Diane Lauver

Optimism and Coping with A Breast Cancer Symptom

This study was conducted to assess whether optimism was associated with less delay and anxiety in seeking cam for breast cancer symptoms, expectations about such care seeking, and the likelihood of having breast cancer. The influence of optimism on delay and anxiety through expectations about care seeking or likelihood of breast cancer was also examined. Participants (N = 135) with breast cancer symptoms and no history of cancer were interviewed at a surgery clinic. Optimism was associated with less delay and anxiety in care seeking and with expectations of desirable outcomes of care seeking. After controlling for expectations about care seeking, the relationship of optimism and anxiety became nonsignificant. Adjusting for differences in occupational status, the relationship of optimism and delay was nonsignificant. Thus, optimism may influence anxiety in care seeking for breast cancer symptoms through situation-specific expectations. The influence of optimism on delay may be confounded with socioeconomic factors.

TESTING THEORETICAL EXPLANATIONS OF MAMMOGRAPHY USE

The theory of care-seeking behavior was tested in the context of mammography use among midwestern women (N = 178). In multivariate logistic regressions, mammography adherence in the past 5 years was related to habit, the interaction of anxiety and barriers, belief in ones risk of breast cancer, age, and family history of breast cancer. Recent use of mammograms (i.e., in the past 1 or 2 years, depending on age) was related to norm and habit. Intention was related to utility beliefs regarding mammography, norm, habit, and belief in ones risk of breast cancer. As proposed from theory, anxiety and barriers interacted to influence adherence, the variables of habit, utility beliefs, and norm were related to either recent use or intention. Contrary to theory, belief in ones risk of breast cancer, age, and family history of breast cancer were related to adherence or intention after controlling for theoretically derived variables. The explanatory variables for each outcome were not identical, indicating that these mammography-related outcomes are characteristically different.

Psychosocial Variables, External Barriers, and Stage of Mammography Adoption

Guided by H. Triandiss (1980) theory of behavior and the transtheoretical model, the study purpose was to examine differences in psychosocial variables and external conditions by stage of mammography adoption. Sampled from a statewide population, participants (N=509) were women aged 51-80. They had been contacted by telephone, screened for eligibility (e.g., no history of cancer or recent mammogram), and interviewed 3-6 months later. Higher utility beliefs, social influences, and practitioner interactions about mammography were associated with improved stage of adoption, as were lower negative affect and external barriers regarding mammography. Higher decisional balance scores, with and without negative affect toward mammography were associated with improved stage. Controlling for variables reflecting pros and cons, negative affect toward mammography further distinguished among stages. A richer set of pros and cons measures could explain screening more fully.

Patient-centered interventions: implications for incontinence.

Background: Nurse researchers in incontinence have focused on testing the effects of standardized interventions; however, nurses in practice usually customize interventions with patients. Patient-centered interventions promise to bring research and practice closer together.Tailored interventions, one kind of patient-centered intervention, have been associated with improved health outcomes and can guide research interventions regarding incontinence. Objectives: To define the concept “patient-centered,” discuss four kinds of patient-centered interventions, offer examples of tailored interventions, and suggest ideas for future incontinence research. Methods: Existing literature on patient-centered interventions was analyzed to generate a plan for future research. Results: Research is needed to demonstrate the efficacy of patient-centered interventions in outcomes, to determine bio-psycho-social factors of subgroups (race, gender, ethnicity) in order to more accurately describe prevalence rates and create effective interventions, and to find common variables among successful interventions. Conclusions: Developing and testing patient-centered interventions regarding incontinence promises to advance knowledge about more effective interventions, conditions under which they are more or less effective, and how they are effective.

Understanding Lesbians' Mammography Utilization

Lesbians face unique barriers to health care, and may be at higher risk for breast cancer than are other women. Yet, no research on lesbians and mammography utilization exists. We conducted telephone interviews of 107 lesbians aged 51-80, of whom 68 had had mammograms in the last year and 39 had not. Responses to open-ended questions identified the barriers lesbians face in obtaining mammography, lesbians, reasons for obtaining mammograms, and factors that would help lesbians obtain mammograms. Some issues identified were particular to lesbians; many issues were common to those identified by general samples of women (which include lesbians).

Development of a questionnaire to measure beliefs and attitudes about breast self-examination.

Breast self-examination (BSE) is recommended for breast cancer screening, but most women do not perform BSE regularly. Greater accuracy of measures of beliefs and attitudes about BSE is essential to clarify the relationships between these variables and the frequency of BSE performance. The purpose of this research was to assess the reliability and validity of selected measures of beliefs and attitudes about BSE. Sixty-four women attending health programs in community settings responded to a questionnaire about selected beliefs, attitudes, and frequency of BSE. Internally consistent scales were derived (Cronbach alpha coefficients = 0.65–0.89) for remembering, competence, comfort, interference, and efficacy related to BSE. Moderate to strong and significant relationships were observed (Spearman rank correlation coefficients = 0.35–0.58; p

Explaining women's intentions and use of hormones with menopause.

The purposes of this theoretically-based study were (a) to examine the contributions of psychosocial variables (i.e., affect, beliefs, and norms), habit, and facilitating conditions to explaining womens intentions and use of hormones with menopause and (b) to assess whether clinical or demographic factors explained intentions and use, when controlling for psychosocial, habit, and facilitating conditions variables. In a cross-sectional design, 184 pre-, peri-, and postmenopausal women completed questionnaire measures. To explain intentions, data from 124 participants who were not using hormones were analyzed. To explain use, data from 125 peri- and postmenopausal participants were analyzed. In multivariate analyses, anxiety was associated inversely with use; norms were associated positively with intentions and use. Age was associated inversely with intentions; hot flashes were associated inversely with use. Future researchers can examine the combined influences of affect, beliefs, and norms on decisions about hormones. Clinicians can address anxieties and assess social influences about hormone use, as well as offer ways to deal with hot flashes.

Psychosocial Variables, Race, And Intention to Seek Care for Breast Cancer Symptoms

This study was designed to assess whether the influences of affect, utility, norm, and habit on intention to seek care promptly for a breast cancer symptom were conditional upon race. Ninety-six participants (68% Caucasian and 32% African American) in community settings completed measures of psychosocial, demographic, and clinical variables, and intention to seek care promptly for a breast lump. Controlling for education, financial coverage for health care, and family history of breast disease, the interactions of both utility and norm with race significantly explained intention. The positive influence of utility on intention was stronger among Caucasians than African Americans, but significant among both groups. The positive influence of social norm on intention was significant for Caucasians, but not for African Americans.

Clinical implications of DES.

Once prescribed to pregnant women to prevent risk of spontaneous abortion, diethylstilbestrol (DES) is now associated with an increased risk of breast cancer, clear cell adenocarcinoma (CCA) of the vagina and cervix, and reproductive anomalies. This article will summarize the potential long-term health implications of DES, the role of nurse practitioners in identifying exposed individuals, and proper clinical management.

Critical Thinking, Perceived Health Status, and Participation in Health Behaviors

BackgroundCritical thinking has been proposed as crucial for processing conflicting information when people make decisions about participation in health behaviors. The critical thinking of individuals about participation in health behaviors may depend on their perceived health status. ObjectivesTo examine the relations between critical thinking and participation in three categories of health behaviors, and to determine whether these relations are moderated by perceived health status. MethodsA cross-sectional, correlational design was used to study a sample of 112 community-dwelling adults who resided in a large, urban Midwest community. The participants were women and men 18 to 90 years of age (mean, 55 ± 20.47 years) who completed self-report, written questionnaires including the Test of Everyday Reasoning and the Health Practices Instrument. ResultsAccording to hierarchical multiple regression analyses, the relation between critical thinking and health promotion behaviors and the relation between critical thinking and secondary prevention behaviors were moderated by perceived health status, whereas the relation between critical thinking and health protection behaviors was not. ConclusionsThe relation between critical thinking and participation in health behaviors depends on perceived health status and category of health behaviors. Researchers can explore the role of other variables (e.g., functional status and perceived susceptibility to disease) to explain why perceived health status moderates the relations between critical thinking and participation in various types of health behaviors differently.