Perceptions of Health Care Provider Communication Activity Among American Cancer Survivors and Adults Without Cancer Histories: An Analysis of the 2003 Health Information Trends Survey (HINTS) Data

Provider communication is an important determinant of health outcomes. We examined the frequency with which five important communication activities were perceived by cancer survivors and adults without a history of cancer to have been performed by their primary care providers. We analyzed data on more than 5,000 adults drawn from the 2003 Health Information National Trends Survey (HINTS), a public dataset of the National Cancer Institute. We analyzed the responses to a question that asked how frequently the respondent's primary care provider had performed the following communication activities in the past 12 months: (1) listening carefully, (2) explaining things, (3) showing respect, (4) spending enough time, and (5) involving the patient in joint decision making. In addition, we compared responses among demographic subgroups. Results showed that regardless of health status or demographic characteristics, the 2003 HINTS respondents reported less than optimal rates of their providers “always” listening carefully, explaining things, showing respect, spending enough time, and involving them in joint decision making. Being Hispanic and having no usual provider or health insurance were associated with a significantly lower frequency of reporting that providers “always” performed the five communication activities (p < .05).     

An Exploratory Study of Older Adults' Comprehension of Printed Cancer Information: Is Readability a Key Factor?

Printed cancer information often is written at or beyond high school reading levels, despite lower average literacy abilities of the public. The objectives of this exploratory study were twofold: (1) to evaluate older adults' comprehension of breast (BC), prostate (PC), and colorectal (CC) cancer information; and (2) to determine if comprehension of BC, PC, and CC information varies according to text readability. Comprehension of printed cancer resources was evaluated with 44 community-dwelling older adults using the Cloze procedure and recall questions. Participants' comprehension scores were compared with Simple Measure of Gobbledegook (SMOG) readability scores (<grade 13 vs. grade 13+). Overall, older adults had satisfactory comprehension of cancer information as measured by Cloze (.86 ± .01) and recall (.71 ± .02). For CC information written at grade 13, however, a significant negative correlation between readability and Cloze comprehension was found (r _s  = ?.44, SE = .17, p = .019), indicating poorer participant comprehension at higher readability levels. Comprehension of BC or PC information did not vary by readability level. Though readability plays a role in older adults' understanding of cancer information, cancer type and content are also important factors that influence comprehension. Use of plain language is recommended for CC resources.     

Relationship of Internet Health Information Use With Patient Behavior and Self-Efficacy: Experiences of Newly Diagnosed Cancer Patients Who Contact the National Cancer Institute's Cancer Information Service

ABSTRACT

This study examines the relationship of Internet health information use with patient behavior and self-efficacy among 498 newly diagnosed cancer patients. Subjects were classified by types of Internet use: direct use (used Internet health information themselves), indirect use (used information accessed by friends or family), and non-use (never accessing Internet information). Subjects were recruited from callers of the National Cancer Institute's (NCI's) Cancer Information Service, Atlantic Region. They were classified by type of Internet use at enrollment and interviewed by telephone after 8 weeks. There were significant relationships among Internet use and key study variables: subject characteristics, patient task behavior, and self-efficacy. Subjects' Internet use changed significantly from enrollment to 8 week follow-up; 19% of nonusers and indirect users moved to a higher level of Internet use. Significant relationships also were found among Internet use and perceived patient–provider relationship, question asking, and treatment compliance. Finally, Internet use was also significantly associated with self-efficacy variables (confidence in actively participating in treatment decisions, asking physicians questions, and sharing feelings of concern). The results of this study show that patients who are newly diagnosed with cancer perceive the Internet as a powerful tool, both for acquiring information and for enhancing confidence to make informed decisions.     

Effects of Program Exposure and Engagement With Tailored Prevention Communication on Sun Protection by Young Adolescents

Few family-based interventions to increase sun safe behavior among adolescents have been evaluated. The present study tested an intervention that included tailored and nontailored print communications delivered by mail to adolescents (age 11 to 15) and their parents who were also participating in an evaluation of an in-school intervention. The use of sunscreen, protective clothing, and avoidance of the sun were promoted, and family communication and environmental change strategies were fostered. Adolescents and their parents were pretested in May of 2002 and posttested from August to October. Adolescents (N = 599) were stratified on experimental condition in the in-school study (in-school intervention vs control) and randomly were assigned from within strata to receive (N = 288) or not receive (N = 311) the summer intervention materials. No statistically significant effects were found for adolescents between the randomized experimental conditions. Parents' had increased knowledge (F = 5.52, p < .05) and propensity to have their child wear sunglasses (F = 4.07, p < .05). Greater program exposure/engagement led to enhanced sun protection behavior (e.g., fewer sunburns) and psychosocial factors among adolescents and parents. Greater exposure/engagement led to improvements in family interaction and home environment (e.g., shade audit completed). Future research is needed on exposure/engagement with family-based health messaging and on family-based sun safety programs for adolescents.     

Culturally Sensitive Interventions and Health and Behavioral Health Youth Outcomes: A Meta-Analytic Review

Despite Census Bureau projections that youth from minority cultures will comprise the majority of the nation's youth in approximately a decade, little research has been conducted on culturally sensitive interventions (CSIs). Accordingly, this study sought to determine: (1) the effectiveness of CSIs designed to address health and behavioral health outcomes, (2) whether effectiveness varies depending on the class or type of outcome, and (3) whether race/ethnicity moderates effectiveness. The results suggest that CSIs (n = 21) are modestly effective (Hedges' g = .239, 95% C.I. = .139 to .339, p < .001). Effectiveness did not vary significantly by outcome class or by race/ethnicity. Especially in the latter case, however, the pattern of point estimates raises the possibility of moderation with an increase in power. Suggestions for future research conclude the article.     

Portrayal of Childhood Cancer in English Language Magazines in North America: 1970–2001

ABSTRACT

This article is a content and discourse analysis of the portrayal of childhood cancer in English language magazines in North America. In a unique specification of published research on the media portrayal of disease, magazines were divided into three market or audience groupings called (1) science, (2) news/special interest, and (3) other (women/teen/parenting/health). The predominate frames or discoursesin these three groups were compared and differences were found amongst them and discussed in the article. Considerable evidence suggests that people with cancer are stigmatized. In the analyzed media focused on children, those with cancer are highly idealized and stereotyped. On the one hand, this can be thought of as a very positive portrayal of children in this situation. Children are described as if they possess heroic and idealized character traits, appearances, social characteristics, and personalities. Possible links between this idealized, polarized, and biased portrayal of children with cancer and their documented experiences of stigma are discussed.     

Reinforcement and Punishment of Substance Abuse During Ongoing Interactions: A Conversational Test of Inconsistent Nurturing as Control Theory

This study is the first to examine inconsistent nurturing as control (INC) theory during ongoing interpersonal influence episodes between substance-abusive individuals and their romantic partners. This study sought to determine how nonverbal (i.e., kinesic and vocalic) and verbal reinforcement and punishment of substance-abusive behavior during actual interactions influenced substance-abusive individuals' recidivism and perceptions of non-using partners' persuasive effectiveness. The findings reveal that consistent verbal punishment of substance abuse (e.g., threats, nagging) predicted lower relapse, while verbal reinforcement (e.g., telling the partner they are more fun when they use) predicted higher relapse. With regard to nonverbal communication, vocalic punishment and vocalic reinforcement predicted relapse and persuasive effectiveness. Results suggest the combination of behaviors resemble intermittent reinforcement and punishment and should actually strengthen the substance-abusive behavior the partner is trying to curtail.     

Aversion to Ambiguity Regarding Medical Tests and Treatments: Measurement,Prevalence, and Relationship to Sociodemographic Factors

Aversion to “ambiguity”—uncertainty about the reliability, credibility, or adequacy of risk-related information—is an important problem that may influence judgments and decisions about medical interventions. Ambiguity aversion (AA) varies among individuals, however, and has been understudied in the health domain. To explore this phenomenon further, we developed a new theory-based measure of aversion to ambiguity regarding medical tests and treatments, and examined the prevalence and association of AA with sociodemographic factors. The “AA-Med” scale was developed using a large survey sample of the U.S. public (n = 4,398), and scale psychometric properties and the population distribution of AA were evaluated. The scale demonstrated acceptable reliability (α = .73) and validity as ascertained by association with respondents' interest in a hypothetical ambiguous cancer screening test. Ambiguity aversion (AA) was associated with older age, non-White race, lower education and income, and female sex. The AA-Med scale is a promising new measure, and AA is associated with several sociodemographic factors. We discuss implications of these findings and potential applications of the scale for future research.     

News Media Tracking of Tobacco Control: A Review of Sampling Methodologies

ABSTRACT

News media tracking can be used to understand the content of news coverage and quantify its influence on public opinion and the social environment. We hypothesize that a parsimonious sampling of public health news coverage can gather statistically equivalent information to capture a census of coverage. We tested two general approaches to sampling. First, we randomly selected articles within a timeframe. Second, we randomly selected dates during 2000. None of these strategies showed a substantial deviation from the 2000 census of articles. We conclude that sampling coverage can produce estimates statistically equivalent to a census. Researchers should utilize coverage sampling.     

The Effectiveness of Media Use in Health Education: Evaluation of an HIV/AIDS Radio Campaign in Ethiopia

ABSTRACT

An effective vehicle to change behaviors is entertainment education. To demonstrate entertainment education effects, researchers must first indicate that participants have been exposed to their program. Exposure to effective programs has been associated with increases in knowledge about program topics, attitude change, and self-efficacious perceptions. The purpose of this study was to develop and test a new exposure technique that accurately and precisely determines direct exposure levels to Ethiopia's Journey of Life. Overall, the study found very high listenership, storyline recall, liking of the program, and strong desire to change behavior while maintaining low error rates in terms of verbatim recall of storylines and reported listenership to a fictitious program.     

Changing Smoking Attitudes by Strengthening Weak Antismoking Beliefs—Taiwan as an Example

ABSTRACT

This study compared alcoholic and nonalcoholic beverage advertising to which adolescents are exposed. A census of beverage advertising (N = 757) in popular magazines and television during November 1999–April 2000 was analyzed. Most alcohol ads appeared in Sports Illustrated (110), Rolling Stone (98), and Playboy (75) and outnumbered nonalcoholic beverage advertising by 3 to 1. Alcohol was almost never associated with dining. Alcohol ads emphasized sexual and social stereotypes and lacked diversity. One of every 6 magazine alcohol ads, and 1 of every 14 video-based ads, appeared to target teenagers. Many similarities existed between alcohol and nonalcohol ads. We conclude that alcohol is advertised heavily to youth through placement and appeals. The fact that themes in alcohol ads frequently parallel those in nonalcoholic beverage ads may further increase youths' receptivity.     

Immigrant women's experiences and views on the prevention of cervical cancer: a qualitative study

Background

Many Western countries have cervical cancer screening programmes and have implemented nation‐wide human papillomavirus (HPV) vaccination programmes for preventing cervical cancer.

Objective

To explore immigrant women''s experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use.

Design

An exploratory qualitative study. The Health Belief Model (HBM) was used as a theoretical framework.

Setting and participants

Eight focus group interviews, 5–8 women in each group (average number 6,5), were conducted with 50 women aged 18–54, who studied Swedish for immigrants. Data were analysed by latent content analysis.

Results

Four themes emerged: (i) deprioritization of women''s health in home countries, (ii) positive attitude towards the availability of women''s health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check‐ups.

Conclusion

The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health‐care providers. Therefore, information needs to be in different languages and provided through different sources. Health‐care professionals should also consider immigrant women''s difficulties concerning cultural norms and pay attention to their experiences.     

Health literacy–listening skill and patient questions following cancer prevention and screening discussions

Objective

Patient question‐asking is essential to shared decision making. We sought to describe patients'' questions when faced with cancer prevention and screening decisions, and to explore differences in question‐asking as a function of health literacy with respect to spoken information (health literacy–listening).

Methods

Four‐hundred and thirty‐three (433) adults listened to simulated physician–patient interactions discussing (i) prophylactic tamoxifen for breast cancer prevention, (ii) PSA testing for prostate cancer and (iii) colorectal cancer screening, and identified questions they would have. Health literacy–listening was assessed using the Cancer Message Literacy Test‐Listening (CMLT‐Listening). Two authors developed a coding scheme, which was applied to all questions. Analyses examined whether participants scoring above or below the median on the CMLT‐Listening asked a similar variety of questions.

Results

Questions were coded into six major function categories: risks/benefits, procedure details, personalizing information, additional information, decision making and credibility. Participants who scored higher on the CMLT‐Listening asked a greater variety of risks/benefits questions; those who scored lower asked a greater variety of questions seeking to personalize information. This difference persisted after adjusting for education.

Conclusion

Patients'' health literacy–listening is associated with distinctive patterns of question utilization following cancer screening and prevention counselling. Providers should not only be responsive to the question functions the patient favours, but also seek to ensure that the patient is exposed to the full range of information needed for shared decision making.     

Breast Cancer Prevention with Older Women: A Gender-Focused Intervention Study

Breast cancer continues to be the most frequently diagnosed cancer in American women, with older women at highest risk (American Cancer Society [ACS], 2007 American Cancer Society (ACS). 2005. Breast cancer facts & figures, 2005–2006, Atlanta: Author.  [Google Scholar]). In this study, the researcher explored whether an educational intervention using feminist pedagogical methods would affect the use of breast cancer screening methods (mammography and breast self-exam) by older women. At 6-month follow-up, those women receiving the education intervention were found to have significantly increased their use of screening methods in comparison with a control group of women of similar age from the same community. The results of this study indicate support for the use of gender-focused educational methods with an emphasis on empowerment to increase the cancer screening practices of older women.     

Posttraumatic growth experiences and its contextual factors in women with breast cancer: An integrative review

Abstract

In this article, we synthesize current research that examines determinants and manifestations of posttraumatic growth (the phenomenon of posttraumatic growth can be embodied in several domains) in women with breast cancer. The findings of the integrative literature review may contribute to facilitating person-centered oncology care by raising health care professionals’ awareness and understanding of posttraumatic growth phenomenon among breast cancer survivors. The identification of factors contributing to posttraumatic growth and manifestations of posttraumatic growth are important in increasing the effectiveness of interventions in supporting women during their breast cancer journey. The methods proposed by Whittemore and Knafl (2005 Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546–553.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) were adopted to guide this integrative review. Quality assessment was conducted using recognized critical appraisal tools relating to quantitative and qualitative studies. Four main manifestations were synthesized from the literature: new perception of self; relatedness to others; new life philosophy; and spiritual and religious growth. Personal characteristics, illness factors, cognitive processing, coping strategies, social support, religion and spirituality, the body’s role and physical activities were identified as influencing posttraumatic growth in women with breast cancer.     

Pharmacy: Comprehensive Pharmacy Services

West Virginia, as is true for the nation as a whole, spends far less on public health interventions than on curative care. In 2008 the United States spent approximately $2.4 trillion on healthcare, of which approximately $72 billion was allocated for public health activities—obviously a very small percentage (Centers for Medicare and Medicaid Services, U.S. Department of Heath and Human Services 2010 Centers for Medicare and Medicaid Services, U.S. 2010. “Department of Health and Human Services”. In National health expenditures 2008–1960 http://www.CMS.hhs.gov/NationalHealthExpendituresData/02-NationalHealthAccountsHistorical.asp (accessed February 2008; site now discontinued) [Google Scholar]). In West Virginia the 2006 per capita budget allocation for Local Boards of Health (LBH) for Basic Public Health Services was about $6.91, and total public health funding was between $63 and $91 per capita depending on the definition of public health. At the same time, Medicaid expenditures by the State are approximately $269 per capita with total Medicaid expenditures around $995 per capita. The difference in funding for Medicaid is almost 10 times the amount allocated to public health. The funding differences between curative care and preventive care may not be the result of the public's lack of understanding of the benefits of prevention, but rather its focus on short term rather than long term economic benefits. For a state like West Virginia, in which per capita income is below the national average, Medicaid is good business for the State's economy. Far too often public health funding is viewed as a drain from a state's budget not as an economic contributor to the state's economy. As a result, the funding of LBHs is almost always insufficient. The authors were interested in evaluating the economic impact of Local Boards of Health on West Virginia's economy. Although the authors recognize that the greatest economic benefits of public health are the costs averted through prevention and early detection, they believe that if LBH produce a positive economic multiplier State officials may view public health allocations in a more positive light. To assess the impact of LBH in West Virginia, spending data for each was collected. The direct, indirect, and induced spending resulting from public health activity was considered. The results were modeled using the IMPLAN (IMPLAN Professional 1999 IMPLAN Professional. 1999. Version 2.0. Computer software, Stillwater, MN: Minnesota IMPLAN Group.  [Google Scholar]) regional input–output simulation software to assess the multiplier effects of direct LBH spending. Findings suggest that LBH produce a positive economic multiplier similar to other service industries in West Virginia. The inferences from this investigation focus on West Virginia however it is possible to make a reasonable argument that the fundamental issues are similar for states with similar economies.     

Use of Song as an Effective Teaching Strategy for Nutrition Education in Older Adults

The objective of this study was to explore whether singing an educational song would be effective in improving older adults' knowledge about nutrition. We used a randomized controlled design to determine whether singing an educational song would result in increased nutrition knowledge in a low-income population of older adults compared to a control group of similar adults who did not sing the song. Eighteen congregate nutrition sites were randomly assigned to the treatment or control group. Analysis via independent samples t-test showed the knowledge gain mean scores for the treatment group were significantly (P < 0.05) greater than those of the control group. This study supports a unique new approach to increasing nutrition knowledge of older adults by using music.     

Assessing Health Diagnosis Disclosure Decisions in Relationships: Testing the Disclosure Decision-Making Model

Illness affects millions of Americans each year, and the disclosure of health conditions can facilitate access to social support, in addition to other physical and physiological benefits. This article tests the Disclosure Decision-Making Model (DD-MM; Greene, 2009 Greene, K. 2009. “An integrated model of health disclosure decision-making”. In Uncertainty and information regulation in interpersonal contexts: Theories and applications, Edited by: Afifi, T. D. and Afifi, W. A. 226–253. New York, NY: Routledge.  [Google Scholar]) to predict factors that influence the likelihood of disclosing (and past disclosure of) nonvisible physical or mental health-related information. One hundred eighty-seven (n?=?187) people were recruited for a study to report on both disclosing and not disclosing a nonvisible health condition. Measured variables included information assessment, relational quality, anticipated reactions (support, relational consequences), confidence in response, disclosure efficacy, and disclosure (likelihood of disclosure and depth of disclosure). Structural equation modeling results supported many of the proposed hypotheses, with a great deal of similarity across models. Specifically, assessing information predicted efficacy, and to some extent relational outcomes. Closeness was related to response overall and to efficacy in one model. Response predicted outcome overall and likelihood of disclosure in one model. Finally, efficacy predicted likelihood of disclosure and depth of disclosure. The article discusses the implications of the findings for understanding information, relationship assessments, and efficacy in disclosing health diagnoses.     

Public health leadership in primary care practice in England: Everybody's business?

This article analyses the concept of leadership in relation to the UK Government's current approach to ‘modernizing’ the NHS in England. Focusing on public health in primary care, the authors consider current developments in the public health workforce, in particular attempts to differentiate between public health ‘specialists’ and ‘practitioners’ by different levels of leadership function. It looks at leadership in policy, theory and practice, and draws attention to a number of key challenges along the leadership path. The concept of ‘leadership skills’ as a taught competence is questioned, and Shelton and Darling's (2001 Shelton, CK and Darling, JR. 2001. The quantum skills model in management: a new paradigm to enhance effective leadership. Leadership and Organisation Development Journal, 22(6): 264–273.  [Google Scholar]) ‘quantum skills’ model of leadership is provided to suggest new ways in which public health leadership in a primary care context might be approached. Whilst this article focuses on public health and primary care in England, the complexity of primary care settings and public health delivery in other international contexts extends its relevance to non-UK settings.