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Parker SL, Amboree TL, Bulsara S, Daheri M, Anderson ML, Hilsenbeck SG, Jibaja-Weiss ML, Zare M, Schmeler KM, Deshmukh AA, Chiao EY, Scheurer ME, Montealegre JR. Self-Sampling for Human Papillomavirus Testing: Acceptability in a U.S. Safety Net Health System. Am J Prev Med 2024; 66:540-547. [PMID: 37935320 DOI: 10.1016/j.amepre.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/28/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Self-sampling for human papillomavirus testing is increasingly recognized as a strategy to expand cervical cancer screening access and utilization. Acceptability is a key determinant of uptake. This study assesses the acceptability of and experiences with mailed self-sampling kits for human papillomavirus testing among underscreened patients in a safety net health system. METHODS A nested telephone survey was administered between 2021 and 2023 to a sample (n=272) of the 2,268 participants enrolled in the Prospective Evaluation of Self-Testing to Increase Screening trial. Trial participants include patients of a safety net health system aged 30-65 years who were not up to date on screening. Participants were asked about barriers to provider-performed screening. Kit users and nonusers were asked about their experiences. RESULTS Prevalent barriers to provider-performed screening included perceived discomfort of pelvic examination (69.4%), being uncomfortable with male providers (65.4%), and embarrassment (57.0%). Among participants who reported using the mailed kit (n=164), most reported good experiences (84.8%). Most reported self-sampling as more/equally convenient (89.0%), less/equally embarrassing (99.4%), and less/equally stressful (95.7%) than provider-performed screening. Among kit nonusers (n=43), reasons for not using the kit included forgetting about it (76.7%), preferring provider-performed screening (76.7%), and fearing cancer (67.4%). CONCLUSIONS Prospective Evaluation of Self-Testing to Increase Screening trial participants generally had a positive experience with self-sampling for human papillomavirus testing. Increased comfort and reduced embarrassment/anxiety with self-sampling are relevant attributes because these were the most prevalent reported barriers to provider-performed screening. High acceptability suggests potentially high uptake when self-sampling for human papillomavirus testing receives regulatory approval and is available in safety net health systems.
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Affiliation(s)
- Susan L Parker
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Trisha L Amboree
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shaun Bulsara
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Maria Daheri
- Ambulatory Care Services, Harris Health System, Houston, Texas
| | - Matthew L Anderson
- Department of Obstetrics and Gynecology, Morsani School of Medicine, University of South Florida, Tampa, Florida
| | - Susan G Hilsenbeck
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | | | - Mohammed Zare
- Department of Community & Family Medicine, McGovern Medical School, The University of Texas Health Science Center-Houston, Houston, Texas
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ashish A Deshmukh
- Department of Public Health, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth Y Chiao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Jane R Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Thompson D, Callender C, Dave JM, Jibaja-Weiss ML, Montealegre JR. Health equity in action: using community-engaged research to update an intervention promoting a healthy home food environment to Black/African American families. Cancer Causes Control 2024; 35:311-321. [PMID: 37736870 DOI: 10.1007/s10552-023-01753-4] [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] [Received: 02/17/2023] [Accepted: 07/05/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Describe the method for conducting community-engaged research to identify needed changes for an existing evidence-based intervention, and prepare it for implementation in a community setting within the Dan L Duncan Comprehensive Cancer Center catchment area in an effort to achieve more equitable outcomes in diet-related disease risk factors. METHODS The intervention, Family Eats, was developed over 10 years ago. It works directly with parents of Black/African American 9-12 year old children to create a healthy home food environment to support prevention of obesity and related cancers. Data collection with community stakeholders occurred through a series of Community Advisory Board (CAB) meetings guided by the Delphi Technique, an iterative approach for gaining group consensus on a topic. RESULTS Key information on needed changes and potential implementation strategies were identified. Perceived level of engagement among CAB members was high overall and in terms of both quantity and quality. CONCLUSION The Delphi Technique shows promise as a method for conducting community-engaged research that promotes engagement and identifies key information needed to adapt and implement an existing intervention in a community setting.
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Affiliation(s)
- Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Chishinga Callender
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jayna M Dave
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Maria L Jibaja-Weiss
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Jane R Montealegre
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Gender Differences in Self-Efficacy for Diabetes Self-Management Among Hispanics: The Mediating Role of Perceived Support and Depressive Symptoms. Sci Diabetes Self Manag Care 2023; 49:91-100. [PMID: 36942695 DOI: 10.1177/26350106231158827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE The purpose of this study is to examine the extent to which perceived support and depressive symptoms might interfere with Hispanic patients' ability to manage their diabetes and whether these effects vary by gender. METHODS Data were collected from a cohort of 232 Hispanic men and women with type 2 diabetes mellitus (T2DM). Conditional process analysis was used to test a moderated mediation model of the time-lagged processes associating gender, diabetes support, and depressive symptoms with reported self-efficacy after 3 months. RESULTS Increased depressive symptoms were associated with lower self-efficacy, but the conditional effects varied among men and women. The index of moderated mediation was significant, indicating that among women, the indirect effect of depressive symptoms on self-efficacy was contingent on lower levels of perceived support. Among men, increased depressive symptoms were directly associated with declines in self-efficacy and were not conditional on perceived support. CONCLUSIONS Results of the study have important implications for gender health equity. Mental health screening and an assessment of support needs may be important for determining appropriate complementary therapies when treating Hispanic women with chronic conditions such as diabetes. Attention to possible differences in gender-specific mental health needs could lead to improved self-management, better glycemic control, and more equitable health outcomes.
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Affiliation(s)
- Carol L Mansyur
- Department of Public Health, California State University, Sacramento, California
| | - Luis O Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Susan G Nash
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria L Jibaja-Weiss
- School of Health Professions, Baylor College of Medicine, Houston, Texas
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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Rodriguez AM, Do TQN, Jibaja-Weiss ML, Chen L, Schmeler KM, Montealegre JR, Kuo YF. Human Papillomavirus Vaccinations During the COVID-19 Pandemic in Middle Schools in the Rio Grande Valley of Texas. Am J Public Health 2022; 112:1269-1272. [PMID: 35862887 PMCID: PMC9382169 DOI: 10.2105/ajph.2022.306970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/04/2022]
Abstract
This quasi-experimental study (a community-based, physician-led human papillomavirus [HPV] education campaign and school-based vaccination program) followed 6481 students at eight Pharr-San Juan-Alamo Independent School District (Rio Grande Valley, Texas) middle schools between August 2016 and March 2021. We describe the successes and challenges experienced during the COVID-19 pandemic. HPV vaccine initiation and completion rates increased 1.29-fold and 1.47-fold, respectively, between June 2019 and March 2021. Between March 2020 and March 2021, 268 HPV vaccine doses were provided through 24 school-based interventions. Our program continued successes seen in increasing HPV vaccination rates and reducing possible HPV-associated cancers. (Am J Public Health. 2022;112(9):1269-1272. https://doi.org/10.2105/AJPH.2022.306970).
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Affiliation(s)
- Ana M Rodriguez
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Thuy Quynh N Do
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Maria L Jibaja-Weiss
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Lu Chen
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Kathleen M Schmeler
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Jane R Montealegre
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
| | - Yong-Fang Kuo
- Ana M. Rodriguez is with the Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston. Thuy Quynh N. Do is with the Department of Preventive Medicine and Population Health, University of Texas Medical Branch. Maria L. Jibaja-Weiss is with the Department of Pediatrics, Section of Hematology-Oncology, Dan L Duncan Comprehensive Cancer Center, Office of Outreach and Health Disparities, Baylor College of Medicine, Houston, TX. Lu Chen and Yong-Fang Kuo are with the Office of Biostatistics, Preventive Medicine and Population Health, University of Texas Medical Branch. Kathleen M. Schmeler is with the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston. Jane R. Montealegre is with the Baylor College of Medicine-Houston School of Health Professions, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine
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Harrison AC, Kanwal F, Asrani SK, Thrift AP, Amos CI, Jibaja-Weiss ML, Montealegre JR, Hwang JP, Singal AG, El-Serag HB. The Texas collaborative center for hepatocellular cancer: Reducing liver cancer mortality in Texas through coordination, collaboration and advocacy. Front Oncol 2022; 12:953933. [PMID: 36059708 PMCID: PMC9437299 DOI: 10.3389/fonc.2022.953933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Texas has the highest age-adjusted incidence rate of hepatocellular carcinoma (HCC) in the United States. To address cancer prevention and early detection through research, Cancer Prevention and Research Institute of Texas (CPRIT) has funded the Texas Collaborative Center for Hepatocellular Cancer (TeCH) to facilitate liver cancer research, education and advocacy activities. This paper describes the organizational structure, program measures, the actions completed and future plans of TeCH. This center is comprised of several cores and committees including the Administrative Core, Steering Committee, Data and Biospecimen Core, Scientific Committee, Clinical Network Committee, and the Community Outreach Committee. Each core and committee provide its own level of connectivity and necessary research support. We have developed and published a TeCH Framework, a conceptual model designed for improving primary and secondary prevention of HCC. TeCH and its committees facilitate connections and collaborations among HCC researchers and clinicians, healthcare leaders, biotechnology companies and the public to reduce liver cancer mortality in Texas by 2030.
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Affiliation(s)
- Ariel C. Harrison
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Fasiha Kanwal
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sumeet K. Asrani
- Department of Medicine, Baylor Scott and White, Dallas, TX, United States
| | - Aaron P. Thrift
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Chris I. Amos
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Maria L. Jibaja-Weiss
- School of Health Professions, Baylor College of Medicine, Houston, TX, United States
| | - Jane R. Montealegre
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Jessica P. Hwang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Amit G. Singal
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Hashem B. El-Serag
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- *Correspondence: Hashem B.El-Serag,
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McGee LU, Parker S, Bulsara S, Escobar B, Kline KN, Jibaja-Weiss ML, Montealegre JR. Adolescent electronic cigarette counselling: knowledge, attitudes and perceived barriers among clinical staff in a primary care setting. J Eval Clin Pract 2021; 27:1398-1402. [PMID: 33624429 DOI: 10.1111/jep.13553] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess knowledge, attitudes, and perceived barriers (KAP) regarding e-cigarette use counselling among adolescent healthcare clinical staff in an urban system, and to compare results between providers and rooming staff. METHODS Primary care clinical staff (n = 169) completed an anonymous survey. Descriptive statistics and Chi-square tests were used to summarize data and compare KAP between medical providers and rooming staff. RESULTS Staff wanted to learn more about e-cigarettes (87.6%). The most common knowledge deficits were how to use the 5As + 5Rs model for tobacco cessation counselling (66.7%) and the chemical content of e-liquids (55.4%), with no differences across groups. Overall, 58% of providers expressed confidence in their ability to talk with adolescent patients about e-cigarette use. The most common barriers to counselling were low knowledge about e-cigarettes (74.0%) and how to refer adolescent patients for cessation support (43.8%). CONCLUSIONS Provider and rooming staff expressed similar educational needs surrounding e-cigarettes, counselling, and treatment for adolescent patients. Clinical staff expressed confidence in their ability to affect change. There were no differences in the identified knowledge gaps or barriers to care between rooming staff and providers, suggesting that the same educational format can be used to target both groups.
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Affiliation(s)
- Lindy U McGee
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Susan Parker
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Shaun Bulsara
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Betsy Escobar
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Kimberly N Kline
- Department of Communication, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Maria L Jibaja-Weiss
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA.,School of Health Professions, Baylor College of Medicine, Houston, Texas, USA
| | - Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
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Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Psychosocial Contributors to Depressive Symptoms in Hispanic Patients With Type 2 Diabetes. Sci Diabetes Self Manag Care 2021; 47:415-424. [PMID: 34715762 DOI: 10.1177/26350106211054420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to identify psychosocial factors associated with depressive symptoms in Hispanic patients with diabetes and explore the extent to which their effects may vary by gender and acculturation. METHODS The authors completed a secondary analysis of data from 247 Hispanic adults with type 2 diabetes. Gender and language groups were compared using chi-square and t tests. Hierarchical multiple regression was used to examine associations of depressive symptoms with perceived support, diabetes-related distress, and social and personal factors. RESULTS Women reported less support than men. English speakers reported more depressive symptoms than Spanish speakers. When adjusting for age, gender, and acculturation, psychosocial factors significantly associated with depressive symptoms included less support received, greater emotional burden, and less ability to socialize or pursue normal activities because of diabetes. CONCLUSIONS Social support provided by family among less acculturated Hispanics may play an important role in reducing emotional burden and lowering the risk of comorbid depression. The quality of interpersonal relationships and the ability to continue normal activities may also be important. More acculturated Hispanic women with diabetes may be at greater risk for comorbid depression and worse health outcomes. Screening for depression and assessment of support needs is warranted for Hispanic women.
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Affiliation(s)
- Carol L Mansyur
- Department of Public Health, California State University, Sacramento, California.,School of Health Professions, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Luis O Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.,School of Health Professions, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Susan G Nash
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.,School of Health Professions, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Maria L Jibaja-Weiss
- School of Health Professions, Baylor College of Medicine, Houston, Texas.,Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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McGee LU, Ressler KS, Boom JA, Bulsara S, Sangi-Haghpeykar H, Jibaja-Weiss ML, Montealegre JR. Incomplete Records as a Leading Cause of Missed Opportunity for Human Papillomavirus Vaccine Initiation in a Safety Net Health System. Acad Pediatr 2021; 21:1118-1125. [PMID: 33359360 DOI: 10.1016/j.acap.2020.12.003] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The goal of this study was to categorize reasons behind missed opportunities for human papillomavirus (HPV) vaccine initiation in an under-resourced population and to identify associated patient and clinic characteristics. METHODS Manual chart review was performed for patients aged 11 to 18 years who visited a primary care clinic in a health system in Texas, USA between 06/01/18 and 08/31/18 and were due for an initial HPV vaccine dose but did not receive it. Reasons for HPV vaccine noninitiation were categorized as follows: incomplete immunization record, no documentation of discussion (no documentation that the HPV vaccine was offered or ordered), refusal, staff/provider error, and medical. Multinomial logistic regression was used to examine factors associated with each category. RESULTS Of 4467 adolescents seen in the study period, 575 (12.9%) were due for the first dose of HPV vaccine but did not receive it. The most common reason for noninitiation was incomplete immunization record (37%), followed by no documentation of discussion (24%), refusal (20%), staff/provider error (15%), and medical (4%). The highest odds of incomplete immunization were among older adolescents. The highest odds of no documentation of discussion were during sick visits. The highest odds of staff/provider error were among patients with commercial insurance. The lowest odds of refusal were in patients with county/indigent insurance. CONCLUSIONS The most common reason for missed opportunity visits for HPV vaccine initiation was lack of adequate immunization records. Our study highlights the importance of immunization record access and bidirectional reporting as important targets for future interventions.
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Affiliation(s)
- Lindy U McGee
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex.
| | - Kelly S Ressler
- Department of Medical Education, Baylor College of Medicine (KS Ressler), Houston, Tex
| | - Julie A Boom
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex
| | - Shaun Bulsara
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine (H Sangi-Haghpeykar), Houston, Tex
| | - Maria L Jibaja-Weiss
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex; School of Health Professions, Baylor College of Medicine (ML Jibaja-Weiss), Houston, Tex
| | - Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex
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Escobar B, Amboree TL, Sonawane K, Deshmukh AA, McGee LU, Rodriguez AM, Jibaja-Weiss ML, Montealegre JR. Human papillomavirus awareness among foreign- and US-born Hispanics, United States, 2017-2018. Prev Med Rep 2021; 22:101379. [PMID: 33996392 PMCID: PMC8102157 DOI: 10.1016/j.pmedr.2021.101379] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) and HPV vaccine knowledge and awareness are known to be lower among Hispanics compared to non-Hispanic whites. However, Hispanics in the US are a non-homogenous population, with significant differences by nativity, particularly between the US-and foreign-born individuals. We examined HPV and HPV vaccine awareness among foreign-born Hispanics, US-born Hispanics, and US-born non-Hispanic whites. METHODS We analyzed data from the Health Information National Trends Survey (HINTS) 5, cycles 1 (2017) and 2 (2018), the most recent HINTS datasets including nativity information. We used descriptive statistics and multivariable regression to compare awareness of HPV and the HPV vaccine among ethnicity/nativity subgroups. RESULTS Over 50% of foreign-born Hispanics had not heard of HPV, compared to 32% of US-born Hispanics (P < 0.01) and 33% of non-Hispanic whites (p < 0.01). Lack of HPV vaccine awareness among foreign-born Hispanics was not significantly different from US-born Hispanics (52% vs. 44%, p = 0.12), but was significantly lower compared to non-Hispanic whites (52% vs. 32%, p < 0.01). In multivariable analyses, non-Hispanic whites had over twice the odds of having heard of HPV than foreign-born Hispanics (p < 0.05), while US-born Hispanics had 75% higher odds (p < 0.05). Regarding HPV awareness, non-Hispanic whites had 95% higher odds of having heard of the HPV vaccine than foreign-born Hispanics (p < 0.05), while differences between US and foreign-born Hispanics were not significant. CONCLUSION There are significant nativity-related differences in HPV and HPV vaccine awareness and knowledge among US-born Hispanics. Over 50% of foreign-born Hispanic adults are unaware of HPV and the HPV vaccine.
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Affiliation(s)
- Betsy Escobar
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Trisha L. Amboree
- Department of Epidemiology, UTHealth School of Public Health, Houston, TX, United States
| | - Kalyani Sonawane
- Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, United States
| | - Ashish A. Deshmukh
- Department of Management, Policy and Community Health, UTHealth School of Public Health, Houston, TX, United States
| | - Lindy U. McGee
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Ana M. Rodriguez
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, United States
| | - Maria L. Jibaja-Weiss
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
- School of Health Professions, Baylor College of Medicine, Houston, TX, United States
| | - Jane R. Montealegre
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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10
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Montealegre JR, Anderson ML, Hilsenbeck SG, Chiao EY, Cantor SB, Parker SL, Daheri M, Bulsara S, Escobar B, Deshmukh AA, Jibaja-Weiss ML, Zare M, Scheurer ME. Mailed self-sample HPV testing kits to improve cervical cancer screening in a safety net health system: protocol for a hybrid effectiveness-implementation randomized controlled trial. Trials 2020; 21:872. [PMID: 33087164 PMCID: PMC7580009 DOI: 10.1186/s13063-020-04790-5] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Almost 20% of U.S. women remain at risk for cervical cancer due to their inability or unwillingness to participate in periodic clinic-based screening. Self-sampling has been shown to be an effective strategy for screening women for high-risk human papillomavirus (HR-HPV) infection in specific contexts. However, its effectiveness among medically underserved women in safety net health systems has not been evaluated. Furthermore, it is also unclear whether implementation strategies such as patient navigation can be used to improve the success of self-sample screening programs by addressing patient-level barriers to participation. METHODS/DESIGN The Prospective Evaluation of Self-Testing to Increase Screening (PRESTIS) trial is a hybrid type 2 effectiveness-implementation pragmatic randomized controlled trial of mailed self-sample HPV testing. The aim is to assess the effectiveness of mailed self-sample HPV testing kits to improve cervical cancer screening participation among patients in a safety net health system who are overdue for clinic-based screening, while simultaneously assessing patient navigation as an implementation strategy. Its setting is a large, urban safety net health system that serves a predominantly racial/ethnic minority patient population. The trial targets recruitment of 2268 participants randomized to telephone recall (enhanced usual care, n = 756), telephone recall with mailed self-sample HPV testing kit (intervention, n = 756), or telephone recall with mailed self-sample HPV testing kit and patient navigation (intervention + implementation strategy, n = 756). The primary effectiveness outcome is completion of primary screening, defined as completion and return of mailed self-sample kit or completion of a clinic-based Pap test. Secondary effectiveness outcomes are predictors of screening and attendance for clinical follow-up among women with a positive screening test. Implementation outcomes are reach, acceptability, fidelity, adaptations, and cost-effectiveness. DISCUSSION Hybrid designs are needed to evaluate the clinical effectiveness of self-sample HPV testing in specific populations and settings, while incorporating and evaluating methods to optimize its real-world implementation. The current manuscript describes the rationale and design of a hybrid type 2 trial of self-sample HPV testing in a safety net health system. Trial findings are expected to provide meaningful data to inform screening strategies to ultimately realize the global goal of eliminating cervical cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT03898167 . Registered on 01 April 2019. TRIAL STATUS Study start data: February 13, 2020. Recruitment status: Enrolling by invitation. Estimated primary completion date: February 15, 2023. Estimated study completion date: May 31, 2024. Protocol version 1.6 (February 25, 2020).
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Affiliation(s)
- Jane R Montealegre
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS: 305, Houston, TX, 77030, USA.
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA.
| | - Matthew L Anderson
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Susan G Hilsenbeck
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Elizabeth Y Chiao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Harris Health System, Houston, TX, USA
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan L Parker
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Shaun Bulsara
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Betsy Escobar
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Ashish A Deshmukh
- Center for Health Services Research, Department of Management, Policy, and Community Health, The University of Texas School of Public Health, Houston, TX, USA
| | - Maria L Jibaja-Weiss
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA
| | - Mohammed Zare
- Harris Health System, Houston, TX, USA
- Department of Family and Community Medicine, The University of Texas McGovern School of Medicine, Houston, TX, USA
| | - Michael E Scheurer
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS: 305, Houston, TX, 77030, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
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11
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Hoffman AS, Lowenstein LM, Kamath GR, Housten AJ, Leal VB, Linder SK, Jibaja-Weiss ML, Raju GS, Volk RJ. An entertainment-education colorectal cancer screening decision aid for African American patients: A randomized controlled trial. Cancer 2017; 123:1401-1408. [PMID: 28001305 PMCID: PMC5384861 DOI: 10.1002/cncr.30489] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 09/03/2016] [Revised: 10/22/2016] [Accepted: 11/11/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Colorectal cancer screening rates for African American patients remain suboptimal. Patient decision aids designed with an entertainment-education approach have been shown to improve saliency and foster informed decision making. The purpose of this study was to assess whether an entertainment-education decision aid tailored for African American patients improved patients' decision making, attitudes, intentions, or colorectal cancer screening behavior. METHODS Eighty-nine participants were randomized to view 1) a patient decision aid video containing culturally tailored information about colorectal cancer screening options and theory-based support in decision making presented in an entertainment-education format or 2) an attention control video about hypertension that contained similarly detailed information. Participants met with their clinician and then completed follow-up questionnaires assessing their knowledge, decisional conflict, self-advocacy, attitudes, perceived social norms, and intentions. At 3 months, completion of screening was assessed by chart review. RESULTS Viewing the culturally tailored decision aid significantly increased African American patients' knowledge of colorectal cancer screening recommendations and options. It also significantly reduced their decisional conflict and improved their self-advocacy. No significant differences were observed in participants' attitudes, norms, or intentions. At three months, 23% of all patients had completed a colonoscopy. CONCLUSIONS Designing targeted, engaging patient decision aids for groups that receive suboptimal screening holds promise for improving patient decision making and self-advocacy. Additional research is warranted to investigate the effectiveness of such aids in clinical practices with suboptimal screening rates and on downstream behaviors (such as repeat testing). Cancer 2017;123:1401-1408. © 2016 American Cancer Society.
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Affiliation(s)
- Aubri S. Hoffman
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lisa M. Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Geetanjali R. Kamath
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ashley J. Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Viola B. Leal
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Suzanne K. Linder
- Division of Rehabilitation Sciences, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Gottumukkala S. Raju
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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12
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Montealegre JR, Mullen PD, L Jibaja-Weiss M, Vargas Mendez MM, Scheurer ME. Feasibility of Cervical Cancer Screening Utilizing Self-sample Human Papillomavirus Testing Among Mexican Immigrant Women in Harris County, Texas: A Pilot Study. J Immigr Minor Health 2016; 17:704-12. [PMID: 25358741 DOI: 10.1007/s10903-014-0125-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Here we evaluate the acceptability and feasibility of self-sample human papillomavirus (HPV) testing (self-HPV) among a sample of predominantly Mexican immigrant women who never or sporadically attend for Pap testing. Immigrant women who had not had a Pap test in the past 3 years (n = 100) were recruited. Participants self-collected a cervical sample for HPV testing. High-risk (HR) HPV-positive women were referred for clinical follow-up. Acceptability of self-HPV was high, with 99% reporting that they would be willing to use self-HPV regularly. Nineteen women (19%) tested positive for HR-HPV. Of these, 50% obtained clinical follow-up within 3 months. For those who did not, the primary barrier to follow-up was difficulty obtaining healthcare coverage. In conclusion, self-HPV is highly acceptable to Mexican immigrant women who otherwise do not attend for Pap testing. While the approach addresses critical barriers to primary screening, questions remain as to whether uninsured HR-HPV positive women are able to attend for clinical follow-up.
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Affiliation(s)
- Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, MS: BCM 305, Houston, TX, 77030, USA,
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13
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Kline KN, Montealegre JR, Rustveld LO, Glover TL, Chauca G, Reed BC, Jibaja-Weiss ML. Incorporating Cultural Sensitivity into Interactive Entertainment-Education for Diabetes Self-Management Designed for Hispanic Audiences. J Health Commun 2016; 21:658-668. [PMID: 27166651 DOI: 10.1080/10810730.2016.1153758] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diabetes self-management education can improve outcomes in adults with Type 2 diabetes mellitus (T2DM). However, Hispanics, a group that carries a large burden of disease, may not participate in diabetes education programs. Audience engagement with entertainment-education has been associated with improved health education outcomes and may engage and empower Hispanic users to active self-care. Successful use of entertainment-education relies on the use of characters and situations with whom the viewers can feel some sense of involvement and for Hispanic audiences is encouraged when storylines and characters are culturally sensitive. In this study, we used a mixed methods approach that included descriptive statistics of closed-ended and content analysis of open-ended questions to measure the cultural sensitivity of the telenovela portion of a novel technology-based application called Sugar, Heart, and Life (SHL). Specifically, we analyzed the responses of 123 male and female patients diagnosed with uncontrolled T2DM to determine viewer involvement with characters and situations in the telenovela, viewer perceived self-efficacy in following recommendations, as well as viewer satisfaction with the program. Our findings indicate that the SHL application achieved its goal of creating a user-friendly program that depicted realistic, culturally sensitive characters and storylines that resonated with Hispanic audiences and ultimately fostered perceived self-efficacy related to following recommendations given about healthy lifestyle changes for diabetes self-management. These findings suggest that the SHL application is a culturally sensitive health education intervention for use by Hispanic male and female individuals that may empower them in self-management of T2DM.
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Affiliation(s)
- Kimberly N Kline
- a Department of Communication , The University of Texas at San Antonio , San Antonio , Texas , USA
| | - Jane R Montealegre
- b Department of Pediatrics , Baylor College of Medicine , Houston , Texas , USA
| | - Luis O Rustveld
- c Department of Family and Community Medicine , Baylor College of Medicine , Houston , Texas , USA
| | - Talar L Glover
- d Diabetes Service Line and Patient Education , Harris Health System , Houston , Texas , USA
| | - Glori Chauca
- c Department of Family and Community Medicine , Baylor College of Medicine , Houston , Texas , USA
| | - Brian C Reed
- c Department of Family and Community Medicine , Baylor College of Medicine , Houston , Texas , USA
| | - Maria L Jibaja-Weiss
- c Department of Family and Community Medicine , Baylor College of Medicine , Houston , Texas , USA
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14
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Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Hispanic Acculturation and Gender Differences in Support and Self-Efficacy for Managing Diabetes. Diabetes Educ 2016; 42:315-24. [DOI: 10.1177/0145721716640905] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to determine whether perceived support, social norms, and their association with self-efficacy varied by gender and language-based acculturation in Hispanic men and women with uncontrolled type 2 diabetes mellitus (T2DM). Methods A cross-sectional, secondary analysis of baseline survey data from a randomized control trial. Participants were 248 Hispanic patients from 4 community health centers who participated in a culturally targeted intervention for diabetes management. Quantitative statistical methods were used, including chi-square analyses, one-way ANOVA, and multiple regression. Results Gender and language both moderated the relationship between social factors and self-efficacy. Regardless of language, better perceived support was associated with improved self-efficacy in women but not men. Dietary norms were associated with self-efficacy in English-speaking men and women, while physical activity norms were associated with self-efficacy for Spanish-speaking women only. Conclusions This study builds on previous research by exploring the extent to which the social context of diabetes self-management may vary in its effects depending on gender and acculturation. The findings revealed potentially important differences based on both gender and language, suggesting that interventions must be designed with these differences in mind. Diabetes-specific support from family members, especially spouses, may be especially important for Hispanic women. For both men and women, it may be effective to find creative ways of involving the family in creating healthier social norms and expectations.
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Affiliation(s)
- Carol L. Mansyur
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
| | - Luis O. Rustveld
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
| | - Susan G. Nash
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
| | - Maria L. Jibaja-Weiss
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
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15
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Montealegre JR, Hanser L, Daheri M, Chenier R, Valverde I, Chauca GS, Rustveld LO, Anderson ML, Ramondetta L, Gould-Suarez M, Benjamin ML, Scott LD, Nangia JR, Reed BC, Hoagland-Sorensen J, Rieber A, Jibaja-Weiss ML. Abstract B78: Using the Quality in the Continuum of Cancer Care framework to develop a multilevel intervention to improve cancer screening and follow-up among the medically underserved. Cancer Epidemiol Biomarkers Prev 2016. [DOI: 10.1158/1538-7755.disp15-b78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: Screening for cervical, colorectal, and breast cancer is an evidence-based strategy to reduce the morbidity and mortality from these cancers. However a large proportion of medically underserved individuals do not obtain regular screening. Using the Quality in the Continuum of Cancer Care (QCCC) framework, we developed and implemented a comprehensive systems design intervention to improve the delivery, uptake, and follow-up of cervical, colorectal, and breast cancer screening within a network of healthcare institutions that serve the medically underserved in Harris County, Texas.
Methods: An academic-community partnership, the Community Network for Cancer Prevention, was established between an academic cancer center, the county's safety net healthcare system, and several academic and community-based healthcare institutions. Clinical advisory boards, comprised of physicians, nurses, and public health professionals, were established for each cancer line. The QCCC framework was used to identify system-level failures that impede processes and transitions in the continuum of care from risk assessment to detection and from detection to diagnosis. Project components were developed to address the identified failures.
Results: System failures identified at the risk assessment to detection phases included 1) failure to identify individuals in need of screening, 2) inadequate capacity to screen, and 3) inadequate access to care. Failures identified at the detection to diagnosis phases included 1) failures in the screening test results notification system, 2) failures in inter-provider communication, 3) failures in inter-institutional referrals for clinical follow-up, 4) patient non-adherence, and 5) inadequate access to care. Project components to address the identified failures include community outreach, patient education, and patient navigation. Community outreach involves a community theater program aimed to increase awareness of cancer risk and the current cancer screening guidelines among medically underserved individuals in the larger community; healthcare access navigators available at each performance assist audience members in applying for healthcare coverage through the safety net healthcare system. Patient education involves using the electronic medical record to identify patients due or past due for cervical, colorectal, and/or breast cancer screening. These patients are then targeted for a video-based patient education intervention while they wait to be seen by their healthcare provider. Motivational messaging in the videos encourages patients to discuss the particular screening test with their provider. Finally, patient navigation involves a team of navigators who actively communicate with patients and providers to ensure follow-up among patients with an abnormal screening test result. A real-time tracking database is used to monitor all screen-test positive patients as they move through the different stages of diagnostic and therapeutic follow-up.
Conclusion: The QCCC provides a systematic approach for assessing factors that influence cancer care processes at the risk assessment, screening, detection, and diagnosis phases, as well as transitions between them. Focusing on transitions between phases is particularly useful for developing systems-level interventions to improve the delivery, uptake, and follow-up of cancer screening.
Citation Format: Jane R. Montealegre, Loretta Hanser, Maria Daheri, Roshanda Chenier, Ivan Valverde, Glori S. Chauca, Luis O. Rustveld, Matthew L. Anderson, Lois Ramondetta, Milena Gould-Suarez, Musher L. Benjamin, Larry D. Scott, Juli R. Nangia, Brian C. Reed, Janet Hoagland-Sorensen, Alyssa Rieber, Maria L. Jibaja-Weiss. Using the Quality in the Continuum of Cancer Care framework to develop a multilevel intervention to improve cancer screening and follow-up among the medically underserved. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B78.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lois Ramondetta
- 3The University of Texas MD Anderson Cancer Center, Houston, TX,
| | | | | | - Larry D. Scott
- 4The University of Texas Health Science Center, Houston, TX
| | | | | | | | - Alyssa Rieber
- 3The University of Texas MD Anderson Cancer Center, Houston, TX,
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16
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Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Social factors and barriers to self-care adherence in Hispanic men and women with diabetes. Patient Educ Couns 2015; 98:805-810. [PMID: 25819551 DOI: 10.1016/j.pec.2015.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 07/16/2014] [Revised: 01/30/2015] [Accepted: 03/01/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore quantitatively the extent to which social support, social norms and barriers are associated with self-efficacy and self-care adherence in Hispanic patients with diabetes and the extent to which these differ for men and women. METHODS Baseline survey data were collected from 248 low-SES, Hispanic men and women who were participants in a randomized controlled trial of a culturally targeted intervention for diabetes management. Student's t, Pearson correlations and multiple regression were used to analyze the data. RESULTS Compared to men, women were less likely to receive support, faced more barriers, reported less self-efficacy and had lower levels of self-care adherence. Perceived support was consistently correlated with better self-efficacy in women but not men, even though men reported higher levels of support. CONCLUSION The lack of adequate support seems to be a fundamental barrier for Hispanic women with diabetes. PRACTICE IMPLICATIONS Health care providers should be sensitive to sociocultural influences in Hispanic groups that may facilitate men's self-care adherence, but could potentially hamper women's efforts. Interventions designed for Hispanics should augment women's support needs and address culture and social factors that may differentially impact the ability of men and women to manage their diabetes.
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Affiliation(s)
- Carol L Mansyur
- School of Community and Environmental Health, Old Dominion University, Norfolk, USA.
| | - Luis O Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, USA
| | - Susan G Nash
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, USA
| | - Maria L Jibaja-Weiss
- School of Allied Health Sciences, Baylor College of Medicine, Houston, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, USA
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17
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Montealegre JR, Gossey JT, Anderson ML, Chenier RS, Chauca G, Rustveld LO, Jibaja-Weiss ML. Implementing targeted cervical cancer screening videos at the point of care. Patient Educ Couns 2014; 97:426-429. [PMID: 25269411 DOI: 10.1016/j.pec.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/27/2014] [Accepted: 09/10/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To develop and implement educational videos to improve cervical cancer health literacy for patients within a safety net healthcare system. METHODS Testimonial-style videos were developed with the goal of describing the Pap test to low literacy patients and motivating them to participate in regular cervical cancer screening. Nurses were trained to use the electronic medical record to identify patients due or past due for a Pap test according to the current screening guidelines. They played the video for all eligible patients as they waited to be seen by their physician in clinical examination rooms. RESULTS Four 2-minute videos were developed in English, Spanish, and Vietnamese. Videos were made available on desktop computers in 458 exam rooms at 13 community health centers. CONCLUSION Integration of educational videos into the workflow of high-volume community health centers is feasible. Future work will focus on optimizing uptake of the videos as well as assessing their efficacy for improving cervical cancer health literacy. PRACTICE IMPLICATIONS Integrating targeted videos into patient flow may be a feasible way to address health literacy barriers to cervical cancer screening within a busy workflow environment.
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Affiliation(s)
- Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine, Houston, USA; Office of Outreach and Health Disparities, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, USA.
| | - John Travis Gossey
- Department of Internal Medicine, Weill Cornell Medical College, New York, USA
| | - Matthew L Anderson
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, USA; Department of Pathology & Immunology, Baylor College of Medicine, Houston, USA
| | - Roshanda S Chenier
- Office of Outreach and Health Disparities, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, USA
| | - Glori Chauca
- Office of Outreach and Health Disparities, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, USA
| | - Luis O Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, USA
| | - Maria L Jibaja-Weiss
- Office of Outreach and Health Disparities, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, USA; School of Allied Health Sciences, Baylor College of Medicine, Houston, USA
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Rustveld LO, Valverde I, Chenier RS, McLaughlin RJ, Waters VS, Sullivan J, Jibaja-Weiss ML. A novel colorectal and cervical cancer education program: findings from the community network for cancer prevention Forum Theater program. J Cancer Educ 2013; 28:684-689. [PMID: 23943276 DOI: 10.1007/s13187-013-0530-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Medically underserved populations continue to be disproportionately burdened by cancer. The exact reason for this disparity has not been fully elucidated, but likely involves multiple factors. We explored the potential utility of a novel community-based cancer education program called Forum Theater (FT), aimed at raising awareness about colorectal (CRC) and cervical cancer (CxC) screening among African-American, Hispanic, and Vietnamese populations. We also determined audience likelihood of obtaining CRC and CxC screening in the 6 months following performances. Thirty FT performances were held between September 2011 and July 2012. A brief survey was administered at each performance, eliciting responses on key CRC and CxC screening questions. A total of 662 community residents (316 Hispanic, 165 African-American, and 181 Vietnamese; overall mean age 50.3 ± 16.4) participated in performances. The survey response rate was 71.1 %. After seeing FT performances, the majority responded correctly (>70 %) on CRC and CxC screening questions. In comparison to Hispanic and Vietnamese participants, African-Americans were less likely to report that CRC and CxC are preventable (p < 0.05), that timely and regular screening saves lives (p = 0.05), and that CxC screening should begin at age 21 for most women (p < 0.05). Our findings suggest that FT may be an effective strategy to disseminate cancer screening information. Lack of awareness that CRC/CxC screening saves lives and that CRC/CxC is preventable, as reported by African-Americans, may not stem from lack of knowledge or misconceptions alone, but may be influenced by a sense of fatalism regarding cancer outcomes in this population.
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Affiliation(s)
- Luis O Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX, 77098, USA,
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Bekker HL, Winterbottom AE, Butow P, Dillard AJ, Feldman-Stewart D, Fowler FJ, Jibaja-Weiss ML, Shaffer VA, Volk RJ. Do personal stories make patient decision aids more effective? A critical review of theory and evidence. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S9. [PMID: 24625283 PMCID: PMC4044102 DOI: 10.1186/1472-6947-13-s2-s9] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources.
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Rochon D, Porto L, McLaughlin R, Waters V, Rustveld L, Jibaja-Weiss ML. Abstract A27: Using community theater to educate the underserved about cancer screening and prevention. Cancer Epidemiol Biomarkers Prev 2011. [DOI: 10.1158/1055-9965.disp-11-a27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: In an effort to engage the lay community around issues related to colorectal and cervical cancer prevention and screening, we formed the Community Network for Cancer Prevention Forum Theater Project, a three-year funded program bringing together collaborators from several disciplines. The goal of the project is to foster communication and understanding of colorectal and cervical cancer risks and prevention strategies among target populations by discovering and addressing barriers to care. This will be accomplished by using an interactive form of community theater in a campaign that addresses health disparities and inequities. Drawing on a method that creates theater in direct collaboration with the community, we are using Forum Theater as a platform for developing colorectal and cervical cancer screening messages to be communicated at performances.
Experimental Procedures: As part of the project, we have trained the first group of Community Health Workers (CHWs) to implement the theater project in Spanish-speaking Hispanic communities. The training took place once a week for seven weeks, with 16 people in attendance. A faculty member from the School of Allied Health conducted the first session, which was an evidence-based cervical and colorectal cancer content session; another faculty member from the School of Allied Health attended most of the sessions not only as an expert on behavioral psychology but as a participant in the Forum Theater training. The remaining six weeks focused in depth on Forum Theater methods and techniques, such as trust exercises, improvisation, building dramatic scenes, rehearsal techniques, maintaining effective dramatic flow, and encouraging audience participation. Throughout the training, participants developed their skills for addressing barriers and myths related to cancer screening and prevention, as well as how to address these issues with community members. Once CHWs are trained, their tasks are to identify and coordinate locations for performances, encourage participation from the communities that they serve, and to facilitate the production of linguistically and culturally appropriate performances.
Expected Results and Conclusions: All of the participants completed a pre-post knowledge and attitudes survey of the content session and a self-administered questionnaire at the end of the seven weeks of training. Results of the pre-post tests indicate that the content session was effective in increasing knowledge levels and improving attitudes about the efficacy of screening and prevention for underserved populations. Findings from the questionnaire, which asked about leadership confidence, skill development, self-efficacy, and satisfaction with the program, suggest that the training program provided CHWs with the necessary tools to implement a successful community theater program for cancer prevention and screening.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A27.
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Jibaja-Weiss ML, Volk RJ, Granchi TS, Neff NE, Robinson EK, Spann SJ, Aoki N, Friedman LC, Beck JR. Entertainment education for breast cancer surgery decisions: a randomized trial among patients with low health literacy. Patient Educ Couns 2011; 84:41-48. [PMID: 20609546 DOI: 10.1016/j.pec.2010.06.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 05/04/2010] [Accepted: 06/04/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients. METHODS Newly diagnosed female patients with early stage breast cancer from two public hospitals were randomized to receive an entertainment-based decision aid for breast cancer treatment along with usual care (intervention arm) or to receive usual care only (control arm). Pre-decision (baseline), pre-surgery, and 1-year follow-up assessments were conducted. RESULTS Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery; however, they appeared better informed and clearer about their surgical options than women assigned to the control group. No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group. CONCLUSIONS Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options. PRACTICE IMPLICATIONS Incorporating patient decision aids, particularly computer-based decision aids, into standard clinical practice remains a challenge; however, patients may be directed to view programs at home or at public locations (e.g., libraries, community centers).
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Affiliation(s)
- Maria L Jibaja-Weiss
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA.
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Palos GR, Mendoza TR, Liao KP, Anderson KO, Garcia-Gonzalez A, Hahn K, Nazario A, Ramondetta LM, Valero V, Lynch GR, Jibaja-Weiss ML, Cleeland CS. Caregiver symptom burden: the risk of caring for an underserved patient with advanced cancer. Cancer 2011; 117:1070-9. [PMID: 20960510 PMCID: PMC3065823 DOI: 10.1002/cncr.25695] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [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: 04/22/2010] [Revised: 08/30/2010] [Accepted: 09/01/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND The growing diversity of the population of the United States and the high burden of cancer-related symptoms reflect the need for caregiver research within underserved groups. In this longitudinal study, the authors assessed changes in symptom severity in caregivers and underserved minority patients diagnosed with advanced solid tumors who were being treated at public hospitals. METHODS A total of 85 matched patient-caregiver dyads completed the M. D. Anderson Symptom Inventory 3 times during 20 weeks of chemotherapy. At each time point, symptom severity and interference with daily activities were assessed. Group-based trajectory modeling was used to classify caregivers into high-symptom or low-symptom burden groups. RESULTS Sadness and distress were more prevalent among caregivers (P = .005). Symptom burden remained stable among caregivers in the high-symptom group (40%), whereas the low-symptom group (60%) demonstrated a statistically significant decrease over time. Multivariate analysis found being a family-member caregiver (adjusted odds ratio [ADJ-OR], 4.1; 95% confidence interval [95% CI], 1.4-11.6) and caring for a highly symptomatic patient (ADJ-OR, 8.0; 95% CI, 1.5-41.4), rather than race, ethnicity, or sociodemographic characteristics, were significant predictors of the caregiver's membership in the high-symptom burden group. CONCLUSIONS Approximately 40% of the caregivers in the current study were found to be at an increased risk for moderate to severe sadness and distress, which remained severe throughout the patient's treatment course at public hospitals. To the authors' knowledge, this study marks the first time that the concept of symptom burden has been used to measure caregiver burden, and the first time that symptom burden has been measured and documented in dyads of caregivers and underserved minority patients. Cancer 2011. © 2010 American Cancer Society.
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Affiliation(s)
- Guadalupe R Palos
- Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Gossey JT, Whitney SN, Crouch MA, Jibaja-Weiss ML, Zhang H, Volk RJ. Promoting knowledge of statins in patients with low health literacy using an audio booklet. Patient Prefer Adherence 2011; 5:397-403. [PMID: 21949603 PMCID: PMC3176179 DOI: 10.2147/ppa.s19995] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Statins are generally well tolerated and effective at reducing a patient's risk of both primary and secondary cardiovascular events. Many patients who would benefit from statin therapy either do not adhere to or stop taking their statin medication within the first year. We developed an audio booklet targeted to low health literacy patients to teach them about the benefits and risks of statins to help the patients adhere to their statin therapy. METHODS Through focus groups and an iterative design, an audio booklet was developed for both English-speaking and Spanish-speaking patients. We then compared the booklet with standard of care in 132 patients from our target patient population to measure its impact on knowledge and understanding of statins. RESULTS The patients enjoyed the audio booklet and showed significant increases in knowledge after listening to it when compared with those who received the standard of care materials. CONCLUSION The audio booklet shows promise as a tool that can be used effectively in clinical practice to teach patients about statin therapy.
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Affiliation(s)
- J Travis Gossey
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Correspondence: J Travis Gossey, Department of Medicine, Weill Cornell Medical College, 575 Lexington Ave, Third Floor, New York, NY 10021, USA, Tel +1 212 746 0471, Fax +1 646 962 0454, Email
| | - Simon N Whitney
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Maria L Jibaja-Weiss
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hong Zhang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, and Houston Center for Education and Research on Therapeutics, Houston, TX, USA
| | - Robert J Volk
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, and Houston Center for Education and Research on Therapeutics, Houston, TX, USA
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Rustveld LO, Pavlik VN, Jibaja-Weiss ML, Kline KN, Gossey JT, Volk RJ. Adherence to diabetes self-care behaviors in English- and Spanish-speaking Hispanic men. Patient Prefer Adherence 2009; 3:123-30. [PMID: 19936154 PMCID: PMC2778413 DOI: 10.2147/ppa.s5383] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Indexed: 11/23/2022] Open
Abstract
We conducted a qualitative study to elicit attitudes, attributions, and self-efficacy related to diabetes self-care in both English- and Spanish-speaking Hispanic men. Transcripts from six focus groups (three in English and three in Spanish) were reviewed by the authors to extract principal and secondary themes. Participants could describe their medication and lifestyle regimens and were aware of whether they were adherent or nonadherent to physician recommendations. Lack of skills on how to incorporate diet and regular physical activity into daily living, lack of will power, and reluctance to change culturally rooted behaviors emerged as significant barriers to diabetes self-management. Medication adherence is for some men the principal diabetes self-care behavior. Nonadherence appeared to fit two profiles: 1) intentional, and 2) nonintentional. In both instances low self-efficacy emerged as a significant influence on attainment and maintenance of diabetes self-care goals. Participants also expressed a strong sense of fatalism regarding the course of their disease, and seemed to have little motivation to attempt long-term dietary control. Educational and counseling messages should stress that a diagnosis of diabetes is not a death sentence, and full functional capacity can be maintained with good control.
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Affiliation(s)
- Luis O Rustveld
- Baylor College of Medicine, Department of Family and Community Medicine, Houston, TX, USA
- Correspondence: Luis O Rustveld, Postdoctoral Fellow, Baylor College of Medicine, Department of Family and Community Medicine, 3701 Kirby Dr Suite 600, Houston, TX 77098, USA, Tel +1 713 798 7756, Email
| | - Valory N Pavlik
- Baylor College of Medicine, Department of Family and Community Medicine, Houston, TX, USA
| | - Maria L Jibaja-Weiss
- Baylor College of Medicine, Department of Family and Community Medicine, Houston, TX, USA
- Outreach and Health Disparities, Dan L. Duncan Cancer Center, Houston, TX, USA
| | - Kimberly N Kline
- Department of Communication, University of Texas at San Antonio, San Antonio, TX, USA
| | - J Travis Gossey
- Baylor College of Medicine, Department of Family and Community Medicine, Houston, TX, USA
| | - Robert J Volk
- Baylor College of Medicine, Department of Family and Community Medicine, Houston, TX, USA
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Volk RJ, Jibaja-Weiss ML, Hawley ST, Kneuper S, Spann SJ, Miles BJ, Hyman DJ. Entertainment education for prostate cancer screening: a randomized trial among primary care patients with low health literacy. Patient Educ Couns 2008; 73:482-9. [PMID: 18760888 PMCID: PMC2867348 DOI: 10.1016/j.pec.2008.07.033] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [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: 12/31/2007] [Revised: 07/14/2008] [Accepted: 07/16/2008] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To evaluate an entertainment-based patient decision aid for prostate cancer screening among patients with low or high health literacy. METHODS Male primary care patients from two clinical sites, one characterized as serving patients with low health literacy (n=149) and the second as serving patients with high health literacy (n=301), were randomized to receive an entertainment-based decision aid for prostate cancer screening or an audiobooklet-control aid with the same learner content but without the entertainment features. Postintervention and 2-week follow-up assessments were conducted. RESULTS Patients at the low-literacy site were more engaged with the entertainment-based aid than patients at the high-literacy site. Overall, knowledge improved for all patients. Among patients at the low-literacy site, the entertainment-based aid was associated with lower decisional conflict and greater self-advocacy (i.e., mastering and obtaining information about screening) when compared to patients given the audiobooklet. No differences between the aids were observed for patients at the high-literacy site. CONCLUSION Entertainment education may be an effective strategy for promoting informed decision making about prostate cancer screening among patients with lower health literacy. PRACTICE IMPLICATIONS As barriers to implementing computer-based patient decision support programs decrease, alternative models for delivering these programs should be explored.
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Affiliation(s)
- Robert J Volk
- Department of Family and Community Medicine, and Houston Center for Education and Research on Therapeutics, Baylor College of Medicine, United States.
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Jibaja-Weiss ML, Volk RJ. Utilizing computerized entertainment education in the development of decision aids for lower literate and naïve computer users. J Health Commun 2007; 12:681-97. [PMID: 17934944 DOI: 10.1080/10810730701624356] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Decision aids have been developed by using various delivery methods, including interactive computer programs. Such programs, however, still rely heavily on written information, health and digital literacy, and reading ease. We describe an approach to overcome these potential barriers for low-literate, underserved populations by making design considerations for poor readers and naïve computer users and by using concepts from entertainment education to engage the user and to contextualize the content for the user. The system design goals are to make the program both didactic and entertaining and the navigation and graphical user interface as simple as possible. One entertainment education strategy, the soap opera, is linked seamlessly to interactive learning modules to enhance the content of the soap opera episodes. The edutainment decision aid model (EDAM) guides developers through the design process. Although designing patient decision aids that are educational, entertaining, and targeted toward poor readers and those with limited computer skills is a complex task, it is a promising strategy for aiding this population. Entertainment education may be a highly effective approach to promoting informed decision making for patients with low health literacy.
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Affiliation(s)
- Maria L Jibaja-Weiss
- Department of Family and Community Medicine, and Houston Center for Education and Research on Therapeutics, Baylor College of Medicine, Houston, Texas 77098, USA.
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Jibaja-Weiss ML, Volk RJ, Friedman LC, Granchi TS, Neff NE, Spann SJ, Robinson EK, Aoki N, Robert Beck J. Preliminary testing of a just-in-time, user-defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions. Health Expect 2006; 9:218-31. [PMID: 16911136 PMCID: PMC5060365 DOI: 10.1111/j.1369-7625.2006.00386.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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: 11/28/2022] Open
Abstract
OBJECTIVE To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. DESIGN Pre-post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. SAMPLE Fifty-one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. INTERVENTION A computerized decision aid that combines entertainment-education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. OUTCOMES Patients' use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). RESULTS Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. CONCLUSIONS A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients.
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Affiliation(s)
- Maria L Jibaja-Weiss
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA.
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Jibaja-Weiss ML, Volk RJ, Granch TS, Nefe NE, Spann SJ, Aoki N, Robinson EK, Freidman LC, Beck JR. Entertainment education for informed breast cancer treatment decisions in low-literate women: development and initial evaluation of a patient decision aid. J Cancer Educ 2006; 21:133-9. [PMID: 17371175 DOI: 10.1207/s15430154jce2103_8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND We report on the development and initial evaluation of a novel computerized decision support system (CDSS) that utilizes concepts from entertainment education (edutainment) to assist low-literate, multiethnic women in making initial surgical treatment decisions. METHOD We randomly assigned 51 patients diagnosed with early stage breast cancer to use the decision aid. RESULTS Patients who viewed the CDSS improved their knowledge of breast cancer treatment; found the application easy to use and understand, informative, and enjoyable; and were less worried about treatment. CONCLUSION The system clearly reached its intended objectives to create a usable decision aid for low-literate, novice computer users.
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Affiliation(s)
- Maria L Jibaja-Weiss
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas 77098, USA.
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Jibaja-Weiss ML, Volk RJ, Smith QW, Holcomb JD, Kingery P. Differential effects of messages for breast and cervical cancer screening. J Health Care Poor Underserved 2005; 16:42-52. [PMID: 15741708 DOI: 10.1353/hpu.2005.0018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to compare responses to two interventions (personalized-form [PF] letter messages versus personalized-tailored [PT] letter messages) using medical record data for promoting appointment scheduling and screening for breast and cervical cancer among urban low-income women from three ethnic groups: African-American, Mexican-American, and non-Hispanic white women. The 1,574 women participating in the randomized controlled trial were assigned to one of three groups: (1) PF letter, (2) PT letter, (3) control (no letter). Logistic regression analyses show that (1) personalized-tailored letters containing individualized references to recipients' cancer risk factors failed to increase rates of recommended cancer screening behaviors, especially among non-Hispanic white women; and that (2) in contrast, a personalized-form letter with general breast and cervical cancer screening messages increased cancer screening rates in this population, especially among non-Hispanic white and Mexican-American women.
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Jibaja-Weiss ML, Volk RJ, Kingery P, Smith QW, Holcomb JD. Tailored messages for breast and cervical cancer screening of low-income and minority women using medical records data. Patient Educ Couns 2003; 50:123-132. [PMID: 12781927 DOI: 10.1016/s0738-3991(02)00119-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Barriers to screening and early detection often result in cancers in low-income and minority women diagnosed at stages too advanced for optimal treatment. This randomized controlled trial examined whether a personalized form (PF) letter containing generic cancer information and a personalized tailored (PT) letter containing minimally tailored individualized risk factor information based on medical records data affected breast and cervical cancer screening among 1574 urban low-income and minority women. The personalized form-letter group was significantly more likely to schedule a screening appointment and to have undergone a Pap test and mammography within 1 year after the intervention than were the tailored letter and control groups (P<0.001 for all comparisons). Personalized tailored letters that contain individualized cancer risk factor information may decrease the likelihood of receiving cancer screening among medically underserved low-income and minority women, but personalized form letters that contain generic cancer information may improve these rates in this disadvantaged population.
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Affiliation(s)
- Maria L Jibaja-Weiss
- Department of Family and Community Medicine, Baylor College of Medicine, 5615 Kirby Drive, Suite 610, Houston, TX 77005, USA.
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