Lynne A. Sturm

Competencies for psychology practice in primary care.

This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

Literature review of human papillomavirus vaccine acceptability among women over 26 years

Vaccines for the human papillomavirus (HPV) are currently licensed for females, ages 9 through 26 years old in the U.S., and for adult women up to 45 years in some countries such as Australia. As licensure for adult women, over 26 years, is sought in other countries, it will be important to determine the acceptability to them. We reviewed the available articles on adult opinions and acceptability of vaccinating women against HPV. Predictors of acceptability included barriers, knowledge, risk, age, and marital status. Overall, acceptability rates were high, if adequate information was given and the cost was affordable.

The Role of Herd Immunity in Parents’ Decision to Vaccinate Children: A Systematic Review

BACKGROUND AND OBJECTIVE: Herd immunity is an important benefit of childhood immunization, but it is unknown if the concept of benefit to others influences parents’ decisions to immunize their children. Our objective was to determine if the concept of “benefit to others” has been found in the literature to influence parents’ motivation for childhood immunization. METHODS: We systematically searched Medline through October 2010 for articles on parental/guardian decision-making regarding child immunization. Studies were included if they presented original work, elicited responses from parents/guardians of children <18 years old, and addressed vaccinating children for the benefit of others. RESULTS: The search yielded 5876 titles; 91 articles were identified for full review. Twenty-nine studies met inclusion criteria. Seventeen studies identified benefit to others as 1 among several motivating factors for immunization by using interviews or focus groups. Nine studies included the concept of benefit to others in surveys but did not rank its relative importance. In 3 studies, the importance of benefit to others was ranked relative to other motivating factors. One to six percent of parents ranked benefit to others as their primary reason to vaccinate their children, and 37% of parents ranked benefit to others as their second most important factor in decision-making. CONCLUSIONS: There appears to be some parental willingness to immunize children for the benefit of others, but its relative importance as a motivator is largely unknown. Further work is needed to explore this concept as a possible motivational tool for increasing childhood immunization uptake.

Adult Women's Attitudes Toward the HPV Vaccine

AIMS Two human papillomavirus (HPV) vaccines have demonstrated efficacy in preventing HPV infection and are currently being administered to adolescent girls in several countries. Although the most efficient HPV prevention strategy is immunizing adolescents before there is any risk of exposure, adult women also may benefit from vaccination. This study aimed to explore the attitudes of women aged 27-55 years toward the HPV vaccine. METHODS Thirty-eight women were recruited from a university-based gynecological practice, completed a demographic questionnaire, and then were interviewed. RESULTS Most participants had heard about the vaccine and were positive about the HPV vaccine for adult women. Women advocated universal access to this vaccine, indicating that all women should have the option. They assessed their risk level in several ways, including level of monogamy, relationship status, previous sexual risk behaviors, history of an abnormal Pap smear, and family history. All but 2 woman described barriers to vaccination, including cost, side effects, and hassle factors. Most women did not believe the vaccine would change risk behaviors. CONCLUSIONS The women from this convenience sample knew the HPV vaccine existed and in general found it acceptable. If an HPV vaccine becomes available to adult women, healthcare professionals will be faced with the challenge of providing accurate information, being sensitive and willing to help each individual woman make a decision, and being creative when developing new ways to eliminate barriers to getting the vaccine.

The effects of vaccine characteristics on adult women's attitudes about vaccination: a conjoint analysis study.

The number of current and future vaccines for adults has been steadily increasing. Yet, vaccine coverage rates for adult vaccinations have historically been low, and less is known about how adults in the mid-adult age range make vaccine decisions for themselves. The purpose of this study was to assess which vaccine characteristics affect vaccine decision-making among mid-adult women. Adult women, aged 27-55 (n=258) rated 9 hypothetical vaccine scenarios, each of which was defined along 4 dimensions: mode of transmission (STI or non-STI), severity of infection (curable, chronic, or fatal), vaccine efficacy (50%, 70%, or 90%), and availability of behavioral methods for prevention (available or not available). Ratings ranged from 0 to 100. Conjoint analysis was used to assess the effect of relative preferences for the vaccine scenario characteristics on participant ratings of scenarios. The mean vaccine scenario rating was 78.2. Nearly half (40%, n=104) of participants rated all nine scenarios the same, with the majority of those (84%) holding strongly positive views. Conjoint analysis of the other 154 participants who discriminated between scenarios indicated that the main drivers for vaccine acceptability were severity of the disease and the efficacy of the vaccine to prevent the disease. Mode of transmission and availability of a preventative behavioral measure did not play a significant role. Future studies should further assess how womens understanding of severity of the disease and efficacy of the vaccine to prevent disease may be useful for increasing vaccine acceptability.

Use of Drawings to Explore U.S. Women's Perspectives on Why People Might Decline HIV Testing

The purpose of this research is to explore through drawings and verbal descriptions womens perspectives about reasons why persons might decline human immunodeficiency virus (HIV) testing. We asked 30 participants to draw a person that would NOT get tested for HIV and then explain drawings. Using qualitative content analysis, we extracted seven themes. We found apprehension about knowing the result of an HIV test to be the most commonly identified theme in womens explanations of those who would not get tested. This technique was well received and its use is extended to HIV issues.

REFLECTION IN HOME VISITING: THE WHAT, WHY, AND A BEGINNING STEP TOWARD HOW

The work of home visitors in early childhood fields may include addressing many challenges to achieving curricular outcomes, including issues such as maintaining boundaries and managing ones own reactions to children, parents, and overall family situations. Increasingly, reflective supervision and consultation are recognized as a way for workers in home-visiting early intervention and early care fields to address these personal and professional challenges and build competence (Watson, Gatti, Cox, Harrison, & Hennes, ). The features of home visiting that make reflective supervision/consultation essential are discussed. Next, results of a pilot project in which a sample of Part C early intervention providers respond to a vignette portraying a challenging parent-child interaction are briefly presented and discussed. Despite often stating the importance of relationships, participants did not identify concrete methods of supporting relationship or demonstrate recognition of parallel process. In addition, providers seldom endorsed the use of reflective skills such as observing, listening, wondering, or reflecting (Weatherston, ), and no providers discussed a need for reflective supervision/consultation. We suggest that these findings illustrate some of the areas in which early intervention home visitors could benefit from participation in reflective supervision/consultation to move from identifying reflective skills as important to actually being able to use such skills in their work with families.

Community Partners as Co-Teachers in Resident Continuity Clinics

Standard approaches to teaching the management of psychosocial issues in pediatrics—visits to community-based organizations and stand-alone block rotations in developmental–behavioral pediatrics and community pediatrics—neither expose residents to models of interdisciplinary collaboration between faculty preceptors and community providers nor take advantage of the efficacy of learning in continuity clinics. The authors describe their project, developed from an existing Community Pediatrics Training Initiative with long-standing relationships with a domestic violence shelter, a community center for Latino families, and a special needs resource organization for parents. They lay out in detail the projects innovative use of partners from community-based organizations, colocated within pediatric continuity clinics, who teach both residents and faculty about community resources and linkages with multidisciplinary providers. The authors present lessons learned by faculty preceptors, residents, the community partners, and project staff that can guide future applications of this model in other residency training programs. Faculty and residents indicated an increased awareness of available community resources and how linkages can be incorporated into pediatric outpatient visits. Community partners identified keys to successful co-teaching, including readiness to adopt an assertive communication style and frequent presence in the clinics. Project staff recognized the challenges of staff turnover at community-based organizations and the need to choose community partners with expertise that fits the sociodemographic issues of the clinics patients.

Predictors of influenza vaccination in the U.S. among children 9–13 years of age

BACKGROUND AND OBJECTIVES U.S. estimates of seasonal influenza (flu) vaccine uptake in 2014-2015 were 62% for 5-12year olds, dropping to 47% for 13-17year olds. The Healthy People 2020 goal for these age groups is 80%. It is important to understand factors associated with influenza vaccination, especially for those ages where rates begin to decline. The objective of this study was to identify factors associated with influenza vaccination acceptance in 9-13year old children. METHODS An online U.S. survey of mothers of children aged 9-13 assessed childrens influenza vaccine uptake in the previous season, healthcare utilization, sociodemographics, and vaccine attitudes. Multivariable logistic regression identified independent predictors of influenza vaccine status. RESULTS There were 2363 respondents (Mean age=38years old). Referent children were 57% female and 66% non-minority race/ethnicity with a mean age of 10.6years. By maternal report, 59% of children had received an influenza vaccine in the previous season. Predictors of influenza vaccine uptake included a recommendation or strong recommendation from a health care provider, seeing a health care provider in the past year, positive attitudes regarding the influenza vaccine, and being a minority race. Child gender, age, insurance coverage, and whether the child had a regular healthcare provider were not associated with influenza vaccine uptake (p=n.s.). CONCLUSIONS This sample reported overall rates of influenza vaccine uptake similar to national surveillance data, but still lower than national goals. Provider recommendations along with health attitudes and seeing a health care provider were associated with vaccine uptake. Promising interventions may include more directive physician messaging for influenza vaccine uptake in youth, encouraging more regular well-child visits during the adolescent years, and promoting influenza vaccination at alternative sites.

Parent-adolescent concordance in reports of sexuality-related behaviors and attitudes

Conclusions: In contrast to prior studies these parents and adolescents were largely concordant in their reports of adolescent sexual intercourse. This finding may be a function of the sample (parents accompanying adolescent to medical appointments). Nonetheless it suggests that parental report in the context of health care visits may be quite reliable. In contrast to this high concordance there was low agreement between parent-adolescent pairs in terms of worries about future STD risk and anticipated reactions to STD acquisition. Health care providers may be in a unique position to help facilitate better communication about these issues between parent and adolescent. may be an effective way of increasing parent child communication about health sexuality and values. Enhancing parents’ ability to communicate their expectations and values about sexuality may help support children in making healthy decisions about sexual behavior as adolescents. (excerpt)