Camille Warner

Structural equation modeling and its relationship to multiple regression and factor analysis

Using a conceptual and nontechnical approach, the meaning of structural equation modeling (SEM) and the similarities to, and differences from, more commonly used procedures such as correlation, regression, path analysis, and factor analysis are explained. Application of the statistical technique is presented using data from a study of the relationships among stresses, strains, and physical health in a random sample of 492 community-dwelling elders aged 65 and older. Advantages of each statistical procedure are described. Theoretical issues related to the use of each procedure are presented with emphasis on the need for a sound theoretical model and match between the statistical procedure and the aims of the analysis.

STRESS, HEALTH, AND DEPRESSIVE SYMPTOMS IN OLDER ADULTS AT THREE TIME POINTS OVER 18 MONTHS

This descriptive study is a secondary analysis of data that examined depressive symptoms in a random sample of 429 community-dwelling adults aged 65 years and older. Participants were classified as having consistently high (n = 20). consistently low (n = 327), or fluctuating (n = 82) levels of depressive symptoms, based on scores from the Center for Epidemiological Studies-Depression Scale (CES-D; L. S. Radloff, 1977) at three time points over the course of 18 months. Differences in stress (life events and daily hassles), health (self-assessed health and physical complaints), and biographic variables among the 3 groups were examined. One quarter of the sample reported high depressive symptoms at least once over 18 months. There were significant differences among the 3 symptom groups on each of the stress and health measures and on marital status. The findings support the relationship among stress, health, and depressive symptoms over time. Implications for clinicians and researchers are discussed.

Health problems and health actions among community-dwelling older adults: results of a health diary study

This study examined the health problems and health actions reported by a sample of older adults (N = 60) who maintained health diaries over a 4-week period. The diary sample was 78% (n = 47) White; 52% (n = 31) were women, with a mean age of 75 years (SD = 5.3). Content analysis was used to examine the types of health problems reported in the diaries, which health problems were likely to be considered an illness, and what health actions were reported. Respondents reported an average of four different types of health problems over the 4-week diary period. There were differences in symptom reports related to gender, age, or race. The most frequently reported health problems were musculoskeletal problems (n = 38), runny nose and respiratory problems (n = 24), gastrointestinal problems (n = 22), and headaches (n = 22). Only 36% of all health problems were considered to be illnesses. Subjects recorded a number of health actions in response to their health complaints, including over-the-counter (OTC) medication use (83%), prescription medication use (53%), self-care activities (72%), and professional consultation (43%). Specific strategies that subjects used to deal with various health problems, implications of the findings, and the usefulness of health diaries as a clinical tool are discussed.

Elderly Persons' Interpretation of a Bodily Change as an Illness Symptom:

Based on a community random sample of 406 elderly, factors that persuade an elderly person to interpret a bodily change as a symptom of illness are described. Three measures of such illness interpretation among 27 different bodily changes are used in analysis: giving an illness label to the change, consulting a physician for it, and/or using self-care for treatment. The three types of representations across all 27 bodily changes taken together, as well as among five typical complaints most commonly experienced, are reported. The findings show that the perceived seriousness of the bodily change and the general health context of the older person in which it has occurred are conducive to interpreting a bodily change as an illness symptom.

Older adults' bodily changes and physician contact

The question of what motivates elders to seek medical advice is explored among a random sample of 467 persons aged 65 and over living in Ohio, USA. The effect of physical and psychological variables on an initial physician visit was analysed for particular bodily changes the subjects had experienced. Unlike the situation in many other utilization studies, these specific complaints could be identified as leading to physician contact in a causal sequence. Multiple regression revealed limited effects of self-assessed health, body awareness, depression and anxiety on the decision to consult a physician, but significant effect of the perceived seriousness of the complaint. The findings cast doubt on the utility of self-assessed health and psychological distress as predictors of physician use in major archival studies. This research is unique among utilization studies in that it provides a cross-sectional opportunity to explain a health behavior prospectively in the presence of a specific prior health problem.

Use of a verbal electronic audio reminder with a patient hand hygiene bundle to increase independent patient hand hygiene practices of older adults in an acute care setting

Graphical abstract: Figure. No Caption available. HighlightsHospitalized patients demonstrate poor hand hygiene practice and face practice barriers.Very few studies support independent patient hand hygiene practice.The addition of a verbal electronic audio reminder to an education bundle is proposed.Independent patient hand hygiene can be improved with the use of a verbal reminder. Background: We hypothesized that the addition of a novel verbal electronic audio reminder to an educational patient hand hygiene bundle would increase performance of self‐managed patient hand hygiene. Methods: We conducted a 2‐group comparative effectiveness study randomly assigning participants to patient hand hygiene bundle 1 (n = 41), which included a video, a handout, and a personalized verbal electronic audio reminder (EAR) that prompted hand cleansing at 3 meal times, or patient hand hygiene bundle 2 (n = 34), which included the identical video and handout, but not the EAR. The primary outcome was alcohol‐based hand sanitizer use based on weighing bottles of hand sanitizer. Results: Participants that received the EAR averaged significantly more use of hand sanitizer product over the 3 days of the study (mean ± SD, 29.97 ± 17.13 g) than participants with no EAR (mean ± SD, 10.88 ± 9.27 g; t73 = 5.822; P ≤ .001). Conclusions: The addition of a novel verbal EAR to a patient hand hygiene bundle resulted in a significant increase in patient hand hygiene performance. Our results suggest that simple audio technology can be used to improve patient self‐management of hand hygiene. Future research is needed to determine if the technology can be used to promote other healthy behaviors, reduce infections, and improve patient‐centered care without increasing the workload of health care workers.