Uwe Hartung

An internet-based approach to enhance self-management of chronic low back pain in the Italian-speaking population of Switzerland: results from a pilot study

SummaryObjective:To illustrate the development and pilot evaluation of a website designed to enhance self-management of chronic low back pain for the Italian-speaking population of Switzerland.Methods:20 patients affected by chronic low back pain used a website – specifically created for the project – for a period of five months, under the monitoring of a team of health professionals. Evaluation was carried out by means of a telephone questionnaire administered at baseline and at the end of the intervention, and intermediate online user-testing performed in the fourth month of the intervention. A control group of 15 patients was created to assist the evaluation.Results:Compared to the control group, results from the pilot evaluation suggest a decrease in the intensity of back pain in people with access to the website; an increase in physical activity; a reduction in both medical consultation and the use of painkillers, and a gain in declarative and procedural knowledge. This coincides with a general positive assessment of the website.Conclusion:The study supports the need to test the proposed approach on a wider scale.

Causes, coping, and culture: a comparative survey study on representation of back pain in three Swiss language regions.

Introduction This study intends to contribute to a research tradition that asks how causal attributions of illnesses affect coping behavior. Causal attributions are understood as the most important element of illness representations and coping as a means to preserve quality of life. The issue is applied to a condition so far often neglected in research on illness representations–back pain–and a third concept is added to the picture: culture. Aim The aim of this study is (a) to explore the causal factors to which persons with back pain attribute the further course of their illness, (b) to find out whether the attributed causes are predictors of coping maxims, and (c) to find out whether cultural factors affect attributions and coping and moderate the relationship between the two. Methods A total of 1259 gainfully employed or self-employed persons with recent episodes of back pain were recruited in the three language regions of Switzerland. They were asked to complete a structured online interview, measuring among many other variables attributed causes, coping maxims, and affiliation to one of the Swiss micro-cultures (German-, French- or Italian-speaking). Results Attributed causes of the illness that can be influenced by a patient go along with more active coping styles. Cultural affiliation impacts on coping maxims independently, but culture moderates the relationship of attributed causes and coping maxims only in two of twenty possible cases. Implications The results show that cultural differences can be analytically incorporated in the models of illness representations. Results may help to improve healthcare providers’ communication with patients and plan public health campaigns. The approach to micro-cultural differences and the substantive relationships between alterability of causes and activity in coping may help the further development of models of illness representations.

Effect of smoke-free legislation on Ticino gastronomy revenue

ObjectiveTo provide evidence on the effects of smoke-free laws on gastronomy revenue in a European setting based on objective data. Damage to gastronomy revenue is a widely used argument against smoke-free legislation.MethodGastronomy revenue in Ticino is compared with the rest of Switzerland before and after Ticino banned smoking from gastronomy in April 2007, being the first (and at the time of the study only) Swiss canton to do that. The study uses breakdowns by cantons of taxable revenue of gastronomy branches and retailers (for comparison) provided by the Swiss tax authorities for the years 2005–2008.ResultsRevenues of restaurants and bars were not damaged by the Ticino smoke-free law. Decreases in Ticino happened before the smoke-free law came into effect. Evidence for night clubs is inconclusive.DiscussionThe absence of detrimental effects on restaurant and bar revenue corroborates the gist of research on the subject from other countries. The argument that the decline of bar and restaurant sales prior to the implementation of the ban might have occurred in anticipation of the new regulation is not considered tenable.

Health Communication Research in Europe: An Emerging Field

There are at least five aspects that can serve as indicators of the establishment of a scholarly discipline: (a) the existence of journals devoted to the field, (b) the existence of scholarly associations, (c) the creation of departments, institutes, and academic positions by universities, (d) the foundation of study programs, and (e) the publication of textbooks. If these criteria are applied, health communication has been an established discipline in the United States for years. As to journals, Health Communication has entered its third decade last year—its first issue appeared in 1989, and the celebration of its 100th issue is the occasion for this brief review. The Journal of Health Communication entered the field 7 years later, in 1996, and the first issue of the Journal of Health & Mass Communication has just appeared. As to associations, the International Communication Association (ICA, strictly speaking not a U.S. association, but under heavy influence of U.S. scholars) has had a health communication division since 1975, with a forerunner reaching 3 years more into the past. The history of the Speech Communication Association (SCA, now the National Communication Association, NCA) health communication division reaches back to 1985. At the same time, the mid-1980s, scholarly conferences on health communication began to be held and multiplied. Teaching and study programs followed suit, as did textbooks such as Kreps and Thornton’s 1984 Health Communication: Theory and Practice, Sharf’s The Physician’s Guide to Better Communication from the same year, and Northouse and Northouse’s Health Communication: A Handbook for Professionals, published a year later (Kreps, Bonaguro, & Query, 1998). So the 1980s are the decade that witnessed the establishment of an academic field called “health communication” in the United States.

Introducing the chronic disease self-management program in Switzerland and other German-speaking countries: findings of a cross-border adaptation using a multiple-methods approach.

BackgroundStanford’s Chronic Disease Self-Management Program (CDSMP) stands out as having a large evidence-base and being broadly disseminated across various countries. To date, neither evidence nor practice exists of its systematic adaptation into a German-speaking context. The objective of this paper is to describe the systematic German adaptation and implementation process of the CDSMP (2010–2014), report the language-specific adaptation of Franco-Canadian CDSMP for the French-speaking part of Switzerland and report findings from the initial evaluation process.MethodsMultiple research methods were integrated to explore the perspective of workshop attendees, combining a longitudinal quantitative survey with self-report questionnaires, qualitative focus groups, and interviews. The evaluation process was conducted in for both the German and French adapted versions to gain insights into participants’ experiences in the program and to evaluate its impact. Perceived self-efficacy was measured using the German version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6G).ResultsTwo hundred seventy eight people attending 35 workshops in Switzerland and Austria participated in the study. The study participants were receptive to the program content, peer-led approach and found principal methods useful, yet the structured approach did not address all their needs or expectations. Both short and long-term impact on self-efficacy were observed following the workshop participation (albeit with a minor decrease at 6-months). Participants reported positive impacts on aspects of coping and self-care, but limited effects on healthcare service utilization.ConclusionsOur findings suggest that the process for cross-border adaptation was effective, and that the CDSMP can successfully be implemented in diverse healthcare and community settings. The adapted CDSMP can be considered an asset for supporting self-management in both German-and French-speaking central European countries. It could have meaningful, wide-ranging implications for chronic illness care and primary prevention and potentially tertiary prevention of chronic disease. Further investigations are needed to tailor the program for better access to vulnerable and disadvantaged groups who might benefit the most, in terms of facilitating their health literacy in chronic illness.

Effects of eHealth Literacy on General Practitioner Consultations: A Mediation Analysis

Background Most evidence (not all) points in the direction that individuals with a higher level of health literacy will less frequently utilize the health care system than individuals with lower levels of health literacy. The underlying reasons of this effect are largely unclear, though people’s ability to seek health information independently at the time of wide availability of such information on the Internet has been cited in this context. Objective We propose and test two potential mediators of the negative effect of eHealth literacy on health care utilization: (1) health information seeking and (2) gain in empowerment by information seeking. Methods Data were collected in New Zealand, the United Kingdom, and the United States using a Web-based survey administered by a company specialized on providing online panels. Combined, the three samples resulted in a total of 996 baby boomers born between 1946 and 1965 who had used the Internet to search for and share health information in the previous 6 months. Measured variables include eHealth literacy, Internet health information seeking, the self-perceived gain in empowerment by that information, and the number of consultations with one’s general practitioner (GP). Path analysis was employed for data analysis. Results We found a bundle of indirect effect paths showing a positive relationship between health literacy and health care utilization: via health information seeking (Path 1), via gain in empowerment (Path 2), and via both (Path 3). In addition to the emergence of these indirect effects, the direct effect of health literacy on health care utilization disappeared. Conclusions The indirect paths from health literacy via information seeking and empowerment to GP consultations can be interpreted as a dynamic process and an expression of the ability to find, process, and understand relevant information when that is necessary.

Do Journalists’ Opinions Affect News Selection in a Low-Key Conflict? Newspaper Coverage of the Discussion of Smoking Bans in Switzerland

This quantitative content analysis applies the theory of instrumental actualization to Swiss newspaper coverage of smoking bans in public places. The theory holds that journalists’ opinions affect news selection; it is studied here for the weighting and evaluation of arguments in news stories. The editorial stance of newspapers was related to the weighting of argumentative fields and the frequency of contradiction of different standpoints. Therefore, elements of both a dialectical (papers of different stance explicitly contradicting one another) and a rhetorical (papers of different stance speaking of different matters) model of discourse were found.

Prior family communication and consent to organ donation: using intensive care physicians’ perception to model decision processes

Generally, the Swiss hold favourable attitudes to organ donation, but only few carry a donor card. If no card is found on a potential donor, families have to be approached about donation. The aim of this paper is to model the role that some family communication factors play in the family decision to consent or not to organ donation by a brain dead relative. Information was gathered in face-to-face interviews, using a questionnaire and recording open answers and comments. Eight heads of intensive care units (ICU) of Swiss hospitals and one representative from Swisstransplant were interviewed. Questions asked respondents to estimate the prevalence and effect of communication factors in families facing a decision to consent to donation. Answers were averaged for modelling purposes. Modelling also relies on a previous representative population survey for cross-validation. The family of the deceased person is almost always approached about donation. Physicians perceive that prior thinking and favourable predisposition to donation are correlated and that the relatives’ predisposition is the most important factor for the consent to donation, up to the point that a negative predisposition may override an acknowledged wish of the deceased to donate. Donor cards may trigger family communication and ease the physicians’ approach to family about donation. Campaigns should encourage donate-willing people to talk to their families about it, make people think about organ donation and try to change unfavourable predispositions. Acknowledgement the authors wish to thank the interviewees whose collaboration has provided them an overview of today’s situation in Switzerland.

“Your risk is low, because …”: argument-driven online genetic counselling

Advances in genetic research have created the need to inform consumers. Yet, the communication of hereditary risk and of the options for how to deal with it is a difficult task. Due to the abstract nature of genetics, people tend to overestimate or underestimate their risk. This paper addresses the issue of how to communicate risk information on hereditary breast and ovarian cancer through an online application. The core of the paper illustrates the design of OPERA, a risk assessment instrument that applies the UK National Institute of Health and Clinical Excellences guidelines on the basis of (i) the number of relatives on the same side of the family with the same cancer or cancers that are known to run together; (ii) the ages of these relatives at diagnosis and (iii) the closeness of the family relationship with the person who is doing the assessment. By relying on the argumentation theory, we explain how the communication strategy that OPERA implements is essentially based on Perelman and Olbrechts-Ty...

H1N1 influenza pandemic in Italy revisited: has the willingness to get vaccinated suffered in the long run?

Background The aim of the study is to assess the long-term secondary effects of personal experience with the H1N1 pandemic of 2009/2010 and the perception of the institutional reaction to it on Italians’ willingness to get vaccinated in case of a novel influenza pandemic. Design and Methods We conducted 140 face-to-face interviews in the Registry Office of the Municipality of Milan, Italy, from October to December 2012. Results Willingness to get vaccinated during a novel influenza pandemic was best predicted by having been vaccinated against the seasonal flu in the past (OR=5.18; 95%CI: 1.40 to 19.13) and fear of losing one’s life in case of an infection with H1N1 (OR=4.09; 95%CI: 1.68 to 9.97). It was unaffected by the assessment of institutional performance. Conclusions The findings of this study do not point to long-term secondary effects of the institutional handling of the H1N1 pandemic. The results highlight the fact that behavioural intention is not the same as behaviour, and that the former cannot simply be taken as an indicator of the latter. Significance for public health Whereas influenza pandemics occurred rather rarely in the last centuries, their frequency can be expected to increase in the future due to the enhanced globalisation and still raising importance of air travelling. Recent examples (Ebola, H1N1, SARS, avian influenza) demonstrate that initially local disease outbreaks often become worldwide health threats of international concern. National and international health authorities are consequently urged to present preparedness plans on how to manage such health crises. However, their success highly depends on their acceptance by the public. To ensure the public compliance with recommended actions, effective communication is needed. Since communication is most successful when it meets the needs of the target audience, a full understanding of the audience is crucial. This study can help public health experts to better understand the variables determining people’s willingness to get vaccinated during influenza pandemic, in terms of behavioural and perceptual variables. This knowledge enables them to correctly address the public’s concerns when having to communicate during the next outbreak of pandemic influenza.