Relation of criminal victimization to health perceptions among women medical patients

The relation of criminal victimization to health perceptions (self-rated current health) was determined among women health maintenance organization patients. Data were survey responses from 2,291 women (45% response rate), 57% of whom had experienced crime. Reliability was evaluated by assessing 241 respondents both by survey and by interview. Data were analyzed by hierarchical multiple regression, which indicated that criminal victimization was an important predictor of health perceptions even after accounting for the contributions of demographics and other stressful life events with known links to illness. Validity was supported because medical care was actually sought by 92% of crime victims during the 1st year following the crime and by 100% during the 2nd year. Conclusions included the following: (a) Crime victimization history is relevant to health status assessment, and (b) primary care medical populations are an important locus from which crime victims could be identified and their treatment options considered.     

The impact of repeated simulation on health and healthcare perceptions of simulated patients

OBJECTIVE: To explore the effect of simulating medical conditions on simulated patients (SPs). Main points of interest are influence on: perception of personal health and perception of their relation with the health care provider (HCP), personal well being. METHODS: Semi-structured interviews were undertaken with eight experienced, well-selected SPs involved in communication training at the medical faculty of Ghent University. Content of the data were analysed qualitatively. RESULTS: SPs believe that their medical knowledge improved, which changes their health-seeking behaviour. Simulating made SPs realize that being a doctor is difficult, making them more critical towards their own GP. SPs enjoy their work; they feel happy and content afterwards. Negative effects are stress, anxiety, exhaustion, dissatisfaction and sleeping problems. DISCUSSION: The perceived 'increased knowledge' leads to a different way of dealing with symptoms. It is positive that SPs are more critical towards their GP, this leads to a more equal relationship. The effects of stress and anxiety probably contribute positively to the performance. Dissatisfaction, anxiety and sleeping problems could be work-related and consequently occur in practicing other occupations. PRACTICE IMPLICATIONS: Proper selection, preparation and guidance could minimize the problems encountered during simulation.     

Provider perceptions of limited health literacy in community health centers

OBJECTIVE: To examine techniques used by community health center (HC) providers to care for patients with limited health literacy (LHL). METHODS: Survey mailed to 803 HC providers in 10 Midwestern states. Response rate was 47.5%. Associations between variables were examined using generalized estimating equations (GEE) models to account for clustering of respondents within HCs. RESULTS: The average provider estimates of LHL prevalence among English- and Spanish-speaking patients were 41+/-24% (mean+/-S.D.) and 48+/-30%, respectively. Those with training in health literacy were more likely to have patients repeat instructions back to check understanding (OR=2.05 and p=0.04) and were more likely to give out health education materials designed for patients with LHL (OR=2.80 and p=0.0002). Providers differed by type in encouraging patients to bring friends or family members to appointments (p=0.02). CONCLUSION: Providers estimate LHL to be highly prevalent in their HCs, and use various techniques to assist patients. PRACTICE IMPLICATIONS: Training in health literacy is associated with increased usage of evidence-based techniques to assist patients with LHL. Providers at all levels would likely benefit from LHL training. Most providers believe providing health education materials designed specifically for patients with LHL would be very helpful.     

Mental health center versus community perceptions of mental health services

A list of 53 mental health programs and services was presented to community samples of county commissioners and mental health board members, mental health program administrators, mental health clinicians, mental health clerical staff, clients, general public, staff of agencies related to mental health, and staff of community agencies not so related with a request to (a) indicate which programs and services were being offered by the mental health agencies of the catchment area, (b) indicate the relative importance of each offered service, and (c) indicate the relative importance for future program development of those not currently offered. Accuracy of program identification is noted and intergroup perceptions of mental health programs and services are compared.     

Staff and student perceptions of a student health service

Results of a survey at one English university suggest that, of the various student personnel services provided by that institution, the Student Health Service was the best known and most used by the students. Both students and academic staff attributed greater importance to that particular service than to any other. Ways in which these two groups of university members justified such special provision are presented and discussed.     

Serotonin transporter (5-HTT) gene polymorphism in psychogeriatric patients

Several studies have attempted to confirm an association between a deletion/insertion polymorphism within the promoter region of the serotonin transporter gene (5-HTT) and Alzheimer's disease independent from the apolipoprotein E (APOE) varepsilon4 status. We examined this deletion/insertion polymorphism of the serotonin transporter gene in a sample of 222 consecutively recruited gerontopsychiatric patients which was divided into four different diagnostic groups: Alzheimer's disease (N=84), mild cognitive impairment (N=29), subjective cognitive complaints (N=49), depression/other psychiatric disorders (N=56) and 118 healthy, non-demented controls. The aim of this approach was to test whether the investigated polymorphism has a high enough selectivity and specificity to distinguish between the different gerontopsychiatric disorders or to differentiate genetically AD from other forms of dementia, respectively. We could not detect any significant differences in the allelic distribution of the deletion/insertion polymorphism of the 5-HTT gene between the four patient subgroups and the control group. This finding indicates that the serotonin transporter does not appear to be a major susceptibility factor in the pathophysiology of Alzheimer's disease and other psychogeriatric disorders.     

Age group and health status effects on health behavior change

The authors explored health behavior change during 5 years, considering age/cohort, health status, and gender effects. The authors divided the sample (n = 1,064) into 4 age/cohort groups: young adults (n = 139; 19-42 years), middle-aged adults (n = 386; 43-62 years), young-old adults (n = 296; 63-72 years), and old-old adults (n = 243; 73+ years) and health status: cardiovascular disease and physical disability. Smoking and seat belt behaviors remained stable, whereas alcohol, food consumption, food preparation, physical activity, dental, and medical behaviors showed change. Change in health behaviors differed by age/cohort group and health status for food consumption, food preparation, and medical care, primarily showing negative change for old-old adults and positive change for individuals with cardiovascular disease. Health behavior interventions need to focus on the old-old, individuals with physical disability, and on smoking and seat belt use. These specific populations and behaviors need to be targeted to promote positive health behavior change, to limit future onsets of disability and morbidity, and to prevent the occurrence of premature death.     

College student perceptions of mental health professionals' qualifications

College students completed a questionnaire dealing with the certification requirements necessary before persons identifying themselves with various professional titles (e.g., psychiatrist, psychologist) can open private mental health practices. Results indicated that few participants possessed accurate knowledge of the type and extent of certification examinations required. In addition, a majority of subjects erroneously indicated that private mental health practitioners must submit themselves for frequent reviews of their psychotherapeutic skills. These findings were seen as underscoring the need for public education regarding agents within the community offering mental health services.     

Community perceptions of natural disasters and post-disaster mental health services

This research was designed to examine the cognitive and affective responses of residential dwellers in the aftermath of a natural disaster (a flood). In a 2 X 3 factorial design, the effects of fear (High, Medium, and Low) and sex on perceptions of the disaster were assessed. The results indicated that respondents who were highly fearful of the disaster were more likely than moderate or low fear respondents to believe that: a) additional flooding would occur in their vicinity, and b) that they resided closer to the flood zone than they actually did. The policy implications of the results suggested that post-disaster mental health services might have to be extended to include residents of geographical areas not directly affected by natural or man-made disasters.     

Role perceptions in a community mental health setting

The increasing trend of utilizing nonprofessional personnel in community mental health has led to considerable controversy. It is suggested that studies comparing the relative competence and efficacy of professional therapists to that of nonprofessional therapists may be counterproductive and in need of augmentation. The present study employed a role perception procedure in which members of three different randomly chosen groups (11 professional therapists, 11 nonprofessional therapists, and 11 children-clients) from a community mental health program were asked to rank various aspects of the therapeutic relationship in order of importance to the children-clients' improvement. It was hypothesized that (a) due to their relatively low self-concept, nonprofessionals would underestimate their own role importance in comparison to that of the professionals; (b) professionals would overestimate their own role importance; and (c) children would selectively value certain aspects of each role without preferring one over the other. The last two hypotheses were supported, but the first hypothesis was not: nonprofessionals, in fact, showed the highest level of overestimation of their own role importance. A further analysis of the data showed that inexperienced nonprofessionals did not overestimate their own role performance. This suggested specific training procedures for nonprofessionals.     

African-American women's perceptions of their most serious health problems

African Americans experience a disproportionate burden of illness. According to the Centers for Disease Control and Prevention (CDC), heart disease, cancer, cerebrovascular disease and diabetes are the most common causes of mortality among African Americans. Data were gathered from 1,055 African-American women to gain their perspectives of the most serious health problems affecting African-American women and their related knowledge, attitudes and health promoting behaviors. Women listed CDC's top four causes of mortality as their top four most serious health threats. Cancer was reported as a serious health threat by 81% of the participants, whereas heart disease, the most common cause of mortality and a disease amenable to prevention and early intervention, was mentioned by only 31% of the women. Diabetes was reported by 59% of the women and cerebrovascular disease by 52%. As the Health Belief and other theoretical models would predict, awareness of the seriousness of these four disease groups among African-American women was associated with a greater likelihood of adherence for several of the recommended behaviors. Many opportunities exist for raising women's awareness of these four diseases and linking women's growing health awareness with those health promoting behaviors known to reduce morbidity and mortality.     

Health perceptions of African HIV-infected patients and their physicians

Objective

We explored how patients from Sub Saharan Africa (SSA) infected with HIV and living in Switzerland, and their treating physicians perceived their health, whether these perceptions correlated with biological markers, and what organisational changes participants considered likely to improve quality of care.

Methods

A prospective standardized questionnaire was submitted to HIV-infected patients from SSA and their physicians. Results were correlated with biological data.

Results

While physicians deduced improved health status from laboratory results, these did not provide an adequate surrogate marker of good health for patients. Patients experienced important social and economical difficulties with adverse consequences on their mental health. They requested social assistance, whereas physicians sought improved cultural competency.

Conclusion

Patients and physicians did not agree in their evaluation of patients’ health status. Patients did not perceive their health through biological markers, but linked their mental health with their socioeconomic context. Physicians underestimated patients’ biological health and their evaluation of global health.

Practice implications

Exploring difficulties perceived by physicians with specific patients lead to identification of structural weaknesses, resulting in suggestions to improve physicians’ medical training and patients’ care. This illustrates the importance of accessing patients’ perspective and not relying solely on physicians’ perception of the problem.     

African-American men's perceptions of health: a focus group study

African-American men are disproportionately affected by preventable medical conditions, yet they underutilize primary care health services. Because healthcare utilization is strongly dependent on health beliefs, the purpose of this qualitative study was to identify and explore African-American men's perceptions of health and health influences. We conducted eight focus group interviews with select subgroups of African-American men, including adolescents, trauma survivors, HIV-positive men, homeless men, men who have sex with men, substance abusers, church-affiliated men and a mixed sample (N=71). Definitions of health, beliefs about health maintenance and influences on health were elicited. Participants' definitions of health went beyond the traditional "absence of disease" definition and included physical, mental, emotional, economic and spiritual well-being. Being healthy also included fulfilling social roles, such as having a job and providing for one's family. Health maintenance strategies included spirituality and self-empowerment. Stress was cited as a dominant negative influence on health, attributed to lack of income, racism, "unhealthy" neighborhoods and conflict in relationships. Positive influences included a supportive social network and feeling valued by loved ones. This study provides insight into African-American men's general health perceptions and may have implications for future efforts to improve healthcare utilization in this population.