The measurement of attitudes towards and beliefs about pain.

This study compared the psychometric properties of two scales designed to measure attitudes towards and beliefs about pain. The Survey of Pain Attitudes (Revised) SOPA(R) (Jensen and Karoly 1987) and the Pain Beliefs and Perceptions Inventory (PBPI) (Williams and Thorn 1989) were examined in terms of internal consistency, discriminant validity, factor structure, construct validity and sensitivity to age and gender effects. Results provided strong support for the SOPA(R) as a useful measurement tool for use with patients with chronic low back pain. Further work is suggested for the PBPI, as the reported factor structure was not replicated. Discussion centered around the possible reasons for this finding, with issues such as the possible orientation of different treatment facilities, the possible differences in attitudes between patients with different types of pain, and the possible influence of length of years in pain or the receipt of workers compensation payments being considered.     

Physician attitudes and beliefs about use of morphine for cancer pain

The recent literature asserts that mistaken physician beliefs and attitudes are critical barriers to adequate cancer pain relief. To determine the prevalence of 12 proposed myths or misconceptions about morphine use in cancer pain management (CPM), we surveyed all physicians engaged in direct patient care in Duluth, Minnesota (N = 243). A 62% response was obtained. Many physicians misunderstood concepts of morphine tolerance, both to analgesia (51%) and to side effects (39%). Many were unaware of the use of adjuvant analgesics (29%), efficacy of oral morphine (27%), and nonexistent risk of addiction in CPM (20%). Analysis of result by physician age and specialy groups confirmed significant levels of misunderstanding in all subsets. Strategies to change physician attitudes and beliefs regarding morphine in CPM should focus on tolerance concepts, dosing schemes, safety, efficacy, lack of addictive risk, use of drug combinations, and the fact that cancer pain can be relieved.     

Student nurses' attitudes and beliefs about breast-feeding.

This study explored the breast-feeding attitudes and beliefs of students newly enrolled in an urban university baccalaureate nursing program. A qualitative approach was used to conduct in-depth semistructured interviews with 12 students prior to their formal course work in maternal-child nursing. Four themes emerged from the data analysis: 1. Personal experiences are important in the development of breast-feeding attitudes and beliefs. 2. The students generally believed that breast-feeding offered benefits for babies and mothers, but the beliefs were stronger for those who grew up with breast-feeding as the norm. 3. All the students believed that there were barriers to breast-feeding in the United States that they identified as the societal view of the breast, dependence/independence conflicts, and concerns about intimacy. 4. The students identified an educational rather than promotional role for nurses in breast-feeding because of conflicts about personal choice. This study suggests that students need help identifying their attitudes and beliefs about breast-feeding and reflecting how their personal experiences influence breast-feeding promotion.     

Patients' attitudes and beliefs about back pain and its management after physiotherapy for low back pain

Background and Purpose . Contemporary guidelines for the management of low back pain often consider patient involvement and responsibility an essential component; however, there has been little exploration of patients' opinions about back pain and its management. Method . A qualitative study of patients' perspectives of back pain in the UK; 34 semi‐structured interviews were conducted with participants who had recently received physiotherapy for back pain; interviews were transcribed and analysed using framework analysis. A topic guide was used to steer the interview and themes were extracted from the data. Results . Thirteen key themes were revealed; seven of these related to issues of satisfaction with physiotherapy and are described elsewhere. The six themes considered here dealt with the participants' experience of and attitudes to back pain and its management. Themes were: the impact of back pain on their life; perspectives about back pain; its management; their involvement in its management; what strategies they had for self‐management; and expectations about the episode of physiotherapy beforehand. Conclusions . In this group of participants with a history of back pain and physiotherapy treatment a common finding was a degree of acceptance of the back pain problem and the belief that patient involvement in management was essential. These findings would suggest that many patients with back pain may respond positively to the message of self‐management. However, acceptance of this message was not automatic, but generally occurred gradually in line with patients' experience of back pain and treatment. Copyright © 2007 John Wiley & Sons, Ltd.     

Nursing attitudes and beliefs in pain assessment and management

Aims. This paper reports a study to determine nurses’ attitudes towards pain assessment tools and the relationship of these attitudes to education and experience. Background. The issue of pain management is of interest to caregivers nationally and internationally. For example, in the United States of America, the National Health and Medical Research Council set guidelines to assist clinicians in pain management. Research on whether healthcare teams use pain assessment tools has yielded contradictory findings. Methods. Using an open‐ended questionnaire developed for this study, which was based on Fishbein and Ajzen expectancy‐value model, a convenience sample of 52 nurses on an acute care unit were asked: (1) What do you believe about the assessment of pain? (2) What do you believe about the use of pain assessment tools? and (3) What do you believe about the use of pain assessment tools in improving the patient's outcome? The nurses then rated their attitudes about each belief and how each belief made them feel. The data were collected in 2003. Results. When Fishbein and Ajzen's formula for calculating attitude was used, attitude scores ranged from ?6 to 28 with an overall mean score of +8·3. The amount of education and experience of each nurse and the attitude measure in regard to the use of pain assessment tools were compared. Conclusions. The Fishbein and Ajzen model provides a useful way to obtain information on the attitude of nurses towards the use of pain assessment instruments. To provide further information, this study with an open‐ended instrument should be followed with a fixed‐response survey with a larger sample size and in various settings.     

Cultural beliefs and attitudes of Black and Hispanic college-age women toward exercise.

The purpose of this study was to examine the cultural knowledge that informs exercise behaviors among Black and Hispanic college-age women. Focus groups were conducted among 26 Black or Hispanic female college students. Questions were based on constructs from social cognitive theory. Data were analyzed using content analysis. Latinas were found to be more likely to view vigorous exercise as "unfeminine" and cited family responsibilities as barriers. Black women enjoyed the competition and camaraderie of exercise, but felt pressure to conform to White standards of beauty. There appear to be distinct differences in the cultural beliefs that inform exercise behaviors among these women.     

Multicultural influences on pain medication attitudes and beliefs in patients with nonmalignant chronic pain syndromes.

The objective was to develop an integrated review of quantitative and qualitative research regarding the influence of patients' beliefs and attitudes toward pain medication prescribed for the treatment of nonmalignant chronic pain on use of the pain medication. Studies involving patients at least 18 years old with nonmalignant chronic pain were included. Studies of patients with acquired immune deficiency syndrome, cancer, and acute pain were excluded. Medline, CINAHL, PsychInfo, and Cochrane databases from 1985 to 2005 were searched. Reference lists were screened for relevant articles. Abstracts were screened for compliance with the study criteria, and the articles were obtained for those that met criteria. By using a systematic process, each article was subjected to repeated review and data abstracted to the collection sheets. Evidence tables were created to assist with data review. High levels of concern positively correlate with nonadherence, preconceived ideas about when the drug should start working can cause the patient to discontinue it before it begins to work, and patients may perceive that if medication is taken on a regular basis to control pain it may not be effective in the future if the pain increases. Research also showed that if patients perceived the benefits of taking the pain medication to be high, they were willing to risk the side effects.     

Direct assessment of beliefs and attitudes of chronic pain patients

Traditional approaches to psychological assessment of chronic pain patients have centered either on underlying psychopathology or environmental reinforcers for pain behavior. The current research focuses on patient beliefs and attitudes about their pain and its treatment, an additional dimension which appears to be important in treatment outcome but has seldom been systematically examined. Patients' ratings of agreement/disagreement with information presented in a brief educational videotape about chronic pain were examined via factor analysis. The four factors which emerged from the rating were: admission of emotionality, perceived relevance of the videotaped information, acknowledgment of personal responsibility in the treatment, and discrimination of noninvasive treatments. These four factors appear to have convergent validity with those suggested by other researchers. The validity and utility of this approach to patient assessment in rehabilitation settings are discussed.     

Chronic pain patients' beliefs about their pain and treatment outcomes

A novel assessment procedure measuring chronic pain patients' agreement with information presented on a clinic orientation videotape was evaluated as a predictor of short-term treatment outcome. One hundred randomly selected outpatients viewed a 15-minute videotape detailing conservative approaches to pain management and completed a questionnaire measuring factual recall of the videotape presentation and their acceptance or rejection (ie, agreement) of this information. Patient ratings of satisfaction with treatment were assessed one month after treatment. Multivariate analyses revealed that extent of agreement with the videotape content was significantly associated with lower pain ratings, increased ratings of physical ability, and higher treatment satisfaction. Prognostic use of this procedure for identifying patients at risk for nonadherence to treatment is discussed.     

The attitudes and beliefs of physiotherapy students to chronic back pain

OBJECTIVES: To describe the attitudes and beliefs of physiotherapy students to chronic low back pain (LBP) and to investigate whether these attitudes change following exposure to a teaching module on chronic back pain. Also, to investigate the effect of current or previous LBP on student attitudes and beliefs. METHODS: Six hundred and eighteen third and fourth year undergraduate physiotherapy students completed the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), 305 of these completing a further scale following exposure to a specialized teaching module about chronic back pain. The scale contains 15 statements that attribute patients' impairment and disability to pain. The student marked on a Likert scale how strongly they agreed with each item, with possible scores varying from 15-105. RESULTS: The mean HC-PAIRS scores for Year 3 physiotherapy students in 1998, 1999, and 2000 were 54.2 (SD = 8.7), 55 (SD = 9.4), and 50.9 (SD = 9.3) respectively. The mean HC-PAIRS score for Year 4 physiotherapy students in 1998 was 52 (SD = 8.9). There was no difference in HC-PAIRS scores between subjects with and without a history of LBP (HC-PAIRS score 50.5 vs. 50.0 P = 0.4). There was a significant difference between the before and after teaching scores for Year 3 students surveyed immediately following the teaching module (1998 Year 3 cohort, mean difference -6.6, 95% CI -8.6 to -4.5, 2000 Year 3 cohort, mean difference -7.7, 95% CI -10.9 to -4.6); however this result needs to be viewed with caution due to the number of students unable to be followed up. DISCUSSION: These results suggest that the attitudes and beliefs of third year physiotherapy students not exposed to teaching are similar to those of community providers. There is no difference between students with and without a history of LBP.     

Changing attitudes about pain and pain control in emergency medicine

Oligoanalgesia continues to be a large problem in the ED. An attitude of suspicion, a culture of ignoring the problem, and an environment that is not conducive to change in practice combine to present formidable obstacles for effective pain management in the emergency setting. Overcoming these obstacles for effective analgesia in the ED is not beyond the capabilities of the individual ED, the emergency physician, or the specialty of emergency medicine. Changing the attitudes of emergency medical providers about pain assessment and management will require attention in several areas of research, education and training. Oligoanalgesia remains a global problem within emergency medicine; however, this awareness is often not felt to be present "in my ED." Individual ownership of the problem may contribute to improvements in pain control. The last 15 years have seen a substantial increase in ED research focused on pain and pain management. Continued research efforts and focused clinical application of these efforts are still required. A better understanding of patient needs and expectations for pain relief, as well as continued efforts at patient education regarding pain, will also improve our treatment of pain in the ED. Recognition by providers of the ethnic, cultural, and gender differences in the expression, reporting, and expectations for treatment of pain should also continue to be a priority in changing attitudes toward pain and pain control. These goals must be realistic within the chaotic and unpredictable environment that defines emergency medicine. Practical and time-sensitive approaches to pain and pain management will continue to bea challenge to enact and enforce in our EDs. The stigma of opioids, in combination with the transient nature of the emergency physician/patient relationship, may be the largest hurdles to overcome for effective pain management not only in the ED, but also following ED discharge. Improvement in provider education of the realities, myths, and misunderstandings of opioid management may provide insight into this problem. The consequences of oligoanalgesia in the ED are not insignificant. To improve our treatment of pain in the ED, a fundamental change in attitude toward pain and the control of pain is required. This is unlikely to occur until pain is adequately addressed and treated appropriately as a true emergency.     

Cross national comparison of medical students’ attitudes and beliefs about medical cannabis and its application for pain management

ObjectivesTo examine attitudes and beliefs about medical cannabis (MC), and specifically about its application for pain management, across medical students in Israel and Thailand.DesignCross-sectional survey which measured attitudes and beliefs about MC. Participants were additionally asked to rate the perceived efficacy of MC for different medical conditions that are related to pain (arthritis, chronic pain, fibromyalgia and multiple sclerosis). Pearson's Chi-squared test was used to compare between students from the participating universities.Results430 medical students participated, 37.9 % (n = 163) from Israel and 62.1 % (n = 267) from Thailand. Personal cannabis use was reported by 55.6 % of the Israeli and only by 6.9 % of the Thai students (p < .001). Israeli secular students, compared to those from Thailand, were more likely to recommend MC for patient treatment, less concerned about serious physical and mental health risks, and more inclined to support legalization of recreational cannabis. Israeli students reported more permissive attitudes toward MC, but reported feeling less prepared to answer patient/client questions about MC than their Thai counterparts.ConclusionsThe findings of this study accentuate the need for curriculum designed around MC use to promote students' preparedness to serve patients in pain or with other medical conditions that may benefit from MC use.     

Chronic pain beliefs: validation of the survey of pain attitudes for the Portuguese language

This study validated the Survey of Pain Attitudes--brief version (SOPA) for the Portuguese language. Sixty-nine Brazilian patients were evaluated. Patients were female (71%), the mean age was 50.8 years (+/-15.4), the mean schooling was 7.4 years (+/-4.8), and the most frequent pain etiologies were: musculoskeletal (39.1%), cancer-related (34.8%), and neuropathic (20.3%). Factorial analysis produced seven domains (Control, Harm, Disability, Medical Cure, Emotion, Medication, Solicitude), as in the original instrument. Indices of reliability tests (mu Chronbach) ranged from .55 to .89, values that are accepted as moderate and good. The Portuguese language version showed conceptual equivalence to the English language version. The availability of SOPA-brief version in Portuguese may contribute for the improvement of research and clinical practices on chronic pain.     

Aboriginal nurses' beliefs,attitudes, and values about sexuality in Taiwan

The potential of risky sexual behaviors and adolescent unplanned pregnancy has become a primary issue in the health care system for aborigines in eastern Taiwan. Using aboriginal nurses to provide information on sexual behaviors may have potential in promoting healthy sexual practices among aborigines. The purposes of this study were to explore Taiwanese aboriginal nurses beliefs. attitudes, and values about sexuality. Several health centers in eastern Taiwan were randomly selected to recruit participants in the year 2000. A self-report questionnaire was administered to 206 female nurses (mean age = 28.4, SD = 7.4) who worked in various clinical units. The results revealed that aboriginal nurses hold moderately positive beliefs, attitudes, and values about sexuality. The conflict between aboriginal nurses' belief and value systems about sexuality was clear. A conflict between aboriginal nurses' value systems and patients behaviors also existed. Strategies to help aboriginal nurses to be more aware of their beliefs, attitudes, and values about sexuality should be an essential issue in the practice and education of nurses.     

Gender differences in knowledge, attitudes, and beliefs about heart disease

The purpose of this article is to review the literature on gender differences in knowledge, attitudes, and beliefs about heart disease. Despite the significant problem of cardiac disease among women, surveys of women's knowledge, attitudes, and beliefs about the risks of heart disease have continually identified substantial gaps in women's knowledge. Overall, knowledge of heart disease, identification of risk factors for coronary artery disease, signs and symptoms of acute myocardial infarction (AMI) was poor for both men and women. The perception that women are less knowledgeable than men about heart disease was not consistent in the literature reviewed. In fact, in some studies, women were more knowledgeable than men in the identification of risk factors and less common symptoms of AMI.