Creating and measuring social presence in online graduate nursing courses.

The literature has shown that social presence is one of the most significant factors in building a sense of community in online education. This pilot study examines the outcomes of integrating social presence strategies into an online graduate nursing course and lays the groundwork for a larger study into dimensions of social presence and student satisfaction. Using a two-group comparison design, the results demonstrate that the purposeful incorporation of specific social presence techniques had a positive impact on student perceptions of social presence and group interaction as well as online learning expectations.

Differences in breast self-examination techniques between Caucasian and African American elderly women.

BACKGROUND: The efficacy of breast self-examination (BSE) is controversial, recommendations to women are mixed, and reported differences by race in BSE are contrary to what is expected. We attribute this, in part, to measurement error in studies assessing the effectiveness of BSE. We assess differences by race in self-reported BSE while controlling selected sociodemographic indicators, BSE training, embarrassment, and perceived competence. METHODS: Data are from personal interviews with 1011 women ages 50 and older, with approximately equal numbers of African Americans and Caucasians reporting that they examine their own breasts. RESULTS: African American women are more likely than Caucasians to report examining their breasts visually, whereas Caucasian women are more likely than African Americans to report tactile examination of breast tissue, consistent with recommended BSE procedure. CONCLUSIONS: BSE measures must be multidimensional to detect differences by race to guide interventions promoting self-detection of breast lumps, early presentation, and mortality reduction.

Initial and repeat mammography screening: different behaviors/different predictors.

Despite evidence of the efficacy of mammography in early detection of breast cancer, many women choose not to have a mammogram. Some women who have an initial mammogram do not return for a second one. Many others, especially minority women, and those who live in rural areas or in a low socioeconomic class, are not being screened according to recommended guidelines. The full benefits of early detection are available only if women receive regular screening. This study of 830 randomly selected women over age 50 from rural, eastern North Carolina included women who had never had a mammogram (213), women who had had a mammogram but not in the prior 2 years (89), and women who reported having had a mammogram in the previous 2 years (528). Logistic regression was used to identify significant mammography predictor variables. The results support the robust role that provider recommendation plays in encouraging mammography behavior; they also demonstrate that past behavior is also a strong predictor of future screening participation. Only 13% of the women who had never had a mammogram reported obtaining a referral from their provider compared with 79% of the women who had a mammogram in the previous 2 years. Likewise, 75% of the women who had engaged in mammography behavior in the prior 2 years expressed a positive intention to be screened in the next year compared with only 14% of those women who had never had a mammogram. Initial and repeat mammography screenings are different behaviors and are influenced by different factors. For provider counseling to be effective, the strategies employed need to consider past behavior as well as current recommendations, and they must incorporate a discussion of beliefs as well as reinforcement of regular screening behavior.

Service learning: preparing a healthcare workforce for the next century.

Service learning coupled with community-based education is an effective way for educators to prepare nurses for their roles in healthcare for the 21st century. Structuring the curriculum to provide learning experiences that prepare nurses to meet the healthcare needs of aggregates and populations is the responsibility of nursing faculty today. Students need opportunities to work both with and within communities as partners, as well as experiences with interdisciplinary collaboration, to achieve this goal. The authors describe how two disciplines within the university and a community in rural eastern North Carolina partnered to accomplish this task.

Disparities in mammography screening in rural areas: analysis of county differences in North Carolina.

The extent to which targeted mammography programs have impacted women in rural areas is not well defined. We investigated mammography screening rates among 843 women age 50 and over from a population-based sample in four predominantly rural eastern North Carolina counties. We examined age, race, education level, county of residence, health insurance, and the self-reported completion of mammography in the past year using contingency tables and logistic regression. African American females aged 65 years or older had the lowest reported mammography rates (42%), while white females aged 50 to 64 had the highest rates (58%). Uninsured women and those with less education were less likely to have received a mammogram. Logistic regression demonstrated that age, education, and health insurance were significant predictors of mammography completion. A county-level analysis revealed that three counties had similar rates and one county had substantially lower rates. A higher-than-expected rate of screening-mammography completion among African American women was noted in one predominantly rural county served by a breast cancer screening program. Logistic regression analysis confirmed that county was a significant predictor for mammography completion. In separate regressions run by race, county remained a significant predictor for African American women but not for white women. Differences in mammography screening appear to persist in some predominantly rural areas and are related to age, race, education, and health insurance. Programs that target hard-to-reach women with efforts tailored specifically to their needs may be effective in reducing persistent racial differences.

Increasing use of mammography among older, rural African American women: results from a community trial.

OBJECTIVES: A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older. METHODS: A stratified random sample of 801 African American women completed baseline (1993-1994) and follow-up (1996-1997) surveys. The primary outcome was self-reported mammography use in the previous 2 years. RESULTS: The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = -1, 14) in community-wide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by low-income women in comparison counties. Adjustment for potentially confounding characteristics did not change the results. CONCLUSIONS: A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.