Marcia M. Worley

Osteoporosis Health Beliefs and Self-Care Behaviors: An Exploratory Investigation

OBJECTIVES (1) To determine whether women could be segmented into meaningful subgroups with similar profiles of osteoporosis health beliefs; (2) to explore associations among osteoporosis belief profiles and calcium/vitamin D and soy supplement use. The associations between group membership and three other self-care behaviors (cigarette smoking, weight-bearing exercise, and limiting alcohol intake) that may influence bone health also were explored. DESIGN Cross-sectional study. SETTING Minnesota. PARTICIPANTS 990 community-dwelling women aged 45 and older living in Minnesota. INTERVENTIONS Mailed survey. MAIN OUTCOME MEASURES Measures of osteoporosis health beliefs and proportions of respondents using calcium/vitamin D supplements, soy-containing products, smoking cigarettes, exercising fewer than three times weekly, and drinking alcohol more than three times weekly. RESULTS Cluster analysis revealed three distinct subgroups of respondents. Members of the first believed they were susceptible to osteoporosis and perceived many benefits and few barriers to using calcium or soy supplements. Women comprising the second group believed they were susceptible to osteoporosis and that its consequences were serious, but also perceived significant barriers and few benefits associated with calcium or soy supplements. Members of the third group perceived a lack of susceptibility to osteoporosis, strong general health beliefs, and had few opinions regarding calcium or soy supplement use. Members of group 1 were most likely to use calcium/vitamin D supplements. Women comprising groups 1 and 3 were more likely than those in group 2 to use soy supplements. CONCLUSION Women can be segmented into groups based upon osteoporosis belief profiles. These profiles are associated significantly with calcium and soy supplement use, as well as other self-care behaviors that may have an effect on bone health. Pharmacists could use this information to tailor interventions in this population.

A thematic analysis for how patients, prescribers, experts, and patient advocates view the prescription choice process.

BACKGROUND Typically, patients are unaware of the cost consequences regarding prescribing decisions during their clinical encounter and rarely talk with their physicians about costs of prescription drugs. Prescription medications that are deemed by patients to be too costly when the costs become known after purchase are discontinued or used at suboptimal doses compared to prescription medications that are deemed to be worth the cost. OBJECTIVES To learn more about the prescription choice process from several viewpoints, the purpose of this study was to uncover and describe how patients, prescribers, experts, and patient advocates view the prescription choice process. METHODS Data were collected via 9 focus group interviews held between April 24 and July 31, 2007 (3 with patients, 3 with prescribers, 2 with experts, and 1 with patient advocates). The interviews were audiotaped and transcribed. The resulting text was analyzed in a descriptive and interpretive manner. Theme extraction was based on convergence and external divergence; that is, identified themes were internally consistent but distinct from one and another. To ensure quality and credibility of analysis, multiple analysts and multiple methods were used to provide a quality check on selective perception and blind interpretive bias that could occur through a single person doing all of the analysis or through employment of a single method. RESULTS The findings revealed 5 overall themes related to the prescription choice process: (1) information, (2) relationship, (3) patient variation, (4) practitioner variation, and (5) role expectations. The results showed that patients, prescribers, experts, and patient advocates viewed the themes within differing contexts. CONCLUSIONS It appears that the prescription choice process entails an interplay among information, relationship, patient variation, practitioner variation, and role expectations, with each viewed within different contexts by individuals engaged in such decision making.

PDP or MA-PD? Medicare part D enrollment decisions in CMS Region 25

BACKGROUND The Medicare Prescription Drug Improvement and Modernization Act of 2003 provides outpatient prescription drug coverage for Medicare beneficiaries through private insurers. This coverage is available through 2 primary venues: stand-alone prescription drug plans (PDPs) and integrated managed care (or Medicare Advantage) plans that also provide prescription drug coverage (MA-PDs). OBJECTIVES The first objective was to describe factors associated with Medicare beneficiaries choosing to enroll in any Medicare part D PDP. The second objective was to describe factors associated with the choice of an MA-PD, given enrollment in the part D program. METHODS The study used a cross-sectional, survey design. Data were collected from a stratified random sample of 5000 community-dwelling adults, aged 65 years and older in the Center for Medicaid and Medicare Services Region 25. Data were collected by means of a mailed questionnaire. Data analyses included univariate and bivariate descriptive statistics and multivariate probit modeling. RESULTS The overall adjusted response rate was 50.2% (2309 of 4603). Data from 1490 respondents (32.4% of those attempted) were analyzed in this study. Nearly 75% of sample members elected to enroll in one of the Medicare part D coverage options in 2007, with more than 3 times as many choosing a PDP compared with a MA-PD option (57.2% vs 17.8%). A variety of variables including rurality, plan price, perceived future need for medications, and preferences emerged as important predictors of choosing to enroll in any Medicare part D drug plan, whereas rurality, state of residence, and number of diagnosed medical conditions were associated with the decision to enroll in a MA-PD. CONCLUSIONS Models of health insurance demand and plan choice applied in this context appear to be modestly effective. Rurality and state of residence were particularly important contributors to both of these decisions, as were a variety of individual characteristics.

The social network paradigm and applications in pharmacy

BACKGROUND There have been calls for research to include contextual and macrolevel factors within explanatory models of human health. A network approach focuses on the influence of relationships to predict behavior. OBJECTIVES The first objective was to describe the social network paradigm based in sociology that uses network principles and methods to visualize, quantify, and predict outcomes using the structure and function of relationships. The second objective was to discuss applications of this approach in the context of health to guide future research in pharmacy. METHODS This was a descriptive overview of conceptual models, methods, measures, and analyses that are used in the social network paradigm. RESULTS The social network paradigm contains conceptual models that rely on relational and structural assumptions to make predictions related to human behavior. Although there is not 1 dominate theory of social networks, several models hold across applications and are commonly used by scholars. The methodology emphasized considerations of network boundaries, sampling strategies, and the type of data collected. Specific variables used in social network analysis were defined and dichotomized into constructs of centrality and cohesion. Network analysis was described in terms of available computational programs, data management, and statistical testing. Related research in health care was applied and ideas for pharmacy were proposed using a social network-based theoretical model. CONCLUSIONS There is growing momentum for health behaviorists to gain familiarity for studying the effect of social networks on behavior. Applications in pharmacy using social network models, methods, and analysis can be used as a stand-alone perspective or in conjunction with other theoretical perspectives in an effort to explain human health or organizational behavior in health care settings.