Linda J. Baumann

Illness representations and matching labels with symptoms.

Three studies are reported that show that health-relevant information (e.g., blood pressure [BP] or symptoms) initiates an active cognitive search process that results in the construction of an illness representation. Study 1 showed that informing subjects that their BP was elevated affected two attributes of illness representation: identity (label and symptoms), and time line or expected chronology of the health threat. Subjects given a high-BP reading reported symptoms commonly associated with high BP, especially if they attributed the high-BP reading to stress. Study 2 showed that the active search process uses causal information (a third attribute of representations) to give meaning to symptoms. Specifically, subjects used environmental cues to interpret whether familiar, unfamiliar, and ambiguous symptoms were due to illness or to stress. In Study 3 we showed that the constructive process, initiated by a high-BP reading, is directed by prior beliefs about the time line for developing high BP and by the presence of external cues about the stressfulness of the subjects daily life. Subjects who believed BP was labile and that they were under high daily stress or who believed BP was stable and that they were under low daily stress reported more symptoms. The significance of these findings for understanding how people process diagnostic labels and symptom information involved in the construction of illness representations is discussed.

Living with a heart transplant: long-term adjustment

Abstract. The number of heart transplants performed worldwide has increased greatly in the past 10 years, and survival rates will continue to improve with the introduction of new immunosuppressive therapies. With this improved lifespan outlook, the experience of living with a heart transplant needs to be understood as a chronic condition. Twenty‐nine recipients who were a minimum of 5 months post‐transplantation (mean 22 months) and 23 significant others were interviewed twice 6 months apart using close‐ended and open‐ended questions developed from the Common Sense Model of health beliefs. Results suggest that although life improved for the majority posttransplantation, recipients continue to experience work problems, financial burdens, family role changes, lifestyle changes, and side effects associated with long‐term drug treatment.

The simultaneous analysis of patient, physician and group practice influences on annual mammography performance

The current study examined the relationship of several variables at the patient (n = 2780), physician (n = 166), and group practice (n = 45) levels for predicting receipt of annual mammography screening. Patient-level variables included constructs from the Triandis Model of Choice; physician-level variables included measures of barriers and receptivity to prevention, as well as demographic information. Hierarchical modeling demonstrated that variables at the patient and physician level reliably predict annual mammography screening, while frequency of screening did not vary across group practices after accounting for patient and physician variables. Patient-level predictors included social norms, perceived consequences and perceived barriers. The only physician-level predictor identified was annual mammography recommendation. These findings add to data which emphasize the importance of public education and social support in health maintenance activities.

Self‐efficacy and Dietary Fat Reduction Behaviors in Obese African‐American and White Mothers

This study examined the influence of weight management and education on five types of fat reduction behaviors mediated through three task‐specific domains of self‐efficacy among young, low‐income obese African‐American and white mothers. It also investigated interaction of race with the relationships between weight management, education, self‐efficacy, and fat reduction behaviors. A sample of obese African‐American and white mothers was recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Wisconsin. Participants reported their weight management status, education, self‐efficacy for eating low‐fat food, and fat reduction behaviors. For both racial groups, weight management status predicted low‐fat food substitution and meat modification behaviors; education predicted meat modification behavior. Three task‐specific domains of self‐efficacy (negative mood, positive mood, and food availability) predicted different types of fat reduction behaviors and differed by race. Weight management influenced behaviors of low‐fat food substitution, meat modification, and fried‐food avoidance, mediated partially through self‐efficacies of negative mood (African Americans), positive mood (African Americans, whites), and food availability (African Americans). Race affected the relationships between weight management, education, three task‐specific domains of self‐efficacy, and five types of fat reduction behaviors. Self‐efficacies operated differentially for African Americans and whites. Thus, strategies to address specific fat reduction behaviors have the potential to be more effective when tailored to specific individual characteristics such as racial background, history of weightmanagement strategies and task‐specific domains of self‐efficacy.

The Effects of Health Information in a Worksite Hypertension Screening Program

Two studies assessed the potential impact of health education messages at worksite blood pressure screenings. The messages sought to: (1) motivate hypertcnsives to enter or return to treatment, (2) motivate normotensivcs to improve health habits and (3) discourage inappropriate use of blood pressure screening by normotensives. A total of 473 participants in the two studies viewed slide/tapc shows about blood pressure and/or health promotion. Individuals with elevated readings at screening viewed either a show containing standard blood pressure information or an experimental show which emphasized the asymptomatic nature of high blood pressure and which described some concrete strategies for coping with high blood pressure. In both studies, individuals with normal readings at screening viewed a standard show or an experimental show which emphasized coping strategies for preventing high blood pressure. In addition, in Study 2, some normotensive individuals viewed one of several experimental shows which focused on health promotion. Results indicate that the experimental programs were significantly more effective than the standard programs in achieving appropriate followup of screening results for both normotensives and hypertensives. Implications for worksite blood pressure screenings are discussed.

Evaluating Feasible and Referable Behavioral Counseling Interventions

The U.S. Preventive Services Task Force (USPTF) recognizes that behaviors have a major impact on health and well-being. Currently, the USPSTF has 11 behavioral counseling intervention (BCI) recommendations. These BCIs can be delivered in a primary care setting or patients can be referred to other clinical or community programs. Unfortunately, many recommended BCIs are infrequently and ineffectually delivered, suggesting that more evidence is needed to understand which BCIs are feasible and referable. In response, the USPSTF convened an expert forum in 2013 to inform the evaluation of BCI feasibility. This manuscript reports on findings from the forum and proposes that researchers use several frameworks to help clinicians and the USPSTF evaluate which BCIs work under usual conditions. A key recommendation for BCI researchers is to use frameworks whose components can support dissemination and implementation efforts. These frameworks include the Template for Intervention Description and Replication (TIDieR), which helps describe the essential components of an intervention, and pragmatic frameworks like Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) or Pragmatic-Explanatory Continuum Indicator Summary (PRECIS), which help to report study design elements and outcomes. These frameworks can both guide the design of more-feasible BCIs and produce clearer feasibility evidence. Critical evidence gaps include a better understanding of which patients will benefit from a BCI, how flexible interventions can be without compromising effectiveness, required clinician expertise, necessary intervention intensity and follow-up, impact of patient and clinician intervention adherence, optimal conditions for BCI delivery, and how new care models will influence BCI feasibility.