Clara Manfredi

Factors Influencing Medical Information Seeking Among African American Cancer Patients

Qualitative research methods were used to explore factors that may affect medical information seeking, treatment engagement, and emotional adjustment among African American cancer patients. Focus group findings suggest that an array of cultural and socioeconomic factors plays important roles in the behavior of African American cancer patients. Participants described a number of important barriers and facilitators of medical information seeking and treatment participation. Factors linked to the health care-related behaviors and adjustment of African American cancer patients included limited knowledge and misinformation about cancer, mistrust of the medical community, concerns about privacy, lack of insurance, religious beliefs, and emotional issues such as fear and stigma associated with seeking emotional support. Recommendations are made that may assist mental and physical health providers in improving patient information and mental and physical health outcomes of African American cancer patients.

The Determinants and Consequences of Information Seeking Among Cancer Patients

This research was designed to examine information seeking behavior among cancer patients. We present a model which identifies the determinants and consequences of information seeking and, in turn, examines the effects of prior variables on four outcome variables: whether patients discussed with their physicians information that they received from other sources, whether the information they obtained helped them make decisions about treatment or care, whether the patient sought a second opinion about his/her diagnosis or treatment, and changes in self-reported stress levels from diagnosis to the time of interview. The model is estimated separately for three groups: patients who sought information from multiple sources including the National Cancer Institutes Cancer Information Service, patients who sought information from multiple sources but did not call the Cancer Information Service, and patients who did not seek information other than from their physician(s). We discuss variables that have similar impacts on outcome variables in all three groups as well as variables that operate differently within the groups. The results indicate that the desire for information and the desire for involvement in medical care decisions are independent factors. Some patients have a strong desire for both information and involvement in making health care decisions. These patients actively seek involvement in their treatment plans. Other patients, however, want to be informed about their disease and treatment but prefer to delegate most decision-making to their physicians. Still other patients choose to delegate information gathering and decision making exclusively to their physicians. We discuss the implications of these results for both patients and providers.

Smoking-related behavior, beliefs, and social environment of young black women in subsidized public housing in Chicago.

Survey data indicate that young Black female smokers living in public housing are heavier smokers and have weaker motivation to quit, health beliefs and social environment less conducive to cessation, and less knowledge of where to get help to quit than other young Black female smokers in metropolitan Chicago. Compared with White women, the latter, other Black women smoke fewer cigarettes daily and have a stronger desire to quit and more concern about health reasons for quitting, but have a weaker belief in the risk of lung cancer from smoking, greater concern about quitting difficulties, and less knowledge of where to get help to quit. Low education, not race, is associated with higher smoking prevalence and less social pressure to quit or support for quitting.

Measuring readiness and motivation to quit smoking among women in public health clinics

We conducted a pilot test of an instrument to assess stage of readiness and level of motivation to change smoking behavior among 495 women smokers in public health clinics. The stages of readiness were based on those proposed by Prochaska and DiClemente but with finer discrimination within the precontemplation stage, where a substantial minority (41%) of the target smokers were situated. Subdividing this earliest group, we found that 8% of the total sample planned no change in smoking ever; 8% were seriously thinking of cutting down; and 25% were seriously thinking of quitting but not within 6 months. Scales in the questionnaire included general motivation to change smoking behavior and confidence in ones ability to do so. The womens scores differed on these scales and on action toward quitting across the five stages of readiness, except that the lowest two groups did not differ on confidence. Pregnancy enhanced readiness to quit. The instrument accommodates the brevity and low literacy requirements for use in these applied settings and is suitable for use in either self-administered questionnaire or interview format.

Measuring readiness and motivation to quit smoking among women in public health clinics: predictive validity

We conducted an independent pilot test of the internal consistency, stability, and predictive validity of the instrument presented by Crittenden, Manfredi, Lacey, Warnecke, and Parsons (1994) using a two-wave panel of female smokers in 12 public health clinics. This instrument subdivides the precontemplation stage proposed by Prochaska and DiClemente into three more distinct stages: not contemplating quitting or cutting down, not contemplating quitting, and not contemplating quitting within 6 months. Findings confirm that the instrument is useful for evaluating movement toward quitting for populations that are largely concentrated in the precontemplative stage. The concurrent and predictive validity of the elaborated stages and the reliability and stability of smoking motivation and confidence indicate that the instrument is sensitive enough to track changes in readiness and motivation across the full readiness continuum.

Use of lay health educators for smoking cessation in a hard-to-reach urban community

A description of the use of indigenous lay health educators as they participated in the implementation of a community-based smoking cessation program is provided. The target population was young black women who resided in several urban public housing developments. The intervention, which was conducted in tandem with a larger televised smoking cessation program, consisted of either class sessions conducted by or reminder visits from community lay health educators. The lay health educators were successful in organizing this population, often viewed as difficult to reach, to become more aware of the dangers of smoking and to become more interested in participating in a structured smoking cessation program. They motivated 235 individuals to sign up for the program; of these, 141 attended at least one class session or accepted at least an initial reminder visit. The results suggest that lay health educators may be able to mobilize this population to participate in health promotion programs. However, due to differences in this population related to smoking, the findings indicate that new methods must be developed for sustaining their involvement after they have been reached.

Results of an intervention to improve compliance with referrals for evaluation of suspected malignancies at neighborhood public health centers.

A study was conducted at Neighborhood Health Centers to evaluate procedures to improve compliance with referrals of patient at risk for cancer. Intervention consisted of a standardized communication from the exit nurse, a patient form to be returned after compliance, and one written and one telephone reminder as needed. Compliance was 68.2 percent in a control group and 89.0 percent among patients who received the experimental intervention, a significant increase of 20.8 percent (95% CI: 12.5, 29.1).

Correlates of quality of life among African American and white cancer survivors.

Background: African Americans continue to suffer disproportionately from cancer morbidity and mortality, with emerging evidence suggesting potential quality of life (QOL) disparities in the survivorship period. Objective: The objective of the study was to assess sociodemographic, clinical, and psychosocial factors associated with physical and mental health QOL (PHQOL and MHQOL) among African American and white cancer survivors. Methods: Patients were recruited from tumor registries. Telephone interviews were conducted with 248 African American and 244 white respondents with a history of breast, prostate, or colorectal cancers. Multivariate regression models were used to assess what factors were associated with PHQOL and MHQOL. Results: Key racial differences in adjusted analyses included poorer MHQOL scores among African Americans compared with white survivors. Furthermore, race moderated the relationship between perceived social support and MHQOL, where higher social support levels were associated with increased MHQOL among African Americans. Other correlates of QOL impacted racial groups similarly. For example, factors associated with PHQOL scores included being unemployed, being uninsured, the presence of medical comorbidities, a longer time since diagnosis, and higher levels of cancer-related stress appraisals. Factors associated with MHQOL scores included being unemployed, higher levels of daily stress, higher levels of stress associated with the diagnosis, higher levels of education, higher levels of perceived social support, and higher levels of spirituality. Conclusion: Interventions aimed at increasing social support may have important implications for improving QOL outcomes among African Americans. Implications for Practice: Measuring and understanding factors associated with QOL have important implications for patient adjustment and clinical decision making.

Sociopsychological Correlates of Motivation to Quit Smoking Among Low-SES African American Women

This article examines correlates of desire and plans to quit smoking among 248 young, low-socioeconomic status African American women, using variables derived from the health belief model (HBM) and the theory of reasoned action. Consistent with these theoretical models, stronger concern about the effect of smoking on ones health and having close others who want the smoker to quit increased motivation to quit smoking. However, motivation was not associated with specific HBM components regarding lung cancer. Heavier smoking and stronger perceptions regarding the functional utility of smoking decreased motivation to quit, but not as much as expected in this study population. Consistent with a process of change approach to smoking cessation, the factors that moved smokers from not planning to planning to ever quit were different from factors associated with further motivation level among the smokers who did plan to ever quit.

Social psychological correlates of health behavior: Knowledge of breast self-examination techniques among black women☆

Abstract This paper examines the relationship between fear, perceived susceptibility and belief in the efficacy of early detection of breast cancer as correlates of the likelihood that a procedure for early detection, self-examination (BSE), will actually be known. The data were obtained via personal interviews as part of a study of practices and beliefs related to cancer detection and prevention among black females in Buffalo, New York. Belief in the efficacy of early detection of the disease to reduce the danger from the disease was found to be the strongest correlate of the ability to perform BSE. However, independent effects of fear as reflected in perceived threat and feelings of personal susceptibility were also apparent.