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Ampofo AG, Mackenzie LJ, Osei Asibey S, Oldmeadow C, Boyes AW. Prevalence and Correlates of Cervical Cancer Prevention Knowledge Among High School Students in Ghana. Health Educ Behav 2024; 51:185-196. [PMID: 38105234 PMCID: PMC10981191 DOI: 10.1177/10901981231217978] [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] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana. METHODS A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores. RESULTS Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students. CONCLUSIONS Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.
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Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Lisa J Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Shadrack Osei Asibey
- Faculty of Applied Sciences and Technology, Kumasi Technical University, Kumasi, Ghana
| | | | - Allison W Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Ampofo AG, Boyes AW, Mackenzie LJ. Preference For Cervical Cancer Education: A Multisite Cross-Sectional Survey of Female Senior High School Students in Ghana. J Cancer Educ 2023; 38:1710-1718. [PMID: 37328710 PMCID: PMC10509060 DOI: 10.1007/s13187-023-02325-5] [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] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Abstract
Cervical cancer incidence continues to rise in Ghana. To enhance knowledge and prevention of cervical cancer among young people in Ghana, there is a need to better understand their education preferences. The study aimed to describe female senior school students' preferences for receiving cervical cancer education. A cross-sectional survey of students from 17 schools in the Ashanti Region of Ghana assessed the strength of preference for receiving cervical cancer education from a range of sources, settings and delivery mediums. Of the 2400 participants (aged 16-24 years), the majority endorsed doctors (87%, 95%CI: 85-88%), nurses (80%, 95%CI: 78-82%) and credible health organisations (78%, 95%CI%: 76-79%) as their preferred source of education, and hospitals 83% (95%CI: 81-84%) as the preferred setting. Nearly all students (92%) endorsed at least three cervical cancer education delivery mediums, with at least three quarters endorsing television (78%, 95%CI: 77-80%), one-on-one health consultation in-person or online (77%, 95%CI: 75-79%; 75%, 95%CI: 73-77%), and health information websites (75%, 95%CI: 73-77%). Findings suggest that cervical cancer education efforts among female senior school students in Ghana should consider the use of a range of more resource-intensive individualised approaches to low-cost anonymous, generic approaches from credible sources and institutions.
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Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia.
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Allison W Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Lisa J Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Ampofo AG, Boyes AW, Asibey SO, Oldmeadow C, Mackenzie LJ. Prevalence and correlates of modifiable risk factors for cervical cancer and HPV infection among senior high school students in Ghana: a latent class analysis. BMC Public Health 2023; 23:340. [PMID: 36793003 PMCID: PMC9930033 DOI: 10.1186/s12889-022-14908-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/08/2022] [Accepted: 12/20/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND While health risk behaviours are likely to co-occur, there is dearth of studies exploring the clustering of cervical cancer and HPV infection risk factors among adolescents. This study aimed to determine: 1) the prevalence of modifiable risk factors for cervical cancer and HPV infection, 2) the clustering of modifiable risk factors for cervical cancer and HPV infection, and 3) factors associated with the identified clusters. METHODS Female students (aged 16-24 years, N = 2400) recruited from 17 randomly selected senior high schools in the Ashanti Region, Ghana completed a questionnaire assessing modifiable risk factors for cervical cancer and HPV infection including sexual experience, early sexual intercourse (< 18 years), unprotected sex, smoking, sexually transmitted infections (STIs); multiple sexual partners (MSP) and smoking. Latent class analysis explored separate classes of students according to their risk factor profiles for cervical cancer and HPV infection. Latent class regression analysis explored factors associated with latent class memberships. RESULTS Approximately one in three students (34%, 95%CI: 32%-36%) reported exposure to at least one risk factor. Two separate classes emerged: high-risk and low-risk (cervical cancer: 24% and 76% of students, respectively; HPV infection: 26% and 74% of students, respectively). Compared to participants in the low-risk classes i) the cervical cancer high-risk class were more likely to report exposure to oral contraceptives; early sexual intercourse (< 18 years); STIs; MSP and smoking; and ii) the HPV infection high risk class were more likely to report exposure to sexual intercourse; unprotected sex and MSP. Participants with higher risk factor knowledge had significantly higher odds of belonging to cervical cancer and HPV infection high-risk classes. Participants with greater perceived susceptibility to cervical cancer and HPV infection were more likely to belong to the high-risk HPV infection class. Sociodemographic characteristics and greater perceived seriousness about cervical cancer and HPV infection had significantly lower odds of belonging to both high-risk classes. CONCLUSIONS The co-occurrence of cervical cancer and HPV infection risk factors suggests that a single school-based multi-component risk reduction intervention could concurrently target multiple risk behaviours. However, students in the high risk class may benefit from more complex risk reduction interventions.
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Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia. .,Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Allison W. Boyes
- grid.266842.c0000 0000 8831 109XHealth Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cEquity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Shadrack Osei Asibey
- grid.462504.10000 0004 0439 6970Faculty of Applied Sciences and Technology, Kumasi Technical University, Kumasi, Ghana
| | | | - Lisa J. Mackenzie
- grid.266842.c0000 0000 8831 109XHealth Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cEquity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia
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Bu S, Smith A‘B, Janssen A, Donnelly C, Dadich A, Mackenzie LJ, Smith AL, Young AL, Wu VS, Smith SJ, Sansom-Daly UM. Optimising implementation of telehealth in oncology: A systematic review examining barriers and enablers using the RE-AIM planning and evaluation framework. Crit Rev Oncol Hematol 2022; 180:103869. [DOI: 10.1016/j.critrevonc.2022.103869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
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Hyde LL, Boyes AW, Mackenzie LJ, Leigh L, Oldmeadow C, Riveros C, Sanson-Fisher R. Electronic Health Literacy Among Magnetic Resonance Imaging and Computed Tomography Medical Imaging Outpatients: Cluster Analysis. J Med Internet Res 2019; 21:e13423. [PMID: 31464188 PMCID: PMC6737886 DOI: 10.2196/13423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/16/2019] [Revised: 06/20/2019] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background Variations in an individual’s electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points. Objective The aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated with class membership. Methods Medical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership. Results Of the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00; P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29; P=.007). Conclusions The identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients’ varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on individuals’ internet use frequency and health information amount preferences.
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Affiliation(s)
- Lisa Lynne Hyde
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
| | - Allison W Boyes
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
| | - Lisa J Mackenzie
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Carlos Riveros
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rob Sanson-Fisher
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
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Hyde LL, J Mackenzie L, Boyes AW, Symonds M, Brown S, Sanson-Fisher R. Medical Imaging Outpatients' Experiences With Receiving Information Required for Informed Consent and Preparation: A Cross-Sectional Study. J Patient Exp 2018; 5:296-302. [PMID: 30574551 PMCID: PMC6295811 DOI: 10.1177/2374373518765794] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Medical imaging outpatients often experience inadequate information provision and report high levels of anxiety. However, no studies have assessed patients' receipt of preparatory information in this setting. OBJECTIVE To examine medical imaging outpatients' perceived receipt or non-receipt of preparatory information from health professionals and imaging department staff prior to their procedure. METHOD Computed tomography and magnetic resonance imaging outpatients at one Australian hospital self-completed a touchscreen computer survey assessing their perceived receipt of 33 guideline-recommended preparatory information items. RESULTS Of 317 eligible patients, 280 (88%) consented to participate. Eight percent (95% confidence interval: 5%-12%) of participants reported receiving all information items. The median number of information items not received was 18 (interquartile range: 8-25). Items most frequently endorsed as "not received" were: how to manage anxiety after (74%) and during the scan (69%). Items most commonly endorsed as "received" were: reason for referral (85%) and how to find the imaging department (74%). CONCLUSION Few medical imaging outpatients recalled receiving recommended preparatory information. Preparatory communication needs to be improved to better meet patient-centered service imperatives.
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Affiliation(s)
- Lisa L Hyde
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Lisa J Mackenzie
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Allison W Boyes
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Michael Symonds
- Hunter New England Imaging, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Sandy Brown
- Hunter New England Imaging, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, Health Behaviour Research Collaborative, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Hyde LL, Boyes AW, Evans TJ, Mackenzie LJ, Sanson-Fisher R. Three-Factor Structure of the eHealth Literacy Scale Among Magnetic Resonance Imaging and Computed Tomography Outpatients: A Confirmatory Factor Analysis. JMIR Hum Factors 2018; 5:e6. [PMID: 29459356 PMCID: PMC5838360 DOI: 10.2196/humanfactors.9039] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 10/03/2017] [Revised: 11/21/2017] [Accepted: 12/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Electronic health (eHealth) literacy is needed to effectively engage with Web-based health resources. The 8-item eHealth literacy scale (eHEALS) is a commonly used self-report measure of eHealth literacy. Accumulated evidence has suggested that the eHEALS is unidimensional. However, a recent study by Sudbury-Riley and colleagues suggested that a theoretically-informed three-factor model fit better than a one-factor model. The 3 factors identified were awareness (2 items), skills (3 items), and evaluate (3 items). It is important to determine whether these findings can be replicated in other populations. OBJECTIVE The aim of this cross-sectional study was to verify the three-factor eHEALS structure among magnetic resonance imaging (MRI) and computed tomography (CT) medical imaging outpatients. METHODS MRI and CT outpatients were recruited consecutively in the waiting room of one major public hospital. Participants self-completed a touchscreen computer survey, assessing their sociodemographic, scan, and internet use characteristics. The eHEALS was administered to internet users, and the three-factor structure was tested using structural equation modeling. RESULTS Of 405 invited patients, 87.4% (354/405) were interested in participating in the study, and of these, 75.7% (268/354) were eligible. Of the eligible participants, 95.5% (256/268) completed all eHEALS items. Factor loadings were 0.80 to 0.94 and statistically significant (P<.001). All reliability measures were acceptable (indicator reliability: awareness=.71-.89, skills=.78-.80, evaluate=.64-.79; composite reliability: awareness=.89, skills=.92, evaluate=.89; variance extracted estimates: awareness=.80, skills=.79, evaluate=.72). Two out of three goodness-of-fit indices were adequate (standardized root mean square residual (SRMR)=.038; comparative fit index (CFI)=.944; root mean square error of approximation (RMSEA)=.156). Item 3 was removed because of its significant correlation with item 2 (Lagrange multiplier [LM] estimate 104.02; P<.001) and high loading on 2 factors (LM estimate 91.11; P<.001). All 3 indices of the resulting 7-item model indicated goodness of fit (χ211=11.3; SRMR=.013; CFI=.999; RMSEA=.011). CONCLUSIONS The three-factor eHEALS structure was supported in this sample of MRI and CT medical imaging outpatients. Although further factorial validation studies are needed, these 3 scale factors may be used to identify individuals who could benefit from interventions to improve eHealth literacy awareness, skill, and evaluation competencies.
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Affiliation(s)
- Lisa L Hyde
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
| | - Allison W Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
| | | | - Lisa J Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Hunter Cancer Research Alliance, Newcastle, Australia
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Daly JB, Mackenzie LJ, Freund M, Wolfenden L, Roseby R, Wiggers JH. Interventions by Health Care Professionals Who Provide Routine Child Health Care to Reduce Tobacco Smoke Exposure in Children: A Review and Meta-analysis. JAMA Pediatr 2016; 170:138-47. [PMID: 26719991 DOI: 10.1001/jamapediatrics.2015.3342] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children. OBJECTIVE To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children. DATA SOURCES A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended search was performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions, were identified. Secondary data extraction was performed in August 2015. STUDY SELECTION Controlled trials of routine child health care delivered by health care professionals (physicians, nurses, medical assistants, health educators, and dieticians) that addressed the outcomes of interest (TSE reduction in children and parental smoking behaviors) were eligible for inclusion in this review and meta-analysis. DATA EXTRACTION AND SYNTHESIS Study details and quality characteristics were independently extracted by 2 authors. If outcome measures were sufficiently similar, meta-analysis was performed using the random-effects model by DerSimonian and Laird. Otherwise, the results were described narratively. MAIN OUTCOMES AND MEASURES The primary outcome measure was reduction in child TSE. Secondary outcomes of interest were parental smoking cessation, parental smoking reduction, and maternal postpartum smoking relapse prevention. RESULTS Sixteen studies met the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05; 95% CI, 0.74-1.50; P = .78). Meta-analysis of the 3 trials that measured maternal postpartum smoking relapse prevention demonstrated a significant overall intervention effect (n = 1293) (risk ratio 1.53; 95% CI, 1.10-2.14; P = .01). High levels of study heterogeneity likely resulted from variability in outcome measures, length of follow up, intervention strategies, and unknown intervention fidelity. CONCLUSIONS AND RELEVANCE Interventions delivered by health care professionals who provide routine child health care may be effective in preventing maternal smoking relapse. Further research is required to improve the effectiveness of such interventions in reducing child TSE and increasing parental smoking cessation. The findings of this meta-analysis have policy and practice implications relating to interventions by routine pediatric health care professionals that aim to reduce child exposure to tobacco smoke.
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Affiliation(s)
- Justine B Daly
- Population Health, Hunter New England Local Health District, Wallsend, Australia2Faculty of Health, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia3Hunter Medical Research Institute, Newcastle, Australia
| | - Lisa J Mackenzie
- Population Health, Hunter New England Local Health District, Wallsend, Australia2Faculty of Health, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia3Hunter Medical Research Institute, Newcastle, Australia
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Wallsend, Australia2Faculty of Health, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia3Hunter Medical Research Institute, Newcastle, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, Australia2Faculty of Health, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia3Hunter Medical Research Institute, Newcastle, Australia
| | | | - John H Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, Australia2Faculty of Health, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia3Hunter Medical Research Institute, Newcastle, Australia
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Mackenzie LJ, Carey M, Sanson-Fisher R, D'Este C, Yoong SL. A cross-sectional study of radiation oncology outpatients' concern about, preferences for, and perceived barriers to discussing anxiety and depression. Psychooncology 2015; 24:1392-7. [DOI: 10.1002/pon.3806] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 02/16/2015] [Accepted: 02/24/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Lisa J. Mackenzie
- School of Medicine and Public Health; The University of Newcastle; Australia
- Hunter Medical Research Institute; Newcastle Australia
| | - Mariko Carey
- School of Medicine and Public Health; The University of Newcastle; Australia
- Hunter Medical Research Institute; Newcastle Australia
| | - Rob Sanson-Fisher
- School of Medicine and Public Health; The University of Newcastle; Australia
- Hunter Medical Research Institute; Newcastle Australia
| | - Catherine D'Este
- School of Medicine and Public Health; The University of Newcastle; Australia
- Hunter Medical Research Institute; Newcastle Australia
- National Centre for Epidemiology and Population Health; The Australian National University; Canberra Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health; The University of Newcastle; Australia
- Hunter Medical Research Institute; Newcastle Australia
- Hunter New England Population Health; NSW Health; Newcastle Australia
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Mackenzie LJ, Suzuki E, Ogura M, Carey M, Sanson-Fisher R, Asada H, Toi M, Hiraoka M, DEste C. Japanese Cancer Patients' Preferences for Discussing Life Expectancy with Their Radiation Oncologist. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu435.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mackenzie LJ, Carey ML, Sanson-Fisher RW, D'Este CA, Paul CL, Yoong SL. Agreement between HADS classifications and single-item screening questions for anxiety and depression: a cross-sectional survey of cancer patients. Ann Oncol 2014; 25:889-895. [PMID: 24667721 DOI: 10.1093/annonc/mdu023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We assessed agreement between reported anxiety and depression levels of cancer patients using (i) single self-report items and (ii) the Hospital Anxiety and Depression Scale (HADS). We also explored whether anxiety and depression assessment by (i) single self-report items or (ii) the HADS was most strongly associated with a preference to be offered professional assistance. The proportion of patients indicating that they would accept (or were currently using) professional support if they were experiencing anxiety or depression was also examined. PATIENTS AND METHODS A consecutive sample of cancer patients undergoing radiotherapy at four metropolitan public hospitals in Australia completed a touch screen computer survey. A consecutive subsample of patients attending three of these treatment centres answered additional questions about psychological support preferences. RESULTS Of 304 respondents, 54% [95% confidence interval (CI) 48% to 60%] perceived that they were currently experiencing mild to severe anxiety and depression. 22% (95% CI 18% to 27%) indicated a preference to be offered professional help. There was moderate agreement between the HADS and single-item responses for categorisation of anxiety and depression. Patient-perceived mild to severe anxiety and depression levels appeared to be the best measure for identifying those with a preference to be offered professional assistance. Of a subsample of 193 respondents, 89% (95% CI 84% to 93%) indicated that if they were experiencing anxiety or depression, they would accept (or were currently using) professional support. CONCLUSIONS Single-item screening in a cancer care setting may not adequately capture clinical anxiety and depression. However, single-items assessing patients' perceived levels of anxiety and depression are useful indicators of whether patients want to be offered, and are likely to accept, psychosocial care.
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Affiliation(s)
- L J Mackenzie
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle; Hunter Medical Research Institute, Newcastle, Australia.
| | - M L Carey
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle; Hunter Medical Research Institute, Newcastle, Australia
| | - R W Sanson-Fisher
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle; Hunter Medical Research Institute, Newcastle, Australia
| | - C A D'Este
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle; Hunter Medical Research Institute, Newcastle, Australia
| | - C L Paul
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle; Hunter Medical Research Institute, Newcastle, Australia
| | - S L Yoong
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle
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Mackenzie LJ, Carey ML, Paul CL, Sanson-Fisher RW, D'Este CA. Do we get it right? Radiation oncology outpatients' perceptions of the patient centredness of life expectancy disclosure. Psychooncology 2013; 22:2720-8. [PMID: 23801643 DOI: 10.1002/pon.3337] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 03/26/2013] [Accepted: 05/20/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A patient-centred approach to discussing life expectancy with cancer patients is recommended in Western countries. However, this approach to eliciting and meeting patient preferences can be challenging for clinicians. The aims of this study were the following: (i) to examine cancer patients' preferences for life expectancy disclosure; and (ii) to explore agreement between cancer patients' preferences for, and perceived experiences of, life expectancy disclosure. METHODS Cancer patients undergoing radiotherapy treatment in metropolitan Australia completed a cross-sectional touchscreen computer survey including optional questions about their life expectancy disclosure preferences and experiences. RESULTS Of the 208 respondents, 178 (86%) indicated that they would prefer their clinician to ask them before discussing life expectancy, and 30 (14%) indicated that they would prefer others (i.e. clinicians, family) to decide whether they were given life expectancy information. Of the 175 respondents who were classified as having a self- determined or other-determined disclosure experience, 105 (60%) reported an experience of life expectancy disclosure that was in accordance with their preferences. Cohen's κ was -0.04 (95% CI, -0.17, 0.08), indicating very poor agreement between patients' preferences for and perceived experiences of life expectancy disclosure (p = 0.74). CONCLUSIONS In light of patient-centred prognosis disclosure guidelines, our findings of a majority preference for, and experience of, a self-determined approach to life expectancy disclosure amongst radiation oncology patients are encouraging. However, poor agreement between preferences and experiences highlights that additional effort from clinicians is required in order to achieve a truly patient-centred approach to life expectancy disclosure.
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Affiliation(s)
- Lisa J Mackenzie
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, Australia
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Abstract
OBJECTIVES We aimed to describe the proportion and characteristics of cancer patients who perceived that better care would have greatly improved their well-being in (1) specific and (2) multiple domains of patient-centred care. DESIGN Cross-sectional touchscreen computer survey. SETTING Four Australian radiation therapy departments located within major urban public hospitals. PARTICIPANTS Radiation therapy outpatients were invited to participate in a touchscreen computer survey. Eligible patients were at least 18 years old, diagnosed with cancer and had sufficient English to complete the survey. PRIMARY OUTCOME MEASURE Participants were asked whether their well-being could have been greatly improved if better care had been provided across eight domains of patient-centred care. Characteristics of those respondents who identified (1) specific and (2) multiple domains where it was perceived that better care would have greatly improved their well-being were examined. RESULTS Of 508 eligible radiation therapy patients, 344 (68%) completed the survey. Patients most frequently perceived that better care in the following domains could have improved their well-being: information and communication about their cancer (22%; 95% CI 18% to 27%); emotional and spiritual support (22%; 95% CI 18% to 27%); management of physical symptoms (21%; 95% CI 17% to 26%) and involvement of friends and family (21%; 95% CI 17% to 26%). Just under one-third of respondents (31%; 95% CI 26% to 36%) indicated that their well-being could have been improved by better care across two or more domains of care. Patients in younger age groups and migrants to Australia had higher odds of endorsing multiple domains where better care would have improved their well-being. CONCLUSIONS Further investigation of patients' perceptions of how their perceived quality of care might be improved is warranted, particularly among patients in younger age groups and migrants to Australia.
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Affiliation(s)
- Lisa J Mackenzie
- Faculty of Health, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Rob W Sanson-Fisher
- Faculty of Health, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Mariko L Carey
- Faculty of Health, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Catherine A D'Este
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Faculty of Health, Priority Research Centre for Health Behaviour, School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Faculty of Health, Priority Research Centre for Gender, Health & Ageing, School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Mackenzie LJ, Carey ML, Sanson-Fisher RW, D'Este CA, Hall AE. Cancer patients' willingness to answer survey questions about life expectancy. Support Care Cancer 2012; 20:3335-41. [PMID: 22576980 PMCID: PMC3480580 DOI: 10.1007/s00520-012-1477-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/16/2012] [Indexed: 11/29/2022]
Abstract
Purpose This study aimed to determine the proportion and characteristics of radiation oncology outpatients who were willing to answer questions about their life expectancy. Methods A cross-sectional patient self-report survey was conducted using touch screen computers in Australian radiation oncology treatment centers. The primary outcome was the respondent’s willingness to complete a survey subsection about life expectancy. Demographic and disease characteristics were also collected, and level of anxiety and depression was assessed using the Hospital Anxiety and Depression Scale. Results Of the 469 oncology outpatients who completed the survey, 327 (70 %; 95 % CI, 65 %, 74 %) indicated that they were willing to answer questions about life expectancy. Being female (p < 0.001), older (p < 0.05), born in Asia (p < 0.05), and being diagnosed with cancer types other than breast and prostate cancer (p < 0.01) were associated with lower odds of answering life expectancy questions. Conclusions The opportunity to opt-out of survey questions about sensitive issues such as life expectancy is a feasible method for accessing important information about patient preferences while minimizing burden. Further research may be needed to improve acceptability of life expectancy research to some patient groups.
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Affiliation(s)
- L J Mackenzie
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
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Rosenstein DI, Joseph LP, Mackenzie LJ, Wyden R. Professional encroachment: a comparison of the emergence of denturists in Canada and Oregon. J Mark Prof 1980; 1:21-5. [PMID: 6937634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Rosenstein DI, Joseph LP, Mackenzie LJ, Wyden R. Professional encroachment: a comparison of the emergence of denturists in Canada and Oregon. Am J Public Health 1980; 70:614-8. [PMID: 7377437 PMCID: PMC1619448 DOI: 10.2105/ajph.70.6.614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In 1978, supporters of denturism in Oregon succeeded in passing an initiative which allows denturists to provide dentures directly to the public. The steps which led to the referendum included three unsuccessful attempts to have the state legislature enact a law legalizing denturism. After capturing broad-based consumer support, the issue was placed on the ballot and passed by an overwhelming margin. Both the denturists and the dentists in Oregon adopted strategies similar to those used in Canada over 20 years ago when the issue was raised in a number of provinces. As was the case in Canada, the denturists prevailed. Denturists stressed the price differential and the issue of freedom of choice. Dentists stressed health and safety issues. The public perceived the dentists' campaign as negative and self-serving. This perception may have contributed to the election results. In order to avoid this tarnished image, dentists must anticipate the public's needs, and formulate strategies to meet such needs.
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