Michael Stellefson

The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making.

Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review

Background Participatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults. Objective To review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s). Methods A systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles. Results Most interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions. Conclusions There is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with chronic disease.

eHealth Literacy and Web 2.0 Health Information Seeking Behaviors Among Baby Boomers and Older Adults

Background Baby boomers and older adults, a subset of the population at high risk for chronic disease, social isolation, and poor health outcomes, are increasingly utilizing the Internet and social media (Web 2.0) to locate and evaluate health information. However, among these older populations, little is known about what factors influence their eHealth literacy and use of Web 2.0 for health information. Objective The intent of the study was to explore the extent to which sociodemographic, social determinants, and electronic device use influences eHealth literacy and use of Web 2.0 for health information among baby boomers and older adults. Methods A random sample of baby boomers and older adults (n=283, mean 67.46 years, SD 9.98) participated in a cross-sectional, telephone survey that included the eHealth literacy scale (eHEALS) and items from the Health Information National Trends Survey (HINTS) assessing electronic device use and use of Web 2.0 for health information. An independent samples t test compared eHealth literacy among users and non-users of Web 2.0 for health information. Multiple linear and logistic regression analyses were conducted to determine associations between sociodemographic, social determinants, and electronic device use on self-reported eHealth literacy and use of Web 2.0 for seeking and sharing health information. Results Almost 90% of older Web 2.0 users (90/101, 89.1%) reported using popular Web 2.0 websites, such as Facebook and Twitter, to find and share health information. Respondents reporting use of Web 2.0 reported greater eHealth literacy (mean 30.38, SD 5.45, n=101) than those who did not use Web 2.0 (mean 28.31, SD 5.79, n=182), t 217.60=−2.98, P=.003. Younger age (b=−0.10), more education (b=0.48), and use of more electronic devices (b=1.26) were significantly associated with greater eHealth literacy (R 2 =.17, R 2adj =.14, F9,229=5.277, P<.001). Women were nearly three times more likely than men to use Web 2.0 for health information (OR 2.63, Wald= 8.09, df=1, P=.004). Finally, more education predicted greater use of Web 2.0 for health information, with college graduates (OR 2.57, Wald= 3.86, df =1, P=.049) and post graduates (OR 7.105, Wald= 4.278, df=1, P=.04) nearly 2 to 7 times more likely than non-high school graduates to use Web 2.0 for health information. Conclusions Being younger and possessing more education was associated with greater eHealth literacy among baby boomers and older adults. Females and those highly educated, particularly at the post graduate level, reported greater use of Web 2.0 for health information. More in-depth surveys and interviews among more diverse groups of baby boomers and older adult populations will likely yield a better understanding regarding how current Web-based health information seeking and sharing behaviors influence health-related decision making.

eHealth Literacy Among College Students: A Systematic Review With Implications for eHealth Education

Background eHealth literacy refers to the ability of individuals to seek, find, understand, and appraise health information from electronic resources and apply such knowledge to addressing or solving a health problem. While the current generation of college students has access to a multitude of health information on the Internet, access alone does not ensure that students are skilled at conducting Internet searches for health information. Ensuring that college students have the knowledge and skills necessary to conduct advanced eHealth searches is an important responsibility particularly for the medical education community. It is unclear if college students, especially those in the medical and health professions, need customized eHealth literacy training for finding, interpreting, and evaluating health- and medical-related information available on the Internet. Objective The objective of our review was to summarize and critically evaluate the evidence from existing research on eHealth literacy levels among college students between the ages of 17 and 26 years attending various 4-year colleges and universities located around the world. Methods We conducted a systematic literature review on numerous scholarly databases using various combinations of relevant search terms and Boolean operators. The records were screened and assessed for inclusion in the review based on preestablished criteria. Findings from each study that met inclusion criteria were synthesized and summarized into emergent themes. Results In the final review we analyzed 6 peer-reviewed articles and 1 doctoral dissertation that satisfied the inclusion criteria. The number of participants in each reviewed study varied widely (from 34 to 5030). The representativeness of the results from smaller studies is questionable. All studies measured knowledge and/or behaviors related to college student ability to locate, use, and evaluate eHealth information. These studies indicated that many college students lack eHealth literacy skills, suggesting that there is significant room for improvement in college students’ ability to obtain and evaluate eHealth information. Conclusion Although college students are highly connected to, and feel comfortable with, using the Internet to find health information, their eHealth literacy skills are generally sub par. College students, especially in the health and medical professions, would be well served to receive more customized college-level instruction that improves general eHealth literacy.

A systematic review of studies comparing body image concerns among female college athletes and non-athletes, 1997–2012

Research prior to 2001 indicated that athletes experienced better body image than non-athletes, with no differences among sport types. Since then, female athletes have become increasingly sexually objectified in the media, and the sociocultural beauty ideal has shifted to emphasize appearing both athletic and thin. Part I of this paper explores the literature describing these changes. Part II presents a systematic and comprehensive literature review of 10 recent studies comparing body image concerns (BIC) among collegiate female athletes and non-athletes to identify the current status of BIC in female athletes. Findings indicate that involvement in collegiate athletics provides some protection from BIC; however, this protection appears attenuated for athletes in more feminine sports (e.g., gymnastics), and higher level athletes (Division I). Researchers should examine how sociocultural pressures unrelated to competition predict female athletes BIC using measures that focus on objectification, positive body image, body functionality, and thin- and athletic-ideal internalization.

Advantages and Limitations of the e-Delphi Technique: Implications for Health Education Researchers

Abstract In the last 30 years, the application of the Delphi technique has been increasing. With the recent availability and established popularity of Internet-based research tools, the Internet has been identified as a means for mitigating Delphi limitations, maximizing its advantages, and expanding the breadth of its application. The discourse on the application of “e-Delphi” has been speculative in nature, however, with pragmatic analysis of Internet-based Delphi administration being limited in scope. Concomitantly, methodological guidance for conducting the e-Delphi in health education is limited, with best-practice implementation strategies yet to emerge. This paper advances the understanding of the e-Delphi technique, contributes to the evolution of this Internet-based research methodology, and provides guidance for the e-Delphi researcher in health education. Further, it offers a contribution to the discourse about Internet-based inquiry generally, and on using the e-Delphi technique in health education specifically. The authors illustrate that e-Delphi has a range of benefits that are effective and efficient in assuaging traditional Delphi limitations; nevertheless, a set of methodological issues remain unaddressed and make apparent the need for future research investments to better understand and alleviate challenges presented for e-Delphi research in health education.

The impact of pregaming on subsequent blood alcohol concentrations: an event-level analysis.

Pregaming has been highlighted as an especially deleterious college drinking ritual. The present study assessed (a) event-level associations between pregaming and biologic samples of blood alcohol concentration (BrAC) and (b) the impact of ones alcohol-related behaviors (measured by AUDIT-C scores) on the likelihood that respondents would report pregaming prior to a night out drinking. The sample included adult (n=1029; collegiate and non-college-affiliated) bar patrons in a southeastern college community. Multiple and linear regressions were conducted to determine the association between pregaming and BrAC levels, and pregaming and the presence of an alcohol use disorder, respectively. After controlling for the influence of time of data collection, gender, age, college student status, and ethnicity, the linear regression model explained 15.5% (R2=.155) of the variance in BrAC levels (F (10, 915)=16.838, p<0.001), of which 10.8% was accounted for by self-reported pregaming alone. Furthermore, pregamers exhibited significantly higher BrACs compared to non-pregamers (β=.332, p<.001). Logistic regression analyses indicated that AUDIT-C scores were the only significant predictor of pregaming status (OR=1.305, Wald=64.843), such that respondents with higher AUDIT-C scores (B=0.266) were more likely to pregame. This event-level study highlights the practice of pregaming as an insidious behavior associated with enhanced levels of drinking behavior and overall intoxication.

Internet-Based Delphi Research: Case Based Discussion

The interactive capacity of the Internet offers benefits that are intimately linked with contemporary research innovation in the natural resource and environmental studies domains. However, e-research methodologies, such as the e-Delphi technique, have yet to undergo critical review. This study advances methodological discourse on the e-Delphi technique by critically assessing an e-Delphi case study. The analysis suggests that the benefits of using e-Delphi are noteworthy but the authors acknowledge that researchers are likely to face challenges that could potentially compromise research validity and reliability. To ensure that these issues are sufficiently considered when planning and designing an e-Delphi, important facets of the technique are discussed and recommendations are offered to help the environmental researcher avoid potential pitfalls associated with coordinating e-Delphi research.

Evaluating the psychometric properties of the AUDIT-C among college students

Abstract Aims: Despite the various settings and diverse populations in which the utility of the AUDIT-C has been examined, college students have remained conspicuously absent from the vast majority of these studies. We evaluated the psychometric properties of the AUDIT-C with a sample of college student bar patrons. Methods: Intercept interviews were used to recruit currently enrolled college students (nu2009=u2009347) exiting bars. A brief face-to-face interview assessed demographic data, alcohol-related behaviors (AUDIT-C), and breath alcohol concentration (BrAC). AUDIT-C responses were subjected to a principal component analysis. BrAC was used as a measure of concurrent validity against two distinct gender-based AUDIT-C cut-off scores. Results: All AUDIT-C items loaded on a single factor, accounting for 68% of total variance. Pearson’s product–moment correlation coefficients between BrAC and both hazardous drinking AUDIT-C cut-offs (ru2009=u20090.32; ru2009=u20090.38) were statistically significant (pu2009<u20090.001). Moreover, those meeting each hazardous drinking gender-based criteria exhibited significantly higher (pu2009<u20090.001) BrAC readings than those not meeting these criteria. Effect sizes for these group differences were considerable (Cohen’s du2009>u20090.70). Reliability and stability statistics indicated strong internal consistency. Conclusions: Results reported herein highlight the sound psychometric qualities of the AUDIT-C and its ability to produce valid and reliable scores among college students.

Analysis of eHealth Search Perspectives Among Female College Students in the Health Professions Using Q Methodology

Background The current “Millennial Generation” of college students majoring in the health professions has unprecedented access to the Internet. Although some research has been initiated among medical professionals to investigate the cognitive basis for health information searches on the Internet, little is known about Internet search practices among health and medical professional students. Objective To systematically identify health professional college student perspectives of personal eHealth search practices. Methods Q methodology was used to examine subjective perspectives regarding personal eHealth search practices among allied health students majoring in a health education degree program. Thirteen (n = 13) undergraduate students were interviewed about their attitudes and experiences conducting eHealth searches. From the interviews, 36 statements were used in a structured ranking task to identify clusters and determine which specific perceptions of eHealth search practices discriminated students into different groups. Scores on an objective measure of eHealth literacy were used to help categorize participant perspectives. Results Q-technique factor analysis of the rankings identified 3 clusters of respondents with differing views on eHealth searches that generally coincided with participants’ objective eHealth literacy scores. The proficient resourceful students (pattern/structure coefficient range 0.56-0.80) described themselves as using multiple resources to obtain eHealth information, as opposed to simply relying on Internet search engines. The intermediate reluctant students (pattern/structure coefficient range 0.75-0.90) reported engaging only Internet search engines to locate eHealth information, citing undeveloped evaluation skills when considering sources of information located on the Internet. Both groups of advanced students reported not knowing how to use Boolean operators to conduct Internet health searches. The basic hubristic students (pattern/structure coefficient range 0.54-0.76) described themselves as independent procrastinators when searching for eHealth information. Interestingly, basic hubristic students represented the only cluster of participants to describe themselves as (1) having received instruction on using the Internet to conduct eHealth searches, and (2) possessing relative confidence when completing a search task. Conclusions Subjective perspectives of eHealth search practices differed among students possessing different levels of eHealth literacy. These multiple perspectives present both challenges and opportunities for empowering college students in the health professions to use the Internet to obtain and appraise evidence-based health information using the Internet.