Technological and Medical Advances: Implications for Health Psychology

Adherence in pediatric kidney transplant recipients: solutions for the system

Non-adherence remains a significant problem among pediatric (and adult) renal transplant recipients. Non-adherence among solid organ transplant recipients results in US$15-100 million annual costs. Estimates of non-adherence range from 30 to 70% among pediatric patients. Research demonstrates that a 10% decrement in adherence is associated with 8% higher hazard of graft failure and mortality. Focus has begun to shift from patient factors that impact adherence to the contributing healthcare and systems factors. The purpose of this review is to describe problems within the systems implicated in non-adherence and potential solutions that may be related to positive adherence outcomes. Systems issues include insurance and legal regulations, provider and care team barriers to optimal care, and difficulties with transitioning to adult care. Potential solutions include recognition of how systems can work together to improve patient outcomes through improvements in insurance programs, a multi-disciplinary care team approach, evidence-based medical management, pharmacy-based applications and interventions to simplify medication regimens, improved transition protocols, and telehealth/technology-based multi-component interventions. However, there remains a significant lack of reliability in the application of these potential solutions to systems issues that impact patient adherence. Future efforts should accordingly focus on these efforts, likely by leveraging quality improvement and related principles, and on the investigation of the efficacy of these interventions to improve adherence and graft outcomes.

Consideration of Insulin Pumps or Continuous Glucose Monitors by Adolescents With Type 1 Diabetes and Their Parents: Stakeholder Engagement in the Design of Web-Based Decision Aids

PURPOSE

This article describes the stakeholder-driven design, development, and testing of web-based, multimedia decision aids for youth with type 1 diabetes who are considering the insulin pump or continuous glucose monitoring and their parents. This is the initial phase of work designed to develop and evaluate the efficacy of these decision aids in promoting improved decision-making engagement with use of a selected device.

METHODS

Qualitative interviews of 36 parents and adolescents who had previously faced these decisions and 12 health care providers defined the content, format and structure of the decision aids. Experts in children's health media helped the research team to plan, create, and refine multimedia content and its presentation. A web development firm helped organize the content into a user-friendly interface and enabled tracking of decision aid utilization. Throughout, members of the research team, adolescents, parents, and 3 expert consultants offered perspectives about the website content, structure, and function until the design was complete.

RESULTS

With the decision aid websites completed, the next phase of the project is a randomized controlled trial of usual clinical practice alone or augmented by use of the decision aid websites.

CONCLUSIONS

Stakeholder-driven development of multimedia, web-based decision aids requires meticulous attention to detail but can yield exceptional resources for adolescents and parents contemplating major changes to their diabetes regimens.

Information for patients with or at risk of cancer-related lymphedema

The Internet has great potential to provide information to patients with or at risk of developing cancer-related lymphedema (CRL), a complication of cancer treatment. To evaluate Web site structure (e.g., accreditation, design) and content (e.g., validity) for available Web sites on CRL, lymphedema, lymphoedema, cancer, and oncology were used with 10 search engines (five French and five English). The first page of each Web site was examined and the content was identified and classified using the evaluation model of the Science Panel on Interactive Communication and Health. The search strategy yielded 120 Web sites. Using inclusion and exclusion criteria, 19 Web sites were selected. The authors found that 79% of the Web sites focused exclusively on CRL and 74% were in English. Although information about each site's sponsor, goal, and target audience was readily available, content material was incomplete and evaluation of Web site impact and effectiveness was nonexistent. This review suggests that Web sites about CRL vary greatly in terms of structure and content.

An empirical test of the materialist framework for understanding the general population's reaction to nonpersonalized genetic health messages

Genetic health messages are increasingly prevalent in our society. The materialist framework of laypeople's genetic knowledge may provide a good basis for understanding the effects of such messages on preventive behavior and related health cognitions. This study provides an empirical test of the predictions of this framework. We presented 929 participants who were aware or unaware of the existence of genetic risk factors for salt sensitivity with either a genetic health message or a general health message about salt sensitivity. Baseline, immediate follow-up, 1-month follow-up, and 6-month follow-up questionnaires assessed risk perception, intention, and salt consumption. Compared with the general health message, previously unaware participants reported lower susceptibility to, and lower severity of, salt sensitivity and lower intentions to restrict salt intake immediately after reading the genetic health message, but not at the 1- and 6-month follow-ups. No such effects were observed for previously aware participants. In addition, the authors observed no effect of health message type on self-reported salt consumption. The authors' findings support the validity of the materialist framework for understanding laypeople's knowledge of genetics. On the basis of the results, several implications were deduced for public education of genetics.

Videoconferencing at psychology internships: interns' perceptions of interactive television experiences and prospects

This article reviews the use and perceptions of videoconferencing in psychology internship training from the perspective of interns. Videoconferencing offers a means of expanding training beyond conventional on-site models. Psychology interns completed an online survey about their experiences with videoconferencing and perspectives of its impact on training. Most participants encountered it in their didactics. Some used it for supervision or other purposes. Interns' perspectives were complex, with videoconferencing seen as supporting learning similar to conventional training in some ways, yet as less desirable overall. Direct comparisons between videoconferencing and on-site training revealed interns perceived videoconferencing as somewhat less effective, and as deleteriously affecting learning dynamics. Challenges and potential benefits of incorporating videoconferencing into psychology internship training were identified. Potential benefits include augmenting available internship training and increasing rural sites' access to training.

Genetic health messages in the mass media: do the general public perceive non-personalized genetic health message as personally relevant?

OBJECTIVES

Although health messages communicating the role of genetics in health and disease development are increasingly prevalent in our society, no research has examined whether the general public perceives such messages as believable or personally relevant. We examined whether the general public accepted genetic health messages and viewed them personally relevant in promoting their preventive behaviour.

DESIGN

Experimental pre-test-post-test measurement design was employed to contrast the information acceptance and perceived personal relevance of the genetic health message with a general health message.

METHODS

We presented a randomly selected group of Dutch participants (N=1,319) with either a health message about the genetic risk factors for salt sensitivity or with a general health message about salt sensitivity without reference to genetic risk factors. Risk perception and intention to restrict salt intake was assessed before and after participants read the messages while information acceptance and perceived personal relevance was only assessed post-test.

RESULTS

Although we observed no effects of health message type on information processing, previously aware participants perceived the genetic health message as less personally relevant compared to the general health message. This difference in personal relevance resulted in lower estimates of susceptibility and a lower intention to engage in preventive behaviour among previously unaware participants.

CONCLUSIONS

Genetic health messages in the mass media may not be effective in promoting (intentions to engage in) preventive behaviour due to their low perceived personal relevance by the public. Hence, identifying strategies to increase personal relevance for genetic education is needed.

The psychologic context of pediatric diabetes

During the past few decades, there has been an explosion of behavioral science research on family management of pediatric diabetes. This article distills the major conclusions from that literature, emphasizing how primary care providers can apply these findings in clinical practice.

Prevention and Health Promotion: Decades of Progress, New Challenges, and an Emerging Agenda

Daily habits (e.g., smoking, diet, and exercise) and their immediate consequences (e.g., obesity) confer risk for most of the major health problems in industrialized nations. Hence, determinants of these behaviors and their modifications have been central topics in health psychology. Considerable scientific and applied progress has been made, but the field faces important challenges and opportunities in the future. These challenges and opportunities include changes in demographics and patterns of health, the need for a more comprehensive model of the domain of health behavior and prevention, the need to integrate behavioral and psychosocial risk and resilience, the incorporation of new technologies, and addressing a variety of professional and economic barriers to the implementation of prevention in health care.

How Changes in Population Demographics Will Impact Health Psychology: Incorporating a Broader Notion of Cultural Competence Into the Field

U.S. population demographics are undergoing striking changes that will impact health care and the research and practice of health psychology. An increase in the number of people who are older; belong to an ethnic minority group; have disabilities; identify as lesbian, gay, bisexual, or transgendered; or live in poverty will influence definitions of aging, health, and illness, and will challenge current psychological and medical treatment models. The authors argue that health psychologists need to become context competent for the field to be relevant and viable over the course of this new century. Health psychologists need to become aware of the multiple, overlapping contexts in which people live and apply this knowledge on a regular basis to research, practice, education and training, and policy in health psychology.

Health Psychology: What Will the Future Bring?

This commentary highlights several important themes and trends in this series of articles focusing on the future of health psychology. First, the challenges posed by changes in populations will only be met if health psychologists can develop a contextual competency. Second, with increasing evidence for the efficacy of health psychology interventions comes heightened interest in testing the effectiveness of these interventions. Third, issues of cost-effectiveness of health psychology will become increasingly important. Fourth, the growing integration of technological advances (e.g., telehealth, the Internet) into health psychology has major implications. Finally, the numerous changes outlined in this series of articles will demand that health psychologists extend and refine their theoretical models including the biopsychosocial model.

Introduction to the Special Section on the Future of Health Psychology

Following 25 years of landmark progress, health psychology faces even greater change in the foreseeable future. Evolving patterns of health and illness and developments in medicine and related fields will shape the future of health psychology. The articles in this special section discuss these future issues in several areas: the biopsychosocial model, changes in demographics, prevention, clinical health psychology interventions, health care financing, and new technologies. In every case, the future holds a variety of important challenges and opportunities in research, practice, training, and policy.