Primary care attributes, health care system hassles, and chronic illness

BACKGROUND: Patients with a chronic illness are likely to report difficulties in their encounters with the health care system. Although most patients with a chronic illness are managed by primary care clinicians, little is known about how the attributes of primary care might be related to health care system hassles. OBJECTIVE: We sought to examine the relationship between attributes of primary care and health care system hassles among veterans with one or more chronic illnesses. RESEARCH DESIGN: This was a cross-sectional mailed survey. SUBJECTS: We included veterans with one or more chronic illnesses who were cared for in the South Texas Veteran's health care system. MEASURES: The Components of Primary Care Instrument was used to measure 4 attributes of primary care: accumulated knowledge of the patient by the clinician, coordination of care, communication, and preference for first contact with their primary care clinician. A 16-item health care systems hassles scale was constructed and demonstrated good face validity and reliability with a Cronbach's alpha of 0.94. RESULTS: Of the 720 surveys administered by mail, 422 (59%) were returned. Patients with multiple chronic illnesses reported a higher level of hassles than patients with a single chronic illness. After controlling for patient characteristics, primary care communication and coordination of care were inversely associated with patient hassles score: as communication and coordination improved, the reported level of hassles decreased. CONCLUSIONS: Effective delivery of primary care to patients with one or more chronic illnesses may be important in decreasing the level of hassles they experience as they interact with the health care delivery system.     

Dominican concepts of health and illness

It is essential that primary health care providers be familiar with the cultural surroundings from which a person emerges. The Dominican immigrants, like all immigrants, bring with them a whole value and belief system concerning health, illness, and disease prevention. Through a better understanding of that belief system, the primary health care provider can offer a more meaningful interaction with the Dominican immigrant population.     

Adolescent hopefulness in illness and health

Hopefulness is believed to be a significant element in the human response to illness, but its clinical impact has not been documented due to conceptual and operational difficulties. This article generates a definition of hopefulness from well and ill adolescents. The study's conceptual orientation included the beliefs that hope is a contributing factor in health maintenance and is especially vital for individuals experiencing life-threatening illness. Grounded theory methodology was used. Interviews, observations and health records were data sources. Data were analyzed during the cross-comparative method. A panel approach was used to assess the reliability and validity of the induced categories. Theoretical saturation on a definition was achieved. Adolescents with cancer had a dimension in the definition not found in the other two groups. The added dimension had a focus on "others" in contrast to only "self."     

Beliefs about AIDS, health, and illness in low-income white women

A sample of 42 low-income white women were interviewed to describe their beliefs about AIDS and its treatment and to determine whether these beliefs were related to the subjects' general framework of beliefs about illness and its treatment. Content analysis was used to classify data. The causes and treatment of AIDS were categorized as professional sector, popular sector, and traditional sector health care beliefs. Professional sector beliefs included the cause and major modes of transmission and prevention identified by the biomedical system and the public health service. Popular sector misconceptions included beliefs about casual transmission and immunizations. Traditional sector beliefs concerned causes such as contamination and impurities and remedies such as herbs and diet. The respondents' explanations for the causes and treatment of AIDS in these three areas were integrated into a lay explanatory model of illness involving germs, resistance, and the immune system.     

Beliefs about AIDS, health, and illness among low-income Latina women.

The purposes of this study were to describe (a) the health beliefs of Latina women about acquired immunodeficiency syndrome (AIDS); and (b) the relationship of these beliefs to the subjects' traditional beliefs about illness and its treatment. The sample consisted of 59 low-income Latina women attending nutrition programs in Los Angeles. A qualitative approach was used to gather the data in semi-structured focus group interviews. Content analysis was used to classify data according to causes of AIDS and prevention and treatment of AIDS. Causes of AIDS included all of the current biomedical and public health explanations of transmission, current popular beliefs and misconceptions about transmission, and long-standing traditional beliefs about the causes of illness. Prevention and treatment of AIDS reflected these same three perspectives. The women's beliefs consisted of accurate, inaccurate, and incomplete information about AIDS. Implications were drawn from the findings for AIDS education and prevention programs which are congruent with the participants' cultural beliefs, values, attitudes, and expectations.     

Perspectives on human response to health and illness

Nursing's domain has been defined as the diagnosis and treatment of human responses to health problems, yet debate rages over what "human responses" are. Without clear meanings for this and other terms used in nursing, the profession cannot claim that its practice is scientifically based, nor can it share that base among disciplines.