Anna Madison

An EMR-based tool to support collaborative planning for medication use among adults with diabetes: design of a multi-site randomized control trial.

Patients with type II diabetes often struggle with self-care, including adhering to complex medication regimens and managing their blood glucose levels. Medication nonadherence in this population reflects many factors, including a gap between the demands of taking medication and the limited literacy and cognitive resources that many patients bring to this task. This gap is exacerbated by a lack of health system support, such as inadequate patient-provider collaboration. The goal of our project is to improve self-management of medications and related health outcomes by providing system support. The Medtable™ is an Electronic Medical Record (EMR)-integrated tool designed to support patient-provider collaboration needed for medication management. It helps providers and patients work together to create effective medication schedules that are easy to implement. We describe the development and initial evaluation of the tool, as well as the process of integrating it with an EMR system in general internal medicine clinics. A planned evaluation study will investigate whether an intervention centered on the Medtable™ improves medication knowledge, adherence, and health outcomes relative to a usual care control condition among type II diabetic patients struggling to manage multiple medications.

Cognition and Health Literacy in Older Adults’ Recall of Self-Care Information

Purpose of the Study Health literacy is associated with health outcomes presumably because it influences the understanding of information needed for self-care. However, little is known about the language comprehension mechanisms that underpin health literacy. Design and Methods We explored the relationship between a commonly used measure of health literacy (Short Test of Functional Health Literacy in Adults [STOFHLA]) and comprehension of health information among 145 older adults. Results Results showed that performance on the STOFHLA was associated with recall of health information. Consistent with the Process-Knowledge Model of Health Literacy, mediation analysis showed that both processing capacity and knowledge mediated the association between health literacy and recall of health information. In addition, knowledge moderated the effects of processing capacity limits, such that processing capacity was less likely to be associated with recall for older adults with higher levels of knowledge. Implications These findings suggest that knowledge contributes to health literacy and can compensate for deficits in processing capacity to support comprehension of health information among older adults. The implications of these findings for improving patient education materials for older adults with inadequate health literacy are discussed.

Defining older adults’ perceived causes of hypertension in the Brief Illness Perception Questionnaire

Objectives: This study sought to make the Brief Illness Perception Questionnaire (BIPQ) to be more informative about illness representation among older adults with hypertension. The authors developed categories for coding the open-ended question regarding cause of illness in the BIPQ – a pervasive quantitative measure for illness representation. Methods: Using inductive thematic analysis, the authors described categories which emerged from analysing the open-ended question of the BIPQ applied to patients with hypertension. Then using deductive thematic analysis, we applied known categories in the literature to causes for hypertension elicited by the BIPQ. Our categories are: behavioural, natural, physical, psychosocial, supernatural, and other. Results: We established inter-coder reliability by applying the coding scheme to a sample of suburban central Illinois (n=197) and urban Tucson, Arizona (n=299) older adults with hypertension (initial kappa=0.61, revised kappa after decision rules=0.987). To demonstrate the utility of the coding scheme we found that both Illinois and Arizona nonwhite patients differ from white patients in how they understand the cause of their hypertension. Conclusion: A more complete illness representation can now be quantified and statistically analysed through the BIPQ using the categories we revised for cause of hypertension. Assessment of causal beliefs through the BIPQ and the authors’ coding scheme may enable tailored and efficient patient education, resulting in more effective provider–patient relationships.

The role of crowding in parallel search: Peripheral pooling is not responsible for logarithmic efficiency in parallel search

Recent results from our laboratory showed that, in fixed-target parallel search tasks, reaction times increase in a logarithmic fashion with set size, and the slope of this logarithmic function is modulated by lure-target similarity. These results were interpreted as being consistent with a processing architecture where early vision (stage one) processes elements in the display in exhaustive fashion with unlimited capacity and with a limitation in resolution. Here, we evaluate the contribution of crowding to our recent logarithmic search slope findings, considering the possibility that peripheral pooling of features (as observed in crowding) may be responsible for logarithmic efficiency. Factors known to affect the strength of crowding were varied, specifically: item spacing and similarity. The results from three experiments converge on the same pattern of results: reaction times increased logarithmically with set size and were modulated by lure-target similarity even when crowding was minimized within displays through an inter-item spacing manipulation. Furthermore, we found logarithmic search efficiencies were overall improved in displays where crowding was minimized compared to displays where crowding was possible. The findings from these three experiments suggest logarithmic efficiency in efficient search is not the result peripheral pooling of features. That said, the presence of crowding does tend to reduce search efficiency, even in “pop-out” search situations.

Singleton search performance predicts performance on heterogeneous displays: Evidence in support of the Information Theory of Vision

Feature singleton search tasks have been characterized as being independent of the number of non-target elements in the display (Treisman and Gelade, 1980; Wolfe, 1994). Previous work from our lab has shown that reaction times on feature singleton search tasks in fact increase logarithmically with the number of non-target (lure) elements in the display and that the steepness of the logarithmic function is modulated by lure-target similarity (Madison, Buetti & Lleras, 2014). Duncan and Humphreys (1989) proposed an effect of distractor heterogeneity on search performance such that distractor-distractor similarity modulates search efficiency, and that distractor rejection is facilitated by the repetition of identical distractors (a mechanism called spreading suppression). Here we challenge those claims and demonstrate that in parallel search, we find no evidence for distractor-distractor effects, nor for spreading suppression (grouping of distractors). We tested search performance in displays containing multiple types of lures simultaneously (e.g., a red target amongst yellow, blue and orange lures). To evaluate performance on these mixed displays, we first computed estimates of logarithmic processing costs for each type of lure (obtained from a different set of subjects) when the target was presented amongst uniform fields of each type of lure (e.g., a red target amongst only orange distractors). We then used those estimates to predict what reaction times in mixed displays ought to be if (a) each item in the display was processed independently from one another and (b) the processing of all items was performed in unlimited capacity parallel fashion. In two separate experiments, with different combinations of lures, this model (a simple linear addition of logarithmic processing costs), was able to account for 95.67% and 94.41% of the variance of reaction times in mixed displays. These results argue strongly against both distractor-distractor interactions as well as spreading suppression effects in parallel search. Meeting abstract presented at VSS 2015.