A Department of Motor Vehicle-Based Intervention to Promote Organ Donor Registrations in New York State.

CONTEXT: Examination of efficacy of motor vehicle representative educational training and dissemination of promotional materials as a means to promote organ donation enrollments in New York State. OBJECTIVE: To increase the number of New York State residents who consent to donation through the department of motor vehicle transactions during project period. SETTING: County-run motor vehicle offices across New York State. PARTICIPANTS: Customers who present to New York Department of Motor Vehicle offices and the representative who work at designated bureaus. INTERVENTIONS: point-of-decision materials including promotional posters, brochures, website, and the motor vehicle representative training sessions. MAIN OUTCOME MEASURES: Reasons for enrollment decision, knowledge/experience with donation, monthly consent rates, enrollment in state organ, and tissue registry. RESULTS: Customers who elected not to register reported no reason or uncertainty surrounding enrollment. The representatives reported experience with donation, discussion with customers, and need for additional education on organ donation. Enrollment cards were mailed to 799 project staff; counties where offices participated in intervention did not indicate significantly higher monthly enrollments when comparing pre- to postenrollment rates. CONCLUSIONS: Use of point-of-decision materials and enrollment cards proved inexpensive method to register customers with a 3.6% return rate. Customers report low (27%) enrollment rate and reticence to consent to donation. Educational training sessions with representatives did not yield significant enrollment increases when evaluating data at county-level enrollment.

The Buffalo Model: Shifting the Focus of Clinical Licensure Exams in Dentistry to Address Ethical Concerns Regarding Patient Care.

Most jurisdictions grant dental licensure to graduating students following successful completion of a clinical exam. Testing agencies, which are independent of dental schools, nevertheless conduct their exams at school facilities. Patient participation in these exams raises ethical concerns regarding such issues as unlicensed providers' performing irreversible procedures with minimal supervision and graduates' limited accessibility to provide follow-up treatment. To address these concerns, a collaborative effort between University at Buffalo School of Dental Medicine faculty and testing agency personnel was launched. The aims of this article are to describe the development and implementation of the resulting Buffalo Model, to highlight ethical advantages in its application, and to identify areas of improvement to be addressed in future iterations. With the Buffalo Model, modifications were made to the traditional exam format in order to integrate the exam into the school curriculum, enabling candidates to take it at various points during their fourth year. In addition, after calibration of school faculty members, 98.5% of cases verified by faculty were accepted by the Commission on Dental Competency Assessments for use in the exam. In two cases, restorative treatment completed during the exam did not meet the school's competency standard. This new approach ameliorates ethical concerns associated with clinical licensure exams because treatment is provided only to patients of record within a sequenced treatment plan and timely and appropriate treatment is provided to all patients. The results of this first year of implementation also suggest that calibrated faculty members will not show bias in the selection of lesions or competency evaluations of candidates.

Measuring the Effectiveness of Mass-Mediated Health Campaigns Through Meta-Analysis.

A meta-analytic review was undertaken to examine the effects of mass communication campaigns on changes in behavior, knowledge, and self-efficacy in the general public. A review of the academic literature was undertaken and identified 1,638 articles from 1966 through 2012. Using strict inclusion criteria, we included 63 studies for coding and analyses. Results from these efforts indicated that campaigns produced positive effects in behavior change (r = .05, k = 61) and knowledge (r = .10, k = 26) but failed to produce significant increases in self-efficacy (r = .02, k = 14). Several moderators (e.g., health topic, the theory underlying the campaign) were examined in relation to campaign principles that are prescribed to increase campaign effects. The major findings are reviewed, and the implications for future campaign design are discussed.

An examination of three theoretical models to explain the organ donation attitude--registration discrepancy among mature adults.

An inconsistency in the research indicates positive attitudes toward organ donation do not map reliably onto organ donor registrations. Various models have sought to explain this inconsistency and the current analysis formally compared three models: the Bystander Intervention Model (BIM), the Organ Donor Model (ODM), and Vested Interest Theory (VIT). Mature (N = 688) adults between the ages of 50 to 64 years completed surveys related to organ donation. Results revealed that VIT accounted for the most variance in organ donation registrations followed by the BIM and ODM. The discussion emphasizes the importance of employing theories to explain a phenomenon as well as the practical implications of the findings.

Reasons for (not) signing the state registry: surveying Department of Motor Vehicles customers in New York state.

CONTEXT: Prior research examining rationales for enrolling as an organ donor is biased because of its reliance on college student samples and retrospective recall. OBJECTIVE: To characterize New York state residents' registry enrollment decisions in close proximity to a registration opportunity. DESIGN: -Surveys were conducted with customers exiting Department of Motor Vehicle offices. PARTICIPANTS: A total of 1325 customers were surveyed upon exiting 1 of 18 Department of Motor Vehicle offices spanning 9 counties. MAIN OUTCOME MEASURE: Customers making donation-relevant transactions (ie, license renewal/registration) reported whether they had registered as a donor that day, and all other customers reported whether they had registered as a donor in the past. Customers reported reasons to justify their enrollment decision through short interview questions. RESULTS: Among current donation-relevant transactions (n = 299), 27% reported enrolling in the registry. Of remaining customers, 39% reported enrolling in the state registry in the past. For those who elected not to enroll, many failed to communicate a reason for their decision, or reported a lack of opportunity to sign or decisional uncertainty. Among enrollees, reasons for registration included the altruistic benefits of donation, prior registration, personal experience with donation, and rational arguments for donation. CONCLUSION: The value of point-of-decision survey data are discussed in relation to strategic efforts to promote organ donor registration.

Providing social support in a persuasive context: forms of social support reported by organ procurement coordinators.

Eighty-five organ procurement coordinators (OPCs) completed face-to-face interviews designed to elicit the emotional and instrumental social support strategies communicated to potential donor families throughout the request for deceased organ donation. OPCs identified six forms of emotional support and eight forms of instrumental support, with greater reported use of instrumental support strategies. In terms of instrumental support, OPCs most frequently ensured in-hospital comfort (61.2%) or met the nutritional needs of family members (51.8%). With respect to emotional support, OPCs most often expressed sympathy (31.8%) to families and provided support in the form of physical contact (27.1%) with family members. Identifying the forms of social support used by OPCs is a first step toward understanding the strategies that are more (or less) effective in achieving persuasive and support goals.

Click to "like" organ donation: the use of online media to promote organ donor registration.

CONTEXT: Efforts to promote organ donation have traditionally relied on mass-mediated or interpersonal communication to promote donor registration. Despite its popularity, the use of online media has yet to be carefully evaluated as a platform to promote organ donation. OBJECTIVE: To describe results of an intervention to promote donor registration that relies solely on online media to communicate to target audiences. DESIGN: For 3 years, 6 campaigns were implemented in 3 different online media formats. SETTING: Online media formats included (1) traditional online advertising, (2) student seeders' social networking sites campaigns, and (3) challenge campaigns. PARTICIPANTS: Online media campaigns primarily targeted college-aged individuals.Intervention-Each campaign directed individuals to the dedicated project website, where they could access educational material about donation and request a donor registration card. MAIN OUTCOME MEASURES: Unique website visitors, webpages viewed per site visit, time spent on site, and organ donor cards requested/received were tracked in relation to each online media format. RESULTS: Traditional online advertising offered greater message exposure but failed to result in a higher proportion of website visitors who registered their donation intentions. Use of student seeders (ie, motivated students who promote donation by using social networking sites) and challenge campaigns resulted in greater attention to the project website, donor card requests, and subsequent returns. Additional research is recommended to reveal the effect of combining 2 or more varying online media formats within a single campaign.

Estimating the risks of acquiring a kidney abroad: a meta-analysis of complications following participation in transplant tourism.

A meta-analysis of odds ratios comparing the risks of participating in transplant tourism by acquiring a kidney abroad to the risks associated with domestic kidney transplant was undertaken. Comparison across 12 medical outcomes indicates transplant tourists are significantly more likely to contract cytomegalovirus, hepatitis B, HIV, post-transplantation diabetes mellitus, and wound infection than those receiving domestic kidney transplant. Results also indicate that domestic kidney transplant recipients experience significantly higher one-yr patient- and graft-survival rates. Analyses are supplemented by independent comparisons of outcomes and provide practitioners with weighted estimates of the proportion of transplant recipients experiencing 15 medical outcomes. Practitioners are encouraged to caution patients of the medical risks associated with transplant tourism. Despite the illegal and unethical nature of transplant tourism, additional efforts are indicated to eliminate the organ trade and to educate wait-listed patients about the risks of transplant tourism.

Asking the difficult questions: message strategies used by organ procurement coordinators in requesting familial consent to organ donation.

The present study provides an in-depth examination of the messages used by organ procurement coordinators (OPCs) in shaping familial requests for organ donation. OPCs (N = 102), recruited from a national sample of 16 organ procurement organizations, participated in a structured interview designed to uncover the communication strategies used in obtaining familial consent for donation. Analysis of interviews indicates OPCs' messages cover 4 domain areas. Specifically, OPCs report use of messages intended to (a) provide education, (b) discuss the benefits to donation, (c) learn about potential donor families, and (d) persuade families to engage in donation. Within the 4 domain areas, OPCs report use of 15 specific messages (e.g., "positively framing the donor," "social proof," "discuss the benefit of donation to grieving") in requesting consent. The present study provides a detailed examination of strategies and offers recommendations for using message strategies to explore the effectiveness of the consent process from the perspective of OPCs in approaching donor families.

Are nonparticipants in prosocial behavior merely innocent bystanders?

Latané and Darley's (1970) bystander intervention theory was used to model individuals' participation in two prosocial behaviors (organ donation, green living). It is argued that nonparticipants in prosocial helping are innocent bystanders who likely fail to notice the need, do not interpret the cause as an emergency, do not accept responsibility for the need to help, and have little knowledge on how to help. Data in study 1 (n = 494) indicate support for the proposed innocent bystander path model (notice event → interpret event as emergency → accept responsibility → knowledge of how to help) in organ donation. Study 2 (n = 519) replicated the model in the context of green living and additionally found a direct path from noticing the event to knowledge of how to help. Implications of framing nonparticipation in prosocial behaviors as innocent bystander effects are discussed in context of campaign communication.

Difficult communication: compliance-gaining strategies of organ procurement coordinators.

Organ procurement coordinators (OPCs) face a formidable communication task when making familial requests for consent to organ donation, because they must provide social support for grieving family members while seeking compliance to the donation request. Structured interviews were conducted with 102 OPCs, representing 16 organ procurement organizations (OPOs) (27.6% of national organizations) across the United States. Responses were transcribed and content-analyzed along four domain areas: (a) establishing credibility, (b) message strategies, (c) timing/setting of requests, and (d) adaptation of messages to diverse families. OPO conversion rates were used as a criterion factor for OPCs' persuasive communication success and regressed onto self-reported strategy use. Results indicate message strategies varied at the OPC level of analysis and 7 techniques significantly predicted 32% of the variance in conversion rates. Two strategies (i.e., gaining early intervention, approaching with additional support) positively influenced conversion rates, whereas 5 strategies (e.g., discussing benefits as a persuasive strategy, emphasizing the need for donation in particular racial/ethnic groups) negatively influenced conversion rates. Future research is recommended to validate the study findings toward the goal of improving OPCs' communication strategies.

Health information seeking: a review of measures and methods.

OBJECTIVE: Outlines the methods and measures commonly used to study active health information seeking and prescribes important considerations in advancing the study of patient information seeking. METHODS: A systematic review of the literature from 1978 to 2010. A single bibliometric database, PsychInfo, identified 648 articles of health information seeking. The 129 articles included in the review were coded by type of sample, measures (n=12) utilized to study health information seeking, and types of study methods (n=5). RESULTS: A majority of studies used non-clinical samples and measured general health information seeking (i.e., whether the participant engaged in a search for health information) through cross-sectional study designs. CONCLUSIONS: There are varying samples, measures, and designs used to identify those who do or do not seek health information. Future research should look into how health information seeking influences health management and should uncover the social and relational functions of health information seeking using more advanced (and less routinely applied) measures and methods of studying health information seeking. PRACTICE IMPLICATIONS: More people are actively searching for health information and health providers should address this in their discussions with patients.

Why families decline donation: the perspective of organ procurement coordinators.

CONTEXT: Current knowledge regarding the barriers to organ donation relies on 3 data sources: potential donor families, hospital staff, and members of the general public. The current study complements these findings by interviewing organ procurement coordinators about their experiences during the familial consent process. OBJECTIVE: To characterize organ procurement coordinators' reports of barriers to obtaining familial consent for donation. DESIGN: Structured, face-to-face interviews. PARTICIPANTS: One hundred and two organ procurement coordinators recruited from a national sample of 16 organ procurement organizations. MAIN OUTCOME MEASURE: Interviews were content analyzed to describe coordinators' experiences with families who decline donation. Manifest coding was used to determine the frequency with which particular barriers were identified by coordinators. Coordinators' reports of barriers were compared with organizational conversion rates to determine which barriers were associated with performance as an organization. RESULTS: Organ procurement coordinators revealed 16 distinct barriers in 4 overlying categories: concerns regarding decedents' wishes, structural barriers to donation, unsupportive belief systems, and lack of public education. Three reported barriers could be used to differentiate between high- and low-performance organizations: (1) familial concerns over bodily disfigurement, (2) failure of families to understand brain death, and (3) families' cultural/racial background. CONCLUSION: These results supplement existing reports of barriers to donation and are discussed in terms of shaping future public education efforts and request processes to improve conversion rates.

A journal-level analysis of Health Communication.

Citation data from 2006 through 2008 were used to examine the journal citation network of Health Communication in comparison to 26 related journals indexed by Journal Citation Reports, a database published by the Institute for Scientific Information (ISI) Web of Knowledge. A recently advanced journal relatedness factor based on out-degree (i.e., cited journals) and in-degree (i.e., citing journals) citations was used to determine the network of peer journals. Results indicate Health Communication serves to link communication and health-related journals. Data were also reported on journal impact and 5-year journal impact factors. When compared to ISI-indexed communication journals, Health Communication is consistently ranked in the top 25% across impact factors and citations to the journal are consistent over the 7 years of analysis from 2002 through 2008. Methods of increasing the impact of Health Communication among journals in social sciences are discussed.

A peer-to-peer campaign to promote organ donation among racially diverse college students in New York City.

PURPOSE: Due to the documented disparities in organ transplantation, individuals from racially diverse backgrounds are encouraged to register as donors and communicate their donation intentions to family. The present study reports an intervention aimed at addressing students' fears and misconceptions related to organ transplantation on college campuses with racially diverse student enrollments. The intervention uses peer-to-peer campaigns at colleges in New York City in an attempt to increase declarations of intent to donate and to educate students about transplantation. PROCEDURES: Six campuses in the New York City area participated in the intervention. Students participating in the college campaign intervention were educated about donation through active learning methods and implemented campus-wide campaigns to recruit fellow students as donors. RESULTS: Student campaigners reported increases in topic salience and self-efficacy from precampaign to postcampaign activities. In addition, rates of donor registration and family communication improved over time. Across 6 campuses, campaigners were able to recruit 1019 students as registered donors. CONCLUSIONS: Participation in the campaign course increases students' vested interest in donation and has proven effective at increasing donor registration among racially diverse groups.

Teaching organ and tissue donation in medical and nursing education: a needs assessment.

CONTEXT: Research on organ donation education is limited by its reliance on convenience samples (ie, small sample sizes and local schools) and its failure to assess methods of instruction on the topic. OBJECTIVE: To describe medical and nursing students' training in organ donation by examining curriculum content and methods of instruction by using a national sample of medical schools and a statewide sample (New York) of nursing schools. DESIGN: Self-report online survey. PARTICIPANTS: Nursing and medical deans responsible for curriculum development and evaluation. MAIN OUTCOME MEASURE: Participants provided information on the inclusion of specific topics in organ donation, skills related to organ donation, and the declaration of personal donation intentions within their respective educational programs. Methods of instruction on such topics (eg, standardized patients, lectures, small groups) also were assessed. RESULTS: Although many educational programs include an organ donation component, a significant proportion of schools failed to provide instruction on donation consent processes, definitions of brain and cardiac death, and the discussion of organ donation during a routine health care visit. Most schools rely on lectures as the sole method of instruction. Recommendations are made for how deficits in instruction might be addressed through future interventions and education.

Comparing college students' value-, outcome-, and impression-relevant involvement in health-related issues.

The purpose of this study was to examine the role of receiver involvement in the context of health communication. Students (N = 277) completed Cho and Boster's (2005) measures of value-, outcome-, and impression-relevant involvement across 6 health behaviors, including cigarette smoking, organ and tissue donation, sunscreen use, alcohol use, sexually transmitted disease testing, and nutrition. Confirmatory factor analyses across all 6 health topics provided evidence of the 3-factor structure conceptualized by Johnson and Eagly (1989) and measured by Cho and Boster (2005). When health behaviors were regressed onto value-, outcome-, and impression-relevant involvement, outcome- and value-involvement, generally speaking, emerged as significant predictors. Results and implications of considering health campaign audience members' levels of involvement are discussed in the domain of preventive medicine.