LaShara A. Davis

Utilization of Internet Technology by Low-Income Adults: The Role of Health Literacy, Health Numeracy, and Computer Assistance

Objectives: To examine whether low-income adults’ utilization of Internet technology is predicted or mediated by health literacy, health numeracy, and computer assistance. Method: Low-income adults (N = 131) from the midwestern United States were surveyed about their technology access and use. Results: Individuals with low health literacy skills were less likely to use Internet technology (e.g., email, search engines, and online health information seeking), and those with low health numeracy skills were less likely to have access to Internet technology (e.g., computers and cell phones). Consistent with past research, males, older participants, and those with less education were less likely to search for health information online. The relationship between age and online health information seeking was mediated by participant literacy. Discussion: The present study suggests that significant advances in technology access and use could be sparked by developing technology interfaces that are accessible to individuals with limited literacy skills.

Entertainment (Mis)Education: The Framing of Organ Donation in Entertainment Television

Researchers and practitioners who have sought to understand public reluctance to donating organs in spite of favorable attitudes toward organ donation have long thought that belief in myths about donation contribute to the problem. How these myths emerged and more important, why they have persisted in spite of national education campaigns is not clear. In the absence of direct personal experience with organ donation or transplantation, we believe that most people receive their information about donation through the media. In this study, we identify all entertainment television shows with organ donation storylines or subplots broadcast on ABC, NBC, CBS, and FOX from 2004–2005. Frame analysis reveals 2 competing metaframes: the moral corruption of the powerful and organ donors are good people. In addition to the metaframes, 4 secondary frames, and 6 tertiary frames are identified. Organ donation is framed in mostly negative terms, with a few notable exceptions. Recommendations for how to address negative framing of organ donation in the media are offered.

Including Limitations in News Coverage of Cancer Research: Effects of News Hedging on Fatalism, Medical Skepticism, Patient Trust, and Backlash

Past research has demonstrated that news coverage of cancer research, and scientific research generally, rarely contains discourse-based hedging, including caveats, limitations, and uncertainties. In a multiple message experiment (k = 4 news stories, N = 1082), the authors examined whether hedging shaped the perceptions of news consumers. The results revealed that participants were significantly less fatalistic about cancer (p = .039) and marginally less prone to nutritional backlash (p = .056) after exposure to hedged articles. Participants exposed to articles mentioning a second researcher (unaffiliated with the present study) exhibited greater trust in medical professions (p = .001). The findings provide additional support for the inclusion of discourse-based hedging in cancer news coverage and suggest that news consumers will use scientific uncertainty in illness representations.

Dispositional Cancer Worry: Convergent, Divergent, and Predictive Validity of Existing Scales

Past research has suggested that dispositional cancer worry may be a key predictor of health behavior. The current study examined seven measures of dispositional cancer worry to see if they were significantly related (convergent validity), significantly different from similar but distinct traits (divergent validity), and capable of predicting cancer-relevant outcomes (predictive validity). Four hundred and eighty nine undergraduate students completed a survey measuring dispositional worry, dispositional cancer worry, and perceived cancer risk. Factor analysis identified four underlying dimensions that explained 67.3% of the variance in dispositional cancer worry: severity (42.8%), frequency (12.3%), psychological reactance (6.9%), and worry impact (5.3%). Four existing measures of dispositional cancer worry were found to represent each of these dimensions. In general, dispositional cancer worry measures were highly correlated with one another and only moderately correlated with measures of dispositional worry, supporting strong convergent and divergent validity. Hierarchical regression analyses revealed that dispositional cancer worry measures predicted significant variance in cancer-relevant outcomes above and beyond dispositional worry. The results of the current study support the notion that dispositional cancer worry and dispositional worry are distinct constructs. Furthermore, two dimensions of dispositional cancer worry (severity and frequency) seemed to have the strongest convergent, divergent, and predictive validity.

The Effectiveness of High- and Low-Intensity Worksite Campaigns to Promote Organ Donation: The Workplace Partnership for Life

This study describes a worksite project designed to promote organ donation while testing the effectiveness of low-intensity (media-only) campaigns compared to high intensity campaigns (media+interpersonal communication), which incorporated on-site visits. All campaigns lasted 10 weeks. A total of 45 companies participated in the project, 15 in each quasi-experimental condition. Companies were counterbalanced by size of organization and industry type. Compared to the control condition, high-intensity worksite campaigns led to a six-percentage point increase in signed donor registrations while low-intensity campaigns led to a three-percentage-point increase. Both forms of worksite campaigns led to increases in attitudes, knowledge and perceived subjective norms from pretest to posttest when compared to control sites. At the same time, worksite campaigns served to significantly reduce individual-level barriers shown to be related to donation, such as medical mistrust and desire to maintain bodily integrity.

Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant.

BackgroundBecause of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients’ knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention.Methods/DesignNine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients’ transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach.DiscussionAt the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings.Trial registrationClinicalTrials.gov, number NCT02181114.

Perceived Visual Informativeness (PVI): Construct and Scale Development to Assess Visual Information in Printed Materials

There is a paucity of research on the visual images used in health communication messages and campaign materials. Even though many studies suggest further investigation of these visual messages and their features, few studies provide specific constructs or assessment tools for evaluating the characteristics of visual messages in health communication contexts. The authors conducted 2 studies to validate a measure of perceived visual informativeness (PVI), a message construct assessing visual messages presenting statistical or indexical information. In Study 1, a 7-item scale was created that demonstrated good internal reliability (α = .91), as well as convergent and divergent validity with related message constructs such as perceived message quality, perceived informativeness, and perceived attractiveness. PVI also converged with a preference for visual learning but was unrelated to a persons actual vision ability. In addition, PVI exhibited concurrent validity with a number of important constructs including perceived message effectiveness, decisional satisfaction, and three key public health theory behavior predictors: perceived benefits, perceived barriers, and self-efficacy. Study 2 provided more evidence that PVI is an internally reliable measure and demonstrates that PVI is a modifiable message feature that can be tested in future experimental work. PVI provides an initial step to assist in the evaluation and testing of visual messages in campaign and intervention materials promoting informed decision making and behavior change.

The Foreign Language Anxiety in a Medical Office Scale: Developing and Validating a Measurement Tool for Spanish-Speaking Individuals

Communication research has been hindered by a lack of validated measures for Latino populations. To develop and validate a foreign language anxiety in a medical office scale (the Foreign Language Anxiety in a Medical Office Scale [FLAMOS]), the authors conducted a survey of low income, primarily Spanish-speaking Latinos (N = 100). The scale factored into a unidimensional construct and showed high reliability (α = .92). The Foreign Language Anxiety in a Medical Office Scale also demonstrated convergent and divergent validity compared with other communication anxiety scales (Personal Report of Communication Apprehension–24, Communication Anxiety Inventory, and Recipient Apprehension Test), and predictive validity for acculturation measures (the Short Acculturation Scale for Hispanics). The Foreign Language Anxiety in a Medical Office Scale provides a validated measure for researchers and may help to explain Latino health care communication barriers.

The conceptualization and measurement of cognitive health sophistication.

This article develops a conceptualization and measure of cognitive health sophistication—the complexity of an individuals conceptual knowledge about health. Study 1 provides initial validity evidence for the measure—the Healthy-Unhealthy Other Instrument—by showing its association with other cognitive health constructs indicative of higher health sophistication. Study 2 presents data from a sample of low-income adults to provide evidence that the measure does not depend heavily on health-related vocabulary or ethnicity. Results from both studies suggest that the Healthy-Unhealthy Other Instrument can be used to capture variability in the sophistication or complexity of an individuals health-related schematic structures on the basis of responses to two simple open-ended questions. Methodological advantages of the Healthy-Unhealthy Other Instrument and suggestions for future research are highlighted in the discussion.