Browsing by Subject "Social Support"
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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 Attachment Influences within a Gynecologic Cancer Population(2012-08-31) Adams, Cassandra Leigh; Evans, Harry M.Despite significant levels of distress and demonstrated benefits of psychosocial intervention, few women diagnosed with gynecologic cancers utilize psychosocial resources. Research indicates adult attachment style and perception of social support impact distress. However, relationships between these variables are poorly understood. Participants completed measures of distress, adult attachment style, and perception of social support and provided information regarding self-reported openness to psychosocial services and barriers to using those services. Our analyses identified significant relationships between adult attachment dimensions, distress, perceived social support, and openness to and use of psychosocial services. Distress was significantly associated with openness to and use of psychiatric medication. Perceived social support demonstrated significant mediation effects between attachment anxiety and distress. Similarly, perceived social support demonstrated significant mediation effects in the relationship of elevated depression and high attachment avoidance to use of psychiatric medication. However, significant study limitations may be assumed to have negatively impacted the ability to draw meaningful conclusions from the data. Future research would benefit from further examination of the relationships among adult attachment, distress, perceived social support, and openness to and use of psychosocial services. Clearer understanding the nature of these relationships could guide care providers in being able to more effectively provide services to women who are experiencing significant distress but fail to access services. More effective provision of services and subsequent reduction in distress would likely improve health outcomes.Item Attachment Style, Depression, and Health Outcomes among Antepartum Patients(2015-07-14) Enander, Richard Anthony; Robinson, Richard C.; Evans, Harry M.; Frank, Blake; Bernstein, Ira; Stringer, Claude A.Clear evidence of the impact of psychosocial factors on healthcare utilization continues to grow. An individual's attachment style is hypothesized to be one such important psychosocial factor related to healthcare utilization. Women with high-risk pregnancies treated in antepartum units have been shown to experience higher levels of stress than the general population, which has been hypothesized to activate adaptive and maladaptive patterns of interpersonal relationships. Therefore, the present study investigated the relationship among attachment style, stress, depression, and healthcare utilization in a sample of women with high-risk pregnancies. Stress and depressive symptoms were hypothesized to serve as moderating variables between patients' attachment styles and their healthcare utilization. To the author's knowledge, this was the first study to examine the role of stress in this manner. One hundred seventeen participants from the antepartum unit of Baylor University Medical Center were enrolled. Participants were administered a demographic questionnaire, the Edinburgh Postpartum Depression Scale, the Experiences in Close Relationships Scale - Short Form, the Attachment Style Questionnaire, the Crowne-Marlowe Social Desirability Scale, and the Perceived Stress Scale. Healthcare utilization data was then collected from participants' electronic medical records. Regression analyses determined that while an insecure attachment style was associated with increased depressive symptoms, the strongest association with depressive symptomatology was subjective stress levels (b = .813, t = 11.54, p < .001). Thus, while the moderator analysis was significant overall, stress was most closely associated with depressive symptoms. With regard to healthcare utilization, a MANOVA revealed no association between attachment style and healthcare utilization, although it did reveal that stress scores were significantly associated with emergency room visits in the past twelve months (F(1, 103) = 11.48, p < .001, partial η2 = .093) as well as with pain scores (F(1, 103) = 5.19, p = .025, partial η2 = .044). Thus, although attachment style is related to depression, stress was found to be more strongly associated with depression and several healthcare variables. Further research is warranted to examine the role that attachment style may play in depressive symptoms and healthcare utilization.Item A Biopsychosocial Model of Attachment Styles and Adverse Birth Outcomes in High-Risk Pregnancies(2016-04-13) Cassedy, Hannah; Robinson, Richard C.; Frank, Blake; Bernstein, Ira; Evans, Harry M.; Stringer, Claude A.Because stress during pregnancy can contribute to preterm birth, low birth weight, and other adverse birth outcomes, there is a need for research on psychosocial factors that may mitigate this risk. Social support and attachment security have been shown to buffer the effects of stress in certain contexts. This study therefore evaluated the degree to which social support, attachment anxiety, and attachment avoidance affect stress-related birth outcomes in a sample of women with high-risk pregnancies. The study focused on women who had been hospitalized for pregnancy complications, as the population was identified as in need of further biopsychosocial research. The hypotheses were that women with more secure attachment would have greater social support, less stress, and therefore superior birth outcomes. Participants (N = 188) completed the 10-Item Perceived Stress Scale, Social Provisions Scale, and Experiences in Close Relationship Scale-Short Form, during their pregnancies. Birth outcome data (gestational age, birth weight, and Apgar scores) were extracted from their medical records after delivery. Biserial correlation analyses revealed that high stress levels were associated with more insecure attachment styles. Analysis of variance indicated that participants were more likely to have avoidant attachment if they were black, poorly educated, or unmarried. Hierarchical multiple regression analyses revealed that stress, social support, and attachment levels were not predictive of birth outcomes over and above the effects of physiological risk factors. This result diverges from research on low-risk pregnancies, where a clear link is observed between stress and adverse birth outcomes. By contrast, in this sample of high-risk pregnancies, psychosocial factors did not influence the profound effects of biological risk. In high-risk pregnancies, therefore, psychosocial interventions may be better suited to target psychosocial, rather than biological, outcomes. Furthermore, this study highlights a need for further research into demographic disparities in attachment styles, as well as the sociocultural factors that may impact them.Item Dissecting the 2015 Nepal Earthquake: Rural Response and Way Forward for Nepal(2017-04-03) Kharel, Ramu; Chang, Mary; Pepe, Paul E.; Nwariaku, FiemuINTRODUCTION: In 2015, a protracted 7.8 Richter-magnitude earthquake, 50 seconds in duration, ravaged Nepal. Officials were not fully prepared for the impact of this catastrophe and mitigation protocols have since been implemented. Based on the Gorkha earthquake experience, however, many response shortcomings persist. This study was designed to review the Gorkha earthquake in the context of other earthquakes worldwide and, in turn, analyze current preparedness strategies for Nepal. Additional recommendations were to be derived based on those findings. METHODS: The Nepali government's home ministry and ministry of health's documents on disaster response protocols were reviewed in detail. Published reports addressing earthquakes in Nepal, Armenia, Japan and Haiti were analyzed for comparison including those discussing banditry and rural politics. Based on these findings and the additional expert advice of disaster specialists, recommendations were assimilated with the intention of augmenting current preparedness strategies for the people of Nepal. RESULTS: A major finding of the analysis was that, although detailed response protocols were developed for Nepal, the focus was largely limited to the urban (high-population) areas. Detailed plans for rural settings were not specifically addressed even though the recent earthquake affected non-urban districts massively. Also, sparse resources, logistical barriers and distance challenges were faced by the rural jurisdictions further hampering the response and recovery and escalating the disparities. CONCLUSION: In the context of other global experience, disaster preparedness, response and recovery protocols are essential to lessening the impact of earthquakes and can change outcomes. Based on the Gorkha earthquake experience, it has been recommended that the Nepali government should now take steps (detailed in the text) to facilitate the first 72 hours of response to its high-risk, logistically-challenged rural jurisdictions by strengthening the local health systems and emergency management response frameworks, ensuring improved parity in disaster preparedness for all citizens.Item Longitudinal Changes in Quality of Life and Distress among Cancer Survivors Enrolled in a Community Survivorship Program(2014-07-24) Funk, Rachel Katherine; Hamann, Heidi; Balasubramanian, Bijal; Businelle, Michael; Howe-Martin, Laura; Kendall, JeffreyBACKGROUND: Cancer can be a life-threatening illness with long-term consequences beyond the initial phases of diagnosis and treatment. The post-treatment period presents unique challenges to psychosocial functioning (i.e., psychological distress and quality of life [QOL]), but little is known about the efficacy of psychological and behavioral interventions for cancer survivors, especially in the community setting. OBJECTIVE: This longitudinal study assessed the relationship between participation in a community-based survivorship program and psychosocial functioning among cancer survivors. Aims also addressed how individual characteristics and program participation related to changes in psychosocial functioning over time. METHOD: Participants included 152 cancer survivors receiving psychosocial and behavioral services (e.g., exercise, dietary consult, psychological counseling) through the Fort Worth Program for Community Survivorship at the University of Texas Southwestern Moncrief Cancer Institute. Participants completed measures of psychological distress and QOL at enrollment and at 3, 6, and 12 months post-enrollment. Service attendance was recorded throughout the 12-month study period. ANALYSIS: Linear mixed modeling techniques examined changes in psychosocial functioning over time. RESULTS: Significant improvements in both QOL and distress were noted for participants during the 12-month study period. The largest improvements in QOL and distress occurred during the first 3 months and appeared to level out during the last 6 months of program participation. This pattern mirrored participants’ attendance in program services, which was highest during the first 3 months of enrollment. Participants with low levels of comorbidity displayed a less pronounced improvement in both psychosocial outcomes over time than those with more comorbid symptoms. Individuals attending exercise and dietary services demonstrated a greater rate of improvement in QOL than those not attending these services. DISCUSSION: Results suggest that the cancer survivorship program was effective in addressing the unmet psychosocial needs of cancer survivors, especially during the first few months of program participation. Uptake of exercise and dietary interventions appeared especially impactful for QOL improvement. Future research should expand assessment of survivorship interventions and utilize non-interventional groups to better understand the specific impact of psychosocial and behavioral survivorship care on psychosocial functioning.Item The Role of Hope and Social Support in Adolescent/Young Adult (AYA) Patients Coping with Cancer Treatment(2019-07-25) Pennant, Sarah Grace; Germann, Julie; Lee, Simon Craddock; Triplett, Kelli; Holm, Suzanne; Howe-Martin, Laura; Campbell, RyanApproximately 70,000 adolescents/young-adults (AYAs; ages 15-39) are diagnosed with cancer annually in the United States (NCI, 2015). This psychosocially at-risk group is less studied and understood than other age cohorts, and experience disparities in access to developmentally-informed treatment. Hope interventions have demonstrated promising outcomes in a wide range of populations; however, no hope interventions have been studied in AYA cancer patients. To develop such interventions, additional research was needed to clarify the hope's role in AYAs' coping with cancer. Study aims were to: 1) determine how AYAs cope with cancer treatment and 2) explain hope's role (defined by Snyder, 1994) in their coping. Participants included 10 AYA cancer patients undergoing treatment at Children's Health (M=18.9 years) and 10 caregivers (M=45.6 years). Demographic variables were collected from the medical record. Participants scored within the normal to high range on measures of hope, depression/anxiety/stress, quality of life, and social support, Participants also completed a semi-structured interview. Qualitative analysis was guided by principles of grounded theory (Glaser & Strauss, 1967) and utilized the constant comparative approach. Guided by study aims, qualitative analysis generated three primary sections: 1) AYAs cancer experience, 2) hope, and 3) opinions/recommendations. Findings describe the in-depth AYA cancer experience and suggest AYAs utilize multiple coping strategies, both independently and by incorporating others. Results propose AYAs utilize an avoidance, rumination, and acceptance process during treatment, which can be enhanced by social supports. Similarly, others have the ability to provide additional coping resources for this population. Concurrent coding suggested hope theory and social supports are instrumental in AYAs coping with cancer, as much of the self- and other-coping findings described agency and pathways thinking. Others have the unique opportunity to increase hope levels through generating additional agency/pathways for AYA patients and assisting with pre-existing self-coping mechanisms. Thus, hope theory is one of inclusivity, bridging multiple coping theories and intervention techniques. Hope theory is a framework to guide clinicians, families, peers, friends, and others through future interventions and support strategies to improve coping for AYA cancer patients. Study results also include recommendations, directly from AYA patients, for social supports and AYA patients.Item The Role of Peers in the Management of Type 1 Diabetes in an Emerging Adult Sample(2015-07-15) Pihlaskari, Andrea Karina; Stewart, Sunita M.; Wiebe, Deborah J.; Hughes, Carroll W.; Iteld, Lily; Roop, MelissaBACKGROUND: During emerging adulthood, individuals with type 1 diabetes are confronted with unique illness-related challenges that place them at risk for adverse health outcomes. There is a sparse and divided literature examining the role of potential protective factors, such as peer support, across this time period. PURPOSE: To examine whether diabetes specific peer support is associated with diabetes outcomes cross-sectionally in late adolescence and in emerging adulthood, and longitudinally across the transition from late adolescence to emerging adulthood. METHOD: Longitudinal observational multi-site study design that focused on youths (N=132) with type 1 diabetes during the last year in high school and then again during the first year post high school. Report of diabetes specific peer support was measured during each of these time points and was used to predict diabetes outcomes above and beyond parental relationship quality as measured by report of parental acceptance. Diabetes outcomes were measured with glycemic control (HbA1c) and adolescent report of adherence. RESULTS: Diabetes specific peer support was associated cross sectionally and longitudinally with adherence above and beyond parental relationship quality. Changes in diabetes specific support across the two time points were associated with changes in both glycemic control and adherence across this time period. CONCLUSIONS: Proximal sources of support, such as diabetes specific peer support, should be examined as potential protective factors for emerging adults with type 1 diabetes.Item The Role of Social Support in PTSD and Depression Symptom Severity(2014-12-22) Bird, Jessica Lynne; Surís, Alina; North, Carol S.; Smith, JuliaBACKGROUND: Many individuals diagnosed with posttraumatic stress disorder (PTSD) have been shown to experience symptoms of avoidance. These symptoms decrease access to social support, which has been shown to be a resilience factor associated with developing PTSD after trauma. MST-related PTSD represents a relative gap in the research. The aim of the current study was to determine if the presence of social support was associated with less MST-related PTSD and depressive symptom severity. SUBJECTS: A sample of 128 participants from a larger study that was examining the effectiveness of Cognitive Processing Therapy (CPT) in survivors of MST. METHOD: The scores of the CAPS, BDI-II, and three questions from the VPAT, a questionnaire specifically developed for the larger study at baseline were compared to see if an association existed between PTSD and depression symptom severity and social support. RESULTS: A series of simple linear regressions were run with the total score of the CAPS, individual criteria of the CAPS against the total social support score and each individual question pertaining to social support. Additionally, the total BDI-II score was run against the total social support score as well as each individual question on the VPAT pertaining to social support. DISCUSSION: Based on these results, it appears that the presence of social support is not associated with less PTSD symptom severity. Moreover, the presence of social support was not related to less depressive symptom severity.