Formal quality criteria for websites do not guarantee complete health information of good quality: we need more attention to information on prognosis

Abstract

Background: General practitioners (GPs) and patients can have different ideas about the causes of fatigue, which may hinder management of fatigue.

Objective: To investigate the causal attributions of patients and their GPs for fatigue, their level of agreement, and the association between patients’ attributions, and fatigue characteristics and other illness perceptions.

Methods: Baseline data, collected between 2004 and 2006, of a prospective cohort study among 642 adult patients presenting to Dutch primary care practices (n = 147) with a main symptom of fatigue, were used. Patient causal attributions and illness perceptions were measured using the revised illness perception questionnaire (fatigue version). GP causal attributions were measured with an open question included in the form that was completed at the end of the patient's visit. Fatigue severity was measured using the checklist individual strength.

Results: Psychosocial causes were among the most often reported causal attributions by both patients and GPs. In 33% of 519 cases, the GP had no idea about the cause whereas the patient did. Overall, the agreement between the first reported causal attribution of patients and GPs was low. Qualitative differences in the labelling of causes were also found. Type of attribution (physical vs psychosocial/psychological) was associated with duration of fatigue (40 vs 25 months), and personal control (score 17.4 vs. 18.9).

Conclusion: Most patients and GPs had ideas about the causes of fatigue, but differences were found in the first reported causes and the labelling of causes. The findings may provide leads for optimizing communication about fatigue.     

Women’s beliefs about what causes obesity: variation by race/ethnicity and acculturation in a Washington State sample

ABSTRACT

Objective: Individuals’ beliefs about the causes of multifactorial health conditions (causal attributions) shape how they conceptualize and respond to health threats and are therefore important for health promotion. Studies of racial/ethnic and cultural variation in obesity causal beliefs, however, are scarce. To address this gap, this study described beliefs about the underlying causes of obesity (genetic inheritance, diet, and physical activity) in Hispanic and non-Hispanic White women participating in a longitudinal cohort study in South King County, Washington State (n?=?1,002).

Design: Analysis of baseline survey data. Self-reported obesity causal beliefs were compared by race/ethnicity and acculturation indicators (survey language and nativity) using marginal effect estimates generated from multinomial logistic regression models.

Results: Hispanic women had a higher probability of not believing ‘at all’ in inheritance and physical activity as causes of obesity – an absolute increase of 33% and 5% over non-Hispanic White women, respectively. Both acculturation indicators were also associated with a higher probability of not believing ‘at all’ in inheritance as a cause of obesity, though Hispanic women who completed the survey in English and were born in the United States had genetic causal beliefs similar to non-Hispanic White women. Behavioral attributions did not vary by acculturation indicators in Hispanic women.

Conclusions: Differences in obesity casual beliefs, particularly genetic attributions, exist and may be important for developing and delivering effective obesity-related health promotion interventions. Identifying the determinants and public health consequences of cultural variation in obesity attributions should be the focus of future research.     

Distribution of secondary medical problems, impairments, and participation limitations among adults with disabilities and their relationship to health and other outcomes

BackgroundThe purpose of this study was to describe the distribution and relationship of 16 secondary medical problems, impairments, and participation limitations among adults with disabilities to demographic characteristics, self-reported health, satisfaction with life, and social participation.MethodsData were analyzed for 4175 respondents to the disability supplements of the 2001 and 2003 Washington State Behavioral Risk Factor Surveillance Survey Disability Supplement.ResultsOf persons with disabilities, 87% reported at least 1 secondary medical problem, impairment, or participation limitation, with a mean of 4.1. Conditions were unevenly distributed in the 73% of those with disabilities with more than 1 condition: a cluster of one-fourth of this group had an average of 9.7 conditions and the remaining three-fourths averaged 3.9 conditions, with no strong correlations among conditions in either cluster. Number and type of condition were related to age, gender, income, and social participation among people with disabilities and explained part of the relationship of disability status to health and life satisfaction.ConclusionThe data provide evidence that prevention and treatment of secondary medical problems, impairments, and participation limitations may reduce disability-related disparities in health and well-being.     

Associations of perceived stigma,perceived environmental inaccessibility,and self-compassion among people with physical disability in Hong Kong

BackgroundPeople with physical disability are chronically stigmatized. They might internalize ableist attitudes and behaviors that they perceive from others, which can negatively affect social participation and well-being. It is essential to explore potential risk and protective factors associated with stigma perceptions.ObjectiveThe present study proposed and tested the positive associations of perceived environmental inaccessibility and self-coldness with perceived stigma, and the negative associations of self-warmth with perceived stigma, respectively, among people with physical disability in Hong Kong.MethodsA cross-sectional sample of 98 adults with physical disability (42.3% female, mean age = 36.4 years) from 10 nongovernmental organizations in Hong Kong participated in the study. They filled in a self-report questionnaire on perceived stigma, perceived environmental inaccessibility, self-compassion, basic activities of daily living (ADL), instrumental activities of daily living (IADL), and demographics.Main resultsHierarchical multiple regression showed that ADL and IADL alone (Model 1) did not significantly predict perceived stigma. The full model of ADL, IADL, perceived environmental inaccessibility, self-warmth, and self-coldness to predict perceived stigma (Model 2) was significant and explained 53.9% variance in perceived stigma. Perceived environmental inaccessibility and self-coldness were significantly and positively associated with perceived stigma, respectively. Self-warmth was significantly and negatively associated with perceived stigma.ConclusionsThe findings supported the important associations of both external contexts (i.e., as environmental inaccessibility) and internal resources (i.e., as self-compassion) with perceived stigma among people with physical disability. The findings inform future research and three-pronged design approaches to stigma reduction programs for people with physical disability.     

Emotional difficulties and self-harm among British adolescents with and without disabilities: Cross sectional study

BackgroundLittle is known about the prevalence of emotional difficulties and self-harm among adolescents with a disability.ObjectiveOur aims were: (1) to estimate the prevalence of emotional difficulties and self-harm among British adolescents with and without disability; (2) to determine whether prevalence varies by gender, severity of disability and type of functional limitation associated with disability.MethodsSecondary analysis of age 14 data from the UK's Millennium Cohort Study.ResultsAdolescents with disability reported significantly higher rates of emotional difficulties and self-harm than their non-disabled peers. Among participants with and without disability, prevalence rates were notably higher among girls for most outcomes. The strength of the association between disability and emotional difficulties and self-harm was greater for: maternal report of adolescent emotional difficulties; disabled adolescents with moderate/severe activity limitations; and adolescents with psychosocial impairments.ConclusionsThere is a clear need for providers of all mental health services to ensure that reasonable accommodations are made to services to ensure that they are responsive to the specific needs of adolescents with disabilities. Further research is needed to determine the extent to which our results can be generalised to adolescents in other settings, to specific subgroups of adolescents with disabilities, to other measures of emotional difficulties and to other informants. Future research is also needed to further explore the consistency and determinants of the intersection between gender by disability regarding adolescent mental health.     

Using Educational Videos and Perspective-Taking to Communicate Gene-By-Environment Interaction Concepts about Eating Behavior: Effects on Empathy and Weight Stigma

ObjectiveThis study investigated whether education about gene-by-environment interaction (G × E) concepts could improve G × E knowledge and positively affect empathy and weight stigma.DesignWe conducted a randomized trial using a 2 × 2 between-subjects design.SettingOnline.ParticipantsFive hundred eighty-two American participants from the Prolific platform.InterventionParticipants were randomly assigned to watch an educational or a control video. Participants then watched a set of vignette scenarios that depicted what it is like to have a predisposition toward obesogenic eating behaviors from either a first-person or third-person perspective.Main Outcome Measure(s)Participants completed questionnaires measuring G × E knowledge, causal attributions, weight stigma, and empathy postintervention.AnalysisTwo-by-two between-subjects ANOVAs and exploratory mediation analyses were conducted.ResultsParticipants who watched the educational video demonstrated greater G × E knowledge, reported higher empathy toward the characters in the vignette scenarios and held fewer stigmatizing attitudes (notably blame) toward individuals with higher weight. Exploratory mediation analyses indicated that the educational video led to these positive downstream effects by increasing the extent to which participants attributed genetic causes to eating behaviors.Conclusions and ImplicationsEducation about G × E causes of eating behaviors can have beneficial downstream effects on attitudes toward people with higher weight.     

Which one? What kind? How many? Types,causes, and prevalence of disability among U.S. adults

BackgroundQuantifying the number of people with and types of disabilities is helpful for medical, policy, and public health planning.Objective/Hypothesis: To update prior estimates on types, prevalence, and main causes of disability among U.S. adults using the Survey of Income and Program Participation (SIPP) data.MethodsWe used cross-sectional data from the SIPP 2008 Panel Wave 6 interviews collected May–August 2010. Analyses were restricted to non-institutionalized adults ages ≥18 years (n = 66,410). Disability was ascertained via five non-mutually exclusive components: 1) specific activity difficulties, 2) selected impairments, 3) use of an assistive aid, 4) household work limitations, and 5) paid work limitations. Prioritized main cause of disability was established for the 95% of respondents with a disability type eligible for health condition questions. We generated weighted population estimates (number and percentage, with 95% confidence intervals (CIs)), accounting for the complex sample survey design.Results50 million U.S. adults (21.8%) experienced a disability in 2010. Mobility-related activity limitations were the most prevalent disabilities across all five components. The most common main causes of disability were arthritis/rheumatism, 9.1 million (19.2%, 95% CI = 18.4–20.0) and back or spine problems, 8.9 million (18.6%, 95% CI = 17.9–19.3).ConclusionsA growing population with disabilities has the potential to put considerable and unsustainable demand on medical, public health, and senior service systems. Strengthening clinical community linkages and expanding the availability of existing evidence-based public health interventions to prevent, delay, and mitigate the effects of disability could improve health and outcomes for people with disabilities.     

Self-esteem as mediator and moderator of the relationship between stigma perception and social alienation of Chinese adults with disability

BackgroundSeveral studies show the relationship between self-esteem and stigma perception and also between self-esteem and social alienation, but none sufficiently analyze the relationship between stigma perception and social alienation of people with disability.Objective/hypothesisThe primary aim of this paper is to investigate the mediator and moderator effects of self-esteem on the relationship between stigma perception and social alienation of people with disability.MethodsThe participants were 129 adults with disability (80 males and 49 females) from eight communities in China. Data was collected by using the stigma perception scale, self-esteem scale, social avoidance scale, social anxiety subscale of the self-consciousness scale, and loneliness scale. Each item is rated on a 5-point scale (1 = “strongly disagree” to 5 = “strongly agree”).ResultsStigma perception was positively correlated with social avoidance (p < 0.001), social anxiety (p < 0.001), and loneliness (p < 0.001). Self-esteem was inversely correlated with social avoidance (p < 0.001), social anxiety (p < 0.001), loneliness (p < 0.001), and stigma perception (p < 0.001).ConclusionsSelf-esteem partially mediated the relationship between stigma perception and social avoidance, social anxiety and loneliness. Moreover, self-esteem moderated the relationship between stigma perception and social avoidance, but not on social anxiety and loneliness.     

Methodological note: Allocation of disability items in the American Community Survey

BackgroundDetermining the prevalence and correlates of disability requires the use of sample surveys in data analysis. In an effort to generate complete datasets, allocation procedures (i.e., the assignment of values to missing or illogical responses) are frequently used for missing or inconsistent responses.ObjectivesThe goal of this investigation was to explore how six disability-related questions vary in their degree of allocation and how research results may be sensitive to this procedure. This is important because many researchers using large disability information banks are not survey methodologists and may be unaware of how the Census Bureau's editing procedures can influence research findings.MethodsWe use 2010 1-year Public Use Microdata Sample files from the American Community Survey (ACS). We investigated the allocation rates of the following disability items: self-care; hearing; vision; independent living; ambulatory; and cognitive ability. We also asked how allocation rates varied by demographic characteristics and whether the allocated values could influence multivariate results.ResultsDisability item allocation in ACS data have detectable patterns, where the rate of disability allocation is higher for mail surveys, males, older people, groups who speak English not well or not at all, US citizens, Latinos(as), and for people living in or near poverty. Multivariate models may be sensitive to how these allocated values are treated.ConclusionsThe rate of allocations varies as a function of demographic variables because of methodological procedures and survey participation behaviors. Because allocation rates may affect research and policy about the disabled population, more research is required.     

Disability training for health workers: A global evidence synthesis

BackgroundHealth worker training on disability is a recognized component of achieving high standards of health for people with disabilities, given that health worker’s lack of knowledge, stigma, and negative attitudes towards people with disabilities act as barriers to high quality health care.ObjectiveTo understand the published literature on training health workers about disability.MethodsWe searched five databases for relevant peer-reviewed articles published between January 2012 and January 2021. Studies that focused on training health care workers to improve knowledge, confidence, self-efficacy, and competence to support people with physical, sensory, or intellectual impairments were included. Data about the details of the intervention (setting, participants, format, impact assessments, etc.) and its effects were extracted.ResultsThere is an array of highly local tools to train health workers across stages of their training and careers (preservice, in-service, and continuing professional development). Studies involving people with disabilities in the training, community placements, simulations, or interactive sessions were found to be most effective in improving knowledge, confidence, competency, and self-efficacy.ConclusionsAs part of initiatives to build inclusive health systems and improve health outcomes for people with disabilities, health workers around the world need to receive appropriate and evidence-based training that combines multiple methods and involves people with disabilities. To monitor progress on the impact of training, there should also be a standardized measure of impact on core outcomes.     

Adjustment to breast cancer: the contribution of resources and causal attributions regarding the illness

The study examined personal resources (sense of coherence and social support) and attributions concerning the causes of illness, and their relationship to adjustment to breast cancer. The research sample included 60 Israeli women with breast cancer, who responded to questionnaires at two stages of their illness: the stage of initial discovery (after first learning of the illness) and approximately six months later (the stage of mitigation and accommodation). The overall level of adjustment to the illness was moderate. While the patients adjusted relatively well in the family and domestic environments, their adjustment in the dimensions of health care, psychological distress, and sexual relations was relatively low. The most frequent causal attributions were psychological factors and family history of illness. The patients' subjective state of health, sense of coherence, and levels of social support were related to most of the adjustment dimensions examined, although both internal and external causal attributions correlated negatively with adjustment in every dimension.     

Interlocking oppressions: the effect of a comorbid physical disability on perceived stigma and discrimination among mental health consumers in Canada

People living with mental health problems often face stigma and discrimination; however, there is a lack of research that examines how comorbid conditions affect this perceived stigma. This study sought to determine whether people who have a comorbid physical and psychiatric disability experience more stigma than those with only a psychiatric disability. It also looked at how perceived stigma and discrimination affect physical and mental health. A secondary analysis on data from interviews with 336 former and current clients of the mental health system in a mid-size Canadian city in 2005 was performed. Of these, 203 (60.4%) reported they had a psychiatric disability, 112 (33.0%) reported that they had a physical disability, with 74 reporting both a psychiatric and a physical disability. People with a self-reported psychiatric disability and a self-reported comorbid physical disability faced more overall perceived discrimination/stigma ( P  = 0.04), than those with a psychiatric disability alone. Perceived discrimination/stigma was positively correlated with psychiatric problem severity ( P  = 0.02), and negatively correlated with self-rated general health ( P  < 0.001), physical condition ( P  < 0.001), emotional well-being ( P  < 0.001) and life satisfaction ( P  < 0.001). These results bring to light the aggravating effect of a physical disability on the perceived stigma for those living with a mental illness, and also strengthen the knowledge that stigma and discrimination have a negative impact on health. Healthcare providers should recognise this negative impact and screen for these comorbid conditions. Policy-makers should take measures such as improving access to housing and employment services to help reduce stigma and discrimination against this particularly vulnerable group.     

“It Was My Fault”: Bullied Students’ Causal and Controllable Attributions in Bullying Blogs

Student bullying is a growing and damaging social problem. The devastating outcomes bullied individuals often experience due to such treatment make understanding this phenomenon imperative. Utilizing Heider’s (1958) attribution theory, this study explores how bullied students (n = 100) attribute locus of causality and controllability for their victimization in 5 bullying blogs. Findings from this investigation reveal that (a) male and female bloggers’ causal and controllable attributions do not differ; (b) bloggers most often attribute blame to bullies, although a noteworthy portion also attribute internal causation; and (c) bloggers often attribute bullying as uncontrollable for several reasons. This study also identifies factors that influence shifts in negative attributions about bullying. These findings inform bullying programs with the hope of reducing destructive attribution formations that potentially lead to prolonged victimization and detrimental consequences.     

Spiritual Coping and Psychosocial Adjustment of Adolescents With Chronic Illness: The Role of Cognitive Attributions,Age, and Disease Group

PurposeSpiritual coping is an important determinant of adjustment in youth with chronic illness, but the mechanisms through which it affects outcomes have not been elucidated. It is also unknown whether the role of spiritual coping varies by age or disease group. This study evaluated whether general cognitive attributions explain the effects of spiritual coping on internalizing and externalizing problems in adolescents with cystic fibrosis and diabetes and whether these relationships vary by age or disease group.MethodsIn this cross-sectional study, adolescents (N = 128; M = 14.7 yrs) diagnosed with cystic fibrosis or diabetes completed measures of spiritual coping and attributional style. Adolescents and their caregivers reported on adolescents' internalizing and externalizing problems.ResultsOverall, positive spiritual coping was associated with fewer internalizing and externalizing problems. Negative spiritual coping was related to more externalizing problems, and for adolescents with cystic fibrosis only, also internalizing problems. Optimistic attributions mediated the effects of positive spiritual coping among adolescents with diabetes. The results did not vary by age.ConclusionsAn optimistic attribution style may help explain the effects of positive, but not negative, spiritual coping on adjustment of youth with diabetes. Youth with progressive, life-threatening illnesses, such as cystic fibrosis, may be more vulnerable to the harmful effects of negative spiritual coping. Future research should examine whether addressing spiritual concerns and promoting optimistic attributions improves adolescents' emotional and behavioral functioning.     

Biogenetic explanations and stigma: A meta-analytic review of associations among laypeople

The stigma and social rejection faced by people with a mental disorder constitute a major barrier to their well-being and recovery. Medicalization has been welcomed as a strategy to reduce blame and stigma, although critics have cautioned that attributing mental disorders to biogenetic causes may have unintended side effects that could exacerbate prejudice and rejection. The present study presents a quantitative synthesis of the literature on relationships between biogenetic explanations for mental disorders and three key elements of stigma, namely blame, perceptions of dangerousness, and social distance. A comprehensive search yielded 25 studies meeting the inclusion criteria. Separate meta-analyses (Ns = 4278–23,816) were conducted for the three stigma types, and assessed the consistency of effects across subgroups of studies involving different types of biogenetic explanations, mental disorders, and samples. We found that people who hold biogenetic explanations for mental disorders tend to blame affected persons less for their problems (r = −0.19), but perceive them as more dangerous (r = 0.09) and desire more distance from them (r = 0.05). The negative association with blame was significant for schizophrenia, belief in genetic causation, and in student samples. The positive association with dangerousness was significant for all disorders, belief in general biogenetic causation, and in community samples. The positive association with social distance was significant for schizophrenia, beliefs in neurochemical and general biogenetic causation, and in community samples. Nevertheless, across all analyses, biogenetic explanations were only weakly related to stigma. We conclude that biogenetic explanations for mental disorders confer mixed blessings for stigma.     

Health system access challenges of people with disabilities increased during Covid-19 pandemic

BackgroundPeople with disabilities (PWDs) have unequal access to health services compared with the general population and this disparity is worsening during the Covid-19 pandemic. Evidence supports the importance of policy development and legislation for addressing the unmet health needs of PWDs, but little is known about the impact of these efforts in Ghana.ObjectiveThis study examined health system experiences of PWDs in Ghana within the context of existing disability legislation and related policies prior to and during the Covid-19 pandemic.MethodsNarrative analysis of data from qualitative research approaches of focus group discussions, semi-structured interviews, and participant observations were used to examine the experiences of fifty-five PWDs, four staff of the Department of Social Welfare, and six leaders of disability-focused non-governmental organizations in Ghana.ResultsStructural and system barriers hinder PWDs access to health services. Bureaucratic bottlenecks hinder PWDs access to Ghana's free health insurance policy and health workers' disability stigma impedes accessibility to health services.ConclusionsAccess barriers and disability stigma increased accessibility challenges for PWDs in Ghana's health system during the Covid-19 pandemic. My findings support the need for increased efforts toward making Ghana's health system more accessible to address health disparities experienced by PWDs.