Knowledge,attitudes, and beliefs related to hypertension and hyperlipidemia self-management among African-American men living in the southeastern United States

ObjectivePerceptions of illness affect cardiovascular disease (CVD) self-management. This study explores knowledge, attitudes, and beliefs regarding hypertension and hyperlipidemia management among 34 African-American men with hypertension and/or hyperlipidemia, age 40–65, living in the Southeastern United States.MethodsIn-person focus groups were conducted using semi-structured interview questions informed by the Health Belief Model (HBM).ResultsParticipants had a high level of knowledge about hypertension self-management, but less about cholesterol self-management. Perceived severity of both conditions was acknowledged, though participants perceived hypertension as more severe. Barriers to self-management included medication side effects and unhealthy dietary patterns. Facilitators included social support, positive healthcare experiences, and the value placed on family. Cultural implications highlighted the importance of food in daily life and social settings. Participants expressed how notions of masculinity affected self-management—noting the impact of feelings of vulnerability and perceived lack of control stemming from diagnosis and treatment expectations.ConclusionsThe findings highlight gaps in knowledge of hyperlipidemia versus hypertension, and the impact of cultural context and perceptions on engagement in self-management behaviors.Practice implicationsPublic health practitioners and healthcare providers serving African-American men should address cultural factors and notions of masculinity which can hinder effective disease management among this population.     

Uncovering myths and transforming realities among low-SES African-American men: implications for reducing prostate cancer disparities

PURPOSE: Prostate cancer provides the most dramatic evidence of cancer disparities based on race and ethnicity among U.S. men. African-American men still hold a commanding lead in both prostate cancer incidence and mortality, particularly among those of low socioeconomic status (SES) and the medically underserved. Therefore, the need for early intervention persists. The purpose of this exploratory pilot study was to: a) assess the knowledge of a cohort of low-SES African-American men regarding prostate health/prostate cancer, and b) uncover myths/misinformation as barriers to prostate health decisions and behaviors. PROCEDURES: Asymptomatic African-American men participated in focus groups to candidly discuss: a) health concerns, b) prostate health, c) prostate cancer screening, diagnosis and treatment, and d) factors influencing prostate health decisions/behaviors. FINDINGS: Participants revealed sociocultural and psychological barriers: myths and lack of accurate/adequate knowledge about prostate health and cancer, fear, denial and apathy. CONCLUSIONS: These findings suggest factors that may explain the reluctance and limited participation in prostate health and prostate cancer services among medically underserved, socioeconomically disadvantaged, African-American men. Lack of knowledge, which affects all barriers to care, is amenable to change. Therefore, improvements in prostate cancer outcomes are achievable through culturally and linguistically appropriate health education tailored to their specific needs.     

A longitudinal qualitative study to explore and optimize self-management in mild to end stage chronic kidney disease patients with limited health literacy: Perspectives of patients and health care professionals

ObjectivesLimited health literacy (LHL) is associated with faster kidney deterioration. Health care professionals (HCPs) promote self-management to maintain kidney function, which is difficult for patients with LHL. Evidence lacks on perceived barriers and best strategies to optimize their self-management. Our study aims to explore experiences with and barriers for self-management from the perspectives of LHL patients and HCPs to identify strategies to optimize self-management.MethodsWe performed a longitudinal qualitative study with semi-structured in-depth interviews and focus group discussions among CKD patients and LHL (n = 24) and HCPs (n = 37) from general practices and hospitals.ResultsFour themes arose among patients: (1) CKD elusiveness, (2) suboptimal intake of knowledge (3) not taking a front-seat role, and (4) maintaining change. Among HCPs, three themes emerged: (1) not recognizing HL problems, (2) lacking effective strategies, and (3) health care barriers.ConclusionWe suggest three routes to optimize self-management: providing earlier information, applying person-centered strategies to maintain changes, and improving competencies of HCPs.Practice implicationsHCPs need to explain CKD self-management better to prevent kidney deterioration. New interventions, based on behavioral approaches, are needed to optimize self-management. HCPs need training to improve recognition and support of LHL patients.     

Preventing HIV infection among young immigrant Latino men: results from focus groups using community-based participatory research

Latinos in the United States have been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs). Using a community-based participatory research (CBPR) approach to problem identification and exploration, a total of 74 Latino men (mean age 22.3, range 18-37) residing in an urban city in northwest North Carolina participated in one of eight focus groups on sexual health. Among the findings of this study, >75% of participants reported Mexico as their country of origin; other participants reported being from Central and South American countries. Qualitative data analysis identified 13 themes, which were grouped into the following three domains: 1) psychosocial factors identified as influencing sexual risk health behaviors; 2) system-level barriers to sexual health; and 3) characteristics of potentially effective HIV prevention intervention approaches. The study findings suggest that community-based, male-centered interpersonal networks that provide individual and group education and skill-building and incorporate curanderos (Latino healers) and bilingual experts may be important elements of potentially effective intervention approaches to reach Latino men, who have been inaccessible to conventional HIV prevention programs.     

Twelve-month outcomes of an Internet-based diabetes self-management support program

Objective

Internet-based programs offer potential for practical, cost-effective chronic illness self-management programs.

Methods

We report 12-month results of an Internet-based diabetes self-management program, with and without additional support, compared to enhanced usual care in a 3-arm practical randomized trial. Patients (n = 463) were randomized: 77.3% completed 12-month follow-up. Primary outcomes were changes in health behaviors of healthy eating, physical activity, and medication taking. Secondary outcomes were hemoglobin A1c, body mass index, lipids, blood pressure, and psychosocial factors.

Results

Internet conditions improved health behaviors significantly vs. usual care over the 12-month period (d for effect size = .09–.16). All conditions improved moderately on biological and psychosocial outcomes. Latinos, lower literacy, and higher cardiovascular disease risk patients improved as much as other participants.

Conclusions

The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact. However, 12-month magnitude of effects was small, suggesting that different or more intensive approaches are necessary to support long-term outcomes. Research is needed to understand the linkages between intervention and maintenance processes and downstream outcomes.

Practice implications

Automated self-management interventions should be tailored and integrated into primary care; maintenance of patient self-management can be enhanced through links to community resources.     

Communicating with older diabetes patients: self-management and social comparison

OBJECTIVE: The health status and life experiences of older diabetes patients may be highly heterogeneous, thus making their perspectives particularly relevant for developing individualized self-management plans for this population. Our earlier research showed older diabetes patients' healthcare goals and self-management behaviors are frequently shaped through social comparisons with peers/family members. The present paper explores this role of social comparison in their self-management practices and develops a conceptual model depicting the process. METHODS: Data were collected using open-ended, semi-structured interviews to elicit 28 older, type 2 diabetes patients' healthcare goals and self-management practices. Qualitative techniques were used to extract salient themes. RESULTS: Social comparison plays a salient role in routinizing older patients' self-management practices. Almost all patients assess their self-management by making "downward" comparisons with individuals doing worse than them; "upward" comparisons are rarely invoked. Occasionally patients' social comparisons lead them to adopt "normalizing" behaviors resulting in deviations from medically recommended self-care. CONCLUSION: The findings formed the basis for developing a conceptual model delineating the role of social comparison in self-management that can be beneficial for providers in tailoring educational interventions for self-management. PRACTICE IMPLICATIONS: Fostering these comparisons can help providers enhance communication on initiating and sustaining self-management practices.     

The Role of eHealth in Optimizing Preventive Care in the Primary Care Setting

Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world’s morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward.     

Barriers to effective self-management in cardiac patients: The patient's experience

Objective

This paper identifies common obstacles impeding effective self-management among patients with heart disease and explores how for disadvantaged patients access barriers interfere with typical management challenges to undermine patients’ efforts to care for their illnesses.

Methods

We convened 33 focus group discussions with heart patients in 10 U.S. communities. Using content analysis, we identified and grouped the most common barriers that emerged in focus group discussions.

Results

We identified nine major themes reflecting issues related to patients’ ability to care for and manage their heart conditions. We grouped the themes into three domains of interest: (1) barriers that interfere with getting necessary services, (2) barriers that impede the monitoring and management of a heart condition on a daily basis, and (3) supports that enable self-management and improve care.

Conclusion

For disadvantaged populations, typical problems associated with self-management of a heart condition are aggravated by substantial obstacles to accessing care.

Practice implications

Ensuring disadvantaged patients with chronic heart conditions are linked to formal systems of care, such as cardiac rehabilitation programs, could better develop patients’ self-management skills, reduce barriers to receiving care and improve the overall health outcomes of these patients.     

Unique Aspects of the Care of HIV-Positive Latino Patients Living in the United States

Latinos are disproportionately affected by HIV, with a higher risk of infection and a delayed presentation to care as compared to non-Hispanic whites. Over the last decade many Latinos, especially foreign-born migrants, have settled in regions of the country with historically low Latino representation. Therefore, clinicians who care for HIV-infected patients are likely to encounter Latino patients, regardless of their practice location. Providing optimal care to this population may be especially challenging for clinicians practicing in areas of newer Latino expansion, where culturally appropriate services may be sparse. In this article, we argue that an understanding of the HIV epidemic among Latinos requires an appreciation of the diversity and heterogeneity of the Latino population in the United States. We also review unique clinical aspects of HIV care among Latinos, including manifestation of co-infections with pathogens endemic in Latin America but rare in the United States.     

When knowing is not enough: Emotional distress and depression reduce the positive effects of health literacy on diabetes self-management

Objectives

Adequate self-management activities are important predictors of diabetes outcomes. As diabetes literacy and self-efficacy are strong predictors of diabetes self-care, self-management education programs focus essentially on these factors. This study investigated whether emotional distress or depression moderates the relation between health literacy, self-efficacy and diabetes self-care behaviors.

Barriers and facilitators to smoking cessation among Latino adults

BackgroundPrevious studies have found that Latinos who smoke are less likely than non-Latino white smokers to use pharmaceutical aids such as nicotine replacement therapies or to receive physician advice to stop smoking. This qualitative study further explored barriers and facilitators to smoking cessation among Latino adults in Maryland.MethodsFive Spanish-language focus groups were conducted in September 2008 in Maryland with Latino current smoker and ex-smoker men and women (n = 55). Participants were recruited through flyers, information sheets, and site visits at community health clinics and Latino events, and were predominately of Central American origin.ResultsPersonal health concerns were the main reason to quit smoking; impact on children and family health and role model pressure were frequently mentioned. Barriers to quit smoking included environmental temptation and social factors, emotional pressure, addiction, and habitual behavior. Respondents mostly relied on themselves for cessation, with little use of cessation products or other medications, or awareness of available services.ConclusionsSocial influence serves both as a strong motivation for Latinos to quit smoking and as a source of temptation to continue smoking. Favored by both current smokers and ex-smokers, lay health promoters are effective agents to reach Latinos with smoking cessation interventions. In addition, the low use of cessation services could be improved by increasing awareness and availability of Spanish-language cessation services.     

Knowledge, attitudes, and behaviors of healthcare providers for botanical and dietary supplement use for postmenopausal health

OBJECTIVE: To identify the knowledge, attitudes, and behaviors of health care providers (physicians and nurses) regarding the use of botanical dietary supplements (BDS) for peri- and postmenopausal women. DESIGN: Health care providers (physicians and nurse practitioners/nurse midwives) completed a questionnaire to assess knowledge, attitudes, and behaviors regarding botanical dietary supplement use for peri- and postmenopausal women. A total of 62 providers were included in the final analysis. RESULTS: Two thirds of providers reported that they had limited or no knowledge about botanical dietary supplements. By far, the majority of providers had no formal training nor had they studied these supplements on their own. Although knowledge was limited, a majority of providers wanted additional training predominantly because of growing patient awareness and use and were open to using these therapies for their patients either in combination with conventional Western medicine or as the only support for relief of peri- and postmenopausal symptoms. However, only 25% of providers regularly asked their peri- and postmenopausal patients about use of botanical dietary supplements. Providers who had practiced longer (> or =11 y) were more likely to be knowledgeable about dietary supplements and to have studied on their own (P < 0.01), to believe that botanicals are part of evidence-based medicine (P < 0.05), and to have talked to their patients (P < 0.05) about use of these therapies. Increased knowledge also appeared to predict a more positive attitude on the part of providers toward their patients who use BDS (P < 0.001) as well as more proactive behavior related to referring and recommending these therapies as treatment (P < 0.01). CONCLUSIONS: Our findings suggest that knowledge about botanical therapies among health care providers caring for peri- and postmenopausal women is quite low, but they are open to learning more about these modalities and using them for treatment, if appropriate. Our results suggest that increased years in practice is related to increased knowledge, more positive attitudes, and more proactive behaviors related to botanical dietary supplements.     

Attitudes,knowledge and practice behaviours of oncology health care professionals towards lesbian,gay, bisexual,transgender, queer and intersex (LGBTQI) patients and their carers: A mixed-methods study

ObjectiveThere is growing recognition that health care professionals (HCPs) and policy makers are insufficiently equipped to provide culturally competent care to lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) cancer patients and their families. We examined HCP attitudes, knowledge, and practices regarding LGBTQI cancer care using a mixed-methods research design.MethodSurveys were completed by 357 oncology HCPs in nursing (40%), medical (24%), allied health (19%), and clinical leadership roles (11%); 48 of the surveyed HCPs were interviewed.ResultsMost HCPs reported being comfortable treating LGBTQI patients, but reported low levels of confidence and knowledge and systemic barriers to LGBTQI cancer care. Most wanted more education and training, particularly on trans and gender-diverse people (TGD) and those born with intersex variations.ConclusionEducation of HCPs and health system changes are required to overcome barriers to the provision of culturally competent cancer care for LGBTQI patients.Practice implicationsThese findings reinforce the need for inclusion of LGBTQI content in HCP education and professional training curricula, and institutional support for LGBTQI-inclusive practice behaviours. This includes administrative and visual cues to signal safety of LGBTQI patients within cancer care, facilitating inclusive environments, and the provision of tailored patient-centred care.     

Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers

African-American and Hispanic women receive fewer indicated cancer early detection services than do majority women. Low rates of cancer screening may, in part, explain the disproportionately higher rates of cancer deaths in this population. The aim of this qualitative study was to explore through individual interviews the perceptions of barriers and facilitators of colorectal, cervical and breast cancer screening among 187 low-income, primarily minority women in four New-York-City-based community/migrant health centers. We identified various barriers and facilitators within each of these categories. Clinician recommendation was the most commonly cited encouragement to cancer screening. Other facilitators of cancer screening identified by patients included personal medical history, such as the presence of a symptom. The perception of screening as routine was cited as a facilitator far more commonly for mammography and Pap tests than for either of the colorectal screenings. Less commonly cited facilitators were insurance coverage and information from the media. The most common barriers were a lack of cancer screening knowledge, patients' perception of good health or absence of symptoms attributable to ill health, fear of pain from the cancer test and a lack of a clinician recommendation. Using standard qualitative techniques, patients' responses were analyzed and grouped into a taxonomy of three major categories reflecting: (1) patients' attitudes and beliefs, (2) their social network experience and (3) accessibility of services. This taxonomy may serve as a useful framework for primary care providers to educate and counsel their patients about cancer screening behaviors.     

Attitudes to the use of health outcome questionnaires in the routine care of patients with diabetes: a survey of general practitioners and practice nurses.

BACKGROUND: Despite the increasing availability of multidimensional health status and outcome measures of the patient's physical and emotional functioning, and a number of national initiatives to promote their use, little is known about the attitudes and behaviour of general practitioners (GPs) and practice nurses (PNs) regarding their use in evaluating the effectiveness of health care. What evidence there is remains largely anecdotal but supports the view that health outcome data is currently not used in the routine management of the patient. AIM: To investigate the attitudes and behaviour of GPs and PNs regarding the use of health outcome data in the routine care of patients with diabetes. METHOD: A questionnaire comprising 20 attitudinal and behavioural statements covering the use and benefits of health outcome data in the routine care of patients with diabetes were sent to 156 GPs and 114 PNs in the Doncaster area together with a covering letter and two examples of multidimensional health outcome measures. RESULTS: Completed questionnaires were received from 90 (58%) GPs and 49 (50% corrected for out of scope) nurses. Median response scores showed that both GPs and nurses expressed a positive overall attitude towards health outcome measurement giving responses favourable to it in 15 (75%) and 18 (90%) of the statements respectively. A key finding was that 48% and 46% of GPs and PNs were unclear as to how they would use health outcome data. CONCLUSION: While our findings reflect a favourable view towards the use of health outcome data for the routine management of the patient with diabetes in a general practice setting, a number of important barriers to their implementation have been identified. These include insufficient knowledge on their use, the need for easily interpretable data, and a lack of resources.     

Exploring attitudes,beliefs, and communication preferences of Latino community members regarding BRCA1/2 mutation testing and preventive strategies

PurposeTo inform development of a culturally sensitive hereditary breast and ovarian cancer communication initiative and related clinical genetic services.MethodsFive focus groups were conducted with 51 female and male Latinos. Educational materials were designed to communicate information about hereditary breast or ovarian cancer and availability of relevant clinical services or prevention strategies. Focus groups explored participants' knowledge, attitudes, and beliefs about hereditary breast and ovarian cancer, BRCA1/2 testing, and communication preferences for hereditary breast and ovarian cancer health messages.ResultsOverall, awareness of familial breast and ovarian cancer and availability of genetic risk assessment was low. Once informed, participants held favorable attitudes toward risk assessment and counseling services. Critical themes of the research highlighted the need to provide bilingual media products and use of a variety of strategies to increase awareness about hereditary cancer risk and availability of clinical genetic services. Important barriers were identified regarding family cancer history communication and cancer prevention services. Strategies were suggested for communicating cancer genetic information to increase awareness and overcome these barriers; these included both targeted and tailored approaches.ConclusionThis research suggests that cancer genetic communication efforts should consider community and cultural perspectives as well as health care access issues before widespread implementation.     

Crossing borders, crossing cultures: barriers to communication about cancer prevention and treatment along the U.S./Mexico border

OBJECTIVE: To describe cultural barriers to cancer prevention and treatment efforts among Latinos living along the U.S./Mexico border. METHODS: In-depth interviews with 8 Mexican immigrants who are residents of a Texas colonia were conducted to understand the roles of culture and poverty in their experiences with cancer. Questions were asked about participants' cancer experiences, religiosity, medical establishment barriers, and cultural identity. Narrative and thematic analysis was used to highlight dialectical tensions inherent in the stories. RESULTS: The participants' narratives illustrate how poverty and Latino cultural beliefs create barriers to effective cancer prevention and treatment based on: (1) metaphysical beliefs about how they developed cancer and religious beliefs about how it was cured; (2) gender identity and treatment in the U.S. medical system and; (3) national/cultural identity and treatment in the U.S. medical system. CONCLUSION: Structural and cultural barriers interact in complex ways as low-income Latino/a patients and their families attempt to receive cancer care on the U.S./Mexico border. The manner in which these patients negotiate the tensions may reinforce barriers and inability to access health care and should be specifically addressed. PRACTICE IMPLICATIONS: Immigrant populations worldwide are especially vulnerable to health care disparities. Effective cancer prevention and treatment messages must be constructed to help patients and families reconcile cultural and economic tensions in ways that allow them maintain their identities but still receive the necessary health care.     

Survey of asthma care in Taiwan: a comparison of asthma specialists and general practitioners.

BACKGROUND: Asthma is a common disease in Taiwan. The promotion of quality care for asthmatic patients should focus not only on new treatment remedies but also on patient adherence to treatment and a continuous education program integrated into treatment plans. One reason for patients' poor response to treatment is the lack of asthma knowledge on the part of physicians in terms of attitudes toward treatment. OBJECTIVE: To investigate the current status of asthma treatment among asthma specialists and general practitioners and their relative acceptance of and adherence to treatment guidelines. METHODS: One thousand questionnaires were distributed to physicians throughout Taiwan using a randomized sampling procedure. The questionnaire asked about the use of different kinds of medications, including inhaled corticosteroids, to treat asthma; adherence to asthma treatment guidelines; the use of a peak flow meter for monitoring asthma status; and self-efficacy in the treatment of asthma. RESULTS: A total of 526 questionnaires were returned. Of these, 90.4% of specialists and 63.2% of general practitioners would follow the guidelines for patient care (P = .002). It was significant that 79.8% of specialists but only 41.9% of general practitioners would instruct patients to use a peak flow meter to monitor symptoms (P < .001). Asthma specialists also seemed to be significantly more competent than general practitioners regarding asthma knowledge, instruction of inhalation techniques, use of peak flow meters to monitor symptoms, and making an action plan. CONCLUSIONS: To minimize the knowledge gap between specialists and general practitioners regarding asthma treatment, recognized treatment guidelines need to be popularized or simplified. Furthermore, the continuing education of general practitioners in asthma knowledge and management skills is important.     

Survey and audit of diabetes care in general practice in south London.

A survey was made of the diabetic care given by general practitioners in six family practitioner committee areas. Replies were received from 388 practices, representing 1034 principals (effective response rate 69%), serving over two million patients. Fourteen per cent of practices offered mini-clinic facilities for their diabetic patients, although a much greater proportion professed to give either full or shared care to patients in ordinary surgery time. One quarter of practices kept a diabetes register, but fewer had a system of recall for patients to ensure anticipatory care. The barriers which general practitioners most often perceived in the provision of adequate care for diabetics were: lack of time, absence of a recall system and deficiency in their own clinical skills. Seventy seven of the doctors responding to the initial questionnaire participated in an audit of the level of supervision provided for 378 of their diabetic patients. Better levels of supervision of non-insulin dependent diabetics were shown in those practices where diabetes registers were kept, and where special arrangements were made for caring for diabetes. The levels of care provided by those doctors setting aside specific clinic times were not demonstrably superior to those who did not. The findings suggest that provision of support services, particularly expertise in dietetics, would help to increase general practitioners' confidence and enable more of them to improve their care of diabetic patients.     

Prevalence and Correlates of Sun Protection and Skin Self-Examination Practices Among Cutaneous Malignant Melanoma Survivors

Little is known about the level of engagement and correlates of sun protection and skin self-exam among individuals diagnosed with melanoma. Participants (N = 229) completed measures of skin self-exam and sun protection practice and knowledge and attitudes. Approximately eighty-four percent of patients reported engaging in skin self-examination at least once in the past year. Engagement in sun protection practices was moderate. Self-exam practice was associated with gender, physician recommendation about self-exam, and perceived benefits and barriers of self-exam. Sun protection was associated with gender, age, medical status and health care access, physician recommendation, knowledge, and a number of psychological factors. Behavioral interventions to improve skin surveillance and sun protection may benefit from an emphasis on physician education regarding self-exam and sun protection, education regarding the efficacy of sunscreen and the risks associated with sunbathing, reducing perceived barriers to self-exam and sun protection, and reducing reliance on social influences on sun protection practices.