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Jones SMW, Weiner BJ. Reliability and validity of intervention characteristic measures for assessing barriers to evidence-based practice use. Transl Behav Med 2024; 14:304-309. [PMID: 38518799 PMCID: PMC11056881 DOI: 10.1093/tbm/ibae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024] Open
Abstract
Assessing barriers before implementing an evidence-based practice can increase the chances of successful implementation. This project evaluated measures of intervention characteristics that could affect implementation: evidence strength and quality; relative advantage; adaptability; trialability; complexity; design quality and packaging; perceived cost; compatibility; observability; risk; and burden. Measures (109 items total) for each intervention characteristic were developed in a previous study, using prior measures, and expert feedback. Measures were scored such that higher scores meant a more positive view. Healthcare personnel implementing a new practice (n = 175) completed two surveys, 1 month apart. Participants completed the intervention characteristic item banks and questions on the use of the evidence-based practice. Reliability and validity were assessed for each item bank. All measures had Cronbach's alphas over 0.7 (range: 0.700-0.932) indicating good reliability. Frequent users of the practice reported better levels of each determinant at the first (Cohen's d range: -0.239 to -0.687) and second surveys (Cohen's d range: -0.043 to -1.081) except for costs (0.096) with use on the second survey. This preliminary test of measures to assess determinants of implementing evidence-based practice supports the validity and reliability of these tools. Additional studies are needed to further test the psychometric properties of the measures and develop short forms of each intervention characteristic measure.
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Affiliation(s)
- Salene M W Jones
- Divsion of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, USA, University of Washington, School of Public Health, Department of Global Health, Seattle, WA
| | - Bryan J Weiner
- Divsion of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, USA, University of Washington, School of Public Health, Department of Global Health, Seattle, WA
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Heffner JL, Ton M, Jones SMW, Malen RC, Cohen SA, Newcomb PA. Prevalence and Correlates of Post-Diagnosis Alcohol Use among Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2024; 33:600-607. [PMID: 38294685 PMCID: PMC10990784 DOI: 10.1158/1055-9965.epi-23-1155] [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: 09/20/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Alcohol is a risk factor for cancer and may pose unique risks for cancer survivors. Population-based studies of confirmed cancer cases are needed to estimate the extent of drinking among cancer survivors and to understand which survivors are most at risk of alcohol-related health problems. METHODS Cancer survivors who resided in the Puget Sound Surveillance, Epidemiology, and End Results (SEER) region, were ages 21 to 74 years at diagnosis, and were 6 to 17 months post-diagnosis at the start of the recruitment period (April 2020-December 2020) were sent a survey that included demographics, substance use, mental health, and cancer-related items. Data from returned surveys (n = 1,488) were weighted to represent the characteristics of the Puget Sound SEER region. We estimated the prevalence of post-diagnosis alcohol use as well as demographic, behavioral, and clinical correlates of three levels of drinking: any drinking, drinking exceeding cancer prevention guidelines, and hazardous drinking. RESULTS The weighted prevalence of any drinking, drinking exceeding cancer prevention guidelines, and hazardous drinking was 71%, 46.2%, and 31.6%, respectively. Higher income and cannabis use were associated with increased odds of all three drinking levels. Lower physical health quality of life, having non-colorectal gastrointestinal cancer, and receiving chemotherapy within the last month were associated with decreased odds of all three drinking levels. CONCLUSIONS The prevalence of any drinking and at-risk drinking was higher than in previous studies and differed based on sociodemographic, substance use, and cancer-related factors. IMPACT Findings highlight the importance of identifying and addressing risky alcohol use in cancer care settings.
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Affiliation(s)
- Jaimee L Heffner
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Mimi Ton
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Salene M W Jones
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Rachel C Malen
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Stacey A Cohen
- Division of Medical Oncology, University of Washington, Seattle, Washington
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Polly A Newcomb
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
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Jones SMW, Ton M, Heffner JL, Malen RC, Cohen SA, Newcomb PA. Association of financial worry with substance use, mental health, and quality of life in cancer patients. J Cancer Surviv 2023; 17:1824-1833. [PMID: 36595185 DOI: 10.1007/s11764-022-01319-4] [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: 08/25/2022] [Accepted: 12/09/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Financial worry is an under-appreciated negative effect of cancer. The relationship of financial worry and health behaviors in cancer is poorly characterized and has important clinical implications. This study examined the association of financial worry with substance misuse, mood, and quality of life. METHODS People with cancer (n = 1473; 6 to 20 months after diagnosis) were recruited from a SEER cancer registry in the Pacific Northwest. Participants completed an online survey assessing financial worry; misuse of cannabis, alcohol, and prescription drugs; tobacco smoking status; quality of life (physical and mental dimensions); anxiety; and depression. Multivariable regressions tested the association of financial worry to each health indicator and outcome. RESULTS In adjusted analyses, financial worry was associated with being a current vs. never smoker (odds ratio (OR) = 1.91, 95% confidence interval (CI): 1.01, 3.60), and a positive screen for an anxiety (OR = 3.01, 95% CI: 1.93, 4.68) and depressive (OR = 3.08, 95% CI: 1.89, 5.00) disorder. Financial worry was not associated with cannabis, alcohol, or prescription drug misuse (all ps > 0.05), but was associated with a decrease in physical (β = - 2.97, 95% CI: - 4.15, - 1.79) and mental (β = - 5.27, 95% CI: - 6.59, - 3.96) quality of life. CONCLUSION Financial worry among cancer survivors is associated with anxiety, depression, and worse quality of life. Of the evaluated substances, there was only an increased odds of current tobacco use with financial worry. Future longitudinal studies should inform the relationships between these factors. IMPLICATIONS FOR CANCER SURVIVORS Financial worry and material hardship may both need to be addressed in cancer survivorship.
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Affiliation(s)
- Salene M W Jones
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | - Mimi Ton
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Jaimee L Heffner
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Rachel C Malen
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Stacey A Cohen
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
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Nichols HB, Wernli KJ, Chawla N, O’Meara ES, Gray MF, Green LE, Baggett CD, Casperson M, Chao C, Jones SMW, Kirchhoff AC, Kuo TM, Lee C, Malogolowkin M, Quesenberry CP, Ruddy KJ, Wun T, Zebrack B, Chubak J, Hahn EE, Keegan TH, Kushi LH. Challenges and Opportunities of Epidemiological Studies to Reduce the Burden of Cancers in Young Adults. CURR EPIDEMIOL REP 2023; 10:115-124. [PMID: 37700859 PMCID: PMC10495081 DOI: 10.1007/s40471-022-00286-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
There are >1.9 million survivors of adolescent and young adult cancers (AYA, diagnosed at ages 15-39) living in the U.S. today. Epidemiologic studies to address the cancer burden in this group have been a relatively recent focus of the research community. In this article, we discuss approaches and data resources for cancer epidemiology and health services research in the AYA population. We consider research that uses data from cancer registries, vital records, healthcare utilization, and surveys, and the accompanying challenges and opportunities of each. To illustrate the strengths of each data source, we present example research questions or areas that are aligned with these data sources and salient to AYAs. Integrating the respective strengths of cancer registry, vital records, healthcare data, and survey-based studies sets the foundation for innovative and impactful research on AYA cancer treatment and survivorship to inform a comprehensive understanding of diverse AYA needs and experiences.
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Affiliation(s)
- Hazel B. Nichols
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Neetu Chawla
- Veterans Health Administration, Greater Los Angeles, CA
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Laura E. Green
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Christopher D. Baggett
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Chun Chao
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Anne C. Kirchhoff
- Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology-Oncology, University of California Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Brad Zebrack
- University of Michigan School of Social Work, Ann Arbor, MI
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Erin E. Hahn
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Theresa H.M. Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), University of California Comprehensive Cancer Center, Sacramento, CA
| | - Lawrence H. Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Koch PA, Paul R, Contento IR, Gray HL, Marín-Chollom AM, Santiago-Torres M, Shen H, Jones SMW, Hershman DL, Greenlee H. Mi Vida Saludable: Content Validity and Reliability of The Preferences and Self-Efficacy of Diet and Physical Activity Behaviors Questionnaire for Latina Women (PSEDPALW) for Cancer Survivors. Nutrients 2023; 15:3563. [PMID: 37630753 PMCID: PMC10457843 DOI: 10.3390/nu15163563] [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: 07/13/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
The purpose of this study is to conduct validity and reliability testing of a new instrument, the Preferences and Self-Efficacy of Diet and Physical Activity Behaviors Questionnaire for Latina Women (PSEDPALW), which is for women who identify as Latina and are breast cancer survivors. PSEDPALW measures preferences and self-efficacy for four behaviors: physical activity (PA), fruit and vegetable (FV) intake, dietary fat (DF) intake, and added sugar (AS) intake (eight scales in total). Validity testing was conducted through an expert panel review and a cognitive interviewing focus group (n = 4). Reliability was tested via internal consistency reliability (n = 118) and test-retest reliability (n = 30). Validity testing was used to refine PSEDPALW. Reliability testing was conducted on three versions with 104, 47, and 41 items. PA scales had acceptable Cronbach's α (>0.70) but low ICC (NS). FV and DF scales had acceptable Cronbach's α (>0.70), with preferences for the shorter (47- and 41-item) versions (Cronbach's α < 0.70), and all scales had moderate ICC (p < 0.05, except the FV scale on the 104-item version (p = 0.07)). The AS preferences scale had Cronbach's α < 0.70, with self-efficacy > 0.70 for all versions and ICC moderate for all versions (p ≤ 0.01). PSEDPALW may be useful to assess diet and physical activity preferences and self-efficacy in theory-based diet and physical activity interventions in women who identify as Latina and are breast cancer survivors.
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Affiliation(s)
- Pamela A. Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.P.); (I.R.C.)
| | - Rachel Paul
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.P.); (I.R.C.)
| | - Isobel R. Contento
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA; (R.P.); (I.R.C.)
| | - Heewon L. Gray
- College of Public Health, University of South Florida, Tampa, FL 33612, USA;
| | - Amanda M. Marín-Chollom
- Department of Psychological Science, Central Connecticut State University, New Britain, CT 06050, USA;
| | | | - Hanjie Shen
- Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (M.S.-T.); (H.S.); (S.M.W.J.); (H.G.)
| | - Salene M. W. Jones
- Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (M.S.-T.); (H.S.); (S.M.W.J.); (H.G.)
| | - Dawn L. Hershman
- College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, NY 10027, USA;
| | - Heather Greenlee
- Fred Hutchinson Cancer Center, Seattle, WA 98109, USA; (M.S.-T.); (H.S.); (S.M.W.J.); (H.G.)
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Lewis CC, Jones SMW, Wellman R, Sharp AL, Gottlieb LM, Banegas MP, De Marchis E, Steiner JF. Social risks and social needs in a health insurance exchange sample: a longitudinal evaluation of utilization. BMC Health Serv Res 2022; 22:1430. [PMCID: PMC9703433 DOI: 10.1186/s12913-022-08740-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 10/25/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Health systems are increasingly attempting to intervene on social adversity as a strategy to improve health care outcomes. To inform health system efforts to screen for social adversity, we sought to explore the stability of social risk and interest in assistance over time and to evaluate whether the social risk was associated with subsequent healthcare utilization.
Methods
We surveyed Kaiser Permanente members receiving subsidies from the healthcare exchange in Southern California to assess their social risk and desire for assistance using the Accountable Health Communities instrument. A subset of initial respondents was randomized to be re-surveyed at either three or six months later.
Results
A total of 228 participants completed the survey at both time points. Social risks were moderate to strongly stable across three and six months (Kappa range = .59-.89); however, social adversity profiles that included participants’ desire for assistance were more labile (3-month Kappa = .52; 95% CI = .41-.64 & 6-month Kappa = .48; 95% CI = .36-.6). Only housing-related social risks were associated with an increase in acute care (emergency, urgent care) six months after initial screening; no other associations between social risk and utilization were observed.
Conclusions
This study suggests that screening for social risk may be appropriate at intervals of six months, or perhaps longer, but that assessing desire for assistance may need to occur more frequently. Housing risks were associated with increases in acute care. Health systems may need to engage in screening and referral to resources to improve overall care and ultimately patient total health.
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Jones SMW. Financial Worry in People with Cancer: Relationship to Employment and Outcomes. Psychooncology 2022; 31:1835-1842. [DOI: 10.1002/pon.6034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022]
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Jones SMW, Gaffney A, Unger JM. Common methods of determining meaningful change in clinical practice: implications for precision patient-reported outcomes. Qual Life Res 2022; 32:1231-1238. [PMID: 36087227 DOI: 10.1007/s11136-022-03246-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are used in clinical practice for several purposes, including to monitor whether a treatment is working or whether a patient is experiencing adverse events from treatment. This study surveyed oncology providers (OP) and mental health providers (MHP) to determine how clinicians from different disciplines determine individual-level meaningful change on PROs. Understanding how clinicians determine change on PROs could help inform methods for individualizing meaningful change definitions, an approach we have dubbed "Precision PROs". METHODS Three hundred and forty-seven providers utilizing PROs completed an online survey about PRO use to monitor patients in clinical practice. A question on methods used to determine individual-level meaningful change on PROs was developed with input from clinicians. Multivariate logistic regression analyses were used to assess whether specific methods were associated with clinician characteristics. RESULTS The most commonly reported method was comparing the previous score to the current score (65%). Other methods included examining the numerical scores without a visual aid (59%), considering other factors affecting scores (42%), comparing scores to norms (31%) and using a graph of scores (29%). Provider age was negatively associated with odds of using a graph (OR = 0.95, 95% CI 0.91, 1.0) but no other method. Provider gender, hours per week in clinical practice and years in practice were not associated with odds of using a specific method. CONCLUSIONS Most providers determined individual-level meaningful change without a visual aid and used only the previous score and current score, the minimum number (2 scores) to determine change. Consistent with current practice, future research on methods of determining within-individual meaningful change for clinical use should focus on methods requiring two rather than three or more scores. When attempting to personalize within-individual change definitions (Precision PROs), methods examining a baseline and single follow-up may be most useful for clinical practice.
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Affiliation(s)
- Salene M W Jones
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | - Aliana Gaffney
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Joseph M Unger
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
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Jones SMW, Sherman KJ, Bermet Z, Palazzo LG, Lewis CC. An experimental study to inform adoption of mindfulness-based stress reduction in chronic low back pain. Implement Sci Commun 2022; 3:87. [PMID: 35933438 PMCID: PMC9356436 DOI: 10.1186/s43058-022-00335-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic low back pain is a common and sometimes disabling condition, and mindfulness-based stress reduction is recommended as a first line of therapy. This study tested whether different descriptions of mindfulness training altered based on influential intervention characteristics increased adoption intentions. METHODS People with chronic low back pain (n = 452) were randomized to review one of four mindfulness training descriptions in an online survey using a 2 × 2 factorial design. The first factor was evidence strength and quality with relative advantage (ER). The second factor was adaptability, trialability, complexity, and design quality and packaging (AD). Each factor had two levels: a description of standardized mindfulness training that described each intervention characteristic and a patient-centered description emphasizing flexibility and patient testimonials. The primary outcomes were intentions to try mindfulness training and practice mindfulness at home. Using structural equation modeling with a bootstrapped distribution, we tested six mediators, three of which are Theory of Planned Behavior predictors of intention-self-efficacy, norms, and attitudes- and the other three are predictors of adoption-feasibility, appropriateness, and acceptability. RESULTS Overall, the mindfulness training descriptions were not associated with an increase in intentions compared to the classic vignette (11/12 p's > 0.05). Most descriptions were unrelated to mediators except the classic ER with patient-centered AD was associated with higher self-efficacy/control and feasibility (p's ≤ 0.05; standardized effect range: 0.111-0.125). Self-efficacy/control (training standardized coefficient: 0.531, home: 0.686), norms (training: 0.303, home: 0.256), and attitudes (training: 0.316, home: 0.293) were all positively associated with intentions to adopt mindfulness training and home practice. Feasibility (training: 0.185; home: 0.293) and acceptability (training: 0.639; home: 0.554) were positively related to intentions to adopt mindfulness training. Appropriateness was related to intentions to adopt home practice (0.187) but not mindfulness training (0.100). None of the indirect effects from experimental group to intentions was significant (all p's > 0.05). CONCLUSIONS Self-efficacy/control and acceptability may be key mediators for increasing patient adoption of mindfulness. Because experimental manipulation did not substantially change intentions to adopt mindfulness, the presentation and delivery of MBSR may need to be tailored to the individual patient's needs rather than a specific format for chronic low back pain.
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Affiliation(s)
- Salene M. W. Jones
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109 USA ,grid.488833.c0000 0004 0615 7519Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Karen J. Sherman
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109 USA ,grid.488833.c0000 0004 0615 7519Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Zoe Bermet
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109 USA ,grid.488833.c0000 0004 0615 7519Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Lorella G. Palazzo
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109 USA ,grid.488833.c0000 0004 0615 7519Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Cara C. Lewis
- grid.270240.30000 0001 2180 1622Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109 USA ,grid.488833.c0000 0004 0615 7519Kaiser Permanente Washington Health Research Institute, Seattle, USA
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Abstract
CONTEXT Most patient-reported outcomes (PRO) are not directly tailored to an individual patient's values, partially because tailored PROs require clinical interviews or are difficult to use in statistical analyses. OBJECTIVES This study tested a method for tailoring pain PROs, Precision PROs, that can be implemented, and analyzed using standard statistical tests. METHODS People with cancer and pain (n = 231) completed an online survey and then a second survey (n = 161) one to two weeks later. Participants reviewed the PROMIS pain interference item bank, chose the four items most important to their quality of life, and then completed those items. Kappas compared choices between the two surveys. Participants completed measures of pain intensity, physical function, and a standard pain interference measure. RESULTS All participants were able to select four items that were personally meaningful. Only one item (enjoyment of life) was chosen by more than half the sample (50.6%). Kappas for item choice were in the moderate to nearly perfect range for 32 of 35 items. The majority of the sample (59%) preferred tailoring their own PRO questions to completing a previously determined, non-patient-specific PRO. The Precision PRO scores had similar associations with pain intensity and physical function as the standard pain interference measure. CONCLUSION The Precision PRO approach was feasible, more preferred by patients, and showed consistency over a short timeframe. This approach could be used to make PRO assessment in clinical care and clinical trials more patient-centered. Additional research is needed to determine the generalizability of this approach to other outcomes and populations.
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Affiliation(s)
- Salene M W Jones
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
| | - Joseph M Unger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Jones SMW, Edwards TC, Leroux BG, Kapp-Simon KA, Patrick DL, Stueckle LP, Rosenberg JM, Albert M, Bellucci CC, Aspinall CL, Vick K, Heike CL. Exploration of Caregiver Interrater Agreement and Test-Retest Reliability on the Infant Cleft Observer Outcomes (iCOO). Cleft Palate Craniofac J 2022:10556656221089155. [PMID: 35341357 PMCID: PMC9515238 DOI: 10.1177/10556656221089155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Caregiver and observer-reported measures are frequently used as outcomes for research on infants and young children who are unable to report on their own health. Our team developed the Infant with Clefts Observation Outcomes Instrument (iCOO) for infants with cleft lip with or without cleft palate. This exploratory study compared test-retest and interrater reliabilities to inform whether differences in caregiver perspective might affect the iCOO. This study is a secondary analysis comparing caregiver interrater agreement to test-retest reliability. Twenty-five pairs of caregivers completed the iCOO before surgery, 1 week later for test-retest reliability, 2 days after surgery, and 2 months after surgery. Reliability was assessed using intraclass correlations (ICCs) and t-tests were used to compare ratings between caregivers. Infants had cleft lip (28%) or cleft lip and palate (72%). Primary caregivers were predominantly mothers (92%) and secondary caregivers were predominantly fathers (80%). Test-retest reliability met psychometric standards for most items on the iCOO (81%-86% of items). Caregiver agreement on the iCOO items was lower than test-retest reliability (33%-46% of items met psychometric standards). Caregivers did not systematically differ in whether they rated infants as healthier or less healthy than the other caregiver (5%-16% of items had statistically significant differences). Caregivers used the measure consistently, but had different experiences and perceptions of their infant's health and functioning. Future studies are needed to explore mechanisms for the differences in test-retest and interrater reliability. Whenever possible, the same caregiver should provide ratings of the infant, including on the iCOO.
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Tuzzio L, Wellman RD, De Marchis EH, Gottlieb LM, Walsh-Bailey C, Jones SMW, Nau CL, Steiner JF, Banegas MP, Sharp AL, Derus A, Lewis CC. Social Risk Factors and Desire for Assistance Among Patients Receiving Subsidized Health Care Insurance in a US-Based Integrated Delivery System. Ann Fam Med 2022; 20:137-144. [PMID: 35346929 PMCID: PMC8959745 DOI: 10.1370/afm.2774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/18/2021] [Accepted: 09/28/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Because social conditions such as food insecurity and housing instability shape health outcomes, health systems are increasingly screening for and addressing patients' social risks. This study documented the prevalence of social risks and examined the desire for assistance in addressing those risks in a US-based integrated delivery system. METHODS A survey was administered to Kaiser Permanente members on subsidized exchange health insurance plans (2018-2019). The survey included questions about 4 domains of social risks, desire for help, and attitudes. We conducted a descriptive analysis and estimated multivariate modified Poisson regression models. RESULTS Of 438 participants, 212 (48%) reported at least 1 social risk factor. Housing instability was the most common (70%) factor reported. Members with social risks reported more discomfort being screened for social risks (14.2% vs 5.4%; P = .002) than those without risks, although 90% of participants believed that health systems should assist in addressing social risks. Among those with 1-2 social risks, however, only 27% desired assistance. Non-Hispanic Black participants who reported a social risk were more than twice as likely to desire assistance compared with non-Hispanic White participants (adjusted relative risk [RR] 2.2; 95% CI, 1.3-3.8). CONCLUSIONS Athough most survey participants believed health systems have a role in addressing social risks, a minority of those reporting a risk wanted assistance and reported more discomfort being screened for risk factors than those without risks. Health systems should work to increase the comfort of patients in reporting risks, explore how to successfully assist them when desired, and offer resources to address these risks outside the health care sector.VISUAL ABSTRACT.
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Affiliation(s)
- Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Robert D Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Laura M Gottlieb
- University of California San Francisco, San Francisco, California
| | | | | | - Claudia L Nau
- Kaiser Permanente Southern California Research and Evaluation Department, Pasadena, California.,Kaiser Permanente School of Medicine Health Systems Science Department, Pasadena, California
| | - John F Steiner
- Kaiser Permanente Institute for Health Research, Denver, Colorado
| | | | - Adam L Sharp
- Kaiser Permanente Southern California Research and Evaluation Department, Pasadena, California.,Kaiser Permanente School of Medicine Health Systems Science Department, Pasadena, California
| | - Alphonse Derus
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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13
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Jones SMW, Sherman KJ, Bermet Z, Palazzo LG, Lewis CC. Theory of Planned Behavior and Mindfulness Intentions in Chronic Low Back Pain. Mindfulness (N Y) 2022; 13:3145-3152. [PMID: 36408120 PMCID: PMC9648996 DOI: 10.1007/s12671-022-02022-2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/12/2022]
Abstract
Objectives Theory of planned of behavior (TPB) constructs have been linked to health behavior intentions. Intentions to try mindfulness-based stress reduction (MBSR), a first-line therapy for chronic low back pain (cLBP), have been less studied. This study aimed to identify which TPB constructs could inform strategies to improve adoption of MBSR. Methods People with cLBP (n = 457) read a description of MBSR then completed survey items assessing TPB constructs: attitudes, norms, self-efficacy, perceived control, and intentions to try MBSR training. Results Structural equation modeling showed self-efficacy/control (coefficient: 0.564), norms (0.245), and attitudes (0.131) were all positively associated with intentions to try mindfulness trainings. Conclusions Results suggest self-efficacy/control may be the most strongly related TPB construct with intentions to try MBSR. Dissemination of MBSR for cLBP could focus on adapting the intervention to increase accessibility and improving available resources to overcome logistical barriers (online formats, drop-in classes). Supplementary Information The online version contains supplementary material available at 10.1007/s12671-022-02022-2.
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Affiliation(s)
- Salene M. W. Jones
- Fred Hutchinson Cancer Research Center, Kaiser Permanente Washington Health Research Institute, University of Washington, 1100 Fairview Ave N, Seattle, WA 98109 USA
| | - Karen J. Sherman
- Fred Hutchinson Cancer Research Center, Kaiser Permanente Washington Health Research Institute, University of Washington, 1100 Fairview Ave N, Seattle, WA 98109 USA
| | - Zoe Bermet
- University of Washington, Seattle, WA USA
| | - Lorella G. Palazzo
- Fred Hutchinson Cancer Research Center, Kaiser Permanente Washington Health Research Institute, University of Washington, 1100 Fairview Ave N, Seattle, WA 98109 USA
| | - Cara C. Lewis
- Fred Hutchinson Cancer Research Center, Kaiser Permanente Washington Health Research Institute, University of Washington, 1100 Fairview Ave N, Seattle, WA 98109 USA
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14
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Wingood M, Jones SMW, Gell NM, Brach JS, Peters DM. The Inventory of Physical Activity Barriers for Adults 50 Years and Older: Refinement and Validation. Gerontologist 2021; 62:e555-e563. [PMID: 34794173 PMCID: PMC9710241 DOI: 10.1093/geront/gnab165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Due to health consequences associated with insufficient physical activity (PA), particularly among aging adults, health care providers should assess and address lack of PA participation. Addressing lack of PA means developing individualized PA prescriptions that incorporate solutions to PA participation barriers. Assessing PA participation barriers can be done through the Social Ecological Model-based Inventory of Physical Activity Barriers Scale (IPAB). This study aimed to refine the initial 40-item IPAB and determine its reliability and validity. RESEARCH DESIGN AND METHODS Five hundred and three community-dwelling adults 50 years and older completed a demographic and health questionnaire, the Physical Activity Vital Sign, the IPAB, and a feedback questionnaire. For scale refinement, half of the data were used for exploratory factor analysis and the other half for confirmatory factor analysis. The refined scale underwent reliability and validity assessment, including internal consistency, test-retest reliability, and construct validity. RESULTS The refined scale contains 27 items consisting of 7 factors and 1 stand-alone item: (a) environmental, (b) physical health, (c) PA-related motivation, (d) emotional health, (e) time, (f) skills, (g) social, and (h) energy (a stand-alone item). The 27-item IPAB has good internal consistency (alpha = 0.91) and high test-retest reliability (intraclass correlation coefficient = 0.99). The IPAB's mean scores were statistically different between those who met the recommended levels of PA and those who did not (p < .001). DISCUSSION AND IMPLICATIONS The information gathered through the IPAB can guide discussions related to PA participation barriers and develop individualized PA prescriptions that incorporate solutions to the identified barriers.
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Affiliation(s)
- Mariana Wingood
- Address correspondence to: Mariana Wingood, PhD, Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Drive, Rowell Building, Burlington, VT 05405, USA. E-mail:
| | - Salene M W Jones
- Public Health Science Division, Fred Hutch, Seattle, Washington, USA
| | - Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Denise M Peters
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
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15
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Jones SMW, Gaffney A, Unger JM. A comparison of oncologist versus mental health provider attitudes towards standardized and tailored patient-reported outcomes. J Patient Rep Outcomes 2021; 5:76. [PMID: 34427805 PMCID: PMC8384935 DOI: 10.1186/s41687-021-00352-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) can be used to monitor patients during treatment. Healthcare provider preferences for individualized vs. standardized PROs have been understudied. METHODS This study surveyed oncology and mental health providers to compare attitudes towards individualized and standardized PROs. We have developed a method for individualizing PROs, called precision PROs, and the survey specifically assessed preferences for this method. We compared attitudes and preferences by provider type and by whether respondents were current or never users of PROs. RESULTS Oncology providers expressed more positive attitudes for standardized PROs in treatment planning compared to mental health providers (F(1,440) = 5.978, p = 0.015). The interaction between provider type (oncology vs. mental health) and type of PRO (individualized vs. standardized) was not significant for the attitudes about the clinical utility of PROs (p = 0.709). When directly asked about the precision PRO approach, oncologists were less likely to prefer standardized items (OR = 0.478, p = 0.001) or have no preference (OR = 0.445, p = 0.007) to the precision PRO approach when compared to mental health providers. Qualitative analyses suggested standardized PROs may be simpler or easier to understand whereas individualized PROs better capture patient variability and the unique aspects of each patient's condition. Some mental health providers expressed reticence about letting patients choose how to tailor PROs. Never users of PROs reported more positive attitudes towards individualized measures than standardized measures whereas current users of PROs did not have a difference in attitudes (p = 0.010). User status was mostly unrelated to preferences. CONCLUSION Results suggest that healthcare provider preference for individualized PROs may differ by medical specialty. How PROs are tailored may need to differ by discipline. This is particularly important given that previous research showing a preference for individualized PROs over standardized was conducted with psychotherapists. Further research on patient preferences for individualized and standardized PROs is warranted as is research on the clinical utility of individualized PROs such as the precision PRO approach.
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Affiliation(s)
- Salene M W Jones
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | - Aliana Gaffney
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Joseph M Unger
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
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16
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Jones SMW, Banegas MP, Steiner JF, De Marchis EH, Gottlieb LM, Sharp AL. Association of Financial Worry and Material Financial Risk with Short-Term Ambulatory Healthcare Utilization in a Sample of Subsidized Exchange Patients. J Gen Intern Med 2021; 36:1561-1567. [PMID: 33469762 PMCID: PMC8175504 DOI: 10.1007/s11606-020-06479-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/15/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Financial burden can affect healthcare utilization. Few studies have assessed the short-term associations between material (debt, trouble paying rent) and psychological (worry or distress about affording future healthcare) financial risks, and subsequent outpatient and emergency healthcare use. Worry was defined as concerns about affording future healthcare. OBJECTIVE Examine whether worry about affording healthcare is associated with healthcare utilization when controlling for material risk and general anxiety DESIGN: Longitudinal observational study PARTICIPANTS: Kaiser Permanente members with exchange-based federally subsidized health insurance (n = 450, 45% response rate) MAIN MEASURES: Survey measures of financial risks (material difficulty paying for medical care and worry about affording healthcare) and general anxiety. Healthcare use (primary care, urgent care, emergency department, and outpatient specialty visits) in the 6 months following survey completion. KEY RESULTS Emergency department and primary care visits were not associated with material risk, worry about affording care, or general anxiety in individual and pooled analyses (all 95% confidence intervals (CI) for relative risk (RR) included 1). Although no individual predictor was associated with urgent care use (all 95% CIs for RR included 1), worry about affording prescriptions (relative risk (RR) = 2.01; 95% CI 1.14, 3.55) and general anxiety (RR = 0.38; 95% CI 0.15, 0.95) were significant when included in the same model, suggesting the two confounded each other. Worry about affording healthcare services was associated with fewer specialty care visits (RR = 0.40; 95% CI 0.25, 0.64) even when controlling for material risk and general anxiety, although general anxiety was also associated with more specialty care visits (RR = 1.98; 95% CI, 1.23, 3.18). CONCLUSIONS Screening for both general anxiety and financial worry may assist with specialty care utilization. Identifying these concerns may provide more opportunities to assist patients. Future research should examine interventions to reduce worry about cost of care.
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Affiliation(s)
| | - Matthew P Banegas
- Kaiser Permanente Oregon Center for Health Research, Portland, OR, USA
| | - John F Steiner
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Emilia H De Marchis
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Adam L Sharp
- Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, CA, USA
- Health Systems Science Department, Kaiser Permanente School of Medicine, Pasadena, CA, USA
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17
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Jones SMW, Gaffney A, Unger JM. Using patient-reported outcomes in measurement-based care: perceived barriers and benefits in oncologists and mental health providers. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01580-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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Jones SMW, Schuler TA, Padamsee TJ, Andersen MR. Financial Anxiety is Associated With Cancer Screening Adherence in Women at High Risk of Breast Cancer. Ann Behav Med 2021; 55:1241-1245. [PMID: 33761532 DOI: 10.1093/abm/kaab010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies have examined the impact of material financial hardship on cancer screening but without focusing on the psychological aspects of financial hardship. PURPOSE This study examined the effects of different types of financial anxiety on adherence to breast cancer screening in women at high risk of breast cancer. Adherence to cervical cancer screening was also examined to determine whether associations between financial anxiety and screening adherence were unique to breast cancer screening or more general. METHODS Women (n = 324) aged 30-50 and at high risk for inherited breast cancer completed a survey on general financial anxiety, worry about affording healthcare, financial stigma due to cancer risk, and adherence to cancer screening. Multivariate analyses controlled for poverty, age, and race. RESULTS More financial anxiety was associated with lower odds of mammogram adherence (odds ratio [OR] = 0.97, confidence interval [CI] = 0.94, 0.99), Pap smear adherence (OR = 0.98, CI = 0.96, 0.996), and clinical breast examination adherence (OR = 0.98, CI = 0.96, 0.995). More worry about affording healthcare was associated with lower odds of clinical breast examination adherence (OR = 0.95, CI = 0.91, 0.9992) but not mammogram or Pap smear adherence (p > .05). Financial stigma due to cancer risk was associated with lower odds of Pap smear adherence (OR = 0.87, CI = 0.77, 0.97) but no other cancer screenings (p > .07). CONCLUSIONS Financial anxiety may impede cancer screening, even for high-risk women aware of their risk status. Clinical interventions focused on social determinants of health may also need to address financial anxiety for women at high risk of breast cancer.
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Affiliation(s)
- Salene M W Jones
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Tammy A Schuler
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Tasleem J Padamsee
- The Ohio State University College of Public Health and James Comprehensive Cancer Center, Columbus, OH, USA
| | - M Robyn Andersen
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
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19
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Lewis CC, Wellman R, Jones SMW, Walsh-Bailey C, Thompson E, Derus A, Paolino A, Steiner J, De Marchis EH, Gottlieb LM, Sharp AL. Comparing the performance of two social risk screening tools in a vulnerable subpopulation. J Family Med Prim Care 2020; 9:5026-5034. [PMID: 33209839 PMCID: PMC7652127 DOI: 10.4103/jfmpc.jfmpc_650_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/10/2020] [Accepted: 07/03/2020] [Indexed: 12/27/2022] Open
Abstract
Background Research shows the profound impact of social factors on health, lead many healths systems to incorporate social risk screening. To help healthcare systems select among various screening tools we compared two tools, the Your Current Life Situation (YCLS) and the Accountable Health Communities (AHC) Screening tools, on key psychometric properties. Method Kaiser Permanente Southern California subsidized exchange members (n = 1008) were randomly invited to complete a survey containing either the YCLS or the AHC tool, as well as other measures related to care experience and health. Healthcare use was measured through the electronic health record. Agreement between the AHC and YCLS was assessed using adjusted kappas for six domains (food - worry, food - pay, insecure housing, housing quality, transportation, utilities). To assess predictive validity, items on the AHC and YCLS were compared to self-rated health and receipt of a flu shot. Results Responders (n = 450) and non-responders (n = 558) significantly differed on sex, language, and depression (P < 0.05) but not anxiety, race/ethnicity, or healthcare use. Agreement between the AHC and YCLS tools was substantial on all items (kappas > 0.60) except for housing quality (kappa 0.52). Four out of six screening questions on the AHC tool and four out of seven on the YCLS tool were associated with self-rated health (P < 0.03). No social needs were associated with flu shot receipt except utilities on the AHC tool (P = 0.028). Conclusion In this sample, the AHC and YCLS tools are similar in their ability to screen for social risks. Differences observed likely stem from the timeframe and wording of the questions, which can be used to guide selection in healthcare systems.
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, USA
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, USA
| | - Salene M W Jones
- Hutchinson Institute for Cancer Outcomes Research, 1100 Fairview Ave. N., Seattle, WA, USA
| | - Callie Walsh-Bailey
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, USA
| | - Ella Thompson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, USA
| | - Alphonse Derus
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, USA
| | - Andrea Paolino
- Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Rd Suite 200 Aurora, CO, USA
| | - John Steiner
- Kaiser Permanente Colorado Institute for Health Research, 2550 S. Parker Rd Suite 200 Aurora, CO, USA
| | - Emilia H De Marchis
- University of California San Francisco, Department of Family and Community Medicine, 505 Parnassus Ave, San Francisco, CA, USA
| | - Laura M Gottlieb
- University of California San Francisco, Department of Family and Community Medicine, 505 Parnassus Ave, San Francisco, CA, USA
| | - Adam L Sharp
- Kaiser Permanent Southern California, Research and Evaluation Department, 100 S Los Robles Ave, Pasadena, CA 91101 Pasadena, CA, USA.,Kaiser Permanente School of Medicine, Health Systems Science Department, 98 S. Los Robles Ave., Pasadena, CA, USA
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Abstract
This study examined the association of healthcare use (HCU) with financial outcomes in a general population sample (n = 395) to determine if HCU was associated with increased financial worry as most research has examined socioeconomic indicators and material financial problems. Participants reported six types of HCUin the previous year, financial anxiety (FA) and worry about affording healthcare (WAH) in an online survey. In bivariate comparisons, WAH was associated with all forms of HCU and FA was associated with all forms of HCU except outpatient visits. In multivariate analyses, WAH was associated with outpatient visits, emergency room visits, number of doctors, number of scans and number of blood tests (p's<0.05) but not urgent care visits. FA was associated with emergency room visits, urgent care visits, and number of doctors (p's<0.05) but not other forms of HCU in multivariate comparisons. As many forms of HCU were associated with more WAH and FA, policy initiatives and patient-level interventions should focus on managing costs rather than shifting from emergency to outpatient care. Results also suggest that the financial costs of healthcare, as indexed by HCU, may have an effect on anxiety and worry specific to healthcare even when controlling for socioeconomic factors.
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Affiliation(s)
- Salene M W Jones
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Paul Litwin
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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21
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Jones SMW, Du Y, Bell-Brown A, Bolt K, Unger JM. Feasibility and Validity of Asking Patients to Define Individual Levels of Meaningful Change on Patient-Reported Outcomes. J Patient Cent Res Rev 2020; 7:239-248. [PMID: 32760755 DOI: 10.17294/2330-0698.1742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Patient-reported outcomes (PROs) are frequently used in clinical care to monitor treatment response. However, most guidelines on PRO use treat all patients the same. This study tested the feasibility and validity of a method for determining individually meaningful change in PRO measures. Methods Participants (n=398) completed 12 pain and distress questions to define individually meaningful change. This mixed-methods study used both quantitative and qualitative analyses, including descriptive statistics, inferential statistics, and content analysis. Results Two-thirds (67%) of the sample reported at least one medical condition, including depression and back pain. Most participants (70%-90%) were able to answer the questions as intended. Participants varied widely in the amount of change they considered meaningful (coefficients of variation: 40%-99%). Higher symptom levels were associated with larger amounts of change considered meaningful and with greater likelihood of answering questions as intended. Participants reported a variety of reasons for why they considered an amount of change in pain or distress meaningful. The hypothetical nature of the questions and the need to reference previous questions was found to be confusing. Conclusions Asking patients to define an individual level for meaningful change on PROs was feasible and valid. Having patients define their own goals on PROs for treatment of pain or distress could make treatment more patient-centered.
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Affiliation(s)
| | - Yuxian Du
- Fred Hutchinson Cancer Research Center, Seattle, WA.,Data Generation and Observational Studies, Bayer HealthCare LLC, Whippany, NJ
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22
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Jones SMW, Du Y, Panattoni L, Henrikson NB. Assessing Worry About Affording Healthcare in a General Population Sample. Front Psychol 2019; 10:2622. [PMID: 31824388 PMCID: PMC6883904 DOI: 10.3389/fpsyg.2019.02622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022] Open
Abstract
This study adapted a measure on worry about affording healthcare. The financial costs of healthcare are increasingly being shifted to patients. Financial burden from healthcare costs can be material (such as bankruptcy) or psychological. Psychological distress can be either worry about affording future care or distress due to material consequences and, despite evidence from clinical psychology that differentiates these types of emotional symptoms, this distinction has largely been ignored for financial burden in healthcare. We adapted a worry about affording healthcare scale for use in the general population (n = 398) to facilitate comparisons between disease groups and across countries. Participants completed a survey through an online platform. The worry about affording healthcare measure showed good reliability and validity through associations with quality of life (QOL) and measures of other types of financial burden. Worry about affording healthcare was also associated with cost-related non-adherence to medical care. Future research on patient QOL should consider worry about affording healthcare.
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Affiliation(s)
- Salene M W Jones
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Yuxian Du
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Bayer Healthcare U.S. LLC, Whippany, NJ, United States
| | - Laura Panattoni
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
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Jones SMW, Parchman M, McDonald S, Cromp D, Austin B, Flinter M, Hsu C, Wagner E. Measuring attributes of team functioning in primary care settings: development of the TEAMS tool. J Interprof Care 2019; 34:407-413. [PMID: 31573363 DOI: 10.1080/13561820.2019.1670628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines attributes of a high-functioning primary care team by creating a survey measuring staff perceptions of team culture in primary care practices with innovative team-based workforce models. Survey data from a national study of 30 exemplar primary care practices with innovative team-based workforce models was used. Staff and clinicians (n = 943) at the 30 primary care sites completed a 31-item survey online. Survey items came from previous surveys of adaptive reserve and team culture. Factor analysis, reliability and validity were examined for the survey. Case summaries from site visits and survey comments were compared for high and low scoring sites to establish validity. Three core attributes of a high-functioning team were identified: joy in practice (4 items), personal growth (3 items), and leadership and learning (20 items). Four items did not measure any attribute. Using item correlations, the 20 items for leadership and learning were reduced to 7 items. All three attribute subscales had good reliability and validity. The final 14-item survey measuring joy in practice, personal growth and leadership and learning may be useful in clinical practice as a practical tool to gauge progress in developing a high-functioning team. Further research is needed to determine the sensitivity of this instrument to change over time with interventions designed to improve team functioning in primary care.
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Affiliation(s)
| | - Michael Parchman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sarah McDonald
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - DeAnn Cromp
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Brian Austin
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Ed Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Abstract
Objective: Financial problems in cancer survivors are associated with distress and reduced quality of life. Most studies have been cross-sectional, and a longitudinal study is needed to guide clinical interventions. Method: We used data from two surveys of the National Health and Aging Trends Study (NHATS). Participants (n = 307) reported whether they experienced six indicators of financial burden. The Patient Health Questionnaire 4 assessed depressive symptoms and general anxiety. Cross-lagged panel analyses assessed whether financial burden predicted distress and health or vice versa. Results: In the total sample, financial burden at the first survey predicted depressive symptoms (p < .01), general anxiety (p < .01), and self-rated health (p < .01) at the second survey. Depressive symptoms, general anxiety, and self-rated health at the first survey did not predict later financial burden (ps > .05). Discussion: Results suggest financial problems predict later distress and poor health. This study highlights the need to address financial burden in cancer survivors.
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Affiliation(s)
| | - Trung Nguyen
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Abstract
Background People with multiple sclerosis (MS) are at increased risk for depression and anxiety. The symptoms of MS are often similar to the somatic or physical symptoms of depression and anxiety (fatigue, trouble concentrating). This study examined whether MS symptoms and effects biased the assessment of somatic symptoms of anxiety and depression. Methods People with MS (n = 513) completed a survey about MS symptoms, treatments, and distress. The Patient Health Questionnaire-9 assessed depression, and the patient-report version of the Primary Care Evaluation of Mental Disorders assessed anxiety. Participants were grouped into low versus high MS symptoms based on self-reported symptoms and as high versus low disability by the Expanded Disability Status Scale (EDSS). Groups were compared using differential item functioning analysis. Results No bias was found on somatic symptoms of depression comparing high versus low MS symptom groups (P > .15) or comparing groups based on EDSS scores (P > .29). Two anxiety symptoms (fatigue and muscle tension) showed bias comparing high versus low MS symptom groups (P < .01) and comparing high versus low groups based on EDSS scores (P ≤ .01). Intraclass correlations suggested a small effect due to bias in the somatic symptoms of anxiety. Conclusions Somatic symptoms of depression are unlikely to be biased by MS symptoms. However, the use of certain somatic symptoms to assess anxiety may be biased for those with high MS symptoms.
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Abstract
The focus on recovery, not just symptom reduction, in mental health care brings a need for psychometrically sound measures of recovery. This study examined the factor structure and sensitivity to change of a common measure of mental health recovery, the Recovery Assessment Scale (RAS). We conducted a secondary data analysis from a randomized clinical trial of self-management for depression (n = 302). We tested both bifactor and the previously found five-factor model. Sensitivity to change was examined three ways: (1) between the intervention and control group; (2) across time in the intervention group; and (3) in those whose depression remitted. The previous five-factor model was supported. One subscale, no domination by symptoms, was particularly sensitive to change and showed sensitivity to change whereas the subscale reliance on others did not show change in any of the comparisons. Results suggest that the subscales of the RAS should be examined separately in future studies of recovery.
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Affiliation(s)
- Salene M W Jones
- Group Health Research Institute, 1730 Minor Ave, #1600, Seattle, WA, 98101, USA.
| | - Evette J Ludman
- Group Health Research Institute, 1730 Minor Ave, #1600, Seattle, WA, 98101, USA
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Carpenter JS, Jones SMW, Studts CR, Heiman JR, Reed SD, Newton KM, Guthrie KA, Larson JC, Cohen LS, Freeman EW, Jane Lau R, Learman LA, Shifren JL. Female Sexual Function Index Short Version: A MsFLASH Item Response Analysis. Arch Sex Behav 2016; 45:1897-1905. [PMID: 27502350 PMCID: PMC5053877 DOI: 10.1007/s10508-016-0804-5] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 06/15/2016] [Accepted: 06/28/2016] [Indexed: 05/25/2023]
Abstract
The Female Sexual Function Index (FSFI) is a psychometrically sound and popular 19-item self-report measure, but its length may preclude its use in studies with multiple outcome measures, especially when sexual function is not a primary endpoint. Only one attempt has been made to create a shorter scale, resulting in the Italian FSFI-6, later translated into Spanish and Korean without further psychometric analysis. Our study evaluated whether a subset of items on the 19-item English-language FSFI would perform as well as the full-length FSFI in peri- and postmenopausal women. We used baseline data from 898 peri- and postmenopausal women recruited from multiple communities, ages 42-62 years, and enrolled in randomized controlled trials for vasomotor symptom management. Goals were to (1) create a psychometrically sound, shorter version of the FSFI for use in peri- and postmenopausal women as a continuous measure and (2) compare it to the Italian FSFI-6. Results indicated that a 9-item scale provided more information than the FSFI-6 across a spectrum of sexual functioning, was able to capture sample variability, and showed sufficient range without floor or ceiling effects. All but one of the items from the Italian 6-item version were included in the 9-item version. Most omitted FSFI items focused on frequency of events or experiences. When assessment of sexual function is a secondary endpoint and subject burden related to questionnaire length is a priority, the 9-item FSFI may provide important information about sexual function in English-speaking peri- and postmenopausal women.
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Affiliation(s)
- Janet S Carpenter
- Department of Science of Nursing Care, School of Nursing, Indiana University, Indianapolis, IN, USA.
- School of Nursing, Indiana University, 600 Barnhill Drive NU 340G, Indianapolis, IN, 46202, USA.
| | | | - Christina R Studts
- Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Julia R Heiman
- Psychological & Brain Sciences, The Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Susan D Reed
- Departments of Obstetrics/Gynecology and Epidemiology, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Katherine A Guthrie
- Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Joseph C Larson
- Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lee S Cohen
- Center for Women's Mental Health, Massachusetts General Hospital, Boston, MA, USA
| | - Ellen W Freeman
- Departments of Obstetrics/Gynecology and Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - R Jane Lau
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Lee A Learman
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Jan L Shifren
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Jones SMW, Lange J, Turner J, Cherkin D, Ritenbaugh C, Hsu C, Berthoud H, Sherman K. Development and Validation of the EXPECT Questionnaire: Assessing Patient Expectations of Outcomes of Complementary and Alternative Medicine Treatments for Chronic Pain. J Altern Complement Med 2016; 22:936-946. [PMID: 27689427 DOI: 10.1089/acm.2016.0242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient expectations may be associated with outcomes of complementary and alternative medicine (CAM) treatments for chronic pain. However, a psychometrically sound measure of such expectations is needed. OBJECTIVES The purpose of this study was to develop and evaluate a questionnaire to assess individuals' expectations regarding outcomes of CAM treatments for chronic low back pain (CLBP), as well as a short form of the questionnaire. METHODS An 18-item draft questionnaire was developed through literature review, cognitive interviews with individuals with CLBP, CAM practitioners, and expert consultation. Two samples completed the questionnaire: (1) a community sample (n = 141) completed it via an online survey before or soon after starting a CAM treatment for CLBP, and (2) participants (n = 181) in randomized clinical trials evaluating CAM treatments for CLBP or fibromyalgia completed it prior to or shortly after starting treatment. Factor structure, internal consistency, test-retest reliability, and criterion validity were examined. RESULTS Based on factor analyses, 10 items reflecting expectations (used to create a total score) and three items reflecting hopes (not scored) were selected for the questionnaire. The questionnaire had high internal consistency, moderate test-retest reliability, and moderate correlations with other measures of expectations. A three-item short form also had adequate reliability and validity. CONCLUSIONS The Expectations for Complementary and Alternative Medicine Treatments (EXPECT) questionnaire can be used in research to assess individuals' expectations of treatments for chronic pain. It is recommended that the three hope questions are included (but not scored) to help respondents distinguish between hopes and expectations. The short form may be appropriate for clinical settings and when expectation measurement is not a primary focus.
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Affiliation(s)
| | - Jane Lange
- 2 Fred Hutchinson Cancer Research Center , Seattle, WA
| | | | - Dan Cherkin
- 1 Group Health Research Institute , Seattle, WA
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Jones SMW, Amtmann D. Differential item function analysis of a scale measuring worry about affording healthcare in multiple sclerosis. Rehabil Psychol 2016; 61:430-434. [PMID: 27571410 DOI: 10.1037/rep0000105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE A measure of worry about affording health care was developed in people with multiple sclerosis (MS) to further the study of how trouble affording health care can affect health. This study examined whether the measure showed bias by gender, age, insurance type, income, and type of MS. Absence of bias would facilitate comparisons between groups in future studies. Research methods/Design: A sample of 433 people with MS completed the 5-item worry about affording health care measure. Demographic information was also collected. To test for bias, we used differential item function analysis with the graded response model of item response theory. We tested for bias from gender, age, insurance type, income, and type of MS. RESULTS Differential item function analyses found no significant bias for the worry about affording health care measure when comparing the following groups: men to women; younger than 55 years old to 55 years and older; public insurance to no public insurance; lower income to higher income; and relapsing/remitting MS type to other MS types. CONCLUSIONS/IMPLICATIONS This brief measure of worry about affording health care can be used in future studies without concern for measurement bias on the factors examined here. Future studies should examine the relationship of this worry to adherence to treatment and other factors that may be affected by worries about health care affordability. (PsycINFO Database Record
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Affiliation(s)
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington
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Abstract
This study examined the accuracy of depression cross-walk tables in a sample of people with multiple sclerosis (MS). The tables link scores of two commonly used depression measures to the Patient Reported Outcome Measurement Information System Depression (PROMIS-D) scale metric. We administered the 8-item PROMIS-D (Short-Form 8b; PROMIS-D-8), the 20-item Center for Epidemiologic Studies Depression Scale (CESD-20), and the 9-item Patient Health Questionnaire (PHQ-9) to 459 survey participants with MS. We examined correlations between actual PROMIS-D-8 scores and the scores predicted by cross-walks based on PHQ-9 and CESD-20 scores. Intraclass correlation coefficients were used to assess correspondence. Consistency in severity classification was also calculated. Finally, we used Bland–Altman plots to graphically examine the levels of agreement. The correlations between actual and cross-walked PROMIS-D-8 scores were strong (CESD-20 = .82; PHQ-9 = .74). The intraclass correlation was moderate (.77). Participants were consistently classified as having or not having at least moderate depressive symptoms by both actual and cross-walked scores derived from the CESD-20 (90%) and PHQ-9 (85%). Bland–Altman plots suggested the smaller differences between actual and cross-walked scores with greater-than-average depression severity. PROMIS cross-walk tables can be used to translate depression scores of people with MS to the PROMIS-D metric, promoting continuity with previous research.
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Affiliation(s)
- Jiseon Kim
- University of Washington, Seattle, WA, USA
| | - Hyewon Chung
- Chungnam National University, Daejeon, Republic of Korea
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Jones SMW, Guthrie KA, Reed SD, Landis CA, Sternfeld B, LaCroix AZ, Dunn A, Burr RL, Newton KM. A yoga & exercise randomized controlled trial for vasomotor symptoms: Effects on heart rate variability. Complement Ther Med 2016; 26:66-71. [PMID: 27261984 DOI: 10.1016/j.ctim.2016.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 08/22/2015] [Revised: 02/14/2016] [Accepted: 03/02/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Heart rate variability (HRV) reflects the integration of the parasympathetic nervous system with the rest of the body. Studies on the effects of yoga and exercise on HRV have been mixed but suggest that exercise increases HRV. We conducted a secondary analysis of the effect of yoga and exercise on HRV based on a randomized clinical trial of treatments for vasomotor symptoms in peri/post-menopausal women. DESIGN Randomized clinical trial of behavioral interventions in women with vasomotor symptoms (n=335), 40-62 years old from three clinical study sites. INTERVENTIONS 12-weeks of a yoga program, designed specifically for mid-life women, or a supervised aerobic exercise-training program with specific intensity and energy expenditure goals, compared to a usual activity group. MAIN OUTCOME MEASURES Time and frequency domain HRV measured at baseline and at 12 weeks for 15min using Holter monitors. RESULTS Women had a median of 7.6 vasomotor symptoms per 24h. Time and frequency domain HRV measures did not change significantly in either of the intervention groups compared to the change in the usual activity group. HRV results did not differ when the analyses were restricted to post-menopausal women. CONCLUSIONS Although yoga and exercise have been shown to increase parasympathetic-mediated HRV in other populations, neither intervention increased HRV in middle-aged women with vasomotor symptoms. Mixed results in previous research may be due to sample differences. Yoga and exercise likely improve short-term health in middle-aged women through mechanisms other than HRV.
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Affiliation(s)
- Salene M W Jones
- Group Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, United States.
| | | | - Susan D Reed
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Carol A Landis
- School of Nursing, University of Washington, Seattle, WA, United States
| | | | - Andrea Z LaCroix
- University of California San Diego, San Diego, CA, United States
| | - Andrea Dunn
- Kaiser Permanente Division of Research, Oakland, CA, United States
| | - Robert L Burr
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Katherine M Newton
- Group Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, United States
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Abstract
OBJECTIVES Multimorbidity, the presence of multiple chronic medical conditions, is particularly prevalent in older adults. We examined the relationship of multimorbidity with mental health, social network and activity limitations in the National Health and Aging Trends Study, a nationally representative, age-stratified sample of older adults. METHOD After excluding participants who used a proxy to complete the survey and those who did not answer any of the depressive symptoms, anxiety symptoms and positive and negative affect items, the final sample was 7026. A disease count of 10 conditions (heart disease, hypertension, arthritis, osteoporosis, diabetes, lung disease, stroke, dementia, cancer, fracture) was used. RESULTS Factor analysis indicated a one factor structure for disease count was tenable, although cancer did not appear to fit the model. Therefore, a count of the nine other diseases was used. Disease count was related to increased depressive symptoms, anxiety symptoms and negative affect and less positive affect. All individual diseases including cancer were related to worse mental health as was having two or more conditions. Disease count, having two or more conditions and several individual diseases (heart disease, hypertension, arthritis, cancer and fracture) were also related to increases in social network size while other individual diseases (osteoporosis, diabetes, lung disease, stroke and dementia) were related to decreases in social network size. All the measures of multimorbidity and individual diseases were associated with the increased odds of activity limitations. CONCLUSIONS Results support a broader focus for older adults with multimorbidity that includes mental health needs.
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Affiliation(s)
- Salene M. W. Jones
- Group Health Research Institute, 1730 Minor Ave, Seattle, WA 98101 USA, Phone: 206-287-2108
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Box 354237, Seattle, WA 98195-4237 USA
| | - Nancy M. Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
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Jones SMW, Ziebell R, Walker R, Nekhlyudov L, Rabin BA, Nutt S, Fujii M, Chubak J. Psychometric investigation of benefit finding among long-term cancer survivors using the Medical Expenditure Panel Survey. Eur J Oncol Nurs 2015. [PMID: 26220893 DOI: 10.1016/j.ejon.2015.07.005] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Benefit finding has been shown to be beneficial for people with cancer and may be an indication that one is coping adequately with the stress of cancer. This study evaluated the psychometric properties of a four-item benefit finding measure from the cancer survivorship supplement of the Medical Expenditure Panel Survey (MEPS). METHODS Long-term survivors (5-10 years post-diagnosis) of breast, prostate, colorectal or lung cancer or melanoma (n = 594) completed the MEPS cancer supplement survey in 2013. Four items asked about benefit finding after the cancer: stronger person, coping better, positive changes and having healthier habits. Information on sociodemographics, disease and activity limitations after the cancer was also collected. We examined factor structure, reliability (Kuder-Richardson 20) and validity. RESULTS The four benefit finding items did not appear to measure one factor. Three of the benefit finding items (stronger person, coping better, positive changes) were related to gender, receipt of chemotherapy and activity limitations but not cancer stage, time since diagnosis or income. Having healthier habits was unrelated to any sociodemographic or disease variable. CONCLUSIONS Three of the items (stronger person, coping better, positive changes) appeared to have validity as they were related to variables that literature has shown are related to benefit finding. However, having healthier habits is likely measuring a separate but related construct. This short instrument may be used in future studies assessing benefit finding post cancer; however, the four items should be analyzed separately.
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Affiliation(s)
| | | | - Rod Walker
- Group Health Research Institute, Seattle, WA, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Department Population Medicine, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA
| | - Borsika A Rabin
- Department of Family Medicine and Colorado Health Outcomes Program, School of Medicine, University of Colorado, USA; Department of Community and Behavior Health, School of Public Health, University of Colorado, USA; Kaiser Permanente Colorado, Denver, CO, USA
| | | | - Monica Fujii
- Group Health Research Institute, Seattle, WA, USA
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Rosenberg DE, Gell NM, Jones SMW, Renz A, Kerr J, Gardiner PA, Arterburn D. The Feasibility of Reducing Sitting Time in Overweight and Obese Older Adults. Health Educ Behav 2015; 42:669-76. [PMID: 25794518 DOI: 10.1177/1090198115577378] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Overweight and obese older adults have high sedentary time. We tested the feasibility and preliminary effects of a sedentary time reduction intervention among adults over age 60 with a body mass index over 27 kg/m2 using a nonrandomized one-arm design. METHODS Participants (N = 25, mean age = 71.4, mean body mass index = 34) completed an 8-week theory-based intervention targeting reduced total sitting time and increased sit-to-stand transitions. An inclinometer (activPAL) measured the primary outcomes, change in total sitting time and sit-to-stand transitions. Secondary outcomes included physical activity (ActiGraph GT3X+ accelerometer), self-reported sedentary behaviors, physical function (Short Physical Performance Battery), depressive symptoms (8-item Patient Health Questionnaire), quality of life (PROMIS), and study satisfaction. Paired t tests examined pre-post test changes in sitting time, sit-to-stand transitions, and secondary outcomes. RESULTS Inclinometer measured sitting time decreased by 27 min/day (p < .05) and sit-to-stand transitions increased by 2 per day (p > .05), while standing time increased by 25 min/day (p < .05). Accelerometer measured sedentary time, light-intensity, and moderate-to-vigorous physical activity improved (all p values ≤ .05). Self-reported sitting time, gait speed, and depressive symptoms also improved (all p values < .05). Effect sizes were small. Study satisfaction was high. CONCLUSIONS Reducing sitting time is feasible, and the intervention shows preliminary evidence of effectiveness among older adults with overweight and obesity. Randomized trials of sedentary behavior reduction in overweight and obese older adults, most of whom have multiple chronic conditions, may be promising.
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Affiliation(s)
| | - Nancy M Gell
- Group Health Research Institute, Seattle, WA, USA
| | | | - Anne Renz
- Group Health Research Institute, Seattle, WA, USA
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Jones SMW, LaCroix AZ, Li W, Zaslavsky O, Wassertheil-Smoller S, Weitlauf J, Brenes GA, Nassir R, Ockene JK, Caire-Juvera G, Danhauer SC. Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative. J Cancer Surviv 2015; 9:620-9. [PMID: 25708515 DOI: 10.1007/s11764-015-0438-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/06/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE Distress and reduced quality of life (QOL) are common among people with cancer. No study has compared these variables after breast cancer diagnosis to pre-cancer diagnosis levels. METHODS Data on women with breast cancer 50 years of age or older (n = 6949) were analyzed from the Women's Health Initiative (1993-2013). Health-related QOL (physical function, mental health) was measured using Rand-36. Depressive symptoms were measured with the six-item Center for Epidemiologic Studies Depression scale. Assessments occurred before and after the cancer diagnosis. Hierarchical linear modeling compared pre-cancer QOL and depressive symptoms to levels post-diagnosis and tested whether pre-cancer physical activity, stressful life events, sleep disturbance, and pain predicted post-diagnosis outcomes. RESULTS Compared with pre-cancer levels, depressive symptoms increased (20.0% increase at 0-6 months, 12.9% increase at 6-12 months), while physical function (-3.882 points at 0-6 months, -3.545 at 6-12 months) and mental health decreased (-2.899 points at 0-6 months, -1.672 at 6-12 months) in the first year after diagnosis (all p < .01). Depressive symptoms returned to pre-cancer levels after 10 years, but QOL remained significantly lower. At more than 10 years post-diagnosis, physical function was 2.379 points lower than pre-cancer levels (p < 0.01) while mental health was 1.922 points lower (p < 0.01). All pre-cancer predictors were associated with all outcomes. Pain predicted uniquely greater decreases in physical function post-diagnosis. CONCLUSIONS Depressive symptoms increased and QOL decreased following breast cancer diagnosis compared with pre-cancer levels, particularly in the first year. IMPLICATIONS FOR CANCER SURVIVORS QOL may remain lower for years after breast cancer diagnosis, although decreases are small.
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Affiliation(s)
- Salene M W Jones
- Group Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA.
| | | | - Wenjun Li
- University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | | | | | - Julie Weitlauf
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | | | - Rami Nassir
- University of California, Davis, Davis, CA, 95616, USA
| | - Judith K Ockene
- University of Massachusetts Medical School, Worcester, MA, 01655, USA
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Jones SMW, Ludman EJ, McCorkle R, Reid R, Aiello Bowles EJ, Penfold R, Wagner EH. A differential item function analysis of somatic symptoms of depression in people with cancer. J Affect Disord 2015; 170:131-7. [PMID: 25240839 PMCID: PMC4253856 DOI: 10.1016/j.jad.2014.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/02/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The overlap of somatic symptoms of depression with symptoms of cancer treatment is widely acknowledged and studied. However, this literature provides little guidance for clinicians as to whether these items should be used in assessing depression. The current study examined the appropriateness of using somatic items for assessment of depression in people with cancer. METHODS People with newly diagnosed breast, lung or colorectal cancer (n=251) completed the Patient Health Questionnaire-9 (PHQ9) shortly after cancer diagnosis but before cancer treatment (baseline), 4 months later, typically during or shortly after treatment, and 12 months later. Pharmacy data was used to classify participants as having low somatic symptoms or high somatic symptoms. Differential item function (DIF) compared the functioning of the somatic items of the PHQ9 in the low vs. high symptom groups and the chemotherapy vs. no chemotherapy groups at the 4-month assessment. RESULTS Significant DIF was not found on any of the four somatic items of the PHQ9 and differences in the item parameters of the somatic items were not consistent across the groups. However, fatigue and sleep indicated only mild depression. Only removing the fatigue item greatly affected the number screening positive for depression at 4 months (8.3%) but removing the other somatic items did not have as large an effect. Only one participant at baseline screened positive for depression by somatic symptoms alone (no psychological symptoms) and no participants screened positive by somatic symptoms alone at 4 months and 12 months. LIMITATIONS The sample size was small for DIF and consisted of mostly women with breast cancer. CONCLUSIONS Somatic symptoms of depression can continue to be administered to people with cancer, however the fatigue and sleep items should be used with caution.
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Abstract
Age is related to less distress in several populations including people with multiple sclerosis (MS). One theory posits this is due to decreased emotional reactivity and better coping as people age and we attempted to test this theory in MS. We used a cross-sectional survey of 429 people with MS. Participants completed measures of physical and cognitive function, depressive symptoms and anxiety. Age moderated the relationship of physical function to distress, such that decreased physical function was related to more distress in younger participants. Age moderated the relationship of cognitive function to depression, such that decreased cognitive function was related to more depressive symptoms in younger participants. Age did not moderate the relationship of cognitive function and anxiety. The effect was only seen in women with MS; however, there were fewer men in the sample. The results are consistent with the theory of decreased emotional reactivity and better coping with age. However, we were unable to test this in much older adults (75+ years of age).
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