Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study

Background

Including content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students’ beliefs and behaviours.

Methods

A total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students’ sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students’ perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses.

Results

Generally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community.

Conclusions

Students’ positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students’ future behaviours and ultimately improve physician relationships with Indigenous patients.

     

Utility of temporal self-regulation theory in health and social behaviours: A meta-analysis

Purpose

Temporal self-regulation theory was developed to address an observed intention-behaviour gap across behaviours. However, a synthesis of studies has not yet been conducted to investigate the theory's utility to explain behaviour and bridge the intention-behaviour gap. This review aimed to evaluate the predictive ability of temporal self-regulation theory to understanding behaviour and pre-registered at PROSPERO (ID: CRD42021253174).

Method

Forward citation searches on the original theory publication through Google Scholar until May 2021 identified 37 eligible articles, including, 12,555 participants assessing at least two of the three theory constructs. Random-effects meta-analyses assessed the strength of associations between theory constructs on behaviour and random effects meta-regressions assessed moderators of behaviour.

Results

Findings provide support for temporal self-regulation theory to explain behaviour with very weak (self-regulatory capacity r = .039, CI = .00, –.07) to moderate (intention r = .331, CI = .26, .40; behavioural pre-potency r = .379, CI = .32, .44) effect sizes. Further, the strength of associations varied across behaviour types and contexts. However, there was high heterogeneity across studies and some moderating effects could not be assessed due to insufficient numbers of studies assessing interactions.

Conclusions

We urge researchers to assess and report interactions for better understanding of the drivers of behaviour to develop effective interventions for positive behaviour change.     

Improving shared health decision making for children and adolescents with chronic illness: A narrative literature review

Objective

This review aims to increase understanding of health decision-making by children and adolescents with chronic illnesses and offer suggestions for improving shared decision-making with healthcare professionals.

eHealth literacy: extending the digital divide to the realm of health information

Background

eHealth literacy is defined as the ability of people to use emerging information and communications technologies to improve or enable health and health care.

Objective

The goal of this study was to explore whether literacy disparities are diminished or enhanced in the search for health information on the Internet. The study focused on (1) traditional digital divide variables, such as sociodemographic characteristics, digital access, and digital literacy, (2) information search processes, and (3) the outcomes of Internet use for health information purposes.

Methods

We used a countrywide representative random-digital-dial telephone household survey of the Israeli adult population (18 years and older, N = 4286). We measured eHealth literacy; Internet access; digital literacy; sociodemographic factors; perceived health; presence of chronic diseases; as well as health information sources, content, search strategies, and evaluation criteria used by consumers.

Results

Respondents who were highly eHealth literate tended to be younger and more educated than their less eHealth-literate counterparts. They were also more active consumers of all types of information on the Internet, used more search strategies, and scrutinized information more carefully than did the less eHealth-literate respondents. Finally, respondents who were highly eHealth literate gained more positive outcomes from the information search in terms of cognitive, instrumental (self-management of health care needs, health behaviors, and better use of health insurance), and interpersonal (interacting with their physician) gains.

Conclusions

The present study documented differences between respondents high and low in eHealth literacy in terms of background attributes, information consumption, and outcomes of the information search. The association of eHealth literacy with background attributes indicates that the Internet reinforces existing social differences. The more comprehensive and sophisticated use of the Internet and the subsequent increased gains among the high eHealth literate create new inequalities in the domain of digital health information. There is a need to educate at-risk and needy groups (eg, chronically ill) and to design technology in a mode befitting more consumers.     

Differential effects of health knowledge and health empowerment over patients’ self-management and health outcomes: A cross-sectional evaluation

Objective

The role of health knowledge and empowerment in explaining behavioral and health outcomes was treated in depth in the literature, but the combined effect of these constructs has been somehow neglected. This study presents an empirical, a priori, cross-sectional evaluation of the differential effects of health knowledge and empowerment on patients’ self-management and health outcomes.

Methods

This study relies on a cross-sectional design involving a total of 209 Fibromyalgia patients. Structural Equation Modeling techniques were employed to analyze the model relationships.

Results

Knowledge and three empowerment dimensions were found to positively impact health outcomes. However, these relationships were not mediated by self-management. Self-management, operationalized in terms of physical exercise and drug intake, was found to be a strong predictor of health outcomes.

Conclusion

Despite the lack of support for the mediating role of self-management, a strong impact of knowledge and empowerment over health outcomes was observed. Theories of health literacy and empowerment may benefit from this result by integrating both dimensions in an overall model of behavioral and health outcomes change.

Practice implications

Results from this study suggest that health interventions targeted to chronic patients should focus simultaneously on knowledge and empowerment, rather than favoring one of these individual constructs.     

The Role of Self-Monitoring and Response Inhibition in Improving Sleep Behaviours

Background

Young adults tend to have poor sleep, which may be a result of poor self-regulation.

Purpose

This study investigated whether manipulating two aspects of self-regulation: self-monitoring and response inhibition could improve sleep behaviours.

Method

University students (N?=?190) were randomly allocated to complete (1) a self-monitoring sleep diary and response inhibition training, (2) a sleep diary only, or (3) a control questionnaire daily for a period of 7 days.

Results

Outcome measures were three sleep hygiene behaviours previously found to be particularly important in this population: avoiding going to bed hungry and thirsty, avoiding anxiety and stress-provoking activity before bed, and making the bedroom and sleep environment restful. Those who completed diary-based self-monitoring successfully avoided anxiety and stress-provoking activity before bed more frequently than control participants, corresponding to a medium effect size, and further development may provide a simple intervention to improve aspects of sleep and other health behaviours.

Conclusion

There was no incremental effect of response inhibition training. Modified response inhibition training tasks may be worth investigating in future research.     

Primary care characteristics and population-orientated health care across Europe: an observational study

Background

The number of patients with chronic diseases is increasing which poses a challenge to healthcare organisations. A proactive, structured, and population-orientated approach is needed: the chronic care model (CCM) provides such a framework.

Aim

To assess organisational conditions for providing structured chronic care according to the CCM across different healthcare systems.

Design of study

International observational study.

Setting

A stratified sample of 315 primary care practices in 10 European countries and Israel in 2008 and 2009.

Method

Practice questionnaires and interviews. Outcome measures were mean practice scores on CCM domains per country, as a percentage of the maximum score, and the influence of practice size and urbanisation on these scores.

Results

Practice size showed large differences with the largest practices in Spain, England, Finland, and Israel. These countries, with a strong primary care orientation, had most physicians and staff involved per practice. The CCM domains ‘clinical information systems’ and ‘decision support’ had total practice means of 90%; other domains scored about 50%. Spain and England scored above average on almost all domains. Practice size and urbanisation had little impact.

Conclusion

Characteristics for chronic care delivery differed for most CCM domains. The most common characteristics related to computerisation, providing a good starting point and high potential everywhere. All countries showed room for improvement. Further research should focus on relations between practice characteristics, organisational features, including health system and primary care orientation, and outcomes. Primary care seems suited for chronic care delivery; however, a stronger primary care was associated with better scores.     

Older adults with multi-morbidity: medication management processes and design implications for personal health applications

Background

Older adults often have multiple chronic problems requiring them to manage complex medication regimens overseen by various clinicians. Personal health applications (PHAs) show promise assisting in medication self-management, but adoption of new computer technologies by this population is challenging. Optimizing the utility of PHAs requires a thorough understanding of older adults’ needs, preferences, and practices.

Objective

The objective of our study was to understand the medication self-management issues faced by older adults and caregivers that can be addressed by an electronic PHA.

Methods

We conducted a qualitative analysis of a series of individual and group semistructured interviews with participants who were identified through purposive sampling.

Results

We interviewed 32 adult patients and 2 adult family caregivers. We identified 5 core themes regarding medication self-management challenges: seeking reliable medication information, maintaining autonomy in medication treatment decisions, worrying about taking too many medications, reconciling information discrepancies between allopathic and alternative medical therapies, and tracking and coordinating health information between multiple providers.

Conclusions

This study provides insights into the latent concerns and challenges faced by older adults and caregivers in managing medications. The results suggest that PHAs should have the following features to accommodate the management strategies and information preferences of this population: (1) provide links to authoritative and reliable information on side effects, drug interactions, and other medication-related concerns in a way that is clear, concise, and easy to navigate, (2) facilitate communication between patients and doctors and pharmacists through electronic messaging and health information exchange, and (3) provide patients the ability to selectively disclose medication information to different clinicians.     

The role of somatic health problems in the recognition of depressive and anxiety disorders by general practitioners

Background

Recognition of depression and anxiety by general practitioners (GPs) is suboptimal and there is uncertainty as to whether particular somatic health problems hinder or facilitate GP recognition. The objective of this study was to investigate the associations between somatic health problems and GP recognition of depression and anxiety.

Methods

We studied primary care patients with a DSM-IV based psychiatric diagnosis of depressive or anxiety disorder during a face-to-face interview (n=778). GPs′ registrations of depression and anxiety diagnoses, based on medical file extractions, were compared with the DSM-IV based psychiatric diagnoses as reference standard. Somatic health problems were based on self-report of several chronic somatic diseases and pain symptoms, using the Chronic Pain Grade (CPG), during the interview.

Results

Depression and anxiety was recognized in sixty percent of the patients. None of the health problems were negatively associated with recognition. Greater severity of pain symptoms (OR=1.18, p=.02), and chest pain (OR=1.56, p=.02), in particular, were associated with more GP recognition of depression and anxiety. Mediation analyses showed that depression and anxiety in these patients were better recognized through the presence of more severe psychiatric symptoms.

Limitations

Some specific chronic diseases had low prevalence.

Conclusions

This study shows that the presence of particular chronic diseases does not influence GP recognition of depression and anxiety. GPs tend to recognize depression and anxiety better in patients with pain symptoms, partly due to more severe psychiatric symptoms among those with pain.     

Actual and perceived substance use of health science students at a university in the Western Cape, South Africa

Background

Substance use among youth is a worldwide epidemic that impacts negatively on the health sector as well as the family and society. Early student life is a time of tremendously high motivation to conform to the behaviours, values, and attitudes that are valued by the youth culture. They observe their peers'' behavior and alter their own behaviour with their peers'' norms and expectations. This compliance with perceived peer norms can however lead to increased smoking, alcohol and drug use.

Objectives

To determine and analyze risky and health promoting behaviour of health science students at a university in the Western Cape, South Africa. In this paper the association between actual risk and perceived risk for substance is discussed.

Methods

A self-administered questionnaire containing items from both the NCHRBS and the ACHA-NCHA were administered to 201 health science students at a South African university.

Results

When perceptions of typical student behaviour were compared to actual reported behaviour, overestimated consumption patterns for the typical student was found for smoking, alcohol and drug use.

Conclusion

The misperceptions of peer norms have important educational or prevention program implications. These findings clearly indicate that educational and awareness programs regarding alcohol and drug use should take perceptions of peer alcohol and drug use into consideration.     

Health and wellness technology use by historically underserved health consumers: systematic review

Background

The implementation of health technology is a national priority in the United States and widely discussed in the literature. However, literature about the use of this technology by historically underserved populations is limited. Information on culturally informed health and wellness technology and the use of these technologies to reduce health disparities facing historically underserved populations in the United States is sparse in the literature.

Objective

To examine ways in which technology is being used by historically underserved populations to decrease health disparities through facilitating or improving health care access and health and wellness outcomes.

Methods

We conducted a systematic review in four library databases (PubMed, PsycINFO, Web of Science, and Engineering Village) to investigate the use of technology by historically underserved populations. Search strings consisted of three topics (eg, technology, historically underserved populations, and health).

Results

A total of 424 search phrases applied in the four databases returned 16,108 papers. After review, 125 papers met the selection criteria. Within the selected papers, 30 types of technology, 19 historically underserved groups, and 23 health issues were discussed. Further, almost half of the papers (62 papers) examined the use of technology to create effective and culturally informed interventions or educational tools. Finally, 12 evaluation techniques were used to assess the technology.

Conclusions

While the reviewed studies show how technology can be used to positively affect the health of historically underserved populations, the technology must be tailored toward the intended population, as personally relevant and contextually situated health technology is more likely than broader technology to create behavior changes. Social media, cell phones, and videotapes are types of technology that should be used more often in the future. Further, culturally informed health information technology should be used more for chronic diseases and disease management, as it is an innovative way to provide holistic care and reminders to otherwise underserved populations. Additionally, design processes should be stated regularly so that best practices can be created. Finally, the evaluation process should be standardized to create a benchmark for culturally informed health information technology.     

Suicidal behaviours in South East London: Prevalence,risk factors and the role of socio-economic status

Background

Low socio-economic status (SES) is an established risk factor of suicidal behaviours, but it is unknown to what extent its association is direct, indirect or confounded, given its strong association to mental health. We aimed to (I) estimate the prevalence of suicidal behaviours; (II) describe relevant risk factors; and (III) investigate direct and indirect effects of SES on suicidal behaviours.

Methods

We used cross-sectional community survey data of adults from randomly selected South East London households (SELCoH). Suicidal outcome measures replicated the 2007 Adult Psychiatric Morbidity Survey in England (APMS). Lifetime prevalence was described by socio-demographics, SES, mental health indicators, and life events. Structured symptom screens and a drug use questionnaire measured mental health. Structural equation models estimated direct and indirect effects of a latent SES variable on suicidal ideation and suicide attempts, adjusting for covariates.

Results

20.5% (95% CI: 18.4–22.7) reported suicidal ideation and 8.1% (95% CI: 6.8–9.7) reported suicide attempts (higher than APMS estimates: 13.7%, 4.8%, respectively). Unadjusted risk factors included poor mental health, low SES, and non-married/non-cohabitating relationship status. Black African ethnicity was protective, and women reported more suicide attempts. SES was directly associated to suicide attempts, but not suicidal ideation. SES had indirect effects on suicidal outcomes via mental health and life events.

Limitations

The cross-sectional design and application of measures for different time periods did not allow for causal inferences.

Conclusions

Suicidal behaviours were more prevalent than in the general UK population. Interventions targeting low SES individuals may prove effective in preventing suicide attempts.     

Consumer health information technology in an adult public health primary care clinic: A heart health education feasibility study

Objective

To explore the feasibility and short term outcomes of using an interactive kiosk integrated into office flow to deliver health information in a primary care clinic.

Methods

Fifty-one adults with BMI ≥25 were randomly assigned to use a kiosk with attached devices to receive a six-week healthy eating/weight monitoring (intervention) or general health/BP monitoring (attention-control) program. Outcomes were measured at baseline, 8 weeks (post) and three month follow-up.

Results

Participants completed an average of 2.73 weekly sessions, with transportation and time given as limiting factors. They found the kiosk easy to use (97%), liked the touchscreen (94%), and would use the kiosk again (81%). Although there were no differences between groups, the 27 completing all assessments showed reduced weight (p = .02), and decreased systolic (p = .01) and diastolic BP (p < .001) at follow-up. Although healthy eating behaviors increased, the change was not statistically significant.

Conclusion

Using a kiosk within a clinic setting is a feasible method of providing health information and self-monitoring. Multi-session educational content can provide beneficial short-term outcomes in overweight adults.

Practice implications

A kiosk with attached peripherals in a clinic setting is a viable adjunct to provider education, particularly in medically underserved areas.     

Relationship of health locus of control with specific health behaviours and global health appraisal: a meta-analysis and effects of moderators

Health locus of control (HLOC) refers to beliefs regarding how one’s health is influenced by oneself, others, or fate. This meta-analysis investigated whether three HLOC dimensions (internality/I-HLOC, powerful others/P-HLOC, chance/C-HLOC) were related to both specific health behaviours and global health appraisal, and whether these relationships were moderated by gender and age compositions, individualism, and power distance. Three-level mixed-effects meta-analysis was performed on studies examining the associations of HLOC with specific health behaviour (k?=?76, N?=?76,580, 57% women, M_age?=?43.75) and global health appraisal (k?=?95, N?=?12,068, 57% women, M_age?=?45.44), respectively. For specific health behaviour, the averaged correlations with the HLOC dimensions were generally weak (r’s?=??.07 to .10). However, the links between P-HLOC and exercise were moderated by all four demographic moderators, and gender composition and individualism moderated the association between the HLOC dimensions and diet. For global health appraisal, all of the averaged correlations were statistically significant (r’s?=??.16 to .21), except that between P-HLOC and mental quality of life. The results further showed individualism and power distance to moderate the links between the HLOC dimensions and both mental and physical quality of life, and gender composition to moderate those between these dimensions and two indicators of emotional problems (depression and anxiety).     

Developments in patient activation of people with chronic illness and the impact of changes in self-reported health: results of a nationwide longitudinal study in The Netherlands

Objective

To explore how patient activation, i.e. patients’ perceived knowledge, skills and self-confidence to manage their health and healthcare, develops within chronically ill individuals over time, and to estimate the impact of self-rated health on this development.

Methods

Linear regression analyses and structural equation modeling were conducted using longitudinal data from 751 people with chronic disease(s). Patient activation was assessed by the patient activation measure; self-rated health was assessed by the SF-36 general health scale.

Results

Mean patient activation score at baseline was 60.6, and 18 months later 56.5. Baseline self-rated health had a positive, indirect effect on patient activation at 18 months. In addition, the change in self-rated health over one year (from baseline) was a significant predictor of patients’ activation scores.

Conclusion

Patient activation is not a stable characteristic of people who have been chronically ill for years. Within individuals both increases and decreases occur, but at group level patient activation slightly decreases over time. This may (partly) be due to the deterioration of health that many people with chronic illness experience in course of time.

Practice implications

Clinical practitioners should assess the activation level of chronically ill patients regularly, especially when changes in health occur.     

非理性拖延量表的修订及其与健康行为的关系:自我效能的中介作用

目的:检验非理性拖延量表(IPS)在我国大学生群体中的适用性,并探讨自我效能在拖延与健康行为之间的中介作用。方法:采用IPS中译本,对348名本科生进行初测;将基于初测修订的IPS中文版与主动拖延量表(NAPS)、一般自我效能感量表(GSES)和自评健康行为量表(RHBC)一起在745名本科生中正式施测。结果:①项目分析之后的IPS的各项指标符合心理测量学要求(α系数为0.883,重测信度为0.822);与主动拖延的相关为-0.008(P>0.05),与学习成绩的相关为-0.220(P<0.05))。②自我效能是拖延影响健康行为的中介变量,其中介效应为0.044,中介效应占总效应的比例为36.2%。结论:中文版IPS具有较好的信、效度。在大学生消极拖延对健康行为的影响中,自我效能起了部分中介作用。     

A mismatch between population health literacy and the complexity of health information: an observational study

Background

Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health.

Aim

To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population skills in relation to these.

Design and setting

An English observational study comparing health materials with national working-age population skills.

Method

Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified. The proportion of the population above and below these thresholds, and the sociodemographic variables associated with a greater risk of being below the thresholds, were described.

Results

Sixty-four health materials were sampled. Two competency thresholds were identified: text (literacy) only, and text + numeracy; 2515/5795 participants (43%) were below the text-only threshold, while 2905/4767 (61%) were below the text + numeracy threshold. Univariable analyses of social determinants of health showed that those groups more at risk of socioeconomic deprivation had higher odds of being below the health literacy competency threshold than those at lower risk of deprivation. Multivariable analysis resulted in some variables becoming non-significant or reduced in effect.

Conclusion

Levels of low health literacy mirror those found in other industrialised countries, with a mismatch between the complexity of health materials and the skills of the English adult working-age population. Those most in need of health information have the least access to it. Efficacious strategies are building population skills, improving health professionals’ communication, and improving written health information.     

GPs asking patients to self-rate their health: a qualitative study

Background

In epidemiological research, self-rated health is an independent predictor of mortality, cardiovascular diseases, and other critical outcomes. It is recommended for clinical use, but research is lacking.

Aim

To investigate what happens in consultations when the question ‘How would you assess your general health compared with others your own age?’ is posed.

Design and setting

Authentic consultations with GPs at health centres in Sweden.

Method

Thirty-three planned visits concerning diabetes, pain, or undiagnosed symptoms were voice-recorded. Dialogue regarding self-rated health was transcribed verbatim and analysed using a systematic text condensation method. Speaking time of patients and doctors was measured and the doctors’ assessment of the value of the question was documented in a short questionnaire.

Results

Two overarching themes are used to describe patients’ responses to the question. First, there was an immediate reaction, often expressing strong emotions, setting the tone of the dialogue and influencing the continued conversation. This was followed by reflection regarding their functional ability, management of illnesses and risks, and/or situation in life. The GPs maintained an attitude of active listening. They sometimes reported a slight increase in consultation time or feeling disturbed by the question, but mostly judged it as valuable, shedding additional light on the patients’ situation and making it easier to discuss difficulties and resources. The patients’ speaking time increased noticeably during this part of the consultation.

Conclusion

Asking patients to comparatively self-rate their health is an effective tool in general practice.     

Greater lifetime stressor exposure is associated with poorer mental health among sexual minority people of color

Background

Research has shown that sexual minority people of color experience pervasive and sometimes severe life stressors that increase their risk of experiencing mental health problems, and that can contribute to lifelong health disparities. However, no studies in this population have investigated stressor exposure occurring over the entire lifespan. Moreover, it remains unknown whether these stressor-health effects differ based on the timing or types of stressors experienced.

Purpose

The purpose of this study is to examine how cumulative lifetime stressor exposure is associated with mental health among Black, Latinx, and biracial Black-Latinx sexual minority persons.

Method

Participants were 285 ethnic/racial minority young adults (M_age = 25.18 years old, SD = 1.94, age range = 19–29 years), who completed the Stress and Adversity Inventory for Adults to assess for retrospective reports of lifetime stressor count and severity. The Brief Symptom Inventory was used to assess participants' symptoms of anxiety, depression, and somatization, which were the main outcomes. Most participants identified as cisgender male (94.7%) and gay (74.2%), with the remaining participants identifying as transgender or genderqueer/nonbinary for gender and bisexual/pansexual, queer, or another sexual orientation.

Results

Multiple regression analyses indicated that experiencing more—and more severe—stressors across the lifespan was related to greater anxiety, depressive, and somatization symptoms. These effects were robust while controlling for race/ethnicity, sexual orientation, education, and employment status, and they differed based on stressor exposure timing, type, primary life domain, and core social–psychological characteristic.

Conclusion

Greater cumulative lifetime stressor exposure is related to poorer mental health among sexual minority people of color. Screening for lifetime stressors may thus help identify at-risk persons and provide an opportunity to intervene to help mitigate or prevent mental health disparities in multiply stigmatized adults.