Quality of life among men with prostate cancer in rural Georgia.

OBJECTIVES: To perform a population-based study on the quality of life (QOL) after prostate cancer treatment in a rural and disadvantaged population, because these have been sparse. METHODS: We conducted a follow-up study of 260 men with incident prostate cancer in a largely rural area of Southwest Georgia. The subjects underwent interviews at baseline and 6 and 12 months after the diagnosis. The analyses compared the 6- and 12-month QOL to that at baseline using linear and Poisson regression analyses for longitudinal data. RESULTS: Across all treatment groups, the self-reported physical and emotional QOL declined significantly after treatment, with little difference between that at 6 and that at 12 months. The decline in physical/emotional QOL did not differ by age, race, education, or Gleason score but was more pronounced among those with no comorbidities. Patients treated with hormones showed the worst deterioration in physical and emotional QOL, with the watchful waiting and external beam radiotherapy groups were the least affected. After 12 months, the percentage of men reporting that sexual, urinary, and bowel function was a large or very large problem was 53%, 22%, and 9% compared with 27%, 25%, and 4% at baseline, respectively. Worse bowel and urinary function played a stronger role than sexual function in predicting the overall physical and emotional QOL. Urinary obstruction improved but incontinence worsened. The doctors' and patients' assessment of the QOL showed only a low correlation, with patients reporting worse post-treatment QOL than the doctors. CONCLUSIONS: The general and most prostate-specific QOL measures (except for urinary function) in this previously understudied population declined after 6 months and remained about the same at 12 months after treatment of prostate cancer.

Examining the relationships of depressive symptoms, stigma, social support and regimen-specific support on quality of life in adult patients with epilepsy.

Epilepsy research efforts have primarily focused on medical treatment and physical management of epilepsy; however, to provide comprehensive care, efforts cannot focus solely on physical manifestations of epilepsy. Research findings show that people with epilepsy face many challenges that can negatively affect quality of life (QOL). In this descriptive study, we examined the individual relationships between depressive symptoms, stigma, social support and regimen-specific support and QOL in adults with epilepsy. Study data were obtained from a subset of patients (N = 147) who participated in a longitudinal study of adult patients with epilepsy. Measures of QOL, depressive symptoms, stigma, social support and regimen-specific support were analyzed to answer the research questions. The results of correlational analyses revealed statistically significant negative correlations between depressive symptoms, stigma and sometimes regimen-specific support and QOL and statistically significant positive correlations between social support and QOL. A hierarchical multiple linear regression model revealed that depressive symptoms accounted for the most variance in QOL. Psychosocial variables measured 3 months prior to QOL were entered into a hierarchical multiple linear regression model, revealing that depressive symptoms, stigma and social support can be used to predict QOL at a later time.

Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study.

The primary aim of this study was to test an intervention to support antiretroviral medication adherence among primarily low-income men and women with HIV. The study was a randomized controlled trial (Get Busy Living) with participants assigned to treatment (Motivational Interviewing [MI]) and control groups. Participants were recruited from an HIV/AIDS clinic in Atlanta, Georgia, US. Of those referred to the study, 247 completed a baseline assessment and were enrolled with 125 randomized to the intervention group and 122 to the control group. Participants were patients beginning antiretroviral therapy or changing to a new drug regimen. The intervention consisted of five MI sessions delivered by registered nurses in individual counselling sessions. Participants were paid for each session attended. The intervention sought to build confidence, reduce ambivalence and increase motivation for ART medication-taking. Medication adherence was measured by the Medication Event Monitoring System (MEMS) from the time of screening until the final follow-up conducted approximately 12 months following the baseline assessment. Participants in the intervention condition showed a trend towards having a higher mean percent of prescribed doses taken and a greater percent of doses taken on schedule when compared to the control group during the months following the intervention period. This effect was noted beginning at about the eighth month of the study period and was maintained until the final study month. Although the finding was weaker for overall percent of prescribed doses taken, the results for the percent of doses taken on schedule suggests that the MI intervention may be a useful approach for addressing specific aspects of medication adherence, such as adherrence to a specified dosing schedule.

Correlates of sexuality communication among mothers and 6-12-year-old children.

PURPOSE: This study assessed the extent to which personal characteristics, knowledge and beliefs, and family interactions and relationships are related to the occurrence of mother-child communication about sexuality. METHODS: The study used a descriptive, cross-sectional design among a convenience sample of 298 predominantly lower- to middle-income African American mothers and 298 of their 6-12-year-old-children recruited from a youth-serving, community-based organization. Participants completed a computer-based interview to collect data on sexuality communication, general mother-child communication, parental involvement and monitoring, parent relationship with child's peer group, child's social skills and problem behaviours, mothers' self-efficacy, outcome expectations, comfort with sexuality communication, and demographics. RESULTS: Mothers were more likely to communicate with daughters and older children. Greater self-efficacy and comfort in sexuality communication were related to greater sexuality communication. We also explored several inconsistent findings in previous studies - mother's age, socio-economic status and religiosity. Mother's age and socio-economic status were not significant, and religiosity approached statistical significance. CONCLUSIONS: Mother's self-efficacy and comfort are potentially modifiable variables and therefore should be taken into consideration when designing interventions that aim to increase parent-child communication about sexuality.

Measurement of parenting self-efficacy and outcome expectancy related to discussions about sex.

The purpose of this study was to evaluate the psychometric properties of two scales--one to measure the self-efficacy of parents to discuss sexual health issues with their adolescents and the other to measure parents' outcome expectancy associated with such discussions. Understanding how parents feel about their confidence in talking with their children about important sexual health issues and the outcomes they expect as a result of such discussions can be useful in guiding both the development and refinement of educational programs to promote parent-child discussions. The responses of 491 mothers who participated in an HIV prevention intervention with their adolescents were used for the present analysis. Mothers ranged in age from 25 to 68 years with a mean of 37.9 years (SD = 6.9). Of mother participants, 33% were married, 96.7% were African American, and 89.2% had completed high school. Their adolescents ranged in age from 11 to 14 years, and 61.5% were male. Assessment of reliability for both scales showed that internal consistency reliability was acceptable for the total scales as well as three of the five subscales. With the exception of one item on the outcome expectancy scale, the inter-item correlations, the mean inter-item correlations, and the item-to-total correlations meet the standard criteria for scale development for both scales. Factor analysis was used to identify the underlying structure of the scales, and hypothesis testing was used to assess construct validity. The results of these analyses provide support for the construct validity of the scales.

Social cognitive correlates of sexual experience and condom use among 13- through 15-year-old adolescents.

PURPOSE: To examine the role of self-efficacy, outcome expectancies, and perception of peer attitudes in the delay of onset of sexual activity among 13- through 15-year-old adolescents. We also explored the role of self-efficacy, outcome expectancies, and perception of friends' condom use behavior in explaining the use of condoms among sexually active adolescents. METHODS: This study was part of a larger cross-sectional study to evaluate personal characteristics and maternal factors associated with early initiation of sexual intercourse. Mothers and adolescents were recruited from a community-based organization that offered afterschool and summer programs for youth. Enrollment was limited to adolescents aged 13-15 years and their mothers. Mothers and adolescents completed separate interviews. For adolescents, the interviews included the assessment of the variables in the present study. Each interview lasted about 60 min and was conducted by a trained interviewer. Data were analyzed using descriptive statistics and regression analysis. The average age of the 405 adolescent participants was 13.86 years, and approximately 30% of them had engaged in sexual intercourse. Slightly more than half (56%) of participants were male, and 82% were African-American. RESULTS: Participants who were less likely to believe that their friends favored intercourse for adolescents and who held more favorable attitudes about the personal benefits of abstaining from sex were less likely to have initiated sexual intercourse. Among sexually active adolescents, those who expressed confidence in putting on a condom, and in being able to refuse sex with a sexual partner, and who expressed more favorable outcome expectancies associated with using a condom were more likely to use condoms consistently. CONCLUSIONS: Human immunodeficiency virus and pregnancy prevention programs should emphasize peer influences in both the initiation of sexual intercourse and the use of safer sex practices among sexually active adolescents, as well as personal attitudes about consequences to self and confidence in negotiating safer sex practices with one's partner.

Description and use of the neuroscience nursing self-efficacy scale.

An instrument for assessing nurses' perceived self-efficacy in implementing a variety of neuroscience nursing tasks was developed. Self-efficacy theory served as the guiding framework. From 1988 to 1998, the instrument was used to assess changes in the perceived self-efficacy of 54 nurses who attended a neuroscience nurse-internship program. Self-efficacy was assessed during clinical orientation, prior to the beginning of the program, and at the end of the program. The results showed that the nurses' confidence in performing a variety of neuroscience nursing skills increased during the 6- to 10-month program. The instrument was also useful in helping program directors identify areas in which nurses could benefit most from the program and refine the program to meet the educational needs of the nurses.

Evaluation of the Neuroscience Nurse Internship Program: the first decade.

This article describes the evaluation of the Neuroscience Nurse Internship Program (NNIP). The NNIP was initiated in 1988 by the National Institutes of Health Clinical Center to meet the demand for highly skilled nurses to care for persons with nervous system disorders. To determine whether the program was meeting its goals, an evaluation component was incorporated into the program. The evaluation process was based on the RSA Model of Continuing Education for nursing. The RSA model consists of four basic components, three of which were included in the assessment of the NNIP--process, content, and outcome. The evaluation revealed that the nurse-interns were satisfied with the lectures and clinical content of the program. Moreover, the nurse-interns improved their knowledge of neuroscience nursing and their confidence in performing neuroscience nursing skills. Information from the evaluation was used to modify the structure of the program and to refine lecture content and clinical requirements.

Correlates of safer sex communication among college students.

Correlates of safer sex communication among college students The purpose of this study was to examine factors that are thought to promote communication about safer sex and HIV among college students in the United States of America and to determine the extent to which communication about safer sex is important in the use of condoms. A better understanding of factors associated with safer sex communication can be helpful in developing HIV and STD prevention programmes for college students. Following approval from the institutional review boards of the six participating colleges and universities, researchers collected data from a random sample of students. The study included participant responses if participants were 18-25 years of age, single and sexually active. For the sample of 1349 participants, the mean age was 20.6 years. Sixty-three per cent of the sample was female, 50.5% white, 42.3% African-American, and the remainder of other ethnic groups. Over 50% of respondents reported frequent condom use, with 28% noting that they used a condom every time and 30.6% reporting condom use almost every time they had sex. Only 9.6% indicated that they never used a condom. The results of hierarchical multiple regression analysis revealed that the perception of quality of general communication with parents, the perception of a partner's attitude towards communication, communication self-efficacy, and communication outcome expectancies, were associated with safer sex communication. However, the association between safer sex communication and condom use was weak, suggesting that other factors excluded from this study are important in determining condom use for this sample of respondents. The findings provide some implications for HIV interventions. Interventions that enhance self-efficacy and positive outcome expectancies related to communication about safer sex are likely to foster discussion with a sexual partner. However, they might not lead to actual condom use.

Social cognitive factors associated with mother-adolescent communication about sex.

To better understand why some mothers talk to their children about sex and others do not, we examined the role of two social cognitive variables--self-efficacy and outcome expectancies--in explaining sex-based communication. The present study was part of a larger study to test the efficacy of two HIV prevention programs for mothers and their adolescents. Mothers and their adolescents were recruited from a large community organization that serves youth who live in disadvantaged circumstances. The sample for the present study included 486 mothers who averaged 38.4 years of age (SD = 6.73). The majority were African American (97.7%), not married (66.7%), and had a high school degree (89.5%). Their adolescents ranged in age from 11 through 14 years of age and most were male (61.3%). The results of the analysis revealed that mothers who expressed higher levels of self-efficacy and more favorable outcomes associated with talking to their children about sex were more likely to do so. In a regression analysis, we learned that the mother's degree of efficacy beliefs, along with her expected outcomes associated with talking about sex, the importance of religious beliefs to her, and the age and sex of her adolescents were important factors associated with talking with them about sex.

An evaluation of a self-generated identification code.

We describe a self-generated coding form used in a study of HIV prevention practices of college students and provide information on the success rate of matching questionnaires over a 3-year period using the form. The data for this study were from a longitudinal study of HIV risk-reduction practices of college students. In order to match questionnaires over the 3-year study period while maintaining anonymity, participants were asked to complete a self-generated identification form at each data collection point. In the second year of the project, we were able to successfully match 74.3% of the questionnaires to those returned during the first year using 6 to 8 of the code elements on the form, and in the third year, we were able to match 73% of questionnaires to those returned in the second year. Participants for whom questionnaires matched were more likely than participants with unmatched questionnaires to be white students enrolled as underclassmen.

The Neuroscience Nurse Internship Program: the description.

This article describes the Neuroscience Nurse Internship Program (NNIP) and its implementation at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD. The program, developed in 1988, is designed to prepare nurses to deliver care to persons with nervous system disorders. The program comprises 6 months of lecture and clinical instruction in the country's most well-known biomedical research center. In order to complete the program, nurse-interns must receive a passing grade of 90% or higher on all written tests and achieve satisfactory completion of all clinical assignments. NNIP is cosponsored by the NIH Clinical Center Nursing Department and the National Institute of Neurological Disorders and Stroke (NINDS). Nurses interested in NNIP may apply by submitting an application and a letter of interest to the Clinical Center Human Resources Department. Evaluation of the program is conducted on a regular basis and consists of both process and outcome assessments.

Communication about sexual issues: mothers, fathers, and friends.

PURPOSE: To identify the content, characteristics, and comfort level of discussions about sexuality held between mothers and their early adolescent children and to determine the extent to which the conversations predicted sexual values and initiation of sexual intercourse of the adolescent. METHODS: This was part of a larger study to evaluate the impact of personal family characteristics on human immunodeficiency virus risk-reduction behavior among low-income predominately African-American adolescents, ages 13-15 years. Adolescents attending a metropolitan community-based afterschool program and their mothers were invited to participate in a 1-hour interview. Mothers and adolescents were interviewed separately. The interview included questions about the type of information related to sexuality that adolescents discussed with mothers, fathers, and friends; in addition, mothers were asked what topics they discussed with their adolescents. Four hundred five adolescents and 382 mothers participated. Some mothers had more than one adolescent in the study. RESULTS: The results showed that both male and female adolescents were more likely to discuss sexual topics with their mothers than their fathers. Male adolescents were more likely than female adolescents to discuss sex-based topics with their fathers. Both male and female adolescents were less likely to discuss sex-based topics with their friends than with their mothers, but more likely to discuss these topics with their friends than their fathers. Content of conversations of male adolescents was fairly consistent among mothers, fathers, and friends, and sexually transmitted disease/acquired immune deficiency syndrome and condom use were popular topics of discussion. Female adolescents tended to talk about the menstrual cycle with their mothers, sexual abstinence with their fathers, and sexual intercourse with their friends. Adolescents who reported a greater number of topics discussed with their mothers were more likely not to have initiated sexual intercourse and to have conservative values, whereas adolescents who reported a greater number of topics discussed with their friends were more likely to report the initiation of intercourse and more "liberal" sexual values. Both male and female adolescents were most comfortable discussing sexual issues with their friends. Male adolescents were less comfortable talking to mothers, but more comfortable talking to their fathers than were females. Mothers were likely to report feeling very comfortable talking about almost all discussion areas. Fathers' comfort level was not measured, as they were not directly questioned. CONCLUSION: Early adolescence (13-15 years old) is characterized by more sex-based discussions with mothers than friends or fathers. Daughters and sons discuss different topics with their fathers, although discussion by both genders with fathers is limited. If an adolescent talks more with the mother about sexual issues than with friends, he/she is less likely to initiate sexual intercourse and more likely to have conservative values. This points to the importance of fostering good communication and comfort between parents and adolescents about sexual issues.

Women's self-reported condom use: intra and interpersonal factors.

In the past several years, the greatest proportionate increase in AIDS diagnoses has occurred among women. Yet, while the risk of HIV infection increases, female college students continue to report inconsistent HIV prevention behaviors. Past research on condom use among college women has focused on intrapersonal aspects of the behavior, and little is known about the influence of interpersonal factors on women's condom use. In this study we examined the relative salience of both intra and interpersonal factors on African American and white women's use of condoms. We found that interpersonal variables were particularly salient predictors of condom use. There were no ethnic differences in the effects of interpersonal variables; however, there were differences in the effects of self-efficacy on condom use.

PIP: The relative importance of intrapersonal and interpersonal factors on women's condom use was assessed in a cross-sectional study of 762 sexually active female students (mean age, 20.5 years) from 6 colleges and universities in Atlanta, Georgia (US), who had never married and were not currently living with a partner. 354 respondents were White and 408 were Black. Measures were taken of self-efficacy for condom use; perceived partner reactions to condom use and self-evaluative outcome expectancies; perceived partner attitudes toward condoms; and condom use. After controlling for race, partner attitude toward condoms was the most salient predictor of actual condom use; this variable explained 17% of the variance. For White women only, higher self-efficacy was associated with increased condom use; however, self-efficacy explained only 2% of the overall variance. These findings confirm the importance of interpersonal variables in influencing both Black and White women's condom use.

Neuroscience nurses' intentions to care for persons with HIV/AIDS.

The purpose of this study, which was based on Ajzen's theory of planned behavior, was to determine the extent to which personal attitudes, subjective norms and perceptions of behavioral control influence the intentions of nurses to care for persons with HIV/AIDS. Questionnaires measuring the concepts of attitudes, subjective norms, perceived behavioral control and intention to care for persons with HIV/AIDS were completed by 368 members of a neuroscience nursing organization. Hierarchial regression analysis was used to determine if nurses' intentions were predicted by their attitudes and subjective norms, and if perceived behavioral control would add to the prediction. Attitudes accounted for a significant percent of variance when entered at the first step, and perceived behavioral control accounted for a significant increase in variance when entered at the second step. In the final model, only perceived behavioral control contributed significantly to the prediction of intention.

Measurement of condom use self-efficacy and outcome expectancies in a geographically diverse group of STD patients.

The aim of this project was to conduct an initial evaluation among sexually transmitted disease (STD) patients of the psychometric properties of two instruments: the National Institute of Mental Health (NIMH) multisite condom use self-efficacy scale and the NIMH multisite condom use outcome expectancy scale. The condom use self-efficacy scale was designed to measure one's degree of confidence in various aspects of condom use, whereas the outcome expectancy scale was designed to measure one's belief about the consequences of using condoms. Using a sample of 641 patients from five geographically diverse STD clinics in the eastern United States, initial reliability coefficients were computed. The alpha coefficient for the self-efficacy scale was .91 and for the outcome expectancy scale .88, indicating high internal consistency for both scales. Both scales were analyzed using common factor analytic procedures. Five factors emerged from the analysis of the self-efficacy scale and six factors from the analysis of the outcome expectancy scale. Reliability coefficients for the individual factors ranged from .76 to .86. Construct validity of each scale was assessed by hypothesis testing. As predicted, participants with higher levels of self-efficacy and more positive outcome expectancies were more likely to use condoms.

Epilepsy self-management: a test of a theoretical model.

This study examines the role of social support, self-efficacy, outcome expectancy, and anxiety as predictors of medication management in persons with epilepsy. A model based on social cognitive theory was constructed to explain managing medications under conditions of scarcity. A survey instrument was sent to 450 individuals who participated in job training programs for persons with epilepsy. One hundred ninety-five completed questionnaires were returned and met the inclusion criteria. The proposed structural model was tested using structural equation modeling procedures. The assistance aspect of social support was positively related to regimen-specific support. The paths from self-efficacy to outcome expectancy and anxiety were significant and in the predicted directions, as was the path from anxiety to self-management.

Mother and adolescent knowledge of sexual development: the effects of gender, age, and sexual experience.

As part of a larger study on the impact of personal and family characteristics on adolescents' HIV risk and risk-reduction behavior, 90 adolescents and 73 mothers were asked to define in their own words seven terms related to sexual development: ejaculation, hormones, menstruation, ovulation, puberty, semen, and wet dreams. Mother and adolescent knowledge of sexual development terms and the effects of age and sexual experience on that knowledge were examined. Results suggest that the mothers were not able to adequately define the sexual development terms and thus may be ill-prepared to teach their children about sex or reinforce information they learn in school. Since adolescent knowledge did not significantly increase with age and sexual experience, the researchers suggest that continuing sex education about normal sexual development is needed.

Preferences concerning epilepsy education: opinions of nurses, physicians, and persons with epilepsy.

The purpose of this study was to determine whether patients with epilepsy treated in outpatient settings would prefer to receive information about epilepsy and its treatment from physicians, nurses or other health care professionals. A second purpose of this study was to determine which health care professionals physicians and nurses believe are able to teach patients about epilepsy. Participants in this study included 59 persons with epilepsy, 73 nurses caring for people with epilepsy, and 38 neurologists and neurosurgeons. Results indicated that people with epilepsy generally prefer physicians to teach about epilepsy and its treatment. Nurses received the most responses about teaching general lifestyle information. Nurses and physicians provided very similar responses to inquiries about which health care professionals were able to teach information about epilepsy. Nurse and physician participants agreed that nurses are the preferred provider of information related to psychological concerns of patients and physicians are the preferred provider of information about the cause and treatment of epilepsy.

Cancer stressors and protective factors: predictors of stress experienced during treatment for childhood cancer.

Perceptions of cancer stressors and protective factors are predictors of stress experienced during treatment for childhood cancer were assessed in this study. Cancer stressors were the type of treatment received during two clinic visits and the child's perception of the cancer experience. Protective factors were self-perception, coping strategies, perceived social support, and family environment. The child's responses to stressors were assessed by epinephrine, norepinephrine, and cortisol levels of urine, and measures of state anxiety. Forty-four children between 6 1/2 and 13 1/2 years of age receiving treatment for cancer were evaluated during two clinic visits. Epinephrine was elevated for children during both clinic visits, while norepinephrine and cortisol remained normal. Stepwise multiple regression analyses revealed that the family environment and global self-worth were the best predictors of epinephrine levels, while social support from friends predicted norepinephrine levels. The family environment and social support from teachers predicted state anxiety.