Browsing by Subject "Health Knowledge, Attitudes, Practice"
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Item Assessing Self-Care Perception in Patients Living with Type 2 Diabetes and Their Physicians(2021-05-01T05:00:00.000Z) Balakrishnan, Naveen Kishore; Day, Philip; Kale, Neelima; Schneider, DavidBACKGROUND: Type 2 diabetes mellitus (T2D) is chronic illness affecting millions in the United States. Patients living with T2D require highly individualized care and significant patient effort. This effort is comprised of the patient's self-care with regards to medication, diet, lifestyle, and mental health. Self-efficacy is a patient's ability to feel agency over their illness and therefore feel able to maintain self-care. Previous literature suggests that improving a patient's self-efficacy through various behavioral health interventions may improve a patient's ability to manage their T2D. Additionally, interventions on self-efficacy are thought to work regardless of health literacy level and might be a generalizable intervention. However, while validated surveys assessing patient diabetes distress, quality-of-life, social determinants of health, adverse childhood events, and more exist, no literature was found attempting to understand a patient's perspective on their self-care, and by extension, their self-efficacy. Under the premise that consistent beliefs between patient and physician regarding self-care are necessary to make meaningful plans promoting self-care and self-efficacy, the authors developed the term self-care perception consistency to assess relationship between patient and physician perceptions of a patient's self-care. OBJECTIVE: The objective is to assess the consistency between patient and physician perceptions of patient self-care through a biopsychosocial and structural/social determinants of health lens. METHODS: This study uses a cross-sectional, quantitative data set obtained by the Research Residency Network of Texas (RRNeT) through a 71-item survey study. This survey was completed across 12 Family Medicine residencies in Texas and included individuals between 18-75 who were living with T2D. Responses ranged from short free response to Likert-scale based questions and covered topics such as demographics, social determinants of health, patient self-care, diabetes distress, quality-of-life, adverse childhood events, and more. The physicians of each patient were asked to complete a shorter 10-item survey with broader analogous questions to the patient survey. This data was collected through RedCap and analyzed through RStudio. RESULTS: The term self-care perception consistency was coined to describe the relationship between the patient's and physician's perception of the patient's self-care. Self-care perception consistency was found to be lacking 31.2% of the time. Only HgA1c (p<0.01) was inversely correlated with self-care perception consistency in both the univariate and multivariate analyses of demographic factors and social determinants of health. Additional analysis was completed to assess the relationship of HgA1c control, patient diabetes distress, patient quality-of-life, and the physician survey with self-care perception consistency. Self-care perception consistent and inconsistent groups were found to have significantly different HgA1c control distributions (p < 0.01) in the subset of patients that rated their self-care positively, but no significant difference was found in the group that rated their self-care negatively. Patient self-care ratings were best correlated with their diabetes distress (p<0.01) and HgA1c (p<0.01) while physician ratings of patient self-care were best correlated with their perception of HgA1c, perception of patient diabetes distress, perception of patient quality-of-life, and perception of patient social connectedness (p<0.01 for all). Notably, trending diabetes distress, quality-of-life, the physician survey, and social determinants of health across patient self-care ratings in self-care perception consistent versus inconsistent groups revealed that only the physician survey showed opposite trends across the consistent and inconsistent groups. CONCLUSION: Self-care perception consistency was found to be lacking 31.2% of the time. Notably, HgA1c is correlated with patient and physician perceptions of patient self-care (p<0.01 for both); however, in instances of patient-physician self-care perception inconsistency, HgA1c is not correlated with patient self-care perception. Instead, diabetes distress remains predictive of patient self-care rating in all instances (p<0.01). Patient-physician self-care perception inconsistency is also associated with inconsistency in patient and physician perceptions of the patient's diabetes distress. As diabetes distress remains consistently correlated with patient self-care rating, using the validated diabetes distress survey-17 with an additional question regarding self-care may help physicians better understand patients and therefore target appropriate education and psychosocial interventions.Item Consult a sickle cell expert: how to apply NIH guidelines in caring for adult sickle cell patients(2017-01-20) Nero, AleciaItem Contraceptive Use Across Cultures: A Cross-Cultural Comparison of Contraceptive Use in Women Seeking Care at Sun Yat-sen University Hospital, China and Monduli District Hospital, Tanzania(2016-04-01) Cheng, Cece; Roberts, Scott; Wells, C. Edward; Niwagaba, LillianOBJECTIVE: The purpose of this study was to determine and compare contraceptive choices in women in China and Tanzania and to assess the factors associated with their contraceptive choice. STUDY DESIGN: A prospective cohort trial was performed at Sun Yat-sen University in Guangzhou, China (06/2013 - 08/2013) and the Monduli District Hospital in Monduli, Tanzania (08/2015 - 09/2015). Women were approached during either an inpatient or outpatient visit with an Obstetrics/Gynecology practitioner and asked to complete a survey in their native language (Mandarin or Kiswahili) after obtaining verbal consent. The survey included demographic and social data, socioeconomic status (SES), obstetric history, and contraceptive choice. Data were analyzed using Student’s T-test and Chi-square test for continuous and categorical data, respectively. A P<0.05 was considered statistically significant. RESULTS: During the study period, a total of 128 Chinese women and 61 Tanzanian women completed the survey. Most women chose to use condoms with very few women using long acting reversible contraceptives. However, in the Tanzania population, other popular methods of contraception included LARCs such as implants as well as injections. In addition, elective abortion rates were significantly higher in Chinese women than Tanzanian women (P <0.05). Chinese women <21 and >35 years of age used some form of contraception compared with women in the 21-35 year old range who were more likely to not use contraception, while very few Tanzanian women in the <21 had ever used contraceptives. In addition, those in higher socioeconomic classes/with higher education were less likely to use contraceptives in the Chinese population, but more likely to use contraceptives in the Tanzanian population. CONCLUSION: Contraceptive use in China and Tanzania was clearly influenced by many factors. The high rate of condom use compared to longer, more sustainable methods of contraception highlight a need for better contraception education in both developing countries.Item The ethics of defibrillators and end of life care: the patient, not the device(2014-07-25) Sulistio, MelanieItem From prehab to rehab: opportunities in geriatric perioperative medicine(2017-06-16) Dalton, Thomas O.Item Health maintenance and IBD: collaborative approach between PCP and specialist(2014-08-22) Ahmed, TasneemItem Healthcare Provider and Community Adult Knowledge and Beliefs about Adolescent Sexual and Reproductive Health(2018-07-20) McDonald, Wade Compton; Stewart, Sunita M.; Faith, Melissa A.; Bordes Edgar, Veronica; LePage, James; Hughes, Jennifer L.Sexual and gender minority (SGM) youth face discrimination and health/healthcare disparities in American society (Mustanski, Birkett, Greene, Hatzenbuehler, & Newcomb, 2014a). Researchers have demonstrated connections between discriminatory beliefs (e.g., homophobia), beliefs about environmental etiology of SGM, and SGM moral condemnation among United States adults (Wood & Bartkowski, 2004). Previous research has not established whether pediatric healthcare providers share attitudes and beliefs with other U.S. adults. To address SGM youth’s healthcare disparities, one important step is to understand pediatric healthcare providers’ SGM-specific attitudes and beliefs, what factors influence providers’ beliefs, and how providers’ beliefs differ from the greater community. Our study surveyed a national sample of community adults (n=258) and a sample of pediatric healthcare providers (n=103). The primary aim was to validate three novel measures in both samples: a measure assessing knowledge about sexual minority health risks, a measure assessing SGM etiology beliefs, and a measure assessing moral condemnation of SGM identities. We expected etiology beliefs and moral condemnation to contain separate sexual minority (SM) and gender minority (GM) factors when subjected to exploratory and confirmatory factor analyses. This study’s secondary and tertiary aims examined associations between SM knowledge, SGM etiology beliefs, moral condemnation, and homophobia in our community adult and pediatric healthcare provider samples. We anticipated healthcare providers would demonstrate more SM health risk knowledge, more biological etiology beliefs, and less moral condemnation. Our measures demonstrated good psychometric properties. Contrary to expectations, the etiology and moral condemnation measures were unidimensional for all SGM behaviors and identities. Providers demonstrated more SM health risk knowledge than community adults, but this knowledge was not statistically explained by the quantity of participants’ self-reported SGM-specific prior training. Providers and community adults demonstrated similar etiology beliefs, which were associated with moral condemnation and self-reported religiosity. Moral condemnation was lower in the provider sample, and was associated with spirituality, religiosity, previous interaction with SM individuals, and the presence of a SGM friend or family member. This study lays groundwork for future research designed to better understand pediatric healthcare providers’ SGM-specific knowledge and beliefs and to, ultimately, improve healthcare provision for at-risk SGM youth.Item Improving Nutritional Knowledge of Caregivers in Hyderabad, India: A Pilot Study(2019-04-02) Tinger, Sophia Tibe; Patterson, Abigail M.; Reed, W. Gary; Phelps, EleanorBACKGROUND: India has the highest prevalence of underweight children under 5 in the world. While lack of access to food is one contributing factor to undernutrition, a caregiver's nutritional knowledge is a more important determinant. Caregivers can improve their nutritional knowledge through nutritional counselling, which is already one of the standard management options for treating children with mild to moderate malnutrition. Therefore, improving nutritional counselling for caregivers can be an effective way to combat undernutrition. OBJECTIVE: The aim of this study was to increase caregiver nutritional knowledge gained after receiving diet counseling at Niloufer Hospital, in Hyderabad, India, by 25% by March 2017 through the use of quality improvement tools. METHODS: Checklists and flipcharts were designed using PDSA cycles and DMAIC, two frequently used quality improvement tools. These interventions were then sequentially implemented in two-week increments over a period of six weeks. Caregivers of children 5 and under were given short surveys both before and after counselling. Change in knowledge scores were calculated from the difference in the pre- and post-counselling survey scores. This was done for three different age groups over each phase of the project: Baseline Phase, Checklist Phase, and Flipchart Phase. This data was then analyzed using a one-way ANOVA, as well as a post-hoc analysis with a student-Newman-Keuls test to confirm the ANOVA. RESULTS: The aim was achieved for all age groups when comparing the change in knowledge scores from the final phase (Flipchart Phase) to the Baseline Phase. For the Under 6 Months age group, the change in knowledge scores were 5.24, 10.17, and 12.20 for the Baseline, Checklist, and Flipchart phases respectively. The percent increase from the Baseline Phase to the Flipchart phase was 132.8%. For the 6 to 35 Months group, the change in knowledge score was 9.25 in the Baseline Phase, 8.14 in the Checklist Phase, and 18.86 in the Flipchart Phase, a 103.9 percent increase from the Baseline Phase. Finally, there was a change of knowledge score of 3.57 in the Baseline Phase, 6.25 in the Checklist Phase, and 29.17 in the Flipchart Phase for the 3-5 Years age group. This age group showed a 717.1 percent increase between the Baseline Phase and the final phase of the study. There were no statistically significant findings in this pilot study. However, there was a positive trend showing the flipcharts were the most effective intervention. CONCLUSION: This pilot study demonstrated that these simple-to-create and low-cost interventions, especially the flipcharts, can improve knowledge gained through counselling in low resource settings. Future studies are needed to determine if these interventions can be improved and expanded for wider use.Item Knowledge and Perception of Cervical Cancer and Screening Programs of Women Seeking Care at Monduli Hospital in Tanzania and St. Paul Hospital in Addis Ababa, Ethiopia(2015-04-03) Ghidei, Luwam; Lea, JayanthiAlthough a 2010 survey assessing Tanzanian women's knowledge and attitude towards cervical cancer demonstrated over 75% of respondents correctly identified early marriage and multiparty, other studies demonstrated a lack of knowledge about cervical cancer screening and HPV transmission among patients and nurses. Additionally, many women in Tanzania are not readily represented in such questionnaires. Women who are able to attend clinics with screening programs are generally from higher socioeconomic backgrounds, younger, and more knowledgeable about cervical cancer.15 Educational programs focused on the importance of cervical screening in rural remote areas of Tanzania may have a positive impact on the early detection and identification of patients at early disease stage. Considering both Tanzania and Ethiopia had established VIA programs in 2011 (Figure 5), I developed a questionnaire to assess the knowledge and perception of cervical cancer and cervical cancer screening programs of women in Tanzania and Ethiopia to guide future cervical cancer prevention and screening educational programs in communities.Item Medicine in this day and age: addressing ageism in healthcare(2023-12-15) Voit, Jessica H.Item [News](1978-03-27) Williams, AnnItem [News](1979-09-12) Spiegel, RichardItem Training through a Novel Community-Engaged Research Project to Reduce Pregnancy-Associated Morbidity and Mortality from Maternal Sepsis in New York City(2024-01-30) Zhao, Alice; Richardson, Briana; LaHote, Jessica; Oktem, Ayda; Plumlee, Austin; Hall, Kelli StidhamMaternal sepsis is the second-leading cause of maternal mortality in the U.S., with a disproportionate impact among racial and ethnic minorities. Although maternal sepsis is largely preventable, there remains little evidence concerning the management of risk factors to ensure safe and equitable maternal care during delivery and transition to postpartum. The EnCoRe MoMS study (Engaging Communities to Reduce Morbidity from Maternal Sepsis) is a comprehensive, community-engaged project focused on reducing pregnancy-associated sepsis risk and promoting maternal health equity in NYC. Community stakeholders are integrated in the community research design process through the Community Organization Leadership Advisory Board (CoLAB). I aimed to contribute to the qualitative portion of the ongoing EnCoRe MoMS study to better understand how the social determinants of health impact the lived experiences of patients and how qualitative interviewing can uncover specific barriers and proposed solutions that may be implemented across the pregnancy continuum. We developed an efficient workflow for the recruitment, consent, and enrollment of patients, then conducted qualitative in-depth interviews (IDIs) with postpartum patients and community focus group discussions (FGDs). Major themes explored during IDIs included prenatal and labor/delivery experiences, facilitators/barriers to accessing quality maternal care, respectful care, community-based resources and solutions, etc. (see table). Ultimately, qualitative data collection through IDIs and the FGD allowed us to observe the lived experiences of patients at high risk of pregnancy and postpartum complications, including sepsis.Item An update: management and treatment of hepatitis C virus infection(2014-09-05) Brown, GeriItem Vaccine hesitancy(2021-05-21) DuVal, Tara