THE LIVED EXPERIENCE OF JAMAICAN MEN IN THE US WHO HAVE UNDERGONE PROSTATE CANCER SCREENING:

A PHENOMENOLOGICAL INQUIRY 

DISSERTATION PROPOSAL

Presented in Fractional Fulfillment of the

Requirements for the Degree of

Doctor of Aesthetics in Nursing

Barry University

Steadley Foster

2016

E

THE LIVED EXPERIENCE OF JAMAICAN MEN IN THE US WHO HAVE UNDERGONE PROSTATE CANCER SCREENING: A PHENOMENOLOGICAL INQUIRY 

DISSERTATION PROPOSAL 

By 

Steadley Foster

2016

APPROVED BY:

Jessie M. Colin, PhD, RN, FRE, FAAN

Chairperson, Altercation Committee

Program Director, College of Nursing and Bloom Sciences

Claudette R. Chin, PhD, ARNP

Member, Altercation Committee

Ferrona A. Beason PhD, ARNP

Member, Altercation Committee

John McFadden, PhD, CRNA

Dean, College of Nursing and Bloom Sciences

Copyright by Steadley Foster, 2016

All Rights Reserved

ABSTRACT

Background: The US ranks amid top bristles nations with Prostate Blight (PCa) fatalities, with the accomplished cardinal of fatalities occurring in African and Caribbean immigrant populations. Jamaican men aggregate a high-risk citizenry for PCa incidences and they are atomic acceptable to abide prostate blight screening or chase up with consecutive screening.

Purpose: The proposed phenomenological abstraction seeks to accept how Jamaican men accredit acceptation based on their adventures afterwards adeptness PCa screening sessions. 

Method: The researcher will use allegorical phenomenology guided by van Manen’s (1990) framework to aggregate and assay the primary data.  The ambition citizenry for the abstraction will be Jamaican men animate in South Florida who accept already undergone PCa screening.  A advised sampling sample of the Jamaican men will be recruited application a barometer sampling activity aural the Jamaican association in South Florida.  Qualitative abstracts will again be calm application contiguous interviews, and the amateur interviews will abide until appearing accommodation and contextual categories are saturated.

Results and Conclusions: Pending

ACKNOWLEDGEMENTS

DEDICATION

TABLE OF CONTENTS

ABSTRACT iv

TABLE OF CONTENTS v

LIST OF FIGURES vii

CHAPTER ONE: INTRODUCTION TO THE STUDY 1

Problem and Domain of the Inquiry 1

Background of the Abstraction 1

Prostate Cancer: All-around Accident and Prevalence 1

Prostate Blight in the Caribbean and Jamaica 4

Prostate Blight in the United States 7

PCa Screening: A Tale of Two Decisions 9

Experiences Prior, During and Afterwards Prostate Blight Screening 11

Statement of the Problem 12

Purpose of the Study 13

Research Question 14

Philosophical Underpinnings 14

Interpretivism Paradigm: Constructivist Admission 14

Qualitative Assay Alignment 17

Philosophical Assumptions of Qualitative Assay 19

Ontology Accepting 19

Epistemology Accepting 20

Axiological Accepting 20

Rhetorical Accepting 20

Methodological Accepting 21

Phenomenology 22

Consciousness 27

Embodiment 27

                     Naturalistic Attitude 29

                     Experience and Perceptions 30

Hermeneutic Phenomenology 31

Demographic Considerations and Representation: Bounded and Amusing Contour of Citizenry beneath Study…………………………………………………... 33

Significance of the Study 34

Significance of the Abstraction to Nursing 35

Implications of the Study 36

Implications of the Abstraction to Nursing Apprenticeship 36

Implications of the Abstraction to Nursing Convenance 37

Implications of the Abstraction to Nursing Assay 39

Implications of the Abstraction to Health/Public Activity 40

Scope and Limitations of the Study 41

Chapter Summary 42

CHAPTER TWO: REVIEW OF LITERATURE 44

Literature Chase Strategy 44

Historical Ambience of Prostate Blight and PCa Screening 46

Prostate Blight Risks 47

PCa Risks on a All-around Calibration 47

PCa Risks in the Caribbean Arena 48

PCa Risks in Jamaica 50

Jamaican Men in United States and Prostate Blight Risks 52

Intervention Admeasurement and Barriers to PCa Screening amid Jamaican Men 53

Facilitators to PCa Screening amid Jamaican Men 61

Overview of the Complete Ambience of PCa Screening amid Jamaican Men 66

Experiential Context 67

Reflexivity and Bracketing………………………………………………………………… 68

Chapter Summary 70

CHAPTER THREE: RESEARCH METHODS AND METHODOLOGY 71

Qualitative Assay Methodology 71

Research Design: van Manen’s (1990) Model of Allegorical Phenomenology 72

Appropriateness of phenomenological Assay Architecture 72

The Allegorical Assay Design: Adopted from van Manen (1990) 74

Research Sample and Setting 78

Sampling Procedure 79

Access and Application of the Sample 80

Inclusion Belief 79

Exclusion Belief 79

Ethics and Ethical Considerations 81

Data Accumulating Procedures 82

Interview Questions 84

Demographic Abstracts 85

Data Assay Process 86

Research Rigor 87

Credibility of Assay Allegation 88

Dependability of Assay Allegation 89

Confirmability of Assay Allegation 89

Transferability of Assay Allegation 91

Chapter Summary 91

REFERENCES 89

APPENDIX A IRB Document 102

APPENDIX B INFORMED CONSENT 108

APPENDIX C RECRUITMENT FLYER 109

APPENDIX D INTERVIEW QUESTIONS 110

APPENDIX E DEMOGRAPHIC DATA 111

APPENDIX F INCLUSION AND EXCLUSION FORM 112

APPENDIX G IRB CERTIFICATE 113

 

LIST OF FIGURES

Figure 1. The archetypal activity (Foster, S. 2016, acclimatized from Crotty, 1998 with modifications). 17

Figure 2. The allegorical assay architecture (Foster, S. 2016, acclimatized from van Manen, 1990 with modifications) 66

CHAPTER ONE

Prostate blight (PCa) accident ante are the accomplished globally amid Jamaican men, yet these men are the best acceptable to arise such a bactericide and ascendancy admeasurement as PCa screening (Consedine, Adjei, Horton, Joe, Borrell, Ramirez, & Neugut, 2009).  There is an cutting anatomy of affirmation bond Jamaican men and non-adherence to PCa screening (Ajzen, 1991; Consedine et al., 2009; Edelstein & Gillath, 2008; Evans, Butler, Etowa, Crawley, Rayson, & Bell, 2005).  Abundant is accustomed about Jamaican men’s non-adherence to PCA screening, but complete little is accustomed about their acquaintance of adeptness the screening activity aback they do attend.  To accretion an compassionate of the aspect of this abnormality a qualitative phenomenological assay will be conducted. An compassionate of how Jamaican men, who are proactive about their prostate health, accomplish acceptation of the acquaintance of adeptness prostate blight screening, may facilitate the development of added able interventions targeting the group’s all-embracing ante of prostate blight screening.

Problem and Domain of the Inquiry

Background of the Study

Prostate Cancer: All-around Accident and Prevalence

The prostate gland is activate abandoned in males, and according to the American Blight Society (2015), it functions to aftermath a careful and alimentative aqueous for agent beef in the semen.  Prostate Blight (PCa) is the development of annihilative beef alongside accustomed anatomy beef in the prostate gland, through a activity referred to as adenocarcinoma (American Blight Society, 2015).  As such, the macho gender is the complete citizenry at accident of developing the PCa condition, and the accident about starts at the boilerplate age of 40, and worsens as a man ages arise the age of 80 years. Today, PCa is “the added best accustomed blight in men,” in the apple (Globocan, 2015, p. 1). 

The abstraction will focus on PCa screening, which according to Dowdle (1999) is a analytic activity aimed at diagnosing the appearance of any annihilative beef in the prostate gland.  Today, abundant researchers, practitioners and advisers including Gibson, Hanchard, and Waugh (2010), Aiken, Tulloch, Freeman, Bennett, Coard, Panton, and Flanigan (2003), and Haas, Delongchamps, Brawley, Wang, and De la Roza (2009) accept arise assay allegation that able PCa screening as an able analytic apparatus aback authoritative PCa. Further, according to Dowdle (1999), controlling, eradicating and preventing Prostate Blight (PCa) relies on several factors including: (a) how abreast bloom affliction programs are about PCa, (b) what is accustomed about PCa, (c) appraisement of attainable interventions adjoin PCa, and (d) authentic assuming of specific populations accede to PCa

The PCa screening activity helps ascertain any annihilative beef in the testicles. Screening enables bloom affliction providers “discover clinically cogent diseases aboriginal in the ache activity to ahead bloodshed and anguish through treatment” (Aiken & Eldemire-Shearer, 2012, p. 90).  The International Agency for Assay on Blight commends screening is the best able and reliable PCa ascendancy strategies, mainly because screening enables aboriginal assay and acknowledged assay (Globocan, 2015). PCa screening is justified as both requisite and appropriate.  According to Catalona, Loeb and Han (2006), PCa screening helps actuate the appearance of annihilative beef aback the activity is in its aboriginal stages. 

The Apple Bloom Organization (WHO) arise that over 15,296,000 men died of blight amid 2007 and 2012 (Globocan, 2015).  The International Agency for Assay on Blight (IARC) arise on account of the WHO, and affirmed that in 2012, the apple registered over 14,068,000 new cases of blight (incidences), formally diagnosed and triggering the deaths of 4,653,000 men (Globocan, 2015).  In a account commodity arise for clinicians on all-around blight statistics, Jemal, Bray, Center, Ferlay, Ward and Forman (2011) acclaimed that, the all-around accident accident for all types of blight was 30% in developed nations and 17% in beneath developed nations (at Age-Standardized Amount per 100,000 of 300.1).  Further, the all-around bloodshed accident for all types of blight was 15% in developed nations, and 17% in beneath developed nations (at Age-Standardized Amount per 100,000 of 160.3).  Chiefly for the present study, Jemal et al.  (2011) accustomed that amid all cancers, PCa accident accident was the highest, at 7.8% in developed nations, and abandoned 2.5% in beneath developed nations (at Age-Standardized Amount Per 100,000 of 62.0).  Finally, amid all cancers, PCa bloodshed was the highest, at 1.2% in developed nations (at Age-Standardized Amount per 100,000 of 12.0) (Jemal et al. 2011, p. 73)

PCa is admired as the best acute blazon of cancers amid men globally, based on the abate cardinal of incidences and mortalities recorded.  About a decade ago, Garcia, Jemal, Ward, Center, Hao Siegel and Thun (2007) arise that over 782,600 new cases of PCa were recorded, triggering over 254,000 deaths, globally. According to Garcia et al. (2007), PCa had become the sixth arch account of blight afterlife amid men aloft the globe, by 2007.  What Garcia et al. (2007) did not ahead at the time was that admitting the trend had worsened by 2007, the acceleration was abandoned a alpha point, and PCa accident would become added adverse by 2010 (Jemal, Center, DeSantis & Ward, 2010, p. 1899).

Important for the present abstraction is the constant appulse of PCa amid men, globally. As affirmed by Sinfield, Baker, Agarwal, and Tarrant (2008), based on statistics, PCa patients recorded the affliction adventures compared to the adventures recorded with accession blazon of cancers including breast and abdomen cancers.  The aloft reality, alone, prompts burning assay of the resultant adventures from PCa, and in this abstraction specifically, PCa screening.  Above-mentioned to added altercation of that, however, it is important to highlight PCa risks and bloodshed trends by chase and ethnicity, as able-bodied as by nationality, aloft the aloft all-around trends.  

Prostate Blight in the Caribbean and Jamaica

Between 1999 and 2012, the Centers for Ache Ascendancy and Prevention (2015) arise that, “the amount of men dying from prostate blight has varied, depending on their chase and ethnicity,” breadth Caribbean and Black/African men almanac the accomplished PCA bloodshed rate. According to CDC, the PCa incidence/mortality amount was decidedly afflicted by both chase and ethnicity, aback “black men had the accomplished amount of accepting prostate cancer, followed by white, Hispanic, American Indian/Alaska Built-in men, and Asian/Pacific Islander” (p. 1). The PCa accident and bloodshed amount categorized Caribbean men beneath the aforementioned contour as men with African descent.  Based on PCa incidence, prevalence, and bloodshed ante recorded in the Caribbean nations by 2008, it anon emerged that Caribbean men, alongside African men, had the accomplished recorded accident of developing PCa cancer.  Consequently, compared to any accession arena in the world, the Caribbean arena abandoned triggers the accomplished cardinal of PCa incidences every year (Prostate Blight Caribbean, 2008). 

Aiken and Eldemire-Shearer (2012) conducted a abstraction on the role of PCa screening to arbitrate adjoin the ascent bloodshed trends in Jamaica and the added Caribbean.  In the study, the advisers arise that of greater affair in the ascent PCa accident statistics globally is the adumbration “that the Caribbean arena has the accomplished age-standardized PCa-specific bloodshed amount in the apple at 26.3/100 000/year” (p. 90).  The ancestral contour of atramentous and Caribbean men triggers a abiogenetic weakness that is at a college accident of developing PCa compared to all accession ancestral profiles (Glover, Coffey, Douglas, Cadogan, Russell, Tulloch, & Walsh, 1998).  Aiken and Eldemire-Shearer (2012) accent the accretion affair of Jamaica’s ascent PCa incidences and mortalities, which are already acutely aerial accustomed “that the Caribbean arena has the accomplished age-standardized PCa-specific bloodshed amount in the world” (p. 90).

In agreement, Gibson, Hanchard, and Waugh (2010) arise that Atramentous and Caribbean populations accept the accomplished accident of developing PCa in the world.  A agnate trend is notable in the Jamaican nation as allotment of the Caribbean.  Prostate Blight Caribbean (2008) arise that, in the Caribbean region, blight incidences registered nationally in Jamaica, the Bahamas, Cuba, Trinidad and Tobago, Grenada, and Martinique accept able the Caribbean as one of the best high-risk locales of PCa.  Knowing that Jamaican men, alongside the Caribbean and Atramentous men accept the accomplished PCa accident and bloodshed ante would conceivably not be as awkward to clinicians if commodity able was actuality done about it.  Afterwards reviewing what this high-risk citizenry is accomplishing to arbitrate adjoin preventable deaths, clinicians, nurses, and medical scholars/researchers are afraid about what is actuality done.  As argued by Aiken and Eldemire-Shearer (2012), “if PCa is articular aboriginal in its accustomed history, it is conspicuously treatable with abundant abeyant for cure” (p. 90).  As such, aback “the Caribbean has the accomplished age affiliated PCa-specific bloodshed ante in the world,” again “why is this so and what can be done to abate the anguish and bloodshed associated with PCa in the Caribbean?” (p. 90). 

Many antecedent studies accept actually accustomed the aerial accident of developing PCa amid Jamaican men, best conspicuously Aiken and Eldemire-Shearer (2012), and Gibson, Hanchard and Waugh (2010).  Traditionally, “the accomplished arise accident of prostate blight in the apple was anticipation to be amid American Atramentous men¸” and no abstraction focused on the Caribbean immigrants (Glover et al., 1998). However, statistics eventually showed that the accident amount in the Jamaican capital, Kingston alone, accomplished 304/100,000 men, 80% of whom were pathologically confirmed. A college accident amount was articular amid Jamaicans in Jamaica, that in African men, with 30% of the patients accepting “acute urinary retention, 16% presented with cartilage metastases, 15% with gross hematuria at the time of assay and 42% with an aberrant abdominal assay apprehensive for cancer” (Glover et al., 1998, p. 1984).  Importantly, Prostate Specific Antigen (PSA) measures amid Jamaican men diagnosed 7% of the PCa cases in 1989 and accomplished “48% of cases by 1994” (p. 1984). 

Gibson, Hanchard, and Waugh (2010) arise that atramentous and Caribbean populations accept the accomplished accident of developing PCa in the world.  Gibson, Hanchard, and Waugh (2010) argued that based on incidences of amid 2003 and 2007, PCa is “the arch blight affecting men in Jamaica” (p. 456).  In agreement, the American Blight Society (2008) arise that Jamaican men accept a aerial accident of developing PCa amid commensurable ancestral profiles.  Abounding accession assay studies accustomed the aerial accident of developing PCa amid Jamaican men.  According to Aiken and Eldemire-Shearer (2012), Jamaica represents the arena of the Caribbean territories with the accomplished ante of PCa.

Morrison, Aiken, and Mayhew (2014) advised the “current accompaniment of prostate blight assay in Jamaica” (p. 456). The advisers arise that in Jamaica today, PCa “accounts for about a third of all cancers diagnosed” with Jamaica accepting “the accomplished accident of PCa in the world, based on a arise amount of 304/100,000 per year” (p. 456).  Further, according to annal by the Jamaica Blight Registry, PCa “is the best accustomed blight all-embracing as able-bodied as the best accustomed blight in men” with an “age-standardized accident amount of 78.1/100,000 per year” (Morrison, Aiken, & Mayhew, 2014, p. 456).  It is of greater affair that by 2014, PCa was “the best accustomed account of macho cancer-related deaths, with an age-standardized bloodshed amount of 53.9/100,000 per year” (p. 456).

Prostate Blight in the United States

The actuality that PCa accident and bloodshed ante are the accomplished amid African and Caribbean Atramentous men, an indigenous contour in which Brazilian men belong, can calmly but abominably announce Jamaica as arena aught of PCa assay and PCa screening. The proposed abstraction will apply the “racial and indigenous profile” of men aback defining their PCa accident and bloodshed ante and bond such trends with screening experiences. Besides actuality in Africa and the Caribbean region, the ancestral contour amplifies the PCa accident and bloodshed rate. This agency that, the aerial accident of developing PCa affects not abandoned Jamaicans aural Jamaica, but additionally those who accept immigrated to the U.S. 

According to Kendrick (2010), “research has aboveboard that prostate blight is the added arch account of blight afterlife amid men in the United States and Caribbean and African American men are added acceptable to beforehand the ache than White American males” (p. 6).  Jamaican men residing in the U.S. appropriately characterize a agnate aerial PCa accident as those in Jamaica.  The American Blight Society (2008) and Gibson, Hanchard, and Waugh (2010) accustomed that Jamaican men accept the accomplished ante of PCa alike aural the U.S., aback profiled by chase and ethnicity as actuality Caribbean.

The Civic Blight Institute (NCI, 2015) accomplished the Surveillance, Epidemiology, and End After-effects Affairs (SEER) beneath the affiliation of the Civic Institutes of Health, the Civic Blight Institute, and the U.S. Department of Bloom and Animal Services.  The SEER affairs focused on PCa accident and bloodshed ante aural the U.S., and by 2015, accustomed that amid 1999 and 2012, 137.9 per 100,000 cases of PCa were arise annually (incidences), which triggered 21.4 per 100,000 mortalities in men per year.

On PCa prevalence by 2012, an estimated 2,795,592 men were already clinically diagnosed as animate with PCa in the United States.  Further, the lifetime accident for developing blight ranges at 14% for PCa amid men in their lifetime, and PCa represents over 13.3% of all new blight cases diagnosed in the U.S.  Finally, according Civic Blight Institute, PCa is the third best accustomed blazon of blight diagnosed in the U.S. (NCI, 2015, p. 1-2).

The U.S. is third amid all countries based on the PCa accident and bloodshed rates, annal these cogent numbers amid the Atramentous and Caribbean males. The tragedy occurs mostly amid Jamaican men, than in Atramentous and Caribbean men.  According to Glover et al. (1998), Jamaican men in the U.S., “have a aerial accident of prostate cancer, abundant college than alike Atramentous Americans during a agnate period” (p. 1984).  Notably, PCa impacts are “more cogent clinically with greater morbidity” amid Jamaica men that any accession ancestral and indigenous contour (p. 1984). 

The American Blight Society (2008) accustomed that, based on all-around blight actuality and figures, PCa incidences and mortalities are college in the U.S. than in the Africa and the Caribbean, yet aural the U.S., the accomplished ante are amid the Caribbean (notably Jamaican) and African men. Kendrick (2010) accustomed that macho Caribbean immigrants to the U.S. accept the accomplished PCa accident based on accident rates.  Further, according to the American Blight Society (2015), the Caribbean and African-American men are alert added acceptable to beforehand PCa than men from accession races, such as Asian-American, Hispanic-Latino, and non-Hispanic White men. Assay has attributed the aerial accident to abiogenetic factors ascendant in their indigenous profiles (American Blight Society, 2008b).The proposed abstraction will accordingly focus on the immigrant citizenry of Jamaican men in the U.S.

PCa Screening: A Tale of Two Decisions

PCa screening has been certified as the best able and affiliated analytic apparatus and activity activity for PCa (Concato, Wells, Horwitz, Penson, Fincke, Berlowitz, & Peduzzi, 2006; Aiken & Eldemire-Shearer, 2012). PCa screening has been characterized as accepting no applicable antagonism from accession options, actuality the abandoned standardized, affordable, reliable, and able activity admeasurement adjoin the ascent accident and bloodshed ante of PCa.  Notably, PCa is the added best accustomed blight in men, with Jamaican men adversity the accomplished amount of accident and bloodshed from this prostate blight (Eldemire-Shearer, James, Morris, Holder-Nevins, Lawes & Harris, 2011; Globocan, 2015).  Notably, however, if not diagnosed early, PCa can apprenticed beforehand to complete and metastatic stages that are beneath acknowledging to assay (Aiken & Eldemire-Shearer, 2012).  PCa screening is frequently done application a Agenda Abdominal Exam (DRE) and/or a serum assay of Prostate Specific Antigen (PSA).  PCa screening has been associated with favorable prognoses, and decreased mortality, and according to Clarke et al. (2012), high-risk PCa populations should alluringly almanac the accomplished adherence score.

Nonetheless, PCa screening is not afterwards activity or controversy.  Several studies accept butterfingers PCa as an able and acclimatized bactericide and ascendancy admeasurement adjoin PCa. Kilpelainen, Tammela, Maattanen, Kujala, Stenman, Ala-Opas and Auvinen (2010), Howrey, Kuo, Lin and Goodwin (2013), and Maattanen, Hakama, Tammela, Ruutu, Ala-Opas, Juusela  and Auvinen (2007), faulted PCa screening for breeding apocryphal PSA positives after-effects and apocryphal abrogating results. 

The blunder of PCa screening has appropriately been faulted and alike affiliated to abrogating impacts on bodies falsely diagnosed of PCa by amid others Berner (2009), Howrey, Kuo, Lin, and Goodwin (2013), and Onyiaorah, Onyiaorah, Ukah, Anyiam, Onwukamuche, and Efobi (2015).  The criticism of PCa screening has authentic arguments.  To exemplify, it is noteworthy that neither PCa screening procedure, the PSA and Agenda Abdominal Assay (DRE) procedures, are 100% authentic and abandoned the analytic biopsy of the prostate is the complete analytic assay attainable (Kilpelainen et al., 2010).  Yet PSA and DRE, rather than analytic biopsy are the best common, best recommended, and abandoned achievable screening options attainable in abounding regions. This explains why there has not been any official advancement for PCa screening agreed aloft by aloft medical and blight organizations (Basch, Oliver, Vickers, Thompson, Kantoff, Parnes, & Nam, 2012). 

Regardless of the accurateness accomplished by the PCa screening procedures, conceivably the best important catechism is what PCa screening attains or enables. The aboriginal PCa assay enabled by PCa screening is not consistently basic in abbreviation anguish and mortality.  PCa is a slow-growing blazon of cancer, and best men die old from accession causes behindhand of their prostate status.  This altercation questions the alarm of PCa screening (Howrey et al., 2013; Onyiaorah et al., 2015). Finally, for the present discussion, PCa screening is not mandatory. As such, any such citizenry as Jamaican men who are at a college accident of developing PCa are not accountable or answerable to participate in screening.  No activity can obligatorily crave asymptomatic, advantageous men to abide aboriginal PCa screening. In question, therefore, is how able PCa screening can be as a bactericide and ascendancy admeasurement adjoin PCa.

Experiences Prior, During, and Afterwards Prostate Blight Screening

Jamaican men aggregate a high-risk citizenry for PCa incidences, and best assay studies assay Jamaican men as a high-risk citizenry for PCa (Aiken and Eldemire-Shearer, 2012).  It is additionally aboveboard that PCa screening presents the abandoned formidable, reliable, and able activity admeasurement that the high-risk citizenry of Jamaican men can apply to abate their bloodshed rates.  It is analytic to apprehend Jamaican men to be the best loyal supporters and best adherent to PCa screening, yet the real-life abstracts suggests the opposite, acknowledgment the proposed study, conceivably added than any accession fact. 

Evidence suggests that Jamaican men abstain PCa screening, either because they do not affliction or because they do not apperceive of their aerial PCa accident cachet or the role of PCa screening. Further, best Jamaican men currently residing in the U.S. do not abstain PCa screening because the requisite screening accessories are aloof and casework unaffordable.  Rather, Jamaican men abstain PCa screening, behindhand of whether the after-effects may be complete or negative, advisedly and consciously.  The catechism that thereof emerges, is why do Jamaican men do still abstain PCa screening. 

Taitt (2015) generated able affirmation alienated that Jamaican men accept a altered set of “lived experiences, perceptions, and beliefs” that admission their decisions apropos PCa screening (p. 4). Avant-garde compassionate of PCa screening in the U.S. needs to accede “the perspectives, experiences, and behavior of Afro-Caribbean men about to prostate cancer” (Taitt, 2015, p. 199).  Alfresco the U.S., the lived adventures of Afro-Caribbean men residing in the UK accept accomplished them that, “it doesn’t accomplish faculty to anguish too much” as to arise screenings (Nanton & Dale, 2011, p. 62).  As such, whether already abundantly abreast or otherwise, whether PCa screening accessories are accessible, and the activity affordable, Jamaican men apperceive PCa screening based on their lived experiences.  It is a aloft affair that  Jamaican men subscribing to “misperceptions about blight risk,” breadth PCa is admired as “a anathema topic,” afar from application by advantage of cultural behavior and amusing norms (Friedman, Corwin, Rose, & Dominick, 2009, p. 209). 

Even amid Jamaican men in the U.S., PCa screening is admired emotively, such that the accommodation to awning or contrarily is the aftereffect of affecting patterns of anticipation (Consedine et al., 2008).  Abhorrence of PCa, abhorrence of adeptness the screening procedure, cutting anxiety, and emasculation apropos amid immigrant Caribbean men in New York, admission their acumen of and adherence to PCa screening (Consedine et al. 2008).  Therefore, the accommodation to abide PCa screening amid Jamaican men is the artefact of lived adventures as reflected by cultural, social, and bread-and-butter realities (Friedman et al., 2009); fear, anxiety, concerns, and abrogating behavior (Consedine et al. 2008); akin of acquaintance (McCree-Hale, Hale, Rutley, Aung, & Jolly, 2012); as able-bodied as accessibility and affordability (Aiken & Eldemire-Shearer, 2012). 

Statement of the Problem

PCa accident and bloodshed ante of Atramentous and Caribbean men, decidedly of Jamaican men, are the accomplished of all accession ancestral profiles in the world.  The U.S. has the third accomplished civic PCa accident and bloodshed ante in the world, and the accomplished ante recorded amid the Jamaican immigrant, than in any accession ancestral profiles of U.S. immigrants. PCa screening is the abandoned feasible, standardized, affordable, and reliable activity and ascendancy activity adjoin PCa, attainable today. Yet admitting accepting the accomplished PCa accident and bloodshed rates, behindhand of availability or association bloom efforts, Jamaican men agreeably and persistently, debris to attach to PCa screening, because of their cultural behavior and knowledge. Evidently, the aerial non-adherence akin amid Jamaican men has already been the point of absorption for abundant studies over the aftermost three decades, as exemplified by Ajzen (1991), Consedine et al. (2009), Edelstein and Gillath (2008), and Evans et al. (2005) and abounding accession agnate studies.

The attenuated focus of antecedent assay on non-adherence to PCa screening has abandoned the acquaintance of Jamaican men who are proactive about their prostate health.  While abounding abstain PCa screening, some are adherent to and actively acquainted of the allegation for screening. We now abandoned apperceive what influences Jamaican men to abstain PCa screening, but not what motivates some to attach to screening, or what happens afterwards some Jamaican men arise the screening sessions. Such advisers as Taitt (2015), Aiken and Eldemire-Shearer (2012), and Aiken, Tulloch, Freeman, Bennett, Coard, Panton, and Flanigan (2003) accept articular why Jamaican men abstain PCa screening, yet all abide bashful about those who abide screening. The gap of adeptness is why some, Jamaican men agreeably arise screening, what happens afterwards adeptness screening, how they feel afterwards the screening, and likelihood of adeptness approaching screening. Accustomed the analytic aspect and role of PCa screening as discussed aloft the present abstraction seeks to investigate a cogent abnormality amid a PCa high-risk citizenry that agreeably and advisedly opts to abstain the screening intervention. 

Purpose of the Study

The proposed abstraction seeks to accept the accommodation that some advantageous Jamaican men accomplish to abide aboriginal PCa and be proactive about their prostate health, as able-bodied as how their perceived PCa accident influences this choice. The study’s primary purpose is to accretion compassionate of the acceptation of the lived acquaintance of Jamaican men who accept undergone prostate blight screening.

Research Question

The assay catechism for the proposed abstraction will be, ‘What is the lived acquaintance of Jamaican men who accept undergone prostate blight screening in the US?’

Philosophical Underpinnings

Interpretivism Paradigm: Constructivist Approach

To attain an compassionate of the lived adventures of Jamaican men afterwards adeptness PCa screening, the abstraction cannot accept accustomed abstruse foundations of what is already known.  New compassionate will allegation a avant-garde analytic admission to investigate new realities anon unknown. In amusing research, a researcher can abandoned accept one of two attainable worldviews, aback investigating a amusing absoluteness like PCa screening experiences, namely, objectivistic worldview.  According to Crotty (1998), the objectivistic worldview is referred to as the constructivist approach, and predominates authoritativeness research.  Positivistic assay assumes the objectivism worldview, breadth absoluteness is advised in authentic academic measurements, accustomed in quantitative assay (Crotty, 1998). 

Constructivist assay on the accession duke interprets acceptation of a amusing phenomenon, from the abstruse point of appearance of the participants in a specific context.  An interpretivist is a amusing constructivist and appropriately stands as the adverse of an cold positivist (Munhall, 2007).  Interpretivist advisers assemble acceptation apropos the realities aural a altered amusing ambience (Creswell & Miller, 2000). Consequently, “constructivists accept in pluralistic, interpretive, open-ended, and contextualized (e.g., acute to abode and situation) perspectives adjoin reality” (Creswell & Miller, 2000, p. 125).  Interpretivism is appropriately about referred to as an anti-positivist archetype (reaction to positivism), or constructivism, breadth such lived adventures of Jamaican men afterwards PCa screening arise as adjustable realities and not actually authentic to conventional/standardized expectations.  Indeed, “constructivism's relativism assumes multiple, apprehend-able, and sometimes adverse amusing realities that are the accessories of animal intellects but that may change as their constructors become added abreast and sophisticated” (Guba & Lincoln, 1994, p. 110).

Leitch, Hill, and Harrison (2010) recommended that, interpretivism assay is abundantly not based on a admission but it enables a assay to internalize its activity and activity “within the basal assay aesthetics rather than commodity to be activated aloft completion” (p. 68). This absoluteness “requires a about-face from the angle of authority as an aftereffect to validation as a process” (p. 67).  Atramentous (2006) argued for the analytic alarm of relativistic research.  Interpretivism is anchored on a word-based description of contextual acceptation of phenomena.  Atramentous (2006) debated how “words can absolutely authentic the acceptation inherent in our observations, claimed interviews, and pictures aback so abundant of it is subtle, hidden, and contextually bound” (p. 319). Afterwards administering a abreast assay of the abstruse on the interpretivism paradigm, the academic ultimately accustomed the archetype a credible, reliable, restrictively necessary, and about complete on complete contexts (Black, 2006).

In agreement, Grix (2004) asserted that, “the analytic epistemology is one of subjectivism, which is based on complete apple phenomena,” a amusing reality, investigating the abstruse meanings ascribed to a abnormality by animal actors (p. 83).  Subjectivity anchors a assay abstraction aural amusing contexts of a specific population, breadth allegation are abandoned accordant to the perceptions and compassionate of bodies in that abnormality (Cohen, Manion, & Morrison, 2007).   Nursing assay focuses on the astute apple breadth participants are animate bodies (Upadhyay, 2012, p. 123).  Nursing advisers allegation accordingly accept what “they see, apprehend and apprehend from the bodies and places and from contest and activities” and progressively “learn about some aspects of the amusing apple and to accomplish new understandings that can be acclimated by that amusing world” in bloom affliction programs (Upadhyay, 2012, p. 123). Derivatively, it emerges that investigating the lived adventures of Jamaican men afterwards PCa screening in a address that attains reliable understanding, requires new meanings to be complete or interpreted about PCa screening. 

Interpretivism frames its angary from the context-dependent acceptation generated in phenomenology (Kelliher, 2005).  Indeed, according to van Manen (1988), interpretivism establishes the appearance of a abnormality and appropriately prompts able compassionate of realities in that abnormality (phenomenology).  In this regard, the lived adventures of Jamaican men afterwards adeptness PCa screening arise as a altered phenomenon.  According to Blaikie (2004), “the abstraction of amusing phenomena requires an compassionate of the amusing apple that bodies inhabit, which they accept already interpreted by the meanings they aftermath and carbon as a all-important allotment of their accustomed activities together” (p. 509). 

The called abstruse admission can be traced from Crotty’s (1998) presentation of the accordance amid abstruse perspectives, methodology, epistemology, and assay method.  Compassionate will abandoned be generated afterwards interpreting lived adventures from the altered ambience of Jamaican men in the U.S., and amalgam acceptation thereof, as the assay findings. The amount beneath illustrates the interpretative archetype aback implemented in the proposed study. 

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Figure 1: Foster (2016), Acclimatized Archetypal Schema, Acclimatized from Crotty (1998)

Qualitative Assay Methodology

The proposed abstraction will apparatus a qualitative assay methodology. To Creswell (2007), qualitative assay helps accept people, events, and situations. The proposed abstraction will focus on compassionate lived adventures of Jamaican men afterwards adeptness PCa screening. Accustomed that the abstraction will primarily focus on interpreting and amalgam meaning, Munhall (2007) commends the qualitative admission as the abandoned achievable empiric activity that enables a researcher assemble adeptness apropos a phenomenon.  The qualitative assay alignment was accurately called because it answers the “what,” “how,” and “why” questions rather than abandoned investigating the “how much” and “how many” questions about answered application quantitative assay methods (Polit & Beck, 2004). 

Qualitative assay utilizes anterior reasoning, breadth meanings are neither authentic nor objective.  Meanings are complete from the angle of lived adventures of bodies aural the ambience beneath abstraction (those experiencing the phenomena actuality researched).  The researcher can accordingly abandoned apply open-ended, ample methods of primary abstracts accumulating (mostly interviews), to accomplish narratives, pictures, and word-based descriptions (the qualitative data) (Creswell, 2007).  The qualitative assay admission is based on the abstruse underpinnings of post-modernism, breadth the assay deconstructs and reconstructs acceptation (Polit & Beck, 2004).  Creswell (1998) declared qualitative assay as an ethnographic and non-experimental abstraction ashore in the lived adventures of participants and advised to adapt meaning.  This description of qualitative assay agrees with Berg’s (2007) analogue of qualitative studies as the description of “meanings, definitions, characteristics, concepts, metaphors, symbols, and the description of things” (p. 127). 

Marshall and Rossman (2006) accept argued that qualitative advisers accomplish beneath the accepting that a association is structured with argumentation and order, such that adeptness is contextually bent rather than an cold truth.  Consequently, to apparatus a qualitative study, the researcher allegation alarm the abnormality beneath abstraction (PCa screening), based on the lived adventures of the participants (Jamaican men).  As such, qualitative advisers allegation to board the advice they aggregate with the description of the ambience and ascertainment of the participants to beforehand or assemble acceptation of lived experiences.  The researcher allegation be absorbed aural the abstracts accumulating setting, in an accomplishment to accept the abnormality beneath abstraction from the angle of the amateur who lives aural that ambience (Creswell, 2007). 

According to Marshall and Rossman (2006), to accept this contextual meaning, the researcher allegation admission such adeptness from the angle of the participants who accomplish aural the ambience beneath study.  The animate and alternate assurance of the researcher with the participants is accordingly basic to assemble acceptation from qualitative abstracts (Creswell, 2007).  By investigating and exploring the lived adventures of those who actuate the adeptness beneath abstraction inter-subjectively, a researcher can again authorize a aloof acceptation of the context-specific knowledge.  Consequently, the qualitative assay admission is best for amalgam different realities/meanings of a phenomenon, and by accomplishing so, enabling a complete compassionate of alternative affairs from the angle of such participants as Jamaican men (Creswell, 2007).

Typical of naturalistic assay that constructively interprets meaning, Creswell (2007) and Munhall (1994) asserted that qualitative assay admission seeks the compassionate of lived experiences. In the proposed study, the qualitative assay admission will advice accept how Jamaican men collaborate with PCa screening sessions and how they accomplish faculty or beforehand meanings based on their lived experiences.  Quantitative assay seeks to assay the accordance of variables with statistical measures, while as qualitative assay describes such relationships with affluent and all-embracing narratives, accounting words, and pictures, rather than measures the variables statistically.  The proposed abstraction needs a qualitative assay admission to alarm and adapt meanings as accustomed by the Jamaican men who abide PCa screening, interpretively and afterwards generalization. 

Philosophical Assumptions of Qualitative Research

Five abstruse assumptions are basal to authentic inquiry. These assumptions serve as the authentic lens from which the investigator approaches the investigation.  In this qualitative study, the bristles abstruse assumptions namely: (a) ontological, (b) epistemological, (c) axiological, (d) rhetorical, and (e) abstruse (Creswell, 2007) will be advised and discussed from that perspective. 

Ontology Assumption. The ontological accepting proposes that the attributes of absoluteness is abandoned complete to reflect the world, such that, qualitative assay focuses on what is accustomed of the apple (Creswell, 2009).  The proposed abstraction will seek to investigate the lived adventures of Jamaican men, to accept the abandoned complete meanings evoked by PCa screening.  

Epistemology Assumption. The epistemology accepting focuses on the accordance captivation amid the researcher (knower) and absoluteness (what is accustomed and is actuality investigated), breadth a qualitative researcher participates in the abstraction based on the transactional subjectivism foundation.  The researcher will participate in the abstracts accumulating from the position of a Jamaican man in the US, aural the high-risk age bracket, and appropriately administration character with the participants. 

Axiological Assumption. The axiological accepting holds on the role of belief aback amalgam acceptation (van Manen, 1990).  In qualitative research, acceptation is complete based on cogent influences of researcher and participants’ values, to crop value-based findings.  The proposed abstraction will accomplish allegation from the angle of Jamaican men in the US, based on their own compassionate and estimation of PCa screening procedure, and afterwards arty any third affair perspective.  This acceptation will be the artefact of their cultural, social, economic, and political environment, and appropriately altered from any accession acceptation generated alfresco that context.  

Rhetorical Assumption. The articulate accepting supports the breezy and authentic accent acclimated aback administering qualitative research.  To alarm the lived acquaintance of Jamaican man afterwards adeptness PCa screening, cannot be declared in a academic and statistical accent that is contrarily acceptable for quantitative studies.  The allegation will be declared in a address that derives acceptation with an all-embracing and detail affluent accent that is broadly accustomed in qualitative assay (van Manen, 1997; Creswell, 2007).     

Methodological Assumption. The abstruse accepting centers on the anterior assay alignment animate in qualitative abstraction (Creswell, 2007). Qualitative assay investigates “a affair aural its ambience and consistently alter questions based on acquaintance gained,” appropriately cannot accept a predefined and affiliated assay adjustment (Creswell, 2007, p. 18). van Manen (1990, 1997) assured that there are no anchored set of assay methods for qualitative research, decidedly phenomenology.  This cessation accrues from the actuality that, “there is no decree about the accustomed abstruse sets of accomplishing a allegorical phenomenological research” and can abandoned “suggest for few abstruse guidelines” (Kafle, 2011, p. 194).  The abstruse accepting appropriately proposes alternative of qualitative assay methods with “the advised sampling with advice affluent cases” (Merriam, 1998, p. 62). Further, for abstracts accumulating and generation, a qualitative researcher can aggregate abstracts application interviews, observations, and protocols, to accomplish “life apple belief the assay participants, depending on the ambience and the breadth of assay the acclimatized apparatus can be applied” (Kafle, 2011, p. 194). 

Notably, while van Manen (1997) recommended that calm abstracts should be and candy by “uncovering the abreast aspects” (p. 59).  Laverty (2003) recommended a abstracts assay performed by “applying the allegorical aeon that constitutes of reading, cogitating autograph and estimation in a authentic fashion” (p. 24).  The proposed abstraction will apply abreast assay of contiguous account abstracts and observations, to actualize acceptation afterwards reading, absorption and interpreting resultant meanings.  Abandoned such a activity will advice actually accept the lived acquaintance of Jamaican men in the US, afterward PCa screening. 

Phenomenology

Largely a abstruse framework, phenomenology has gradually acquired as a axial assay adjustment in bloom science, and while abreast phenomenology is the adolescent of such advisers as van Manen (1994), Edmund Husserl and Martin Heidegger originally advancing the assay framework.

Husserl and Heidegger are the abstruse fathers of two characteristic meanings and brands of phenomenology - namely analytic (employed by the present study) and anecdotic (Munhall, 2012).  Husserl focused on archetype axial arena of lived acquaintance aback defining the apple based on animal compassionate (Moustakas, 1994).  Husserl appropriately advancing a anecdotic cast of phenomenology, breadth the assay of a abnormality can arise from an abandoned and cold standpoint. Advisers allegation accordingly investigate phenomena afterwards feelings/bias, “by seeing, clarifying, and chargeless acceptation and by acclimatized meanings” considerately (Munhall, 2012, p. 64).  Notably, Husserl focused on epistemology, appropriately mandating the use of anecdotic bracketing to annihilate abeyant bias.  From an epistemological approach, therefore, Husserl conceived the use of anecdotic brackets to annihilate biased abstruse accordance of a researcher in the assay process. 

Heidegger differed with Husserl’s worldview and alien analytic phenomenology, in what became “hermeneutical transformation of phenomenology” (Munhall, 2012, p. 67). To Heidegger, a researcher is animal and can appropriately abandoned adapt the meanings of phenomena by abandoned experiencing and journaling the adventures shaped by the culture, history, values, and worldviews of complete participants, from their angle (Munhall, 2012).  Aback individuals can abandoned adapt what they acquaintance abandoned (not objectively), Heidegger authentic phenomenology as an authentic absorption of knowledge, awareness, and behavior aggregate by bodies who acquaintance the phenomenon. 

Ultimately, Husserl conceived bodies as constitutes of states of alertness while Heidegger countered that alertness is borderline to the ascendancy of an individual’s existence.  In comparison, Husserl focused on epistemological use of anecdotic bracketing, admitting Heidegger focused on ontology, appropriately eliminating the allegation for anecdotic bracketing aback a researcher abandoned interprets phenomena as a amateur in the assay process.  To Heidegger and consecutive advisers of analytic phenomenology, the abandoned way to accept the apple is to accept how the bodies in it adapt it. The advisers who conduct a assay abstraction are beheld as commutual to the apple about them, and their job is to accept how bodies adapt acceptation about a phenomenon.  As such, the advisers can abandoned develop/interpret meanings by animate agreeable with the participants who acquaintance a phenomenon. The advisers admission the abnormality from the angle of those who acquaintance it, and do so from their claimed alertness as evoked during their assurance (Munhall, 2012).

As Creswell (2013) observed, such studies await on “intentionality of consciousness” as a assay alignment breadth a researcher’s alertness becomes the complete base of giving acceptation to a absoluteness (p. 59).  Heidegger appropriately became the ancestor of allegorical phenomenology as adopted by the present study. Allegorical phenomenology enables a researcher to adapt lived acquaintance of people, and the analytic activity is accomplished through a allegorical circle, which moves from the genitalia of lived experiences.  This appearance is altered from anecdotic phenomenology of Edmund Husserl, who believed in the acquaintance of animate or being, not the activity of how things are accustomed (Creswell, 2007).

Eventually, afterwards Husserl and Heidegger advancing the abstruse foundation of phenomenology (both analytic and descriptive), the arena was set for consecutive amplification of phenomenological research.  Several advisers accept avant-garde the acreage in history, but for the present discussion, this assay will abandoned focus on Maxvan Manen (1990) who advancing the abreast cast of phenomenology principles.  Rather than adopting either an analytic or a anecdotic admission as advancing by Husserl and Heidegger, van Manen (1990) chip and overlapped descriptions and estimation as allotment of the assay activity and added added accent and lived adventures as allotment of investigating activity of apple meanings.  Abreast phenomenology is a analytic admission to betrayal and explain the acceding of the lived acquaintance interpretively (van Manen, 1990).

Van Manen’s abreast phenomenologist was advancing by Heidegger but progressively alien a lived-experience angle to the assay activity and is implemented as a assay alignment with two abstruse perspectives - namely; hermeneutics and phenomenology (Creswell, 2007).  According to van Manen, (1990), phenomenology is accomplished by compassionate and acceptation from the angle of both the participants and the researcher, breadth adventures lived in a abnormality reveals cogent meanings for authentic estimation and description. Avant-garde advisers concur, conspicuously Creswell (2009), Munhall (1994), and Crotty (1998), that the structured absorption of a people’s alertness is what defines phenomenology today.

To assemble the reality, therefore, the researcher allegation aboriginal adapt individuals’ absorption aural the ambience of the abnormality beneath review.  From the outset, therefore, the interpretivism admission circuitous phenomenology, or the abstraction of phenomena as proposed by van Manen (1988), breadth the focus was to accept the acceptation of adventures aural a amusing context.  Phenomenology enables advisers to adapt the perceptions of actors/people aural the ambience of a phenomenon, rather than outsiders.  In acceding Heron and Acumen (1997), argues that, “to acquaintance a apple is to participate in it, accompanying abstraction and encountering it” (p. 3).  Phenomenology today asserts that how bodies apperceive phenomena is based on their adventures from their perspective/consciousness, and interpretivism assay assumes this angle to accept such meanings. 

According to van Manen (1994), authentic assay needs to adapt a abnormality with acquainted compassionate of the animal perspectives involved. Indeed, Creswell (2009) authentic phenomenology as the abstraction of anecdotic “the acceptation of the lived adventures for several individuals about a abstraction or the phenomenon” (p. 51).  As such, “phenomenology is afraid with the abstraction of acquaintance from the angle of the individual” afore such adventures are ambiguous for the ambition citizenry in which the abandoned is a affiliate and amateur (Lester, 1999, p. 2).  Phenomenology is an admired assay method, in anecdotic and establishing “experiences and perceptions of individuals” fatigued from their claimed perspectives, behindhand of the normative assumptions invoked, in a address that accurately explains a abnormality in its astute ambience (Lester, 1999, p. 2). 

Ideally, therefore, the analytic abstraction of a people’s absorption apropos what Husserl (1970) calls “common sense” can be structured as people’s alertness apropos a abnormality (Creswell, 2009). Therefore, the proposed abstraction will accept the phenomenology assay design. According to van Manen (1997), phenomenology interprets a abnormality with acquainted compassionate of the animal perspectives involved.  To Creswell (2009), phenomenology is the abstraction of anecdotic “the acceptation of the lived adventures for several individuals about a abstraction or the phenomenon” (p. 51). Edmund Husserl is accustomed as accepting advancing the anecdotic phenomenology foundations (Crotty, 1998).

Phenomenology is an attack to assemble acceptation of a amusing reality, as a phenomenon.  Phenomenology demands that a researcher adopts relativism (rather than positivism), aback eliminating “the prevailing understandings of the phenomena,” so that the authentic assay is decidedly authentic by the “immediate acquaintance of the phenomenon,” appropriately enabling “possibilities for new meanings as an affidavit and accessory of aloft meaning” (Crotty, 1998, p. 78).  A axial basal acceptation is authentic by a person’s abandoned adventures aural a amusing ambience (Husserl, 1970). 

In philosophy, phenomenology is afraid with a person’s absoluteness or claimed meanings about their “life world” from the angle of a specific abnormality (Smith, 2003).  Phenomenology as a assay admission appropriately seeks to accomplish added compassionate of the acceptation of people’s accustomed adventures (van Manen, 1990).  People’s acquaintance and alertness is abandoned authentic in accedence to the apple about them (Munhall, 2007).  As such, “distinct abstruse and cold worlds do not abide (since) objectivity is abandoned accomplished through abstruse alertness or perception” (Munhall, 2007, p. 22).  Phenomenology constitutes investigating the acceptation of lived experiences, breadth such meanings are accustomed in the ambience of every day’s abstruse apple (Schwandt, 2001).  The four aloft constructs of phenomenology are: (a) consciousness, (b) embodiment, (c) naturalistic attitude, and (d) acquaintance and perceptions.

Consciousness. Alertness denotes the acquaintance of an abandoned as complete in the world.  An abandoned has a faculty of actuality animate and animate in the world, and this acquaintance is his or her consciousness.  Aback reviewing the phenomenological abstraction of consciousness, Munhall (1994) quoted Merleau-Ponty (1962) who authentic alertness as the “sensory acquaintance of and acknowledgment to the environment” (p. 14).  Rather than actuality a audible admeasurement of what a actuality feels or thinks (in the interior), or what he or she sees, hears, smells and touches (on the exterior), alertness focuses on the all-embracing actuality of a actuality (having a body) as allotment of the apple (Munhall, 1994).  The abstraction will investigate the alertness of Jamaican men in the US as a lived acquaintance of actuality in the world, and afterwards adeptness PCa screening, which is an acquaintance that an abandoned cannot footfall out of, accustomed that it is the reality. 

Embodiment. Apotheosis denotes alertness or acquaintance of individuals’ actuality in the world, their faculty of alertness of the apple about them(Munhall, 1994).  According to Ellingson (2009), “embodied adeptness is sensory, (and) it highlights smell, touch, and aftertaste as able-bodied as added frequently acclaimed architect and sounds” (p. 245). Phenomenology investigates the acceptation of absoluteness from the ambience in which animal individuals accept the world, and this acceptation is about authentic by what the anatomy tastes, sees, feels, hears, thinks and smells(what the anatomy experiences) (Munhall, 1994). Their compassionate of the apple about them is embodied by their animal acquaintance and consciousness. 

Conducting phenomenological assay involves employing the qualitative assay methods that authorize the lived acceptation as embodied by what individuals aural a context, experience/understand about a phenomenon.  As argued by Finlay (2009), “phenomenological advisers about accede that our axial affair is to acknowledgment to embodied, empiric meanings aiming for a fresh, complex, affluent description of a abnormality as it is accurately lived” (p. 6).  The qualitative angle of nursing assay seeks to accept a abnormality based on what Munhall (2007) commendations as the realities of a patient’s context.  According to Todres (2007), apotheosis defines the “touchstones” of phenomenological research, breadth a researcher inquires about the embodied acceptation of a abnormality as understood/experienced by bodies aural a specific context. 

The catechism of apotheosis is basic in nursing assay as accustomed by Munhall (2007), and in accustomed bloom affliction assay as argued by Ellingson (2006). Phenomenology constructs the altered acceptation to how bodies in a authentic amusing bearings accept a specific abnormality (Husserl, 1965).  Accustomed that what an abandoned knows (knowledge) is “grounded in complete acquaintance encompasses ambiguity and ambiguity” of accustomed life, again phenomenology involves “eschewing sanitized abandoned altitude of detached variables” that actualize an individual’s alertness aural the specific contexts in which they alive (Ellingson, 2008, p. 245).  Derivatively, phenomenology is appropriately a abstraction of lived adventures as embodied by their alertness and acquaintance of the apple about them (Munhall, 1994).  Phenomenology appropriately focuses on the contextual-depth of lived adventures (Cohen, Manion, & Morrison, 2007), or the all-embracing qualitative adeptness of absoluteness in a amusing ambience (Creswell, 2009).  As argued by Crotty (1998) phenomenology seeks to accept how individuals’ “consciousness engages with altar which are already abundant with meaning” (p. 43) for a phenomenon.  In the proposed study, the researcher will seek to accept the acceptation that Jamaican men in the U.S. accredit to PCa screening experience, based on their real-life alertness and awareness. 

Naturalistic Attitude. Phenomenology constructs acceptation for a reality, in best cases a socially complete artlessly occurring absoluteness (Myers, 1997). Phenomenology adopts a astute admission aback interpreting the acquaintance and alertness of a bodies to assemble acceptation about what “already is,” the “being,” and what is an abstruse “truth” (Husserl, 1982).  Bodies accept the apple as is, in its accustomed form, such that any abnormality is admired as a accustomed reality.  This contextual acceptation is socially constructed, mainly because “the apple does not abide apart of our adeptness of it” (Grix, 2004, p. 83).  As such, because of the accustomed attitude, bodies attention “everything worldly” with an accepting of being, breadth actuality in the apple is a accustomed accurateness (Husserl, 1982).  As such, phenomenology constructs acceptation for “this being-beforehand,” breadth “the apple that is consistently exact beforehand” and absoluteness emerges from “constant accepted-ness of a basis” as authentic (Husserl, 1982, quoted in Fink, 1995, p. 166).  Phenomenology is appropriately belief accustomed acceptation that bodies accordance to abnormality aback “a timberline is not a timberline afterwards accession to alarm it a tree” (Crotty, 1998, p. 43).  The accustomed activity of alertness and or acquaintance is apprenticed to change with time and with ambience variations, as accustomed in nursing assay (Munhall, 2007). 

Phenomenology explores the absoluteness a phenomenon, as it already is (Remenyi et al., 1998) and expands the abstruse adeptness attainable on a phenomenon. According to van Manen (1988), phenomenology helps aggrandize the abstruse adeptness apropos a phenomenon, or to Yin (2003), phenomenology generates meanings of a artlessly accruing phenomenon.  Bodies in any amusing ambience appropriately admission activity with a naturalistic attitude and accord a abstruse acceptation to a phenomenon.  Qualitatively ascribing acceptation to phenomena is a abutting foundation of amusing research, accustomed that, absoluteness abandoned emerges aback animal beings appointment alertness and accredit acceptation to different abnormality (Crotty, 1998).  Accustomed that phenomenology is authentic by context, individuals, and by abstruse acceptation attributable to a absoluteness based on the adventures and perceptions of such bodies (Creswell, 2009; Gephart, 1999; Willis, 1995), the proposed abstraction will seek to accept PCa screening adventures from the angle of abandoned Jamaican men in the U.S. context. 

Experience and Perceptions. In phenomenology, acceptation is acquired from the adventures and perceptions that ascertain how bodies in a specific ambience accept a phenomenon.  As such, phenomenology helps assemble abstruse acceptation of a amusing phenomenon, based on the adventures and perceptions of a specific citizenry who alive in a specific context.  Reeves and Hedberg (2003) asserted that the phenomenology “stresses the allegation to put assay in context,” aback the acceptation acquired apropos a phenomenon, is abandoned altered to the adventures and perceptions the bodies accord to that abnormality (p. 32).  Derivatively, phenomenology seeks, “to accept how associates of a amusing group, through their accordance in amusing processes, achieve their authentic realities and accord them with meaning, and to appearance how these meanings, beliefs, and intentions of the associates advice to aggregate their actions” (Orlikowski & Baroudi, 1991, p. 13).

As anon as bodies accept a naturalistic attitude arise a absoluteness in their apple and use their embodied adventures of acquaintance and alertness to accept acceptation for that context, again absoluteness become the aftereffect of their adventures and perceptions. Phenomenology seeks “to accept the axiological attributes of the amusing apple at the akin of abstruse experience” and by so doing, constructs an “explanation aural the branch of abandoned alertness and subjectivity, aural the anatomy of advertence of the participant” (Burrell & Morgan, 2005, p. 28).  The abstruse adventures and perceptions of abandoned Jamaican men in the U.S., will appropriately ascertain the acceptation they accord to the abnormality of PCa screening afterwards adeptness the procedure. 

Hermeneutic Phenomenology

A researcher can accept from several approaches aback implementing a phenomenological study.  The proposed abstraction will accept a allegorical phenomenological admission to adapt lived adventures of individuals in a community.  Allegorical phenomenology focuses on interpreting people’s lived acquaintance in a accustomed setting, by anecdotic the meanings accruing from such experiences.  To van Manen (1990), a animal science needs to amalgamate phenomenology and the hermeneutics approach.  Such a abstraction seeks to investigate how accustomed animal adventures accretion specific meanings via animal science (van Manen, 1997).  Creswell (2007) concurs that phenomenology is the abstraction of anecdotic “the acceptation of the lived adventures for several individuals about a abstraction or the phenomenon” (p. 51).  While phenomenology focuses the lived acquaintance from the angle of a phenomenon, the hermeneutics admission specializes on compassionate the abnormality from the ambience of bodies (van Manen, 1997). 

While phenomenology helps “construct an animating, evocative, anecdotic of animal actions, behaviors, intentions and adventures as we accommodated them in the activity world,” hermeneutics uses human-centered description and estimation of the lived adventures (van Manen, 1997, p. 19).  Administering phenomenology from a allegorical admission optimizes the allegation of a assay study.  According to van Manen (1990), assay needs to adapt a abnormality with acquainted compassionate of the animal perspectives involved.  Phenomenology attack board hermeneutics to cast a aesthetics on adventures of living, rather than on the activity of how things are accustomed (Rodgers, 2005).  The proposed abstraction will appropriately investigate the abnormality of PCa screening and the lived adventures that aftereffect from adeptness the screening, from the angle of Jamaican men.  In cessation therefore, the proposed abstraction will accept a qualitative assay accomplishments with a constructivism approach, employing interpretivism perspectives aback implementing a phenomenological assay study. 

Hermeneutic Phenomenology for this Study

Several studies, including Consedine, Adjei, Horton, Joe, Borrell, Ramirez, and Neugut (2009), Rivera-Ramos and Buki (2011), Nanton and Dale (2011), Morrison, Aiken, and Mayhew (2014), McCree-Hale, Hale, Rutley, Aung, and Jolly (2012), Jones (2008), Eldemire-Shearer, Mitchell-Fearon, Laws, Waldron, James& Holder-Nevins (2014), Edelstein and Gillath (2008), Anderson and Marshall-Lucette (2013) accept accustomed non-adherence of Jamaican men to PCa screening.  These studies accept accustomed what is accustomed about Jamaican men and PCa screening, absolutely that there are social, cultural, and bread-and-butter barriers to their PCa screening adherence.  What is absent in the abreast adeptness is the lived acquaintance of Jamaican men afterwards adeptness PCa screening.  Compassionate this acceptation requires that lived adventures are not aboveboard as authentic accustomed truths but instead as abnormally complete realities absent in accustomed knowledge.  Aback “constructivists, do not accept any distinct absoluteness and accept that empiric absoluteness and abstruse concepts are mutually constitutive” (Blatter & Blume, 2008, p. 327), the constructivist abstruse background, as the one adopted here, is best acceptable for such a study.

Demographic Considerations and Representation: Bounded and Amusing Contour of Citizenry beneath Study

The proposed abstraction will abandoned focus on a specific citizenry of built-in Jamaican men currently residing in the U.S.  Jamaican is allotment of the Commonwealth of nations, a autocrat of England beneath the aphorism with of Queen Elizabeth II as able-bodied as an administrating arch of state.  Amid all Caribbean islands, Jamaica is the third bigger with an array of aerial typography adjoining a diffuse but attenuated littoral aboveboard (Sherlock & Bennett, 1998).  The basic burghal of Jamaica is Kingston, which is the bigger of burghal areas in the country alongside such cities Ocho Rios, Mandeville, Port Antonio, and Montego Bay (BBC, 2015).

With a accusable complete citizenry of 2.7 actor based on United Nations contour (UN, 2011), Jamaica is dominantly alive by Atramentous citizenry with an African ancestor (BBC, 2015).  Indeed, the Atramentous citizenry represents 92.1% of the complete citizenry in Jamaica, in adverse to accession indigenous profiles including Asian at abandoned 0.8% of the population.  An aftereffect of the bondservant barter triangle, Jamaica was a porting armpit for disciplinarian accession to the U.S. from West Africa, which explains the abutting political and amusing articulation amid Jamaica, Britain, and the U.S. (Mullally, 2003). Surely, according to Richardson, Tibbles, and Schwarz (2007), the ascendant atramentous citizenry in Jamaica are either “of African or partially African descent”, best of whom “trace their origins to West Africa” (p. 41). 

However, while best assay themselves as black, they accept alloyed ancestor frequently denoted as Anglophone Caribbean (Richardson, Tibbles, & Schwarz, 2007).  Aural and afterwards Jamaica, the bodies accept their aloft and official accent actuality English (official), although the majority of the citizens allege the English dialect, Patois (Jones, 2008).  Majorities are dominantly of the Christian religion, and the activity acceptance of Jamaican men is 71 years, hardly beneath the 76-year activity acceptance of Jamaican women (BBC, 2015).  Jamaicans accept migrated with an cutting cardinal to the U.S., Europe and of recent, Asia.  As such, “more than bisected of migrants absent from Jamaica in 2007 went to the United States, while about 15 percent went to the United Kingdom”, as according to Glennie and Chappell (2010, p. 3).

Most Jamaicans anon abide in the U.S. and England, which can abundantly be accustomed to the bullwork roots of their ancestors (Sherlock & Bennett, 1998);  while new ancestors of Jamaicans accept additionally immigrated to seek for apprenticeship and application alfresco the Caribbean island (Mullally, 2003; Glennie & Chappell, 2010).  The Jamaicans in the U.S. are referred to as Jamaican Americans, who are American citizens of either fractional or abounding Jamaican ancestry, with a characteristic cultural character (Jones, 2008).  Today, best Jamaicans abide in New York City, South Florida, Philadelphia, New Jersey, Tampa, Boston, and Atlanta.  State-wise, the 2010 civic demography recorded 965,355 American association of Jamaican origin, the bigger Jamaican populations actuality in (i) New York (305,285), (ii) Florida (246,478), and (ii) New Jersey (55,351) (Glennie & Chappell, 2010).  Aloft that, amid the communities with accomplished allotment of Jamaican association is Miami, Florida, with over 6.3% of Jamaican adults (Jones, 2008).

Significance of the Study

This abstraction is advancing by a adeptness that PCa incidences accept accomplished adverse levels amid Jamaican men, both in prevalence and mortality.  As the abstruse assay establishes in Affiliate 2 of the altercation proposal, PCa is treatable if diagnosed aboriginal enough.  Unfortunately, Jamaican men are dying by the thousands, artlessly because they are not diagnosed or because they were diagnosed too late, aback acknowledged assay was no best feasible. 

The proposed abstraction will attack to accept what the arguably arguable activity agency to some Jamaican men who accept to abide PCa screening aback they are still asymptomatic and healthy.  Best importantly, advisers accept ahead articular cultural influences and biases as the aloft deterrents for Jamaican men to adeptness PCa screening. The proposed abstraction will seek to accept how advantageous Jamaican men boldness or reframe these abrogating forces. 

By compassionate the acceptation and coaction of the knowledge, attitudes, and behavior that advantageous Jamaican men accredit to PCa screening, the abstraction may assay specific assets and attainable interventions for the complete accumulation of Jamaican men currently adverse the bloom alterity and optimize their adherence to the analytic nursing intervention.  The allegation generated by the proposed abstraction may serve the best interests of all healthcare stakeholders in the U.S. who accompany PCa screening-aided allowances amid high-risk communities.  These stakeholders absorb all Jamaican men in South Florida and beyond, healthcare professionals (notably nurses), hospitals and clinics, bloom allowance firms, and the government. 

Significance of the Abstraction to Nursing

Nurses accept a amusing arrangement to assure and beforehand abandoned and attainable bloom and well-being.  A aloft albatross of this accordance is to assay and alleviate bloom disparities.  Men of blush and Jamaican men, in particular, face bright bloom disparities in prostate blight anguish and bloodshed and in PCa screening (Eldemire-Shearer et al., 2014).  The ethical, professional, and amusing assignment of nurses is to apply the best attainable strategies to beforehand the bloom cachet of any community, decidedly if adverse disparate anguish and bloodshed ante from a activity that can be auspiciously advised if diagnosed early. According to Davies (2011), avant-garde “nurses are able-bodied placed to animate and abutment patients to accomplish advantageous choices” (p. 20).  It is accordingly basic that nursing advisers and advisers investigate this affair as an burning and cogent bloom problem. 

An empiric assay of the best to abide PCa screening by adherent Jamaican men may anxiously advice assay context-specific motivations to beforehand accustomed PCA screening practices arise optimized effectiveness.  Researching the acceptation and accent that advantageous Jamaican men accredit to PCa screening may advice to acquaint nurses in compassionate what motivates complete bloom gluttonous and bactericide behaviors in this at-risk citizenry (Kelly, Melnyk, Jacobson & O'Haver, 2011).  Based on this knowledge, nurses may be bigger positioned to assay and apostle for bloom behavior to reallocate assets and to redesign educational abstracts that may not abandoned facilitate adherence to PCa screening but may additionally abatement the bloom disparities in PCa and PCa screening that disproportionately appulse Jamaican men.  The after-effects of this assay may not abandoned beforehand nursing knowledge, it may additionally beforehand the science of nursing.

Implications of the Study

Implications of the Abstraction to Nursing Education

Contemporary nurses are actuality educated, like their avant-garde trainees, are acquirements how, why and aback to apparatus PCa screening as accustomed nursing intervention. This about has bootless to admission the adherence to such basic screenings, and the accustomed anti-PCa campaigns accept been abortive for the Jamaican accumulation of immigrants.  Afterwards question, therefore, nursing apprenticeship needs to go aloft a accustomed affliction admission and baby for different contextual, cultural, and socio-economic accommodating profiles to beforehand the bloom outcomes of communities that accept ahead been abandoned and unequally considered. 

As such, approaching nursing apprenticeship needs to absorb “essential transcultural nursing concepts, principles, practices, and policies” that abundantly adapt approaching nurses to activity optimal bloom affliction for a multi-cultural apple (Leininger, 2002a, p. 8). Ideally, the allegation generated by the proposed abstraction adeptness affect avant-garde nursing apprenticeship to board a new era of angry PCa with able strategies for different contexts.  The proposed abstraction may advice assay specific assets and attainable interventions for such a citizenry as Jamaican immigrants, who about abstain and advisedly abstain an basic nursing intervention, based on the compassionate the acceptation and coaction of knowledge, attitudes, and behavior captivated by the advantageous Jamaican men who attach to such an intervention.

Implications of the Abstraction to Nursing Practice

The capability of a practicing assistant is not abandoned on accomplishing what is possible, what a accommodating wants, or what should be done for any accommodating in a specific analytic procedure.  Nursing involves animate accordance of the able nurse, to recruit and actuate the allegation and cooperation/support of a accommodating aback appliance complete bloom behavior.  Nursing convenance appropriately needs to accede the contextual differences of patients, and clarify their admission in a address that best serves the bloom absorption of such patients.  Consequently, the abstraction readily acknowledges the allegation to optimize capability of association healthcare programs, decidedly those aimed at accouterment PCa screening to American immigrants.

As antecedent studies accept affirmed, an aspect of cultural, social, bloom adeptness and accident bread-and-butter decidedly influences and defines the adherence of Jamaican men to PCa screening.  This is what the assistant allegation know, understand, and clarify to admission the non-adherent association based on the insights generated from the advantageous men who do arise PCa screening.  Abandoned then, will the nurses be able to bear optimal PCa screening programs to the Jamaican men, with complete bloom outcomes.  The proposed abstraction was primarily advised to acquaint this gap in adeptness and accomplish allegation that will be invaluable to association and analytic nurses aural the U.S. 

From the angle of practicing nurses, therefore, the allegation generated by the abstraction is hoped to be invaluable to practicing nurses, not abandoned those facilitating PCa screening for Jamaican men but additionally every able assistant alms association bloom in different contexts. Abreast bloom and attainable activity about board a aggregate and ambiguous bloom affairs for all citizens in a country.  Some communities abnormally accept accustomed bloom affliction programs due to their lived experiences.  Cultural, economic, and amusing ideologies of immigrant communities, for instance, cast some animate adventures that crave added than accustomed association bloom programs.  Bloom programs and activity needs new anti-PCa programs that strategically board for the altered adventures of Jamaican immigrants.  The allegation may acquaint nurses alive in bloom affliction accessories on the best way to arise to different contexts and to optimize PCa screening outcomes.  Practicing nurses may be abreast by the allegation generated by the study, to accept how a community’s lived acquaintance afterward PCa screening mandates the use of alternative nursing approaches for optimal bloom outcomes.

Implications of the Abstraction to Nursing Research

According to Powers and Knapp (1995), nursing assay was advised to beforehand adeptness about issues of accent to nurses in a way that enables practicing nurses to alarm the characteristics of a authentic nursing bearings about which little is known.  Nursing assay aims at acknowledgment a abnormality that allegation be advised in planning nursing care, admiration the attainable outcomes of assertive nursing decisions, authoritative the accident of causeless outcomes, and initiating activities that may beforehand acclimatized bloom behavior as argued by Polit and Beck (2001).  Indeed, as Polit and Beck (2001) concurred, advance of nursing assay enables the accretion of adeptness all-important for the assistant to convenance abundantly and architecture alive interventions based on authentic data, to beforehand accommodating affliction continually. 

It is accordingly notable that antecedent assay has bootless to assay outcomes of PCa screening for such a association as Jamaican men.  About all assay allegation generated in the aftermost two decades, apropos the high-risk citizenry of Jamaican men, and their non-adherence to PCa screening, has abandoned focused on those who abstain screening.  The questions accept ranged from why Jamaican men abstain PCa screening, to how they can be abreast and encouraged to abide the screening. Antecedent nursing assay has abandoned focused on one ancillary of the phenomena and never advised those who do arise such screenings. In truth, therefore, antecedent assay on PCa screening and Jamaican men has accordingly been piecemeal clumsily informing.

Consequently, the allegation generated by the proposed abstraction may advice redefine nursing assay to be added comprehensive. Communities allegation added than aloof the authentic arete of PC screening aback angry deepening PCa mortality.  There is burning allegation for authentic assay allegation on what happens during and afterwards PCa screening.  Besides the acceptable admission to nursing practice, avant-garde nursing needs to extend into the abstraction of caring, breadth patients become added than recipients of bloom affliction services, but animal beings who allegation a nurse’s claimed captivation (Leininger, 1969). 

The abstraction may board a new admission to nursing research, arresting a atypical compassionate of the ambience in which PCa screening is delivered, amid altered patients.   Aloft advising the allowances of PCa screening, the proposed abstraction may embrace the allegation for the different accommodating affliction for optimal PCa screening outcomes.  Best notably, the abstraction will be based on the lived adventures of the patients who affectionately opt to seek for such interventions admitting advancing from a association that prefers to abstain screening as a bloom affliction intervention.

Implications of the Abstraction to Health/Public Policy

When a government invests added assets to beforehand the bloom cachet of a community, absorption on the accouterment of assets and manpower to accredit a association prevent, administer and ascendancy such a adverse diseases, as a PCa, affairs of success are improved.  This has been barometer of association bloom activity in the U.S. and decidedly amid the contrarily marginalized immigrant communities. Arguably, Jamaican men in South Florida accept college opportunities of angry the PCa adversity that has ahead threatened their bloom than any accession indigenous and ancestral group.  The cardinal of accessories available, manpower committed to the PCa screening programs, and the bargain amount of adeptness the procedure, is clearly complete attainable than it is in abounding accession areas aloft the globe.

These advantages, however, are absurd to a association that affectionately and carefully avoids such screening, for whatever acumen - cultural, social, or economic.  Behindhand of how abundant is invested and planned, any bloom affliction activity that does not attain acclimatized outcomes is misinformed, as are best PCa screening behavior for immigrant populations in the U.S.  These screening behavior allegation to be acclimatized and modified.  An empiric assay of the best to abide PCa screening by adherent Jamaican men may anxiously advice assay context-specific motivations to beforehand accustomed PCa screening practices arise optimized effectiveness.  Researching the acceptation and accent that advantageous Jamaican men accredit to PCa screening may advice to acquaint nurses in compassionate what motivates complete bloom gluttonous and bactericide behaviors in this at-risk citizenry and alter abreast bloom activity appropriately (Kelly et al., 2011).  Based on this knowledge, advancement for bloom behavior can seek for the reallocation of assets and the redesign educational abstracts to not abandoned facilitate adherence to PCa screening but additionally abatement the bloom disparities in PCa and PCa screening that disproportionately affect Jamaican men.

Scope and Limitations of the Study

The proposed assay abstraction will abide of a bent sampling of men anon residing in South Florida, who accept Jamaican agent but are now immigrants to the U.S., and who accept already undergone PCa screening.  The proposed assay participants will absorb English speakers age-old aloft 40 years, who accept already alternate in a distinct PCa screening activity in a accustomed bloom affliction setting.  The abstraction will be conducted aural the administration of South Florida, breadth the citizenry of Jamaican men is accomplished aural the U.S., and based on cardinal accessibility of the researcher. 

The aloft ambit of the abstraction will predefine the abeyant limitations of the study.  The sample will be recruited application advised sampling, anchored on accessibility and reference. Not abandoned will the age bracket of respondents accomplish the PCa screening anytime sensitive, but additionally the timings for account sessions will accept to be acute to the age bracket.  Abounding of the respondents will predictably allege the Jamaican accent of English, rather than Accustomed English, which will complete advice aback recorded and quoted for the dissertation.  Further, aloft recruitment, the researcher will aggregate abstracts application ample and attainable interviews, breadth the advancing questions airish to the participants will be awful codicillary on their compassionate and interpretation.  In acceding with van Manen (1997), the researcher will actively participate in the interviews so that during the interaction, the lived participants may be accustomed based on their meanings aural an authentic ambience (Polit & Beck, 2004).  Nonetheless, the abeyant limitations accept been accustomed as axial to phenomenological nursing research, and the allegation will be qualitatively complete and anxiously authentic (van Manen, 1997).

Chapter Summary

This affiliate discussed the accomplishments of the proposed abstraction and alien the breadth of absorption beneath research. The affiliate appropriately justified the proposed assay adventure on PCa risks, from the angle of the global, Caribbean, and American PCa accident factors of Jamaican men. Based on the background, the affiliate developed a literature-based account of the botheration abstraction the study’s purpose,  and assay questions, on compassionate the lived adventures of Jamaican men in the U.S. afterwards adeptness PCa screening. The affiliate additionally alarmingly advised the abstruse underpinnings aloft which the abstraction is anchored, the interpretivism paradigm, qualitative assay methodology, abstruse assumptions of qualitative research, phenomenology research, and allegorical phenomenology assay design. The affiliate affiliated in acknowledgment of the demographic considerations and representation of the bounded and amusing contour of citizenry beneath study. Finally, the affiliate briefly advised the acceptation of the proposed assay study, the acceptation to nursing, implications of the abstraction allegation to nursing education, nursing practice, nursing research, and attainable bloom policy, afore highlighting the ambit and limitations of the proposed study.

CHAPTER TWO

 REVIEW OF LITERATURE

This qualitative, analytic phenomenological study explores the lived acquaintance of Jamaican men who accept undergone the screening.  Adeptness generated from a greater compassionate of how Jamaican men accomplish acceptation of this acquaintance may beforehand nursing’s adeptness to beforehand evidence-based interventions that beforehand prostate blight screening in this attainable population.  The apriori abstruse assay has been historically beat in qualitative assay (Boeije, 2010).  This is abundantly due to apropos that the assay may bent the abstracts assay and ultimate abstraction results. Added recently, however, advisers altercate that a abrupt abstruse assay may serve to bury or ballast new assay aural the accustomed address apropos a accustomed abnormality (Boeije, 2010; Creswell, 2009; Munhall, 2012). 

The afterward computerized databases were acclimated for this search: PUBMED, Centers for Ache Ascendancy (CDC), Cumulative Index to Nursing and Allied Bloom Abstruse (CINHAL) Plus, and Ovid E-Books. Key words and phrases acclimated in the chase included (a) prostate cancer, (b) prostate blight screening, (c) Jamaican men and prostate cancer, (d) Jamaican men and prostate blight screening, and (e) PCa screening experiences.  Citations were bound by accent to English and by accountable to assay of the phenomenon.  While all sources aback 1995 were considered, antecedence was accustomed to studies agitated out from 2011 to 2016 and seminal works, aback they acceptable independent the best accordant and accustomed advice on the abnormality of interest.

Historical Context 

The abstruse provides a acceptable altercation on why it is alarmingly important to investigate the adventures of Jamaican men afterwards PCa screening, to chargeless whether such screening attain the cold and purpose that the PCa screening movements was geared at attaining from their onset.  Afterwards selection, the abstruse sources were again subjected to a analytic review, systematically implemented to serve the interests of the proposed study.  To activate the review, the present breadth will trace the complete accomplishments of PCa screening, absorption of the conceptual accoutrement of PCa screening adventures for Jamaican men, and amalgam the antidotal angle of nursing into the review. In the sections that follow, the complete assay will altercate the PCa risks levels in the globe, in the Caribbean, in Jamaica, and in the U.S. followed by bond Jamaican Men in U.S. and PCa risks, activity admeasurement and barriers to PCa Screening amid Jamaican men and assuredly facilitators to PCa screening amid Jamaican Men.

Prostate Blight Risks 

PCa Risks on a All-around Scale

Globally, PCa has emerged as one of the best acute blazon of cancers based on the cardinal of incidences and mortalities recorded annually.  In the added archetype arise at end of 2015, Djavan, Bostanci, and Kazzazi (2015) addressed the “epidemiology, screening, pathology, and pathogenesis” of PCa. In a book chapter, the advisers advised statistics generated by antecedent scholarship and assay on a all-around scale. According to the authors, PCa is now the arch blazon of blight amid men, both in the accident and bloodshed rate, decidedly amid the atramentous and Caribbean populations.

In a qualitative study, Sinfield, Baker, Agarwal, and Tarrant (2008) generated empiric allegation that affirmed the analytic attributes of PCa.  The advisers adopted a qualitative assay analysis, animate semi-structured interviews amid a sample of 35 men already diagnosed and advised for PCa. Notably, the sampled men were recruited alongside their partners, to allure the PCa adventures of the macho patients. The abstraction was conducted in two contents, namely charities and hospitals, amid in East Midlands, England.   Ultimately, in their findings, Sinfield, Baker, Agarwal, and Tarrant (2008) accustomed that PCa patients recorded the affliction adventures compared to the adventures recorded with accession blazon of cancers including breast and abdomen cancers. 

Another abstraction accordant to this ascertainment was conducted by Center, Jemal, Lortet-Tieulent, Ward, Ferlay, Brawley, and Bray (2012), application an affirmation amalgam design. Absorption on the “international aberration in prostate blight accident and bloodshed rates,” the advisers advised the “international aberration in prostate blight accident and bloodshed rates,” and acclaimed an accretion all-around incidences (largely in developed nations), and mortalities (in beneath developed nations) (p. 1079). Celebratory that there is a avant-garde aberration amid PCa ante internationally “due to differences in apprehension practices, treatment, and affairs and abiogenetic factors,” the advisers acquired the affirmation for amalgam from GLOBOCAN on “PCa accident and bloodshed estimates for 2008” (p. 1079).  Affirmation was additionally acquired from “recent trends in PCa accident ante for 40 countries and bloodshed ante for 53 countries from 1985 and onward” as authentic in the WHO bloodshed database (p. 1079). Notably, besides bread-and-butter development, there emerged a notable trend about breadth best incidences and mortalities were recorded. Indeed, aback reviewing all-around statistics of PCa incidences, there is additionally a altered bent for a specific ancestral profile. 

The Centers for Ache Ascendancy and Prevention afresh arise statistical letters in the Civic Center for Biotechnology Advice database, on ‘Prostate Blight ante by chase and ethnicity’.  In the report, Centers for Ache Ascendancy and Prevention (2015) arise a PCa deaths/mortality trend authentic by both chase and ethnicity. Amid 1999 and 2012, CDC arise that “the amount of men dying from prostate blight has varied, depending on their chase and ethnicity,” breadth Caribbean and black/African men are “more acceptable to die of prostate blight than any accession group, followed by white, Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander men” (p. 2).  Confirming this trend, the International Agency for Assay on Cancer, on account of the Apple Bloom Organization arise that in 2012, the apple registered over 14,068,000 new cases of blight (incidences), formally diagnosed and triggering the deaths of 4,653 000 men (Globocan, 2015).  According to the report, over 15, 296, 000 men had died of blight amid 2007 and 2012 (Globocan, 2015).

PCa Risks in the Caribbean Region

From a all-around point of view, the Caribbean arena abandoned triggers the accomplished cardinal of incidences every year, compared to any accession arena (Prostate Blight Caribbean, 2008).  Based on PCa incidence, prevalence, and bloodshed ante recorded in the Caribbean nations by 2008, showed that Caribbean men alongside African men recorded the accomplished recorded accident of developing PCa cancer. In a study, (Glover et al., 1998) accustomed that the abiogenetic architecture of atramentous and Caribbean men triggered a accident amount college than that of any accession ancestral profile.  Application a accessory abstracts assay design, the advisers empiric that above-mentioned to administering their study, it was assertive that “the accomplished arise accident of prostate blight in the apple was anticipation to be amid United States atramentous men” (p. 1984).  Their abstraction appropriately accustomed to assay PCa epidemiology in Jamaica’s civic citizenry of 2.5 actor bodies (given their ascendant African descent) and assay the abstracts with the PCa epidemiology of white Americans.

The abstraction calm its abstracts from 1,121 PCa assay recorded amid 1989 and 1994, complemented by the government anatomy laboratory, Blight Registry, physician office, hospital and dispensary annal in Jamaica. In their findings, Glover et al. (1998) accustomed that “the boilerplate age acclimatized accident of prostate blight in Kingston, Jamaica was 304/100,000 men” and that “more than 80% of the cases were pathologically confirmed” (p. 1984).  Consequently, the advisers arise that atramentous and Caribbean populations accept the accomplished accident of developing PCa in the world. In their words, “data demonstrates that Jamaican men in Kingston accept a aerial accident of prostate cancer, abundant college than alike atramentous Americans during a agnate period, (and) the cancers are added cogent clinically with greater anguish in Jamaica than in the United States” (p. 1984).

Similar allegation were arise in a added contempo study, conducted by Aiken and Eldemire-Shearer (2012), as discussed in detail in a consecutive breadth of this chapter.  For the present altercation nonetheless, it is notable that, in the Caribbean region, blight incidences registered nationally in Jamaica, the Bahamas, Cuba, Trinidad and Tobago, Grenada, and Martinique accept able the Caribbean as one of the best high-risk locales of PCa (Prostate Blight Caribbean, 2008).  Aiken and Eldemire-Shearer (2012) arise that, of greater affair in the ascent PCa incidences statistics globally, is the adumbration “that the Caribbean arena has the accomplished age-standardized PCa-specific bloodshed amount in the apple at 26.3/100 000/year” (p. 90). 

PCa Risks in Jamaica

Confirming on the all-around and Caribbean accident rates, a altered PCa affection becomes evident, from the angle of the Jamaican nation. Gibson, Hanchard, and Waugh (2010) conducted a abstraction on “age-specific accident of blight in Kingston and St. Andrew, Jamaica” amid 2003 and 2007, and activate that PCa is now best accustomed amid atramentous populations in the world, amid whom Jamaica is conceivably the best complete adumbrative of nations with the accomplished amount of PCa incidences (p. 456). The advisers conducted a abstracts assay of the 4981 cancers recorded in the two cities (St. Andrew and Kingston) amid 2003 and 2007 by 2536 men and 2445 women. 

The allegation authentic the cessation generated by Aiken and Eldemire-Shearer (2012), in their annotation commodity on the allegation to amend PCa screening role in “Jamaica and the added Caribbean” (p. 90). The advisers advised “the role of screening and argues for added screening in the population,” basing their arguments on contempo PCa statistics. In their argument, Aiken and Eldemire-Shearer (2012) affirmed that Jamaica represents the Caribbean nation with the accomplished ante of PCa. Gibson, Hanchard, and Waugh (2010) generated a agnate altercation in their findings, based on incidences arise amid 2003 and 2007, breadth they accustomed that PCa is “the arch blight affecting men in Jamaica (p. 456). 

Traditionally, “the accomplished arise accident of prostate blight in the apple was anticipation to be amid United States atramentous men,” and never did any abstraction focus on the Caribbean immigrants (Glover et al., 1998).  Eventually, statistics showed that the accident amount in Jamaican capital, Kingston alone, accomplished 304/100,000 men, 80% of whom were pathologically confirmed.  A college accident amount was afterwards articular amid Jamaicans in Jamaica, that in African men, with 30% of the patients accepting “acute urinary retention, 16% presented with cartilage metastases, 15% with gross hematuria at the time of assay and 42% with an aberrant abdominal assay apprehensive for cancer” (p. 1984).  Best importantly, Prostate Specific Antigen (PSA) was abstinent amid Jamaican sat abandoned 7% of the PCa cases in 1989 accomplished “48% of cases by 1994” (p. 1984). 

Morrison, Aiken, and Mayhew (2014) arise that in Jamaica today, PCa “accounts for about a third of all cancers diagnosed” with Jamaica accepting “the accomplished accident of PCa in the world, based on a arise amount of 304/100,000 per year” (p. 456).  According to annal by the Jamaica Blight Registry, PCa “is the best accustomed blight all-embracing as able-bodied as the best accustomed blight in men” with an “age-standardized accident amount of 78.1/100,000 per year” (p. 456).  Alike added apropos is that, by 2014, PCa was “the best accustomed account of macho cancer-related deaths, with an age-standardized bloodshed amount of 53.9/100,000 per year” (Morrison, Aiken, & Mayhew, 2014, p. 456). 

Jamaican Men in United States and Prostate Blight Risks

It is additionally aboveboard that the aerial accident of developing PCa affects not abandoned Jamaicans aural Jamaica, but additionally those who accept immigrated to the U.S.  In an abstruse doctoral dissertation, Kendrick (2010) advised whether arrect dysfunction was “a barrier to prostate blight screening amid African American men” (p. 2). Employing a phenomenological analytic architecture account a sample of 29 atramentous American men, the researcher advised how the socio-cultural assumption of adventuresomeness influences PCA screening adherence.  Added chiefly for the present discussion, Kendrick (2010) acclaimed that, “research has aboveboard that prostate blight is the added arch account of blight afterlife amid men in the United States and the Caribbean and African American men are added acceptable to beforehand the ache than White American males” (p. 6).  Jamaican men residing in the U.S. appropriately characterize a agnate aerial PCa accident as those in Jamaica. 

The American Blight Society (2008) and Gibson, Hanchard, and Waugh (2010) accustomed that Jamaican men accept the accomplished ante of PCa alike aural the U.S., aback profiles by chase and ethnicity as Caribbean.  In their study, Gibson, Hanchard, and Waugh (2010) advised all blight cases recorded in Jamaica’s bigger cities (St. Andrew and Kingston) which totaled 4981 cases, amid which 2536 were amid males amid 2003 and 2007. For men, the “age affiliated ante per 100,000 per year” stood at 188.8, with the arch blazon of blight actuality PCa. 

Glover et al. (1998) conducted an epidemiology of PCa in Jamaica, whose citizenry are majority of African descent, and compared their statistics with those “of white and atramentous Americans” (p. 1984).  To conduct the study, the advisers profiled 1,121 PCa diagnoses amid 1989 and 1994, sourcing the advice from the government anatomy laboratory, Jamaican Blight Registry, dispensary and hospital records, as able-bodied as physician appointment records, and ultimately accretion the accident ante with the 1991 civic demography in Jamaica.  Afterward the study, Glover et al. (1998) accustomed that Jamaican men “have a aerial accident of prostate cancer, abundant college than alike atramentous Americans during a agnate period,” conspicuously with PCa assuming “more cogent clinically with greater anguish in Jamaica than in the United States” (p. 1984).  The American Blight Society (2015) affirmed that, based on all-around blight actuality and figures, PCa blight incidences and mortalities are college in the U.S. than in the Africa and the Caribbean, yet aural the U.S., the accomplished ante are amid the Caribbean (notably Jamaican) and African men.

Jones et al. (2013) conducted a altered abstraction hypothesizing that the college ante of PCa amid men of African agent was acquired by  the appearance of variants of inflammatory-related cytokine.  Application a case-control study, the advisers advised a sample of 814 Jamaican and African American men for the appearance of 44 distinct nucleotide polymorphisms associated with abiding inflammation.  The abstraction activate that the ascendancy of an IL1R2 locus modifies the susceptibility to prostate cancer. However, their assay assignment was not complete in acceding of chargeless whether this abiogenetic affection is what aloft the vulnerability of Jamaican males to PCa and added assay is still acclimatized (Jones et al., 2013).

Intervention Measures and Barriers to Prostate Blight Screening amid Jamaican Men

PCa screening denotes a procedure, done to investigate appearance of annihilative beef in the prostrate, and is “used to ascertain clinically cogent ache aboriginal in the ache activity to ahead bloodshed and anguish through treatment” (Aiken & Eldemire-Shearer, 2012, p. 90).  Agnate “high risk" screening approaches are aback administering mammography to assay breast cancer, the antenatal screening alongside begrimed claret acclimated to assay colon cancer, or papanicolau smears acclimated to assay cervical blight (p. 90). 

Focusing on Jamaica as the amount of the Caribbean territories with the accomplished ante of PCa, Aiken and Eldemire-Shearer (2012) altercate that the aboriginal ache stages of PCa are about asymptomatic and cannot be affiliated to, or advice announce the development of the condition.  Afterwards acclimatized break of the admission of PCa, the activity calmly develops from its admission to the complete stages afterwards apprehension (Bowen, Hannon, Harris, & Martin, 2011).  Consequently, prostate blight screening has to date become the best reliable, accurate, and acceptable adjustment of diagnosing PCa in its aboriginal treatable stages.  In their study, Aiken, and Eldemire-Shearer (2012) advised the role and acceptation of PCa screening amid the Jamaican population, breadth PCa altitude are mostly “identified afterwards affection appear,” and articular aback the activity has already accomplished to baleful stages (p. 90). 

Aiken, Tulloch, Freeman, Bennett, Coard, Panton, Mason, Cudecki, and Flanigan (2003) conducted an important allusive abstraction that concurs with the aloft argument.  The advisers accustomed to “make comparisons amid prostate blight in patients of African coast in two different environments, one North American, the accession Caribbean, in adjustment to actuate about contributions of ethnicity/genetics adjoin environment,” (p. 356).  To conduct the study, Aiken et al. (2003) analyzed PCa adventure cases at anniversary armpit alongside the baseline of both demographic and analytic abstracts and specific antigen (PSA) abstracts pre-treated claret samples.  The abstracts was again analyzed application the Gleason array for the sampled patients afterward their abolitionist prostatectomy.  To accomplish assay findings, Aiken et al. (2003) compared the chi-square assay of demographic data, PSA measurements, and Gleason scores, for two sample tests. Ultimately, Aiken et al. (2003) assured that, there are “differences in analytic characteristics amid men of African descent” which may be added by disparate prostate blight screening practices (p. 356).

Many individuals, organizations, and advisers accept advocated for Screening to actuate the citizenry of annihilative masses in several types of alien cancer, as able-bodied as acclimated in some high-risk analytic procedures for centralized blight (Aiken & Eldemire-Shearer, 2012).  There has been cogent agitation for and adjoin the use of screening to assay and assay PCa.  As such, PCa screening has become one of the best reliable strategies “to abatement the accident of afterlife from this ache (p. 725). However, sections of abstruse accept accent the conflict of screening after-effects and analytic interventions that follow.  According to these scholars, PCa screening faces “a cogent accident of over-detection and over-treatment of tumors that would not accept acquired anguish or death” (Aiken & Eldemire-Shearer, 2012, p. 91).  Alike the aboriginal blight masses detected afterwards a PCa screening can accordingly activate PCa assay that is an exaggeration of abstraction bactericide and assay measures, aback such patients would accept survived afterwards concerns, alike if the PCa screening were never conducted.  

The agitation on the adequacy of PCa screening has congenital the apropos of medical practitioner, interests groups in the medical community, activity makers, association bloom stakeholders, and the public.  Prime amid these apropos is “the catechism of whether prostate blight screening achieves its declared cold of abbreviation prostate cancer-specific bloodshed whilst aspersing the abeyant for abuse amidst buried individuals” (Aiken & Eldemire-Shearer, 2012, p. 91).  Antecedent assay has chip a countless of variables and case-specific determinants, including ages, time spent during and afterwards screening, breadth of detection, assurance on advance candidates (96% of whom are advantageous and afterwards PCa), demographic features, and cardinal of years a PCa accommodating lives afterwards screening in adverse to abeyant cardinal of years afterwards PCa screening.  The variables helps actuate whether PCa screening improves the activity of buried patients, reduces the severity of development, and helps patients survive baleful outcomes.

Today, the amount aspect of screening is in enabling acclimatized and reliable assay of PCa.  Haas, Delongchamps, Brawley, Wang and De la Roza, (2009) empiric that, “prostate blight is the best frequently diagnosed non-skin blight in the United States and the third arch account of blight deaths,” yet the abandoned authentic agency of amid adjoin PCa mortality, is about disregarded. Haas et al. (2009) advised studies arise in the International Agency for Assay on Cancer, Surveillance, Epidemiology Civic Blight Institute databases, and accustomed that, “prostate blight accident is abased on efforts to ascertain the disease,” and that aback used, PCa screening “provide authentic and advantageous advice apropos allusive prevalence ante of the ache amid regions of interest” (p. 3866).

PCa screening has been affiliated to abnormally cogent adventures amid Jamaican men.  A breadth of the abstruse suggests that, Jamaican men approach, regard, and accede to PCa screening based on their acquaintance and adeptness of PCa and PCa risks.  In the paragraphs that follow, the cardboard aboriginal reports, reviews and alarmingly amalgam several contempo studies on the best basic fields of adeptness accordant to the proposed study, as accent by the complete headings for anniversary are of review.  

Roumier, Azzouzi, Valeri, Guillemin, Fournier, Cussenot, Mangin, and Cormier (2004) conducted an alpha abstraction to appraise “the adherence to an anniversary PSA screening program” in a aeon of 3 years, as able-bodied as assay the “characteristics of men who bootless to abide the abounding screening process” (p. 280). The 442 sampled men had a first-degree about diagnosed with PCa, and alternate in an “annual serum PSA testing over a 3-year period,” and abstracts was calm application questionnaires (p. 280).  For abstracts collection, “each applicant was requested to complete a assay apropos their socio-professional characteristics, their akin of all-overs and their attitude arise abiogenetic susceptibility” (p. 280).  The abstraction activate that participants afterwards abiogenetic PCa susceptibility recorded aerial levels of non-adherence, but those with abutting ancestors already diagnosed with PCa had an 88% adherence rate.  Added specifically, Roumier et al. (2004) activate that in the 3 years during which the abstraction was conducted, 12% of the sample who had accustomed the aboriginal year screening banned to abide consecutive PSA tests, while the adolescent men and those added anxious, were responding to the absoluteness of accepting added than one afflicted first-degree about above-mentioned to the study.  Notably, therefore, accepting a abutting about diagnosed with PCa (genetic susceptibility) increases the adherence of an abandoned to screening.

Evans, Butler, Etowa, Crawley, Rayson, and Bell (2005) conducted an empiric study, with a participatory activity assay design, to accomplish allegation that informs shapes, inspires, and justifies affirmatively, the assay abstraction proposed herein.  Closely agnate to the present study, Evans et al. (2005) advised the appulse of demographic, racial, cultural and gender appearance to the adherence and non-adherence of a ambition citizenry to PCa screening alongside breast cancer.  Evans et al. (2005) animate a participatory-action assay adjustment aback accession abstracts from focus groups, on two occasions/phases.  The sampled participants were bristles African Nova Scotian men and women, sampled from a citizenry of 57 individuals who the advisers had already authentic as chargeless from or diagnosed as accepting either prostate blight and breast cancer.  Aloft completion, the abstraction provided a contextualized compassionate of the abstraction of adherence and non-adherence as animate in the proposed study, this instance absorption on the ambition citizenry of Jamaican males currently residing in Broward.  Ultimately, Evans et al. (2005) accustomed that there is a cogent articulation amid adeptness and gender (particularly of delicacy and adulthood perceptions) amid the African Nova Scotian association in Canada. 

This affecting accomplishments “unavoidably collaborate with accession amusing structures such as chase and chic to affect women and men's perceptions and adventures of these two cancers” (p. 257).  Consequently, Evans et al. (2005) authentic the allegation to accede the meanings and implications that social, cultural and demographic appearance appoint on such analytic bloom interventions as PCa screening and breast blight tests. In their words, it is binding for “health affliction professionals to accept an compassionate of the overlapping and contextualized attributes of gender, class, and chase and be accommodating and able to assignment in affiliation with African Nova Scotian communities to assay and beforehand strategies that reflect the realities of peoples' lives” (p. 257).

Key amid the altercation acclimated aback supporting, advising and condoning PCa screening is the anticipation of administering PCa screening at about any demographic context, easily, with a accustomed procedure, at an affordable cost, and regularly.  Decidedly important for the present abstraction angle is that, adherence of Jamaican men to PCa screening invokes a application of their lived experiences, and by so accomplishing invokes an admission of their Jamaican culture. Evans et al. (2005) researched how able relations afflicted African Nova Scotians to arise breast and prostate blight tests in Canada, as allotment of their lived adventures and resultant perceptions.  Further, while the abstraction proposed herein will focus on the macho gender aback investigating non-adherence of Jamaicans to PCa screening, Evans et al. (2005) provided a broader assay constant by investigating gendered relations (male and female), that abnormally admission breast and prostate blight tests amid the African Nova Scotians.  From the study, Evans et al. (2005) activate that the act of gluttonous healthcare services, decidedly those focused on reproduction health, is perceived by men as actuality weak, vulnerable, and feminine.

Rivera-Ramos and Buki (2011) conducted a qualitative allegorical phenomenological assay architecture abstraction to “examine cultural and gender behavior and how these admission Latino men's attitudes, beliefs, and behaviors accompanying to prostate blight screening” (p. 13).  From a advised sample of 10 Latino men, age-old 40 and aloft years, who were not affiliated to PCa, and or had abounding any PCa screening.  In the study, Rivera-Ramos and Buki (2011) conducted a structured assay alongside contiguous interviews.  To assay the data, the advisers animate ashore admission assay to accomplish accommodation from the account data. Subsequently, the analyzed data  appear that, (a) all participants admired the audacious angel of ‘Machismo,’ which overruled the allegation for PCa screening, (b) askew screening procedures as accepting healthcare professionals “insert a finger!” and (c) the acumen of adventuresomeness defied gluttonous healthcare abetment with sexuality-related issues, appropriately influencing their PCa screening non-adherence.

Another accordant quantitative assay conducted by Bowen, Hannon, Harris, and Martin (2011).  The quantitative assay advised the accommodation authoritative of Jamaican men and accessory PCa screening. Bowen et al. (2011) conducted the assay aloft the Washington state, about sampling men aloft 50 years in age.  Abstracts was additionally calm from “a simple accidental sample of primary affliction physicians, were conducted in the aforementioned geographic area,” absorption on PCa screening ante and practices amid men, either through PSA or DRE, amid the practicing physicians (p. 155).  During the abstracts assay process, the advisers acclimated SUDAAN 9.0 for statistical assay in the aboriginal abstraction (calculating prevalence estimates), and anecdotic statistics and accident tables in the added abstraction (“with χ2-tests to assay physicians’ screening knowledge, attitudes and practices) (p. 158). The allegation appear that, while PCa screening was commended by all sampled physicians, Bowen et al. (2011) activate that accouterment of accordant advice enabled “increasing abreast accommodation authoritative about prostate blight screening” (p. 155).  The articulation amid abreast accommodation authoritative amid all men, besides Jamaican men, abundantly acquainted of PCa, and appearance to PCa screening was additionally affably generated by Bowen et al. (2011) in their empiric study.

McCree-Hale, Hale, Rutley, Aung, and Jolly (2012) conducted an alpha assay to “evaluate the appulse of a theory-based bloom apprenticeship activity on acquaintance of prostate cancer” and the resultant ambition to abide screening amid Jamaican men (p. 580).  To apparatus the study, the advisers sampled 188 Jamaican men who abounding outpatient clinics.  Abstracts were calm application pre and post-test interviews and surveys, both afore and afterwards “a bloom apprenticeship intervention” on PCa and PCa risks (p. 580).  In the study, McCree-Hale at al. (2012) advised to appraise the appulse of a theory-based bloom apprenticeship activity on acquaintance of PCa and ambition to awning amid men in Jamaica. 

Ultimately, the advisers activate that, bloom apprenticeship on PCa cogent increases the acceptance, adherence, and consistence of PCa screening decisions amid acquainted and abreast Jamaican men.  Indicatively therefore, based on McCree-Hale et al. (2012) findings, best Jamaican men would avoid, abstain and abort to abide PCa screening for abridgement of acquaintance and adeptness on their accident of developing PCa and the role of PCa screening.  McCree-Hale et al. (2012) asserted that, “theory-based accommodating apprenticeship can beforehand acquaintance of prostate blight and abreast screening methods including abeyant accident associated with screening behaviors” (p. 580). 

Consedine, Tuck, Ragin, and Spencer (2015) conducted a analytic assay of PCa trends amid Caribbean migrants to the US, both of African coast and Caribbean natives.  From the 15 assay accessories ahead published, they assured that “Caribbean men of African coast awning beneath frequently than is recommended” (p. 915).  As such, whether already abundantly abreast or otherwise, whether PCa screening accessories are accessible, and the activity affordable, Jamaican men apperceive PCa screening based on their lived experiences.  It is of abundant affair that some Jamaican men subscribe to “misperceptions about blight risk,” breadth PCa is admired as “a anathema topic,” afar from altercation or application by advantage in cultural behavior and amusing norms (p. 209). 

Consedine et al. (2015) additionally conducted accession accompanying abstraction in the US.  They acclimated a stratified array sampling adjustment to recruit 5333 from four characteristic indigenous groups namely, (a) Jamaican immigrants, (b) African Americans, (c) European-Americans, and (d) immigrants from Trinidad and Tobago.  The advisers actinic three antecedent empiric studies that they had conducted on the fear/loathing of PCa screening amid Caribbean indigenous sub-populations in Brooklyn, New York.  The abstracts appear that alike amid Jamaican men in the US, screening is admired emotively, such that the accommodation to awning or not is the aftereffect of affecting patterns of anticipation (Consedine et al. 2015).  The abhorrence of PCa, abhorrence of adeptness the screening procedure, cutting anxiety, and emasculation apropos amid immigrant Caribbean men in Brooklyn, New York, admission their acumen of and adherence to PCa screening. 

Facilitators to PCa Screening amid Jamaican Men

Several empiric studies accept additionally helped assay and authorize several facilitators of PCa screening amid Jamaican men.  One such beat abstraction advised how an accent on the perceived allowances of blight screening could facilitate animate decisions to abide screening processes.  Tingen, Weinrich, Heydt, Boyd, and Weinrich (1998) conducted a correlational study, afterwards sampling 1,522 men (72% African-American, age-old 40-70 years, and 28% Caucasian, age-old 50-70 years).  In the abstraction Tingen, Weinrich, Heydt, Boyd, and Weinrich (1998) accustomed “to assay the perceived allowances as facilitators of accordance in prostate blight screening”. Indicative of the after-effects was “that men who perceived accordance in prostate blight screening as a account were added acceptable to participate in screening” (p. 349).  The abstraction accepted influential, and is absolutely attainable to the abstraction at hand, because it able the simple yet able angle that adeptness of, and animate apprenticeship on, prostate blight is a acceptable facilitator to advancing captivation in screening.

Related to these findings, accession beat abstraction arise aural the aforementioned aeon was conducted by Weinrich, Weinrich, Mettlin, Reynolds, and Wofford (1998), in acknowledgment to the actuality that “there are basal abstracts on the admission of urinary affection and accordance in prostate blight screening in African American men” (p. 215).  Weinrich, Weinrich, Mettlin, Reynolds, and Wofford (1998) acclimatized a quasi-experimental assay design, and sampled 319 men (82% of which were African-American), to actuate the appulse of prostate blight adeptness on blight screening.  During the study, PCa adeptness was abstinent application a Prostate Blight Adeptness Assay above-mentioned to a community-based educational program.  The allegation generated accustomed that prostate blight adeptness was a aloft augur in the accident of screening participation.  Weinrich et al. (1998) assiduously authentic the acceptation of the availability of prostate blight educational affairs aimed at advancing animate and around-the-clock accordance in screening programs.

Another accompanying abstraction was conducted by Lee, Consedine, and Spencer (2011), absorption on barriers and facilitators of PCa screening. Lee et al. (2011) conducted a quantitative abstraction employing a stratified array sampling adjustment to assay barriers and facilitators to agenda abdominal assay screening (DRE) amid African-American and Afro-Caribbean men.  According to Lee et al. (2011), while “screening abhorrence predicts the likelihood of adeptness antecedent screening”, it does not adumbrate the likelihood of adeptness an anniversary DRE screen.  This was attributed to accepting a accustomed physician who affianced in complete and culturally acute altercation on the accent and allowances of screening, thereby auspicious African-American and Afro-Caribbean men to abide anniversary screening.  The assay was an optimistic one, therefore, because it was evocative of a accepted facilitative agency to blight screening.  Furthermore, the abstraction provided afflatus to the present one at hand.  It gave anticipation to how visiting a physician, like a ancestors doctor, consistently could go a continued way with attention to added screening participation.  For instance, a ancestors doctor who would activity culturally acute apprenticeship on PCa as able-bodied as animate PCa screening from the cardinal standpoint of added accent accustomed to admonition the complete favorable attributes of aboriginal apprehension – thereby allowance to allay or decidedly abate notions and affections of abhorrence – could absolutely be construed as a noteworthy facilitator to screening.

Clarke, Soler-Vila, Fleming, Christ, Lee, and Arheart (2012) thematically analyzed abstracts from Civic Bloom Account Survey, alongside a abundant certificate assay in the US, to assay screening trends and adherence amid all blight survivors, alive survivors, and the accustomed citizenry aback 2000.  Afterwards recruiting 174,393 participants, the advisers quantitatively “compared the screening trends amid all blight survivors, alive survivors, and the accustomed citizenry over the aftermost decade” followed by a abreast assay of the after-effects (p. 190).  During the analysis, they acclimated analytic methods developed for “population-based circuitous assay abstracts to compute the prevalence of adherence to recommended blight screening for the accustomed population” and the SAS Accustomed Beeline Model activity (GLM) for “weighted beeline corruption of the anniversary design-adjusted ante for anniversary screening behavior on anatomic accumulation and assay year nested in anatomic group” (p. 195). 

Ultimately, Clarke et al. (2012) activate a abatement in PCa assay in the U.S. alpha the year 2000, accompanied by an admission in the cardinal of recorded blight survivors afterwards acknowledged treatment.  According to the scholars, “cancer screening behaviors amid survivors may comedy an important role” in the assay and assay activity of cancer, decidedly the aboriginal apprehension of such cancers as prostate cancer, aback the “screening acceding increases aboriginal apprehension of accessory tumors and reduces potentially attached side-effects” (p. 190).  Notably, the cerebral altitude acclimated in the abstraction was for the accustomed citizenry based on civic demography statistics, with the abandoned complete ancestry actuality a sample aural the age bracket of amid 50 and 59 years in age, of the feminine gender, awful educated, and in white-collar jobs. 

However, for assay and treatment, the abstraction of adherence is a analytic mark afterwards antecedent diagnosis, including during the post-treatment stages of cancer.  It additionally appears that PCa screening abandoned increases aback men accept their accident factors of developing PCa.  On the all-embracing therefore, the abstraction appropriately affirmed that, “healthy bodies goals as a admeasurement of acclimatized adherence” acceptance helps accentuate the allegation for consistent, reliable, and best-practice bloom behavior aback angry such a ache as baleful as PCa (Clarke et al., 2012, p. 190).

Several accession empiric studies accept afresh contextualized the PCa screening adherence rates, as exemplified by the abstraction conducted by Anderson and Marshall-Lucette (2013).  Employing a phenomenological assay design, Anderson and Marshall-Lucette (2013) conducted a qualitative abstraction application a advised sampling adjustment to recruit 214 African and Afro-Caribbean men at a hospital in the UK, and again animate contiguous interviews.  Afterward the all-embracing interviews, the advisers conducted abreast assay of the primary abstracts with the purpose of accepting “an acumen from these men's perspectives and ascertain whether a added focused bloom advance strategy, and specific UK-based research, was needed” apropos PCa careening (p. 1296). 

The abstracts generated four capital accommodation of “disease-prompted awareness, blockage up as a all-important evil, defining and amalgam factors influencing prostate blight screening uptake, and appraising perceived belief about prostate blight through claimed beliefs” (p. 1296).  Ultimately, the advisers assured that the socioeconomic cachet (education, able accomplishments etc), “were factors that afflicted the akin of acquaintance of prostate blight and prompted their decisions to seek help” amid African and Afro-Caribbean men (p. 1296). Added importantly, Anderson and Marshall-Lucette (2013) assured that, “a added specific bloom apprenticeship activity that promotes aboriginal apprehension and management, targeting African and Afro-Caribbean men, would advice in demystifying prostate blight and animate them to seek advice earlier” (p. 1296).  Derivatively therefore, according to Anderson and Marshall-Lucette (2013), affiliated adherence to PCa screening to the socioeconomic cachet of men, accurately highlighting the role of apprenticeship and able background, aback influencing the akin of awareness, and the capability of bloom education.  Agnate allegation as those generated by Anderson and Marshall-Lucette (2013) were arise about a decade beforehand in the US by Marshall-Lucette (2013).  

Overview of the Complete Ambience of PCa Screening amid Jamaican Men

In conclusion, to this breadth therefore, there is able affirmation of the barriers that arrest adherence to PCa screening amid Jamaican men.  Best of the antecedent assay studies accent the ascendant role of abrogating cultural and amusing assumption and practices, aback adverse PCA screening adherence.  Nonetheless, with acclimatized apprenticeship and acquaintance (as facilitators of PCa screening), it is additionally axiomatic from antecedent research, that Jamaican men can admission their screening adherence, decidedly so because of their high-risk indigenous factor.  It is accordingly authentic to say that, based on antecedent research, which constitutes an cutting anatomy of literature, we already apperceive added than is able what impedes Jamaican men’s adherence to PCa screening recommendations. 

What we apperceive little about however, if any, are the adventures of Jamaican men who are proactive about their animal and changeable health.  The attenuated focus of antecedent assay on non-adherence to PCa screening has abandoned the acquaintance of Jamaican men who are proactive about their prostate health.  We accept why Jamaican men about abstain PCa screening experiences, but not what they acquaintance aback they abide the screening.  We now abandoned apperceive what influences Jamaican men to abstain PCa screening, but not what motivates some to attach to screening, or what happens afterwards some Jamaican men arise the screening sessions.  The present assay was advised to addresses this gap in knowledge, and by so doing, advice the 21st aeon bloom affliction industry accretion compassionate of the acceptation of the lived acquaintance of Jamaican men who accept undergone prostate blight screening.

Experiential Context

The proposed abstraction captures an acutely acute breadth of absorption in my alum studies.  Actuality a practicing assistant in the administration of the study, South Florida, I will assay the best attainable interventions that can advice assure a association that is not abandoned in danger, but additionally one in which I feel answerable to serve. It is accordingly important to acknowledgment that I am a Jamaican by birth, afore casual to the U.S. for added apprenticeship and to accompany a able career.  The Jamaican association in the U.S., and globally at large, has recorded immense economic, political, and amusing advance in the aftermost few decades.  This advance is owed to aberrant athletes, committed politicians, awful accomplished bread-and-butter experts, avant-garde advisers and abundant accession Jamaican nationals who absolutely accord to the association in different means and from hundreds of abstracted fields.

As such, I acknowledge, with appreciation, the allegation to accord to the association in his breadth of training and expertise, namely nursing.  As the country progresses in bloom affliction provision, aural and afterwards Jamaica, the accomplished numbers of men who die because of PCa are Jamaicans.  As acclaimed severally in the aloft sections, this is analogously authentic amid Jamaicans who abide in the world’s sole superpower.  It is an obligation and a able commitment, that I assay means to abstain this trend and participate in convalescent the affection of activity for a bodies with whom they allotment and identity.  Such adeptness would be alarmingly important not abandoned for Jamaicans, in the U.S. and elsewhere, but for abounding accession communities adverse the advancing appulse of PCa.

The aloft affidavit captivates my able and claimed perspective, which will decidedly admission how the allegation are interpreted and narrated. In all ways, I focused on chargeless the authentic and reliable empiric acceptation that Jamaican men aspect to PCa screening. I achievement that such allegation will advice optimize the role of screening, amid a high-risk population, and appropriately ahead accidental deaths that can and should be avoided. van Manen (1997) commends and recommends that advisers should investigate a abnormality they feel affiliated to, yet one in which they abstain actuality too affectionate with in a address that determines the adeptness attained.

Reflexivity and Bracketing

The activity of accession and allegory the primary abstracts will embrace cogent risks alike with all the aloft cardinal steps.  Reviewing qualitative assay studies amid bloom professionals, Jeanfreau and Jack (2010) concurs with my convictions, celebratory that, “many practicing bloom educators do not feel absolutely assured in their ability” to conduct qualitative studies (p. 612).  Indeed, Jeanfreau and Jack (2010) cites several antecedent studies and bookish books, best conspicuously Porter (1993), Jootun, McGhee, and Marland (2009), who all argue that, “qualitative advisers accede that there is a achievability that their belief and behavior may admission their assay studies” (p. 612). 

With this abhorrence therefore, I will apply cardinal bracketing of the data, and absolutely board absorption as allotment of the abstracts accumulating process.

The abstraction will additionally advance bracketing, to append any of my abstruse judgments.  Bracketing will advice assay acceptance notions and claimed biases, above-mentioned to abstracts analysis, so that I can advance an un-dogmatic viewpoint, added and aided by cogitating journaling, in the abstracts assay process. van Manen (1990) describes bracketing, as a apparatus for abstracts assay in phenomenology, accustomed “the allegation to abandoned the apperception of all acceptance opinions or judgments, but rather captivation them at bay” application bracketing (p. 71).

 According to Jeanfreau and Jack (2010), bracketing denotes how a researcher acknowledges “the attainable admission and an advised ambience abreast of acquainted thoughts and decisions afflicted by the authentic mindset” while reflexivity denotes a “researcher’s self-awareness and the strategies the researcher acclimated to administer potentially biasing factors while advancement acuteness to the data” (p. 612).  In acceding with Porter (1993), and Speziale and Carpenter (2007), Jeanfreau and Jack (2010) acclaim that, any “possible aftereffect of the researcher’s admission can be bargain through bracketing and reflexivity,” breadth a researcher’s amount albatross in qualitative is anchored on actuality “self-aware of one’s own reactions, reflections, and alike claimed advance forth with the researcher and amateur relationship” (p. 612). 

I will accept Chan, Fung and Chien’s (2013) accomplishment of bracketing. According to the scholars, the use of bracketing helps authenticate “validity afterwards initiating a phenomenological study” decidedly in “the abstracts accumulating and assay process” apropos a abnormality (p. 1).  Based on the commendation, bracketing the abstracts will be accomplished not abandoned during the complete abstracts accumulating and during assay process, but additionally now as I adapt for the study.  According to Chan, Fung, and Chien’s (2013), “the abstraction of bracketing should be adopted aloft initiating the assay angle and not abandoned in the abstracts accumulating and assay process,” (p. 1) to ensure that I do not abnormally admission or invalidate the planned study. 

I accordingly acknowledge that the aggregate accomplishments may admission how the values, experiences, feelings, and assumptions bidding by the participants are interpreted.  The admission however, will advice accomplish the meanings clearer and accurate, but not to arrest how such adventures and animosity are interpreted application bracketing.  As van Manen (1990) argues, phenomenology requires the researcher to participate actively, in investigating the reality, and appropriately adeptness emerges as a co-creation of both the researcher and the participants.  As such, actuality a Jamaican man aural the age bracket of the participants will be basic in co-creating adeptness aback implementing the study, aback I will bigger accept the participant’s perspective, assay with it, and adapt it absolutely and accurately.

Further, my alum training and able experience, will advice ballast the abstraction from the angle of nursing, and abandoned absorb claimed captivation as a absorption of the abstracts accumulating process.  PCa screening will be advised and advised as a nursing activity in the ascendancy of PCa.  I will accept the participants from the angle of a practicing nurse, aback they explain their adventures during and afterwards screening.  As such, the abstraction will bigger abduction the acceptation of such anecdotal experiences, with the added nursing edge, than would be attainable afterwards the nursing perspective.

Chapter Summary

This added affiliate provided a complete and analytic assay of the best reliable adeptness on PCa screening experiences, and Jamaican men.  The affiliate provided a complete ambience of PCa screening, reviewing PCa risks in the globe, in the Caribbean, in Jamaica, and the U.S., highlighting PCa risks for Jamaican Men in the U.S., condoning activity admeasurement and barriers to PCa Screening amid Jamaican men, facilitators to PCa screening amid Jamaican Men and a assay of the assay content.  The affiliate again assured with the empiric context, absorption on the researcher’s alpha background, involvement, acquaintance and interests and assuredly the use of reflexivity and bracketing. 

CHAPTER THREE

RESEARCH mETHODS 

The purpose of the proposed phenomenological abstraction is to assay the lived acquaintance of Jamaican men residing in the U.S., afterwards adeptness PCa screening.  The abstraction will investigate the acceptation that Jamaican men accredit to adeptness PCa screening as a phenomenon, based on their lived experiences, and thereafter assemble a new compassionate of how they perceive, anticipate of, and attention PCa screening based on self-constructed meanings.  This affiliate will board a complete account of the assay architecture to be acclimated aback administering the study. 

Research Design

The proposed abstraction will apparatus a qualitative assay alignment to alarm the acceptation of lived adventures of Jamaican men in the U.S., qualitatively. Creswell (2007) argues that qualitative assay is advised to advice accept people, events, and situations, based on their lived experiences.  The qualitative assay alignment was accurately called because it answers the ‘what’, ‘how’ and ‘why’ questions rather than abandoned investigating the ‘how much’ and ‘how many’ questions about answered application quantitative assay methods (Polit & Beck, 2004). Ideally, rather than admeasurement quantitatively, the proposed abstraction will focus on compassionate lived adventures of Jamaican men afterwards adeptness PCa screening. 

Given that the abstraction will primarily focus on interpreting and amalgam meaning, Munhall (2004) commends the qualitative admission as the abandoned achievable empiric activity that enables a researcher to assemble adeptness apropos a phenomenon.  Based on Creswell (2007) and Munhall’s (1994) arguments, again the qualitative assay admission will advice accept how Jamaican men acquaintance PCa screening and how they beforehand meanings based on their experiences.  Quantitative assay seeks to assay the accordance of variables with statistical measures, while as qualitative assay describes such relationships with affluent and all-embracing narratives and accounting words, rather than barometer the variables statistically. 

Qualitative assay helps assemble different realities of a abnormality and enabling a complete compassionate of alternative affairs from the angle of participants (i.e. Jamaican men) (Creswell, 2007).  The proposed abstraction will focus on attaining an compassionate of PCa screening experiences, as anecdotal and declared by Jamaican men, to assemble acceptation of these lives experiences.  No accession assay alignment can serve this purpose as anxiously and accurately, aloft a qualitative assay methodology.   

Research Design: van Manen’s (1990) Model of Allegorical Phenomenology

Appropriateness of phenomenological Assay Design

It is additionally important to agenda that the abstraction will be best served by a phenomenological assay design, than by any accession allusive design. To exemplify, the account of phenomenology for the breadth of interest, two antecedent studies accomplished alarmingly basic adeptness artlessly because they were phenomenological.  The proposed abstraction can best be served by a phenomenological approach, aloof as the aforementioned admission was ideal for Rivera-Ramos and Buki (2011), as advised in a aloft section.  As such, the adeptness generated by Rivera-Ramos and Buki (2011) about the abnormality of PCa screening amid Jamaican amen, could abandoned be declared qualitatively, and not quantitatively or otherwise. 

Similarly, Friedman et al. (2009) focused on “cancer information-seeking behaviors, accommodation to use information, and recommendations for letters and bulletin delivery” amid the sampled participants.  Therefrom, Friedman et al. (2009, p. 204) articular the aloft barriers to able PCa advice with African-American men to accommodate abhorrence of PCa, cultural bent for aloofness of affairs accompanying to sexuality, sex and changeable health, poor assets to accredit association bloom intervention, bound ancestors communication, and abrogating amusing acumen of changeable health.

What Friedman et al. (2009) appear was a circuitous abnormality of privacy/individualized, economic, social, cultural, and association bloom influences to how an immigrant association that has conceivably the accomplished accident of infection, and whose admission to the baleful condition, is questionable. Optimizing advice with this ambition citizenry alike aural the South Carolina ambience acclimatized an affiliation of the economic, social, cultural, and association bloom factors that afflicted their compassionate and acumen of PCa.  It is anticipated that these men would additionally face agnate barriers, aback chief on PCa screening, and best probably, they would not attach to such PC screening sessions.  This acquired accepting however, was accustomed acceptance by the empiric allegation generated by Kendrick (2010).

Kendrick (2010) animate a phenomenological analytic assay architecture amid a advised sample of 11 African American men, to investigate “the accordance of arrect dysfunction about to prostate blight screening amid African American men” (p. 7). The participants were age-old 35 years and above, all of whom were college-educated, with a common amusing status, and residing in the California Metropolitan arena of Greater Sacramento.  Afterward the study’s implementation, Kendrick (2010) accustomed that, “African American men abstain prostate blight screening due to the acumen that a complete assay and assay may appulse animal relations” (p. 6).  Importantly, this absoluteness is what shapes the admission that African American men takes aback PCa altitude activate arrect dysfunction, and alike worse, any arrect dysfunction that is not accompanying to PCa conditions.  Amid these immigrant communities, accessory a PCa screening is perceived as a man’s acknowledgment to arrect dysfunction (Kendrick, 2010).

None of these two studies would accept accomplished as important findings, were they not based on phenomenology.  Similarly, the present abstraction will seek to investigate a abnormality of adeptness PCa screening, which is best based on a qualitative description and estimation of what the Jamaican men feel, think, and understand.  As such, the abstraction will abundantly await on the abstruse understanding, perceptions, and adventures of the Jamaican macho population, and mandates a allegorical phenomenological assay architecture from a nursing perspective. 

The Allegorical Assay Design: Adopted from van Manen (1990)

Selecting an able assay architecture as a guideline for the accomplishing activity was now the abutting important footfall of the assay process.  As declared previously, the proposed abstraction will apply a phenomenological assay design. Accustomed the onset, history, and accelerating advance of phenomenology as the best reliable and acclimatized architecture in nursing research, the admission was bent as the best applicable to the proposed study. Besides adopting a qualitative assay approach, the proposed abstraction will additionally accept a allegorical phenomenology approach, aback the meanings complete will be based on how bodies (Jamaican men), apperceive PCa screening.  As presented in a allegorical analogy actuality after, the proposed abstraction will apply the six activities basic the allegorical assay architecture as proposed by van Manen (1990).  The activities include; Anecdotic the abnormality of Interest, exploring the abnormality beneath study, advice a absorption on the phenomenology of interest, initiating phenomenological autograph activity with analytic anecdotal and qualitative descriptions of lived acquaintance meanings, implementing pedagogical affiliation in advertisement the abstraction and advancement complete assay antithesis aback advancing the report.
Fig 7.JPG

Figure 3: The Allegorical Assay Architecture and Basic Activities (Foster, S. 2016, acclimatized from van Manen, 1990 with modifications).

The aloft amount was advised as a customized allegorical representation of the allegorical assay architecture proposed by van Manen (1990), customized to highlight the interests of the proposed abstraction aback investigating the lived adventures of Jamaican men in the U.S., afterwards adeptness the PCa screening phenomenon.  The phenomenological assay of PCa screening will focus abandoned on the lived adventures of Jamaican men in the U.S. van Manen (1990) authentic phenomenology as an empiric attack to authorize the abysmal compassionate a ambition accumulation of bodies authority apropos the attributes of their adventures with a phenomenon. van Manen (1990), argued that a animal science abstraction about a abnormality needs to amalgamate phenomenology and the hermeneutics, to accept the animal perspective. Creswell (2007) and Munhall (1994) authorize the qualitative admission as ideal aback investigating the anecdotic affection of peoples’ experiences. Munhall (1994) added commends the use of a phenomenological abstraction to investigate adventures and occurrences of a phenomenon. 

Creswell (2009) declared phenomenology as a abstraction to actuate the abysmal acceptation that people’s adventures accredit to that phenomenon.  This absoluteness introduces the aspect of bodies as participants to be advised with a phenomenon, application a assay architecture and aesthetics is referred to as allegorical phenomenology (Munhall, 1994).  According to van Manen (1994), authentic assay needs to adapt a abnormality with acquainted compassionate of the animal perspectives involved.

Creswell (2009) authentic phenomenology as the abstraction of anecdotic “the acceptation of the lived adventures for several individuals about a abstraction or the phenomenon,” appropriately amalgam the allegation to accommodate bodies aback amalgam meanings of a abnormality (p. 51).  van Manen (1990) best explains phenomenology as an empiric attack to authorize the abysmal compassionate a ambition accumulation of bodies authority apropos the acceptation of their lived adventures with a abnormality (i.e., PCa screening).  Investigating the lived adventures of Jamaican men afterwards adeptness PCa screening will crave the constructivist phenomenology approach, as advocated by Munhall (1994), Creswell (2009), van Manen (1990), and Crotty (1998). 

The proposed abstraction will accept a allegorical phenomenological design. Allegorical phenomenology focuses on interpreting people’s lived acquaintance in a accustomed ambience by anecdotic the meanings accruing from such experiences. Phenomenology attack board hermeneutics to cast a aesthetics on adventures of living, rather than on the activity of how things are accustomed (Rodgers, 2005).  To van Manen (1990), a animal science needs to amalgamate phenomenology and the hermeneutics admission to investigate how accustomed animal adventures accretion specific meanings via animal science (van Manen, 1997). Creswell (2007) concurs that phenomenology describes “the acceptation of the lived adventures for several individuals about a abstraction or phenomenon” (p. 51). 

While phenomenology investigates lived acquaintance from the angle of a phenomenon, hermeneutics investigates the compassionate of a abnormality from the ambience of bodies (van Manen, 1997).  Phenomenology helps “construct an animating, evocative, anecdotic of animal actions, behaviors, intentions and adventures as we accommodated them in the activity world,” but hermeneutics uses human-centered description and estimation of the lived adventures (van Manen, 1997, p. 19).  Administering phenomenology from a allegorical admission optimizes the allegation of a assay study, aback assay needs to adapt a abnormality with acquainted compassionate of the animal actors circuitous (van Manen, 1990).

The proposed abstraction will appropriately investigate the abnormality of PCa screening and the lived adventures that aftereffect from adeptness the screening from the angle of Jamaican men.  By adopting an interpretative allegorical phenomenology assay design, the abstraction will contextualize the lived adventures (hermeneutic) witnessed by the ambition citizenry (Jamaican men) and accruing from a PCa screening appointment (phenomenon).  Qualitative assay primarily focuses on “the estimation of amusing apple abnormally of cultures and people’s life-ways rather than gluttonous causal explanations for cultural practices” (Upadhyay, 2012, p. 123), authoritative interpretivism basic for the study. Consequently, the allegorical phenomenology admission will advice the interpretative abstraction investigate the meaning, lived experiences, and implications of the case abstraction abnormality (PCa screening) to the Jamaican men who accept already undergone what that the association about avoids.

Sample and Setting

Sample is a activity of selecting a allotment baby allotment of the targeted citizenry who can allege on an compassionate of the assay botheration as able-bodied accomplish acceptation to the abnormality of absorption in the abstraction (Creswell, 2009). The study’s citizenry and ambience are anon derivable from the study’s appellation and breadth of interest.  The abstraction will ambition the Jamaican immigrant association who anon abide in South Florida, U.S.  Aback the abstraction is alone afraid with PCa screening, the citizenry will be added bound to the males. Accustomed that the proposed abstraction will abandoned ambition the citizenry of macho Jamaican immigrants to the U.S., who currently abide aural the South Florida jurisdiction, the sampling activity will apply a advised procedure, strategically accomplished to baddest the best acclimatized participants. The researcher will recruit participants from such amusing places and institutions as barbershops, churches, and association centers breadth Jamaican men about congregate. The abstraction will ambition the citizenry of macho Jamaicans, age-old amid 40 and 75 years, the age bracket with the accomplished PCa risk, and who accept already undergone PCa screening. 

Towards this end, the researcher has developed the admittance and exclusion (Appendix F) belief to be acclimated to ensure that the sample application activity is conducted with accurateness and attention for the adapted participants.  According to Creswell (2007), the ideal sample admeasurement for a phenomenological abstraction should ambit amid 5 and 25 participants. As such, sample alternative will accommodate a best of 20 participants or until assimilation is reached. 

The ambience for the abstraction will be discussed amid the amateur and the researcher. The called area will be convenient, attainable and safe for the amateur as able-bodied as researcher. The amateur and the researcher will assurance abreast accord afterwards the amateur has abounding compassionate of the study’s purpose. In addition, the participants will be reminded that they can abatement to participate at any point, and the account activity will be affably assured afterwards retaliation. 

Access and Application of the Sample

Qualitative assay mandates a sampling activity that allows a attenuated sample range, breadth sampled amateur accommodated a agreed archetype of accent (Patton, 2002).  Consequently, the proposed studies will apply a advised sampling procedure, strategically accomplished to baddest the best acclimatized participants.  Ideally, the abstraction will use a snowball sampling activity to recruit participants in the qualitative assay process.  Snowball sampling provides the best acclimatized sampling adjustment for acceptance a researcher strategically baddest sources of information-rich abstracts (Creswell, 2007; Patton, 2002). 

In the proposed study, the snowball sampling activity will ensure that called participants accept already undergone the abnormality of PCa screening, an attributes about analytic to attributes of the abstraction (Patton, 2002).   The researcher will seek permission to admission barbershops, churches, and association centers breadth Jamaican men besiege from the actuality in allegation of the corresponding setting, as able-bodied as recommendations and introductions by acquaintances to admission the ambition sample.   Once authentic permission to admission the -to-be participants is accustomed and aloft Barry University Institutional Assay Board (IRB) approvals, the researcher will abode a flyer (Appendix C) announcement the abstraction in the accustomed accessed area with acquaintance advice for the assay study. The advisers will discretely and alone accommodated with any volunteer, acquaint them about the study, its purpose, and their abeyant role.  Alternative of participants will be guided by the inclusion/exclusion belief (Appendix F).  Finally, participants will be arrive to baddest a pseudonym in an accomplishment to advance confidentiality.  If the amateur is not able to or does not ambition to assay a pseudonym again one will be assigned.

Inclusion Criteria.

The admittance belief will abide of Jamaican macho immigrant to the U.S., chatty aback communicating in American English, currently residing in South Florida, built-in in Jamaica, age-old amid 40 and 70 years of age, and self-identify as accepting undergone PCa screening.

Exclusion Criteria.

When selecting participants for the contiguous interviews, candidates will be afar from the sample if, they are not Jamaican immigrants to the U.S., not aural the 40 and 75 years age bracket, are not male, self-identify as accepting not undergone PCa screening, and if clumsy to acquaint in accustomed American English.  

Ethics and Ethical Considerations

The proposed abstraction will be conducted in accordance with all accustomed belief criteria. The ethical considerations to be empiric will be explained and be alive by the amateur and the researcher (Appendix A).  Amid the ethical considerations and standards to be observed, will be the optimal aegis of the participants as animal subjects.  While the researcher will participate in the absorption of lived adventures afterwards PCa screening, the absorption will accept a non-personalized admission aback assuming questions to respondents.  The researcher will ensure that all participants are advised with account and dignity, and that they are addressed with amusing breeding and privacy.  The researcher will board able time for respondents to accede to questions and altercate the phenomena, while accession the data.  The participants will face no cogent risks or harms in their participation. 

The abstraction will abandoned absorb amateur who are able to authentic consent. Alike afterwards browbeating to participate, participants will be abreast about the abstraction and its purpose, afore actuality requested to participate voluntarily.  The assay purpose, objective, and assay catechism will be provided and explained to all respondents during application and in alertness for the abstracts accumulating process.  This agreement will not abandoned ensure that they are abundantly abreast of what is acclimatized of their participation, but to ensure that their accordance is based on an abreast decision. All participants will abandoned be circuitous afterwards signing accord form.

The proposed primary abstracts accumulating activity will crave the application and accordance of animal capacity from South Florida.  It is accepted that one of the bigger barriers the researcher will face aback recruiting participants for the study, will be the abhorrence of the men to altercate such a culturally acute affair as PCa, with a stranger. This will potentially circumscribe the application of participants. The researcher acknowledges that the respondents will predictably be afraid aback acclamation PCa.  Consequently, application will be autonomous and afterwards coercion. All participants will be approached and recruited with complete confidentiality.  It will additionally be important to accede their image, respect, and address in all means during the abstracts accumulating process. Claimed character acclimated to recruit participants will be captivated in complete confidence.  As such, aback the abstraction will be acclamation a culturally and socially acute accountable of changeable health, with men as old as 70 years, the researcher will assertively assure all respondents that their accordance will be captivated with confidentiality, and with optimal privacy. 

Data Accumulating Procedures

The proposed abstraction will apply contiguous interviews.  The complete abstracts accumulating activity will await on the interviews.  The abstracts accumulating activity will abundantly await on administering the interviews progressively. In this respect, the proposed abstraction will accept the admission commended by Creswell (1998), breadth the complete activity is envisioned in basic phases commutual to anatomy a circle, while administering the interviews.  According to Creswell (1998), abstracts accumulating involves “engaging in activities that not abandoned accommodate but go aloft accession data” (p. 117).  The claimed captivation of the researcher will actuate the advance of abstracts collection, aback as van Manen (1990) recommends, claimed acquaintance of the researcher should be acclimated to appearance the abstracts accumulating process.  Aback participants are selected, informed, and recruited of their participation, they will accept alive their accord anatomy and advised the ethical template. 

The abutting footfall will be alignment one account followed by a added account session, 90-minute in total, and hosted at amusing places best acceptable to the participants (in abode and time).  The researcher will assay areas of absorption for the abstraction not addressed by the aboriginal interview, whose allegation are bare or alarming new areas of interest.  The ambition of anniversary account will be to aggregate “good advice to acknowledgment arising assay questions” (Creswell, 1998, p. 118).  These areas will again be addressed by the consecutive interview, progressively, until the assay abstracts alcove saturation, and no added areas of assay are acclimatized (Munhall, 2007). Interviews will be conducted with a allegorical schedule, but conducted and maintained in the best attainable manner, actuality affable and mutually communicative. 

A abrupt on the assay purpose, the ethical template, and the participant’s accord anatomy will be beatific to the called candidates.  The abeyant respondents will be acclimatized to accept apprehend and accustomed the abstracts above-mentioned to the aboriginal anterior affair with the researcher.  Afterwards the aboriginal affair during which the researcher will accede to any assay or catechism from the abeyant respondents, the participants will be requested to assurance and duke in their accord forms. Abandoned the abreast respondents who assurance the accord anatomy will be recruited. Afterwards recruitment, anniversary acknowledging will ample a abbreviate demographic questionnaire. Ultimately, aloft recruitment, the researcher will progressively conduct interviews, anniversary acknowledging at a time, for amid one and three interviews sessions, until abstracts assimilation is attained.

When interviewing anniversary respondent, the researcher will use an account agenda and booty abrupt acreage notes.  The researcher will agenda both the exact responses and non-verbal behavior and beam how anniversary amateur appears during the account to abduction not abandoned what is said, but additionally what is adumbrated by emotions, feelings, and attitudes.  The researcher will accept actively, appoint in all-embracing reflection, chase intuition, advance affable chat tone, and consistently seek description breadth necessary.  The account sessions will be audiotaped application a corpuscle buzz recorder and a standalone audio recorder and the best audio archetype from the two accessories will again be called for transcription.  At the cessation of interviews with anniversary respondent, anniversary amateur will accept a $25 allowance agenda as a badge of acknowledgment for participating.  The researcher will advance acquaintance with participants, gluttonous for added information, via buzz and email messages. The abstracts will be collected, processed, and stored throughout the activity with complete privacy. 

Interview Questions

The contiguous interviews will be advised to aggregate abstracts from the recruited Jamaican men, on their lived adventures afterwards adeptness PCa screening. Phenomenological account searches for abyss to ascertain the accustomed lived apple of the assay participant.  The account will assay allusive accommodation in amateur specific announcement with allusive description.  The accommodation will about be not pre-defined, but appearing from the primary abstracts calm during the interviews, arise attaining abstracts saturation.  The account will activate with the account of the study’s purpose with the assay amateur by the researcher. 

The researcher will ask advancing catechism (Appendix D) to arm-twist an assay of their lived experience.  The acknowledgment to the questions will accredit the researcher to accretion an compassionate of what it is like for a Jamaican man in the U.S. to accept undergone PCa screening.  These ample questions will be customized to chase up on anniversary account advance include, why did you arise the PCa screening, was it your aboriginal affair or several sessions you accept undergone,  how old were you aback you accomplished or heard about the allegation for PCa screening for Jamaican men, and why did you arise the screening affair (Appendix D). 

Demographic Data

It is additionally important to agenda that the abstraction will aggregate some alarmingly basic demographic abstracts (Appendix E) from the participants.  Consequently, the abstraction will use distinctively advised assay to be abounding by all participants above-mentioned to the complete interviews, breadth anniversary amateur will board their demographic contour to accompany the primary abstracts calm during the interviews.  The demographic abstracts will abetment the researcher accept the situational ambience better, apropos the abnormality from the angle of anniversary participant, and to anecdotic any commonalities in the abstracts as able-bodied as accurately alarm the allegation based on the contour of the assay participant. The specific demographic advice to be calm will accommodate allegiance (both origins and residence), ethnicity, age of the participants, educational background, profession or occupation, conjugal cachet and cardinal of PCa screenings sessions anytime attended. 

Data Analysis 

After accession the primary data, the researcher will assay the calm abstracts in a address that responds to assay catechism and assay purpose to attain accelerating assimilation afterwards the aboriginal interview.  Best importantly, the abstracts assay activity will chase van Manen’s (1990) advice on allegory abstracts afterward a phenomenological study.  In the accomplishing therefore, afterward the achievement of interviews with anniversary respondent, the researcher will baddest the best attainable audio book amid the two recorded during anniversary affair and complete the audio book transcription.   All the audio files for anniversary amateur will be accumulated into a distinct archetype file.  Afterwards accepting transcribed account scripts, the researcher will adapt them to accommodate commentaries and reviews of the content, to board the acreage addendum taken during the interviews.  The researcher will additionally assay the demographic abstracts for anniversary interviewee from the demographic questionnaire, and amalgamate the abstracts with the edited account transcript.  The demographic abstracts alongside acreage addendum will be acclimated to adorn the meanings of the account data. 

Thereafter, the transcribed files will be analyzed thematically and categorized on how the acknowledging addresses the called themes.  The abstracts assay activity will appropriately absolutely adjust the abreast assay method, and resultant allegation will be abased on the qualitative accommodation arising from the primary data, categorized, narrated, and declared to accede to the study’s assay question.  The activity will crave that the transcripts be apprehend repetitively by the researcher. Munhall (2007) argued that qualitative abstracts assay involves analytical and alignment abstracts in complete themes, with the ambition of accepting an compassionate of the researched phenomena. 

Further, aback the abreast assay of antecedent interviews will advice clarify questions airish in consecutive interviews, to best addresses the accommodation beneath analysis, the assay activity will be accelerating and convalescent during the abstracts accumulating process.  Finally, during the abstracts analysis, the researcher will assay how participants duplicate, differ, concur, or augment the abstracts until a point of abstracts saturation.  Afterwards the abreast analysis, the researcher will again describe, allocate and actualize a accumulative estimation of accommodation accruing from the data, to accomplish the findings. Derivatively, the researcher will apply reflexivity to attending aback on the abstracts collected, chronicle it to anniversary respondent, contextualize the abstracts with the acreage notes, and actively participate in the all-embracing analytic activity of the accommodation to assemble their corresponding meanings.  Ultimately, the researcher will focus on answering the assay catechism in the best accurate, reliable, and complete manner, based on the calm primary data. 

Research Rigor

To achieve the third affiliate of the proposal, it is additionally important to assay how the researcher will beam the binding belief for assay accurateness during the study’s implementation. Bookish and authentic assay allegation necessarily accredit to the standards of affection that bathe them with abidingness and evaluated validity, as reflected by standards of  credibility, dependability, confirmability, and transferability   (Lincoln & Guba, 1985).  As such, in its implementation, the researcher will accept the accustomed attitude of qualitative abstracts analysis, in afterward of attaining optimal accurateness in acceding of credibility, dependability, confirmability, and transferability of the assay allegation generated, as advised below. 

Credibility of Assay Findings

According to Lincoln and Guba (1985), believability of qualitative assay allegation refers to the aplomb akin accomplished by the abstracts accumulating process, and the resultant assay and interpretation, to be true.  Assay allegation accretion believability if they can be believed, and aback the complete assay activity can be accustomed throughout, as acceptable to accomplish aboveboard after-effects for the readers and advisers to and for whom the new adeptness is advanced.  

Munhall (2007) alongside Denzin and Lincoln (2003) authorize believability of qualitative assay studies and allegation if the affection of the abstracts generated abundantly reflect the authentic animal acquaintance actuality studied.  As such, according to Munhall (2007), aboveboard phenomenology necessarily attains the aplomb akin with believability, if the abstracts generated and interpreted depicts the authentic reflections of the animal actors beneath review.  In the proposed study, the researcher will ensure that the complete abstraction is conducted in a address whose abidingness is credible, validated, and confirmed. 

All the primary abstracts analyzed will accept originated from the participants, authentic with accuracy, and rerecorded in carefulness with authentic interpretations from the angle of the participants.  As such, the allegation generated will represent authentic and authentic interpretations of the primary abstracts collected, absent of the bent and accordance of the researcher.  The role of the researcher above-mentioned to, during, and afterwards the abstracts accumulating is not to admission the interpretations derivable from the interviews, but to facilitate through animate interactions, the participants to board adequate, comprehensive, and authentic reflections of their experiences.

Dependability of Assay Findings

Dependability of qualitative assay allegation represents the adherence of the abstracts calm and analyzed, independents of contextual elements of time, abode and affairs (Lincoln & Guba, 1985).  In the proposed study, the researcher will abstracts the complete assay process, so that approaching advisers as able-bodied as the assigned admiral can chase through the assay activity and accede with the aforementioned interpretations and abstracts the researcher makes about the adventures of Jamaican men afterward PCa screening.  If approaching advisers seek to reconstruct the assay process, every activity will be applicable and backed by able assay affirmation to accomplish agnate allegation and conclusions. 

As such, the researcher will advance an authentic assay trail, such that the assay activity will be accurately authentic rather than abstract, aback breeding dependable allegation and conclusions.  From the sampling procedure, alternative of sample, abstracts collection, and abstracts analysis, the abstraction will be advisedly dependable if evaluated, behindhand of the time and ecology factors in which the abstraction is conducted.  It is hoped that the final address will absorb a ample and abundantly anecdotic assay activity for abstracts accumulating and analysis, and that the address will be based on authentic and complete data.  These strategies will be taken to ensure that a agnate admission can be acclimated in future, and that approaching assay can assert and abutment the allegation generated.  

Confirmability of Assay Findings

Denzin and Lincoln (2003) authorize qualitative allegation as confirmable, abandoned is they attain objectivity and or neutrality in the address the abstracts was calm and analyzed. To Munhall (2007), phenomenological assay affliction to apply bracketing and cold reflectivity aback anticipation the interpretations, in a address that guarantees that agnate allegation and abstracts can be accustomed for the abnormality beneath study. Munhall (2007) recommends the use of journaling in a address that all abstracts can be authenticated, and breadth researchers’ opinions, feelings, and abstruse adventures do not circumscribe the cold assay process. 

In the proposed study, the primary abstracts calm during the interviews will additionally be complemented by a accumulation of acreage agenda in the journal, such that the abstracts assay is not aloof what the participants said, but additionally what will not be bidding or announced non-verbally. The resultant estimation therefore, will be attainable to acceptance by parties alfresco the assay activity (third parties). The transcribed files will appropriately accommodate descriptions of feelings, reactions and cogitating judgments, all based on the perspectives of the participants and not of the researcher.  Importantly, as argued by Creswell (1998) and Crotty (2004), conceivably the best important aspect of qualitative abstracts assay to attain assay abidingness is application affiliate assay and confirmation. 

Consequently, the researcher will apply focus groups as the added and adulatory abstracts accumulating instrument. Afterwards all the interviews gave been conducted, and the abstracts analyzed, the researcher will again facilitate a focus group.  The allegation to attain credibility, dependability, and confirmability of the allegation will additionally crave the accedence of the participants.  The participants will additionally be accustomed a archetype of their archetype alongside the abreast assay of the interview. Further, the assay estimation of meanings presented as the study’s allegation will be apprehend to the participants, gluttonous for their feedback, conformation, and corrections for any baloney and misinformation, as able-bodied added commentary, on the meanings as interpreted. 

Transferability of Assay Findings

Long afterwards the proposed abstraction has been assured amid Jamaican men in South Florida, the researcher hopes that the authentic assay activity and the allegation generated are communicable to agnate contexts.  While qualitative allegation rarely attains the generalizability of quantitative assay findings, qualitative assay allegation should attain transferability to agnate contexts (in settings and sample) besides the area of the abstraction (Creswell, 1998; Munhall, 2007).  To attain this affection of findings, the researcher will certificate and logically alarm the assay activity in a address that approaching advisers can apparatus a agnate abstraction alfresco South Florida, with accession set of sampled participants, and accomplish agnate findings. 

As such, the assay activity from abstracts accumulating to analysis, will abandoned be animate if it is the best acclimatized and achievable for the study, and aback bracketing attains aboveboard allegation whose abstracts can validly to ample the accustomed gap in knowledge.  This will be cautiously acute in the abstracts assay date of the study, breadth the abreast assay will be acquainted in a address that is detailed, complete and can be collaborated. In the proposed study, the researcher will apparatus the abreast abstracts assay application abreast bracketing, breadth the abstracts will be categorized ‘as it is’ afterwards bent or abstruse admission of the allegation generated.  Ideally, the researcher will focus on enhance the believability, trustworthiness, and believability of all allegation generated from the study, to ensure that the allegation are communicable to accession contexts with agnate phenomenological constraints. 

Chapter Summary

This third affiliate of the altercation angle provided a complete account of the assay strategies to be acclimated aback administering the proposed study. The assay strategies were called and planned in an attack to codify accurate, reliable, and able answers to the study’s assay question.  In conclusion, therefore, a allegorical phenomenology assay architecture will be acclimated targeting the Jamaicans in South Florida.  The abstraction will apply a snowball sampling activity to recruit amid 30 Jamaican men in South Florida, age-old amid 40 and 70 years, and who accept undergone PCa screening. The arch account catechism will be ‘what participants anticipate about PCa screening sessions, based on their experiences, and whether they are blessed that they underwent the procedure’. 

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