A Case Report of College Students' Rating of a Shared Decision-Making Tool for Taking Antidepression Medication.

Forty-nine students enrolled at a medium size public university volunteered to review an interactive decision-making tool constructed to present the pros and cons of taking antidepression medication. The tool is built according to guidelines for shared decision-making with 7 educational sections followed by 4 queries on expectations about antidepressants, 3 key knowledge questions, and determination of readiness to take action. The most frequently cited reason for the content being helpful was improved understanding (78%) followed by increased personal confidence (37%) and helped me take action (14%). The most frequently cited reason for the content not being more helpful was already known information (74%) followed by not enough information (12%). The range of personal preferences underscores the complexity of motivations in responding to depressive symptoms. The prevalence of depression in the college population with a range of treatment options, limitations on resources, and new challenges mounted with the pandemic for campus life recommends further study of such tools.

Patients' expectations for and experiences with primary healthcare services received from a patient centered medical home.

OBJECTIVE: Expectations for and experiences with healthcare services are summarized for 1143 patients receiving care in a statewide demonstration of Patient Centered Medical Homes (PCMH). METHODS: Patients were recruited from 91 primary care clinics for semi-structured interviews to determine what patients expect, what they plan to do and how they intend to execute their plans in partnership with their healthcare team. RESULTS: The majority (78%) of patients defined the patient-team partnership as a collaborative and problem-solving effort. Overall, 68% defined responsibility for own health as a personal responsibility; 55% defined listening to patient's concerns and answering questions as a responsibility of their healthcare team. Diet and exercise came up most frequently whether as a personal responsibility, issues for receiving additional help from their clinic, or plans for personal change. CONCLUSION: Patients' preferred a collaborative, problem-solving healthcare team partnership but also had boundaries for what additional services they wanted from this team. PRACTICE IMPLICATIONS: Patients' expectations for a collaborative partnership, acceptance of personal responsibility and interest in diet and exercise expands opportunities for patient education and teamwork. Clinics' engagement with broader resources would be needed to address patients' many and varied challenges to taking care of their health.

Assessment of the usability and impact of the Idaho Health Data Exchange (IHDE).

Eighty four health care professionals participated in an online survey assessing the usability, and clinical and administrative impact of the Idaho Health Data Exchange's (IHDE) Virtual Health Record (VHR). The IHDE VHR allows authorized users to use a secure web interface to view lab, radiology and transcribed reports from multiple facilities and view medical histories on patients in the data exchange. Results indicate the usability of the IHDE VHR was almost universally positively rated with the Software Usability Measurement Inventory (SUMI) utilized as the assessment method. Medical providers however had the lowest rating of the exchange, raising concerns about the need for additional training and support. The addition of other Idaho health care organizations to the health data exchange was most widely desired, with the most frequently cited benefit being more comprehensive access to patients' records. In contrast to other published evaluations of health data exchanges in the U.S., few of the concerns emerged about cost of implementation of the data exchange or trust in the quality of information contained therein.

Characteristics of child sexual assault within a child advocacy center client population.

This descriptive study summarized data from a child advocacy center to illustrate how such information might be used to profile the scope and character of child sexual abuse (CSA) at the community level. This detailed information is not available from national or state data but is needed to understand the circumstances of the children receiving services and the type of care they may need. Variables included victim demographics, type of sexual abuse and relationship to the perpetrator, and the person to whom the victim was most likely to disclose their sexual assault. A total sample of 841 case reports was reviewed. Chi-square tests were used to determine if there were statistically significant associations between the age groupings, type of abuse, and the perpetrator according to age grouping. Those children most often seen at this child advocacy center were girls (73%); White (67%); and living with their mothers, with both parents, or with parent and stepparent (80%). The incidence of CSA increased for girls across age groups. However, boys aged 6-10 years comprised the greatest percentage of the male sample (56%) who experienced CSA. For all three age groups, over half of the perpetrators were identified as relatives. Most children (85%) experienced high-impact sexual abuse behaviors of fondling, penetration, or some combination thereof. Children most often disclosed CSA to their mothers. Understanding patterns of CSA at the local level provides guidance beyond national and state data to forensic nurses regarding child and family needs within their communities.

The effect of online chronic disease personas on activation: within-subjects and between-groups analyses.

BACKGROUND: Although self-management of chronic disease is important, engaging patients and increasing activation for self-care using online tools has proven difficult. Designing more tailored interventions through the application of condition-specific personas may be a way to increase engagement and patient activation. Personas are developed from extensive interviews with patients about their shared values and assumptions about their health. The resulting personas tailor the knowledge and skills necessary for self-care and guide selection of the self-management tools for a particular audience. OBJECTIVE: Pre-post changes in self-reported levels of activation for self-management were analyzed for 11 chronic health personas developed for 4 prevalent chronic diseases. METHODS: Personas were created from 20 to 25 hour-long nondirected interviews with consumers with a common, chronic disease (eg, diabetes). The interviews were transcribed and coded for behaviors, feelings, and beliefs using the principles of grounded theory. A second group of 398 adults with self-reported chronic disease were recruited for online testing of the personas and their impact on activation. The activation variables, based on an integrated theory of health behavior, were knowledge of a given health issue, perceived self-management skills, confidence in improving health, and intention to take action in managing health. Pre-post changes in activation were analyzed with a mixed design with 1 within-subjects factor (pre-post) and 1 between-group factor (persona) using a general linear model with repeated measures. RESULTS: Sixteen pre-post changes for 4 measures of activation were analyzed. All but 2 of the within-subjects effects were statistically significant and all changes were in the direction of increased activation scores at posttest. Five significant differences between personas were observed, showing which personas performed better. Of low activation participants, 50% or more shifted to high activation across the 4 measures with minimal changes (≤5%) in the reverse direction. CONCLUSIONS: The majority of participants using a persona-tailored learning path reported high levels of satisfaction with their online user experience and increased levels of activation about their own health. In the body of work on patient activation, the current study adds to understanding of both short-term impact and the content of a brief, online intervention for engagement of specific groups in self-management.

The relationship of metabolic syndrome and health-promoting lifestyle profiles of Latinos in the Northwest.

Latinos are at elevated risk for metabolic syndrome (MetS), a cluster of metabolic factors predictive of cardiovascular disease and diabetes. This study summarizes the association of MetS risk factors with self-reported health behaviors for 225 low-income, Northwest Latino men and women according to age and gender. The Health-Promoting Lifestyle Profile II (HPLP II) in English and Spanish was used to measure the extent to which participants engaged in health-promoting behavior. Biophysical measures included body composition, blood pressure, and fasting venous blood analysis. Men had significantly higher triglycerides, blood glucose, and systolic and diastolic blood pressure readings. Both men and women had central obesity measurements above the recommended cutoffs. There were no statistically significant differences except for physical activity on the HPLP II scores according to level of risk for MetS.

A Five Step Process for Interactive Parent-Adolescent Communication About HIV Prevention: Advice from Parents Living With HIV/AIDS.

AIM: This study investigated how parents living with HIV communicated about HIV prevention with their 10-18 year old children. METHODS: Interviews with 76 mothers and fathers were analyzed for (1) their experiences discussing HIV prevention with adolescents, and (2) advice on how to best broach HIV-related topics. RESULTS: Interactive conversations, where both parents and adolescents participated, were regarded as effective. Parents emphasized that adolescents should have a "voice" (be able to voice their concerns) and a "choice" (have a variety of effective prevention strategies to choose from) during HIV-related talks. DISCUSSION: A five step process for interactive communication emerged as a result of these discussions. IMPLICATIONS: Health care professionals can facilitate adolescent sexual health by encouraging parents to actively involve their children in discussions about HIV prevention. CONCLUSION: Future HIV prevention programs could benefit by providing parents with appropriate tools to foster interactive discussions about sexual health with adolescents.

Communicating in complex situations: a normative approach to HIV-related talk among parents who are HIV+.

Parents with HIV/AIDS are confronted with unique challenges when discussing HIV-related information with their children. Strategies for navigating these challenges effectively have not been systematically examined. In this study, we conducted in-depth interviews with 76 parents with HIV/AIDS who had children ages 10-18 years. Guided by O'Keefe and Delia's definition of a complex communication situation and Goldsmith's normative approach to interpersonal communication, we examined parents' goals for discussing HIV-related information, factors that made conversations challenging, and instances where these conversational purposes conflicted with one another. Our data reveal the following parent-adolescent communication predicaments: relaying safety information about HIV while minimizing child anxiety, modeling open family communication without damaging one's parental identity, and balancing parent-child relational needs amid living with an unpredictable health condition. Parents also described a variety of strategies for mitigating challenges when discussing HIV-related topics. Strategies parents perceived as effective included reframing HIV as a chronic, manageable illness; keeping talk educational; and embedding HIV-related topics within more general conversations. The theoretical and practical applications of these findings are discussed with regard to their relevance to health communication scholars and HIV care professionals.

Facilitators and barriers to discussing HIV prevention with adolescents: perspectives of HIV-infected parents.

OBJECTIVES: We examined HIV-infected parents' conversations about HIV prevention with their uninfected children, including what facilitated or hindered communication. METHODS: Parents with HIV/AIDS (n = 90) who had children aged 10 to 18 years were recruited for a mixed method study from 2009 to 2010. Interviews assessed facilitators and barriers to discussing HIV prevention. A questionnaire identified the frequency and content of conversations, parental confidence level, and perceived importance of discussing preventive topics. RESULTS: Eighty-one percent of parents reported "sometimes" or "often" communicating about HIV prevention. A subset of parents found these conversations difficult; 44% indicated their desire for support. Facilitators to communication included utilizing support, focusing on the benefits of talking, and having a previous relationship with one's child. Barriers to discussions included fear of negative consequences, living in denial, and lacking a parental role model who discussed safer sex. Parents varied as to how they believed their HIV status affected communication. Those who did not disclose their HIV status to their children reported less frequent communication; self-efficacy partially mediated this relationship. CONCLUSIONS: Findings highlighted the need for communication skills training that support HIV-infected parents in their efforts to discuss HIV-related information with adolescents.

Northwest Latinos' health promotion lifestyle profiles according to diabetes risk status.

A sample of 225 low income and low education, middle aged Latinos with concern about diabetes and living in a mid-size Idaho city volunteered for a physical assessment for risk status for the disease. The health promoting lifestyles of Latino congregants were measured using the Health Promoting Lifestyle Profile II. Diabetes risk was measured by clinically standard glycated hemoglobin readings. From no risk for the disease to full blown diabetes as determined by glycated hemoglobin levels, the respondents reported engaging in basically the same levels of physical activity, monitoring of nutrition and use of health care services thus evidencing no apparent understanding of the role of lifestyle in disease management. The findings point to the imperative of a broad, comprehensive and especially culturally attuned educational campaign on basic disease pathophysiology, the value of prevention for individual health, and the necessity of day-to-day self-care should diabetes be diagnosed.

Early adolescent participation in physical activity: correlates with individual and family characteristics.

BACKGROUND: Early adolescence is developmental period when youth begin to shift exercise and physical activity patterns toward increased sedentary living. The major causes and contributing factors to this change are poorly understood. This study examines the relationship between sociodemographic factors, behavioral and family factors that influence physical activity patterns of middle grades students. METHODS: The 1578 youth ranged in age from 12 (22%) to 13 (78%) and were divided between white (65%), African American (19%), and Hispanic (16%) subpopulations, with 37% overall qualifying for reduced-price or free school lunches. The assumptions for Analysis of Covariance versus Analysis of Variance (ANOVA) were examined, with the final results reported separately for attitudes toward exercise as predictors and sociodemographic variables and measures of family functioning as predictors. RESULTS: Positive attitudes were more strongly associated than were negative attitudes with exercise. Of the categorical predictors, student gender and family involvement with fitness had the most statistically significant associations with self reported exercise (6 for gender and 5 for family involvement with fitness). CONCLUSIONS: The results of this analysis of a diverse and large sample of young adolescents are placed in the context of family leisure and work time in our "hurried" culture.

Hear today, gone tomorrow: an assessment of portable entertainment player use and hearing acuity in a community sample.

BACKGROUND: Noise-induced hearing loss (NIHL) is a common but preventable disability. The purpose of this study was to assess the understanding of NIHL in a community sample in the context of exposure to portable music players, including MP3 players, and personal hearing acuity as tested with the Welch Allyn Audioscope 3. METHODS: A cross-sectional convenience sample of 94 adults (18 to 65 years old) at a university recreation center completed an analysis of personal use of portable digital music players (MP3 players), concerns about hearing loss, and a 3-dB-level hearing test at 4 levels of speech frequency in a low ambient noise setting. RESULTS: The majority of participants (85%) were concerned about hearing loss, willing to protect their hearing with lower volume (77%), had little measurable hearing loss but were exposed to longer and louder periods of noise than other national samples, and mistakenly felt that NIHL is a medically reversible condition. Many (40%) also wanted their family medicine physician to be more concerned about their hearing. CONCLUSIONS: Family medicine physicians are in a key position to provide basic information on the preventability and negative consequences of NIHL, as well as to identify and refer patients with identified hearing loss.

When the party for some becomes a problem for others: the effect of perceived secondhand consequences of drinking behavior on drinking norms.

The authors examined the influence of fraternity men's expectancies regarding secondhand consequences of excessive drinking behavior on normative standards regarding alcohol use and consumption levels. Participants were 381 men from 26 chapters of 2 national fraternities. One organization participated in a brief intervention involving discussion of secondhand consequences of excessive drinking. Immediate influence of the intervention on perceived secondhand consequences of alcohol use was assessed using a posttest-only, randomized groups design. Results supported a hypothesized measurement model with 1 overall secondhand consequence expectancy construct and 4 subfactors: (a) Noise Disruptive of Sleep and Study, (b) Violence, (c) Sexual Assault, and (d) Property Damage. Cross-sectional analysis at the chapter and individual levels demonstrated that secondhand expectancies had an indirect effect on alcohol consumption, mediated by personal consumption standards for limiting alcohol consumption. The intervention had an effect on secondhand expectancies. Findings suggest that interventions with intact groups can increase secondhand expectancies regarding excessive drinking and may lead to a reduction in excessive alcohol consumption.

Bad luck or bad decisions: college students' perceptions of the reasons for and consequences of their alcohol overdose.

Reasons for and immediate consequences of an alcohol overdose were explored for 217 undergraduate students requiring a medical emergency transport because of excessive alcohol consumption. The sample was categorized into 26 students attributing their overdose solely to bad luck and 191 students citing bad decision making as an explanation. A discriminant analysis portrayed the bad luck students as more likely to change the type of alcohol consumed, worrying more about problems with friends, less likely to change how much they drink and less likely to feel that they learned something about themselves. Friends were not named as being involved, but lapses in knowing how to pace consumption were frequently cited. Design of preventive educational programs for underage drinkers with the aim of avoiding an overdose is discussed.

Employment issues and assistive technology use for persons with spinal cord injury.

In this study, we examined associations between assistive technology (AT) cost, underwriting, ownership, use, employment, and employer accommodations for two groups (civilian and veteran) of working age adults (18-64 yr) with spinal cord injury or dysfunction (SCI/D). The project included the development of a survey instrument, and initial findings indicate that AT is important for the employment success of individuals with SCI/D. The majority of the AT devices owned by the respondents were characterized as important to work, and these devices were 3.5 times more expensive. The mean cost of assistive devices was 68% to 124% greater for persons who were self-employed compared with persons employed by others. Education was related to employment status for both groups. In addition, satisfaction with assistive devices was very high regardless of employment status or history.

Computerized training in breast self-examination: a test in a community health center.

Fifty-eight women recruited from a community health center completed either a brief interactive multimedia training program on breast self-examination using a breast model and computer guided feedback on accuracy of lump detection or read a National Cancer Institute pamphlet on breast self-examination and breast lumps. Women using the computer program as compared to the pamphlet group reported a higher sense of self-efficacy for being able to perform a breast self-examination immediately after their educational session and 1 month later. However, the increase in self-efficacy for the computer group diminished over 4 weeks, underscoring the importance of an environment that reminds and reinforces learning for women about the performance of regular breast self-examination. The increase in sense of self-efficacy to perform breast self-examination with roughly 20 minutes of computer-based training and the partial maintenance of that self-efficacy 30 days later suggests the utility of incorporating short, focused interventions in busy primary healthcare settings.

Young adult's immediate reaction to a personal alcohol overdose.

Following an emergency medical transport for alcohol overdose, first-year college students were asked to complete a survey assessing their reactions to the transport experience, their assessment of why they required this emergency response, and plans for future personal alcohol consumption. Transported students who responded to a baseline survey of all first-year students regarding expectations about alcohol are compared to first-year students overall. The 50 first-year transported students did not perceive themselves at risk for alcohol overdose prior to the event and were typically not heavy consumers of alcohol. The majority attributed the overdose event to bad decision making. Most students planned to alter the amount and the pace of their future alcohol consumption. Additional education on the circumstances of alcohol overdose may help young adults learn their own limits for safe consumption.

Considerations for more effective social norms based alcohol education on campus: an analysis of different theoretical conceptualizations in predicting drinking among fraternity men.

OBJECTIVE: Recent alcohol education campaigns targeting college students have focused on correcting the erroneous perception students have of the amount of alcohol their peers consume. This strategy is based on assumptions that college students overestimate the amount of alcohol their peers consume and that correcting that misperception will lessen the pressure they feel to consume heavily. However, other theoretical constructs of normative influence may be as or more valuable in improving effectiveness of social norms based education for high-risk college students. This study evaluates the effects of three social normative influence factors on alcohol consumption among fraternity men. METHOD: Participants were 379 members of randomly selected chapters from two large student fraternity organizations. We used hierarchical linear models to analyze the predictive value of normative influence variables in explaining alcohol consumption differences, both across individuals within chapters and across chapters. RESULTS: Perceived consumption norms and perceived subjective norms were significant predictors of alcohol consumption levels. Both normative influence variables are significant in predicting differences in consumption within chapters and across chapters of fraternity men. General approval of alcohol use did not account for significant variance within chapters in consumption or any unique variance in consumption between chapters. CONCLUSIONS: Perceived subjective norms as defined by long-standing behavior theory may provide an alternative and potentially more promising intervention target for this high-risk student population than does the current focus on correcting students' errors in estimating the amount of alcohol their peers consume.

An e-learning caregiving program for prostate cancer patients and family members.

e-health interventions have the potential to augment caregiving training for management of chronic disease. Instruction on caregiving functions often key to patients and families' well being is time consuming but not reimbursable in our current health care system. A theoretically defined interactive multimedia program is described which would assess patient and family member's level of preparedness for specific caregiving functions for prostate cancer and provide tailored skill building vignettes on caregiving techniques. Maximizing today's technology, this program is best designed for a hybrid delivery utilizing both web-based resources and a CD-ROM. Feedback from 45 prostate patients and family members from a Midwest cancer center on perceived needs for caregiving training underscores the potential value of a computer supported intervention for some patients and families. Implementation of the software, marketing, and distribution will be guided in part by recent e-health experiences that leave many health professionals appropriately skeptical about the utility of such products.