbally were interviewed immediately, lasting about 20-45 minutes. Interviewing continued until saturation occurred. Four open-ended question guided the interview: (1) What difficulties so you have in taking your blood pressure medicati ons as prescribed by your doctor; (2) What situations make it hard for you to take your blood pressure mediations as prescribed by your doctor; (3) What situations make it easy for you to take your blood pressure medications as prescribed by your doctor; and (4) What are the skills that make it necessary for you to take your blood pressure medications as prescribed? All interviews were tape recorded and transcribed. Medical records were used to determine if blood pressure was controlled at less than 140/90 mmHg and retrieve antihypertension medications and comorbidities. Data analysis and collection occurred at the same time. Grounded theory methodology was used to analyze data whereby data of previous subjects was compared to that of new subjects. Transcripts were read over and over until recurring concepts to coding, to categories to themes to final coding to final categories. A qualitative software package, Ethnograph, was used to organize date and help with analysis. No menti on was made of moving to the theoretical level in the research study. The grounded theory approach was a good choice, considering the limited research in 2004 when this study was completed. One area of concern was the telephone interview, since the non-verbal responses were not captured. From the methodological perspective, the visualization of an emerging theory was not evident. The study seems more like phenomenology, the lived experience rather than grounded research. In another study (Lukoschek, 2003), focus groups were used to explore different beliefs held by adherent and nonadherent subjects that affect treatment. Uninsured, Medicaid-insured, and lower socioeconomic class African Americans with hypertension who attended an outpatient medical clinic in a large urban setting were invited to participate in this study. Contacts were made during visits, via telephone, or mail. IRB approval and inclusion and exclusion criteria was listed. A qualitative, comparative case de sign was used to categorized subjects as nonadherent, noncontrolled hypertensive, or as adherent, controlled hypertensive. Groups were in session for 90 minutes. All groups were audiotaped and tapes were transcribed. Sociodemographic variables were obtained and subjects received a $15 incentive for participation. Eight focus groups were obtained from 42 subjects. African American research assistants who were trained in focus group methodology served as moderators along with an assistant who took care of logistics such as refreshments, tape recording, and took field notes. The moderator began each session with a story to foster nonjudgemental atmosphere. Groups were asked eight identical, open ended questions that evolved from the health belief model. Examples of questions included: What do you think is hypertension; Why do you think some people get hypertension; Is there anything a person could do to treat hypertension; and What do you think patients about the medication that doc tors give to patients for their hypertension? SPSS was used to compute statistical analysis sociodemographic data. A comparison of the three groups was completed with chi-square for categorical data and f-test for continuous data. The principal investigator along with moderators and assistants analyzed all transcripts, independently for themes, and group discussion and agreement of categories and themes. Group work continued until themes were identified and agreed on by all and theoretical saturation occurred. The QRS NUD*IST software program was used for data analysis. The à ¢Ã¢â€š ¬Ã‹Å"Bestà ¢Ã¢â€š ¬Ã¢â€ž ¢ Research Method For the purposed research study on medication adherence issues in African American women with hypertension, a quantitative research design will serve as the best methodological approach. From the review of the literature, two qualitative studies were found on the proposed topic. According to Munhall (2007), quantitative research has its origins in qualitative research. The descriptions, interpretations, and understandings from qualitative data, if appropriate, may become the focus of a quantitative study, and unexplained grey areas of statistical data may lead back to another qualitative study. Munhall (2007)describes this process as the qualitative-quantitative cyclical continuum. A number of qualitative studies have been written on African Americans with hypertension (L. M. Lewis, Askie, Randleman, Shelton-Dunston, 2010; Lukoschek, 2003; Ogedegbe, et al., 2004; Ogedegbe, Schoenthaler, Fernandez, 2007; Peters, Aroian, Flack, 2006; Wexler, Elton, Pleister, Feldman, 2009). Al l of these studies mention antihypertension medication adherence in some form. As a result, the data has begun to repeat itself or saturate. Many of the themes are similar. In other words, we have a good idea of the problem, now it is time to determine relationships among variables and determine if certain combinations of variables predict adherence to the prescribed treatment regimen. Quantitative research will allow more sophisticated manipulation of data. When unexplained grey areas arise, we can resort back to qualitative research to gain more insight and the cyclical continuum may continue to evolve. Strengths and Weaknesses of Using Multiple Regression Multiple regression is concerned with relationships and prediction among variables. Multiple regression involves a single dependent variable (DV) and two or more independent variables (IV). The IV can be dichotomous or continuous and the DV is continuous (Huck, 2008; Tabachnick Fidell, 2007). For example, a study might want to learn, what are the best predictors of an elevated blood pressure (greater than 140/90)? The dichotomous IV can have two values such as reactance/nonreactance or coping/not coping. A continuous IV such as age, or a continuous DV such as blood pressure can have infinite measures. There are many strengths of multiple regression such as more than two IVs. These IVs can be combined to predict a value of the DV. For example, the relationship between a set of IVs such as coping, perceived racism, and trust in health care provider can be correlated with the DV blood pressure (Tabachnick Fidell, 2007). When each of the IVs are strongly correlated with the DV, th e regression is better (Polit, 1996; Tabachnick Fidell, 2007). With multiple regression, IVs can be analyzed in different units of measure by converting the IVs to z scores, thus making standardized scores for all IVs. This allows all IVs to be measured on the same scale with a mean of zero and a standard deviation of one (Polit, 1996). Multiple regression can be set up to accommodate covariates that researchers wish to control while looking at the impact of other IVs on the DV (Huck, 2008). In addition, regression modeling can be done whereby variables can be placed in or taken out of the model using methods such as simultaneous, hierarchical, or stepwise regression strategies (Polit, 1996). Another strength is the ability to ensure accurate and reliable statistical results by calculating a power analysis. The sample size is dependent on the number of IVs, the desired power, alpha level, and expected effect size(Tabachnick Fidell, 2007). In addition, when data is missing, i t can be estimated from other variables and instead of the grand mean by using computer statistical packages such as SPSS (Tabachnick Fidell, 2007). There are many weaknesses of multiple regression, one of which is assumptions. The results of multiple regression are not trustworthy when assumptions are violated, resulting in Type I or Type II error. Knowledge of assumption violations and not reporting them leads to serious bias and the validity of data is questioned and difficult to interpret (Tabachnick Fidell, 2007). Assumptions include independence, normality, linearity, and homoscedasticy. Of these assumptions, independence is robust to violation, if the violations are not too bad. Normality violations indicate skewed distributions representing increased variance in the form of outliers. Outliers are problematic, can affect the multiple regression analysis, and cause bias results, but they can also a means for further investigation to determine the reason they occurred (Huc k, 2008). Nonlinearity is problematic because the residuals are not concentrated in the center along a straight line (Polit, 1996). The homoscedasticity assumption is violated when the variance is not constant (Polit, 1996). If assumptions are violated, transformations can be done to stabilize linearity and normality (Polit, 1996). Another potential weakness is multicollinearity that occurs when two or more IVs are highly correlated to each other, and essentially measuring the same thing(Tabachnick Fidell, 2007). An example would be two predictors of high blood pressure: (1) not taking blood pressure medications and (2) not taking blood pressure medications on most days. The medication taking behavior is redundant since the blood pressure medication is rarely to never taken. In addition, if the sample size is too small, taking the time, energy, and resources to complete the research study is futile. If the sample is too large, results are vague and not useful (Tabachnick Fid ell, 2007). Also, missing data could be problematic. For example, if study participants refuse to answer sensitive demographic data such as income, which may be related to another variable such as reactance, then if the participantà ¢Ã¢â€š ¬Ã¢â€ž ¢s data is deleted, it could distort the sampleà ¢Ã¢â€š ¬Ã¢â€ž ¢s values on the reactance variable (Tabachnick Fidell, 2007). Misinterpretations of data analysis are seen as a weakness, not of the statistic, but with the researcher. With multiple regression, only relationships can be determined and there is never an underlying cause and effect mechanism (Huck, 2008). For example, there may be a strong relationship between lower income and blood pressure measurements 140/90, but we cannot conclude that lower income causes an elevated blood pressure. The most likely explanation of the correlation may be medication nonadherence related to an inability to afford the costs of medications (these variables need to be included in the study t o determine their relationship to high blood pressure). The higher the blood pressure, two or more drug categories may be needed to manage the blood pressure. Lastly, statistical data may have statistical significance but have little to no clinical significance (Huck, 2008). With an increased emphasis on evidence-based research, studies that yield practical clinical significance are held in high regard. Strengths and Weaknesses of Using Logistic regression Like multiple regression, logistic regression is also concerned prediction, trying to predict whether something will or will not happen. Logistic regression involves a single DV and one or more IVs. The DV is dichotomous, for example, a study might want to learn, whether or not a person will adhere to their blood pressure medication regime. The IVs can be categorical or continuous. A categorical IV has no numerical meaning such as gender, neighborhood, or types of comorbidities and an example of continuous IVs may be blood pressure, height, or weight. Logistic regression has several advantages, one of which includes less restrictive assumptions than multiple regression. For instance, logistic regression does not assume multivariate normality (Polit, 1996). In addition, IVs do not have to be linearly related or have equal variances within each group. Another strength, like multiple regression is that logistic regression can be done using methods such as simultaneous, hierarchical , or stepwise regression strategies (Tabachnick Fidell, 2007). In addition, the DV is calculated into the probability that an event will happen using an odds ratio, that transforms the probability of an event occurring into two probabilities, occurring or not occurring. An example is the probability of developing cardiovascular disease or the probability of adhering to hypertension medications. Overall, logistic regression is a more flexible analysis than multiple regression. Logistical regression has several disadvantages, one of which is that too few cases to the number of IVs predicts outcomes poorly. Therefore, a power analysis will needed to determine sample size. In addition, logistic regression can be costly especially when the number of IVs is large. Also, with multiple regression, there is a sensitivity to high correlations among IVs and this could result in multicollinearity whereby redundant variables need to be deleted. Lastly, sensitivity to outliers is problematic as with multiple regression. Which Regression for Continuous or Dichotomous Dependent Variable In summary, when a DV is continuous, multiple regression is used and when a DV is dichotomous, logistic regression is used. Multiple regression allows the measurement of variables that are continuous or interval, representing a numerical value such as age, income, and blood pressure. On the other hand, logistical regression allows the measurement of variables that are categorical or nominal, representing two possible levels such as gender (male or female), religious (yes or no), and neighborhood (urban or rural). It is possible for continuous variable such as age or income to be transformed into dichotomous variables, for example age can be displayed as 65 years of age or 65 years of age, and income can be displayed as $30,000 or $30,000. For the proposed research study on à ¢Ã¢â€š ¬Ã…“Issues Influencing Mediation Adherence among African American Women with Hypertensionà ¢Ã¢â€š ¬?, logistic regression will be chosen to analyze data resulting from the proposed aims and ass ociated research questions listed: Examine the relationships of demographic characteristics, perceived injustice, relationship with health care provider, medication knowledge, and coping to medication adherence in African American women with hypertension. Q1. Do the demographic characteristics (age, education, income, etc.), perceived injustice, relationship with health care provider, medication knowledge, and coping predict medication adherence in African American women with hypertension? Q2. When controlling for demographic characteristics, do perceived injustice, relationship with health care provider, medication knowledge, and coping predict medication adherence in African American women with hypertension? Explore the association between antihypertensive medication adherence and reactant behaviors in African American women. Q3. Is there a relationship between medication adherence and reactant behaviors in African American women with hypertension? The research q uestion drives the method and in this instance, the IVs are categorical (education, perceived injustice, relationship with health care provider, medication knowledge, and coping) or continuous (age, income) and the DV is dichotomous (medication adherence; adhere or not adhere). The intent of the research questions are to determine which IVs are predictors of whether or not medication adherence will occur and to determine if the odds ratio for these IVs indicate the likelihood of whether or not medication adherence will occur. Ethical Implications of Perceived Injustice in African Americans Justice implies equality, being just, treating people fairly and equally (Hall, 1996). Many African Americans in the U. S. have experienced perceived injustices in the health care system and been victims of disparate health care. Research findings confirmed the perceptions of injustices and discrimination experienced by many African Americans in various health care situations. An extensive study (Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in healthcare, 2002) revealed that minorities are less likely than Caucasians to receive needed services, procedures, and routine treatments for common health problems and diseases such as cancer, cardiovascular disease, and diabetes. For example, cardiac care is one area of health care that consistently demonstrates disparity in health care access and delivery. When compared to Caucasians with similar clinical manifestations for cardiovascular disease, African Americans are less likely to r eceive pharmacological therapy (e.g. thrombolytic therapy), diagnostic angiography, heart transplantation, cardiac catheterization and invasive surgical treatments (e.g. coronary bypass surgery) even when treatments and procedures are judged to be appropriate. Although disparate health care is evident, another factor is the strong link between finances and access to cardiac care (Mayberry, Mili, Ofili, 2002). A sad but true revelation in healthcare as well as other facets of life is that injustice is pervasive among the poor and needy. African Americans have the highest poverty rate in the U.S. at 24.7% as compared to 8.6% of Caucasians (Income, poverty and health insurance coverage in the United States: 2008, 2009, September). However, this does not explain the injustices to people of color who have the ability to pay for health care (Kennedy, Mathis, Woods, 2007). Coping with perceived injustices may contribute to illness. A cross-sectional comparative study on discriminat ion and hypertension in older African Americans and Caucasian adults provided support that perceived discrimination was associated with higher diastolic BP. Authors concluded that discrimination may cause adverse effects on BP levels in people of African American descent (T. T. Lewis, et al., 2009). In another cross-sectional study of diverse middle aged women (African-American, Hispanic, White, Japanese, and Chinese women) examined the association between perceived unfair treatment and hypertension. African American women reported the highest levels of perceived unfair treatment followed by Chinese women. However, results did not indicate a positive correlation between perceived unfair treatment and elevated blood pressure (Brown, Matthews, Bromberger, Chang, 2006). Although the results of these studies show conflicting results, the realities of prolonged exposure to perceived injustices may contribute to illness. The issues surrounding hypertension are complex with multiple ca uses for this complex health disparity that results in disproportionate mortality rates. According to Fiscella and Holt (2008) the elimination of racial disparities in African Americans with hypertension will substantially decrease the number of deaths from cardiovascular disease. Better control of hypertension among African Americans can be obtained with adequate resources to discover and address treatment adherence (Fiscella Holt, 2008; Fongwa, Evangelista, Doering, 2006). However, it is imperative that current resources are equitable, and clients are treated fairly and given quality health care without regard to racial or ethnic status (Clark, 2009). Ethical Implications of Coping in African Americans Non-maleficence is the duty to do no harm or duty not to harm others (Hall, 1996). In the health care arena, harm seems inherent for those with a lower socioeconomic status, especially when healthcare services are not readily available when illnesses occur. Being unable to get proper medical care may create undue harm by overtaxing an individualà ¢Ã¢â€š ¬Ã¢â€ž ¢s coping skills with multiple fears and anxiety because of increased healthcare costs and decreased access to care. Historical evidence has shown that socioeconomic status is a strong predictor of health outcomes with poverty as the leading cause of avoidable morbidity and mortality (Bierman Dunn, 2006). James (1996) noted an inverse correlation between socioeconomic status and health; those with lower socioeconomic status are more likely to experience illness and premature death than those with higher socioeconomic status, thus adversely affecting African Americans, and other minority/ethnic groups. One hypothesis a ccording to James (1996) that may be a possible explanation for how socioeconomic status increases the susceptibility of African Americans and other minority/ethnic groups to increased morbidity and mortality is derived from the legend of John Henry. Based on this folktale, there was a contest between John Henry and a machine; he defeated the machine and suffered mental and physical exhaustion resulting in death. According to James (1996), John Henry symbolizes the relentless struggles of unskilled laborers in their effort to cope with psychosocial, economic, and environmental stressors that eventually erodes their health over time contributing to increased morbidity and mortality. Thus, harm is evident when differences in access to treatment play a role in why morbidity and mortality rates for some diseases are higher among African Americans than among Caucasians (Stover, 2002). African Americans and other minority/ethnic groups as compared to Caucasians have poorer access to he alth care services as evidenced by less annual visits to a health care provider, lower use of preventive services, an increased likelihood of not having a primary health care provider, and the likelihood of being uninsured (Mayberry, et al., 2002). Greater ethnic/racial disparities are found among the uninsured and Medicaid populations than those who are privately insured with indications that financial factors outweigh race/ethnicity when considering access to medical care (Mayberry, et al., 2002). Williams (2009, November) purports that a lower socioeconomic status predicts everything in society from the cradle to the grave, including SAT scores, income, jobs, housing, health, and health insurance coverage. Williams (2009, November) states that socioeconomic status is stronger than genetics and a lower socioeconomic status is greatly impacted when race and racism becomes part of the equation. However, the difference in health disparity between lower versus higher socioeconomic status is bigger than the health disparity between African Americans and Caucasians (Williams, 2009, November). According to Williams (2009, November), the issue is not one of availability of health care, but one of care that is accessible (office hours, distance, transportation, affordability, risk of job loss verses doctor appointment, etc.). In a research study conducted by Kumar, Schlundt and Wallston et al, (2009), a telephone survey of 2001 community based participants revealed that race concordance was not a significant predictor of health care quality. Findings did show that other factors such as higher income, higher education, and health insurance were predictors of better health care quality. In addition, socioeconomic status and access to quality health care were more important factors in achieving health status and health satisfaction. This study provides evidence that access to health care is primarily determined by socioeconomic status and daunting assumption that inaccessible health care may result in undue harm. Ethical Implications of Relationship with Health Care Provider in African Americans Respect for persons has two meanings: the (1) client should be treated as an autonomous agent, able to make their own choices, and (2) client who is unable to be autonomous has the right to be protected. It is important that the client and health care provider establish a working relationship built on mutual trust (Clark, 2009). In relationships, trust is vital, especially since the primary matter is adherence to the treatment regime. For many African Americans, health care disparities have hindered the establishment of a trusting client-provider relationship (L. M. Lewis Ogedegbe, 2008). African Americans differ from other racial/ethnic groups, such as Caucasians and Hispanics, because of their history of slavery, oppression, and discrimination. Because of skin color and other distinctive features such as hair texture, thick lips, body shape, the lives of African Americans was not valued. They were frequently used in medical experiments by Caucasian doctors to perfect their te chnique before attempting procedures on the Caucasian race. These types of exploitations by Caucasian physicians endured a long history (Gamble, 1997). As a result, perceived stereotypes and prejudices experienced by African Americans in the health care arena have resulted in mistrust, refusal of treatment, and/or poor adherence with treatment regimes by African Americans (Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in healthcare, 2002). A study conducted by Benkert, Peters, Clark, and Keves-Foster (2006) found that the majority of low-income, urban dwelling African Americans were fairly trusting of their healthcare providers and satisfied with the health care given, although negative effects of perceived racism on trust and satisfaction were evident. This study confirms that African Americans do experience an element of trust is in their health care providers, but skepticism continues. According to Benkert, Hollie, Nordstrom, Wickson and Bins-Emerick (2009), nurse practitioners have better trusting relationships with African American clients. Study participants with higher trust and satisfaction were in concordant client-provider relationships. Further study findings revealed that African American men reported less satisfaction with care provided by nurse practitioners and were more suspicious of the health care system. Reasons for lack of trust in this study was not investigated. However, if the men in the study perceived that their treatment was different from Caucasian clients, then that may contribute to mistrust (Clark, 2009). Disparate health care among African Americans and other racial/ethnic groups is well documented (Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in healthcare, 2002). Because remnants of African American history continue to exist in subtle configurations, many approach health care with fear, skepticism, and caution (Gamble, 1997 ). Therefore, it is important that health care providers, along with African American clients, devise mechanisms to transcend the effects of history, restore trust in the health system, and overcome barriers to forming relationships to foster optimal health care.