Heather L. Stuckey

The Connection Between Art, Healing, and Public Health: A Review of Current Literature

This review explores the relationship between engagement with the creative arts and health outcomes, specifically the health effects of music engagement, visual arts therapy, movement-based creative expression, and expressive writing. Although there is evidence that art-based interventions are effective in reducing adverse physiological and psychological outcomes, the extent to which these interventions enhance health status is largely unknown. Our hope is to establish a foundation for continued investigation into this subject and to generate further interest in researching the complexities of engagement with the arts and health.

Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross‐national benchmarking of diabetes‐related psychosocial outcomes for people with diabetes

The second Diabetes Attitudes, Wishes and Needs (DAWN2) study aimed to assess psychosocial outcomes in people with diabetes across countries for benchmarking.

A Silent Response to the Obesity Epidemic Decline in US Physician Weight Counseling

Background:Guidelines recommend that physicians screen all adults for obesity and offer an intensive counseling and behavioral interventions for weight loss for obese adults. Current trends of weight-related counseling are unknown in the setting of the US obesity epidemic. Objectives:To describe primary care physician (PCP) weight-related counseling, comparing counseling rates in 1995–1996 and 2007–2008. Research Design:Data analysis of outpatient PCP visits in 1995–1996 and 2007–2008, as reported in the National Ambulatory Medical Care Survey. Subjects:A total of 32,519 adult primary care visits with PCPs. Measures:Rates of counseling for weight, diet, exercise, and a composite variable, weight-related counseling (defined as counseling for weight, diet, or exercise) between survey years. Adjusted analyses controlled for patient and visit characteristics. Results:Weight counseling declined from 7.8% of visits in 1995–1996 to 6.2% of visits in 2007–2008 [adjusted odds ratios, 0.64; 95% confidence intervals, 0.53, 0.79]. Rates of receipt of diet, exercise, and weight-related counseling similarly declined. Greater declines in odds of weight-counseling receipt were observed among those with hypertension (47%), diabetes (59%), and obesity (41%), patients who stand the most to gain from losing weight. Conclusions:Rates of weight counseling in primary care have significantly declined despite increased rates of overweight and obesity in the United States. Further, these declines are even more marked in patients with obesity and weight-related comorbidities, despite expectations to provide such care by both patients and policymakers. These findings have implications for determining deliverable, novel ways to engage PCPs in addressing the obesity epidemic.

Practices Associated with Weight Loss Versus Weight-Loss Maintenance Results of a National Survey

BACKGROUND Few studies have examined the weight-control practices that promote weight loss and weight-loss maintenance in the same sample. PURPOSE To examine whether the weight control practices associated with weight loss differ from those associated with weight-loss maintenance. METHODS Cross-sectional survey of a random sample of 1165 U.S. adults. The adjusted associations of the use of 36 weight-control practices in the past week with success in weight loss (≥10% lost in the past year) and success in weight-loss maintenance (≥10% lost and maintained for ≥1 year) were examined. RESULTS Of the 36 practices, only 8 (22%) were associated with both weight loss and weight-loss maintenance. Overall, there was poor agreement (kappa=0.22) between the practices associated with weight loss and/or weight-loss maintenance. For example, those who reported more often following a consistent exercise routine or eating plenty of low-fat sources of protein were 1.97 (95% CI=1.33, 2.94) and 1.76 (95% CI=1.25, 2.50) times more likely, respectively, to report weight-loss maintenance but not weight loss. Alternatively, those who reported more often doing different kinds of exercises or planning meals ahead of time were 2.56 (95% CI=1.44, 4.55) and 1.68 (95% CI=1.03, 2.74) times more likely, respectively, to report weight loss but not weight-loss maintenance. CONCLUSIONS Successful weight loss and weight-loss maintenance may require two different sets of practices. Designing interventions with this premise may inform the design of more effective weight-loss maintenance interventions.

The Diabetes Attitudes, Wishes and Needs Second Study

Study A. Holt RIG, Nicolucci A, Burns KK, et al., on behalf of the DAWN2 Study Group. Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national comparisons on barriers and resources for optimal care—healthcare professional perspective. Diabet Med 2013;30:789–798. Study B. Nicolucci A, Burns KK, Holt RIG, et al., on behalf of the DAWN2 Study Group. Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med 2013;30:767–777. Study C. Burns KK, Nicolucci A, Holt RIG, et al., on behalf of the DAWN2 Study Group. Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national benchmarking indicators for family members living with people with diabetes. Diabet Med 2013;30:778–788. Study D. Peyrot M, Egede LE, Campos C, et al. Ethnic differences in psychological outcomes among people with diabetes: USA results from the second Diabetes Attitudes, Wishes and Needs (DAWN2) study. Curr Med Res Opin 2014, 1–14. Epub ahead of print (DOI: 10.11485/03007995.2014.947023). Objectives. The overall purpose of the Diabetes Attitudes, Wishes and Needs second study (DAWN2) was to build on the findings of the original DAWN study (1), determine progress made in achieving the needed actions identified by DAWN stakeholders, and explore new methods and strategies for improving diabetes care (2). The primary objective of DAWN2 was to assess current diabetes care and self-management among people with diabetes (PWDs), family members (FMs), and health care professionals (HCPs) and to elucidate determinants of effective treatment and self-management of diabetes (2). Secondary objectives included establishing national benchmarks for health status, quality of life, self-care, and access to diabetes self-management education and support (DSME/S); assessing access to, and use and benefit of, support from health care teams, family and friends, communities, and society; identifying and understanding the most important facilitators and barriers to person-centered care; …

Using Positive Deviance for Determining Successful Weight-Control Practices

Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3x/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight.

Personal Accounts of the Negative and Adaptive Psychosocial Experiences of People With Diabetes in the Second Diabetes Attitudes, Wishes and Needs (DAWN2) Study

OBJECTIVE To identify the psychosocial experiences of diabetes, including negative accounts of diabetes and adaptive ways of coping from the perspective of the person with diabetes. RESEARCH DESIGN AND METHODS Participants were 8,596 adults (1,368 with type 1 diabetes and 7,228 with type 2 diabetes) in the second Diabetes Attitudes, Wishes and Needs (DAWN2) study. Qualitative data were responses to open-ended survey questions about successes, challenges, and wishes for improvement in living with diabetes and about impactful experiences. Emergent coding developed with multinational collaborators identified thematic content about psychosocial aspects. The κ measure of interrater reliability was 0.72. RESULTS Analysis identified two negative psychosocial themes: 1) anxiety/fear, worry about hypoglycemia and complications of diabetes, depression, and negative moods/hopelessness and 2) discrimination at work and public misunderstanding about diabetes. Two psychosocial themes demonstrated adaptive ways of coping with diabetes: 1) having a positive outlook and sense of resilience in the midst of having diabetes and 2) receiving psychosocial support through caring and compassionate family, friends, health care professionals, and other people with diabetes. CONCLUSIONS The personal accounts give insight into the psychosocial experiences and coping strategies of people with diabetes and can inform efforts to meet those needs and capitalize on strengths.

The Role of Creative Expression in Diabetes: An Exploration Into the Meaning-Making Process

In this narrative exploration of meaning making through the use of creative arts, we recorded the experiences of 8 women with type 1 diabetes. Through a conceptual framework of creative expression as a way of knowing, we designed this study to evoke affective and metaphorical connections to the meaning of diabetes. The initial narrative interview findings reflected the experience of the participants, with three primary themes emerging: experiencing negative emotions about diabetes, putting a positive “spin” on the negative as a way to make meaning, and resisting against diabetes and the medical approach. During the creative arts process, we encouraged further exploration into the meaning-making process using imagery and photographs created by the participants. Final interview findings addressed the need for moving beyond numbers, and attention to the meaning-making process in patient care.

Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool

OBJECTIVE To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period. DESIGN Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation. SETTING University-based, tertiary-care hospital. PARTICIPANTS Internal medicine resident physicians admitting patients from the emergency department. INTERVENTION An electronic handoff tool (eSignout) utilizing automated paging communication and responsibility acceptance without mandatory verbal communication between emergency department and medicine ward providers. MAIN OUTCOME MEASURES (i) Incidence of reported near misses/adverse events, (ii) communication of key clinical information and quality of verbal communication and (iii) characterization of near misses/adverse events. RESULTS Seventy-eight of 80 surveys (98%) and 1058 of 1388 surveys (76%) were completed before and after eSignout implementation. Compared with pre-intervention, residents in the post-intervention period reported similar number of shifts with a near miss/adverse event (10.3 vs. 7.8%; P = 0.27), similar communication of key clinical information, and improved verbal signout quality, when it occurred. Compared with the former process requiring mandatory verbal communication, 93% believed the eSignout was more efficient and 61% preferred the eSignout. Patient safety issues related to perceived sufficiency/accuracy of diagnosis, treatment or disposition, and information quality. CONCLUSIONS The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs.

An arts-based intervention at a nursing home to improve medical students' attitudes toward persons with dementia.

Purpose Emerging data suggest that students’ attitudes toward older patients may be positively affected by geriatric experiences that are not clinically based, but no known interventions have used creative arts to integrate humanistic experiences into medical student geriatric education. This 2012 study evaluated whether participating in TimeSlips, a creative group-based storytelling program involving persons with dementia, improved medical students’ attitudes toward such patients. Method The authors administered the Dementia Attitudes Scale (DAS) to 22 fourth-year medical students to evaluate the mean change in their self-reported attitudes toward persons with dementia. The authors used paired t tests or Wilcoxon signed-rank tests to analyze pre- and post-program scores on the individual items of the DAS, on the subdomains of “comfort” and “knowledge,” and on the overall scale. They used Cronbach alpha to evaluate the internal consistency and reliability of the “comfort” and “knowledge” subdomains and of the overall scale. Results Medical students’ attitudes, as measured by the significantly higher scores on 12 of the 20 items, on each of the two subdomains, and on the overall scale, showed improvement after the TimeSlips sessions. The DAS showed acceptable to good internal consistency on both subdomains and on the overall scale both pre and post session; however, the internal consistency analysis is preliminary because of small sample size. Conclusions The authors’ findings provide preliminary evidence that participation in a creative storytelling program at a nursing home improves medical students’ attitudes toward persons with dementia and adds to evidence supporting the reliability of the DAS.