Lauren Penwell-Waines

Student perspectives on sexual health: implications for interprofessional education

Abstract Interprofessional collaboration requires that health professionals think holistically about presenting concerns, particularly for multimodal problems like sexual dysfunction. However, health professions students appear to receive relatively little sexual health education, and generally none is offered on an interprofessional basis. To assess current degree of interprofessional thinking in sexual health care, 472 health professions students in Georgia, United States, were presented with a sexual dysfunction vignette and asked to rate the relevance of, and their familiarity with, interventions offered by several professionals. They also were asked to identify the most likely cause of the sexual dysfunction. Students rated relevance and familiarity with interventions as highest for physicians and lowest for dentists, with higher ratings of nurses by nursing students. More advanced students reported greater familiarity with mental health, physician, and physical therapy interventions. Finally, nursing students were less likely to attribute the dysfunction to a physical cause. These findings indicate that students may prioritize biomedical approaches in their initial assessment and may need additional supports to consider the spectrum of biopsychosocial factors contributing to sexual functioning. To encourage interprofessional critical thinking and prepare students for interprofessional care, sexual health curricula may be improved with the inclusion of interprofessional training. Specific recommendations for curriculum development are offered.

Perceptions of caregiver distress, health behaviors, and provider health-promoting communication and their relationship to stress management in MS caregivers

Abstract This study applied the Stress/Health Model to examine a novel approach for promoting stress management among 67 caregivers of persons with multiple sclerosis, who often face unique caregiving challenges. Hierarchical regressions indicated that caregiver distress (i.e., emotional burden) and engagement in other health-promoting activities (i.e., controlling alcohol use) were the best predictors of caregiver stress management. Communication with the MS care recipient’s health provider about caregiver engagement in health-promoting activities was associated with caregiver stress management, but not significantly more so than explained by the other factors (i.e., caregiver distress and engagement in health-promoting behaviors). A more controlled study would be indicated to further explain how to encourage, within the medical setting, caregiver engagement in self-care activities.

Developing a measure to assess identity reconstruction in patients with multiple sclerosis

Purpose/Objective: To develop and test initial validation of a theory-driven quantitative measure of identity reconstruction in patients with multiple sclerosis (MS) based upon previous qualitative research. Research Method/Design: This study uses a cross-sectional survey design, in which 137 patients living with MS were recruited from an outpatient MS Center in the Southeastern U.S. Participants completed demographic items, Identity Reconstruction Assessment Scales (IRAS), Patient Determined Disease Steps, Medical Outcomes Study Measures of Patient Adherence, Chronic Disease Self-Efficacy Scale, Hospital Anxiety and Depression Scale, Leeds MS Quality of Life Questionnaire, MS-Related Stigma Scale, and Posttraumatic Growth Inventory—Short Form. Results: The IRAS conformed to a 3-factor solution consisting of 23 items accounting for 42.6% of the variance. The 3 factors, labeled as “sustained identity” (&agr; = .84), “reactionary identity” (&agr; = .74), and “integrated identity” (&agr; = .65), were not significantly correlated with each other, necessitating and allowing for independent scoring of the scales. Higher scores on “sustained identity” scale were associated with less anxiety, depression, perceived disability, and MS-related stigma, as well as with increased self-efficacy, treatment adherence, and quality of life. “Reactionary identity” scale was positively correlated with anxiety and MS-related stigma. “Integrated identity” was significantly associated with age and perceived disability. Conclusions/Implications: Identity reconstruction provides needed context for understanding adjustment to and living with MS. Examination of the IRAS within a larger sample and in other disease groups can provide additional construct validity evidence.

Attitudes Toward HIV Among Health Professions Students in the Southeastern United States: Implications for Interprofessional Education

INTRODUCTION The Southeastern United States is disproportionately affected by HIV, and unfavorable attitudes toward HIV among healthcare providers in these communities can negatively impact persons living with HIV (PLWH). Moreover, attitudinal differences between providers impede collaboration in interdisciplinary HIV treatment teams and can have detrimental effects on patient care. Identifying attitudinal differences during health professions training and student characteristics associated with those differences may help narrow these gaps by revealing potential areas for improving education. METHODS Health professions students in nursing, allied health, medical, mental health, and dental training programs in Georgia (n = 475) completed measures of attitudes toward HIV and patient care for PLWH, and measures of personal and educational characteristics including religiosity, attitudes toward lesbian, gay, bisexual, and transgender (LGBT) patients, and clinical and classroom experiences relevant to sexual health. RESULTS Beliefs about disclosing patients’ HIV status without consent, concerns about the effects of working with PLWH on students’ health, and perceptions of adequacy of HIV education differed across disciplines. Several personal and educational factors were correlated with students’ attitudes (e.g., having positive attitudes toward LGBT patients, more patient contact hours relevant to sexual health). CONCLUSION Addressing HIV-related concepts in health professions training (e.g., exposure to patients with sexual health concerns or who are LGBT) could improve attitudes about HIV and patient care. Interprofessional clinical and classroom opportunities, where students with varied personal and educational backgrounds can learn from and with each other about HIV, also could improve student attitudes and interdisciplinary collaboration in HIV clinical care. Received: 12/26/2013 Accepted: 03/19/2013 Published: 04/22/2014

Testing the health promotion model for adherence and quality of life in individuals with multiple sclerosis

Abstract The nature of multiple sclerosis (MS) presents challenges to health-promoting behaviors (e.g. adherence) and quality of life. The Health Promotion Model (HPM) proposes that these outcomes are explained by individual characteristics (i.e. biological, social, psychological) and behavior-specific cognitions (e.g. self-efficacy). The current study sought to test the HPM in explaining self-reported adherence and MS quality of life among 121 MS patients receiving care in an MS clinic in the southeastern United States. Hierarchical regression models partially supported the HPM for adherence (R2 = .27) and more fully for quality of life (QoL) (R2 = .64). Depression and stigma were among the variables most strongly related to both adherence and QoL; contrary to HPM theory, self-efficacy was not significantly related to adherence but was to QoL. Thus, the HPM may help to guide strategies used to improve QoL among individuals living with MS; however, the model may need further refinement to be used with adherence.