Carmen Alvarez

Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels

PURPOSE We aimed to identify the strategies used to support patient behavior change by clinicians whose patients had an increase in patient activation. METHODS This mixed methods study was conducted in collaboration with Fairview Health Services, a Pioneer Accountable Care Organization. We aggregated data on the change in patient activation measure (PAM) score for 7,144 patients to the primary care clinician level. We conducted in-depth interviews with 10 clinicians whose patients’ score increases were among the highest and 10 whose patients’ score changes were among the lowest. Transcripts of the interviews were analyzed to identify key strategies that differentiated the clinicians whose patients had top PAM change scores. RESULTS Clinicians whose patients had relatively large activation increases reported using 5 key strategies to support patient behavior change (mean = 3.9 strategies): emphasizing patient ownership; partnering with patients; identifying small steps; scheduling frequent follow-up visits to cheer successes, problem solve, or both; and showing caring and concern for patients. Clinicians whose patients had lesser change in activation were far less likely to describe using these approaches (mean = 1.3 strategies). Most clinicians, regardless of group, reported developing their own approach to support patient behavior change. Those whose patients showed high activation change reported spending more time with patients on counseling and education than did those whose patients showed less improvement in activation. CONCLUSIONS Clinicians vary in the strategies they use to promote behavior change and in the time spent with patients on such activities. The 5 key strategies used by clinicians with high patient activation change are promising approaches to supporting patient behavior change that should be tested in a larger sample of clinicians to validate their effectiveness.

Provider Screening and Counseling for Intimate Partner Violence A Systematic Review of Practices and Influencing Factors

Background: Primary care providers have an important role in identifying survivors of intimate partner violence (IPV) and providing safety options. Routine screening rates by providers have been consistently low, indicating a need to better understand providers’ practices to ensure the translation of policy into clinical practice. Aim: This systematic review examines common themes regarding provider screening practices and influencing factors on these practices. Method: A literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search focused on research articles which met the following criteria: (1) health-care providers as participants, (2) provider reports on screening and counseling practices for IPV, and (3) were in English or Spanish. Results: A total of 35 studies were included in the review. Across studies, providers commonly acknowledged the importance of IPV screening yet often used only selective screening. Influencing factors on clinic, provider, and patient levels shaped the process and outcomes of provider screening practices. Overall, a great deal of variability exists in regard to provider screening practices. This variability may be due to a lack of clear system-level guidance for these practices and a lack of research regarding best practices. Conclusions: These findings suggest the necessity of more facilitative, clearly defined, and perhaps mandatory strategies to fulfill policy requirements. Future research directions are outlined to assist with these goals.

The role of primary care providers in patient activation and engagement in self-management: a cross-sectional analysis

BackgroundThe increasing burden of chronic illness highlights the importance of self-care and shifts from hierarchical and patriarchal models to partnerships. Primary care providers (PCPs) play an important role in supporting patients in self-management, enabling activation and supporting chronic care. We explored the extent to which PCPs’ beliefs about the importance of the patients’ role relate to the frequency in which they report engaging in collaborative and partnership-building behaviors with patients.MethodsPCPs’ beliefs were measured using the Clinician Support for Patient Activation Measure (CS-PAM). We also assessed whether PCPs’ CS-PAM scores were positively associated with changes in their patients’ Patient Activation Measure (PAM) scores. Participants included 181 PCPs from a single accountable care organization in Minnesota who completed an online survey. We conducted bivariate analyses and multivariate regression models to examine relationships between CS-PAM and PCP self-management support behaviors and changes in level of patient activation.ResultsPCPs with high CS-PAM scores were much more likely to engage in supportive self-management and patient behavior change approaches, such as involving the patient in agenda-setting, problem-solving, and collaboratively setting behavioral goals, than were PCPs with low CS-PAM scores. More positive PCPs’ belief in the patients’ role in self-management was positively correlated with improvements in their patients’ level of patient activation.ConclusionsMore positive PCP beliefs about the patients’ role in self-management was strongly related to PCP behaviors geared towards increasing patient activation.

Elements of Effective Interventions for Addressing Intimate Partner Violence in Latina Women: A Systematic Review.

Background Intimate partner violence remains a global problem and is of particular concern in Latina diasporas. Aim To identify effective elements of interventions to address intimate partner violence in Latina women. Method The systematic review was undertaken according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We focused the search on intervention studies assessing intimate partner violence as an outcome measure and on publications in English and Spanish from the last 11 years (2004–2015). Results Despite the scope of the problem, from the 1,274 studies screened only four met the search criteria and only a single study included an exclusive Latino population. Of the four interventions, one was only as effective as the control treatment. Heterogeneity of study populations and designs prohibited meta-analytic methods. Conclusions Theoretically derived interventions that are gender specific, culturally appropriate, target mutual aid through group dynamics, and that are developed collaboratively with the target population are likely to be most effective.

Food insecurity, food assistance and health status in the U.S. community health center population.

Objectives. This study explored the relationship between food insecurity, food assistance, and self-reported health status among community health center (CHC) clients. Methods. Using data from the 2009 Community Health Center Patient Survey (n = 4,562), representing Federally Qualified Health Center clients, we conducted logistic regression analyses to identify the association between food insecurity and fair/poor health status, controlling for food assistance and sociodemographic factors. Results. Approximately 1/3 of the sample (31.9%) reported fair/poor health status, 10.9% reported food insecurity, and 52.6% reported public food assistance. Multivariate analyses revealed that, among women, those with food insecurity had significantly higher odds of reporting fair/poor health status (AOR = 2.14, 95% CI 1.20–3.82). Conclusions. Expansion of financial access to health care via the Patient Protection and Affordable Care Act coupled with recent funding cuts to the Supplemental Nutrition Assistance Program means that CHCs play an increasingly important role in addressing food insecurity.

Sexual communication among young adult heterosexual Latinos: A qualitative descriptive study

Sexual communication between sexual partners is an important component in prevention efforts against unintended consequences of sex. The purpose of this study was to describe sexual communication among young adult Latinos. Four semistructured, sex-segregated focus groups were used for this study. Participants (N = 20) were 18-30 years old self-identified Latinos who were in heterosexual and sexually active relationships (more than 3 months). Participants revealed that initial sexual communication with their partners was avoided related to a lack of interest in a partners sexual history, feeling embarrassed about the topic, or concern for offending ones partner or partners family. As a result of these beliefs and attitudes, initial sexual communication was nonverbal and focused on sexual pleasure. After the initiation of sexual activity, verbal sexual communication expanded to include sexual history. These findings highlight the importance of attitudes and subjective norms toward verbal sexual communication. Attitudes and subjective norms toward sexual communication in the context of a romantic relationship and how it may impact sexual behavior in the relationship should be further explored.

Integrating the 3Ds: A Nursing Perspective

The 3Ds (diversity, disparities, and determinants) that serve as a framework for this supplement are concepts that are key foundations of nursing education, practice, and research. Despite this fact, however, the nursing profession has faced challenges recognizing the full potential of these concepts. While their importance is documented and acknowledged, they are not clearly evident or easily recognized within the nursing profession. In fact, there are many barriers to the integration of these concepts. We identify and address two barriers to addressing health disparities and increasing diversity: disconnects and discrimination. Furthermore, we discuss three factors—dissemination, durability, and data—that may facilitate nursings efforts to integrate the 3Ds into the profession. Five pivotal models that address these barriers and facilitators are presented as exemplars that have the potential to guide efforts to address diversity, disparities, and social determinants of health and act as catalysts for change within the nursing profession.

Adherence to clinical preventive services guidelines: Population-based online randomized trial

The Patient Protection and Affordable Care Act (ACA) addresses use of clinical preventive services relative to evidence-based guidelines by mandating that most health insurance plans provide coverage without cost-sharing for services that receive an A or B rating. However, knowledge about and positive attitudes towards guidelines are extremely low. This study was a population-based randomized experiment to examine beliefs about and intentions to adhere to screening guidelines for the Prostate Specific Antigen (PSA) and Pap tests. The study had two objectives: (1) test reactions to and understanding of guidelines, and (2) experimentally compare receptivity to messages to promote PSA and Pap test recommendations. We first surveyed a population-based sample of (1) US adults age 18 and over, (2) subsample of women aged 65 or younger, (3) subsample of men aged 40 or older. A sample of 2923 completed an initial questionnaire. Next a subset of participants meeting eligibility criteria were recruited from the population-based sample into a message testing experiment: (1) women aged 65 or younger, (2) and men aged 40 or older. Participants meeting these eligibility requirements were randomized to gain, loss, or balanced PSA (men) or Pap test (women) message stimulus conditions and followed for 8 weeks. Data were collected through the GfK Custom Research panel. A total of 2401 were eligible, 2321 completed the baseline, and 1730 completed follow up. Mixed effect regression models revealed that higher receptivity to messages was associated with greater intentions to seek cancer information and to speak to a Doctor about PSA and Pap tests. The loss frame was associated with higher intentions to speak to friends and family about PSA and Pap tests. Finally, perceived importance and personal understanding of guidelines predicted intentions to seek more information about them. This study contributes to evidence on how best to inform and engage consumers regarding preventive services.

Sexual Communication and Sexual Behavior Among Young Adult Heterosexual Latinos

&NA; We examined verbal sexual health communication, pleasure discussions, and physical sexual communication in relation to condom use by young adult, heterosexual Latinos (ages 18–30 years). Participants (N = 220, 51% female) were recruited in a Midwestern state. Verbal sexual health communication was positively associated with consistent condom use among men (odds ratio [OR] = 2.66, p < .05) and women (OR = 3.12, p < .05). For men, pleasure discussions were negatively associated with consistent condom use (OR = 0.21, p < .05). For women, verbal sexual health communication was positively associated with condom use at last sex (OR = 2.75, p < .05), whereas physical sexual communication was negatively associated with condom use at last sex (OR = .29, p < .05). Various aspects of sexual communication may be important in HIV‐prevention programs with young Latinos. Physical sexual communication and pleasure discussions, in particular, warrant further exploration given negative relationships with condom use.

Younger African American Adults’ Use of Religious Songs to Manage Stressful Life Events

The aim of this study was to explore the use of religious songs in response to stressful life events among young African American adults. Fifty-five young African American adults aged 18–49 participated in a qualitative study involving criterion sampling and open-ended interviews. Data analysis included content analysis and descriptive statistics. Stressful life events were related to work or school; caregiving and death of a family member; and relationships. Religious songs represented five categories: Instructive, Communication with God, Thanksgiving and Praise, Memory of Forefathers, and Life after Death. The tradition of using religious songs in response to stressful life events continues among these young adults. Incorporating religious songs into health-promoting interventions might enhance their cultural relevance to this population.