Kathleen S. Crittenden

Effects of health literacy on health status and health service utilization amongst the elderly

Amid increased concerns about the adverse consequences of low health literacy, it remains unclear how health literacy affects health status and health service utilization. With a sample of 489 elderly Medicare patients in a Midwestern city in the USA, we explored the intermediate factors that may link health literacy to health status and utilization of health services such as hospitalization and emergency care. We expected to find that individuals with higher health literacy would have better health status and less frequent use of emergency room and hospital services due to (1) greater disease knowledge, (2) healthier behaviors, (3) greater use of preventive care, and (4) a higher degree of compliance with medication. Using path analysis, we found, however, that health literacy had direct effects on health outcomes and that none of these variables of interest was a significant intermediate factor through which health literacy affected use of hospital services. Our findings suggest that improving health literacy may be an effective strategy to improve health status and to reduce the use of expensive hospital and emergency room services among elderly patients.

Social support and depression among elderly Korean immigrants in the United States.

Based on the integrative concept of social support, we investigated the effects of quantitative, structural, and functional aspects of social relationships on the level of depressive symptoms among elderly Korean immigrants, taking into account their level of acculturation and life stress. Korean elders having more close persons and more frequent contacts with them exhibited fewer depressive symptoms. Networks providing instrumental support consisted mainly of family ties; networks for emotional support included diverse relationships as well as family members. Emotional support was found to moderate the harmful effect of life stress, and thus to be more relevant than instrumental support to the mental health of Korean elderly.

Measuring readiness and motivation to quit smoking among women in public health clinics

We conducted a pilot test of an instrument to assess stage of readiness and level of motivation to change smoking behavior among 495 women smokers in public health clinics. The stages of readiness were based on those proposed by Prochaska and DiClemente but with finer discrimination within the precontemplation stage, where a substantial minority (41%) of the target smokers were situated. Subdividing this earliest group, we found that 8% of the total sample planned no change in smoking ever; 8% were seriously thinking of cutting down; and 25% were seriously thinking of quitting but not within 6 months. Scales in the questionnaire included general motivation to change smoking behavior and confidence in ones ability to do so. The womens scores differed on these scales and on action toward quitting across the five stages of readiness, except that the lowest two groups did not differ on confidence. Pregnancy enhanced readiness to quit. The instrument accommodates the brevity and low literacy requirements for use in these applied settings and is suitable for use in either self-administered questionnaire or interview format.

The measure of stage of readiness to change : Some psychometric considerations

Previous research in the smoking cessation literature has shown that the key component of the transtheoretical model of change, the stage of readiness to change, is a valid independent measure (C. C. DiClemente & J. O. Prochaska, 1985; C. C. DiClemente et al., 1991; W. F. Velicer, J. S. Rossi, J. O. Prochaska, & C. C. DiClemente, 1996). Recently, however, other health service researchers (e.g., A. J. Farkas et al., 1996b) have begun to question the utility of this model; especially its predictive validity (e.g., A. J. Farkas et al., 1996a). However, no research to date has examined the reliability and stability of the stage of readiness to change measure. In this study, the longitudinal measurement of stage of readiness to change was treated as a quasi-simplex model (K. G. Joreskog, 1970). Estimates of the stability and reliability for 261 female smokers in a general community sample were obtained. Results indicate that the stage of change measure has desirable psychometric properties.

Measuring readiness and motivation to quit smoking among women in public health clinics: predictive validity

We conducted an independent pilot test of the internal consistency, stability, and predictive validity of the instrument presented by Crittenden, Manfredi, Lacey, Warnecke, and Parsons (1994) using a two-wave panel of female smokers in 12 public health clinics. This instrument subdivides the precontemplation stage proposed by Prochaska and DiClemente into three more distinct stages: not contemplating quitting or cutting down, not contemplating quitting, and not contemplating quitting within 6 months. Findings confirm that the instrument is useful for evaluating movement toward quitting for populations that are largely concentrated in the precontemplative stage. The concurrent and predictive validity of the elaborated stages and the reliability and stability of smoking motivation and confidence indicate that the instrument is sensitive enough to track changes in readiness and motivation across the full readiness continuum.

The effects of a home-based intervention for young children with intellectual disabilities in Vietnam.

BACKGROUND This study was conducted to examine the impact of a 1-year intervention for children with intellectual disabilities (ID) in Vietnam. METHOD Subjects were 30 preschool-aged children with ID (ages 3 to 6 years). Sixteen were assigned to an intervention group and 14 to a control group. Based on the Portage Curriculum (CESA 5 2003), the intervention trained parents to work with their children through modelling and coaching by teachers during weekly home visits. RESULTS Comparison of pre-, mid- and post-intervention assessments of the children based on the Vineland Adaptive Behavior Scales (Sparrow et al. 1984a) indicated that the intervention was promising: children in the intervention group improved significantly in most domains of adaptive behaviours, and also performed significantly better than the control group in the areas of personal care and motor skills. CONCLUSIONS The results from the Vietnam programme are discussed in terms of its implications and strategies for developing programmes for children with disabilities in developing countries.

Asian Self-Effacement or Feminine Modesty?: Attributional Patterns of Women University Students in Taiwan

This report describes the attributional styles of women university students in Taiwan and compares these patterns to those of men students in Taiwan and women students in the United States. Using a self-presentational perspective on attributions and drawing on data involving audience reactions to attributional accounts in Taiwan and the United States, the author explains the patterns in terms of two sociocultural factors: cultural norms and gender-role stereotypes. Women students in Taiwan are more self-effacing than Taiwan men students and are more external and self-effacing than American women students. They are relatively external because they are Chinese; they are self-effacing and modest because they conform to Chinese cultural values and, more important, to gender-role stereotypes within that culture. Both attributional styles and gender-role stereotypes characterize women as socially responsible and likable but relatively incompetent.

Health Literacy, Social Support, and Health Status Among Older Adults

The study examines whether social support interacts with health literacy in affecting the health status of older adults. Health literacy is assessed using the short version of the Test of Functional Health Literacy in Adults. Social support is measured with the Medical Outcome Study social support scale. Results show, unexpectedly, that rather than buffering the negative effect of low health literacy, social support has a more positive impact on physical health in older adults with high health literacy. Implications for improving the health status of older adults through health literacy and social support are discussed.

A Cross-Cultural Study of Self-Report Depressive Symptoms among College Students

A study of self-report depressive symptoms as measured by the Zung Self-Rating Depression Scale (SDS) was conducted in three Asian countries-Korea, the Philippines, and Taiwan - and in the United States. Mean scores for the 966 college students varied significantly across countries, with Korean students reporting high levels of depressive symptoms. Further, there are marked differences between countries in symptomatic manifestations, even after controlling for between-country differences in response set and overall level of symptoms. Future research addressed to cross-cultural differences in level and manifestations of depression should incorporate (a) research designs that control for identifiable measurement artifacts and (b) triangulation of measurement strategies.

Size of University Classes and Student Evaluations of Teaching.

For 981 undergraduate classes, mean student ratings of instruction decrease with increasing class size. This relationship remains strong when other variables known or believed to influence ratings are held constant.