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McDonald J, Clements J. Evaluation of a brief video intervention aimed at UK-based veterinary surgeons to encourage neutering cats at four months old: A randomised controlled trial. PLoS One 2022; 17:e0263353. [PMID: 35139101 PMCID: PMC8827477 DOI: 10.1371/journal.pone.0263353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/16/2022] [Indexed: 12/04/2022] Open
Abstract
In the UK, it is currently recommended that owned cats be neutered from four months of age. However, its uptake is inconsistent across the veterinary profession. Here we assess the effect of a brief video intervention that aimed to encourage four month neutering, whilst preserving clinical autonomy. We compare this theory-driven approach with traditional information giving and a control group. Veterinary surgeons who regularly undertook feline neutering work in the UK but did not routinely neuter cats at four months and/or recommend four month neutering for client owned cats were randomised into three groups (n = 234). Participants received either no information, a written summary of evidence or the video. The primary behaviour outcomes were the recommending and carrying out of neutering cats at four months. Evaluative, belief and stages of change measures were also collected. Self-reported outcomes were assessed pre-intervention, immediately post-intervention, two months post-intervention and six months post-intervention. At two months, participants that had received the video intervention were significantly more likely to have started recommending neutering cats at four months. At six months, participants that had received the video intervention were significantly more likely to have started carrying out neutering cats at four months. There were no significant behaviour changes for the other groups. At two months, the video intervention was associated with a significant increase in thinking about, and speaking to colleagues about, four-month neutering, relative to the control group. The written summary of evidence had no similar effect on stages of change, despite it being perceived as a significantly more helpful resource relative to the video. To conclude, a brief one-off video intervention resulted in an increase in positive behaviours towards neutering cats at 4 months, likely mediated by the social influences of the intervention prompting the opportunity to reflect and discuss four-month neutering with colleagues.
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Affiliation(s)
- Jenni McDonald
- Veterinary Department, Cats Protection, National Cat Centre, Haywards Heath, United Kingdom
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
- * E-mail: (JMD); (JC)
| | - Jane Clements
- Veterinary Department, Cats Protection, National Cat Centre, Haywards Heath, United Kingdom
- * E-mail: (JMD); (JC)
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Deng Q, Liu W. The Effect of Social Norms on Physicians’ Intentions to Use Liver Cancer Screening: A Cross-Sectional Study Using Extended Theory of Planned Behavior. Healthc Policy 2022; 15:179-191. [PMID: 35173496 PMCID: PMC8841539 DOI: 10.2147/rmhp.s349387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Liver cancer is a globally acknowledged threat to public health, and there is a critical and urgent need to determine factors associated with the use of liver cancer screening and to further promote its use. Purpose To examine whether the extended theory of planned behavior (TPB) incorporating social norms predicts physicians’ intentions to use liver cancer screening and to identify the associated factors quantitatively, using contrast-enhanced ultrasound (CEUS) as an example. Methods A research framework was established by adding social norms to the TPB, based on which the questionnaire for this study was developed. Through multistage random sampling, a cross-sectional questionnaire survey was conducted among 292 physicians in Fujian and Jiangxi provinces. Due to the multicollinearity problem of the data, ridge regression was applied to determine the influencing factors of physicians’ intentions to use CEUS. Results Most participants (87.30%) reported that they were willing to use liver cancer screening in their clinical practice. The scores of TPB variables were generally higher than those of social norms variables. Ridge regression results indicated that the proposed model was explanatory, which has accounted for 73.5% of the total variance in physicians’ intentions. Analyses also illustrated the significant role of TPB variables (attitude and perceived behavioral control) and social norms variables (personal norms, organizational norms, and industrial norms) on physicians’ intentions to use CEUS. Conclusion The study extended the TPB by including the concepts of social norms, which is not only conducive to expanding the knowledge of factors associated with physicians’ intentions to use liver cancer screening, but also provides implications for developing strategies to promote the use of certain health services or products, such as playing the role of core members, holding panel meetings, and establishing information push systems.
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Affiliation(s)
- Qingwen Deng
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Wenbin Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
- Correspondence: Wenbin Liu, Tel +86 13799983766, Email
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McDonald J, Clements J. Contrasting practices and opinions of UK-based veterinary surgeons around neutering cats at four months old. Vet Rec 2020; 187:317. [PMID: 32764034 PMCID: PMC7606499 DOI: 10.1136/vr.105887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/21/2020] [Accepted: 06/19/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Many cats in the UK are not neutered before reaching potential breeding age. The purpose of this investigation was to understand the prevalence of veterinarians' behaviours around neutering cats at four months of age and to identify any needs of the veterinary profession on this. METHODS A sample of 483 veterinarians that completed a cross-sectional online questionnaire were included in quantitative and qualitative analyses. RESULTS Almost 70 per cent of veterinarians indicated they were comfortable carrying out neutering on cats of four months of age, and approximately half of veterinarians indicated they would recommend neutering client-owned cats at four months of age if practice policy permitted. There was no association found between these practices and geographic risk factors. Instead, neutering at four months was associated with the gender of the veterinarian, their practice policy and whether they routinely neuter unowned cats. Veterinarians have contrasting beliefs on similar themes, depending on whether they neuter kittens at four months or not, including differing opinions on general anaesthetic, surgery risks, owner compliance and their perceptions of neutering practices within the wider profession. CONCLUSION Familiarity and experience with the procedure, alongside perceived norms, are central to beliefs. We also highlight informational and learning barriers.
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Affiliation(s)
- Jenni McDonald
- Veterinary Department, Cats Protection, Haywards Heath, UK
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Jane Clements
- Veterinary Department, Cats Protection, Haywards Heath, UK
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Pinto NM, Henry KA, Grobman WA, Ness A, Miller S, Ellestad S, Gotteiner N, Tacy T, Wei G, Minich LL, Kinney AY. Physician Barriers and Facilitators for Screening for Congenital Heart Disease With Routine Obstetric Ultrasound: A National United States Survey. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1143-1153. [PMID: 31875341 PMCID: PMC7357993 DOI: 10.1002/jum.15199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/06/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Prenatal detection of congenital heart disease with obstetric screening remains at less than 50% in most population studies, far from what is thought to be achievable. We sought to identify barriers/facilitators for screening from the perspective of interpreting physicians and to understand how these barriers/facilitators may be associated with interpretation of screening images. METHODS Our mixed-methods studies included 4 focus groups in centers across the United States with obstetric, maternal-fetal medicine, and radiology providers who interpreted obstetric ultrasound studies. Themes around barriers/facilitators for fetal heart screening were coded from transcripts. A national Web-based survey was then conducted, which quantitatively measured reported barriers/facilitators and measured physicians' ability to interpret fetal heart-screening images. Multivariable generalized linear random-effect models assessed the association between barriers/facilitators and the accuracy of image interpretation at the image level. RESULTS Three main themes were identified in the focus groups: intrinsic barriers (ie, comfort with screening), external barriers (ie, lack of feedback), and organizational barriers (ie, study volumes). Among 190 physician respondents, 104 interpreted ultrasound studies. Perceptions of barriers varied by practice setting, with nontertiary providers having lower self-efficacy and perceived usefulness of cardiac screening. Facilitators associated with the odds of accurate interpretation of screening images were knowledge (odds ratio, 2.54; P = .002) and the volume of scans per week (odds ratio, 1.01 for every additional scan; P = .04). CONCLUSIONS Some of the main barriers to cardiac screening identified and prioritized by physicians across the United States were knowledge of screening and minimal volumes of scans. Targeting these barriers will aid in improving prenatal detection of congenital heart disease.
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Affiliation(s)
- Nelangi M Pinto
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Kevin A Henry
- Department of Geography, Temple University, Philadelphia, Pennsylvania, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amen Ness
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California, USA
| | - Stephen Miller
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah Ellestad
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nina Gotteiner
- Division of Pediatric Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Theresa Tacy
- Division of Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Guo Wei
- Division of Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - L LuAnn Minich
- Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, and Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey, USA
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Carter-Harris L, Davis LL, Rawl SM. Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research. Res Theory Nurs Pract 2018; 30:333-352. [PMID: 28304262 DOI: 10.1891/1541-6577.30.4.333] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. METHODS Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. RESULTS Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. CONCLUSION This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development.
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Galaviz KI, Jauregui-Ulloa E, Fabrigar LR, Latimer-Cheung A, Lopez y Taylor J, Lévesque L. Physical activity prescription among Mexican physicians: a structural equation analysis of the theory of planned behaviour. Int J Clin Pract 2015; 69:375-83. [PMID: 25683617 DOI: 10.1111/ijcp.12546] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022] Open
Abstract
AIM To describe the physical activity (PA) prescribing behaviour of Mexican primary care physicians and determine if the theory of planned behaviour (TPB) explains this behaviour. METHODS 633 physicians (56% male, mean age 38 years) from 305 primary care clinics in Jalisco, Mexico self-reported PA prescription behaviour, PA involvement, attitude, subjective norm, perceived behavioural control (PBC) and intention related to PA prescription behaviour. Structural equation modelling (SEM) was employed. RESULTS 48% of physicians reported they always ask patients about their PA, 33% provide verbal prescriptions, 6% provide written prescriptions, 8% refer patients to PA resources and 4% assess patient fitness. SEM analysis showed that the fit of the TPB model was satisfactory (RMSEA = 0.05, CFI = 0.98, SRMR = 0.05). The model explained 79% of the variance on intention (r(2) = 0.79, p < 0.05), and 14% of the variance on prescription behaviour (r(2) = 0.14, p < 0.05). Subjective norm (β = 0.73, p < 0.05) and attitude (β = 0.16, p < 0.05) explained behavioural intention, while PBC (β = 0.38, p < 0.05) and physician PA (β = 0.15, p < 0.05) explained prescription behaviour. DISCUSSION The TPB provided useful insight into physician prescription behaviour, although not all the theory tenets were supported. More research testing the TPB and other theories is needed to better understand psychosocial predictors of this behaviour. CONCLUSION Strategies aimed at improving physicians' perceived ability to prescribe PA and their own PA involvement seem worthwhile.
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Affiliation(s)
- K I Galaviz
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
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Gorin SS, Badr H, Krebs P, Prabhu Das I. Multilevel interventions and racial/ethnic health disparities. J Natl Cancer Inst Monogr 2012; 2012:100-11. [PMID: 22623602 PMCID: PMC3482960 DOI: 10.1093/jncimonographs/lgs015] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To examine the impact of multilevel interventions (with three or more levels of influence) designed to reduce health disparities, we conducted a systematic review and meta-analysis of interventions for ethnic/racial minorities (all except non-Hispanic whites) that were published between January 2000 and July 2011. The primary aims were to synthesize the findings of studies evaluating multilevel interventions (three or more levels of influence) targeted at ethnic and racial minorities to reduce disparities in their health care and obtain a quantitative estimate of the effect of multilevel interventions on health outcomes among these subgroups. The electronic database PubMed was searched using Medical Subject Heading terms and key words. After initial review of abstracts, 26 published studies were systematically reviewed by at least two independent coders. Those with sufficient data (n = 12) were assessed by meta-analysis and examined for quality using a modified nine-item Physiotherapy Evidence Database coding scheme. The findings from this descriptive review suggest that multilevel interventions have positive effects on several health behavior outcomes, including cancer prevention and screening, as well improving the quality of health-care system processes. The weighted average effect size across studies for all health behavior outcomes reported at the individual participant level (k = 17) was odds ratio (OR) = 1.27 (95% confidence interval [CI] = 1.11 to 1.44); for the outcomes reported by providers or organizations, the weighted average effect size (k = 3) was OR = 2.53 (95% CI = 0.82 to 7.81). Enhanced application of theories to multiple levels of change, novel design approaches, and use of cultural leveraging in intervention design and implementation are proposed for this nascent field.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- SAIC, Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, 6130 Executive Blvd, Bethesda, MD 20892-7344, USA.
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Ontario family physician readiness to collaborate with community pharmacists on drug therapy management. Res Social Adm Pharm 2011; 7:39-50. [DOI: 10.1016/j.sapharm.2010.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 02/18/2010] [Accepted: 02/18/2010] [Indexed: 11/21/2022]
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Coolidge T, Skaret E, Heima M, Johnson EK, Hillstead MB, Farjo N, Asmyhr O, Weinstein P. Thinking about going to the dentist: a Contemplation Ladder to assess dentally-avoidant individuals' readiness to go to a dentist. BMC Oral Health 2011; 11:4. [PMID: 21272356 PMCID: PMC3045398 DOI: 10.1186/1472-6831-11-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 01/27/2011] [Indexed: 11/11/2022] Open
Abstract
Background The Transtheoretical Model suggests that individuals vary according to their readiness to change behavior. Previous work in smoking cessation and other health areas suggests that interventions are more successful when they are tailored to an individual's stage of change with regards to the specific behavior. We report on the performance of a single-item measure ("Ladder") to assess the readiness to change dental-avoidant behavior. Methods An existing Contemplation Ladder for assessing stage of change in smoking cessation was modified to assess readiness to go to a dentist. The resulting Ladder was administered to samples of English-speaking adolescents (USA), Spanish-speaking adults (USA), and Norwegian military recruits (Norway) in order to assess construct validity. The Ladder was also administered to a sample of English-speaking avoidant adolescents and young adults who were enrolled in an intervention study (USA) in order to assess criterion validity. All participants also had dental examinations, and completed other questionnaires. Correlations, chi square, t tests and one-way ANOVAs were used to assess relationships between variables. Results In two samples, participants who do not go to the dentist had significantly more teeth with caries; in a third sample, participants who do not go to the dentist had significantly worse caries. Ladder scores were not significantly related to age, gender, caries, or dental fear. However, Ladder scores were significantly related to statements of intention to visit a dentist in the future and the importance of oral health. In a preliminary finding, Ladder scores at baseline also predicted whether or not the participants decided to go to a dentist in the intervention sample. Conclusions The data provide support for the convergent and divergent construct validity of the Ladder, and preliminary support for its criterion validity. The lack of relationship between dental fear and Ladder scores suggests that avoidant individuals may be helped to decide to go to a dentist using interventions which do not explicitly target their fear.
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Affiliation(s)
- Trilby Coolidge
- Dental Public Health Sciences, University of Washington, Seattle WA, USA.
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Sibille K, Greene A, Bush JP. Preparing Physicians for the 21 Century: Targeting Communication Skills and the Promotion of Health Behavior Change. ANNALS OF BEHAVIORAL SCIENCE AND MEDICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR THE BEHAVIORAL SCIENCES AND MEDICAL EDUCATION 2010; 16:7-13. [PMID: 22187518 PMCID: PMC3242004 DOI: 10.1007/bf03355111] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The prevalence of behavior-related diseases is a predominant concern in the health care profession. Further complicating matters, the biomedical disease model has demonstrated limited effectiveness in treating the consequential array of chronic health conditions. Medical educators have been tasked with developing curricula to better prepare physicians to address the complex health issues of the 21(st) century. A review of empirically supported educational endeavors is essential in planning for future interventions. Prior efforts specific to physician-patient communication and the promotion of health behavior change will be reviewed. Opportunities to enhance medical education by targeting patient-centered care, attitudinal measures, individualized training, and an empirically supported, theoretically based model of change will be presented.
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A national physician survey on prescribing syringes as an HIV prevention measure. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2009; 4:13. [PMID: 19505336 PMCID: PMC2700789 DOI: 10.1186/1747-597x-4-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 06/08/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Access to sterile syringes is a proven means of reducing the transmission of human immunodeficiency virus (HIV), viral hepatitis, and bacterial infections among injection drug users. In many U.S. states and territories, drug paraphernalia and syringe prescription laws are barriers to syringe access for injection drug users (IDUs): pharmacists may be reluctant to sell syringes to suspected IDUs, and police may confiscate syringes or arrest IDUs who cannot demonstrate a "legitimate" medical need for the syringes they possess. These barriers can be addressed by physician prescription of syringes. This study evaluates physicians' willingness to prescribe syringes, using the theory of planned behavior to identify key behavioral influences. METHODS We mailed a survey to a representative sample of physicians from the American Medical Association physician database. Non-responding physicians were then called, faxed, or re-sent the survey, up to four times. RESULTS Twenty percent responded to the survey. Although less than 1 percent of respondents had ever prescribed syringes to a known injection drug user, more than 60% of respondents reported that they would be willing to do so. Physicians' willingness to prescribe syringes was best predicted by the belief that it was a feasible and effective intervention, but individual and peer attitudes were also significant. CONCLUSION This was the first nationwide survey of the physician willingness to prescribe syringes to IDUs. While the majority of respondents were willing to consider syringe prescription in their clinical practices, multiple challenges need to be addressed in order to improve physician knowledge and attitudes toward IDUs.
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Feeley TH, Cooper J, Foels T, Mahoney MC. Efficacy expectations for colorectal cancer screening in primary care: identifying barriers and facilitators for patients and clinicians. HEALTH COMMUNICATION 2009; 24:304-315. [PMID: 19499424 DOI: 10.1080/10410230902889241] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs) in primary care (PC) specialties, as well as patients, participated in a series of peer-level focus groups to explore how colorectal cancer (CRC) screening is approached in PC. Twenty-seven focus groups were conducted, including 8 groups composed of MDs (n = 56), 7 with NP/PAs (n = 47), and 12 with patients (n = 103). Clinicians (MDs, NPs, PAs) reported discussing CRC screening during well visits and were alerted to patients in need of screening through flow sheets, chart reminders (paper, electronic) or by office personnel, and cited lack of time, patient reluctance, and challenges related to scheduling colonoscopy as barriers to screening. Clinicians identified communication skills and the convenience of office-based screening procedures as facilitators of CRC screening. Patients recalled discussing CRC screening during PC office visits and most commonly identified colonoscopy and fecal occult blood test as common CRC screening tests. Physician recommendation and knowing someone who has/had cancer were the most common factors motivating patients' decision to complete CRC screening. Results are framed according to patient and clinician perceptions of self-efficacy related to CRC screening.
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Affiliation(s)
- Thomas Hugh Feeley
- Department of Communication, University at Buffalo-The State University of New York, Buffalo, NY 14260, USA.
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Cook PF, Friedman R, Lord A, Bradley-Springer LA. Outcomes of multimodal training for healthcare professionals at an AIDS education and training center. Eval Health Prof 2009; 32:3-22. [PMID: 19131377 DOI: 10.1177/0163278708328736] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is an ongoing need for continuing professional education (CPE) in the rapidly changing field of HIV care, but the best instructional methods remain a subject of debate. This study assessed the effects of training at an AIDS Education and Training Center (AETC) over an 18-month period. Health care professionals (HCP) who attended more than one training event showed small but significant improvements over time in HIV-related clinical practice behaviors. The type of training also predicted self-reported practice behavior, with interactive trainings and individual consultations associated with greater change, and intensive clinical training activities associated with a faster rate of change but not better scores on the self-reported behavior measure. Participants also reported high levels of satisfaction, knowledge improvement, and intention to change after each training event; however, these results were unrelated to whether trainees actually reported improved practice behavior.
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Affiliation(s)
- Paul F Cook
- University of Colorado, Denver, Aurora, Colorado 80045, USA.
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Guilfoyle S, Franco R, Gorin SS. Exploring older women's approaches to cervical cancer screening. Health Care Women Int 2008; 28:930-50. [PMID: 17987461 DOI: 10.1080/07399330701615358] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this qualitative study (N = 98, 11 focus groups) is to investigate how low-income, African American and Hispanic older women make decisions about cervical cancer screening. Using the health belief model to guide content analysis of transcripts, we found that primary barriers to screening were; embarrassment with, fear of, and pain from the test, difficulty in accessing screening, stigma associated with Medicaid coverage, and prior negative experiences with cancer detection. Women experienced cues to screening from their own bodies, in symptoms, and relied on spiritual beliefs to support them in coping with their health problems. Enhanced understanding of these factors could increase uptake of cervical cancer screening among the unscreened and underscreened.
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Affiliation(s)
- Sharon Guilfoyle
- Department of Health Policy and Management, Columbia University, New York, New York 10027, USA
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15
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Gorin SS, Ashford AR, Lantigua R, Desai M, Troxel A, Gemson D. Implementing academic detailing for breast cancer screening in underserved communities. Implement Sci 2007; 2:43. [PMID: 18086311 PMCID: PMC2266776 DOI: 10.1186/1748-5908-2-43] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 12/17/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND African American and Hispanic women, such as those living in the northern Manhattan and the South Bronx neighborhoods of New York City, are generally underserved with regard to breast cancer prevention and screening practices, even though they are more likely to die of breast cancer than are other women. Primary care physicians (PCPs) are critical for the recommendation of breast cancer screening to their patients. Academic detailing is a promising strategy for improving PCP performance in recommending breast cancer screening, yet little is known about the effects of academic detailing on breast cancer screening among physicians who practice in medically underserved areas. We assessed the effectiveness of an enhanced, multi-component academic detailing intervention in increasing recommendations for breast cancer screening within a sample of community-based urban physicians. METHODS Two medically underserved communities were matched and randomized to intervention and control arms. Ninety-four primary care community (i.e., not hospital based) physicians in northern Manhattan were compared to 74 physicians in the South Bronx neighborhoods of the New York City metropolitan area. Intervention participants received enhanced physician-directed academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer. Control group physicians received no intervention. We conducted interviews to measure primary care physicians' self-reported recommendation of mammography and Clinical Breast Examination (CBE), and whether PCPs taught women how to perform breast self examination (BSE). RESULTS Using multivariate analyses, we found a statistically significant intervention effect on the recommendation of CBE to women patients age 40 and over; mammography and breast self examination reports increased across both arms from baseline to follow-up, according to physician self-report. At post-test, physician involvement in additional educational programs, enhanced self-efficacy in counseling for prevention, the routine use of chart reminders, computer- rather than paper-based prompting and tracking approaches, printed patient education materials, performance targets for mammography, and increased involvement of nursing and other office staff were associated with increased screening. CONCLUSION We found some evidence of improvement in breast cancer screening practices due to enhanced academic detailing among primary care physicians practicing in urban underserved communities.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- Department of Health and Behavior Studies, Columbia University, 525 W 120Street, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168Street, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, 1130 St. Nicholas Avenue, New York, NY, USA
| | - Alfred R Ashford
- Herbert Irving Comprehensive Cancer Center, 1130 St. Nicholas Avenue, New York, NY, USA
- Harlem Hospital Center, MLK Pavilion, New York, NY, USA
- College of Physicians and Surgeons, Columbia University, 600 W 168Street, New York, NY, USA
| | - Rafael Lantigua
- Herbert Irving Comprehensive Cancer Center, 1130 St. Nicholas Avenue, New York, NY, USA
- College of Physicians and Surgeons, Columbia University, 600 W 168Street, New York, NY, USA
| | - Manisha Desai
- Herbert Irving Comprehensive Cancer Center, 1130 St. Nicholas Avenue, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168Street, New York, NY, USA
| | - Andrea Troxel
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 632 Blockley Hall, Philadelphia, PA, USA
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Hirai K, Komura K, Tokoro A, Kuromaru T, Ohshima A, Ito T, Sumiyoshi Y, Hyodo I. Psychological and behavioral mechanisms influencing the use of complementary and alternative medicine (CAM) in cancer patients. Ann Oncol 2007; 19:49-55. [PMID: 17965113 DOI: 10.1093/annonc/mdm494] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study explored the psychological and behavioral mechanisms of complementary and alternative medicine (CAM) use in Japanese cancer patients using two applied behavioral models, the transtheoretical model (TTM), and theory of planned behavior (TPB). PATIENTS AND METHODS Questionnaires were distributed to 1100 patients at three cancer treatment facilities in Japan and data on 521 cancer patients were used in the final analysis. The questionnaire included items based on TTM and TPB variables, as well as three psychological batteries. RESULTS According to the TTM, 88 patients (17%) were in precontemplation, 226 (43%) in contemplation, 33 (6%) in preparation, 71 (14%) in action, and 103 (20%) in maintenance. The model derived from structural equation modeling revealed that the stage of CAM use was significantly affected by the pros, cons, expectation from family, norms of medical staff, use of chemotherapy, period from diagnosis, and place of treatment. The primary factor for the stage of CAM use was the expectation from family. CONCLUSIONS The findings revealed the existence of a number of psychologically induced potential CAM users, and psychological variables including positive attitude for CAM use and perceived family expectation greatly influence CAM use in cancer patients.
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Affiliation(s)
- K Hirai
- Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita Osaka 565-0871, Japan.
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Jerant A, Kravitz RL, Rooney M, Amerson S, Kreuter M, Franks P. Effects of a tailored interactive multimedia computer program on determinants of colorectal cancer screening: a randomized controlled pilot study in physician offices. PATIENT EDUCATION AND COUNSELING 2007; 66:67-74. [PMID: 17156968 DOI: 10.1016/j.pec.2006.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 10/06/2006] [Accepted: 10/22/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Screening reduces colorectal cancer (CRC) mortality and is cost-effective, yet uptake is suboptimal. We developed and evaluated a personally tailored interactive multimedia computer program (IMCP) to encourage CRC screening. METHODS Randomized controlled pilot trial evaluating the effects of the personally tailored CRC screening IMCP as compared with a non-tailored IMCP ("electronic leaflet") control. The IMCP was tailored to patient preference, self-efficacy, barriers, and readiness and deployed in busy primary care offices before scheduled doctor visits. Main outcomes were: CRC screening knowledge, self-efficacy, benefits and barriers, and stage of readiness. RESULTS We enrolled 54 subjects; software glitches occurred in 5, leaving 49 subjects for analysis. In adjusted analyses, compared with control, the experimental group had a significant increase in CRC screening self-efficacy (p=0.049), a significantly greater likelihood of moving to a more advanced stage of readiness for screening (p=0.034), a trend toward fewer perceived barriers to screening (p=0.149), and no difference in perceived benefits or knowledge of screening. CONCLUSION Our personally tailored IMCP was significantly more effective than control in bolstering CRC screening readiness and self-efficacy. PRACTICE IMPLICATIONS If further streamlined, personally tailored IMCPs might be usefully deployed in busy primary care offices to improve uptake of CRC screening.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine (DF&CM), University of California Davis (UCD) School of Medicine (SOM), 4860 Y Street, Suite 2300, Sacramento, CA 95817, United States.
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Gorin SS, Wang C, Raich P, Bowen DJ, Hay J. Decision making in cancer primary prevention and chemoprevention. Ann Behav Med 2007; 32:179-87. [PMID: 17107290 DOI: 10.1207/s15324796abm3203_3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND We know very little about how individuals decide to undertake, maintain, or discontinue cancer primary prevention or chemoprevention. PURPOSE The aims of this article are to (a) examine whether and, if so, how traditional health behavior change models are relevant for decision making in this area; (b) review the application of decision aids to forming specific, personal choices between options; and (c) identify the challenges of evaluating these decision processes to suggest areas for future research. METHODS Theoretical models and frameworks derived from the health behavior change and decision-making fields were applied to cancer primary prevention choices. Decision aids for the human papillomavirus (HPV) vaccine, Hormone Replacement Therapy (HRT), and tamoxifen were systematically examined. RESULTS Traditional concepts such as decisional balance and cues to action are relevant to understanding cancer primary prevention choices; Motivational Interviewing, Self-Determination Theory, and the Preventive Health Model may also explain the facilitators of decision making. There are no well-tested HPV vaccine decision aids, although there have been some studies on aids for HPV testing. There are several effective decision aids for HRT and tamoxifen; evidence-based decision aid components have also been identified. CONCLUSIONS Additional theory-based empirical research on decision making in cancer primary prevention and chemoprevention, particularly at the interface of psychology and behavioral economics, is suggested.
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