Ray Marks

A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part I).

Disability and poor quality of life attributable to chronic diseases such as arthritis, diabetes, and heart disease constitute challenging public health problems for American society. In the absence of any effective cure for these conditions, the secondary prevention of complications and improving quality of life and functional capacity through better disease self-management becomes critical and are key objectives of Healthy People 2010. The organizing focus of such disease self-management should be on improving coping, communication, and control by enhancing self-efficacy. Part I of this two-part article describes the common clinical features of chronic diseases and the diverse disease management strategies used for alleviating pain and preventing disability associated with these and reviews the role of self-efficacy as a theoretical framework for successful self-management interventions. Part II identifies and synthesizes the key research evidence for educational interventions designed to enhance individual self-efficacy perceptions and presents implications for practice in patient education.

Hip fractures among the elderly: causes, consequences and control

This review examines all pertinent literature sources published in the English language between 1966 to the present concerning hip fracture epidemiology, hip fracture injury mechanisms, and hip fracture management strategies. These data reveal hip fractures have several causes, but among these, the impact of falls and muscle weakness, along with low physical activity levels seems to be the most likely explanation for the rising incidence of hip fracture injuries. Related determinants of suboptimal nutrition, drugs that increase fall risk and lower the safety threshold and comorbid conditions of the neuromuscular system may also contribute to hip fracture disability. A number of interventions may help to prevent hip fracture injuries, including, interventions that optimize bone mass and quality, interventions that help prevent falls and falls dampening interventions. Rehabilitation outcomes may be improved by comprehensive interventions, prolonged follow-up strategies and ensuring that all aging adults enjoy optimal health.

Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009.

Hip fractures – which commonly lead to premature death, high rates of morbidity, or reduced life quality – have been the target of a voluminous amount of research for many years. But has the lifetime risk of incurring a hip fracture decreased sufficiently over the last decade or are high numbers of incident cases continuing to prevail, despite a large body of knowledge and a variety of contemporary preventive and refined surgical approaches? This review examines the extensive hip fracture literature published in the English language between 1980 and 2009 concerning hip fracture prevalence trends, and injury mechanisms. It also highlights the contemporary data concerning the personal and economic impact of the injury, plus potentially remediable risk factors underpinning the injury and ensuing disability. The goal was to examine if there is a continuing need to elucidate upon intervention points that might minimize the risk of incurring a hip fracture and its attendant consequences. Based on this information, it appears hip fractures remain a serious global health issue, despite some declines in the incidence rate of hip fractures among some women. Research also shows widespread regional, ethnic and diagnostic variations in hip fracture incidence trends. Key determinants of hip fractures include age, osteoporosis, and falls, but some determinants such as socioeconomic status, have not been well explored. It is concluded that while more research is needed, well-designed primary, secondary, and tertiary preventive efforts applied in both affluent as well as developing countries are desirable to reduce the present and future burden associated with hip fracture injuries. In this context, and in recognition of the considerable variation in manifestation and distribution, as well as risk factors underpinning hip fractures, well-crafted comprehensive, rather than single solutions, are strongly indicated in early rather than late adulthood.

Obesity Profiles with Knee Osteoarthritis: Correlation with Pain, Disability, Disease Progression

Objectives: To identify the prevalence of overweight among community‐dwelling adults diagnosed as having knee osteoarthritis (OA) and the relationship between the weight status of these individuals, selected disease‐related outcomes, and disease progression.

Efficacy theory and its utility in arthritis rehabilitation: review and recommendations

Purpose: Self-efficacy, a cognitive construct implicating ones self-perception about ones performance ability, has been found to be a significant predictor of psychological well-being, adherence to prescribed treatments, and pain coping mechanisms of persons with arthritis. Heightened self-efficacy may also ameliorate arthritis-related symptoms of fatigue and depression, and preserve function and prolong physical wellbeing. Methods: To elaborate upon the utility of self-efficacy enhancing strategies as this pertains to ameliorating arthritisrelated disability, this paper examined the related literature on this topic and detailed the outcomes and nature of those selfefficacy enhancing strategies that have been incorporated into arthritis treatment regimens. Results: Despite limitations in the prevailing database, results indicated: (1) self-efficacy is potentially a potent predictor of the overall health status of the person with arthritis; and (2) carefully designed self-efficacy enhancing strategies are likely to impact favourably upon the magnitude of the disability experienced by individuals with arthritis. Conclusions : In relation to maximizing the therapeutic outcomes for disabling arthritis, the concept of self-efficacy is very worthy of the clinical practitioners and the clinical researchers attention.

Self-efficacy in management of osteoarthritis.

Self-efficacy, a psychologic construct defined as ones confidence in performing a particular behavior, is a significant predictor of psychologic well-being, adherence to prescribed treatments, and pain coping mechanisms in persons who have arthritis. This article reviews the theory of self-efficacy, describes application of self-efficacy to the management of osteoarthritis (OA), and presents approaches to enhancing the patients self-efficacy in management of OA and prevention of OA-related disability.

Relationship between physical activity and general mental health

PURPOSE We investigated the relationship between physical activity and mental health and determined the optimal amount of physical activity associated with better mental health. METHOD Self-reported data from a national random sample of 7674 adult respondents collected during the 2008 U.S. Health Information National Trends 2007 Survey (HINTS) were analyzed in 2012. Mental health was plotted against the number of hours of physical activity per week using a fractional 2-degree polynomial function. Demographic and physical health factors related to poorer mental health were examined. The optimal range of physical activity associated with poorer mental health was examined by age, gender, and physical health. RESULTS A curvilinear association was observed between physical activity and general mental health. The optimal threshold volume for mental health benefits was of 2.5 to 7.5h of weekly physical activity. The associations varied by gender, age, and physical health status. Individuals who engaged in the optimal amount of physical activity were more likely to have reported better mental health (odds ratio=1.39, p=0.006). CONCLUSIONS This study established a hyperbolic dose-response relationship between physical activity and general mental health, with an optimal range of 2.5 to 7.5h of physical activity per week.

Relationships among health literacy, knowledge about hormone therapy, self-efficacy, and decision-making among postmenopausal health.

Little is known about how health literacy affects womens decisions about their menopausal health care. This exploratory study provides a crucial first step in gaining an understanding of the relationship between health literacy and potential factors such as knowledge, self-efficacy, and intent to take hormone therapy among postmenopausal women. Data were collected for 106 participants, age range 45–65, who were attending a family clinic. Participants completed a questionnaire that included questions on hormone therapy knowledge, self-efficacy, behavioral intent concerning hormone therapy, and health literacy as well as demographic data. Inferential statistical tests were used to assess the relationships among health literacy, knowledge, self-efficacy, and behavioral intent concerning hormone therapy. Pearson correlations indicated a positive relationship between both health literacy and knowledge about hormone therapy (r = .64; p ≤ .01) and between health literacy and self-efficacy regarding hormone therapy (r = .69; p ≤ .01). Only two variables, health literacy and self-efficacy, achieved sufficient strength to enter the stepwise regression. Sixty-six percent of the variance for behavioral intent concerning hormone therapy was accounted for by decision self-efficacy, and 9% was accounted for by health literacy (R2 = .75; p < .05). Further research to better understand the relationship between health literacy and self-efficacy and the impact of these factors on actual health outcomes and decision making is likely to have important communication implications for both patients and their providers.

Perceptions of Health Care Provider Communication Activity Among American Cancer Survivors and Adults Without Cancer Histories: An Analysis of the 2003 Health Information Trends Survey (HINTS) Data

Provider communication is an important determinant of health outcomes. We examined the frequency with which five important communication activities were perceived by cancer survivors and adults without a history of cancer to have been performed by their primary care providers. We analyzed data on more than 5,000 adults drawn from the 2003 Health Information National Trends Survey (HINTS), a public dataset of the National Cancer Institute. We analyzed the responses to a question that asked how frequently the respondents primary care provider had performed the following communication activities in the past 12 months: (1) listening carefully, (2) explaining things, (3) showing respect, (4) spending enough time, and (5) involving the patient in joint decision making. In addition, we compared responses among demographic subgroups. Results showed that regardless of health status or demographic characteristics, the 2003 HINTS respondents reported less than optimal rates of their providers “always” listening carefully, explaining things, showing respect, spending enough time, and involving them in joint decision making. Being Hispanic and having no usual provider or health insurance were associated with a significantly lower frequency of reporting that providers “always” performed the five communication activities (p < .05).

Schools and health education: What works, what is needed, and why?

Purpose – The purpose of this article is to provide a rationale for and background to the present contributions in this special issue on school health education. Design/methodology/approach – The paper argues that health promotion in schools has a vital place to play in improving the health of children, summarises the key themes that emerge from the five papers in the issue and contextualizes them within the current health promotion literature. Findings – The issue makes clear that there are several important ways in which health educators can foster the wellbeing of school health children who merit further research and the attention of policy makers. All have something to say about children in the classroom setting, and in particular their exposure to personal and situational events that can impact on their wellbeing and educational attainment, and possibilities for developing the knowledge, skills, motivation, and support they need to choose health‐enhancing behaviors. They comment particularly on the need to address teacher motivation, and involve parents. Originality/value – The research and ideas embedded in this special issue can assist in the development or improvements of school‐based health promotion programs and provide some direction about what action is needed in future and why.