Using the Extended Health Belief Model to understand siblings’ perceptions of risk for hereditary hemochromatosis

Objective

This research focuses on individuals’ reactions to news that a sibling has been diagnosed with hereditary hemochromatosis (HH). We used the Extended Health Belief Model (EHBM) to frame our analysis of siblings’ perceptions of risk for HH and decision of whether to obtain diagnostic testing.

Method

60 patient and 25 sibling interviews were transcribed and thematically analyzed for the six components of the EHBM.

Results

Patient and sibling reports of siblings’ perceptions were categorized into the six components of the EHBM: susceptibility, severity, benefits, barriers, cue to action, and self-efficacy.

Conclusion

In the case of HH, siblings’ perceptions of HH are varied and include a range of motivators and barriers that may impact family-based detection. Family-based detection can often play an important part of effective public health strategies to address inherited risk of disease. Further research should examine the EHBM with other genetic conditions.

Practice implications

This analysis using the EHBM suggests areas of importance for message development for both medical personnel and HH patients to promote diagnostic testing of at-risk siblings.     

Lingering questions and doubts: online information-seeking of support forum members following their medical visits

Objective

To examine the prevalence and predictors of patients’ post-appointment online health information-seeking and the reasons behind their information searches.

Methods

Survey of 274 Internet support community members who had been seen by a physician within 30 days. The questionnaire included measures of trust in the physician, health worries, changes in amount of worrying following the visit, online health information-seeking, and standard demographic and visit characteristics.

Results

A majority of respondents (68%) went online in search of information after their visits. In a logistic regression analysis, going online was associated with lower trust (P = .002), greater worrying (P = .049), and becoming more (P = .024) or less worried (P = .05) by the visit. Among those who went online, the most common reasons for doing so were sheer curiosity (71%) and disappointment with some aspect of the physician's behavior (32%).

Conclusion

Patients in this online forum routinely turned to the Internet after their medical visits, but were especially likely to do so when trust in the physician was low, anxieties were high, and the visit altered (for better or worse) their anxiety levels.

Practice Implications

Since many patients seek online information after their appointments, physicians should suggest credible websites suited to the circumstances of each patient.     

Preferences for decision-making about contraception and general health care among reproductive age women at an abortion clinic

Objective

Studies suggest that not all patients desire shared decision making, and little is known about decision making around contraception. This study compared decision-making preferences for contraception to preferences for general health among reproductive-aged women.

Methods

257 women receiving abortion care in an urban hospital completed a survey which included questions adapted from the Problem-Solving Decision-Making Scale about their preferences for medical decision making.

Results

Women were significantly more likely to desire autonomous decision making about contraception than about their general health care (50% vs. 19%, p < .001). No patient characteristics were associated with contraceptive decision-making preferences. Women with Medicaid insurance were more likely to desire autonomous decision making about contraception than about general health care (51% vs. 17%, p < .001).

Conclusion

Women desire more autonomy in their contraceptive decisions than in their decisions about general health care.

Practice implications

Health care providers should be attentive to the existence of variation in preferences in decision making across health domains. Contraceptive providers should proactively assess decisional preferences to ensure the most appropriate counseling is provided to each individual.     

What are the standard functions of electronic clinical pathways?

Purpose

The present study was performed to determine the standard functions of electronic clinical pathways (eCP) embedded in electronic medical records with regard to demand definition.

Methods

The standard functions of eCP were decided by the required functions determined from interviews with hospital staff, those derived from the implementation of paper-based clinical pathways (CPs), and additional functions generated through the shift from a paper-based to an electronic system. Moreover, the proposed standard functions and those of eCP embedded in electronic medical records for large hospitals were compared by interviews with five vendors.

Results

Seventeen functions were deemed necessary for eCP, and these were classified into six categories: displaying, recording, ordering, editing, variance, and statistics. Although most of these functions are already included in eCP products, their implementations differ between products.

Conclusions

We propose 17 standard functions required for eCP embedded in electronic medical records. The functions for editing patient checklists, checking the occurrence of variance, and statistics are especially important and should be implemented as standard functions. This study will aid in the future development of eCP embedded in electronic medical records.     

Education level, not health literacy, associated with information needs for patients with cancer

Objective

Cancer patients receiving adjuvant therapy encounter increasingly complex situations and decisions with each new procedure and therapy. To make informed decisions about care, they need to be able to access, process, and understand information. Individuals with limited health literacy may not be able to obtain or understand important information about their cancer and treatment. The rate of low health literacy has been shown to be higher among African Americans than among non-Hispanic Whites. This study examined the associations between race, health literacy, and self-reported needs for information about disease, diagnostic tests, treatments, physical care, and psychosocial resources.

Methods

Measures assessing information needs were administered to 138 newly diagnosed cancer patients. Demographics were assessed by survey and health literacy was assessed with two commonly used measures: the Rapid Estimate Adult Literacy in Medicine (REALM) and the Short Test of Health Literacy in Adults (STOFHLA).

Results

Study findings indicate that educational attainment, rather than health literacy, is a significant predictor of information needs.

Conclusion

Overcoming barriers to information needs may be less dependent on literacy considerations and more dependent on issues that divide across levels of educational attainment.

Practice implications

Oncologists and hospital staff should be attentive to the fact that many patients require additional assistance to meet their information needs.     

The relationship of patient participation and diabetes outcomes for patients with high vs. low health literacy

Objective

To examine whether patient participation in medical consultations have differing effects on self-efficacy and diabetes control by the level of patient communicative health literacy (CHL).

Methods

Participants were 143 outpatients with type 2 diabetes at a university-affiliated hospital. Patient CHL was measured using a newly developed self-rated scale of health literacy. Patient perceived participation in medical consultations and self-efficacy of diabetes self-care were assessed using the self-reported questionnaire. Patient clinical characteristics were obtained from electronic medical records.

Results

Both patient CHL and perceived participation were related to greater self-efficacy and decreased HbA1c at the 3-month follow-up. Patient CHL had a moderating effect on the relationship between perceived participation and self-efficacy. Patients with lower CHL reported greater self-efficacy when they actively participated in patient-physician communication, whereas this relationship was less evident among patients with higher CHL.

Conclusions

The examination of patient CHL levels may provide a better understanding of the potential barriers to patients’ self-management of disease.

Practice implications

The benefit of active participation may be greater among patients with lower CHL who are likely to have greater difficulties in communicating with the physician, yet tend to rely on the physician as the sole source of health information.     

Correlating reading comprehension and health numeracy among adults with low literacy

Objective

Using the Test of Functional Health Literacy for Adults (TOFHLA), a pilot study was conducted to assess whether reading comprehension and numeracy scores sufficiently correlate in health contexts among adults with low literacy skills.

Methods

The TOFHLA was administered to 144 adults with low literacy enrolled in a health literacy program prior to the start of coursework. Raw scores for reading and numeracy were calculated. Weighted numeracy scores were calculated and compared to raw reading comprehension scores.

Results

Among 143 participants, 20% (n = 28) had a higher numeracy score than reading comprehension score, while an additional 20% scored lower in numeracy than in reading comprehension.

Conclusion

This study found that reading comprehension and numeracy skill in the context of understanding health information do not necessarily correlate for specific disadvantaged groups. This finding calls attention to the need to further examine numeracy as a construct which is conceptually separate from reading comprehension, and highlights the importance of including a numerate component in health literacy evaluations.

Practice implications

The results of this study have important implications for medical decision-makers, health educators, and health promoters working with traditional methods of assessing health literacy.     

Evaluating verbal and non-verbal communication skills, in an ethnogeriatric OSCE

Objective

Communication during medical interviews plays a large role in patient adherence, satisfaction with care, and health outcomes. Both verbal and non-verbal communication (NVC) skills are central to the development of rapport between patients and healthcare professionals. The purpose of this study was to assess the role of non-verbal and verbal communication skills on evaluations by standardized patients during an ethnogeriatric Objective Structured Clinical Examination (OSCE).

Methods

Interviews from 19 medical students, residents, and fellows in an ethnogeriatric OSCE were analyzed. Each interview was videotaped and evaluated on a 14 item verbal and an 8 item non-verbal communication checklist. The relationship between verbal and non-verbal communication skills on interview evaluations by standardized patients were examined using correlational analyses.

Results

Maintaining adequate facial expression (FE), using affirmative gestures (AG), and limiting both unpurposive movements (UM) and hand gestures (HG) had a significant positive effect on perception of interview quality during this OSCE. Non-verbal communication skills played a role in perception of overall interview quality as well as perception of culturally competent communication.

Conclusion

Incorporating formative and summative evaluation of both verbal and non-verbal communication skills may be a critical component of curricular innovations in ethnogeriatrics, such as the OSCE.     

An investigation into the empowerment effects of using online support groups and how this affects health professional/patient communication

Objective

The current research investigates the potential of online support groups (OSGs) to foster empowerment and how membership might affect the patient/health professional relationship.

Methods

246 participants across 33 OSGs completed an online questionnaire.

Results

All empowerment processes and outcomes identified by van Uden-Kraan et al. [1] were found to be present. All empowerment outcomes were adequately predicted by empowerment processes. The majority (82.2%) of participants had discussed information found online with their health professional and most (74.2%) were satisfied with the response. Around 60% of participants felt membership of an OSG had affected the relationship with their health professional and from qualitative responses the effects were mostly positive.

Conclusion

OSGs have the potential to produce empowerment outcomes for those who choose to use them. Furthermore, users report a positive reaction to information found online from their health professionals.

Practice implications

Although not all patients will benefit from using OSGs, health professionals suggesting their use could ensure that they reach the maximum receptive audience. Furthermore, this research could be used to encourage a more ‘net friendly’ attitude amongst health professionals.     

Sensitivity and specificity of the mood disorder questionnaire and the bipolar spectrum diagnostic scale in Argentinean patients with mood disorders

Objective

To assess the sensitivity and specificity of two self-report instruments for detection of bipolarity in a sample of Argentinean patients.

Method

Spanish versions of the MDQ and the BSDS were administered over four months at 11 sites in Argentina. Diagnoses were made using DSM-IV criteria and the MINI. The study sample consisted of patients diagnosed with Bipolar Disorder (BD) Types I, II, or NOS. BDNOS diagnoses were made using extended guidelines for bipolar spectrum symptoms. Unipolar patients were used as a control group. Of 493 patients screened, 354 completed evaluation by MDQ and MINI, and 363 by BSDS and MINI.

Results

Specificity of MDQ was 0.97 and BSDS was 0.81. MDQ sensitivity was 0.70 for bipolar type I (BD-I), 0.52 for bipolar II (BD-II) and 0.31 for bipolar not otherwise specified (BDNOS). BSDS sensitivities were 0.75, 0.70 and 0.51 respectively.

Limitations

This study was performed in specialized outpatient settings and thus its results are not necessarily representative for other clinical settings. There was not a systematic evaluation of comorbid psychiatric disease or test-retest reliability.

Conclusion

The local versions of the MDQ and the BSDS showed a sensitivity and specificity comparable to previous research. Our results indicate that in this sample, MDQ was more specific for BD and BSDS was more sensitive to detect BD-II and NOS. Since BD-I is more readily recognized than bipolar spectrum disorders, enhanced sensitivity of BSDS for soft bipolarity may be an advantage.     

Desire for autonomy in health care decisions: A general population survey

Objective

To examine factors associated with desire for autonomy in health care decisions in the general population.

Methods

Mailed survey of 2348 residents of Geneva, Switzerland. Participants answered questions on a scale measuring their desire for autonomy in health care decisions. The scale was scored between 0 (lowest desire for autonomy) and 100 (highest desire for autonomy).

Results

On average the respondents favoured shared or active involvement in medical decisions (mean score 62.0, SD 20.9), but attitudes varied considerably. In the multivariate model, factors associated with a higher desire for autonomy included female gender, younger age, higher education, living alone, reporting an excellent global health and - a new observation compared to previous studies - having made several medical decisions in the past 6 months.

Conclusions

The attitudes of the general public appear to be consistent with the model of shared decision making. However, people vary considerably in their desire for autonomy.

Practice implications

An explicit assessment of each individual's desire for autonomy may improve the decision-making process. Such an assessment should be repeated regularly, as familiarity with medical decisions may increase the desire for autonomy.     

The landscape of postgraduate education in palliative care for general practitioners: results of a nationwide survey in Flanders, Belgium

Objective

To describe the offer of continuing medical education (CME) in palliative care in Flanders, Belgium and to explore the way providers of CME address the preferences of general practitioners (GP's) towards CME.

Methods

Questionnaire-survey among official providers of formal CME.

Results

The response rate was 43%, equally distributed over all 5 provinces of Flanders. Data show large content gaps, an under usage of appropriate educational techniques and an absence of evaluation of the impact of CME on clinical practice. Providers of CME explain how they take the preferences of GP's concerning education in palliative care into account.

Conclusions

The present offer of CME is insufficient to educate GP's in palliative care. The absence of quality criteria and the lack of coordination between different providers results in an unattractive labyrinth of courses leaving GP's and their patients in the cold.

Practice implications

A comprehensive offer of CME sessions should be installed in a coordination between all providers. This could render the use of means (logistics and speakers) more efficient. Further research could look into other ways of acquiring palliative care competences such as evaluating the learning effect of GP's working together with specialized palliative home care teams.     

Computer-based execution of clinical guidelines: a review

Purpose

Clinical guidelines are useful tools to standardize and improve health care. The automation of the guideline execution process is a basic step towards its widespread use in medical centres. This paper presents an analysis and a comparison of eight systems that allow the enactment of clinical guidelines in a (semi) automatic fashion.

Methods

This paper presents a review of the literature (2000-2007) collected from medical databases as well as international conferences in the medical informatics area.

Results

Eight systems containing a guideline execution engine were selected. The language used to represent the guidelines as well as the architecture of these systems were compared. Different aspects have been assessed for each system, such as the integration with external elements or the coordination mechanisms used in the execution of clinical guidelines. Security and terminology issues complement the above study.

Conclusions

Although these systems could be beneficial for clinicians and patients, it is an ongoing research area, and they are not yet fully implemented and integrated into existing careflow management systems and hence used in daily practice in health care institutions.     

Factors influencing health information technology adoption in Thailand's community health centers: Applying the UTAUT model

Background

One of the most important factors for the success of health information technology (IT) implementation is users’ acceptance and use of that technology. Thailand has implemented the national universal healthcare program and has been restructuring the country's health IT system to support it. However, there is no national data available regarding the acceptance and use of health IT in many healthcare facilities, including community health centers (CHCs). This study employed a modified Unified Theory of Acceptance and Use of Technology (UTAUT) structural model, to understand factors that influence health IT adoption in community health centers in Thailand and to validate this extant IT adoption model in a developing country health care context.

Methods

An observational research design was employed to study CHCs’ IT adoption and use. A random sample of 1607 regionally stratified CHC's from a total of 9806 CHCs was selected. Data collection was conducted using a cross-sectional survey by means of self-administered questionnaire with an 82% response rate. The research model was applied using the partial least squares (PLS) path modeling.

Results

The data showed that people who worked in CHCs exhibited a high degree of IT acceptance and use. The research model analyses suggest that IT acceptance is influenced by performance expectancy, effort expectancy, social influence and voluntariness. Health IT use is predicted by previous IT experiences, intention to use the system, and facilitating conditions.

Conclusions

Health IT is pervasive and well adopted by CHCs in Thailand. The study results have implications for both health IT developmental efforts in Thailand and health informatics research. This study validated the UTAUT model in the field context of a developing country's healthcare system and demonstrated that the PLS path modeling works well in a field study and in exploratory research with a complex model.     

A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication

Objective

To determine the efficacy and effectiveness of training to improve primary care providers’ patient-centered communication skills and proficiency in discussing their patients’ health risks.

Methods

Twenty-eight primary care providers participated in a baseline simulated patient interaction and were subsequently randomized into intervention and control groups. Intervention providers participated in training focused on patient-centered communication about behavioral risk factors. Immediate efficacy of training was evaluated by comparing the two groups. Over the next 3 years, all providers participated in two more sets of interactions with patients. Longer term effectiveness was assessed using the interaction data collected at 6 and 18 months post-training.

Results

The intervention providers significantly improved in patient-centered communication and communication proficiencies immediately post-training and at both follow-up time points.

Conclusions

This study suggests that the brief training produced significant and large differences in the intervention group providers which persisted 2 years after the training.

Practice implications

The results of this study suggest that primary care providers can be trained to achieve and maintain gains in patient-centered communication, communication skills and discussion of adverse childhood events as root causes of chronic disease.     

“I Wouldn’t Be this Firm if I Didn’t Care”: Preventive clinical counseling for reproductive health

Objective

This qualitative study of health care clinicians serving women at heightened risk of sexually transmitted infections and unintended pregnancy was undertaken to explore concepts underlying reproductive health counseling messages in clinical encounters.

Methods

In-depth interviews were conducted with 31 clinicians, including physicians and advanced practice nurses serving primarily low-income patients in high-risk communities throughout the U.S.

Results

Most of the clinicians describe their influence on patients and protective behaviors as derived from medical authority and the presentation of information. The use of a parental style of authority, particularly for young or vulnerable patients, and emotional appeals to evoke negative emotions, such as fear, were also used to motivate protective behaviors. Many clinicians highlighted the importance of empathy, and understanding the cultural and social context of health behaviors. A few clinicians described innovative efforts to empower women to protect themselves and exert more control in relationships.

Conclusion

Some of the reproductive health counseling approaches described by clinicians are not consistent with leading health behavior change theories or patient-centered counseling.

Practical implications

To improve counseling, these messages and concepts need to be evaluated for effectiveness, and possibly used to inform the development of novel theories for use in reproductive health counseling.     

Determinants of Internet use as a preferred source of information on personal health

Objective

To understand the personal, social and cultural factors likely to explain recourse to the Internet as a preferred source of personal health information.

Design

A cross-sectional survey was conducted among a population of 2923 Internet users visiting a firmly established website that offers information on personal health. Multiple regression analysis was performed to identify the determinants of site use.

Measurement

The analysis template comprised four classes of determinants likely to explain Internet use: beliefs, intentions, user satisfaction and socio-demographic characteristics. Seven-point Likert scales were used. An analysis of the psychometric qualities of the variables provided compelling evidence of the construct's validity and reliability. A confirmatory factor analysis confirmed the correspondence with the factors predicted by the theoretical model.

Findings

The regression analysis explained 35% of the variance in Internet use. Use was directly associated with five factors: perceived usefulness, importance given to written media in searches for health information, concern for personal health, importance given to the opinions of physicians and other health professionals, and the trust placed in the information available on the site itself.

Conclusion

This study confirms the importance of the credibility of information on the frequency of Internet use as a preferred source of information on personal health. It also shows the potentially influential role of the Internet in the development of personal knowledge of health issues.     

Shared decision making in medicine: The influence of situational treatment factors

Objective

Although shared decision making (SDM) has become increasingly important in bioethical discussions and clinical practice, it is not clear in which treatment situations SDM is suitable. We address this question by investigating social norms on the appropriateness of SDM in different situations.

Methods

We conducted qualitative expert interviews with patients, general practitioners, and health administration and research professionals.

Results

SDM was considered to be most important in severe illness and chronic condition. Furthermore, SDM was indicated to be required if there is more than one therapeutic option, especially if it is not clear which option is best. Interviewees classified end-of-life decisions and decisions about prevention as those that primarily should be made by informed patients. On the other hand a paternalistic decision was considered most appropriate in emergency situations and when the patient does not want to participate in decision making.

Conclusion

This study demonstrates that multiple situational factors and their interactions must be considered regarding the scope of SDM in medical consultation.

Practice implications

Research addressing this question will help physicians adjust their consultation style and allow implementations of SDM and decision aids to be tailored more appropriately to complex treatment situations.     

Employing immersive virtual environments for innovative experiments in health care communication

Objective

This report reviews the literature for studies that employ immersive virtual environment technology methods to conduct experimental studies in health care communication. Advantages and challenges of using these tools for research in this area are also discussed.

Methods

A literature search was conducted using the Scopus database. Results were hand searched to identify the body of studies, conducted since 1995, that are related to the report objective.

Results

The review identified four relevant studies that stem from two unique projects. One project focused on the impact of a clinician's characteristics and behavior on health care communication, the other focused on the characteristics of the patient. Both projects illustrate key methodological advantages conferred by immersive virtual environments, including, ability to maintain simultaneously high experimental control and realism, ability to manipulate variables in new ways, and unique behavioral measurement opportunities.

Conclusion

Though implementation challenges exist for immersive virtual environment-based research methods, given the technology's unique capabilities, benefits can outweigh the costs in many instances.

Practice implications

Immersive virtual environments may therefore prove an important addition to the array of tools available for advancing our understanding of communication in health care.     

Helminthic infection and the risk of neurologic disease progression in HTLV-1

Background

Infection with the human T-cell lymphotropic virus, type 1 (HTLV-1) has been associated with an increased Th1 response. Interestingly, a higher prevalence of helminthic coinfection has been observed among infected individuals, and subsequent modulation of the immune response typically associated with helminths may influence clinical outcomes among HTLV-1 coinfected individuals.

Objective

This study was conducted to elucidate the association between helminthic coinfection and the development of clinically characterized neurologic disease that occurs in HTLV-1 infection.

Study design

In a cohort analysis, incidence of HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP) was recorded. Incidence of clinical outcomes and disease-free survival of several neurologic outcomes associated with HTLV-1 were estimated using the Kaplan-Meier method with log-rank tests. The relationships between helminthic infection and risk of HTLV-1 neurologic outcomes were assessed by Cox proportional hazard modeling.

Results

Seventy-four coinfected and 79 non-coinfected patients were followed, with 92 helminthic infections observed in the coinfected group. One patient per group developed HAM/TSP and the risk of progression to neurologic disease outcomes did not differ among those with and without helminthic coinfection (p > 0.45). A significant difference was noted in the prevalence of neurologic disease outcomes among all patients at the conclusion of the study (p < 0.01).

Conclusions

These data suggest that treated helminthic infection does not affect risk of development of neurologic disease in HTLV-1 infection, and reinforce that treatment of helminths does not adversely affect patients with HTLV-1. Importantly, among all patients, an overall progression of neurologic disease was observed.