James D. Campbell

Determining Relationships Between Physical Health and Spiritual Experience, Religious Practices, and Congregational Support in a Heterogeneous Medical Sample

Previous research indicates that increased religiosity/spirituality is related to better health, but the specific nature of these relationships is unclear. The purpose of this study was to determine the relationships between physical health and spiritual belief, religious practices, and congregational support using the Brief Multidimensional Measure of Religiousness/Spirituality and the Medical Outcomes Scale Shortform-36. A total of 168 participants were surveyed with the following medical disorders: Cancer, Spinal Cord Injury, Traumatic Brain Injury, and Stroke, plus a healthy sample from a primary care setting. The results show that individuals with chronic medical conditions do not automatically turn to religious and spiritual resources following onset of their disorder. Physical health is positively related to frequency of attendance at religious services, which may be related to better health leading to increased ability to attend services. In addition, spiritual belief in a loving, higher power, and a positive worldview are associated with better health, consistent with psychoneuroimmunological models of health. Practical implications for health care providers are discussed.

Patients' views about discussing spiritual issues with primary care physicians

Objectives: The authors sought to explore patients’ views about discussing spiritual issues with primary care physicians, including perceived barriers to and facilitators of discussions. Methods: The study was a qualitative, semistructured interview of 10 chronically or terminally ill patients who were deliberately selected to represent a range of demographic factors (religious background, age, sex). We coded each interview and evaluated interviews for themes through content analysis. Results: Themes included rationale for addressing spiritual issues; prerequisites for these discussions; roles in spiritual discussions; principles of spiritual assessment; and barriers to and facilitators of spiritual discussions. Patients justified spiritual assessment on the basis of importance of spirituality in life and health. They asserted that patients must feel honored and respected by their physician to risk discussing spiritual issues. They affirmed that physicians are helpful when legitimizing their spiritual concerns. Citing physicians’ neglect of spirituality as a barrier, they affirmed that spiritual assessment in the context of other life issues facilitates spiritual discussions. Conclusions: Patients’ willingness to discuss spiritual issues may depend on their sense of physicians’ respect for their spiritual views, attitudes about spiritual health, and qualities of openness and approachability.

Collaborative practice and provider styles of delivering health care

The delivery of primary health care involves complex interactive communication between the provider and patient. Describing the manner or style of this communication is important to more completely understand the delivery of primary health care. The purpose of this study was to examine providers style of interaction with the patient and to compare the styles of nurse practitioners and physicians in joint practice. A total of 412 provider/patient clinic visits including 276 with physicians and 136 with nurse practitioners were videotaped and analyzed using a content-based interactive analysis system. Five provider style dimension indices were constructed including affiliation, control, somatic, psychosocial, and information indices. The results of this study show that the development of a content-based interactional analysis system which focuses on clinician activities can be useful in describing important aspects of the provider/patient encounter. Overall, there was little difference between nurse practitioner and physician style of interaction. Nurse practitioners, however, exhibited significantly more concern with psychosocial issues than physicians. Type of visit and visit history were also factors associated with provider style. Using the style dimension indices constructed for this study a typology of provider styles was developed.

Concordant Spiritual Orientations as a Factor in Physician--Patient Spiritual Discussions: A Qualitative Study

Objectives: To understand the impact of physicians’ and patients’ religious/spiritual orientation on discussions of spiritual issues. Methods: We performed semi-structured interviews of 10 Missouri family physicians and 10 patients of these physicians, selecting subjects nonrandomly to represent a range of demographic factors, practice types, and chronic or terminal illness. We coded and evaluated transcribed interviews for themes. Results: Respondents expressed that similar belief systems facilitate patient–physician spiritual interactions and bring confidence to their relationships. Those holding dissimilar faiths noted limited ability to address spiritual questions directly. They cited significant barriers to spiritual interaction but considered that ecumenism, use of patient-centered care, and negotiation skills lessen these barriers. Conclusions: Our respondents view spirituality similarly to other aspects of the physician–patient relationship involving differing viewpoints. Where discordance exists, cross-cultural, patient-centered, diplomatic approaches facilitate spiritual discussions.

Introducing Computer-Based Telemedicine in Three Rural Missouri Counties

This study investigated predictors of utilization of the computer-based telemedicine in three rural Missouri counties. Participating health care agencies were given computers and access to an Internet-based workstation that provided e-mail and World Wide Web (WWW) services. Utilization data for e-mail messages sent and WWW pages accessed were collected through proxy servers. A survey was distributed to those employees who are enrolled in the Rural Telemedicine Evaluation Project (RTEP), which addressed perceptions of the Internet-based RTEP workstation. The results of the survey were analyzed to see how perceptions and demographic variables predicted actual utilization. The findings of the study revealed that for e-mail, behavioral intentions/attitude, age, organizational support, and time were the most significant predictors. For WWW, only the behavioral intentions/attitude subscale predicted utilization. The majority of respondents did not utilize the e-mail technology. Strategies need to be developed through training interventions and organizational policies to address non-utilization.

The Influence of Patriarchal Behavior on Birth Control Access and Use Among Recent Hispanic Immigrants

It is commonly assumed that Hispanic immigrants in the United States subscribe to a patriarchal ideology that keeps women subordinated to men, often through violence and exploitative reproductive behaviors. If this assumption is true, we might expect to find that in the Hispanic culture patriarchal males control decision-making about access to and use of birth control. Structured interviews of 100 Hispanic men and 100 Hispanic women who were recent immigrants to a Midwest community were conducted to examine this assumption. Results did not support this assumption among this study population. We found no patriarchal ideology supporting women’s subordination to men, violence as a mechanism of control, reproduction as a way of exploitation, or cultural influences discouraging access to and use of birth control in the Hispanic community. Rather, these immigrants revealed adequate knowledge of birth control use and positive perceptions of gender equality. Gaining a better understanding of the limited influence of patriarchal ideology on the use of birth control and family planning services among this Hispanic community may inform the development of family planning services tailored for new Hispanic immigrants.

Internet by proxy: how rural physicians use the Internet

This study investigated utilization of computer-based telemedicine in three rural Missouri counties. Participating health care agencies were given computers and access to an Internet-based workstation that provided e-mail and World Wide Web (WWW) services. Ten rural practices from three Missouri counties were profiled. Utilization data for e-mail messages sent and received, along with the number of WWW pages accessed, were collected through a proxy server. Results showed that most physicians received more messages than they sent and utilized the WWW more than they did e-mail. Moreover, physicians connected to a tertiary care center and who currently use extenders in their practice are more likely to use Internet technology, even if it is through a proxy user such as a nurse practitioner or office staff.

The social pregnancy interaction model: conceptualizing cognitive, social and cultural barriers to prenatal care

Although prenatal care appears to improve perinatal outcome, many women fail to seek care. Research has established the importance of removing structural barriers for women by improving financial access, establishing providers of care, and providing transportation. Such steps are essential, but not sufficient to ensure that all women receive adequate prenatal care. Individual experiences, attitudes, beliefs, social setting, and culture are important in the decision to seek prenatal care. Most research on these nonstructural barriers to prenatal care, however, has been limited by the use of inadequate instruments and retrospective and cross-sectional collection of data. More importantly, this field of inquiry lacks a comprehensive theoretical framework to guide its research agenda. In this paper, we propose the social pregnancy interaction model (SPIM), a theoretical model for predicting the utilization of prenatal care which incorporates the theory of reasoned action and the concept of social pregnancy from symbolic interaction theory. The SPIM illustrates that a womans decision to initiate prenatal care occurs within a social, cultural, and historical context that depends on social interpretations. If validated, this model has the potential to increase our understanding of the process of initiating prenatal care, to provide much greater predictive power in anticipating the use of prenatal care, and to facilitate the development and evaluation of effective approaches to increase the early utilization and continuation of prenatal care in a variety of cultural, social, and economic settings. The model also may be useful for studying other issues surrounding pregnancy such as family planning, contraceptive behavior, infertility, and elective abortion. We conclude by framing a research agenda and posing a series of research questions that emerge from this model.