Emily M. Cramer

A two-way text-messaging system answering health questions for low-income pregnant women

OBJECTIVE The purpose of the study was to gauge the effectiveness of a low-cost, automated, two-way text-messaging system to distribute pregnancy and health-related information to low-income expectant women. METHODS In total, 20 participants were recruited for a one-month intervention involving the use of cell phones to text pregnancy-related questions to the system. Participants received either a direct answer or encouragement to seek answers from health care providers. Pre- and post-tests as well as a focus group at the end of the intervention were conducted. RESULTS Participants uniformly found the system easy to use and accessible. Using the system increased levels of perceived pregnancy-related knowledge and facilitated patient-provider communication. Moreover, participants reported significant reductions in stress and depression and improved mental health after using the system. The system responded to most known questions quickly and accurately, and also encountered many new topics and linguistic expressions. CONCLUSION Overall, the data indicated that the text messaging system offered psychological benefits and promoted health communication by providing health information and encouraging patient-provider communication. PRACTICE IMPLICATIONS An automated, two-way text messaging system is an efficient, cost-effective, and acceptable method for providing health information to low-income pregnant women.

Information Needs, Seeking Behaviors, and Support Among Low-Income Expectant Women

Previous studies have consistently found associations between low income and infant health outcomes. Moreover, although health information-seeking is a maternal behavior related to improved health outcomes, little is known about the health information-seeking behaviors and information needs of low-income pregnant women. The purpose of the current investigation was to examine the information needs, information-seeking behaviors, and perceived informational support of low-income pregnant women. Accordingly, the study recruited 63 expectant women enrolled in a subsidized prenatal care program in Milwaukee, Wisconsin, during two time periods: March–May 2011 and October–December 2011. Results indicated that participants relied heavily upon interpersonal sources of information, especially family and the father of the baby; rarely used the Internet for health-related information; and desired information beyond infant and maternal health, such as finding jobs and accessing community/government resources. Participants who used family members as primary sources of information also had significantly increased levels of perceived informational support and reduced uncertainty about pregnancy. Our findings have implications for the dissemination of pregnancy-related health information among low-income expectant women.

Information Gathering and Technology Use Among Low-Income Minority Men at Risk for Prostate Cancer

Health communication researchers, public health workers, and health professionals must learn more about the health information-gathering behavior of low-income minority men at risk for prostate cancer in order to share information effectively with the population. In collaboration with the Milwaukee Health Department Men’s Health Referral Network, a total of 90 low-income adult men were recruited to complete a survey gauging information sources, seeking behavior, use of technology, as well as prostate cancer awareness and screening behavior. Results indicated participants primarily relied on health professionals, family, and friends for information about general issues of health as well as prostate cancer. The Internet was the least relied on source of information. A hierarchical regression indicated interpersonal information sources such as family or friends to be the only significant predictor enhancing prostate cancer awareness, controlling for other sources of information. Prostate screening behaviors were predicted by reliance on not only medical professionals but also the Internet. Practical implications of the study are discussed.

The Chaplain Profession from the Employer Perspective: An Analysis of Hospice Chaplain Job Advertisements

Hospitals and hospice organizations who are hiring chaplains to provide spiritual care for terminally ill patients post online job advertisements with specific qualifications and communication skills that applicants should possess. An examination of job advertisements can uncover trends in credentials and responsibilities expected of hospice chaplains. Results of a framework analysis of 71 hospice chaplain job advertisements indicated that 44% of chaplain job advertisements did not require chaplain applicants to have completed clinical pastoral education (CPE) and 41% did not required ordination and/or endorsement from a recognized denomination. Only 37% of hiring organizations required or preferred professional certification. Furthermore, patient support (70%), ambassadorship (54%), team collaboration (52%), and interfaith proficiency (46%) were the communication skills that advertisements tended to emphasize. This article focuses on how the study findings reflect ongoing challenges for the chaplain occupational group on its path to professionalization.

Translating Spiritual Care in the Chaplain Profession

Chaplains provide a much-needed service to patients and families requiring spiritual care in the healthcare setting. Despite evidence documenting improvements quality of life for patients using spiritual services, chaplains experience challenges in translating the benefits they provide into concepts understood by patients, team members, and administrators. A qualitative study using interviews with 19 chaplains found that translation problems occur in three main areas: (a) justifying the role to patients and families, (b) determinations of what constitutes a “productive” employee, and (c) effective collaboration with other members of the health care team. This study outlines several strategies used by chaplains to ease the process of translation, as well as some directions for future research.

Talking about end-of-life preferences in marriage: applying the theory of motivated information management.

The theory of motivated information management (TMIM) provides one framework to examine information-seeking behaviors, especially in conversations involving sensitive or difficult information such as preferences for end-of-life (EOL) care. The spouse plays a significant role in decision making surrounding EOL care. Consequently, individuals need information about spouses’ EOL preferences in order to ensure carrying out those desires. Our findings support the value of TMIM as a framework to understand factors that influence couples’ EOL care information-seeking behaviors. In support of the theory, we provide factors that influence the initiation or avoidance of EOL conversations between spouses.

Assessing Technologies for Information-Seeking on Prostate Cancer Screening by Low-Income Men

Purpose: This paper presents a multipart investigation of the benefits and challenges in deploying automated question-answering as an alternative to web-based searching to provide information about prostate cancer screening for low-income men age 40 years and older. Methods: The study comprised: 1) a survey assessing current use of the Internet, mobile phones and texting; 2) a controlled observational study of both web-based searching and automated question-answering for information about prostate cancer; and 3) a formative field study in which subjects interacted with a health department nurse using text messages. Results: Survey results suggest the target population has greater access to, and familiarity with, cell phones and text messaging compared to the Internet and web-based searching. Participants were significantly more confident using a cell phone and preferred to get health information through text messaging. Participants in the controlled observational study accepted the text messaging system, with most indicating it answered their questions, was easy to use and was a favorable tool for information-seeking. The field study also demonstrated potential for automated question-answering and text messaging to help the target population access health information. Conclusion: A two-way text messaging system has great potential to promote health communication and health information distribution. Participant interest in this system was high and did not seem to be specific to prostate cancer screening, suggesting that information about other topics, such as high blood pressure screening, could be provided similarly. We believe more investigations should be focused on this area, especially on benefits for the low-income community. (J Patient-Centered Res Rev. 2014;1:188-196.)

Communicating Healthy Food Choice

This research examines cultural influence on the preference of promotive (i.e., trying to eat more healthy foods) and preventive (i.e., trying to avoid unhealthy foods) dietary practices. Survey data were collected from students and older adults in Korea (N = 287) and the U.S. (N = 245). Only students participated in the survey in Japan (N = 145). Consistent with the prediction, Study 1 shows Korean mature adults are more willing to adopt preventive dietary practices, while American counterparts favor promotive eating habits. The pattern of the data was inconsistent with the prediction among student participants across the three nations. Individual-level data from Study 2 (N = 284) confirm that independent self-construal affects promotive dietary practice via increasing promotive regulatory self-focus. The indirect impact of interdependent self-construal on preventive dietary practice was less apparent. Practical implications for doctor-patient communication are discussed.