Sally H. Rankin

Internet-based patient education and support interventions: a review of evaluation studies and directions for future research

The Internet provides patients, families, and health providers with unparalleled opportunities to learn, inform, and communicate with one another. This paper is a review of studies that have evaluated the impact of professionally facilitated Internet-based programs for diverse clinical populations on health outcomes, utilization, and user satisfaction. The findings suggest that some outcomes in certain groups can be moderately improved and that user satisfaction has been generally positive. Given the increasing need to provide timely and effective patient-centered care, a stronger evidence base for eHealth applications must be established before broader deployment of such programs will take place.

The effects of a collaborative peer advisor/advanced practice nurse intervention: cardiac rehabilitation participation and rehospitalization in older adults after a cardiac event.

Background: After the cardiovascular events of myocardial infarction (MI) and coronary artery bypass surgery (CABS), unpartnered older adults are a vulnerable group that may benefit from interventions to improve health outcomes. The purpose of this analysis is to determine if a community-based collaborative peer advisor/advanced practice nurse intervention increased participation in cardiac rehabilitation programs and reduced hospital readmissions after MI and CABS and determine whether the type of cardiovascular event influenced rehospitalization. Subjects and Methods: This study was a randomized clinical trial that enrolled 247 unpartnered older adults who were single, widowed, or divorced. Subjects were randomized into 4 groups: standard of care group for MI and for CABS and standard of care plus the treatment groups for MI and for CABS, for 12 weeks after discharge. There were 163 women/84 men, with a mean age of 76.4 years, who were admitted for MI (n = 93) or CABS (n = 154) and who were enrolled from 5 academic medical centers. The treatment consisted of a community-based intervention of a home visit within 72 hours and telephone calls at 2, 6, and 10 weeks from an advanced practice nurse and 12 weekly telephone calls from a peer advisor. Participation in a cardiac rehabilitation program and rehospitalizations were collected at 6 weeks and 3, 6, and 12 months by telephone interview. Results and Conclusions: There were significantly more participants in cardiac rehabilitation programs after 3 months in the treatment group, and this increase was seen up to 1 year after MI and CABS. There were no statistical differences, although there were fewer rehospitalizations between 3 and 6 months after MI and CABS in the treatment group compared with the standard of care group. Overall, the evidence from this study suggests that a community-based collaborative peer advisor/advanced practice nurse intervention can play a role in promoting active participation in cardiac rehabilitation programs and fewer rehospitalizations in unpartnered older adults after MI and CAGS.

School-based drama interventions in health promotion for children and adolescents: systematic review.

AIM The paper is a report of a review of the literature on the effects of school-based drama interventions in health promotion for school-aged children and adolescents. BACKGROUND Drama, theatre and role-playing methods are commonly used in health promotion programmes, but evidence of their effectiveness is limited. The educational drama approach and social cognitive theory is share the assumption that learning is based on self-reflection and interaction between environment and person. However, educational drama also emphasizes learning through the dialectics between actual and fictional contexts. DATA SOURCES A search was carried out using 10 databases and hand searching for the period January 1990 to October 2006. METHODS A Cochrane systematic review was conducted. RESULTS Nine studies met the criteria for inclusion. Their topics included health behaviour (five studies), mental health (two) and social health (two). Actor-performed drama or theatre play followed by group activities was the intervention in five studies, and classroom drama in four studies. Four of the studies were randomized controlled trials and five were non-randomized controlled studies. Four reports gave the theory on which the intervention was based, and in eight studies at least some positive effects or changes were reported, mostly concerning knowledge and attitudes related to health behaviour. The diversity of designs and instruments limited comparisons. CONCLUSION There is a need for well-designed and theory-based studies that address drama interventions in health promotion for children and families. The challenge is to find or develop a theory, which combines educational, drama and health theories with valid and reliable measurements to examine the effects of the intervention.

The Peer Advisor Experience Providing Social Support

Research shows a link between increased social support and decreased complications after myocardial infarction (MI). In a current randomized controlled trial (RCT), a social support intervention administered by nurse and peer advisors is being examined to determine its influence on the health outcomes of unpartnered, post-MI elders. This qualitative study (as part of the larger RCT) sought a better understanding regarding the experience of the peer advisor. Data sources included peer advisor logs, a focus group, and telephone interviews with peer advisors. Findings revealed that helping, mutual sharing, committing, and benefiting are characteristics of peer experiences. Primarily because of their personal experience of recovery from MI, peer advisors had a remarkable ability to relate to assigned post-MI elders, offering a unique form of social support complementary to current health practices.

RELIABILITY AND VALIDITY DATA FOR A CHINESE TRANSLATION OF THE CENTER FOR EPIDEMIOLOGICAL STUDIES-DEPRESSION

A translated version of the CES-Depression scale attained a reliability coefficient alpha of 0.92 in a group of 30 adult Chinese persons with noninsulin-dependent diabetes mellitus. Fifteen percent of the sample scored 16 or above, which has been noted as indicative of depression in U.S. samples. The validity of the instrument was assessed through an in-depth content analysis and through convergent validity analyses. Comparison of depression scores of this sample with those from English-speaking Occidentals shows that diabetes disease-related factors may be an important influence on depression.

Malawi Women and HIV: Socio-Cultural Factors and Barriers to Prevention

ABSTRACT. Heterosexually transmitted HIV/AIDS continues to devastate the health and economy of sub-Saharan African countries. In Malawi, 15.4% of 15–49 year olds are infected with HIV and 18–26% of pregnant women are living with HIV. Research has shown that socio-cultural factors, especially gender roles and relationships, play a significant role in the transmission of HIV in Africa but little is known about Malawi womens perspective on HIV/AIDS. What do Malawi women say about the impact of HIV/AIDS on their lives, their role in prevention, and the barriers they face in trying to stem the spread of the disease? To answer these questions, three focus groups with Malawi women were conducted and analyzed for themes. The purpose of this paper is to describe one emergent theme captured in the statement, “We are just vessels for our husbands.” This theme is explicated through discussions of womens and mens images, womens roles, gender/power relationships, disempowerment, role models and empowerment. Evident in this theme are interrelated messages for those involved in HIV/AIDS prevention. Health education alone is insufficient to stem the tide of HIV in Malawi. A multidisciplinary, systematic approach that includes womens education and economic empowerment as well as modifying legal and social structures that contribute to the spread of HIV/AIDS in Malawi is suggested as necessary additions to HIV and AIDS intervention programs. Only through forging partnerships between health, education, womens development groups, and political and social leaders will we be able to reduce the impact of HIV/AIDS in Malawi.

Cluster analysis of elderly cardiac patients' prehospital symptomatology.

Background: Chest pain routinely brings patients into the healthcare system, and elderly patients may present with more complex symptoms presaging ischemic heart changes than do younger patients. Objective: To examine, using cluster analysis, how elderly patients experiencing an ischemic coronary heart disease cluster based on presenting symptoms in the week before hospitalization and how they vary in terms of their general physical and mental health, mood states, and quality of life. Methods: Elderly (age ≥65 years), unpartnered patients (N = 247) admitted with ischemic coronary heart disease to one of five university medical centers were inducted into a clinical trial; only baseline data are reported. Interviews assessed cardiac symptoms, medical history, general physical and mental health, mood states, and quality of life. Patients were clustered (grouped) using squared Euclidean distances and weighted average linkage. Characteristics of patients were examined using analysis of variance and chi-squared analyses. Results: Three clusters (groups) were identified: (a) Classic Acute Coronary Syndrome (severe ischemic pain; 22%), (b) Weary (severe fatigue, sleep disturbance, and shortness of breath; 29%), and (c) Diffuse Symptoms (mild symptomatology; 49%). Post hoc tests revealed that the Weary group was more likely to have a history of heart failure; they also exhibited significantly more psychological distress and lower quality of life than the other subgroups. Conclusion: Cluster analysis proved useful in grouping patients based on their symptom experience, but further research is needed to clarify the relationships among identified symptoms, psychological distress, and health outcomes; develop interventions for Weary patients; and extend the findings of this study.

Donkey Work: Women, Religion, and HIV/AIDS in Malawi

Addressed in this article are the familial, cultural and religious influences on Malawi women that contribute to HIV/AIDS. Thirty-nine adult Malawi women representing voluntary assistance groups, religious groups, and university women participated in 3 focus groups in Malawi. Interview data were taped, transcribed, and analyzed using qualitative descriptive analysis. Findings revealed that multiple burdens in the lives of Malawi women resulting from poverty and responsibility for family members are made more onerous by religious institutions, sexual practices, and cultural beliefs. In conclusion, womens “donkey work” may result in at-risk sexual behavior as a means of survival, thus increasing the incidence of HIV/AIDS. Alleviating the burdens involves efforts from religious groups and restructuring of belief systems.

Supporting cardiac recovery through eHealth technology.

The Internet continues to evolve as a popular and increasingly vital channel for health information and communication among patients, families, and health providers. This article provides an overview of published studies that have described or tested Internet-based resources and interventions designed to support recovery and enhance health outcomes for the cardiac population. Three categories of applications are discussed: (1) peer support communities; (2) information support through automated, tailored patient education; and (3) professionally facilitated education and support programs. The article also address key issues such as barriers to innovation adoption, patient literacy, and the digital divide that must be overcome for successful integration of such interventions into clinical practice. How Internet-based interventions will fit with existing conventional programs and clinical practice structures is not yet clear. However, evidence that supports use of this new communication channel is likely to emerge as more programs are developed and rigorously evaluated.

Perceptions of Coronary Heart Disease Risk in Korean Immigrants With Type 2 Diabetes

PURPOSE The purpose of this study was to examine coronary heart disease (CHD) risk perception, risk factor status, and factors associated with CHD risk perception in Korean immigrants with type 2 diabetes mellitus. METHODS A community sample of 143 Korean adults with type 2 diabetes, aged 30 to 80 years old, completed questionnaires and biological measures. A multiple regression analysis was conducted to evaluate the relationships between CHD knowledge, general health, smoking, medications for CHD risk factors, demographic variables (independent variables), and the perception of CHD risk (dependent variable). RESULTS Participants had low perception of CHD risk, with most (76.9%) indicating their risk to be the same or lower than people of the same age and sex in the general population. Overall, CHD risk factor control was suboptimal according to American Diabetes Association guidelines. Only 41.3% of participants met the HbA1c goal of less than 7%. More than half (55%) had uncontrolled blood pressure, and a similar proportion (53.6%) had higher low-density lipoprotein cholesterol than the target goal. CHD knowledge and self-reported general health influenced the perception of CHD risk. More CHD knowledge and poor general health were associated with higher perception of CHD risk. CONCLUSIONS To increase the perception of CHD risk in Korean immigrants with type 2 diabetes, diabetes educators and clinicians should educate such patients about CHD risk factors and discuss their risk status at every visit. Those who report their health to be good deserve particular attention.