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El-Amir A, El-Baiomy EM, Sabry NA, Kassem L, Chesney MA, Wallston KA. The relationship between coping self-efficacy and B cells in breast cancer patients. J Egypt Natl Canc Inst 2023; 35:28. [PMID: 37661196 DOI: 10.1186/s43046-023-00187-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Breast cancer is the most common tumor among women throughout the world. Diagnosis and treatment of breast cancer are associated with stress and depression. Self-efficacy is one of the most important personal characteristics, studied in cancer, and is correlated with depression and immunity. The aim of the study is as follows: 1. Examining the correlation between coping self-efficacy with depression, DHEA levels, and immunity 2. Examining the correlation between depression and DHEA levels 3. Studying the effect of depression and DHEA levels on immunity 4. Examining the intermediate effect of DHEA levels on the correlation between coping self-efficacy and immunity METHODS: Thirty newly diagnosed breast cancer patients recruited from the Oncology Department, Kasr EL-Aini, Cairo University (ages 51.40 + 8.24 years) responded to two questionnaires: Coping Self-Efficacy Scale (CSES) and Patient Health Questionnaire-9 (PHQ-9); blood samples were collected to measure the phenotype of patients' cellular immunity and DHEA levels by flowcytometry and ELISA technique. RESULTS There was a significant negative correlation between CSES and PHQ-9, a significant positive correlation between PHQ-9 and B-cell count, and there is a significant negative correlation between CSES and B-cell count. The presence of DHEA has no mediatory role on correlation between CSES and B-cell count. CONCLUSION This paper presents a new model of psychoneuroimmunology by suggesting an effect of coping self-efficacy on immunity against breast cancer patients.
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Affiliation(s)
- Azza El-Amir
- Immunology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Eman M El-Baiomy
- Immunology Department, Faculty of Science, Cairo University, Cairo, Egypt.
| | - Noha A Sabry
- Psychiatry Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Loay Kassem
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Margaret A Chesney
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Kenneth A Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Hu JR, Huang S, Bosworth HB, Freedland KE, Mayberry LS, Kripalani S, Wallston KA, Roumie CL, Bachmann JM. Association of Perceived Health Competence With Cardiac Rehabilitation Initiation. J Cardiopulm Rehabil Prev 2023; 43:93-100. [PMID: 36730182 PMCID: PMC9974554 DOI: 10.1097/hcr.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Cardiac rehabilitation (CR), a program of supervised exercise and cardiovascular risk management, is widely underutilized. Psychological factors such as perceived health competence, or belief in one's ability to achieve health-related goals, may play a role in CR initiation. The aim of this study was to evaluate the association of perceived health competence with CR initiation among patients hospitalized for acute coronary syndrome (ACS) after adjusting for demographic, clinical, and psychosocial characteristics. METHODS The Vanderbilt Inpatient Cohort Study (VICS) characterized the effect of psychosocial characteristics on post-discharge outcomes in ACS inpatients hospitalized from 2011 to 2015. The primary outcome for this analysis was participation in an outpatient CR program. The primary predictor was the two-item Perceived Health Competence Scale (PHCS-2), which yields a score from 2 to 10 (higher scores indicate greater perceived health competence). Multiple logistic regression was used to evaluate the relationship between the PHCS-2 and CR initiation. RESULTS A total of 1809 VICS participants (median age: 61 yr, 39% female) with ACS were studied, of whom 294 (16%) initiated CR. The PHCS-2 was associated with a higher odds of CR initiation (OR = 1.15/point increase: 95% CI, 1.06-1.26, P = .001) after adjusting for covariates. Participants with comorbid heart failure had a lower odds of CR initiation (OR = 0.31: 95% CI, 0.16-0.60, P < .001) as did current smokers (OR = 0.64: 95% CI, 0.43-0.96, P = .030). CONCLUSION Perceived health competence is associated with outpatient CR initiation in patients hospitalized with ACS. Interventions designed to support perceived health competence may be useful for improving CR participation.
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Affiliation(s)
- Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut (Dr Hu); Departments of Biostatistics (Dr Huang) and Medicine (Drs Mayberry, Kripalani, Roumie, and Bachmann), Vanderbilt University Medical Center, Nashville, Tennessee; Departments of Population Health Sciences and Medicine, Duke University Medical Center and Durham Veterans Affairs Medical Center, Durham, North Carolina (Dr Bosworth); Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri (Dr Freedland); Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee (Drs Mayberry, Kripalani, Wallston, Roumie and Bachmann); and Medicine Service, Veterans Affairs Tennessee Valley Healthcare System-Nashville Campus, Nashville, Tennessee (Drs Roumie and Bachmann)
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Martinez W, Hackstadt AJ, Hickson GB, Knoerl T, Rosenbloom ST, Wallston KA, Elasy TA. The My Diabetes Care Patient Portal Intervention: Usability and Pre-Post Assessment. Appl Clin Inform 2021; 12:539-550. [PMID: 34192774 DOI: 10.1055/s-0041-1730324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND My Diabetes Care (MDC) is a novel, multifaceted patient portal intervention designed to help patients better understand their diabetes health data and support self-management. MDC uses infographics to visualize and summarize patients' diabetes health data, incorporates motivational strategies, and provides literacy level-appropriate educational resources. OBJECTIVES We aimed to assess the usability, acceptability, perceptions, and potential impact of MDC. METHODS We recruited 69 participants from four clinics affiliated with Vanderbilt University Medical Center. Participants were given 1 month of access to MDC and completed pre- and post-questionnaires including validated measures of usability and patient activation, and questions about user experience. RESULTS Sixty participants completed the study. Participants' mean age was 58, 55% were females, 68% were Caucasians, and 48% had limited health literacy (HL). Most participants (80%) visited MDC three or more times and 50% spent a total of ≥15 minutes on MDC. Participants' median System Usability Scale (SUS) score was 78.8 [Q1, Q3: 72.5, 87.5] and significantly greater than the threshold value of 68 indicative of "above average" usability (p < 0.001). The median SUS score of patients with limited HL was similar to those with adequate HL (77.5 [72.5, 85.0] vs. 82.5 [72.5, 92.5]; p = 0.41). Participants most commonly reported the literacy level-appropriate educational links and health data infographics as features that helped them better understand their diabetes health data (65%). All participants (100%) intended to continue to use MDC. Median Patient Activation Measure® scores increased postintervention (64.3 [55.6, 72.5] vs. 67.8 [60.6, 75.0]; p = 0.01). CONCLUSION Participants, including those with limited HL, rated the usability of MDC above average, anticipated continued use, and identified key features that improved their understanding of diabetes health data. Patient activation improved over the study period. Our findings suggest MDC may be a beneficial addition to existing patient portals.
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Affiliation(s)
- William Martinez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Amber J Hackstadt
- Department of Biostatistics, Vanderbilt University Medicine Center, Nashville, Tennessee, United States
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Thomas Knoerl
- Upstate Medical University, State University of New York, Syracuse, New York, United States
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Kripalani S, Goggins K, Couey C, Yeh VM, Donato KM, Schnelle JF, Wallston KA. Disparities in Research Participation by Level of Health Literacy. Mayo Clin Proc 2021; 96:314-321. [PMID: 33549253 PMCID: PMC7874435 DOI: 10.1016/j.mayocp.2020.06.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/09/2020] [Accepted: 06/02/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine at which phase in the recruitment process for participation in clinical research studies do health literacy and other patient characteristics influence recruitment outcomes. PATIENTS AND METHODS Using a sample of 5872 patients hospitalized with cardiovascular disease approached for participation in the Vanderbilt Inpatient Cohort Study from October 2011 through December 2015, we examined the independent association of patients' health literacy with two steps in their research participation decision-making process: (1) research interest - willingness to hear more about a research study; and (2) research participation - the decision to enroll after an informed consent discussion. Best practices for effective health communication were implemented in recruitment approaches and informed consent processes. Using logistic regression models, we determined patient characteristics independently associated with patients' willingness to hear about and participate in the study. RESULTS In unadjusted analyses, participants with higher health literacy, and those who were younger, female, or had more education had higher levels of both research interest and research participation. Health literacy remained independently associated with both outcomes in multivariable models, after adjustment for sociodemographic factors. CONCLUSION Because identical variables predicted both research interest and eventual consent, efforts to recruit broad populations must include acceptable methods of approaching potential participants as well as explaining study materials.
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Affiliation(s)
- Sunil Kripalani
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN.
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
| | - Catherine Couey
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
| | - Vivian M Yeh
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | | | - John F Schnelle
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
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Nair D, Cavanaugh KL, Wallston KA, Mason O, Stewart TG, Blot WJ, Ikizler TA, Lipworth LP. Religion, Spirituality, and Risk of End-Stage Kidney Disease Among Adults of Low Socioeconomic Status in the Southeastern United States. J Health Care Poor Underserved 2021; 31:1727-1746. [PMID: 33416749 DOI: 10.1353/hpu.2020.0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Religiosity, encompassing spirituality and religious practices, is associated with reduced disease incidence among individuals of low socioeconomic status and who self-identify as Black. We hypothesized that religiosity associates with reduced end-stage kidney disease (ESKD) risk among Black but not White adults of low socioeconomic status. DESIGN Cox models of religiosity and ESKD risk in 76,443 adults. RESULTS Black adults reporting high spirituality had reduced ESKD risk after adjusting for demographic characteristics [Hazard Ratio (HR) .82 (95% Confidence Interval (CI)) (.69-.98)], depressive symptoms, social support, and tobacco use [HR .81 (CI .68-.96)]. When clinical covariates were added, associations between spirituality and ESKD were slightly attenuated and lost significance [HR .85 (CI .68-1.06)]. Associations were not demonstrated among White adults. CONCLUSIONS Spirituality associates with reduced ESKD risk among Black adults of low socioeconomic status independent of demographic, psychosocial, and behavioral characteristics. Effect modification by race was not statistically significant.
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Nair D, Bonnet K, Wild MG, Umeukeje EM, Fissell RB, Faulkner ML, Bahri NS, Bruce MA, Schlundt DG, Wallston KA, Cavanaugh KL. Psychological Adaptation to Serious Illness: A Qualitative Study of Culturally Diverse Patients With Advanced Chronic Kidney Disease. J Pain Symptom Manage 2021; 61:32-41.e2. [PMID: 32711122 PMCID: PMC7770006 DOI: 10.1016/j.jpainsymman.2020.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022]
Abstract
CONTEXT Psychological distress is associated with adverse health outcomes in serious illness and magnified among patients of low socioeconomic status. Aspects of one's culture, such as religion and spirituality, can influence these patients' coping response to distress. Advanced chronic kidney disease (CKD) is a serious illness that disproportionately affects patients of low socioeconomic status, but a theory-based understanding of this group's lived experience of CKD is lacking. OBJECTIVES We explored the cognitions, emotions, and coping behaviors of patients with CKD with emphasis on those of low socioeconomic status. We further inquired into any influences of religion or spirituality. METHODS We interviewed 50 English-speaking or Spanish-speaking adults with advanced CKD from three medical centers in Nashville, Tennessee. Analyses occurred with isolation of themes; development of a coding system; and creation of a conceptual framework using an inductive-deductive approach. RESULTS Median age was 65 years; median annual income was $17,500 per year; and 48% of participants had not progressed beyond high school. Key beliefs (awareness of mortality and lack of control) influenced patients' emotions (existential distress in the form of death anxiety, prognostic uncertainty, and hopelessness) and coping behaviors (acceptance, avoidance, emotion regulation via spirituality, and seeking socialsupport via a religious community). CONCLUSION Individuals with advanced CKD and low socioeconomic status lack control over disease progression, experience death anxiety and existential distress, and emphasize spirituality to cope. Our study identifies novel components for a psychotherapeutic intervention for patients with advanced CKD at high risk for adverse health outcomes.
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Affiliation(s)
- Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee, USA.
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Marcus G Wild
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Ebele M Umeukeje
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee, USA
| | - Rachel B Fissell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee, USA
| | | | - Nader S Bahri
- Division of Nephrology, Meharry Medical College, Nashville, Tennessee, USA
| | - Marino A Bruce
- Program for Research on Faith, Justice, and Health, Department of Population Health, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA; Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Kenneth A Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee, USA; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Nelson LA, Greevy RA, Spieker A, Wallston KA, Elasy TA, Kripalani S, Gentry C, Bergner EM, LeStourgeon LM, Williamson SE, Mayberry LS. Effects of a Tailored Text Messaging Intervention Among Diverse Adults With Type 2 Diabetes: Evidence From the 15-Month REACH Randomized Controlled Trial. Diabetes Care 2021; 44:26-34. [PMID: 33154039 PMCID: PMC7783936 DOI: 10.2337/dc20-0961] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/02/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Text messaging interventions have high potential for scalability and for reductions in health disparities. However, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. RESEARCH DESIGN AND METHODS Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized controlled trial and were assigned to receive Rapid Education/Encouragement and Communications for Health (REACH) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence and nontailored texts supporting other self-care behaviors. Outcomes included hemoglobin A1c (HbA1c), diabetes medication adherence, self-care, and self-efficacy. RESULTS Participants (N = 506) were approximately half racial/ethnic minorities, and half were underinsured, had annual household incomes <$35,000, and had a high school education or less; 11% were homeless. Average baseline HbA1c was 8.6% ± 1.8%; 70.0 ± 19.7 mmol/mol) with n = 219 having HbA1c ≥8.5% (69 mmol/mol). Half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI -0.61%, -0.02%) was greater among those with baseline HbA1c ≥8.5% (-0.74%; 95% CI -1.26%, -0.23%), and there was no evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. CONCLUSIONS REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain the effects.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Andrew Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, TN
| | - Kenneth A Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Chad Gentry
- Department of Pharmacy, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, TN
| | - Erin M Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah E Williamson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
- Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Novak LL, George S, Wallston KA, Joosten YA, Israel TL, L Simpson C, Vaughn Y, Williams NA, Stallings S, Ichimura JS, Wilkins CH. Patient Stories Can Make a Difference in Patient-Centered Research Design. J Patient Exp 2020; 7:1438-1444. [PMID: 33457599 PMCID: PMC7786662 DOI: 10.1177/2374373520958340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Amid increasing interest in improving the patient-centeredness of research, new forms of engagement are emerging that enable researchers to get input from community members on research goals, methods, and implementation. This input often includes stories, which are useful for understanding lived experiences of illness and encounters with health care organizations, and for locating these experiences within larger meta-narratives of specific communities. We analyzed the stories in transcripts of 13 Community Engagement Studios and identified 4 major functions that the stories served in the sessions. Major functions included: (1) establishing mutual understanding, (2) adding expansion and depth, (3) characterizing abstract concepts, and (4) providing context for experience, with the latter being the most frequent. We assert that stories can serve to better communicate the complex contexts of patient experiences, helping to align research priorities and research design with community interests, leading to more patient-centered innovations in clinical practice.
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Affiliation(s)
- Laurie Lovett Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, USA
| | - Sheba George
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Center for Biomedical Informatics and Department of Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Kenneth A Wallston
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, USA
| | - Yvonne A Joosten
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, USA
| | - Tiffany L Israel
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | | | | | - Consuelo H Wilkins
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Meharry-Vanderbilt Alliance, Nashville, TN, USA
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Umeukeje EM, Osman R, Nettles AL, Wallston KA, Cavanaugh KL. Provider Attitudes and Support of Patients' Autonomy for Phosphate Binder Medication Adherence in ESRD. J Patient Exp 2020; 7:708-712. [PMID: 33294605 PMCID: PMC7705840 DOI: 10.1177/2374373519883502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This cross-sectional study of 56 dialysis providers from 3 dialysis clinics examined providers' attitudes and perception of autonomy support for patients' medication adherence behaviors. Respondents completed surveys assessing attitudes and perception of autonomy support. Compared to all other provider types, physicians and nurse practitioners (MD/NP) thought it was "less true" that phosphate binder medications are very important for dialysis patients (MD/NP vs others: 5.1 [1.4] vs 6.1 [1.1]; P = 0.02). More dialysis technicians (19%) offered the highest level of support. Attitudes and perception of autonomy support for medication adherence are suboptimal, vary by dialysis provider type, and are targets for quality improvement in dialysis care. This study addresses critical gap in existing knowledge about these two novel provider-based psychosocial factors and their potential impact on phosphate binder medication adherence.
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Affiliation(s)
- Ebele M Umeukeje
- Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
| | - Rabia Osman
- Ohio State University College of Medicine, Columbus, OH, USA
| | - Arie L Nettles
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Vanderbilt University School of Nursing, Nashville, TN, USA
- Vanderbilt Institute for Medicine and Public Health, Nashville, TN, USA
| | - Kerri L Cavanaugh
- Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
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Sack DE, Frisby MB, Diemer MA, De Schacht C, Graves E, Kipp AM, Emílio A, Matino A, Barreto E, Van Rompaey S, Wallston KA, Audet CM. Interpersonal reactivity index adaptation among expectant seroconcordant couples with HIV in Zambézia Province, Mozambique. BMC Psychol 2020; 8:90. [PMID: 32859272 PMCID: PMC7456002 DOI: 10.1186/s40359-020-00442-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/15/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The ability to understand another's emotions and act appropriately, empathy, is an important mediator of relationship function and health intervention fidelity. We adapted the Interpersonal Reactivity Index (IRI) - an empathy scale - among seroconcordant expectant couples with HIV in the Homens para Saúde Mais (HoPS+) trial - a cluster randomized controlled trial assessing couple-based versus individual treatment on viral suppression - in Zambézia Province, Mozambique. METHODS Using baseline data from 1332 HoPS+ trial participants (666 couples), an exploratory factor analysis assessed culturally relevant questions from the IRI. Because empathy is interdependent among couples, we validated the results of the exploratory factor analysis using a dyadic confirmatory factor analysis (CFA) with dyadic measurement invariance testing. Finally, we assessed the relationship between scores on our final scale and basic demographic characteristics (sex, age, education, and depression) using t-tests. RESULTS We found two subscales: 1) a seven-item cognitive empathy subscale (Cronbach's alpha 0.78) and 2) a six-item affective empathy subscale (Cronbach's alpha 0.73). The dyadic CFA found acceptable model fit and metric invariance across partners (Comparative Fit Index (CFI) = 0.914, Tucker Lewis Index = 0.904, Root Mean Squared Error of Approximation = 0.056, ΔCFI = 0.011). We observed higher cognitive (p: 0.012) and affective (p: 0.049) empathy among males and higher cognitive (p: 0.031) and affective (p: 0.030) empathy among younger participants. More educated participants had higher affective empathy (p: 0.017) and depressed participants had higher cognitive empathy (p: < 0.001). This two-subscale, 13-item version of the IRI measures cognitive and affective empathy in HoPS+ trial participants and adults while accounting for the interdependent nature of empathy within partner dyads. CONCLUSIONS This scale will allow us to assess the interplay between empathy and other psychometric constructs (stigma, social support, etc.) in the HoPS+ trial and how each relates to retention in HIV, adherence to treatment, and prevention of maternal to child HIV transmission. Furthermore, this scale can be adapted for other sub-Saharan African populations, which will allow researchers to better assess HIV-related intervention efficacy. TRIAL REGISTRATION This study is within the context of the HoPS+ trial, registered at ClinicalTrials.gov as number NCT03149237 . Registered May 11, 2017.
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Affiliation(s)
- Daniel E Sack
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.
| | | | | | | | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
| | | | | | | | | | | | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA
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Mayberry LS, Berg CA, Greevy RA, Nelson LA, Bergner EM, Wallston KA, Harper KJ, Elasy TA. Mixed-Methods Randomized Evaluation of FAMS: A Mobile Phone-Delivered Intervention to Improve Family/Friend Involvement in Adults' Type 2 Diabetes Self-Care. Ann Behav Med 2020; 55:165-178. [PMID: 32706852 DOI: 10.1093/abm/kaaa041] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Family and friends have both helpful and harmful effects on adults' diabetes self-management. Family-focused Add-on to Motivate Self-care (FAMS) is a mobile phone-delivered intervention designed to improve family/friend involvement, self-efficacy, and self-care via monthly phone coaching, texts tailored to goals, and the option to invite a support person to receive texts. PURPOSE We sought to evaluate how FAMS was received by a diverse group of adults with Type 2 diabetes and if FAMS improved diabetes-specific family/friend involvement (increased helpful and reduced harmful), diabetes self-efficacy, and self-care (diet and physical activity). We also assessed if improvements in family/friend involvement mediated improvements in self-efficacy and self-care. METHODS Participants were prospectively assigned to enhanced treatment as usual (control), an individualized text messaging intervention alone, or the individualized text messaging intervention plus FAMS for 6 months. Participants completed surveys at baseline, 3 and 6 months, and postintervention interviews. Between-group and multiple mediator analyses followed intention-to-treat principles. RESULTS Retention, engagement, and fidelity were high. FAMS was well received and helped participants realize the value of involving family/friends in their care. Relative to control, FAMS participants had improved family/friend involvement, self-efficacy, and diet (but not physical activity) at 3 and 6 months (all ps < .05). Improvements in family/friend involvement mediated effects on self-efficacy and diet for FAMS participants but not for the individualized intervention group. CONCLUSIONS The promise of effectively engaging patients' family and friends lies in sustained long-term behavior change. This work represents a first step toward this goal by demonstrating how content targeting helpful and harmful family/friend involvement can drive short-term effects. TRIAL REGISTRATION NUMBER NCT02481596.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Robert A Greevy
- Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Lyndsay A Nelson
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin M Bergner
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Kenneth A Wallston
- Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kryseana J Harper
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | - Tom A Elasy
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA.,Vanderbilt Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA
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Nelson LA, Spieker A, Greevy R, LeStourgeon LM, Wallston KA, Mayberry LS. User Engagement Among Diverse Adults in a 12-Month Text Message-Delivered Diabetes Support Intervention: Results from a Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e17534. [PMID: 32706738 PMCID: PMC7404018 DOI: 10.2196/17534] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/06/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023] Open
Abstract
Background Text message–delivered interventions are a feasible and scalable approach for improving chronic disease self-care and reducing health disparities; however, information on long-term user engagement with these interventions is limited. Objective The aim of this study is to examine user engagement in a 12-month text message–delivered intervention supporting diabetes self-care, called REACH (Rapid Education/Encouragement And Communications for Health), among racially and socioeconomically diverse patients with type 2 diabetes (T2D). We explored time trends in engagement, associations between patient characteristics and engagement, and whether the addition of a human component or allowing patients to change their text frequency affected engagement. Qualitative data informed patients’ subjective experience of their engagement. Methods We recruited patients with T2D for a randomized trial evaluating mobile phone support relative to enhanced treatment as usual. This analysis was limited to participants assigned to the intervention. Participants completed a survey and hemoglobin A1c (HbA1c) test and received REACH text messages, including self-care promotion texts, interactive texts asking about medication adherence, and adherence feedback texts. For the first 6 months, texts were sent daily, and half of the participants also received monthly phone coaching. After 6 months, coaching stopped, and participants had the option to receive fewer texts for the subsequent 6 months. We defined engagement via responses to the interactive texts and responses to a follow-up interview. We used regression models to analyze associations with response rate and thematic and structural analysis to understand participants’ reasons for responding to the texts and their preferred text frequency. Results The participants were, on average, aged 55.8 (SD 9.8) years, 55.2% (137/248) female, and 52.0% (129/248) non-White; 40.7% (101/248) had ≤ a high school education, and 40.7% (101/248) had an annual household income <US $25,000. The median response rate to interactive texts was 91% (IQR 75%-97%) over 12 months. Engagement gradually declined throughout the intervention but remained high. Engagement did not differ by age, gender, education, income, diabetes duration, insulin status, health literacy, or numeracy. Black race and worse baseline medication adherence and HbA1c were each associated with lower engagement, although the effects were small. Nearly half of the participants chose to continue receiving daily texts for the last 6 months of the intervention. Participants who continued daily text messages said they wanted to continue experiencing benefits to their health, whereas those who chose fewer texts said that the daily texts had helped them create routines and they no longer needed them as often. Engagement was not impacted by receiving coaching or by participants’ chosen text frequency. Conclusions Well-designed interactive text messages can engage diverse patients in a self-care intervention for at least 1 year. Variation in and reasons for frequency preference suggest that offering a frequency choice may be important to users’ engagement.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Andrew Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kenneth A Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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13
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White RO, Chakkalakal RJ, Wallston KA, Wolff K, Gregory B, Davis D, Schlundt D, Trochez KM, Barto S, Harris LA, Bian A, Schildcrout JS, Kripalani S, Rothman RL. The Partnership to Improve Diabetes Education Trial: a Cluster Randomized Trial Addressing Health Communication in Diabetes Care. J Gen Intern Med 2020; 35:1052-1059. [PMID: 31919724 PMCID: PMC7174470 DOI: 10.1007/s11606-019-05617-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Effective type 2 diabetes care remains a challenge for patients including those receiving primary care in safety net settings. OBJECTIVE The Partnership to Improve Diabetes Education (PRIDE) trial team and leaders from a regional department of health evaluated approaches to improve care for vulnerable patients. DESIGN Cluster randomized controlled trial. PATIENTS Adults with uncontrolled type 2 diabetes seeking care across 10 unblinded, randomly assigned safety net clinics in Middle TN. INTERVENTIONS A literacy-sensitive, provider-focused, health communication intervention (PRIDE; 5 clinics) vs. standard diabetes education (5 clinics). MAIN MEASURES Participant-level primary outcome was glycemic control [A1c] at 12 months. Secondary outcomes included select health behaviors and psychosocial aspects of care at 12 and 24 months. Adjusted mixed effects regression models were used to examine the comparative effectiveness of each approach to care. KEY RESULTS Of 410 patients enrolled, 364 (89%) were included in analyses. Median age was 51 years; Black and Hispanic patients represented 18% and 25%; 96% were uninsured, and 82% had low annual income level (< $20,000); adequate health literacy was seen in 83%, but numeracy deficits were common. At 12 months, significant within-group treatment effects occurred from baseline for both PRIDE and control sites: adjusted A1c (- 0.76 [95% CI, - 1.08 to - 0.44]; P < .001 vs - 0.54 [95% CI, - 0.86 to - 0.21]; P = .001), odds of poor eating (0.53 [95% CI, 0.33-0.83]; P = .01 vs 0.42 [95% CI, 0.26-0.68]; P < .001), treatment satisfaction (3.93 [95% CI, 2.48-6.21]; P < .001 vs 3.04 [95% CI, 1.93-4.77]; P < .001), and self-efficacy (2.97 [95% CI, 1.89-4.67]; P < .001 vs 1.81 [95% CI, 1.1-2.84]; P = .01). No significant difference was observed between study arms in adjusted analyses. CONCLUSIONS Both interventions improved the participant's A1c and behavioral outcomes. PRIDE was not more effective than standard education. Further research may elucidate the added value of a focused health communication program in this setting.
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Affiliation(s)
- Richard O White
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
| | - Rosette James Chakkalakal
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathleen Wolff
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Becky Gregory
- Vanderbilt Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dianne Davis
- Vanderbilt Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Karen M Trochez
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shari Barto
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura A Harris
- Mid-Cumberland Regional Office, Tennessee Department of Health , Nashville, TN, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | | | - Sunil Kripalani
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Russell L Rothman
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
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14
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El-Baiomy EM, Salem ML, El-Amir A, Sabry NA, Wallston KA, El-Mashad N. Correlations between MHLC scores and Indicators of Immune Response in Egyptian Women with Breast Cancer. Gulf J Oncolog 2020; 1:7-11. [PMID: 32342912 DOI: pmid/32342912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies indicate the immune dysfunction in cancer patients in comparison with healthy individuals. The quality and quantity of this dysfunction are not equal in all patients even with similar cancer type. AIM This study aims to correlate health locus of control (HLC) beliefs with CD4+ helper T (Thelper) cells, T regulatory (Treg) cells, NK cells, IL-1ß and TNF-a in breast cancer patients. PATIENTS AND METHODS The study included 30 early diagnostic breast cancer patients who responded to Form C of the MHLC questionnaire that assessed internal (IHLC), chance (CHLC), doctor (DHLC) and other person's (OHLC) control of the patient's health status. Peripheral blood samples were collected to analyze the numbers and phenotype of Thelper cells, Treg cells and NK cells by flow cytometry and to measure gene expression of IL-1ß and TNF-a with real time PCR. RESULTS A significant positive correlation was found between IHLC with Thelper cells and NK cells. However, a significant inverse correlation was found between DHLC with NK, Thelper and Treg cells. CONCLUSION There is strong probability that the quality of immunity in cancer patients is related to their MHLC beliefs. Further research is recommended for studying whether MHLC beliefs of patients with other types of cancer can improve their immune responses and how beliefs control immune system.
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Affiliation(s)
- Eman M El-Baiomy
- Immunology Department, Faculty of Science, Cairo University, Egypt
| | - Mohamed L Salem
- Immunology and biotechnology Department, Faculty of Science, Tanta University, Egypt
- Center of Excellence in Cancer Research, Tanta, Egypt
| | - Azza El-Amir
- Immunology Department, Faculty of Science, Cairo University, Egypt
| | - Noha A Sabry
- Psychiatry Department, Faculty of Medicine, Cairo University, Egypt
| | - Kenneth A Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
| | - Nehal El-Mashad
- Oncology Department, Faculty of Medicine, Tanta University, Egypt
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15
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Layne DM, Nemeth LS, Mueller M, Wallston KA. The Negative Behaviors in Healthcare Survey: Instrument Development and Validation. J Nurs Meas 2019; 27:221-233. [PMID: 31511406 DOI: 10.1891/1061-3749.27.2.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Examine the psychometric properties and factor structure of the Negative Behaviors in Healthcare (NBHC) Survey. METHODS A principal axis factor analysis with varimax rotation was conducted utilizing the 2012 NBHC survey data (n = 1,918) to explore the underlying structure of the NBHC instrument. A confirmatory factor analysis using AMOS 23 (Arbuckle, 2014) was then conducted using the 2014 NBHC survey data (n = 1,479). RESULTS Internal consistency reliability was supported for four of the five identified factors, while construct validity for a five factor solution was established with acceptable model fit indices (Goodness of Fit Index [GFI] = 0.98; Relative Fit Index [RFI] = 0.98, Normed Fit Index [NFI] = 0.98, Root Mean Square Residual [RMR] = 0.05). CONCLUSIONS The NBHC instrument is a valid reliable instrument to assess negative behaviors among interprofessional healthcare team members, adding to a select few available instruments measuring negative behavior among interprofessional healthcare workers.
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Affiliation(s)
- Diana M Layne
- Medical University of South Carolina, Charleston, South Carolina
| | - Lynne S Nemeth
- Medical University of South Carolina, Charleston, South Carolina
| | - Martina Mueller
- Medical University of South Carolina, Charleston, South Carolina
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16
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Cronin RM, Jerome RN, Mapes B, Andrade R, Johnston R, Ayala J, Schlundt D, Bonnet K, Kripalani S, Goggins K, Wallston KA, Couper MP, Ellitt MR, Harris P, Begale M, Munoz F, Lopez-Class M, Cella D, Condon D, AuYoung M, Mazor KM, Mikita S, Manganiello M, Borselli N, Fowler S, Rutter JL, Denny JC, Karlson EW, Ahmedani BK, O’Donnell C. Development of the Initial Surveys for the All of Us Research Program. Epidemiology 2019; 30:597-608. [PMID: 31045611 PMCID: PMC6548672 DOI: 10.1097/ede.0000000000001028] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The All of Us Research Program is building a national longitudinal cohort and collecting data from multiple information sources (e.g., biospecimens, electronic health records, and mobile/wearable technologies) to advance precision medicine. Participant-provided information, collected via surveys, will complement and augment these information sources. We report the process used to develop and refine the initial three surveys for this program. METHODS The All of Us survey development process included: (1) prioritization of domains for scientific needs, (2) examination of existing validated instruments, (3) content creation, (4) evaluation and refinement via cognitive interviews and online testing, (5) content review by key stakeholders, and (6) launch in the All of Us electronic participant portal. All content was translated into Spanish. RESULTS We conducted cognitive interviews in English and Spanish with 169 participants, and 573 individuals completed online testing. Feedback led to over 40 item content changes. Lessons learned included: (1) validated survey instruments performed well in diverse populations reflective of All of Us; (2) parallel evaluation of multiple languages can ensure optimal survey deployment; (3) recruitment challenges in diverse populations required multiple strategies; and (4) key stakeholders improved integration of surveys into larger Program context. CONCLUSIONS This efficient, iterative process led to successful testing, refinement, and launch of three All of Us surveys. Reuse of All of Us surveys, available at http://researchallofus.org, may facilitate large consortia targeting diverse populations in English and Spanish to capture participant-provided information to supplement other data, such as genetic, physical measurements, or data from electronic health records.
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Affiliation(s)
- Robert M. Cronin
- Department of Biomedical Informatics and Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca N. Jerome
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brandy Mapes
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Regina Andrade
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca Johnston
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Ayala
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathryn Goggins
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kenneth A. Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mick P. Couper
- Survey Research Center, University of Michigan. Ann Arbor, MI, USA
- Joint Program in Survey Methodology, University of Maryland, College Park, MD, USA
| | - Michael R. Ellitt
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Paul Harris
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Fatima Munoz
- Department of Research and Health Promotion, San Ysidro Health, San Diego, California, USA
| | - Maria Lopez-Class
- National Institutes of Health, Office of the Director, Bethesda, Maryland, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Condon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mona AuYoung
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California, United States
| | | | - Steve Mikita
- Spinal Muscular Atrophy Foundation, New York, New York, United States of America
| | | | | | - Stephanie Fowler
- National Institutes of Health, Office of the Director, Bethesda, Maryland, USA
| | - Joni L. Rutter
- National Institutes of Health, Office of the Director, Bethesda, Maryland, USA
| | - Joshua C. Denny
- Department of Biomedical Informatics and Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth W. Karlson
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Section of Clinical Sciences, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brian K. Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Chris O’Donnell
- Cardiology Section, Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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17
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Mayberry LS, Berg CA, Greevy RA, Wallston KA. Assessing helpful and harmful family and friend involvement in adults' type 2 diabetes self-management. Patient Educ Couns 2019; 102:1380-1388. [PMID: 30922622 PMCID: PMC6546510 DOI: 10.1016/j.pec.2019.02.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Develop and evaluate a measure assessing helpful and harmful family/friends' involvement in adults' type 2 diabetes (T2D) self-management. METHODS Prior mixed-methods research, cognitive interviews, and expert input informed measure development. We administered the measure in two studies (N = 392 and N = 512) to evaluate its factor structure, internal consistency reliability, test-retest reliability, and construct, criterion and predictive validity. RESULTS Analyses supported a two-factor solution: helpful and harmful involvement with internal consistency reliability α = .86 and .72, respectively. Three-month test-retest reliability was rho = 0.64 for helpful and rho = 0.61 for harmful (both p < 0.001). Over 90% reported at least one instance of family/friend involvement in the past month. Associations with other measures of diabetes involvement were as anticipated (all p < .01). Helpful and harmful involvement were independently associated with diabetes self-efficacy, diet, blood glucose testing and medication adherence cross-sectionally [βs 0.13-0.39 helpful, -0.12--0.33 harmful; all p < .05]. Harmful involvement independently predicted worse HbA1c (β = 0.08), and worsening HbA1c over three months (β = 0.12, both p < 0.05). CONCLUSION The Family and Friend Involvement in Adults' Diabetes (FIAD) is a reliable and valid measure assessing family/friend involvement in adults' T2D. PRACTICE IMPLICATIONS FIAD use can inform interventions to improve social contexts in which adults manage diabetes.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; School of Nursing, Vanderbilt University, Nashville, TN, USA
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18
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Yeh VM, Mayberry LS, Bachmann JM, Wallston KA, Roumie C, Muñoz D, Kripalani S. Depressed Mood, Perceived Health Competence and Health Behaviors: aCross-Sectional Mediation Study in Outpatients with Coronary Heart Disease. J Gen Intern Med 2019; 34:1123-1130. [PMID: 30565150 PMCID: PMC6614237 DOI: 10.1007/s11606-018-4767-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/03/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Identifying potential mechanisms that link depressed mood with worse health behaviors is important given the prevalence of depressed mood in patients with coronary heart disease (CHD) and its relationship with subsequent mortality. Perceived health competence is an individual's confidence in his/her ability to successfully engineer solutions to achieve health goals and may explain how depressed mood affects multiple health behaviors. OBJECTIVE Examine whether or not perceived health competence mediates the relationship between depressed mood and worse health behaviors. DESIGN A cross-sectional study conducted by the Patient-Centered Outcomes Research Institute-funded Mid-South Clinical Data Research Network between August 2014 and September 2015. Bootstrapped mediation was used. PARTICIPANTS Patients with coronary heart disease (n = 2334). MAIN MEASURES Two items assessing perceived health competence, a single item assessing depressed mood, and a Health Behaviors Index including: the International Physical Activity Questionnaire (IPAQ); select items from the National Adult Tobacco Survey and the Alcohol Use Disorder Inventory Test; and single items assessing diet and medication adherence. KEY RESULTS Depressed mood was associated with lower perceived health competence (a = - 0.21, p < .001) and lower perceived health competence was associated with worse performance on a Health Behaviors Index(b = 0.18, p < .001). Perceived health competence mediated the influence of depressed mood on health behaviors (ab = - 0.04, 95% CI = - 0.05 to - 0.03). The ratio of the indirect effect to the total effect was used as a measure of effect size (PM = 0.26, 95% CI: 0.18 to 0.39). CONCLUSIONS Depressed mood is associated with worse health behaviors directly and indirectly via lower perceived health competence. Interventions to increase perceived health competence may lessen the deleterious impact of depressed mood on health behaviors and cardiovascular outcomes.
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Affiliation(s)
- Vivian M Yeh
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA. .,Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Lindsay S Mayberry
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin M Bachmann
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA.,School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Christianne Roumie
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA
| | - Daniel Muñoz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Moore ER, Watters R, Wallston KA. Effect of Evidence‐Based Practice (EBP) Courses on MSN and DNP Students’ Use of EBP. Worldviews Evid Based Nurs 2019; 16:319-326. [DOI: 10.1111/wvn.12369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 11/30/2022]
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Stevens NR, Adams N, Wallston KA, Hamilton NA. Factors associated with women's desire for control of healthcare during childbirth: Psychometric analysis and construct validation. Res Nurs Health 2019; 42:273-283. [PMID: 31016758 DOI: 10.1002/nur.21948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/12/2019] [Accepted: 03/26/2019] [Indexed: 11/07/2022]
Abstract
The desire for control of healthcare is a significant moderator of outcomes related to childbirth. Researchers have shown that a sense of control of healthcare during childbirth is strongly correlated with postpartum maternal well-being. The aims of this study were to examine (a) the psychometric characteristics of an instrument to assess women's desire for control of healthcare during childbirth, and (b) examine desire for control in relation to parity, medical complications of pregnancy, and women's choices of childbirth providers and setting. The study design was cross-sectional using two different samples totaling 385 pregnant women. In Sample 1, (n = 193) we conducted an exploratory factor analysis to reduce the initial item pool. In Sample 2, (n = 192) we conducted a confirmatory factor analysis (CFA) of the final 12-item instrument and examined factors related to the desire for control. Results of the analysis in Sample 1 were supportive of a single-factor structure reflecting women's desire to influence the childbirth healthcare environment and decision-making. The final 12-item instrument had high internal consistency reliability (Cronbach's alpha = 0.93). CFA in Sample 2 was supportive of the single-factor structure with good model fit. The desire for control was directly correlated with an internal locus of control. Nulliparous women reported a lower desire for control compared with multiparous women. The desire for control among women with self-reported medical complications of pregnancy was comparable to that among women without pregnancy complications. The desire for control was a predictor of choosing midwives (vs. obstetricians), home or birth center (vs. hospitals), and professional labor support (e.g., doulas). Implications for future research on the impact of desire for control on maternal health outcomes are discussed.
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Affiliation(s)
- Natalie R Stevens
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Natasia Adams
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Kenneth A Wallston
- Vanderbilt University Medical Center, Center for Health Services Research, Nashville, Tennessee
| | - Nancy A Hamilton
- Department of Psychology, University of Kansas, Lawrence, Kansas
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21
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Kripalani S, Heerman WJ, Patel NJ, Jackson N, Goggins K, Rothman RL, Yeh VM, Wallston KA, Smoot DT, Wilkins CH. Association of Health Literacy and Numeracy with Interest in Research Participation. J Gen Intern Med 2019; 34:544-551. [PMID: 30684202 PMCID: PMC6445877 DOI: 10.1007/s11606-018-4766-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/03/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is much attention to recruitment of diverse populations in research, but little is known about the influence of health literacy and numeracy skills. OBJECTIVE To determine if health literacy and numeracy affect individuals' interest to participate in research studies. DESIGN Cross-sectional survey data were pooled from 3 large studies conducted in the Mid-South Clinical Data Research Network. PARTICIPANTS Adult patients enrolled in 1 of 3 Mid-South Clinical Data Research Network studies. MAIN MEASURES The survey domains included demographic items, the 3-item Brief Health Literacy Screen (range 3-15), and the 3-item Subjective Numeracy Scale (range 3-18). The outcome was a sum index measure of a 7-item instrument (range 7-21) assessing individuals' interest in participating in different types of research, including research that involves taking surveys, giving a blood sample, participating via phone or internet, taking an investigational medication, meeting at a local community center or school, including family, or staying overnight at a hospital. KEY RESULTS Respondents (N = 15,973) were predominately women (65.5%), White (81.4%), and middle aged (M = 52.8 years, SD = 16.5); 32.4% previously participated in research. Self-reported health literacy was relatively high (M = 13.5 out of 15, SD = 2.1), and subjective numeracy skills were somewhat lower (M = 14.3 out of 18, SD = 3.6). After adjustment for age, gender, race, income, education, and other characteristics, lower health literacy and numeracy skills were each independently associated with less interest in research participation (p < 0.001 for each). Prior research participation was associated with greater interest in future research participation (p < 0.001). CONCLUSIONS After adjustment for factors known to be predictive of interest, individuals with lower health literacy or numeracy scores were less interested in participating in research. Additional work is needed to elucidate reasons for this finding and to determine strategies to engage these populations.
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Affiliation(s)
- Sunil Kripalani
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA.
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - William J Heerman
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Niral J Patel
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Natalie Jackson
- Division of General Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Kathryn Goggins
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Russell L Rothman
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vivian M Yeh
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN, USA
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Duane T Smoot
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Consuelo H Wilkins
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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22
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Wallston KA. Historical perspective on behavioral medicine's success in bringing different disciplines to the table. J Behav Med 2019; 42:95-101. [PMID: 30825092 DOI: 10.1007/s10865-018-9977-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/04/2018] [Indexed: 10/27/2022]
Abstract
This article presents the author's perspective on the success of the field of behavioral medicine in recruiting, involving, and retaining upwards of 17 different professional disciplines over the 40 years of its existence. Acknowledging that health psychologists have historically dominated this interdisciplinary field, the author presents some possible solutions to increasing the viability and visibility of the other disciplines in carrying out the mission of behavioral medicine.
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23
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Mayberry LS, Schildcrout JS, Wallston KA, Goggins K, Mixon AS, Rothman RL, Kripalani S. Health Literacy and 1-Year Mortality: Mechanisms of Association in Adults Hospitalized for Cardiovascular Disease. Mayo Clin Proc 2018; 93:1728-1738. [PMID: 30414733 PMCID: PMC6299453 DOI: 10.1016/j.mayocp.2018.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/03/2018] [Accepted: 07/10/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To test theorized patient-level mediators in the causal pathway between health literacy (HL) and 1-year mortality in adults with cardiovascular disease (CVD). PATIENTS AND METHODS A total of 3000 adults treated at Vanderbilt University Hospital from October 11, 2011, through December 18, 2015, for acute coronary syndrome or acute decompensated heart failure (ADHF) participated in the Vanderbilt Inpatient Cohort Study. Participants completed a bedside-administered survey and consented to health record review and longitudinal follow-up. Multivariable mediation models examined the direct and indirect effects of HL (a latent variable with 4 indicators) with 1-year mortality after discharge (dichotomous). Hypothesized mediators included social support, health competence, health behavior, comorbidity index, type of CVD diagnosis, and previous-year hospitalizations. RESULTS Of the 2977 patients discharged from the hospital (60% male; mean age, 61 years; 83% non-Hispanic white, 37% admitted for ADHF), 17% to 23% had inadequate HL depending on the measure, and 10% (n=304) died within 1 year. The total effect of lower HL on 1-year mortality (adjusted odds ratio [AOR]=1.31; 95% CI, 1.01-1.69) was decomposed into an indirect effect (AOR=1.50; 95% CI, 1.35-1.67) via the mediators and a nonsignificant direct effect (AOR=0.87; 95% CI, 0.66-1.14). Each SD decrease in HL was associated with an absolute 3.2 percentage point increase in the probability of 1-year mortality via mediators admitted for ADHF, comorbidities, health behavior, health competence, and previous-year hospitalizations (listed by contribution to indirect effect). CONCLUSION Patient-level factors link low HL and mortality. Health competence and health behavior are modifiable mediators that could be targeted by interventions post hospitalization for CVD.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN.
| | | | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN; School of Nursing, Vanderbilt University, Nashville, TN
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda S Mixon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN
| | - Russell L Rothman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN
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24
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Wilkins CH, Villalta-Gil V, Houston MM, Joosten Y, Richmond A, Vaughn YC, Stallings SC, Wallston KA. Development and validation of the Person-Centeredness of Research Scale. J Comp Eff Res 2018; 7:1153-1159. [PMID: 30411976 PMCID: PMC6615408 DOI: 10.2217/cer-2018-0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Person-centeredness shifts the focus of healthcare and research to the needs and priorities of patients and communities, and may improve health outcomes. There are no instruments available, however, with which we can assess the degree to which research is indeed person-centered. Our aim was to develop and validate a quantitative instrument to rate person-centeredness of research. MATERIALS & METHODS Scale development and validation entailed a multistep approach that led to the seven-item Person Centeredness of Research Scale (PCoR Scale) that uses a 5-point Likert rating scale. The scale was validated using ratings of the Patient-Centered Outcomes Research Institute-funded research abstracts or abstracts submitted to a translational science meeting. RESULTS Psychometric properties of the PCoR Scale showed high internal consistency (α = 0.96). All seven items were highly correlated with the total score (rs range from 0.63 to 0.90). An exploratory factor analysis demonstrated that all of the items loaded on a single factor, explaining 80% of the variance. The Patient-Centered Outcomes Research Institute-funded research abstracts had a mean PCoR Scale score of 6.52 (±8.01) that was significantly higher than the abstracts submitted to the translational science meeting (-2.56 (±9.18); t = 8.09; p < 0.0001). Inter-rater reliability in the validation of the revised instrument was high (Intraclass Correlation Coefficient [ICC](group1) = 0.89; ICC(group2) = 0.95). CONCLUSION This brief, quantitative rating scale is the first to assess the main constructs that describe person-centeredness of research products. The PCoR Scale can be used to assess person-centeredness in research products; for example, by funders evaluating proposals, data networks evaluating data requests or researchers evaluating their research designs.
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Affiliation(s)
- Consuelo H Wilkins
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, 37208, Nashville, TN, USA.,Department of Medicine. Vanderbilt University Medical Center, 37232, Nashville, TN, USA.,Meharry Medical College, 37208, Nashville, TN, USA
| | - Victoria Villalta-Gil
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, 37208, Nashville, TN, USA
| | - Mckenzie M Houston
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, 37208, Nashville, TN, USA
| | - Yvonne Joosten
- Department of Medicine. Vanderbilt University Medical Center, 37232, Nashville, TN, USA
| | - Alan Richmond
- Community Campus Partners for Health, 27605, Raleigh, NC, USA
| | | | - Sarah C Stallings
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, 37208, Nashville, TN, USA.,Department of Medicine. Vanderbilt University Medical Center, 37232, Nashville, TN, USA
| | - Kenneth A Wallston
- Department of Medicine. Vanderbilt University Medical Center, 37232, Nashville, TN, USA.,School of Nursing, Vanderbilt University, 37232, Nashville, TN, USA
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25
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Wild MG, Ostini R, Harrington M, Cavanaugh KL, Wallston KA. Validation of the shortened Perceived Medical Condition Self-Management Scale in patients with chronic disease. Psychol Assess 2018; 30:1300-1307. [PMID: 29781666 PMCID: PMC6172142 DOI: 10.1037/pas0000572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Self-efficacy, or perceived competence, has been identified as an important factor in self-management behaviors and health outcomes in patients with chronic disease. Measures of self-management self-efficacy are currently available for multiple forms of chronic disease. One established measure is the 8-item Perceived Medical Condition Self-Management Scale (PMCSMS). This study investigated the use of the PMCSMS in samples of patients with a chronic disease to develop an abbreviated version of the scale that could be more readily used in clinical contexts or in large population health cohort studies. The PMCSMS was administered as either a generic scale or as a disease-specific scale. The results of analyses using item response theory and classical test theory methods indicated that using 4 items of the scale resulted in similar internal consistency (α = .70-0.90) and temporal stability (test-retest r = .75 after 2 to 4 weeks) to the 8-item PMCSMS (r = .81 after 2 to 4 weeks). The 4 items selected had the greatest discriminability among participants (α parameters = 2.49-3.47). Scores from both versions also demonstrated similar correlations with related constructs such as health literacy (r = .13-0.29 vs. 0.14-0.27), self-rated health (r = .17-0.48 vs. 0.26-0.50), social support (r = .21-0.32 vs. 0.25-0.34), and medication adherence (r = .20-0.24 vs. 0.20-0.25). The results of this study indicate that 4-item PMCSMS scores are equally valid but more efficient, and have the potential to be beneficial for both research and clinical applications. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Remo Ostini
- Rural Clinical School Research Centre, The University of Queensland
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26
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Martinez W, Threatt AL, Rosenbloom ST, Wallston KA, Hickson GB, Elasy TA. A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing. JMIR Hum Factors 2018; 5:e26. [PMID: 30249579 PMCID: PMC6231745 DOI: 10.2196/humanfactors.9569] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022] Open
Abstract
Background Health apps and Web-based interventions designed for patients with diabetes offer novel and scalable approaches to engage patients and improve outcomes. However, careful attention to the design and usability of these apps and Web-based interventions is essential to reduce the barriers to engagement and maximize use. Objective The aim of this study was to apply design sprint methodology paired with mixed-methods, task-based usability testing to design and evaluate an innovative, patient-facing diabetes dashboard embedded in an existing patient portal and integrated into an electronic health record. Methods We applied a 5-day design sprint methodology developed by Google Ventures (Alphabet Inc, Mountain View, CA) to create our initial dashboard prototype. We identified recommended strategies from the literature for using patient-facing technologies to enhance patient activation and designed a dashboard functionality to match each strategy. We then conducted a mixed-methods, task-based usability assessment of dashboard prototypes with individual patients. Measures included validated metrics of task performance on 5 common and standardized tasks, semistructured interviews, and a validated usability satisfaction questionnaire. After each round of usability testing, we revised the dashboard prototype in response to usability findings before the next round of testing until the majority of participants successfully completed tasks, expressed high satisfaction, and identified no new usability concerns (ie, stop criterion was met). Results The sample (N=14) comprised 5 patients in round 1, 3 patients in round 2, and 6 patients in round 3, at which point we reached our stop criterion. The participants’ mean age was 63 years (range 45-78 years), 57% (8/14) were female, and 50% (7/14) were white. Our design sprint yielded an initial patient-facing diabetes dashboard prototype that displayed and summarized 5 measures of patients’ diabetes health status (eg, hemoglobin A1c). The dashboard used graphics to visualize and summarize health data and reinforce understanding, incorporated motivational strategies (eg, social comparisons and gamification), and provided educational resources and secure-messaging capability. More than 80% of participants were able to successfully complete all 5 tasks using the final prototype. Interviews revealed usability concerns with design, the efficiency of use, and content and terminology, which led to improvements. Overall satisfaction (0=worst and 7=best) improved from the initial to the final prototype (mean 5.8, SD 0.4 vs mean 6.7, SD 0.5). Conclusions Our results demonstrate the utility of the design sprint methodology paired with mixed-methods, task-based usability testing to efficiently and effectively design a patient-facing, Web-based diabetes dashboard that is satisfying for patients to use.
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Affiliation(s)
- William Martinez
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anthony L Threatt
- Health Information Technology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - S Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Gerald B Hickson
- Quality, Safety & Risk Prevention, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
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27
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Layne DM, Nemeth LS, Mueller M, Schaffner MJ, Stanley KM, Martin MM, Wallston KA. Negative behaviours in health care: Prevalence and strategies. J Nurs Manag 2018; 27:154-160. [PMID: 30171644 DOI: 10.1111/jonm.12660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 03/02/2018] [Accepted: 05/16/2018] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the effectiveness of a professionalism taskforce and the prevalence of negative behaviours across interdisciplinary groups at a south-eastern US academic medical centre. BACKGROUND Negative behaviours within health care organisations may undermine patient safety. These behaviours are associated with decreased productivity, increased turnover, and poor patient and staff outcomes. METHODS A pre-post study design using an adapted instrument, the Negative Behaviors in HealthCare (NBHC) survey, assessed perceptions of negative behaviours by physicians, clinical, and managerial staff both before and after a professionalism taskforce was convened in 2012 to identify and promulgate key strategies to improve behaviours. RESULTS The 1,980 respondents completed the pre-survey in January 2012 and 1,423 completed the post-survey in 2014. Significant reductions in use of lateral aggression (LA) and vertical aggression (VA) (χ2 = 5.65, p < 0.017), observation of LA and VA (χ2 = 4.90, p < 0.027), and experience with contributing factors associated with negative behaviours (χ2 = 9.03, p < 0.003) were identified. CONCLUSIONS Findings suggest that a professionalism taskforce guiding key strategies to elevate professionalism significantly affected beliefs about lateral and vertical aggression. IMPLICATIONS FOR NURSING MANAGEMENT Decreasing negative behaviours in health care will require additional strategies and consistent implementation. Additional research addressing fear, retaliation, and job stress, and linking these behaviours to patient safety outcomes, is required.
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Affiliation(s)
- Diana M Layne
- Medical University of South Carolina, Charleston, SC
| | | | | | | | | | - Mary M Martin
- Medical University of South Carolina, Charleston, SC
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28
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Donato KM, León-Pérez G, Wallston KA, Kripalani S. Something Old, Something New: When Gender Matters in the Relationship between Social Support and Health. J Health Soc Behav 2018; 59:352-370. [PMID: 30058378 PMCID: PMC6178235 DOI: 10.1177/0022146518789362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This paper investigates how social support differentially benefits self-rated health among men and women hospitalized with heart disease. Using cross-sectional data about patients admitted to a university hospital, we examine the extent to which gender moderates effects for the frequency of contact with family, friends, and neighbors on health and whether these effects differ between those with new versus established diagnoses. We find that gender differentiates the effect of nonmarital family contact on health but only when heart disease is newly diagnosed. When newly diagnosed, more frequent contact with family is associated with better self-rated health for women but not men. Men and women with preexisting diagnoses benefit equally from more frequent contact with family.
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Affiliation(s)
| | | | - Kenneth A. Wallston
- Center for Effective Health Communication, Vanderbilt University Medical Center
| | - Sunil Kripalani
- Center for Effective Health Communication, Vanderbilt University Medical Center
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29
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Nelson LA, Wallston KA, Kripalani S, LeStourgeon LM, Williamson SE, Mayberry LS. Assessing barriers to diabetes medication adherence using the Information-Motivation-Behavioral skills model. Diabetes Res Clin Pract 2018; 142:374-384. [PMID: 29879495 PMCID: PMC6083841 DOI: 10.1016/j.diabres.2018.05.046] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/29/2018] [Accepted: 05/24/2018] [Indexed: 11/20/2022]
Abstract
AIMS Medication nonadherence is a prevalent and costly problem among patients with type 2 diabetes. Applications of theory can inform and improve adherence promotion interventions. We used a new assessment based on the Information-Motivation-Behavioral skills (IMB) model of adherence to assess patient-reported barriers and test the theoretical model. METHODS Participants (N = 237) completed a card sorting task to identify barriers to adherence, a survey, and a hemoglobin A1c (HbA1c) test. We identified the most commonly reported adherence barriers and examined associations between patient characteristics and barriers mapped onto each of the IMB constructs. We used structural equation modeling to test the IMB model and determine if barriers as reported on this measure predict patients' self-reported diabetes medication adherence and, in turn, HbA1c levels. RESULTS The most frequently reported barriers were forgetting doses, thinking brand name medicine works better than generic medicine, not seeing immediate benefit, and feeling burned out with taking diabetes medicine. Younger age and lower health literacy were associated with higher barrier scores for all IMB model constructs. Information and social motivation barriers affected adherence via behavioral skills barriers (indirect effects -0.19, CI [-0.33, -0.09] and -0.24, CI [-0.37, -0.14], respectively). The IMB barrier constructs explained 44% of the variance in diabetes medication adherence which, in turn, was significantly associated with and explained 8% of the variance in HbA1c (both p < .001). CONCLUSIONS Results suggest this assessment task can identify patient-specific barriers to diabetes medication adherence. Interventions targeting patient-specific barriers using this assessment could improve adherence and HbA1c.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- School of Nursing, Vanderbilt University, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah E Williamson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
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30
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Birdee GS, Wallston KA, Ayala SG, Ip EH, Sohl SJ. Development and psychometric properties of the Self-efficacy for Mindfulness Meditation Practice scale. J Health Psychol 2018; 25:2017-2030. [PMID: 29956564 DOI: 10.1177/1359105318783041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study aimed to develop a self-efficacy measure for mindfulness meditation practice (Self-efficacy for Mindfulness Meditation Practice scale). The scale was developed through a process of expert consensus, cognitive interviewing, and evaluation among 199 mindfulness meditation practitioners who completed an online survey. The 9-item Self-efficacy for Mindfulness Meditation Practice scale was unidimensional with three subconstructs of attention, compassion, and emotion. The omega hierarchical coefficient for the total scale was 0.78, and test-retest reliability was intraclass correlation coefficient = 0.85 (95% confidence interval: 0.80, 0.89). This study provides preliminary evidence that Self-Efficacy for Mindfulness Meditation Practice scale is a reliable and valid measure of self-efficacy for mindfulness meditation practice.
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31
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Bachmann JM, Mayberry LS, Wallston KA, Huang S, Roumie CL, Muñoz D, Patel NJ, Kripalani S. Relation of Perceived Health Competence to Physical Activity in Patients With Coronary Heart Disease. Am J Cardiol 2018; 121:1032-1038. [PMID: 29602441 DOI: 10.1016/j.amjcard.2018.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/14/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
Physical inactivity is highly associated with mortality, especially in patients with coronary heart disease. We evaluated the effect of perceived health competence, a patient's belief in his or her ability to achieve health-related goals, on cumulative physical activity levels in the Mid-South Coronary Heart Disease Cohort Study. The Mid-South Coronary Heart Disease Cohort Study consists of 2,587 outpatients (32% were female) with coronary heart disease at an academic medical center network in the United States. Cumulative physical activity was quantified in metabolic equivalent (MET)-minutes per week with the International Physical Activity Questionnaire. We investigated associations between the 2-item Perceived Health Competence Scale (PHCS-2) and MET-minutes/week after adjusting for co-morbidities and psychosocial factors with linear regression. Nearly half of participants (47%) exhibited low physical activity levels (<600 MET-minutes/week). Perceived health competence was highly associated with physical activity after multivariable adjustment. A nonlinear relation was observed, with the strongest effect on physical activity occurring at lower levels of perceived health competence. There was effect modification by gender (p = 0.03 for interaction). The relation between perceived health competence and physical activity was stronger in women compared with men; an increase in the PHCS-2 from 3 to 4 was associated with a 73% increase in MET-minutes/week in women (95% confidence interval 43% to 109%, p <0.0001) compared with a 53% increase in men (95% confidence interval 27% to 84%, p <0.0001). In conclusion, low perceived health competence was strongly associated with less physical activity in patients with coronary heart disease and may represent a potential target for behavioral interventions.
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Nelson LA, Wallston KA, Kripalani S, Greevy RA, Elasy TA, Bergner EM, Gentry CK, Mayberry LS. Mobile Phone Support for Diabetes Self-Care Among Diverse Adults: Protocol for a Three-Arm Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e92. [PMID: 29636319 PMCID: PMC5915673 DOI: 10.2196/resprot.9443] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/19/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
Background Nonadherence to self-care is common among patients with type 2 diabetes (T2D) and often leads to severe complications. Moreover, patients with T2D who have low socioeconomic status and are racial/ethnic minorities disproportionately experience barriers to adherence and poor outcomes. Basic phone technology (text messages and phone calls) provides a practical medium for delivering content to address patients’ barriers to adherence; however, trials are needed to explore long-term and sustainable effects of mobile phone interventions among diverse patients. Objective The aim of this study is to evaluate the effects of mobile phone–based diabetes support interventions on self-care and hemoglobin A1c (HbA1c) among adults with T2D using a 3-arm, 15-month randomized controlled trial with a Type 1 hybrid effectiveness-implementation approach. The intervention arms are (1) Rapid Encouragement/Education And Communications for Health (REACH) and (2) REACH + Family-focused Add-on for Motivating Self-care (FAMS). Methods We recruited primary care patients with T2D (N=512) from Federally Qualified Health Centers and an academic medical center, prioritizing recruitment of publicly insured and minority patients from the latter. Eligible patients were prescribed daily diabetes medication and owned a cell phone with text messaging capability. We excluded patients whose most recent HbA1c result within 12 months was <6.8% to support detection of intervention effects on HbA1c. Participants were randomly assigned to REACH only, REACH + FAMS, or the control condition. REACH provides text messages tailored to address patient-specific barriers to medication adherence based on the Information-Motivation-Behavioral skills model, whereas FAMS provides monthly phone coaching with related text message content focused on family and friend barriers to diet and exercise adherence. We collect HbA1c and self-reported survey data at baseline and at 3, 6, and 12 months, and again at 15 months to assess sustained changes. We will use generalized estimating equation models to test the effects of REACH (either intervention arm) on HbA1c relative to the control group, the potential additive effects of FAMS, and effects of either intervention on adherence to self-care behaviors and diabetes self-efficacy. Results The trial is ongoing; recruitment closed December 2017. We plan to perform analyses on 6-month outcomes for FAMS in July 2018, and project to have 15-month data for REACH analyses in April 2019. Conclusions Our study will be one of the first to evaluate a long-term, theory-based text messaging intervention to promote self-care adherence among racially/ethnically and socioeconomically diverse adults with T2D. Moreover, our study will assess the feasibility of a family-focused intervention delivered via mobile phones and compare the effects of text messaging alone versus text messaging plus phone coaching. Findings will advance our understanding of how interventions delivered by phone can benefit diverse patients with chronic conditions. Trial Registration ClinicalTrials.gov NCT02409329; https://clinicaltrials.gov/ct2/show/NCT02409329 (Archived by WebCite at http://www.webcitation.org/6yHkg9SSl); NCT02481596; https://clinicaltrials.gov/ct2/show/NCT02481596 (Archived by WebCite at http://www.webcitation.org/6yHkj9XD4)
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Affiliation(s)
- Lyndsay A Nelson
- Center for Health Behavior and Health Education, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kenneth A Wallston
- Center for Diabetes Translation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,School of Nursing, Vanderbilt University, Nashville, TN, United States.,Center for Effective Health Communication, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sunil Kripalani
- Center for Effective Health Communication, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Clinical Quality and Implementation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Center for Health Behavior and Health Education, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Diabetes Translation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Erin M Bergner
- Center for Health Behavior and Health Education, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Chad K Gentry
- Department of Pharmacy, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, TN, United States
| | - Lindsay S Mayberry
- Center for Health Behavior and Health Education, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Diabetes Translation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Effective Health Communication, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Heerman WJ, Bennett WL, Kraschnewski JL, Nauman E, Staiano AE, Wallston KA. Willingness to participate in weight-related research as reported by patients in PCORnet clinical data research networks. BMC Obes 2018; 5:10. [PMID: 29507737 PMCID: PMC5831204 DOI: 10.1186/s40608-018-0187-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/23/2018] [Indexed: 11/19/2022]
Abstract
Background Since 2014 the Patient Centered Outcomes Research Institute (PCORI) has funded 13 Clinical Data Research Networks (CDRNs) around the country to support large-scale comparative effectiveness research and pragmatic clinical trials. To provide guidance for future recruitment efforts among CDRNs this study described differential willingness to participate in weight-related research by body mass index (BMI) and sociodemographic characteristics. Methods During 2014–2016 we surveyed participants from three CDRNs including the Mid-South CDRN, REACHnet, and the PaTH Network, representing 14 medical centers. Participants were eligible if they were ≥18 years, had ≥2 weights and ≥1 height in the electronic health record. Respondents were recruited face-to-face in primary care and specialty clinics, and via email from doctors’ offices, patient registries and health systems’ patient portals. Data was collected on willingness to participate in weight-related research (four items combined into a single scale; range 4–12), BMI, and sociodemographics (age, sex, number of people in household, marital status, education level, race, and ethnicity). Adjusted ordinal regression models tested associations between participant characteristics and willingness to participate in weight-related research. Results Among 11,624 respondents, mean BMI was 29.6 (SD 7.6) kg/m2. Mean willingness to participate in weight-related research was 7.1 (SD 2.5). More respondents were willing to participate in studies with lower burden: healthy lifestyles (82.2%), genetics (71.3%), medication (52.2%), and surgery (22.6%). In adjusted models, higher BMI was associated with greater willingness to participate in weight-related research (OR = 1.13) as were younger age (OR = 0.98), being a woman (OR 1.59), and college education (OR = 1.72) (all p < 0.001). Conclusions Associations among BMI, age, sex, and education level with willingness to participate in weight-related research highlight the need for future research to reduce barriers for populations less willing to engage in weight-related research.
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Affiliation(s)
- William J Heerman
- 1Vanderbilt University Medical Center, 2146 Belcourt Ave, 2nd Floor, Nashville, TN 37212 USA
| | - Wendy L Bennett
- 2The Johns Hopkins University School of Medicine, Baltimore, MD USA
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Sterling MR, Safford MM, Goggins K, Nwosu SK, Schildcrout JS, Wallston KA, Mixon AS, Rothman RL, Kripalani S. Numeracy, Health Literacy, Cognition, and 30-Day Readmissions among Patients with Heart Failure. J Hosp Med 2018; 13:145-151. [PMID: 29455228 PMCID: PMC5836748 DOI: 10.12788/jhm.2932] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Numeracy, health literacy, and cognition are important for chronic disease management. Prior studies have found them to be associated with poorer selfcare and worse clinical outcomes, but limited data exists in the context of heart failure (HF), a condition that requires patients to monitor their weight, fluid intake, and dietary salt, especially in the posthospitalization period. OBJECTIVE To examine the relationship between numeracy, health literacy, and cognition with 30-day readmissions among patients hospitalized for acute decompensated HF (ADHF). DESIGN, SETTING, PATIENTS The Vanderbilt Inpatient Cohort Study is a prospective longitudinal study of adults hospitalized with acute coronary syndromes and/or ADHF. We studied 883 adults hospitalized with ADHF. MEASUREMENTS During their hospitalization, a baseline interview was performed in which demographic characteristics, numeracy, health literacy, and cognition were assessed. Through chart review, clinical characteristics were determined. The outcome of interest was 30-day readmission to any acute care hospital. To examine the association between numeracy, health literacy, cognition, and 30-day readmissions, multivariable Poisson (log-linear) regression was used. RESULTS Of the 883 patients admitted for ADHF, 23.8% (n = 210) were readmitted within 30 days; 33.9% of the study population had inadequate numeracy skills, 24.6% had inadequate/marginal literacy skills, and 53% had any cognitive impairment. Numeracy and cognition were not associated with 30-day readmissions. Though (objective) health literacy was associated with 30-day readmissions in unadjusted analyses, it was not in adjusted analyses. CONCLUSIONS Numeracy, health literacy, and cognition were not associated with 30-day readmission among this sample of patients hospitalized with ADHF.
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Affiliation(s)
- Madeline R Sterling
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
- Division of General Internal Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Division of General Internal Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Kathryn Goggins
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sam K Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Amanda S Mixon
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
- Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
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Osborn CY, Kripalani S, Goggins KM, Wallston KA. Financial strain is associated with medication nonadherence and worse self-rated health among cardiovascular patients. J Health Care Poor Underserved 2018; 28:499-513. [PMID: 28239015 DOI: 10.1353/hpu.2017.0036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-traditional indicators of socioeconomic status (SES; e.g., home ownership) may be just as or even more predictive of health outcomes as traditional indicators of SES (e.g., income). This study tested whether financial strain (i.e., difficulty paying monthly bills) predicted medication non-adherence and worse self-rated health. Research assistants administered surveys to 1,527 patients with acute coronary syndromes or acute decom-pensated heart failure. In adjusted models, having a higher income was associated with being more adherent (p < .001), but was non-significant when adjusted for financial strain. Education, income, less financial strain, and being employed were each associated with better self-rated health (p < .001). Financial strain was associated with less adherence (β =-.17, p < .001) and worse self-rated health (β = -.23, p < .001), and mediated the effect of income on adherence (coeff = .078 [BCa 95% CI: .051 to .108]). Future research should further explore the nuanced link between SES and health behaviors and outcomes.
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Martinez W, Wallston KA, Schlundt DG, Hickson GB, Bonnet KR, Trochez RJ, Elasy TA. Patients' perspectives on social and goal-based comparisons regarding their diabetes health status. BMJ Open Diabetes Res Care 2018; 6:e000488. [PMID: 29862032 PMCID: PMC5969729 DOI: 10.1136/bmjdrc-2017-000488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/18/2018] [Accepted: 04/25/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Social comparisons (ie, self-evaluation in comparison with others) influence patients' perspectives of their disease and may impact motivation and health behavior; however, little is known about patients' perspectives toward receiving such information in a clinical context (eg, from their doctor's office or health system). This study aims to understand patients' perspectives and anticipated responses to receiving social comparison information regarding measures of their diabetes-related health status (eg, A1C) and how receiving such information would compare with goal-based comparisons (ie, self-evaluation in comparison with goal). RESEARCH DESIGN AND METHODS We conducted semistructured interviews with 25 patients with type 2 diabetes mellitus (T2DM) regarding social and goal-based comparisons involving their diabetes health status and qualitatively analyzed interviews for themes. RESULTS We identified seven major themes: self-relevance, motivation, self-concept, emotions, information seeking, medical care, and self-care. Participants commonly anticipated increased motivation and improved health behaviors in response to both social and goal-based comparisons. Subthemes unique to social comparisons included belief that this information would be motivating by engaging some patients' competitiveness, perception that this information was more 'personalized' than comparisons with a standard goal (eg, A1C<7), and desire to learn from individuals similar to oneself who were doing better. CONCLUSIONS Our findings provide significant insights into the anticipated response of patients with T2DM to receiving social and goal-based comparison information regarding their diabetes health status. Providing patients with diabetes with social and goal-based comparison information may affect motivation, mood, and self-concept in ways that may improve or sustain diabetes self-care behaviors for some patients.
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Affiliation(s)
- William Martinez
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - David G Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Gerald B Hickson
- Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kemberlee R Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Ricardo J Trochez
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tom A Elasy
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Wild MG, Wallston KA, Green JA, Beach LB, Umeukeje E, Wright Nunes JA, Ikizler TA, Steed J, Cavanaugh KL. The Perceived Medical Condition Self-Management Scale can be applied to patients with chronic kidney disease. Kidney Int 2017; 92:972-978. [PMID: 28528132 PMCID: PMC5610608 DOI: 10.1016/j.kint.2017.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 02/19/2017] [Accepted: 03/09/2017] [Indexed: 01/14/2023]
Abstract
Chronic Kidney Disease (CKD) is a major burden on patients and the health care system. Treatment of CKD requires dedicated involvement from both caretakers and patients. Self-efficacy, also known as perceived competence, contributes to successful maintenance of patient's CKD self-management behaviors such as medication adherence and dietary regulations. Despite a clear association between self-efficacy and improved CKD outcomes, there remains a lack of validated self-report measures of CKD self-efficacy. To address this gap, the Perceived Kidney/Dialysis Self-Management Scale (PKDSMS) was adapted from the previously validated Perceived Medical Condition Self-Management Scale. We then sought to validate this using data from two separate cohorts: a cross-sectional investigation of 146 patients with end-stage renal disease receiving maintenance hemodialysis and a longitudinal study of 237 patients with CKD not receiving dialysis. The PKDSMS was found to be positively and significantly correlated with self-management behaviors and medication adherence in both patient cohorts. The PKDSMS had acceptable reliability, was internally consistent, and exhibited predictive validity between baseline PKDSMS scores and self-management behaviors across multiple time points. Thus, the PKDSMS is a valid and reliable measure of CKD patient self-efficacy and supports the development of interventions enhancing perceived competence to improve CKD self-management.
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Affiliation(s)
- Marcus G Wild
- Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA
| | - Kenneth A Wallston
- Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA
| | - Jamie A Green
- Geisinger Health System, Danville, Pennsylvania, USA
| | - Lauren B Beach
- Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA
| | - Ebele Umeukeje
- Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA
| | | | - T Alp Ikizler
- Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA
| | - Julia Steed
- Vanderbilt University, Nashville, Tennessee, USA
| | - Kerri L Cavanaugh
- Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA.
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Silvestri DM, Blevins M, Wallston KA, Afzal AR, Alam N, Andrews B, Derbew M, Kaur S, Mipando M, Mkony CA, Mwachaka PM, Ranjit N, Vermund SH. Nonacademic Attributes Predict Medical and Nursing Student Intentions to Emigrate or to Work Rurally: An Eight-Country Survey in Asia and Africa. Am J Trop Med Hyg 2017; 96:1512-1520. [PMID: 28719284 DOI: 10.4269/ajtmh.16-0756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractWe sought to identify independent, nonacademic predictors of medical and nursing student intent to migrate abroad or from rural to urban areas after graduation in low- and middle-income countries (LMIC). This was a cross-sectional survey of 3,199 first- and final-year medical and nursing students at 16 training institutions in eight LMIC. Questionnaires assessed demographics, career intentions, and preferences regarding selected career, location, and work-related attributes. Using principal component analysis, student preferences were reduced into four discrete categories of priorities: 1) work environment resources, 2) location livability, 3) altruistic job values, and 4) individualistic job values. Students' preferences were scored in each category. Using students' characteristics and priority scores, multivariable proportional odds models were used to derive independent predictors of intentions to emigrate for work outside the country, or to work in a rural area in their native country. Students prioritizing individualistic values more often planned international careers (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.16-1.78), whereas those prioritizing altruistic values preferred rural careers (aOR = 1.82, 95% CI = 1.50-2.21). Trainees prioritizing high-resource environments preferentially planned careers abroad (aOR = 1.38, 95% CI = 1.12-1.69) and were unlikely to seek rural work (aOR = 0.60, 95% CI = 0.49-0.73). Independent of their priorities, students with prolonged prior rural residence were unlikely to plan emigration (aOR = 0.67, 95% CI = 0.50-0.90) and were more likely to plan a rural career (aOR = 1.53, 95% CI = 1.16-2.03). We conclude that use of nonacademic attributes in medical and nursing admissions processes would likely increase retention in high-need rural areas and reduce emigration "brain drain" in LMIC.
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Affiliation(s)
- David M Silvestri
- Vanderbilt University Institute for Global Health, Nashville, Tennessee
| | - Meridith Blevins
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.,Vanderbilt University Institute for Global Health, Nashville, Tennessee
| | - Kenneth A Wallston
- Vanderbilt University School of Nursing, Nashville, Tennessee.,Vanderbilt University Institute for Global Health, Nashville, Tennessee
| | - Arfan R Afzal
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada.,International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nazmul Alam
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Ben Andrews
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Vanderbilt University Institute for Global Health, Nashville, Tennessee
| | - Miliard Derbew
- Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Simran Kaur
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India.,Department of Physiology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, Delhi, India
| | | | - Charles A Mkony
- Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Nirju Ranjit
- Department of Anatomy, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Sten H Vermund
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.,Vanderbilt University Institute for Global Health, Nashville, Tennessee
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Nemeth LS, Stanley KM, Martin MM, Mueller M, Layne D, Wallston KA. Lateral Violence in Nursing Survey: Instrument Development and Validation. Healthcare (Basel) 2017; 5:E33. [PMID: 28753961 PMCID: PMC5618161 DOI: 10.3390/healthcare5030033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 06/14/2017] [Accepted: 07/08/2017] [Indexed: 11/24/2022] Open
Abstract
An examination of the psychometric properties of the Lateral Violence in Nursing Survey (LVNS), an instrument previously developed to measure the perceived incidence and severity of lateral violence (LV) in the nursing workplace, was carried out. Conceptual clustering and principal components analysis were used with survey responses from 663 registered nurses and ancillary nursing staff in a southeastern tertiary care medical center. Where appropriate, Cronbach's alpha (α) evaluated internal consistency. The prevalence/severity of lateral violence items constitute two distinct subscales (LV by self and others) with Cronbach's alpha of 0.74 and 0.86, respectively. The items asking about potential causes of LV are unidimensional and internally consistent (alpha = 0.77) but there is no conceptually coherent theme underlying the various causes. Respondents rating a potential LV cause as "major" scored higher on both prevalence/severity subscales than those rating it a "minor" cause or not a cause. Subsets of items on the LVNS are internally reliable, supporting construct validity. Revisions of the original LVNS instrument will improve its use in future work.
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Affiliation(s)
- Lynne S Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Karen M Stanley
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Mary M Martin
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Diana Layne
- College of Nursing, Medical University of South Carolina, Charleston, SC 29425, USA.
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Heerman WJ, Jackson N, Hargreaves M, Mulvaney SA, Schlundt D, Wallston KA, Rothman RL. Clusters of Healthy and Unhealthy Eating Behaviors Are Associated With Body Mass Index Among Adults. J Nutr Educ Behav 2017; 49:415-421.e1. [PMID: 28363804 PMCID: PMC5747265 DOI: 10.1016/j.jneb.2017.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/31/2017] [Accepted: 02/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To identify eating styles from 6 eating behaviors and test their association with body mass index (BMI) among adults. DESIGN Cross-sectional analysis of self-report survey data. SETTING Twelve primary care and specialty clinics in 5 states. PARTICIPANTS Of 11,776 adult patients who consented to participate, 9,977 completed survey questions. VARIABLES MEASURED Frequency of eating healthy food, frequency of eating unhealthy food, breakfast frequency, frequency of snacking, overall diet quality, and problem eating behaviors. The primary dependent variable was BMI, calculated from self-reported height and weight data. ANALYSIS k-Means cluster analysis of eating behaviors was used to determine eating styles. A categorical variable representing each eating style cluster was entered in a multivariate linear regression predicting BMI, controlling for covariates. RESULTS Four eating styles were identified and defined by healthy vs unhealthy diet patterns and engagement in problem eating behaviors. Each group had significantly higher average BMI than the healthy eating style: healthy with problem eating behaviors (β = 1.9; P < .001), unhealthy (β = 2.5; P < .001), and unhealthy with problem eating behaviors (β = 5.1; P < .001). CONCLUSIONS AND IMPLICATIONS Future attempts to improve eating styles should address not only the consumption of healthy foods but also snacking behaviors and the emotional component of eating.
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Affiliation(s)
- William J Heerman
- General Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; Center for Health Services Research, Vanderbilt University, Nashville, TN.
| | - Natalie Jackson
- Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; Center for Health Services Research, Vanderbilt University, Nashville, TN
| | | | - Shelagh A Mulvaney
- Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; School of Nursing, Vanderbilt University, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University, Nashville, TN
| | - David Schlundt
- Center for Health Services Research, Vanderbilt University, Nashville, TN
| | | | - Russell L Rothman
- Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; Center for Health Services Research, Vanderbilt University, Nashville, TN
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Moses KA, Heslop D, Griffith DM, Holmes A, Sherden L, Wilkins CH, Wallston KA. Development and Initial Testing of the FLOW Instrument: Novel Assessment of Lower Urinary Tract Symptoms in Men. J Urol 2017; 198:657-662. [PMID: 28411070 DOI: 10.1016/j.juro.2017.04.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE We sought to develop a method to assess lower urinary tract symptoms regardless of literacy and numeracy. MATERIALS AND METHODS We convened focus groups and developed a questionnaire based on 4 identified domains of urinary function, including frequency, incontinence (leakage), nocturia (overnight voiding) and weak stream. We pilot tested the novel FLOW (frequency, leakage, overnight voiding and weak stream) questionnaire in 64 men and performed quantitative analysis to determine internal consistency. Criterion validity was established via direct comparison to the AUA (American Urological Association) symptom score in a larger cohort of 161 men. RESULTS Median time to complete the FLOW questionnaire was 18.0 seconds (IQR 15.8-21.0). The mean number of positive responses to the FLOW instrument was 1.7. Test-retest reliability was 0.91 and the Cronbach α was 0.67. In the validation cohort there was a significant correlation between FLOW scores and AUA symptom score (r = 0.63, p <0.001). All men regardless of health literacy completed FLOW. However, fewer men with low health literacy completed the AUA symptom score compared to men with adequate health literacy (81% vs 100%, p <0.001). For FLOW health literacy was unrelated to the median completion time (21.5 seconds), the median number of prompts needed (0) or the median score (2). CONCLUSIONS A critical analysis of the AUA symptom score using valid health literacy scales revealed that it is frequently not completed, requires prompting and takes longer to complete for men with low health literacy. The FLOW instrument represents a novel method to assess lower urinary tract symptoms in all men. It represents a valid alternative to the AUA symptom score.
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Affiliation(s)
- Kelvin A Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Derek M Griffith
- Center for Research on Men's Health, Vanderbilt University, Nashville, Tennessee
| | | | - Lisa Sherden
- Vanderbilt University Medical Center, Nashville, Tennessee; Meharry-Vanderbilt Alliance, Nashville, Tennessee
| | - Consuelo H Wilkins
- Vanderbilt University Medical Center, Nashville, Tennessee; Meharry-Vanderbilt Alliance, Nashville, Tennessee
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Abstract
OBJECTIVE Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL. DESIGN Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and its treatment (intervention) or about daily activities (control) for four, 20-min sessions. MAIN OUTCOME MEASURES Outcome measures were several indicators of QoL assessed at baseline, one, three, and six months post-intervention (total scores and subscales of Upper Limb Lymphedema 27 and Functional Assessment of Cancer Therapy-Breast). Hypothesised moderators of change in QoL were dispositional optimism, avoidant behaviours, and time since lymphedema diagnosis. RESULTS There was no statistically significant intent-to-treat main effects of expressive writing on QoL. Statistically significant moderating effects on change in different indicators of QoL were observed for all three moderators. Expressive writing was more effective for improving QoL in women who were higher on optimism, lower on avoidance and had less time since a lymphedema diagnosis. CONCLUSION These results provide further evidence that there are subsets of individuals for whom expressive writing is more effective. Future research may investigate targeting expressive writing based on identified moderators.
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Affiliation(s)
- Stephanie J Sohl
- a Department of Social Sciences & Health Policy , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Mary S Dietrich
- b Vanderbilt University School of Nursing , Nashville , TN , USA
| | | | - Sheila H Ridner
- b Vanderbilt University School of Nursing , Nashville , TN , USA
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Bachmann JM, Goggins KM, Nwosu SK, Schildcrout JS, Kripalani S, Wallston KA. Perceived health competence predicts health behavior and health-related quality of life in patients with cardiovascular disease. Patient Educ Couns 2016; 99:2071-2079. [PMID: 27450479 PMCID: PMC5525151 DOI: 10.1016/j.pec.2016.07.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/07/2016] [Accepted: 07/13/2016] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Evaluate the effect of perceived health competence, a patient's belief in his or her ability to achieve health-related goals, on health behavior and health-related quality of life. METHODS We analyzed 2063 patients hospitalized with acute coronary syndrome and/or congestive heart failure at a large academic hospital in the United States. Multivariable linear regression models investigated associations between the two-item perceived health competence scale (PHCS-2) and positive health behaviors such as medication adherence and exercise (Health Behavior Index) as well as health-related quality of life (5-item Patient Reported Outcome Information Measurement System Global Health Scale). RESULTS After multivariable adjustment, perceived health competence was highly associated with health behaviors (p<0.001) and health-related quality of life (p<0.001). Low perceived health competence was associated with a decrease in health-related quality of life between hospitalization and 90days after discharge (p<0.001). CONCLUSIONS Perceived health competence predicts health behavior and health-related quality of life in patients hospitalized with cardiovascular disease as well as change in health-related quality of life after discharge. PRACTICE IMPLICATIONS Patients with low perceived health competence may be at risk for a decline in health-related quality of life after hospitalization and thus a potential target for counseling and other behavioral interventions.
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Affiliation(s)
- Justin M Bachmann
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.
| | - Kathryn M Goggins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.
| | - Samuel K Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA.
| | | | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA.
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López-Pina JA, Meseguer-Henarejos AB, Gascón-Cánovas JJ, Navarro-Villalba DJ, Sinclair VG, Wallston KA. Measurement properties of the brief resilient coping scale in patients with systemic lupus erythematosus using rasch analysis. Health Qual Life Outcomes 2016; 14:128. [PMID: 27619635 PMCID: PMC5020451 DOI: 10.1186/s12955-016-0534-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 09/08/2016] [Indexed: 12/02/2022] Open
Abstract
Bacground Resilience has been defined as the capacity or the ability to rebound from and positively adapt to significant stressors, despite experiences of significant adversity or trauma. To capture to what extent an individual copes with stress in a resilient fashion the Brief Resilient Coping Scale (BRCS) was developed. This tool was validated in people with chronic disease, such as rheumatoid arthritis using standard psychometric techniques of classical test theory, but not yet in patients with Systemic lupus erythematosus (SLE). The aim of this study was to explore the psychometric properties of the Brief Resilient Coping Scale in patients with SLE using Rasch analysis. Method This study used cross-sectional data. The BRCS was administered to 232 patients with systemic lupus erythematosus. The aspects analyzed were unidimensionality, local independence and differential item functioning (DIF) to construct an interpretative scale of scores with the Rasch model. Results Rating scale mode (RSM) showed that the four categories used in the items of the BRCS are properly ordered. The four items provided a good fit to the polytomous Rasch model. Moreover, the parameters were sufficiently separated to measure resilience in patients with SLE. BRCS is a unidimensional scale (eigenvalue = 1.843) of resilience and the items were locally independent. There was no DIF between males and females in the sample. Only marginally significant differences depending on the level of education were found. The BRCS showed adequate discriminant validity between groups of scores. Conclusions BRCS is a suitable scale for measuring resilience in patients with SLE. This scale might be useful for clinicians to obtain information concerning the degree of resilience that each patient has, allowing individuals with low resilience to be identified who need interventions aimed at developing coping skills.
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Affiliation(s)
- José-Antonio López-Pina
- Department of Basic Psychology and Methodology, Faculty of Psychology, Campus of Espinardo, University of Murcia, 30100, Murcia, Spain.
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Cunningham-Erves J, Talbott LL, O'Neal MR, Ivankova NV, Wallston KA. Development of a Theory-based, Sociocultural Instrument to Assess Black Maternal Intentions to Vaccinate Their Daughters Aged 9 to 12 Against HPV. J Cancer Educ 2016; 31:514-521. [PMID: 26081311 DOI: 10.1007/s13187-015-0867-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The human papillomavirus (HPV) vaccine could assist in reducing the cervical cancer disparity existing between Black and White women. Understanding factors influencing Black maternal intentions to vaccinate their daughter is essential in improving vaccination uptake. However, existing instruments do not comprehensively assess factors (e.g., culture) influencing maternal intentions. This paper describes the development of the Human Papillomavirus Vaccination Survey for Black Mothers with Girls Aged 9 to 12 (HPVS-BM), the first instrument to measure knowledge, attitudes, subjective norms, and cultural beliefs relating to Black maternal intentions to vaccinate their daughters aged 9 to 12 years against HPV. The items and scales were refined using content review by experts, as well as cognitive interviews and pilot testing with target audience participants. The final version of the HPVS-BM was administered to 242 Black mothers with adolescent daughters. Internal reliability was determined using Cronbach's alpha. An a priori hypothetical model was developed to determine convergent and discriminant validity. All scales of the HPVS-BM had an acceptable internal reliability of 0.70 or higher. The intention scale of HPVS-BM was significantly correlated (p < .05) with perceived benefits, perceived barriers, and subjective norms, supporting strong convergent validity. Moderate discriminant construct validity was also demonstrated. Exhibiting good psychometrics, this instrument could be used by healthcare researchers and professionals to develop programs to increase HPV vaccination among Black adolescent females aimed at reducing the racial disparities in cervical cancer. Further psychometric testing of this survey tool for understanding factors influencing maternal intentions is warranted.
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Affiliation(s)
- Jennifer Cunningham-Erves
- Department of Surgery and Office of Research, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd., Nashville, TN, 37208-3599, USA.
| | - Laura L Talbott
- Department of Human Studies, School of Education, The University of Alabama at Birmingham, EB 255, 901 13th Street South Room 255, Birmingham, AL, 35294-1250, USA
| | - Marcia R O'Neal
- Department of Human Studies, School of Education, The University of Alabama at Birmingham, EB 233, 1720 2nd Ave. S, Birmingham, AL, 35294-1250, USA
| | - Nataliya V Ivankova
- School of Health Professions, The University of Alabama at Birmingham, SHPB 560, 1720 2nd Ave. S, Birmingham, AL, 35294-1212, USA
| | - Kenneth A Wallston
- School of Nursing, Vanderbilt University, 461 21st Ave. S, Nashville, TN, 37240, USA
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Abstract
Problems inherent in generalizing from data based on a small number of subjects whose beliefs were measured when they were under considerable stress about their health, especially when scores for even one person are aberrant, limit sharply any possible challenge to theoretical commonality between two measures of locus of control.
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Abstract
Data from four studies of adults are used to address the relationship between expectancies for control of one's health (an outcome) and preference for control of health care (a process). The former is operationalized by the use of the Multidimensional Health Locus of Control (MHLC) Scales; the latter by the B and I subscales of the Krantz Health Opinion Survey (KHOS). Descriptive data from the four studies are presented. Significant correlations exist between the B subscale and the PHLC and IHLC scales. Factor analysis of datafrom three of the studies reveals that, along with selected items from other scales, all of the items from both the PHLC scale and the B subscale load on the first factor. Both theoretical and methodological reasons for these findings are discussed.
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Wallston KA, Jordan-Marsh M. The Decision Tree. West J Nurs Res 2016. [DOI: 10.1177/019394598100300406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kenneth A. Wallston
- Nursing School of Nursing Vanderbilt University, Nashville, Tennessee, School of Nursing UCLA
| | - Maryalice Jordan-Marsh
- Nursing School of Nursing Vanderbilt University, Nashville, Tennessee, School of Nursing UCLA
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