The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations

ObjectiveOur goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection.MethodsData were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses’ Health Study 3 between the follow-up period of 1996–2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI).ResultsProvider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001).ConclusionProvider-patient communication may benefit sexual minority women’s contraceptive practices and engagement with STI testing.Practice implicationsDifferences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters.     

The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men

Background

High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland.

Methods

In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time–space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011.

Results

43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from −18% to −28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression.

Limitations

Community-level assessment with no control.

Conclusions

Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking.     

The role of self-assessed health in the relationship between gender and depressive symptoms among adolescents

OBJECTIVE: To examine the concurrent and longitudinal relations between gender, self-assessed health (SAH), and depressive symptoms among adolescents. METHOD: Two measures of SAH (physical symptom reports and global health ratings) and a measure of depression were completed on two occasions over two years by 232 adolescent boys and girls. RESULTS: Physical symptom reports were related to depressive symptoms both concurrently and longitudinally. Longitudinal path analysis revealed a significant path from gender to physical symptom reports (Wave 1) to depressive symptoms (Wave 2). Although global health ratings were related to depressive symptoms concurrently, the prospective relation was not significant in the cross-lagged path model. CONCLUSIONS: These findings suggest that the development of poorer SAH, particularly the perception of physical symptoms, may place adolescent girls at risk for subsequent depressive symptoms. Potential mechanisms for the SAH-depression relationship are discussed.     

The role of parent health literacy among urban children with persistent asthma

Health literacy (HL) affects adult asthma management, yet less is known about how parent HL affects child asthma care.     

Consumers' perceptions about and use of the internet for personal health records and health information exchange: analysis of the 2007 Health Information National Trends Survey

Background

Personal health records (PHRs) and the sharing of health information through health information exchange (HIE) have been advocated as key new components in the effective delivery of modern health care. It is important to understand consumer attitudes toward utilization of PHRs and HIE to evaluate the public’s willingness to adopt these new health care tools.

Objective

The purpose of this study was to examine consumer attitudes toward PHRs and their health care providers’ use of HIE, as well as to evaluate consumer use of the Internet for tracking PHRs.

Methods

Analysis of data from the 2007 iteration of the Health Information National Trends Study (HINTS, N=7674) was conducted using multivariate logistic regression to identify predictors of consumer (1) appraisal of PHRs, (2) appraisal of health care provider use of HIE, and (3) use of the Internet for tracking PHRs.

Results

: Approximately 86% of US adults rated electronic access to their PHRs as important. However, only 9% of them used the Internet for tracking PHRs. Those who rated electronic access to their PHRs as important were more likely to be Hispanic (odds ratio [OR] = 1.34, 95% confidence interval [CI] 1.04 - 1.72) and Internet users (OR = 1.27, 95% CI = 1.02 - 1.57) and less likely to be age 65 and above (OR = 0.50, 95% CI = 0.38 - 0.67) or individuals whose doctors always ensured their understanding of their health (OR = 0.62, 95% CI = 0.49 – 0.78). Those who rated HIE as important were more likely to be 45 to 54 years of age (OR = 1.46, 95% CI = 1.03 - 2.08), 55 to 64 years of age (OR = 1.83, 95% CI = 1.32 - 2.53), or 65 and above (OR = 1.76, 95% CI = 1.27 - 2.43) and less likely to be women (OR = 0.80, 95% CI = 0.68 - 0.95) or individuals who perceive their health information as not safely guarded by their doctors (OR = 0.53, 95% CI = 0.40 - 0.69). Among Internet users, those who used the Internet to track their PHRs were more likely to be college graduates (OR = 1.84, 95% = 1.32 - 2.59) or to have completed some college courses (OR = 1.46, 95% CI = 1.02 - 2.11), to be Hispanic (OR = 1.92, 95% CI = 1.23 - 2.98), or to be individuals with health care provider access (OR = 1.90, 95% CI = 1.21 - 2.97). Women were less likely to use the Internet for tracking PHRs than men (OR = 0.78, 95% CI = 0.61 - 1.00).

Conclusions

Despite widespread positive appraisal of electronic access to PHRs as important, Internet use for tracking PHRs remains uncommon. To promote PHR adoption, the digital divide associated with the gap in health literacy must be improved, and cultural issues and the doctor-patient relationship need to be studied. Further work also needs to address consumer concerns regarding the security of HIE.     

‘What matters to Andrew’. The problem of premissary relevance in automated health advisors. Insights from pragma-dialectics

Objective

To influence health behavior, communication has to be relevant on an individual level and, thus, fulfill the requirement of premissary relevance. This paper attempts to enrich the design of automated health advisors by, first, reviewing main solutions to the challenge of premissary relevance found in the literature and, second, highlighting the value in this field of the theory of argumentation known as pragma-dialectics.

Methods

A conceptual paper grounded in persuasion research and argumentation theory.

Results

Automated health advisors enable argumentative exchanges with users. But there is a need to design these systems as to make them work in an audience-centered perspective. The theory of pragma-dialectics can be used to analyze the factors that favor or hinder the agreement of users to engage in certain health behaviors, and to identify argumentation strategies targeted to behavior change.

Conclusion

Pragma-dialectics can be used to enhance the design of automated health advisors as it operationalizes the dialogical nature of the reasoning process that can influence health behavior.

Practice implications

Premissary relevance is a challenge of communication for health promotion at large that can be promisingly addressed through synergies among persuasion research, argumentation theory and Artificial Intelligence.     

Effects of presentation formats on consumers’ performance and perceptions in the use of personal health records among older and young adults

Objective

To examine the effects of presentation formats on consumers’ performance and perceptions in the use of personal health records (PHRs) and to compare the effects between older and young adults.

新疆青少年心理健康素质现状及特点

目的:考察新疆青少年心理健康素质的现状及特点。方法:通过分层抽样方法,在新疆地区选取了2138名10~19岁在校中小学生(来自汉族、维吾尔族和哈萨克族),采用中国青少年心理健康素质调查表(Chinese Adolescent Mental Health Qualities Inventory,CAMHQI)进行调查,该调查表包含适应状况、人际沟通、个性素质、动力系统、自我、认知风格、归因风格和应对方式8个分量表。结果:(1)新疆青少年心理健康素质各项指标均值都在3分左右。新疆青少年的适应状况、人际沟通、个性素质、自我、认知风格、应对方式分量表分均高于全国青少年常模,而动力系统、归因风格分量表分均低于全国青少年常模。(2)哈萨克族青少年的认知风格及归因风格分量表分均高于汉族青少年;汉族和哈萨克族青少年的适应状况、人际沟通、个性素质、动力系统、自我以及归因风格分量表分均高于维吾尔族青少年。(3)小学五年级学生各分量表(除应对方式外)得分均高于其他年级学生;除认知风格分量表外,初三年级学生各分量表得分均高于初一学生;高二、高三年级学生的动力系统得分高于高一年级学生。(4)女生动力系统得分高于男生,而认知风格得分低于男生。结论:新疆地区青少年各方面心理健康素质的水平都比较高,有6种素质的水平高于全国平均水平;小学生五年级心理健康素质的发展水平最高,初中阶段呈先降后升,高中阶段的发展水平处于稳定状态;哈萨克族和汉族青少年心理健康素质的发展与维吾尔族青少年相比具有明显的优势。     

Use of the internet to communicate with health care providers in the United States: estimates from the 2003 and 2005 Health Information National Trends Surveys (HINTS)

Background

Despite substantial evidence that the public wants access to Internet-based communication with health care providers, online patient-provider communication remains relatively uncommon, and few studies have examined sociodemographic and health-related factors associated with the use of online communication with health care providers at a population level.

Objective

The aim of the study was to use nationally representative data to report on the prevalence of and changes in use of online patient-provider communication in 2003 and 2005 and to describe sociodemographic and health-related factors associated with its use.

Methods

Data for this study are from two iterations of the Health Information National Trends Survey (HINTS 2003, HINTS 2005). In both years, respondents were asked whether they had ever used email or the Internet to communicate with a doctor or a doctor’s office. Adult Internet users in 2003 (n = 3982) and 2005 (n = 3244) were included in the present study. Multivariate logistic regression analysis was conducted to identify predictors for electronic communication with health care providers.

Results

In 2003, 7% of Internet users had communicated online with an health care provider; this prevalence significantly increased to 10% in 2005. In multivariate analyses, Internet users with more years of education, who lived in a metro area, who reported poorer health status or who had a personal history of cancer were more likely to have used online patient-provider communication.

Conclusions

Despite wide diffusion of the Internet, online patient-provider communication remains uncommon but is slowly increasing. Policy-level changes are needed to maximize the availability and effectiveness of online patient-provider communication for health care consumers and health care providers. Internet access remains a significant barrier to online patient-provider communication.     

Speech difficulties and patient health communication mediating effects on worry and health‐related quality of life in children,adolescents, and young adults with Neurofibromatosis Type 1

The objective was to investigate the serial mediating effects of speech difficulties, patient health communication, and disease‐specific worry in the relationship between neurofibromatosis (NF) symptoms (pain and skin symptoms) and total generic health‐related quality of life (HRQOL) in children, adolescents, and young adults with NF Type 1 (NF1) from the patient perspective. The Speech, Communication, Worry, Pain, Skin Itch Bother, and Skin Sensations Scales from the Pediatric Quality of Life Inventory (PedsQL) NF1 Module and the PedsQL 4.0 Generic Core Scales were completed in a multi‐site national study by 305 patients ages 5–25 years. A serial multiple mediator model analysis was conducted to test the hypothesized sequential mediating effects of speech difficulties, health communication, and worry as intervening variables in the association between NF1 symptoms and HRQOL. Symptoms predictive effects on total generic HRQOL were serially mediated by speech difficulties, patient health communication, and worry. In predictive analytics models utilizing hierarchical multiple regression analyses with age and gender demographic covariates, the pain, skin itch bother, and skin sensations multiple mediator models accounted for 61%, 59%, and 56% of the variance in generic HRQOL (p < .001), reflecting large effect sizes. Speech difficulties, patient health communication, and disease‐specific worry explain in part the mechanism of symptoms predictive effects on total generic HRQOL in pediatric patients with NF1. Identifying NF1‐specific predictors and serial mediators of total generic HRQOL in pediatric patients with NF1 from the patient perspective enables a patient‐centered comprehensive care approach for children, adolescents, and young adults with NF1.     

The role of health literacy in perceived information provision and satisfaction among women with ovarian tumors: A study from the population-based PROFILES registry

Objective

To assess the association of subjective health literacy (HL) and education with perceived information provision and satisfaction.

Methods

Women (N = 548) diagnosed with an ovarian or borderline ovarian tumor between 2000 and 2010, registered in the Eindhoven Cancer Registry, received a questionnaire including subjective HL, educational level, perceived information provision, and satisfaction with the information received. Multiple linear and logistic regression analyses were performed, controlled for potential confounders.

Results

Fifty percent of the women responded (N = 275). Thirteen percent had low and 41% had medium subjective HL. Women with low HL reported less perceived information provision about medical tests, and were less satisfied with the information received compared to women with high HL. Low educated women reported that they received more information about their disease compared to highly educated women.

Conclusion

Low subjective HL among women with ovarian tumors is associated with less perceived information provision about medical tests and lower information satisfaction, whereas low education is associated with more perceived information provision about the disease.

Practice implications

HL should not be overlooked as a contributing factor to patients’ perceived information provision and satisfaction. Health care providers may need training about recognizing low HL.     

The influence of primary health care professionals in encouraging exercise and physical activity uptake among White and South Asian older adults: Experiences of young older adults

Objective

To explore the influence of primary health care professionals in increasing exercise and physical activity among 60–70-year-old White and South Asian community dwellers.

Method

Fifteen focus groups and 40 in-depth interviews with community dwelling White and South Asian 60–70-year olds. The sample was selected to include people with very different experiences of participation and non-participation in exercise and physical activity. Data were analysed using framework analysis.

Results

Primary health care professionals’ advice and support was found to be a motivator to the initiation of exercise and physical activity. However, this was usually in relation to advice on weight reduction, cardiac conditions and mobility issues, but not generally to improve or increase activity levels. An underlying attitude of genuine interest and empathy was valued and shaped decisions about initiating and/or increasing activity levels.

Conclusion

Primary health care professionals should be encouraged to show interest and empathy with older people about the positive benefits of exercise and physical activity to them individually. This advice needs to be tailored to the older adult's symptoms.

Practice implications

Primary health care professionals need to be able to provide specific advice as to the quantity (frequency, duration, intensity and type) of exercise or physical activity to undertake. Practitioners need to listen to their patients’ needs, show empathy and avoid ageism during consultations.