Playing the numbers: how hepatitis C patients create meaning and make healthcare decisions from medical test results.

In this article we describe how patients assign meanings to medical test results and use these meanings to justify their actions. Evidence is presented from lay interpretations of medical tests for monitoring hepatitis C viral infection (HCV) to show how numeracy becomes embodied in the absence of physical symptoms. Illness narratives from 307 individuals infected with HCV were collected from the internet and analysed qualitatively. As part of standard medical care, chronically infected HCV patients are required to have periodic blood tests for laboratory testing. The lab results are presented numerically and compared with established physiological standards. HCV patients' knowledge and interpretations of test results have important consequences for their health behaviour and their medical decisions. In their stories, the patients described their decisions to begin, delay or stop treatment and developed strategies to alter their diet, exercise and use alternative therapies according to changes in their test result. The perceived meanings of test results are powerful signifiers that are capable of altering the course of HCV patients' illness, lives and stories. An interpretive model of health numeracy has the advantage of promoting understanding between patients and healthcare providers over a model that views innumeracy as a skill deficit.

A novel protocol for streamlined IRB review of Practice-based Research Network (PBRN) card studies.

PURPOSE: The "card study," in which clinicians record brief information about patient visits during usual clinical care, has long been a rapid method for conducting descriptive studies in practice-based research networks. Because an increasingly stringent regulatory environment has made conducting card studies difficult, we developed a streamlined method for obtaining card study institutional review board (IRB) approval. METHODS: We developed a protocol for a study of the card study method, allowing new card study proposals of specific research questions to be submitted as addenda to the approved Card Study Protocol. RESULTS: Seven card studies were proposed and approved under the Card Study Protocol during the first year after implementation, contrasted with one-card study proposed in the previous year. New card study ideas submitted as addenda to an approved protocol appeared to increase IRB comfort with the card study as a minimal risk method while reducing the hurdles to developing new study ideas. CONCLUSIONS: A Card Study Protocol allowing new study questions to be submitted as addenda decreases time between idea generation and IRB approval. Shortened turn-around times may be useful for translating ideas into action while reducing regulatory burden.

Keys to successful diabetes self-management for uninsured patients: social support, observational learning, and turning points: a safety net providers' strategic alliance study.

OBJECTIVE: To examine how medically uninsured patients who receive health care at federally qualified health centers and free clinics are able to successfully self-manage diabetes compared to patients who are less successful. METHODS: Two distinct groups of patients with diabetes for 6 months or longer were enrolled: (1) successful, defined as those with glycated hemoglobin (HbA1c) of 7% or less or a recent improvement of at least 2% (n=17); and (2) unsuccessful, defined as patients with HbAlc of at least 9% (n=9) and without recent improvement. Patients were interviewed about enabling factors, motivators, resources, and barriers to diabetes self-management. Data from interviews, chart reviews, and clinician surveys were analyzed using qualitative methods and statistical techniques. RESULTS: African Americans comprised 57.7% of the sample and whites 38.5% (N=26). No significant differences were detected between successful and unsuccessful groups in age, race, education, or employment status. Clinicians rated unsuccessful patients as having more severe diabetes and significantly lower levels of control than successful patients. Compared to unsuccessful patients, successful patients more often reported having friends or family with diabetes, more frequently sought information about the disease, used evidence-based self-management strategies, held more accurate perceptions of their own diabetes control, and experienced "turning point" events that motivated increased efforts in disease management. CONCLUSIONS: Patients who successfully managed diabetes learned from diabetic family members and interpreted disease-related events as motivational turning points. It may be beneficial to incorporate social learning and motivational enhancement into diabetes interventions to increase patients' motivation for improved levels of self-management.

Complexity of measuring "cigar use" in adolescents: results from a split sample experiment.

INTRODUCTION: Inclusion of brand-specific examples (BE) in health surveys assessing lifetime and current cigar use has been shown to impact response rates. A split sample experimental design was used to investigate whether these rates are consistent by race, gender, and geographic locale. METHODS: The 2009 Cuyahoga County Youth Risk Behavior Survey was conducted among 20 randomly selected high schools. Two versions of the survey were created; the first included items assessing lifetime and current cigar use with no brand-specific examples (NBE) while the second included BE in the items assessing cigar use. Both survey versions were distributed randomly within selected classrooms in participating schools. RESULTS: Within the City, both White and Black BE respondents reported higher lifetime cigar product use prevalence and current cigar product use compared to the NBE group; however, the difference was only significant among Black respondents (odds ratio [OR] = 1.45, 95% CI 1.02-2.06). In the Outer Ring, White BE respondents were significantly less likely to report lifetime cigar use (OR = 0.73, 95% CI: 0.54 - 0.98) and current cigar use (OR = 0.66, 95% CI: 0.44-0.99) when compared with White NBE respondents. CONCLUSIONS: Inclusion of BE in current measures of cigar product use may improve product use estimates in at-risk groups. However, better estimation of cigar product use may be accomplished by creating additional items to assess the use of subtypes of cigars.

Measuring cigar use in adolescents: inclusion of a brand-specific item.

INTRODUCTION: This study examined whether the standard measure of cigar use in adolescents could be improved by the addition of a brand-specific example. METHODS: In 2002, prevalence of tobacco use was assessed in six midwestern U.S. high schools using the Youth Risk Behavior Survey. The survey was readministered to the same schools in 2004, with the brand name "Black and Milds" added to the item measuring cigar use. Changes in local prevalence rates were compared with national rates. RESULTS: Local rates of cigar and cigarette use in 2002 were consistent with national rates reported in 2003. In 2004, when the cigar item was modified to include a brand-specific example, the percentage of students reporting cigar use nearly doubled-from 12.9% to 20.7%. This difference was particularly notable among Black teens. During the same period, local rates of cigarette use remained constant, as did national rates of reported cigar and cigarette use. DISCUSSION: Results suggest that the current national survey item may not adequately measure cigar use. Accordingly, prevalence of cigar use among adolescents may be greatly underestimated, especially among Black youth.