Brian F. Geiger

The effect of a self-monitoring tool on self-efficacy, health beliefs, and adherence in patients receiving hemodialysis

OBJECTIVE Assess the effectiveness of a self-monitoring tool on perceptions of self-efficacy, health beliefs, and adherence in patients receiving hemodialysis. DESIGN A monthly intervention using a pretest, posttest design over a 6-month period. Both the treatment and control groups were randomly selected and received surveys to assess health beliefs, perceptions of self-efficacy for performing specific healthful behaviors, and renal diet knowledge at baseline, before intervention, and 6 months later. The treatment group also received monthly feedback of monthly phosphorus levels and interdialytic weight gains. SETTING A university hospital-based 43-chair ambulatory dialysis center. SUBJECTS Forty patients with end-stage renal disease (25 men and 15 women, age 26 to 78 years), on chronic hemodialysis for at least 2 months and with a history of noncompliance with phosphorus and/or fluid restrictions for 1 or more months. MAIN OUTCOME MEASURES Self-efficacy, health beliefs, knowledge, biochemical, and demographic variables were analyzed. Analysis of variance tests of repeated measures were used to examine relationships between adherence with phosphorus and fluid restrictions to health beliefs and perceptions of self-efficacy after training in self-monitoring. RESULTS Overall, there were no significant improvements in adherence with phosphorus and fluid restrictions between the two groups, although a comparison within the groups revealed the treatment group had a statistically significant decrease in mean phosphorus levels of 7.14 to 6.22 mg/dL (P = .005) from baseline to month 3. However, because this value was not maintained, it was not statistically significant. No significant differences existed between the two groups for health beliefs and perceptions of self-efficacy. Knowledge scores in the treatment group, however, improved significantly as compared to the control group (P = .008) and was a significant increase from baseline (P = . 002). In the control group, all scores fell slightly but this difference was not significant. CONCLUSIONS The benefits of patient self-monitoring and behavioral contracting upon adherence in patients on hemodialysis are inconclusive, as serum phosphorus and interdialytic weight gains did not differ between the two groups. The interventional tools also appeared to have little effect on perceptions of self-efficacy and health beliefs. Trends of improvement, however, did exist for phosphorus within the treatment group and subjects in this group had a statistically significant increase in knowledge scores over time. Additional research using repeated measures design is needed to explore the effects of increased frequency and duration of an intervention on the attainment of patient clinical outcome measures.

Drinking Likelihood, Alcohol Problems, and Peer Influence Among First-Year College Students

Excessive alcohol consumption is a predominant health concern on college campuses in the United States. A stepwise multiple regression analysis was used to examine the predictive values of demographic factors in relation to alcohol subscales (Drinking Context Scale, College Alcohol Problems Scale-revised, and Social Modeling Scale) with the outcome of number of drinking days in the past 30 days among a sample (n = 224) of first-year college students. The final model predicted 37.5% of the variability in drinking days in the past month. All variables, except for race, were significantly associated with the outcome (p <. 05).

Ecological Strategies to Promote Healthy Body Image Among Children

BACKGROUND Personal habits of children and adolescents related to healthy body image (BI) are influenced by various determinants in the micro- and macroenvironment. These include attitudes and behaviors about eating; exercise and physical appearance modeled by parents, teachers, and peers; as well as opportunities to learn new habits and social praise for healthy choices. The coordinated school health program (CSHP) is compatible with the 5 levels of an ecological approach to developing new health behaviors. METHODS Authors systematically applied the ecological model to all 8 components of coordinated school health. Next, strategies for each of the components were developed using the professional literature as well as author expertise in the areas of health education, exercise science, and dietetics. RESULTS For each strategy, applicable health and physical education standards, as well as goals for each strategy and additional Web resources, were provided to assist educators and administrators in supporting healthy BI among students. CONCLUSIONS Educators may effectively use a coordinated approach to guide multiple intervention activities aimed at increasing healthy habits among adolescents and their families. The strength of the CSHP is its collaborative nature with active participation by students, faculty members, family caregivers, agency professionals, community residents, and health care providers.

A method for standardizing procedures in rehabilitation: use in the extremity constraint induced therapy evaluation multisite randomized controlled trial.

OBJECTIVE An enduring problem in the field of rehabilitation has been the lack of standardization in the protocols of treatments and tests. To develop a process evaluation method to standardize the administration of rehabilitation procedures used in the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial, a randomized controlled trial of upper-extremity constraint-induced therapy implemented across 7 sites. DESIGN Process evaluation. SETTING Research laboratory. PARTICIPANTS Convenience sample or research personnel. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Checklist scoring sheets were developed to rate videotapes using systematic application of prescribed steps for each of 5 procedures across 3 time periods. Time periods were immediately after training, and 1 and 2 years later. A performance score of at least 90% was required before individual research personnel were allowed to participate in the trial. RESULTS Overall performance scores ranged from 85.8% to 95% of performance items correctly executed. There was a significant improvement in standard performance of procedures between the first time period (immediately after training) and each of the subsequent time periods for all but 1 procedure. The scoring of standardized performance when carried out with routine participant testing and training did not differ significantly from scoring from videotaped sessions submitted for standardization rating for 2 of the procedures, suggesting adequate validity of scoring from videotape. CONCLUSIONS The present method was successful in assessing protocol fidelity for the EXCITE research personnel and represents 1 means of addressing the longstanding problem in rehabilitation of the lack of standardization in administering different treatments and tests.

Working with Colleges and Universities to Enhance the Health of Students and Schools

University health educators have long promoted comprehensive school health programs. Faculty members in other disciplines can also provide support and assistance. Successful collaboration between colleges and universities and public schools requires understanding the expectations and needs of faculty members and administrators in each setting. This article presents important barriers and opportunities related to successful school health partnerships between public schools and higher education. Fourteen Prevention Research Centers participated in a project funded by the Centers for Disease Control and Prevention. The purpose was to study innovative partnerships to identify practical methods for higher education to work with public schools to improve the health of young people. This article includes selected results of the project and related recommendations for partnership activities. Specific examples illustrate the importance of gaining the trust and support of gatekeepers. The intent of the authors is to provide guidance to others interested in establishing collaborative partnerships.

Why Don't Parents Participate in School Health Education?.

Abstract This study examined factors that inhibit parent involvement in school health education. Parents of middle school children were surveyed to determine what factors constituted barriers to their participation in school health education activities. Specifically, this study examined the synergistic effects of multiple factors on parent involvement. Results illustrate that parents are likely to have low levels of participation in school health education if they (1) have a limited knowledge of opportunities to participate, (2) perceive that the school does not want them to participate, (3) perceive that the health education curriculum does not allow for parent involvement, and (4) perceive that their children would be embarrassed by their participation at school. When these factors combine, parents are far less likely to be involved at school. Implications of the study findings are discussed with particular focus on needed future research.

HealthyME HealthyU©2010UCPGB: A Collaborative Project to Enhance Access to Health Information and Services for Individuals With Disabilities

In response to the limited information about health information and training needs among persons with disabilities, a collaborative group of Alabama researchers, educators, and clinicians was formed to implement a statewide needs assessment with support provided by the Alabama Council for Developmental Disabilities and the National Network of Libraries of Medicine. Educational and assessment activities were guided by the Systems Model of Clinical Preventive Care and Health Information National Trends Survey (HINTS) methodology. Four constructs from the 2007 HINTS Annotated Version were identified as relevant to the concepts of local interest. Results of printed and online surveys administered to 251 family and other caregivers, 87 individuals with disabilities, 110 clinical service providers, and 570 health professions students revealed outstanding health communication needs to improve access to reliable consumer information and clinical services. HealthyME HealthyU©2010UCPGB developed new educational materials that address issues identified from the needs assessment, specifically (a) accessibility of health care facilities; (b) patient–provider communication; (c) personal health management by consumers and families/caregivers; and (d) sources of trustworthy electronic health information. Six brief digital video training modules were developed for consumers, families, and professionals featuring as speakers health care providers, health professions students, and individuals with cognitive disabilities. Following field testing, video modules were revised and then widely distributed to consumers, family caregivers, and service providers. Preliminary evaluation indicates content is relevant and comprehensible to individuals with disabilities.

Validation of the Drinking Context Scale (DCS-9) for use with non-adjudicated first-year college students

The Drinking Context Scale (DCS-9) has been used to measure the impact of drinking during social, emotional, and situational contexts. Psychometric properties remain unevaluated in a population of non-adjudicated first-year college students in the southeast. Liseral 8.8 was used to test the factorial validity of the DCS, using Confirmatory Factor Analysis. The original three factor model for the DCS represented acceptable fit to the data (chi(2)=36.72, df=24, p=0.047, CFI=0.991, SRMR=.0406) supporting its use with first-year college students. Invariance between gender, ethnic group, and geographical regions should be examined by future researchers.

Validation of the College Alcohol Problem Scale-revised (CAPS-r) for use with non-adjudicated first-year students.

First-year students in transition to college are at increased risk for consuming greater amounts of alcohol and are subject to subsequent alcohol-related problems. The 8-item College Alcohol Problem Scale-revised (CAPS-r) has been used to measure alcohol-related problems in adjudicated undergraduates and psychology majors. However, structural validity of the CAPS-r has not been examined in a general first-year student population. Confirmatory factor analysis (CFA) was used to test the structural validity of this two-factor model using LISREL 8.5. The original two-factor measurement model for the 8-item CAPS-r represented acceptable fit to the data (chi(2)=37.52, df=19, p=.007, CFI=.968, SRMR=.0449), supporting its use with first-year college students. Future studies need to examine invariance across ethnic, gender, and geographical groups.

Readying the Health Education Specialist for Emergencies.

This article provides a resourceful guide for the health education specialist to improve emergency management knowledge and skills specific to their setting, including training and preparing for emergencies and providing adequate support to students, clients, and colleagues. Five steps guide competent health education practice before, during, and after a crisis event. Free training resources and priority actions are emphasized. The authors underscore professional benefits of emergency readiness that align with performance expectations established by the Coalition of National Health Education Organizations, including promoting and protecting the health of individuals, families, and communities and providing education and services to reduce costly premature deaths and disability.