H.W. van den Borne

Openness to discuss cancer in the nuclear family: scale, development, and validation.

Objective To describe the development and validation of a scale for assessing openness to discuss cancer in the family. Method: Two studies were conducted. Study 1 was a cross-sectional study designed to test the factor structure of the scale. Four hundred ninety-eight patients with either breast cancer or Hodgkins disease were interviewed. In Study 2, a longitudinal study, 133 patients with cancer in the head and neck were tested at four points in time: just before treatment, 6 weeks, 13 weeks, and 52 weeks after treatment. Study 2 aimed to confirm the factor structure established in Study 1, to test for construct validity in a new population, to test the psychometric properties of the Openness Scale, and to test the scales sensitivity to change. Results: In Study 1, a one-factor solution was revealed, resulting in a scale of eight items. In Study 2, the factor structure found in Study 1 was confirmed. In line with theoretical expectations, subjects who perceived their communication about cancer as more open showed more positive rehabilitation outcomes especially at 13 weeks after treatment (less uncertainty, fewer negative feelings, more control, higher self-esteem, fewer psychological and physical complaints). Furthermore, more open communication related with more support by family members and more discussion with the partner. The scale was found to be stable over time. Conclusions: The scales construction and subsequent analysis show that open discussion of problems (related to cancer) in the family can be measured reliably with an eight-item instrument. Additional validation of the scale is indicated.

The patient from receiver of information to informed decision-maker

Abstract In this article the change of paradigm currently taking place within the field of patient education is indicated. In this change of paradigm the patient is increasingly being seen as responsible for his own health or recovery and as someone who makes independent choices in this respect. This has consequences for the role the patient is given in decisions on individuals care. The consequences of current developments within the Dutch society and in medical techniques as these relate to the need for patient education are enlightened. Some of the main topics for patient education are mentioned and the effects of patient education as established through meta-analyses are summarised. A planning model for a systematic development of patient education interventions is recommended. Relevant topics for research on patient education in the Netherlands are indicated.

Psychosocial correlates of cancer relapse and survival: a literature review.

This article reviews literature on the psychosocial correlates of cancer relapse and survival from 1979 through 1995. The factors studied were structured according to a theoretical model of coping with cancer. Reviewed studies have shown that factors most frequently evaluated were depression, anxiety, hopelessness/helplessness, hostility, marital status and social involvement. Mainly inconsistent results were found. The strongest evidence for a relationship between psychosocial variables and prognosis was found for social involvement/social support; in 7 of 15 studies a positive relationship was demonstrated, while no negative associations were found. Coping styles e.g., fighting spirit and stoic acceptance, and severe/stressful life events were found to have no conclusive influence on the length of survival. Important determinants of the coping model, such as uncertainty and information given by the specialist were not studied as possible predictors of survival and/or relapse free period. Among the factors that showed no correlation at all was multidimensional health locus of control. For the inconsistent findings, a considerable number of methodologic shortcomings with respect to study design, sample size, measure and statistical analysis are enumerated.

Health care seeking behaviour of patients with sexually transmitted diseases: determinants of delay behaviour

The study aimed to determine the factors associated with a delay in seeking health care for symptoms of sexually transmitted diseases (STDs) among a sample of 1482 patients attending STD clinics. Of the sample 78% were male, 58% sought help from the clinic within the first 6 days of noticing symptoms, 24% waited between 7 and 10 days and 17% waited longer than 10 days before seeking health care. Patients who delayed were those who treated themselves prior to seeking health care, who were female, whose friends waited before seeking treatment, who held misconceptions regarding the cause of STDs, who perceived STDs not to be serious and who valued personal autonomy in sexual behaviours less and had less positive outcome expectations of refusing sex. The data suggest that targeted interventions should be directed specifically at women and the youth. Early health care seeking could be facilitated through improved basic knowledge regarding STDs, control over ones own sexual behaviour and social support for early health care seeking.

Psychosocial problems, coping strategies, and the need for information of parents of children with Prader–Willi syndrome and Angelman syndrome

The aim of the present study was to identify the psychosocial problems of parents of a child with Prader-Willi syndrome or a child with Angelman syndrome. In addition, the strategies these parents apply to cope with these problems as well as their need for information are described. To assess these topics, parents filled in a self-report questionnaire. Both parent groups were found to have a high need for information, high feelings of loss of control, relatively high depressive feelings, particularly in mothers in both syndrome groups. Differences due to the type of syndrome were found on the fear factor. Parents of a child with Angelman syndrome had greater feelings of fear for the negative consequences for themselves, whereas parents of Prader-Willi children were more concerned about the consequences for the child. In general, coping strategies were not found to be different between the parent groups of children who had either type of syndrome.

Condom use promotion among isiXhosa speaking women living with HIV in the Western Cape Province, South Africa: a pilot study

Abstract The prevalence of HIV infection continues to increase among women in South Africa while there are few interventions specifically targeting condom use promotion in this population. We report the results of an experimental pilot study of a health education intervention aimed at enhancing coping skills and consistent condom use among HIV-positive women attending primary health clinics in the Western Cape province of South Africa. One hundred and twenty women were randomised into the intervention condition or a control condition. Both groups completed an interviewer administered questionnaire that included measures of self-esteem, attitude towards condom use, and self-efficacy towards condom use and negotiating condom use, and provided vaginal swab specimen at baseline and three months after the intervention. Tests for intervention effects at three months while controlling for baseline revealed that only self-esteem was significantly higher in the intervention group relative to the control group. No significant differences were found on measures of coping skills and condom use behaviour. Importantly, incidence for Chlamydia Trachomatis, Neisseria Gonorrhea and Trichomona vaginalis during the study period were significantly lower in the intervention group than the control group. These results are strong indications that this intervention could serve as a basis for the development of potentially effective interventions to reduce STI-related sexual risk behaviours among HIV-positive black women in South Africa.

Cancer patients' personality characteristics, physician-patient communication and adoption of the Moerman diet☆

Breast cancer patients and patients with Hodgkins disease (N = 663) were contacted initially by medical specialists at 15 medical centers across The Netherlands and subsequently 498 of them were interviewed in their homes in order to examine interactions between their personality characteristics, their assessment of the adequacy of information feedback from their physicians about their illness, its treatment and prognosis, and their adoption of an unproven diet remedy. The data indicate that patients who believed they had received insufficient and unclear information were more likely to be adopters of the Moerman diet than patients who believed the information was adequate. Personality moderator analyses indicated further that the relationship between information adequacy and diet adoption held specifically for those patients with high trait anxiety, low self-esteem, angry-aggressive coping styles or impulsive attitudes. The discussion focused on rational and irrational elements in physician-patient communications, the strategies available to physicians to improve their communication skills, the desirability of constructing and distributing educational and informational materials for use by patients, and the need for physicians to offer their patients an opportunity for contact with companions in distress.

Correlates of grief among older adults caring for children and grandchildren as a consequence of HIV and AIDS in South Africa

Objectives: Over the past few years, older people have become the main caregivers for their sick adult children and orphaned grandchildren due to HIV/AIDS in South Africa. This article aims to investigate the scope of care provided by older people, with a specific focus on the experience of grief due to multiple losses and its correlates. Methods: Quantitative interviews were conducted among 820 isiXhosa speaking caregivers of 60 years and older in the Eastern Cape of South Africa. Results: Older persons are involved in a wide range of care activities with several dependents to care for. Grief among older adults is most strongly predicted by perceived stigma around HIV and AIDS and worries about providing the care. Discussion: This study provides insight into correlates of grief among older caregivers and results in useful information to inform the development of interventions to assist older persons in coping with their responsibilities as caregivers.

Exposures to war-related traumatic events and post-traumatic stress disorder symptoms among displaced Darfuri female university students: an exploratory study

BackgroundWith the deaths of hundreds of thousands and the displacement of up to three million Darfuris, the increasingly complex and on-going war in Darfur has warranted the need to investigate war-related severity and current mental health levels amongst its civilian population. The purpose of this study is to explore the association between war-related exposures and assess post-traumatic stress disorder (PTSD) symptoms amongst a sample of Darfuri female university students at Ahfad University for Women (AUW) in Omdurman city.MethodsAn exploratory cross-sectional study among a representative sample of Darfuri female university students at AUW (N = 123) was conducted in February 2010. Using an adapted version of the Harvard Trauma Questionnaire (HTQ), war-related exposures and post-traumatic stress disorder (PTSD) symptoms were assessed. Means and standard deviations illustrated the experiential severity of war exposure dimensions and PTSD symptom sub-scales, while Pearson correlations tested for the strength of association between dimensions of war exposures and PTSD symptom sub-scales.ResultsApproximately 42 % of the Darfuri participants reported being displaced and 54 % have experienced war-related traumatic exposures either as victims or as witnesses (M = 28, SD = 14.24, range 0 – 40 events). Also, there was a strong association between the experiential dimension of war-related trauma exposures and the full symptom of PTSD. Moreover, the refugee-specific self-perception of functioning sub-scale within the PTSD measurement scored a mean of 3.2 (SD = .56), well above the 2.0 cut-off.ConclusionsThis study provides evidence for a relationship between traumatic war-related exposures and symptom rates of PTSD among AUW Darfuri female students. Findings are discussed in terms of AUW counseling service improvement.

Explaining perceived ability among older people to provide care as a result of HIV and AIDS in South Africa

Abstract In South Africa, older people have become the primary caregivers of children and grandchildren infected or affected by HIV and AIDS. This study explores the determinants of the perceived ability to care for children and grandchildren in the domains of providing nursing care, communicating with (grand) children, generating income and to relax. Structured one-on-one interviews were conducted among 409 isiXhosa speaking older people in two sites in the Eastern Cape Province of South Africa. Results showed that perceived ability among older people to provide nursing care was primarily dependent on the level of knowledge on accessing grants and personal norm towards providing care. Perceived ability to communicate effectively with children and grandchildren was most strongly predicted by a positive attitude towards communication and perceived ability to provide income was influenced by a more negative attitude towards people living with HIV or AIDS. Perceived ability to relax was dependent on more negative attitudes towards communication, lower perceived responsibility to provide income and a higher perceived behaviour control over providing nursing care. The findings of this study add relevant information to understanding the psychosocial context in which older people provide HIV and AIDS related care and support the development of targeted programmes to assist older people in their role as caregiver.