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Kamsvaag B, Tevik K, Šaltytė Benth J, Wu B, Bergh S, Selbaek G, Helvik AS. Does Elevated Alcohol Consumption Delay the Diagnostic Assessment of Cognitive Impairment among Older Adults? Dement Geriatr Cogn Dis Extra 2022; 12:14-23. [PMID: 35350466 PMCID: PMC8921958 DOI: 10.1159/000521924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The time from symptom debut to assessment of cognitive impairment (TSA) is usually substantial, and many factors can influence the length of this interval. Our objective was to discern whether elevated alcohol consumption is associated with TSA. Methods Alcohol consumption was measured among 3,236 older Norwegians assessed for cognitive impairment. Elevated consumption was defined as drinking 4–7 times a week. TSA was defined as the number of months between symptom debut and assessment. The association between alcohol consumption and TSA was examined with a multiple regression analysis controlled for sociodemographic and clinical covariates. Results Mean (SD) and median TSA were 34.8 (35.8) and 24.0 months, respectively. Elevated alcohol consumption was not associated with TSA. Longer TSA was associated with being male, having a high education level, being retired or unemployed, being single, having low scores on the Mini-Mental State Examination (MMSE) or Personal Activities of Daily Living (PADL), having high subsyndrome scores of depression or agitation on The Neuropsychiatric Inventory − Questionnaire (NPI-Q), or having a spouse/cohabitant as the designated next of kin. Conclusion This study indicates that elevated alcohol consumption does not influence TSA. Possible explanations are discussed, but further research is needed to determine the effect of alcohol definitively. We did identify other novel characteristics associated with TSA which may be important in minimizing the risk of delayed cognitive assessments and should be kept in mind when considering assessment.
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Affiliation(s)
- Ben Kamsvaag
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- *Ben Kamsvaag,
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jūratė Šaltytė Benth
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Sverre Bergh
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Starnoni M, De Santis G, Lolli F, Pinelli M. Factors related to delayed treatment: A case report of a huge cutaneous horn and review of the literature. Ann Med Surg (Lond) 2020; 60:384-388. [PMID: 33235713 PMCID: PMC7670244 DOI: 10.1016/j.amsu.2020.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
We present a case of a man with a giant cutaneous horn over his frontal region. This case has been presented for the size of the lesion, due to delayed treatment, and to illustrate the reasons why the growth of this lesion has been possible in a western country, in the 21st century. It was a solitary, not painful lesion which caused significant aesthetic problems. The diagnosis was based on an ultrasonographic study and the treatment of choice was a surgical excision. This case is an opportunity to review the literature about the cutaneous horns, to talk about the main causes of delayed diagnosis and treatment of cutaneous lesions and, to define the role of the specialist in the assessment of emotions and patient support.
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Affiliation(s)
- Marta Starnoni
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
| | - Giorgio De Santis
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
| | - Francesca Lolli
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
| | - Massimo Pinelli
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
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Fried D, McAndrew LM, Helmer DA, Markowitz S, Quigley KS. Interrelationships between symptom burden and health functioning and health care utilization among veterans with persistent physical symptoms. BMC FAMILY PRACTICE 2020; 21:124. [PMID: 32611312 PMCID: PMC7329405 DOI: 10.1186/s12875-020-01193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/15/2020] [Indexed: 11/12/2022]
Abstract
Background Between 10 and 50% of primary care patients present with persistent physical symptoms (PPS). Patients with PPS tend to utilize excessive or inappropriate health care services, while being stuck in a deleterious cycle of inactivity, deconditioning, and further worsening of symptoms and disability. Since military deployment (relative to non-deployment) is associated with greater likelihood of PPS, we examined the interrelationships of health care utilization, symptom burden and functioning among a sample of recently deployed Veterans with new onset persistent physical symptoms. Methods This study analyzed a cohort of 790 U.S. soldiers who recently returned from deployment to Iraq or Afghanistan. Data for this analysis were obtained at pre- and post-deployment. We used moderation analyses to evaluate interactions between physical symptom burden and physical and mental health functioning and four types of health care utilization one-year after deployment, after adjusting for key baseline measures. Results Moderation analyses revealed significant triple interactions between physical symptom burden and health functioning and: primary care (F = 3.63 [2, 303], R2Δ = .02, p = 0.03), specialty care (F = 6.81 [2, 303] R2Δ =0.03, p < .001), allied therapy care (F = 3.76 [2, 302], R2Δ = .02, p = 0.02), but not mental health care (F = 1.82 [1, 303], R2Δ = .01, p = .16), one-year after deployment. Conclusions Among U.S. Veterans with newly emerging persistent physical symptoms one-year after deployment, increased physical symptom burden coupled with decreased physical and increased mental health functioning was associated with increased medical care use in the year after deployment. These findings support whole health initiatives aimed at improving health function/well-being, rather than merely symptom alleviation.
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Affiliation(s)
- Dennis Fried
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ, 07018, USA. .,Department of Epidemiology, Rutgers, The State University of New Jersey, 185 South Orange Avenue, MSB, Newark, NJ, 07101, USA.
| | - Lisa M McAndrew
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ, 07018, USA
| | - Drew A Helmer
- Department of Veterans Affairs, NJ War Related Illness & Injury Study Center, 385 Tremont Ave. Mailstop 129, East Orange, NJ, 07018, USA.,New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, MSB, Newark, NJ, 07101, USA
| | | | - Karen S Quigley
- Interdisciplinary Affective Science Laboratory, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, USA.,Department of Veterans Affairs, Bedford Memorial Hospital, 200 Springs Rd, Bedford, MA, 01730, USA
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Bernal Cárdenas CY, Céspedes-Cuevas VM, Sanhueza-Alvarado OI. Modelo conceptual del manejo del síntoma: evaluación y crítica. AQUICHAN 2018. [DOI: 10.5294/aqui.2018.18.3.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivos: evaluar, analizar y criticar el modelo conceptual del manejo del síntoma a partir de los pasos planteados por Fawcett en 2013, y mostrar la relevancia que tiene este ejercicio académico en el área investigativa, tanto a nivel académico como asistencial en enfermería. Materiales y métodos: se realizó una búsqueda sistemática de piezas de investigación, las cuales fueron sometidas a un proceso de lectura crítica por medio de la aplicación de las siguientes herramientas: Critical Appraisal Skills Programme (CAPS) para las piezas de investigación cualitativas, MacMaster University para la piezas de investigación de tipo cuantitativo, el rigor metodológico y la estructura conceptual teórico-empírica planteada por Fawcett en 2013, con lo cual se garantizó la calidad de las piezas de investigación seleccionadas. Resultados: se logró identificar los planteamientos del Modelo conceptual del manejo del síntoma y de investigaciones donde se utilizó este modelo como marco teórico para realizar una evaluación y crítica de este, en la que se tuvieron en cuenta: sus orígenes, el enfoque único del modelo, su congruencia lógica, la generación de teoría, su credibilidad y las contribuciones para la disciplina de enfermería, que corresponden a los pasos recomendados por Fawcett para la evaluación crítica de modelos conceptuales. Conclusión: a pesar de ser un modelo conceptual nuevo cuenta con fuertes bases teóricas y filosóficas que permiten su aplicación a cualquier fenómeno referente a la experiencia de los síntomas; sin embargo, se debe realizar más investigación donde se haga uso de las dimensiones de “los componentes de estrategias de manejo de los síntomas” y “resultados”, ya que un amplio volumen de investigación realizada hasta el momento ha hecho uso de la dimensión “la experiencia de los síntomas”.
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Kinnamon DD, Morales A, Bowen DJ, Burke W, Hershberger RE. Toward Genetics-Driven Early Intervention in Dilated Cardiomyopathy: Design and Implementation of the DCM Precision Medicine Study. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.117.001826. [PMID: 29237686 DOI: 10.1161/circgenetics.117.001826] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The cause of idiopathic dilated cardiomyopathy (DCM) is unknown by definition, but its familial subtype is considered to have a genetic component. We hypothesize that most idiopathic DCM, whether familial or nonfamilial, has a genetic basis, in which case a genetics-driven approach to identifying at-risk family members for clinical screening and early intervention could reduce morbidity and mortality. METHODS On the basis of this hypothesis, we have launched the National Heart, Lung, and Blood Institute- and National Human Genome Research Institute-funded DCM Precision Medicine Study, which aims to enroll 1300 individuals (600 non-Hispanic African ancestry, 600 non-Hispanic European ancestry, and 100 Hispanic) who meet rigorous clinical criteria for idiopathic DCM along with 2600 of their relatives. Enrolled relatives will undergo clinical cardiovascular screening to identify asymptomatic disease, and all individuals with idiopathic DCM will undergo exome sequencing to identify relevant variants in genes previously implicated in DCM. Results will be returned by genetic counselors 12 to 14 months after enrollment. The data obtained will be used to describe the prevalence of familial DCM among idiopathic DCM cases and the genetic architecture of idiopathic DCM in multiple ethnicity-ancestry groups. We will also conduct a randomized controlled trial to test the effectiveness of Family Heart Talk, an intervention to aid family communication, for improving uptake of preventive screening and surveillance in at-risk first-degree relatives. CONCLUSIONS We anticipate that this study will demonstrate that idiopathic DCM has a genetic basis and guide best practices for a genetics-driven approach to early intervention in at-risk relatives. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT03037632.
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Affiliation(s)
- Daniel D Kinnamon
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.).
| | - Ana Morales
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.)
| | - Deborah J Bowen
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.)
| | - Wylie Burke
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.)
| | - Ray E Hershberger
- From the Division of Human Genetics (D.D.K., A.M., R.E.H.) and Cardiovascular Division (R.E.H.), Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus; and Department of Bioethics & Humanities, University of Washington, Seattle (D.J.B., W.B.).
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Helvik AS, Engedal K, Šaltytė Benth J, Selbæk G. Time from Symptom Debut to Dementia Assessment by the Specialist Healthcare Service in Norway. Dement Geriatr Cogn Dis Extra 2018; 8:117-127. [PMID: 29706988 PMCID: PMC5921216 DOI: 10.1159/000487233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/28/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives We described the duration from symptom debut to assessment at specialist healthcare outpatient clinics for dementia in Norway and explored whether educational level was associated with time from symptom debut to dementia assessment. Methods The study comprised 835 persons from a register for individuals with cognitive symptoms (NorCog). The outcome variable was time in months from symptom debut to assessment. The main independent variable was the number of years of education. Also age, gender, marital status, cognitive function, neuropsychiatric symptoms, assistance and location were assessed. Results In an adjusted linear mixed model, a higher educational level was associated with a longer duration from symptom debut to assessment, where 5 additional years of education increased the time from symptom debut to consultation by 10%. Conclusion The findings may perhaps be explained by the hypothesis that highly educated people may be able to compensate better for cognitive impairment, which is in line with a hypothesis of cognitive reserve.
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Affiliation(s)
- Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,St Olavs University Hospital, Trondheim, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Health Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Phillips LA, Leventhal H, Burns EA. Choose (and use) your tools wisely: "Validated" measures and advanced analyses can provide invalid evidence for/against a theory. J Behav Med 2016; 40:373-376. [PMID: 27757769 DOI: 10.1007/s10865-016-9807-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Affiliation(s)
- L Alison Phillips
- Department of Psychology, Iowa State University, Ames, IA, 50011, USA.
| | - Howard Leventhal
- Department of Psychology, Institute for Health, Rutgers University, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - Edith A Burns
- Division of Geriatrics, Medical College of Wisconsin, Milwaukee, WI, 53295, USA
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Simons G, Mason A, Falahee M, Kumar K, Mallen CD, Raza K, Stack RJ. Qualitative Exploration of Illness Perceptions of Rheumatoid Arthritis in the General Public. Musculoskeletal Care 2016; 15:13-22. [PMID: 26833593 PMCID: PMC4903170 DOI: 10.1002/msc.1135] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Treating patients with rheumatoid arthritis (RA) within three months of symptom onset leads to significantly improved outcomes. However, many people delay seeking medical attention. In order to understand the reasons for this delay, it is important to have a thorough understanding of public perceptions about RA. The current study investigated these perceptions using the Self‐Regulation Model (SRM) as a framework to explain how health behaviour is influenced by illness perceptions (prototypes) through qualitative interviews with 15 members of the public without RA. Interviews were audio‐recorded, transcribed and analysed using framework analysis based on SRM illness perceptions. Both accurate and inaccurate perceptions about the identity, causes, consequences, controllability and timeline of RA were identified. This highlights opportunities to enhance public knowledge about RA. These findings further support the utility of exploring prototypical beliefs of illness, suggesting their potential role in influencing help‐seeking behaviours and identifying probable drivers/barriers to early presentation. © 2016 The Authors Musculoskeletal Care Published by John Wiley & Sons Ltd.
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Affiliation(s)
| | - Anna Mason
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Kanta Kumar
- University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,University of Manchester, Manchester, UK
| | | | - Karim Raza
- University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Rebecca J Stack
- University of Birmingham, Birmingham, UK.,Nottingham Trent University, Nottingham, UK
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Developing a Complex Educational-Behavioural Intervention: The TREAT Intervention for Patients with Atrial Fibrillation. Healthcare (Basel) 2016; 4:healthcare4010010. [PMID: 27417598 PMCID: PMC4934544 DOI: 10.3390/healthcare4010010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 11/17/2022] Open
Abstract
This article describes the theoretical and pragmatic development of a patient-centred intervention for patients with atrial fibrillation (AF). Theoretical models (Common Sense Model, Necessity-Concerns Framework), clinical frameworks, and AF patient feedback contributed to the design of a one-off hour-long behaviour-change intervention package. Intervention materials consisted of a DVD, educational booklet, diary and worksheet, which were patient-centred and easy to administer. The intervention was evaluated within a randomised controlled trial. Several “active theoretical ingredients” were identified (for e.g., where patients believed their medication was less harmful they spent more time within the therapeutic range (TTR), with general harm scores predicting TTR at 6 months). Allowing for social comparison and adopting behaviour change techniques enabled accurate patient understanding of their condition and medication. The process of developing the intervention using theory-derived content and evaluation tools allowed a greater understanding of the mechanisms by which this intervention was successful. Alleviating concerns about treatment medication by educating patients can help to improve adherence. This process of intervention development could be adopted for a range of chronic illnesses and treatments. Critical elements should include the use of: (1) clinical guidelines; (2) appropriate theoretical models; (3) patient input; and (4) appropriate evaluation tools.
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Simons G, Mallen CD, Kumar K, Stack RJ, Raza K. A qualitative investigation of the barriers to help-seeking among members of the public presented with symptoms of new-onset rheumatoid arthritis. J Rheumatol 2015; 42:585-92. [PMID: 25641894 DOI: 10.3899/jrheum.140913] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Treating patients with rheumatoid arthritis (RA) within 3 months of symptom onset leads to significantly improved clinical outcomes. However, many people with RA symptoms wait a long time before seeking medical attention. To develop effective health interventions to encourage people to seek help early, it is important to understand what the general public knows about RA, how they would react to the symptoms of RA, and what might delay help-seeking. METHODS Qualitative interviews were conducted with 38 members of the general public (32 women) without any form of inflammatory arthritis about their perceptions of RA symptoms and decisions to seek help were they to experience such symptoms. The interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS A number of barriers and drivers to help-seeking were identified and grouped into 5 themes: perceived causes of symptoms; factors related to presentation, location, and experience of symptoms; perceived effect of symptoms on daily life; self-management of symptoms; and general practitioner-related drivers and barriers. CONCLUSION To our knowledge, our study is the first to investigate barriers to and drivers of help-seeking in response to the onset of RA symptoms in individuals without a diagnosis of RA. It has revealed a number of additional factors (e.g., the importance of the location of the symptoms) besides those previously identified in retrospective studies of patients with RA. Together with the data from previous research, these findings will help inform future health interventions aimed at increasing knowledge of RA and encouraging help-seeking.
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Affiliation(s)
- Gwenda Simons
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust.
| | - Christian David Mallen
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust
| | - Kanta Kumar
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust
| | - Rebecca Jayne Stack
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust
| | - Karim Raza
- From the Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; Sandwell and West Birmingham Hospitals National Health Service (NHS) Trust, Birmingham; Arthritis Research United Kingdom Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele; and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester, Manchester, UK.G. Simons, Research Fellow, PhD; R.J. Stack, Research Fellow, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham; C.D. Mallen, Professor of General Practice Research, PhD, Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University; K. Kumar, National Institute for Health Research Clinical Doctoral Research Fellow, MSc, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Faculty of Medical and Human Sciences, School of Nursing, University of Manchester; K. Raza, Professor of Clinical Rheumatology, Honorary Consultant Rheumatologist, PhD, Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, and the Sandwell and West Birmingham Hospitals NHS Trust
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Stack RJ, Mallen CD, Deighton C, Kiely P, Shaw KL, Booth A, Kumar K, Thomas S, Rowan I, Horne R, Nightingale P, Herron-Marx S, Jinks C, Raza K. The development and initial validation of a questionnaire to measure help-seeking behaviour in patients with new onset rheumatoid arthritis. Health Expect 2014; 18:2340-55. [PMID: 24889289 DOI: 10.1111/hex.12203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Early treatment for rheumatoid arthritis (RA) is vital. However, people often delay in seeking help at symptom onset. An assessment of the reasons behind patient delay is necessary to develop interventions to promote rapid consultation. OBJECTIVE Using a mixed methods design, we aimed to develop and test a questionnaire to assess the barriers to help seeking at RA onset. DESIGN Questionnaire items were extracted from previous qualitative studies. Fifteen people with a lived experience of arthritis participated in focus groups to enhance the questionnaire's face validity. The questionnaire was also reviewed by groups of multidisciplinary health-care professionals. A test-retest survey of 41 patients with newly presenting RA or unclassified arthritis assessed the questionnaire items' intraclass correlations. RESULTS During focus groups, participants rephrased questions, added questions and deleted items not relevant to the questionnaire's aims. Participants organized items into themes: early symptom experience, initial reactions to symptoms, self-management behaviours, causal beliefs, involvement of significant others, pre-diagnosis knowledge about RA, direct barriers to seeking help and relationship with GP. The test-retest survey identified seven items (out of 79) with low intraclass correlations which were removed from the final questionnaire. CONCLUSION The involvement of people with a lived experience of arthritis and multidisciplinary health-care professionals in the preliminary validation of the DELAY (delays in evaluating arthritis early) questionnaire has enriched its development. Preliminary assessment established its reliability. The DELAY questionnaire provides a tool for researchers to evaluate individual, cultural and health service barriers to help-seeking behaviour at RA onset.
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Affiliation(s)
- Rebecca J Stack
- Centre for Translational Inflammation Research, School of Infection and Immunity, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Chris Deighton
- Department of Rheumatology, Derby Hospitals NHS Foundation Trust, Derby, UK
| | - Patrick Kiely
- Department of Rheumatology, St Georges Healthcare Trust, London, UK
| | - Karen L Shaw
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Alison Booth
- Department of Rheumatology, Derby Hospitals NHS Foundation Trust, Derby, UK
| | - Kanta Kumar
- Centre for Translational Inflammation Research, School of Infection and Immunity, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Susan Thomas
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Ian Rowan
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Rob Horne
- School of Pharmacy, University of London, London, UK
| | - Peter Nightingale
- Wolfson Computer Laboratory, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sandy Herron-Marx
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Keele University, Staffs, UK
| | | | - Karim Raza
- Centre for Translational Inflammation Research, School of Infection and Immunity, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
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12
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Appraisal of emerging symptoms of colorectal cancer: associations with dispositional, demographic, and tumor characteristics. J Behav Med 2013; 37:698-708. [PMID: 23712574 DOI: 10.1007/s10865-013-9519-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 05/16/2013] [Indexed: 10/26/2022]
Abstract
The time it takes for individuals to realize that their emerging colorectal cancer (CRC) symptoms are serious is often an impediment to expeditious help-seeking. Tailored educational efforts to hasten symptom appraisal time would benefit from knowledge of the characteristics of individuals who tend to neglect their symptoms as well as the nature of symptoms that are most often neglected. In a sample of 112 CRC patients, we investigated associations between duration of symptom appraisal and: (1) trait anxiety, and (2) tumor location, which affects symptomatology. Symptom appraisal duration was associated with a sex-by-anxiety interaction (p = 0.007). The longest times (in weeks) were among high anxiety females (Mdn = 26.0) and low anxiety males (Mdn = 17.0), with shorter times among low anxiety females (Mdn = 9.0) and high anxiety males (Mdn = 2.0). Symptom appraisal times were also longer for patients with distal (vs. proximal) tumors (p = 0.036).
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Bergman HE, Reeve BB, Moser RP, Scholl S, Klein WMP. Development of a Comprehensive Heart Disease Knowledge Questionnaire. AMERICAN JOURNAL OF HEALTH EDUCATION 2013; 42:74-87. [PMID: 21720571 DOI: 10.1080/19325037.2011.10599175] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND: Heart disease is the number one killer of both men and women in the United States, yet a comprehensive and evidence-based heart disease knowledge assessment is currently not available. PURPOSE: This paper describes the 2 phase development of a novel heart disease knowledge questionnaire. METHODS: After review and critique of the existing literature, a questionnaire addressing 5 central domains of heart disease knowledge was constructed. In Phase I, 606 undergraduates completed a 82-item questionnaire. In Phase II, 248 undergraduates completed a revised 74-item questionnaire. In both phases, item clarity and difficulty were evaluated, along with the overall factor structure of the scale. RESULTS: Exploratory and confirmatory factor analyses were used to reduce the scale to 30 items with fit statistics, CFI = .82, TLI = .88, and RMSEA = .03. Scores were correlated moderately positively with an existing scale and weakly positively with a measure of health literacy, thereby establishing both convergent and divergent validity. DISCUSSION: The finalized 30-item questionnaire is a concise, yet discriminating instrument that reliably measures participants' heart disease knowledge levels. TRANSLATION TO HEALTH EDUCATION PRACTICE: Health professionals can use this scale to assess their patients' heart disease knowledge so that they can create a tailored program to help their patients reduce their heart disease risk.
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Affiliation(s)
- Hannah E Bergman
- Division of Cancer Control and Population Sciences, National Cancer Institute
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14
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Siegel K, Lekas HM, Schrimshaw EW, Brown-Bradley CJ. Strategies adopted by late middle-age and older adults with HIV/AIDS to explain their physical symptoms. Psychol Health 2012; 26 Suppl 1:41-62. [PMID: 21337262 DOI: 10.1080/08870441003681299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although the attributions individuals make about what causes their physical symptoms are known to influence their care seeking and self-care behaviours, much less is known about the strategies they use to arrive at these attributions. The strategies employed to understand the causes of their symptoms were investigated using in-depth interviews with 100 late middle-age and older adults with HIV/AIDS in New York City. The data revealed that most participants actively sought to explain their symptoms. The explanatory strategies identified included: relying upon illness or medication representations, lay beliefs about the body and ageing, invoking pre-existing vulnerabilities, engaging in lay experimentation, social comparison processes, considering temporal ordering and consulting authoritative sources. While most of them offered a single cause for their symptoms, some offered more complex multi-causal explanations. These findings provide understanding into the reasons why some older adults with HIV/AIDS misattribute symptoms resulting in delay in care or care over-utilisation, suggesting the need for patient education.
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Affiliation(s)
- Karolynn Siegel
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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15
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Elliott AM, McAteer A, Hannaford PC. Incongruous consultation behaviour: results from a UK-wide population survey. BMC FAMILY PRACTICE 2012; 13:21. [PMID: 22433072 PMCID: PMC3338366 DOI: 10.1186/1471-2296-13-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 03/20/2012] [Indexed: 12/03/2022]
Abstract
Background Symptom characteristics are strong drivers of care seeking. Despite this, incongruous consultation behaviour occurs and has implications for both individuals and health-care services. The aim of this study was to determine how frequently incongruous consultation behaviour occurs, to examine whether it is more common for certain types of symptoms and to identify the factors associated with being an incongruous consulter. Methods An age and sex stratified random sample of 8,000 adults was drawn from twenty UK general practices. A postal questionnaire was used to collect detailed information on the presence and characteristics of 25 physical and psychological symptoms, actions taken to manage the symptoms, general health, attitudes to symptom management and demographic/socio-economic details. Two types of incongruous consultation behaviour were examined: i) consultation with a GP for symptoms self-rated as low impact and ii) no consultation with a GP for symptoms self-rated as high impact. Results A fifth of all symptoms experienced resulted in consultation behaviour which was incongruous based on respondents' own rating of the symptoms' impact. Low impact consultations were not common, although symptoms indicative of a potentially serious condition resulted in a higher proportion of low impact consultations. High impact non-consultations were more common, although there was no clear pattern in the type of associated symptoms. Just under half of those experiencing symptoms in the previous two weeks were categorised as an incongruous consulter (low impact consulter: 8.3%, high impact non-consulter: 37.1%). Employment status, having a chronic condition, poor health, and feeling that reassurance or advice from a health professional is important were associated with being a low impact consulter. Younger age, employment status, being an ex-smoker, poor health and feeling that not wasting the GPs time is important were associated with being a high impact non-consulter. Conclusions This is one of the first studies to examine incongruous consultation behaviour for a range of symptoms. High impact non-consultations were common and may have important health implications, particularly for symptoms indicative of serious disease. More research is now needed to examine incongruous consultation behaviour and its impact on both the public's health and health service use.
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Affiliation(s)
- Alison M Elliott
- Centre of Academic Primary Care Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, West Block Foresterhill, Aberdeen AB25 2ZD, UK.
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Yardley L, Joseph J, Michie S, Weal M, Wills G, Little P. Evaluation of a Web-based intervention providing tailored advice for self-management of minor respiratory symptoms: exploratory randomized controlled trial. J Med Internet Res 2010; 12:e66. [PMID: 21159599 PMCID: PMC3056528 DOI: 10.2196/jmir.1599] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 10/18/2010] [Accepted: 11/08/2010] [Indexed: 11/17/2022] Open
Abstract
Background There has been relatively little research on the role of web-based support for self-care in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions. Objective This study was designed as an evaluation of the usage and effects of the “Internet Doctor” website providing tailored advice on self-management of minor respiratory symptoms (eg, cough, sore throat, fever, runny nose), in preparation for a definitive trial of clinical effectiveness. The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services, to test whether the tailored, theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information (the control condition). The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups, and by analyzing usage of the Internet Doctor webpages and predictors of intention change. Methods Participants (N = 714) completed baseline measures of beliefs about their symptoms and self-care online, and were then automatically randomized to the Internet Doctor or control group. These measures were completed again by 332 participants after 48 hours. Four weeks later, 214 participants completed measures of enablement and health service use. Results The Internet Doctor resulted in higher levels of satisfaction than the control information (mean 6.58 and 5.86, respectively; P = .002) and resulted in higher levels of enablement a month later (median 3 and 2, respectively; P = .03). Understanding of illness improved in the 48 hours following use of the Internet Doctor webpages, whereas it did not improve in the control group (mean change from baseline 0.21 and -0.06, respectively, P = .05). Decline in intentions to consult the doctor between baseline and follow-up was predicted by age (beta = .10, P= .003), believing before accessing the website that consultation was necessary for recovery (beta = .19, P < .001), poor understanding of illness (beta = .11, P = .004), emotional reactions to illness (beta = .15, P <.001), and use of the Diagnostic section of the Internet Doctor website (beta = .09, P = .007). Conclusions Our findings provide initial evidence that tailored web-based advice could help patients self-manage minor symptoms to a greater extent. These findings constitute a sound foundation and rationale for future research. In particular, our study provides the evidence required to justify carrying out much larger trials in representative population samples comparing tailored web-based advice with routine care, to obtain a definitive evaluation of the impact on self-management and health service use.
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Affiliation(s)
- Lucy Yardley
- School of Psychology, University of Southampton, Southampton, United Kingdom.
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Kayaniyil S, Gravely-Witte S, Stewart DE, Higginson L, Suskin N, Alter D, Grace SL. Degree and correlates of patient trust in their cardiologist. J Eval Clin Pract 2009; 15:634-40. [PMID: 19522723 PMCID: PMC2972247 DOI: 10.1111/j.1365-2753.2008.01064.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Trust in one's doctor has been associated with increased treatment adherence, patient satisfaction and improved health status. This study investigated the level and correlates of patient trust in their cardiac specialist. METHODS All 386 urban cardiologists in Southern Ontario (95 participating, response rate = 30%) were approached to recruit a sample of their coronary artery disease outpatients. A total of 1111 recent and consecutive patients consented to participate (approximately 13 patients per cardiologist, 317 female (26.7%); response rate = 60%), and clinical data were extracted from their medical charts. Participants completed a mailed survey including the Trust in Physicians scale, in addition to an assessment of socio-demographic, clinical and psychosocial correlates. RESULTS The mean trust score was equivalent to that reported in studies of primary care patients. Results of the significant multivariate model (F = 7.631, P < 0.001) revealed that less education (P < 0.001), higher systolic blood pressure (P = 0.022), less perceived cyclical/unpredictable illness timeline (P = 0.007) and greater perceived personal control over their heart condition (P = 0.004), were significant correlates of greater trust in cardiologist care. CONCLUSIONS The significance of education is corroborated by findings of lower satisfaction with cardiac care among those of higher socio-economic status, despite having generally greater access to care in Ontario. Moreover, the relationship between hypertension and greater trust may suggest that such perceptions are not based on doctor competence. Future studies should further investigate the correlates of trust, as well as the impact of trust on cardiac health outcomes.
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Affiliation(s)
- Sheena Kayaniyil
- Department of Kinesiology and Health Science, York University, Toronto, Canada
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18
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Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin Psychol Rev 2008; 28:1426-46. [PMID: 18848740 PMCID: PMC2669084 DOI: 10.1016/j.cpr.2008.09.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 08/15/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
Abstract
Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.
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19
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Searle A, Wetherell MA, Campbell R, Dayan C, Weinman J, Vedhara K. Do patients' beliefs about type 2 diabetes differ in accordance with complications: an investigation into diabetic foot ulceration and retinopathy. Int J Behav Med 2008; 15:173-9. [PMID: 18696310 DOI: 10.1080/10705500802212940] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous research has examined patients' beliefs in diabetes and how these beliefs may affect patient outcomes. However, changes in symptoms and complications are a common feature of diabetes, and these can significantly alter the patient's "disease experience." However, no consideration has been given to how beliefs about diabetes vary according to the complications patients have. PURPOSE The present study was designed to compare the beliefs of 22 patients with diabetic foot ulcers and 22 age-and gender-matched patients with diabetic retinopathy, and 22 age-and gender-matched controls with type 2 diabetes but without either complication. METHODS Beliefs about diabetes were assessed with the Revised Illness Perception Questionnaire (IPQ-R; Moss-Morris et al., 2002). RESULTS Patients with foot ulcers held a greater belief in personal control of diabetes, but perceived treatment control was lower than that of diabetic controls without serious complications (p < .05). Patients with foot ulcers also demonstrated less illness coherence than patients with retinopathy and diabetic controls (p < .01) and also perceived their diabetes to be more cyclical in nature (p < .01). CONCLUSION Differences were found in diabetic patients' beliefs according to their complications. Future interventions should consider how the complications associated with diabetes may affect patients' beliefs and subsequent emotional and behavioral responses to the disease.
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Affiliation(s)
- Aidan Searle
- Department of Social Medicine, University of Bristol, Bristol, UK
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20
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Pau A, Croucher R, Marcenes W. Determinants of perceived need for dental pain medication. Community Dent Oral Epidemiol 2008; 36:279-86. [DOI: 10.1111/j.1600-0528.2007.00396.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Leventhal H, Mora PA. Predicting Outcomes or Modeling Process? Commentary on the Health Action Process Approach. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 2008. [DOI: 10.1111/j.1464-0597.2007.00322.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Donovan HS, Ward SE, Song MK, Heidrich SM, Gunnarsdottir S, Phillips CM. An update on the representational approach to patient education. J Nurs Scholarsh 2007; 39:259-65. [PMID: 17760800 PMCID: PMC2526460 DOI: 10.1111/j.1547-5069.2007.00178.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To provide an update on the representational approach to patient education. ORGANIZING CONSTRUCT The representational approach to patient education to guide a wide-range of educational interventions. METHODS Four intervention trials based on the representational approach are discussed: the representational intervention to decrease cancer pain (RIDcancerPain), patient-centered advance care planning (PC-ACP), an individualized representational intervention to improve symptom management (IRIS), and the written representational intervention to ease symptoms (WRITE symptoms). RESULTS Findings from these trials show that interventions based on the representational approach are efficacious. Results of these trials have provided information for strengthening the approach and extending it to novel clinical problems and delivery modes. CONCLUSIONS The representational approach to patient education appears to be adequately flexible to guide interventions in different patient care situations, while also sufficiently structured to be replicable and testable.
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Affiliation(s)
- Heidi Scharf Donovan
- University of Pittsburgh School of Nursing, Department of Acute & Tertiary Care, Pittsburgh, PA 15261, USA.
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Neuroticism, Side Effects, and Health Perceptions Among HIV-Infected Individuals on Antiretroviral Medications. J Clin Psychol Med Settings 2007; 14:69-77. [PMID: 18568088 DOI: 10.1007/s10880-007-9056-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Side effects from antiretroviral therapy (ART) for HIV disease can deter treatment, impact quality of life, and impede medication adherence. Individual differences in neuroticism may account for variations in the experience of side effects and perceptions of health status. Cross-sectional assessments were conducted with 258 HIV-infected participants with confirmed HIV infection and current ART regimen. Structural equation modeling (SEM) was used to evaluate a model of self-reported ART side effect frequency and severity and perceived health status, as related to symptoms of neuroticism. Symptoms of neuroticism were associated with greater reports of ART side effects and poorer perceived health but unrelated to reported CD4 count and viral load. A structural model was supported in which greater symptoms of neuroticism are linked to poorer perceived health through greater side effect frequency and severity. Individual differences in symptoms of neuroticism can explain variations in side effect reporting and consequential impairments in perceived health in the context of HIV treatment. Identification and intervention with individuals high in symptoms of neuroticism may be warranted to alleviate side effect-related concerns and maximize treatment benefit.
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Pitts MK, Smith AMA, Mischewski A, Fairley C. Men, bodily change and urethritis: a qualitative study. Sex Health 2006; 2:25-8. [PMID: 16334710 DOI: 10.1071/sh04018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe how men narrate the process of bodily change as a trigger to presentation for a suspected sexually transmissible infection. METHODS The study was qualitative with 18 men presenting at a specialist sexual health centre in an urban setting. RESULTS All men gave narratives that included accounts of bodily changes prior to presentation. The nature, severity and persistence of those changes were unrelated to subsequent diagnosis. Men responded particularly to visual changes as cues to action. CONCLUSIONS The men exhibited limited skills in understanding the significance and the specifics of bodily change as they may relate to a sexually transmissible infection. While these men identified a broad range of changes as potentially indicative of a sexually transmissible infection, their ability to act on visceral rather than visual cues appears constrained in that they were less able to respond to the feel of their body than the way that it looked.
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Affiliation(s)
- M K Pitts
- Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, Vic. 3000, Australia.
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Moran TE, O'Hara MW. Maternal psychosocial predictors of pediatric health care use: Use of the common sense model of health and illness behaviors to extend beyond the usual suspects. ACTA ACUST UNITED AC 2006; 9:e171-e180. [PMID: 18379647 DOI: 10.1016/j.cein.2006.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Determinants of pediatric health care use extend beyond the health status of the child and economic and access considerations. Parental factors, particularly those associated with the mother, are critical. The common sense model of health and illness behaviors, which was developed to account for adult health care use, may constitute a framework to study the role of mothers in determining pediatric health care use. In the common sense model, the person's cognitive representations of and affective reactions to bodily states influence health care decision-making. There is a growing literature that points to the importance of maternal psychopathology (reflecting the affective component of the common sense model) and maternal parenting self-efficacy (reflecting the cognitive component of the model) as important contributors to pediatric health care use. The implications of this conceptualization for future research and clinical practice are discussed.
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Cameron LD, Petrie KJ, Ellis C, Buick D, Weinman JA. Symptom experiences, symptom attributions, and causal attributions in patients following first-time myocardial infarction. Int J Behav Med 2005; 12:30-8. [PMID: 15743734 DOI: 10.1207/s15327558ijbm1201_5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We examined symptom experiences, symptom attributions, and causal attributions reported by patients hospitalized for a first-time myocardial infarction (MI). We also explored the roles of symptoms, negative affect, and risk factors in promoting stress and other causal attributions. Patients (N = 65) completed measures of symptom experiences and attributions, perceived causes of their MI, state and trait negative affect, and risk factors. Patients attributed most of their symptoms to the heart condition, although rates varied from 48% (headaches) to 97% (nausea). The most common causal attribution was stress, followed by high cholesterol, heredity, fat consumption, and hypertension. Stress attributions were positively associated with state anxiety and specific, stress-related symptoms (e.g., fatigue and breathlessness). Anxious mood and stress-related symptoms appear to enhance the plausibility of stress as a cause of MI. Risk factors were moderately correlated with associated causal attributions. For many patients, however, attributions to hypertension, cholesterol, and family history of heart disease were discordant with their clinical data. Causal attributions remained stable over the subsequent 6 months.
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Affiliation(s)
- Linda D Cameron
- Department of Psychology, University of Auckland, New Zealand.
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Leventhal H, Mora PA. Is there a Science of the Processes Underlying Health and Illness Behaviors? A Comment on Maes and Karoly. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 2005. [DOI: 10.1111/j.1464-0597.2005.00209.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scisney-Matlock M, Watkins KW. Validity of the Cognitive Representations of Hypertension Scales (CRHTN)1. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2003. [DOI: 10.1111/j.1559-1816.2003.tb01926.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Melamed S, Froom P, Green MS. Hypertension and sickness absence: the role of perceived symptoms. J Behav Med 1997; 20:473-87. [PMID: 9415857 DOI: 10.1023/a:1025503616826] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The association between perceived symptoms and absenteeism was examined in five groups of employed adults: normotensives, unaware hypertensives, aware and untreated hypertensives, aware and treated hypertensives, and falsely aware normotensives. Aware hypertensives (untreated and treated) and falsely aware normotensives had a higher average of perceived symptoms than normotensives, whereas unaware hypertensives had lower. The absenteeism rate across the groups showed a similar pattern. A significant interaction of perceived symptoms by study group on absenteeism was uncovered. Hypertensives and falsely aware normotensives who reported a low level of symptoms were not absent more than their normotensive counterparts. However, aware hypertensives and falsely aware normotensives who perceived a high symptoms level showed higher absenteeism than unaware hypertensives and normotensives with a similar level. This suggests that aware hypertensives have a greater tendency than both normotensives and unaware hypertensives to equate their symptoms with ill health and to act accordingly. Special attention should be directed to aware hypertensives who perceive a threat to their health.
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Affiliation(s)
- S Melamed
- Occupational Health and Rehabilitation Institute, Loewenstein Hospital, Raanana, Israel
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Abstract
This study explores and describes experiences of chronic liver disease from the patient's perspective. No qualitative research studies appear to have examined the experiences of these patients. In-depth focused interviews and grounded theory data collection and data analysis methods were used. A two-stage theoretical framework (becoming ill, and not living) of the experience of transcending chronic liver disease is presented. Sociological and psychological literature on common sense models of health and illness are briefly reviewed. Several suggestions for further research are made. The way in which this qualitative research study is leading to a quantitative and qualitative appraisal of the psychological adjustment in end-stage chronic liver disease patients is outlined.
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Affiliation(s)
- S P Wainwright
- Department of Nursing Studies, King's College London, UK
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32
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Cameron LD, Leventhal H. Vulnerability Beliefs, Symptom Experiences, and the Processing of Health Threat Information: A Self-Regulatory Perspective. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 1995. [DOI: 10.1111/j.1559-1816.1995.tb01821.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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