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Sass J, Hampton D, Edward J, Cardarelli R. Evaluation of the Impact of Discharge Clinic Follow-Up Interventions on 30-Day Readmission Rates. Popul Health Manag 2024; 27:137-142. [PMID: 38484314 DOI: 10.1089/pop.2023.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Care transition programs can result in cost avoidance and decreased resource utilization. This project aimed to determine whether implementation of a discharge clinic, referral to a community paramedicine program, or a second postdischarge call affected 30-day readmission rates. This single-center retrospective exploratory design study included 727 discharged patients without access to a primary care provider who were scheduled for a discharge clinic transitions appointment. Readmission rates were 17.7% for those who completed a discharge appointment and 24.7% for those who did not; 4% for those completing a second postdischarge call and 26% for those who did not; and 11.1% for those referred to a community paramedicine program and 24.9% for those not referred. A completed discharge clinic appointment resulted in 36% lower odds of readmission. A completed discharge clinic appointment was effective in reducing 30-day readmission rates as was a follow-up call.
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Affiliation(s)
- Jessica Sass
- Family & Community Medicine, UK Healthcare, Lexington, Kentucky, USA
| | - Debra Hampton
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Jean Edward
- UK College of Nursing, Lexington, Kentucky, USA
- Markey Cancer Center, UK Healthcare, Lexington, Kentucky, USA
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Yeager KA, Zahnd WE, Eberth JM, Vanderpool RC, Rohweder C, Teal R, Vu M, Stradtman L, Frost EL, Trapl E, Gonzalez SK, Vu T, Ko LK, Cole A, Farris PE, Shannon J, Askelson N, Seegmiller L, White A, Edward J, Davis M, Petermann V, Wheeler SB. Correction to: Financial navigation: staff perspectives on patients' financial burden of cancer care. J Cancer Surviv 2024; 18:631-632. [PMID: 35194758 DOI: 10.1007/s11764-022-01191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Whitney E Zahnd
- University of Iowa, Iowa City, IA, USA
- University of South Carolina, Columbia, SC, USA
| | | | | | | | - Randall Teal
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maihan Vu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Erika Trapl
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Thuy Vu
- University of Washington, Seattle, WA, USA
| | - Linda K Ko
- University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Arica White
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Melinda Davis
- Oregon Health & Science University, Portland, OR, USA
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Edward J, Brown KA, Caldwell M, Ruschman EA, Fariduddin H, Northrip KD, D'Orazio JA. Two Case Reports on Financial Toxicity and Healthcare Transitions in Adolescent and Young Adult Cancer Survivors. Clin J Oncol Nurs 2024; 28:227-231. [PMID: 38511924 DOI: 10.1188/24.cjon.227-231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
A team conducted semistructured interviews and developed case reports about financial toxicity (FT) and healthcare transitions (HCTs) with two adolescent and young adult (AYA) cancer survivors. These reports found poor HCTs f.
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Yeager KA, Zahnd WE, Eberth JM, Vanderpool RC, Rohweder C, Teal R, Vu M, Stradtman L, Frost EL, Trapl E, Gonzalez SK, Vu T, Ko LK, Cole A, Farris PE, Shannon J, Askelson N, Seegmiller L, White A, Edward J, Davis M, Petermann V, Wheeler SB. Financial navigation: Staff perspectives on patients' financial burden of cancer care. J Cancer Surviv 2023; 17:1461-1470. [PMID: 35080699 PMCID: PMC9314461 DOI: 10.1007/s11764-022-01175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe perceptions of financial navigation staff concerning patients' cancer-related financial burden. METHODS This qualitative descriptive study used a semi-structured interview guide to examine perceptions of financial navigation staff concerning patients' cancer-related financial burden. Staff who provided financial navigation support services to cancer patients were interviewed from different types of cancer programs across seven states representing rural, micropolitan, and urban settings. Interviews lasted approximately one hour, were audio recorded, and transcribed. Transcripts were double coded for thematic analysis. RESULTS Thirty-five staff from 29 cancer centers were interviewed. The first theme involved communication issues related to patient and financial navigation staff expectations, timing and the sensitive nature of financial discussions. The second theme involved the multi-faceted impact of financial burden on patients, including stress, difficulty adhering to treatments, and challenges meeting basic, non-medical needs. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: Cancer-related financial burden has a profound impact on cancer survivors' health and non-health outcomes. Discussions regarding cancer-related costs between cancer survivors and healthcare team members could help to normalize conversations and mitigate the multi-faceted determinants and effects of cancer-related financial burden. As treatment may span months and years and unexpected costs arise, having this discussion regularly and systematically is needed.
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Affiliation(s)
| | - Whitney E Zahnd
- University of Iowa, Iowa City, IA, USA
- University of South Carolina, Columbia, SC, USA
| | | | | | | | - Randall Teal
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maihan Vu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Erika Trapl
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Thuy Vu
- University of Washington, Seattle, WA, USA
| | - Linda K Ko
- University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Arica White
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Melinda Davis
- Oregon Health & Science University, Portland, OR, USA
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Edward J. Addressing the Social Determinants of Health Equity. Am J Nurs 2023; 123:15. [PMID: 37345773 DOI: 10.1097/01.naj.0000944896.53423.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
A call to action for nurses.
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Affiliation(s)
- Jean Edward
- Jean Edward is associate professor and assistant dean for diversity, equity and inclusion at the University of Kentucky College of Nursing in Lexington. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise
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Griggs S, Hampton D, Edward J, McFarlin J. Impact of Case Review Debriefings on Moral Distress of Extracorporeal Membrane Oxygenation Nurses. Crit Care Nurse 2023; 43:12-18. [PMID: 37257873 DOI: 10.4037/ccn2023870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Moral distress occurs when nurses know the ethically correct action to take but are restrained from taking it. Moral distress is prevalent in nurses who work in intense stress situations, as do extracorporeal membrane oxygenation nurses. LOCAL PROBLEM Nurses who work in critical care settings have higher levels of moral distress than nurses who work in other practice areas. The purpose of this project was to evaluate the effectiveness of case review debriefings on moral distress of extracorporeal membrane oxygenation nurses. METHODS Thirty-nine critical care registered nurses with specialty training in extracorporeal membrane oxygenation were invited to participate in this clinical improvement project. The intervention consisted of 2 case review debriefings. The Moral Distress Scale-Revised and the Moral Distress Thermometer were used to measure long-term and acute (short-term) moral distress. RESULTS Of a potential range of 0 to 336, the mean Moral Distress Scale-Revised score was 134.0 before intervention and 131.8 after intervention. The frequency of experiencing moral distress did not change after intervention, but the level of moral distress increased after intervention. Moral Distress Thermometer scores decreased for 80% of participants and increased for 20%. Five items related to perceptions of prolonging death and suffering were the most frequent causes of moral distress. CONCLUSIONS Developing strategies and providing opportunities to mitigate moral distress are crucial to a healthy future nursing workforce. Implications include the potential for improved patient care, decreased turnover rates and costs, and improved nurse satisfaction rates.
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Affiliation(s)
- Sherry Griggs
- Sherry Griggs is an assistant patient care manager at University of Kentucky Healthcare, Lexington, Kentucky
| | - Debra Hampton
- Debra Hampton is Assistant Dean of the Master of Science in Nursing and Doctor of Nursing Practice programs, an academic program coordinator for graduate leadership programs, and an associate professor at the University of Kentucky College of Nursing, Lexington
| | - Jean Edward
- Jean Edward is Assistant Dean of Diversity, Equity and Inclusion and an associate professor at the University of Kentucky College of Nursing and a nurse scientist at University of Kentucky Healthcare
| | - Jessica McFarlin
- Jessica McFarlin is the Division Chief of Palliative Care and an assistant professor at University of Kentucky Healthcare
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Edward J, Peterman VM, Eberth JM, Zahnd WE, Vanderpool RC, Askelson N, Rohweder CL, Koopman Gonzalez S, Stradtman LR, Ko LK, Farris PE. Interventions to address cancer-related financial toxicity: Recommendations from the field. J Rural Health 2022; 38:817-826. [PMID: 34861066 PMCID: PMC9163204 DOI: 10.1111/jrh.12637] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Addressing financial toxicity among cancer patients is a complex process that requires a multifaceted approach, particularly for rural patients who may face additional cost-related barriers to care. In this study, we examined interventions being implemented by financial navigation staff at various cancer centers that help address financial toxicity experienced by oncology patients. METHODS We conducted semistructured interviews with a convenience sample of financial navigation staff across 29 cancer centers in both rural and urban areas in 7 states. Interviews were audio-recorded and transcribed. Descriptive coding and thematic analysis techniques were used to analyze the data. FINDINGS Thirty-five participants were interviewed, the majority of whom worked in cancer centers located in rural counties. Participants identified the use of screening tools, patient education, and access to tailored financial assistance resources as best practices. Immediate resource needs included additional financial navigation staff, including lay navigators and community health workers, to promote linkages to local resources. Suggested clinical areas for intervention included proactive and early implementation of financial assessments and discussions between providers and patients, along with training and access to regularly updated resources for those in financial navigator/counselor roles. Participants also discussed the need for policy-level interventions to reform health systems (including employment protections) and health insurance programs. CONCLUSIONS Implementing proactive methods to screen for and address financial needs of patients is essential to improving cancer-related outcomes. Additional programs and research are needed to help establish systematic and standardized methods to enhance financial navigation services, especially for underserved rural communities.
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Affiliation(s)
- Jean Edward
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Victoria M. Peterman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jan M. Eberth
- Epidemiology and Biostatistics, Arnold School of Public Health & Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
| | - Whitney E. Zahnd
- Holden Comprehensive Cancer Center, College of Public Health, University of Iowa, Iowa City, Iowa
| | | | - Natoshia Askelson
- Community and Behavioral Health, University of Iowa, Iowa City, Iowa
| | - Catherine L. Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sarah Koopman Gonzalez
- Department of Population and Quantitative Health Sciences, Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, Ohio
| | - Lindsay R. Stradtman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Linda K. Ko
- Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington
| | - Paige E. Farris
- Knight Cancer Institute’s Community Outreach and Engagement Program, Oregon Health & Science University, Portland, Oregon
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Darville A, Williams L, Edward J, Butler K, Rademacher K, Gray B, Tischner CM, Keeler H, Hahn EJ. Enhancing Tobacco Treatment for Medicaid Recipients. South Med J 2022; 115:603-610. [PMID: 35922046 DOI: 10.14423/smj.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Medicaid recipients are vulnerable to increased morbidity and mortality secondary to high tobacco use prevalence and barriers to accessing tobacco treatment. The purpose of the pilot study was to explore managed care administrators' perceptions of the facilitators and barriers to tobacco treatment for Medicaid recipients. METHODS Focus groups with key informants (n = 14) from managed care organizations were conducted in fall 2018. Participants included case, integrated care, quality and field care managers, and individuals working in provider and network relations. RESULTS Facilitators to tobacco treatment were universal quality reporting requirements, access to medications, and the role of case management in identifying and engaging tobacco users in treatment. Barriers included bias regarding smokers' ability to quit, communication challenges, and competing priorities. CONCLUSIONS The analysis provided data to support the development of a policy brief and recommendations to the Department for Medicaid Services for enhancing tobacco dependence treatment.
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Affiliation(s)
- Audrey Darville
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Lovoria Williams
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Jean Edward
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Karen Butler
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Kathy Rademacher
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Brittney Gray
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Clair M Tischner
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Hannah Keeler
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Ellen J Hahn
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
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Gomez ML, Azam T, Edward J, Bowman H, Williams LB. Assessing the Intention, Attitudes, and Social Influences on COVID-19 Preventive Behaviors Among Non-rural Black and Rural Appalachian White Populations: A Faith-Based Community Study. J Appalach Health 2022; 4:45-64. [PMID: 38028329 PMCID: PMC10629878 DOI: 10.13023/jah.0402.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Introduction The COVID-19 pandemic has had detrimental impacts in non-rural Black and rural Appalachian populations. Yet despite the pandemic's magnitude, there is a scarcity of research exploring potential influences of attitudes and social influences within these populations on their adherence to COVID-19 public health preventive behaviors. Purpose This study examines the intention, attitudes, and social influences to adhere to COVID-19 preventive behaviors among non-rural Black and rural Appalachian congregants in Kentucky by integrating the Theory of Planned Behavior (TPB). Methods Secondary analysis of cross-sectional data was used to assess the association between the TPB constructs and four key public health behaviors: obeying a stay-at-home order, social distancing, good hygiene practices, and wearing a mask in public. Generalized estimating equation-type logistic regression models were fit for all binary outcomes. Results A total of 942 respondents completed the survey. Eighty-nine per cent were older than 36 years, and 73% were female. Of the respondents who were White, 97.7% lived in rural Appalachia Kentucky, and of those who were Black, 93.5% lived in non-rural Kentucky. Attitude towards the behavior was negatively associated with the stay-at-home order ( p=0.003). Both attitude toward the behavior ( p<0.001) and the subjective norm ( p=0.025) were negatively associated with mask wearing. Perceived behavioral control was positively associated with mask wearing ( p=0.023) with non-rural respondents more likely to wear a mask than rural ones ( p<0.001). None of the TPB constructs showed significant association with hygiene practices or with social distancing. Implications This study provides further insight into the cultural and societal influences that intersect during a global pandemic. The intention to comply with public health recommendations may vary at favorable and unfavorable levels. The results lend support to the importance of designing effective, culturally tailored communication for future public health preparedness.
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Edward J, Bowling W, Chitwood H, Vanderpool R. Availability and Accessibility of Cancer Care Delivery Approaches to Reduce Financial Toxicity of Rural and Urban Cancer Patients in Kentucky. J Oncol Navig Surviv 2022; 13:156-164. [PMID: 36698508 PMCID: PMC9873237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Cancer care delivery approaches to address financial toxicity among cancer patients are not well-established, especially in rural communities. Objectives To identify healthcare staff perspectives of financial toxicity experienced by cancer patients and to examine staff- and systems-level cancer care delivery approaches for addressing financial toxicity, with a focus on rural cancer survivors in Kentucky. Methods We conducted key informant interviews using a semistructured interview guide with cancer center staff who provided financial navigation and/or assistance to oncology patients and their caregivers at 15 cancer centers in Kentucky. Results Findings from this study revealed several key factors related to the availability and accessibility of cancer care delivery approaches at patient, staff, and system levels for reducing financial toxicity and improving access to care for rural and urban cancer survivors. Participants perceived high financial toxicity among cancer patients, especially in rural regions, related to the high cost of cancer care, as well the patients' limited ability to engage in cost-of-care conversations, low cost-related health literacy, and challenges in navigating cancer care. The availability of trained financial navigators/counselors dedicated solely to assisting the cancer patient population was limited, as was the use of standardized and proactive screening methods for financial toxicity. While in-house and external financial assistance programs were frequently tapped into, there were limitations in the navigators' ability to provide cost estimates based on insurance coverage and in assisting patients with applying for health insurance. Gaps in cancer care delivery approaches to reduce financial toxicity of patients included enhanced transportation options, additional financial navigation staff, early assessment of patient financial barriers and concerns, increased cost transparency, and enhanced cost-of-care conversations between patients and clinicians. Conclusion Establishing sustainable oncology-designated financial navigation roles is imperative to expanding patient support and improving health and financial outcomes of cancer patients. Future research is needed to gather evidence that informs programs targeted at mitigating financial toxicity of cancer patients in rural communities.
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Affiliation(s)
- Jean Edward
- Assistant Professor, College of Nursing; Nurse Scientist, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - William Bowling
- Department of Psychiatry, University of Kentucky, Lexington, KY
| | - Holly Chitwood
- College of Nursing, University of Kentucky, Lexington, KY
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Zahnd WE, Del Vecchio N, Askelson N, Eberth JM, Vanderpool RC, Overholser L, Madhivanan P, Hirschey R, Edward J. Definition and categorization of "rural" and assessment of realized access to care. Health Serv Res 2022; 57:693-702. [PMID: 35146771 DOI: 10.1111/1475-6773.13951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine how three measures of realized access to care vary by definitions and categorizations of "rural". DATA SOURCES Health Information National Trends Survey (HINTS) data, a nationally representative survey assessing knowledge of health-related information, were used. Participants were categorized by county-based Urban Influence Codes (UICs), Rural-Urban Continuum Codes (RUCCs), and census tract-based Rural-Urban Commuting Area (RUCAs). STUDY DESIGN Three approaches were used across categories of UICs, RUCCs, and RUCAs: 1) non-metropolitan/metropolitan, 2) 3-group categorization based upon population size, and 3) 3-group categorization based on adjacency to metropolitan areas. Wald Chi-square tests evaluated differences in sociodemographic variables and three measures of realized access across 3 of Penchansky's "A's of access" and approaches. The three outcome measures included: having a regular provider (realized availability), self-reported "excellent" quality of care (realized acceptability), and self-report of the provider "always" spending enough time with you (provider attentiveness--realized accommodation). The average marginal effects corresponding to each outcome were calculated. DATA COLLECTION/EXTRACTION METHODS N/A PRINCIPAL FINDINGS: All approaches indicated comparable variation in sociodemographics. In all approaches, RUCA-based categorizations showed differences in having a regular provider (e.g., 68.9% of non-metropolitan and 64.4% of metropolitan participants had a regular provider). This association was attenuated in multivariable analyses. No rural-urban differences in quality of care were seen in unadjusted or adjusted analyses regardless of approach. After adjustment for covariates, rural respondents reported greater provider attentiveness in some categorizations of rural compared to urban (e.g., non-metropolitan respondents reported 6.03 percentage point increase in probability of having an attentive provider [CI = 0.76-11.31%] compared to metropolitan). CONCLUSIONS Our findings underscore the importance of considering multiple definitions of rural to understand access disparities and suggest that continued research is needed to examine the interplay between potential and realized access. These findings have implications for federal funding, resource allocation, and identifying health disparities. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA
| | | | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA
| | - Jan M Eberth
- Health Communication and Informatics Research Branch, National Cancer Institute, Bethesda, MD
| | - Robin C Vanderpool
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, SC
| | - Linda Overholser
- Department of Internal Medicine, University of Colorado, Denver, CO
| | - Purnima Madhivanan
- Health Promotion Sciences Department, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Rachel Hirschey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jean Edward
- College of Nursing, University of Kentucky, Lexington, KY
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Edward J, Thompson RA, Wiggins A. Health Insurance Literacy Levels of Information Intermediaries: How Prepared Are They to Address the Growing Health Insurance Access Needs of Consumers? Health Lit Res Pract 2022; 6:e30-e36. [PMID: 35263232 PMCID: PMC8919673 DOI: 10.3928/24748307-20220201-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: With rising unemployment rates brought on by coronavirus disease 2019 pandemic, the rates of underinsured and uninsured consumers are likely to rise. Health information intermediaries play a critical role in assisting consumers with navigating the complexities of the United States health care system and the ever-changing health care policy landscape. Not much is known about the health insurance literacy (HIL) levels of information intermediaries and their ability to assist consumers with making informed decisions about their health insurance. Objective: This study aimed to examine the association between information intermediary levels of HIL, sociodemographic factors, and confidence and behaviors in assisting consumers with health insurance needs. Methods: We surveyed 118 information intermediaries from various roles to assess objective and subjective HIL, frequency, and confidence in assisting consumers, and confidence in understanding changes in federal health reform policies and state Medicaid waiver programs. Key Results: Less than one-half (39%) of information intermediaries had high subjective HIL and much fewer (13%) had high objective HIL. The average frequency of assisting consumers with health insurance scores were somewhat low, and confidence in assisting consumers with health insurance scores and confidence with understanding state and federal policies were modest. Results from our logistic regression model indicated that confidence in assisting consumers was found to be the only significant contributor to high subjective HIL. For every one-point increase on the confidence assisting subscale, there was a 35% increase in the information intermediaries having high subjective HIL. Conclusions: Findings from this study, coupled with rising uninsured rates, indicate the need for tailored training programs and resources to equip our information intermediaries to provide timely and appropriate health insurance support for consumers. [HLRP: Health Literacy Research and Practice. 2022;6(1):e30–e36.] Plain Language Summary: In a sample of 118 information intermediaries, representing community health workers, navigators, and other people in outreach roles, the majority had low subjective and objective HIL. We also found that as confidence with assisting consumers with health insurance needs increases, HIL increased as well. These findings indicate that tailored training programs and resources are needed to equip information intermediaries to provide health insurance support for consumers.
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Affiliation(s)
- Jean Edward
- Address correspondence to Jean Edward, PhD, RN, College of Nursing, University of Kentucky, 751 Rose Street, Room 557, Lexington, KY 40536;
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Abstract
An estimated 11%-33% of persons taking methotrexate for rheumatoid arthritis (RA) are intolerant to this medication. Medications for RA are often discontinued or changed because of patient intolerance. Yet, intolerance is a poorly defined perspective, specifically the patient's perspective. This study used descriptive qualitative methodologies to describe methotrexate intolerance from the perspective of adult patients with RA. Semistructured, audio-recorded individual interviews were conducted with 14 adult English-speaking patients with RA who had been prescribed, were taking, or had ever taken methotrexate. Methotrexate intolerance involves a complex belief system involving 3 themes: beliefs about the risk of methotrexate, beliefs about the benefits of methotrexate, and beliefs about the threat of RA. Participants reported a threshold by which perceived risks and benefits of methotrexate were weighed against perceived risks of RA. The critical underpinnings of the largely undefined and unique patient perspective of methotrexate intolerance are described.
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Affiliation(s)
- Elizabeth Salt
- Elizabeth Salt, PhD, APRN, Associate Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
- Kristine Lohr, MD, Professor, and Chair, Division of Rheumatology, College of Medicine, University of Kentucky, Lexington, KY
- Jean Edward, PhD, RN, CHPE, Assistant Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
| | - Kristine Lohr
- Elizabeth Salt, PhD, APRN, Associate Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
- Kristine Lohr, MD, Professor, and Chair, Division of Rheumatology, College of Medicine, University of Kentucky, Lexington, KY
- Jean Edward, PhD, RN, CHPE, Assistant Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
| | - Jean Edward
- Elizabeth Salt, PhD, APRN, Associate Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
- Kristine Lohr, MD, Professor, and Chair, Division of Rheumatology, College of Medicine, University of Kentucky, Lexington, KY
- Jean Edward, PhD, RN, CHPE, Assistant Professor, Department of Nursing Instruction, College of Nursing, University of Kentucky, Lexington, KY
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Hudson L, Samons KM, Dicken HE, Prichard C, Weiss LT, Edward J, Vanderpool RC, Vanderford NL. A Brief Educational Intervention Enhances Basic Cancer Literacy Among Kentucky Middle and High School Students. J Cancer Educ 2021; 36:735-740. [PMID: 31989408 PMCID: PMC7388006 DOI: 10.1007/s13187-020-01696-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Kentucky experiences the highest overall cancer incidence and mortality rates in the USA with the greatest burden in the eastern, Appalachian region of the state. Cancer disparities in Kentucky are driven in part by poor health behaviors, poverty, lack of health care access, low education levels, and low health literacy. Individuals with inadequate health literacy are less likely to participate in preventive measures such as obtaining screenings and making healthy lifestyle choices, thus increasing their chances of developing and dying from cancer. By increasing cancer literacy among youth and adults, it may be possible to decrease cancer disparities across Kentucky. This study aimed to establish connections with middle and high schools in Kentucky that would facilitate pilot implementation of a brief cancer education intervention and assessment of cancer health literacy among these student populations. A baseline pretest cancer literacy survey consisting of 10 items was given to 349 participants, followed by the delivery of a cancer education presentation. Immediately following the presentation, participants were given a posttest with identical items to the pretest. Participants were primarily Caucasian (89.4%), female (68.7%), and in 10th through 12th grade (80.5%). Significant (p < 0.0001) increases in both average and median percent of correctly marked items were observed between the pretest and posttest (average, pretest = 56% versus posttest = 85%; median, pretest = 60% versus posttest = 90%). The scores for all individual items increased after the brief intervention. The results demonstrated a significant increase in cancer literacy levels immediately after the pilot educational intervention. We suggest that it may be possible to improve cancer literacy rates in Kentucky by integrating cancer education into middle and high school science and/or health education curricula. This could ultimately drive changes in behaviors that may help lower cancer incidence and mortality rates. Plans for future interventional studies measuring long-term cancer knowledge retention and resultant behavioral changes among middle and high school students as well as the feasibility of integrating cancer education into middle and high school curricula are also discussed.
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Affiliation(s)
- Lauren Hudson
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | | | - Haley E Dicken
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Chris Prichard
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - L Todd Weiss
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Jean Edward
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | | | - Nathan L Vanderford
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
- Department of Toxicology & Cancer Biology, College of Medicine, University of Kentucky, Ben F. Roach Building, 800 Rose Street, CC140, Lexington, KY, 40536-0096, USA.
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Siddig S, Kaboush M, Dabora M, Gafer N, Khair Allah M, Zakaria S, Salim S, Edward J. Omission of radiation therapy after breast conserving surgery in older early breast cancer among Sudanese patients. Breast 2021. [DOI: 10.1016/s0960-9776(21)00117-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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McLouth LE, Nightingale CL, Dressler EV, Snavely AC, Hudson MF, Unger JM, Kazak AE, Lee SJC, Edward J, Carlos R, Kamen CS, Neuman HB, Weaver KE. Current Practices for Screening and Addressing Financial Hardship within the NCI Community Oncology Research Program. Cancer Epidemiol Biomarkers Prev 2020; 30:669-675. [PMID: 33355237 DOI: 10.1158/1055-9965.epi-20-1157] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer-related financial hardship is associated with poor care outcomes and reduced quality of life for patients and families. Scalable intervention development to address financial hardship requires knowledge of current screening practices and services within community cancer care. METHODS The NCI Community Oncology Research Program (NCORP) 2017 Landscape Assessment survey assessed financial screening and financial navigation practices within U.S. community oncology practices. Logistic models evaluated associations between financial hardship screening and availability of a cancer-specific financial navigator and practice group characteristics (e.g., safety-net designation, critical access hospital, proportion of racial and ethnic minority patients served). RESULTS Of 221 participating NCORP practice groups, 72% reported a financial screening process and 50% had a cancer-specific financial navigator. Practice groups with more than 10% of new patients with cancer enrolled in Medicaid (adjOR = 2.81, P = 0.02) and with less than 30% racial/ethnic minority cancer patient composition (adjOR = 3.91, P < 0.01) were more likely to screen for financial concerns. Practice groups with less than 30% racial/ethnic minority cancer patient composition (adjOR = 2.37, P < 0.01) were more likely to have a dedicated financial navigator or counselor for patients with cancer. CONCLUSIONS Most NCORP practice groups screen for financial concerns and half have a cancer-specific financial navigator. Practices serving more racial or ethnic minority patients are less likely to screen and have a designated financial navigator. IMPACT The effectiveness of financial screening and navigation for mitigating financial hardship could be tested within NCORP, along with specific interventions to address cancer care inequities.See related commentary by Yabroff et al., p. 593.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, University of Kentucky, Markey Cancer Center, Center for Health Equity Transformation, Lexington, Kentucky.
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew F Hudson
- NCORP of the Carolinas, Prisma Health, Greenville, South Carolina
| | - Joseph M Unger
- Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, SWOG Statistics and Data Management Center, Seattle, Washington
| | - Anne E Kazak
- Centers for Healthcare Delivery Service, Nemours Children's Health System, Wilmington, Delaware
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, University of Texas-Southwestern Medical Center, Dallas, Texas
| | - Jean Edward
- College of Nursing, University of Kentucky, Markey Cancer Center, UK Healthcare, Lexington, Kentucky
| | - Ruth Carlos
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Heather B Neuman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Abstract
Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women's mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas' conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.
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Affiliation(s)
- Mollie E Aleshire
- School of Nursing, University of Louisville, Louisville, Kentucky, United States
| | | | - Omar A Escontrías
- Office of Community Outreach and Engagement, The University of Arizona Cancer Center, Phoenix, United States
| | - Jean Edward
- College of Nursing, University of Kentucky, Lexington, United States
| | - Jennifer Hatcher
- Office of Community Outreach and Engagement, The University of Arizona Cancer Center, Phoenix, United States
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18
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Zhang Y, Leveille SG, Edward J. Wisdom teeth, periodontal disease, and C-reactive protein in US adults. Public Health 2020; 187:97-102. [PMID: 32942171 DOI: 10.1016/j.puhe.2020.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study aim was to evaluate the associations among the presence of wisdom teeth (third molars, M3), periodontal disease, and serum C-reactive protein (CRP) in the US adult population, thus to generate population-based evidence to inform heart disease prevention and dental care. STUDY DESIGN We performed secondary data analysis of the 2009-2010 National Health and Nutrition Examination Survey (NHANES), and included 3752 people aged 30 years and older who participated in the periodontal examination. METHODS Descriptive analyses were performed to determine the prevalence of M3 presence, periodontal disease, and elevated CRP. Multivariate logistic regression modeling was used to determine the association between M3 presence, periodontal disease, and elevated CRP. RESULTS The prevalence of M3 presence, periodontal disease (probing periodontal pockets depth (PPD)≥ 4 mm), and elevated serum C-reactive protein level (≥5 mg/L) was 39%, 41%, and 19% respectively. M3 presence was highest among men, younger adults, Blacks and Hispanics compared to Non-Hispanic Whites, those who did not attend college, and people with low incomes (P < 0.001). M3 presence, adjusted for sociodemographic and health characteristics, was independently associated with periodontal disease (adjusted [Adj.] odds ratio [OR] 1.61, 95% confidence interval [CI] 1.31, 1.97), and periodontal disease was independently associated with elevated serum CRP (Adj. OR 1.35, 95% CI 1.06, 1.73), but we did not find M3 presence associated with elevated serum CRP (Adj. OR 1.02, 95% CI 0.79, 1.31). CONCLUSIONS We observed expected associations between M3 presence and periodontal disease, and periodontal disease and elevated CRP. However, M3 presence alone is not associated with elevated CRP. Further research into cardiovascular health hazards related to the retention of wisdom teeth is needed, including examining possible relationships with other inflammatory factors.
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Affiliation(s)
- Y Zhang
- College of Nursing and Health Science, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA
| | - S G Leveille
- College of Nursing and Health Science, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, USA.
| | - J Edward
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
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Edward J, Thompson R, Jaramillo A. Availability of Health Insurance Literacy Resources Fails to Meet Consumer Needs in Rural, Appalachian Communities: Implications for State Medicaid Waivers. J Rural Health 2020; 37:526-536. [PMID: 32583893 PMCID: PMC8359253 DOI: 10.1111/jrh.12485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose With the impending changes to state Medicaid programs and other health reform policies, it is imperative to understand the factors at play in promoting consumer health insurance literacy and health system engagement. This study examines the availability of health system and community‐based programs promoting health insurance literacy and supporting informed consumer health care decision making in rural communities in Kentucky. Methods Forty‐six health systems, community‐based providers, and outreach workers participated in 4 focus groups and 10 semistructured interviews. Descriptive and analytic coding techniques were used to identify 5 major themes and subthemes from interview and focus group transcripts. Findings Consumers were generally identified as having low health insurance literacy, especially in rural communities, serving as a barrier to accessing health care insurance and services. Participants identified their own lack of knowledge and understanding around health systems, resulting from lack of training and challenges with staying updated on constant changes in health systems and policies. Overall, consumer demand or need for health insurance literacy resources and programs far exceeded supply or availability. Constant changes in the status of Kentucky's Medicaid program and the proposed changes to eligibility, specifically work requirements and copays, have caused increased confusion among both providers and consumers. Conclusions Findings indicate a pressing need for implementing programs that provide training, tools, and resources to outreach workers to help them better assist consumers with accessing and using health insurance, especially in low‐income, rural areas. Health reform policies need to be responsive to the health insurance literacy needs and abilities of consumers.
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Affiliation(s)
- Jean Edward
- College of Nursing, University of Kentucky, Lexington, Kentucky.,Markey Cancer Center, University of Kentucky Healthcare, Lexington, Kentucky
| | | | - Andrea Jaramillo
- Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
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20
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Edward J. Effective Cost Conversations: Addressing Financial Toxicity and Cost-Related Health Literacy. Clin J Oncol Nurs 2020; 24:209-213. [PMID: 32196003 DOI: 10.1188/20.cjon.209-213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer survivors have greater risk of experiencing financial toxicity, or the undue financial burden and stress that patients face related to the costs of cancer care. Cost-related health literacy promotion should begin at the point of care with effective cost-of-care conversations that help to identify and manage patient financial needs. Nurses are uniquely positioned and often sought out as trusted sources of cost-of-care information and play a key role in engaging in effective cost conversations that help consumers to understand and manage their costs of care.
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21
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Zahnd WE, Askelson N, Vanderpool RC, Stradtman L, Edward J, Farris PE, Petermann V, Eberth JM. Challenges of using nationally representative, population-based surveys to assess rural cancer disparities. Prev Med 2019; 129S:105812. [PMID: 31422226 PMCID: PMC7289622 DOI: 10.1016/j.ypmed.2019.105812] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022]
Abstract
Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. Our objective is three-fold. First, we examined the characterization of "rural" in four, population-based surveys commonly referenced in the literature: 1) Health Information National Trends Survey (HINTS); 2) National Health Interview Survey (NHIS); 3) Behavioral Risk Factor Surveillance System (BRFSS); and 4) Medical Expenditures Panel Survey (MEPS). Second, we identified and described the challenges of using these surveys in rural cancer studies. Third, we proposed solutions to address these challenges. We found that these surveys varied in use of rural-urban classifications, sampling methodology, and available cancer-related variables. Further, we found that accessibility of these data to non-federal researchers has changed over time. Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr. Suite 204, Columbia, SC 29210, United States of America.
| | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, United States of America.
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, United States of America.
| | - Lindsay Stradtman
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, United States of America.
| | - Jean Edward
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, United States of America.
| | - Paige E Farris
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - Victoria Petermann
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall Campus Box #7460, Chapel Hill, NC 27599-7460, United States of America.
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr. Suite 204, Columbia, SC 29210, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America; Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America.
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Shawler C, Edward J, Ling J, Crawford TN, Rayens MK. Impact of Mother-Daughter Relationship on Hypertension Self-management and Quality of Life: Testing Dyadic Dynamics Using the Actor-Partner Interdependence Model. J Cardiovasc Nurs 2019; 33:232-238. [PMID: 28990970 PMCID: PMC5886818 DOI: 10.1097/jcn.0000000000000448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although hypertension (HTN) treatment rates are similar across age groups of women, effective control is significantly worse among older women. Only 20% of hypertensive women aged 70 to 79 years have controlled blood pressure. OBJECTIVES The purpose of this longitudinal study was to test the effects of the quality of mother-daughter relationship, inner strength, and control on HTN self-management and health-related quality of life (HRQOL) for both members of the dyad at 6 months. The Actor-Partner Interdependence Model was used to examine the direct ("actor") and indirect ("partner") effects of 46 dyads. RESULTS The mothers' perceived relationship quality with daughters directly impacted their own self-management of HTN and HRQOL while also indirectly affecting their daughters' self-management. Similarly, the daughters' perceived strength of their relationship with their mothers directly influenced their self-management and HRQOL and indirectly affected their mothers' self-management and HRQOL.
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Affiliation(s)
- Celeste Shawler
- Celeste Shawler, PhD, PMHCNS-BC Associate Professor, University of Louisville School of Nursing, Kentucky. Jean Edward, PhD, RN, CHPE Assistant Professor, College of Medicine, University of Kentucky Medical School, Lexington. Jiying Ling, PhD, MS, RN Assistant Professor, School of Nursing, Michigan State University, East Lansing. Tim N. Crawford, PhD, MPH Assistant Professor and Biostatistician, University of Louisville School of Nursing, Kentucky. Mary Kay Rayens, PhD Professor, University of Kentucky College of Nursing, Lexington
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Edward J, Wiggins A, Young MH, Rayens MK. Significant Disparities Exist in Consumer Health Insurance Literacy: Implications for Health Care Reform. Health Lit Res Pract 2019; 3:e250-e258. [PMID: 31768496 PMCID: PMC6831506 DOI: 10.3928/24748307-20190923-01] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/20/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Health insurance literacy (HIL) is defined as a person's ability to seek, obtain, and understand health insurance plans, and once enrolled use their insurance to seek appropriate health care services. Objective: The objectives of this study were to assess sociodemographic disparities in HIL, including knowledge of health insurance terms and costs, and confidence in using insurance to access health care in a nationally representative adult sample. Methods: We conducted a secondary data analysis of the Health Reform Monitoring Survey, which included 15,168 adults age 18 years and older who responded to surveys in the third quarter of 2015 and first quarter of 2016. Rao-Scott chi-square tests and weighted logistic regression were used for analysis. Key Results: The majority of our sample (51%) reported having inadequate HIL as measured by knowledge of basic insurance terms, and close to one-half (48%) had low confidence in using their insurance to access health care. Logistic regression analysis indicated significant disparities in HIL, with multiple groups identified as being at higher risk for having inadequate HIL (as measured by both knowledge and use of health insurance). These included young adults, women, those with Hispanic ethnicity, those who were not U.S. citizens, and those who were currently unmarried. Also identified to be at risk were those who are unemployed, uninsured, and enrolled in public health insurance plans, and those with lower levels of education and income. Most had inadequate knowledge of their annual out-of-pocket costs and insurance plan's deductible amounts. Conclusions: One-half of U.S. adults rate themselves as having inadequate HIL. Sociodemographic disparities in self-reported HIL underscore the need for increased consumer education, as well as efforts to simplify the health care system by promoting value-based care, supporting delivery system reforms, and designing services to be responsive to consumer HIL needs and abilities. [HLRP: Health Literacy Research and Practice. 2019;3(4):e250–e258.] Plain Language Summary: In a nationally representative sample of 15,168 adults, the majority had low knowledge about basic health insurance terms and had difficulty using health insurance to access needed health care services. These findings indicate that health insurance literacy is a major concern in our community that disproportionately affects some underserved groups more than others, including young adults, groups with low-income, and people who are uninsured.
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Affiliation(s)
- Jean Edward
- Address correspondence to Jean Edward, PhD, RN, College of Nursing, University of Kentucky, 751 Rose Street, Room 557, Lexington, KY 40536;
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Glassman SD, Carreon LY, Brown ME, Jones JS, Edward J, Li J, Williams MV. The impact of health literacy on health status and resource utilization in lumbar degenerative disease. Spine J 2019; 19:711-716. [PMID: 30395960 DOI: 10.1016/j.spinee.2018.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Health literacy, defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions," has been demonstrated to affect access to care and appropriate healthcare utilization. PURPOSE To determine the impact of health literacy in the evaluation and management of patients with chronic low back pain. STUDY DESIGN Cross sectional. PATIENT SAMPLE Patients seen at a multisurgeon spine specialty clinic. OUTCOME MEASURES Oswestry Disability Index, EQ-5D, and Numeric Rating Scales (0-10) for back and leg pain. METHODS The Newest Vital Sign (NVS) and Health Literacy Survey, Oswestry Disability Index, EQ-5D and pain scales were administered to patients undergoing evaluation and treatment for lumbar degenerative disease in the outpatient setting. Patients were surveyed regarding their use of medication, therapy, and pain management modalities. RESULTS Of 201 patients approached for participation, 186 completed the health literacy surveys. Thirty (17%) were assessed as having limited literacy, 52 (28%) as possibly having limited literacy and 104 (56%) having adequate literacy based on their NVS scores. The cohort with low NVS scores also had low Health Literacy Survey Scores. Patients with limited literacy had worse back and leg pain scores compared with patients with possibly limited literacy and adequate literacy. Patients with adequate health literacy were more likely to use medications (80% vs. 53%, p = .017) and were more likely to see a specialist (34% vs. 17%) compared with those with limited literacy. Patients with limited health literacy were not more likely to see a chiropractor (7% vs. 7%), but reported more visits (19 vs. 8). CONCLUSIONS Patients with lower health literacy reported worse back and leg pain scores, indicating either more severe disease or a fundamental difference in their responses to standard health-related quality of life measures. This study also suggests that patients with limited health literacy may underutilize some resources and overutilize other resources. Further study is needed to clarify these patterns, and to examine their impact on health status and clinical outcomes.
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Affiliation(s)
- Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA.
| | - Morgan E Brown
- Norton Leatherman Spine Center, 210 East Gray St, Suite 900, Louisville, KY 40202, USA
| | - Jeffrey S Jones
- University of Louisville School of Medicine, 323 E Chestnut St, Louisville, KY 40202, USA
| | - Jean Edward
- Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA
| | - Jing Li
- Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA
| | - Mark V Williams
- Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA
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Edward J, Carreon LY, Williams MV, Glassman S, Li J. The importance and impact of patients' health literacy on low back pain management: a systematic review of literature. Spine J 2018; 18:370-376. [PMID: 28939167 DOI: 10.1016/j.spinee.2017.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 08/31/2017] [Accepted: 09/11/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Health literacy (HL) and the overall ability of patients to seek, understand, and apply health information play an important role in the management of chronic pain conditions. Awareness of how patients' HL skills influence their pain experience and how their ability to understand the treatment regimen and to manage chronic pain may allow physicians to adjust clinical treatment accordingly. Despite the prevalence and the substantial economic impact of chronic low back pain (LBP), little is known about the relationship between HL and the treatment and management of this common disease entity. PURPOSE The purpose of this systematic review of published research was to examine the importance and the implications of HL in the treatment and management of LBP. STUDY DESIGN AND METHODS A literature search was performed in Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychInfo using medical subject heading (MeSH) terms related to LBP, HL, and patient education, which yielded only three studies that directly addressed HL among patients suffering from LBP. RESULTS We identified only a limited number of studies that focused specifically on HL in the LBP population that were included in this review. The majority of studies excluded from this review focused on patient levels of educational attainment and patient education programs without addressing patients' HL levels and their impact on adherence to educational programs, self-care management, and rehabilitation, among other factors. The three studies that are critically reviewed in this review either use a direct measure of HL or make an effort to address HL in their programs. All three studies emphasize the importance of considering the HL of patients in the treatment and management of LBP. CONCLUSIONS Building on these studies and the narrative review of other relevant literature, we identified significant gaps in current research addressing HL in the treatment and management of LBP. We developed recommendations for future research based on an assessment of strengths and limitations of available evidence-based studies.
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Affiliation(s)
- Jean Edward
- Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA
| | - Leah Yacat Carreon
- Department of Surgery, Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
| | - Mark V Williams
- Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA
| | - Steven Glassman
- Department of Surgery, Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
| | - Jing Li
- Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA.
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Edward J, Morris S, Mataoui F, Granberry P, Williams MV, Torres I. The impact of health and health insurance literacy on access to care for Hispanic/Latino communities. Public Health Nurs 2018; 35:176-183. [DOI: 10.1111/phn.12385] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jean Edward
- Center for Health Services Research; University of Kentucky; Lexington KY USA
| | - Sarah Morris
- Datalys Center for Sports Injury Research and Prevention, Inc.; Indianapolis IN USA
| | - Fatma Mataoui
- College of Nursing and Health Sciences; University of Massachusetts Boston; Boston MA USA
| | - Phillip Granberry
- Mauricio Gastón Institute for Latino Community Development and Public Policy; University of Massachusetts; Boston MA USA
| | - Mark V. Williams
- Center for Health Services Research; University of Kentucky; Lexington KY USA
| | - Idali Torres
- Mauricio Gastón Institute for Latino Community Development and Public Policy; University of Massachusetts; Boston MA USA
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Edward J, Mir N, Monti D, Shacham E, Politi MC. Exploring Characteristics and Health Care Utilization Trends Among Individuals Who Fall in the Health Insurance Assistance Gap in a Medicaid Nonexpansion State. Policy Polit Nurs Pract 2017; 18:206-214. [PMID: 29460689 PMCID: PMC5993619 DOI: 10.1177/1527154418759312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
States that did not expand Medicaid under the Affordable Care Act (ACA) in the United States have seen a growth in the number of individuals who fall in the assistance gap, defined as having incomes above the Medicaid eligibility limit (≥44% of the federal poverty level) but below the lower limit (<100%) to be eligible for tax credits for premium subsidies or cost-sharing reductions in the marketplace. The purpose of this article is to present findings from a secondary data analysis examining the characteristics of those who fell in the assistance gap ( n = 166) in Missouri, a Medicaid nonexpansion state, by comparing them with those who did not fall in the assistance gap ( n = 157). Participants completed online demographic questionnaires and self-reported measures of health and insurance status, health literacy, numeracy, and health insurance literacy. A select group completed a 1-year follow-up survey about health insurance enrollment and health care utilization. Compared with the nonassistance gap group, individuals in the assistance gap were more likely to have lower levels of education, have at least one chronic condition, be uninsured at baseline, and be seeking health care coverage for additional dependents. Individuals in the assistance gap had significantly lower annual incomes and higher annual premiums when compared with the nonassistance gap group and were less likely to be insured through the marketplace or other private insurance at the 1-year follow-up. Findings provide several practice and policy implications for expanding health insurance coverage, reducing costs, and improving access to care for underserved populations.
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Affiliation(s)
- Jean Edward
- 1 Center for Health Services Research, University of Kentucky, Lexington, KY, USA
| | - Nageen Mir
- 2 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise Monti
- 2 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Enbal Shacham
- 3 College for Public Health and Social Justice, Department of Behavioral Sciences and Health Education, Saint Louis University, MO, USA
| | - Mary C Politi
- 2 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Abstract
The primary roles of nurse scientists in conducting health policy research are to increase knowledge in the discipline and provide evidence for informing and advancing health policies with the goal of improving the health outcomes of society. Health policy research informs, characterizes, explains, or tests hypotheses by employing a variety of research designs. Health policy research focuses on improving the access to care, the quality and cost of care, and the efficiency with which care is delivered. In this article, we explain how nurses might envision their research in a policy process framework, describe research designs that nurse researchers might use to inform and advance health policies, and provide examples of research conducted by nurse researchers to explicate key concepts in the policy process framework. Health policies are well informed and advanced when nurse researchers have a good understanding of the political process. The policy process framework provides a context for improving the focus and design of research and better explicating the connection between research evidence and policy. Nurses should focus their research on addressing problems of importance that are on the healthcare agenda, work with interdisciplinary teams of researchers, synthesize, and widely disseminate results.
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Affiliation(s)
- Carol Hall Ellenbecker
- 1 Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, MA, USA
| | - Jean Edward
- 2 Center for Health Services Research, College of Medicine, University of Kentucky, Lexington, KY, USA.,3 College of Nursing, University of Kentucky, Lexington, KY, USA
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Edward J, Biddle DJ. Using Geographic Information Systems (GIS) to Examine Barriers to Healthcare Access for Hispanic and Latino Immigrants in the U.S. South. J Racial Ethn Health Disparities 2016; 4:297-307. [PMID: 27129855 DOI: 10.1007/s40615-016-0229-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/11/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022]
Abstract
Geographic barriers to accessing timely and appropriate primary health care services have been identified as significant social determinants of health that contribute to the growing health inequities among Hispanic and Latino immigrants in the United States. The purpose of this study was to examine the geographic factors that serve as barriers to healthcare access for Hispanic and Latino immigrants in the southern community of Louisville, Kentucky. Accessibility to healthcare services was examined using spatial analysis techniques, a Geographic Information System and geographic data from the U.S. Census Bureau and the Louisville and Jefferson County Information Consortium. Results from this study indicated that physical location, socioeconomic factors, distance, and transportation served as barriers to accessing healthcare services. Findings provide significant implications for future research and policy-based interventions focused on eliminating geographic barriers and promoting social and health equity for the underserved.
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Affiliation(s)
- Jean Edward
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA, 02125, USA.
| | - Donald J Biddle
- Department of Geography and Geosciences, University of Louisville, Louisville, KY, USA
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Logsdon MC, Martin VH, Stikes R, Davis D, Ryan L, Yang I, Edward J, Rushton J. Lessons Learned From Adolescent Mothers: Advice on Recruitment. J Nurs Scholarsh 2015; 47:294-9. [PMID: 25968179 DOI: 10.1111/jnu.12142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE Adolescent mothers have high rates of depressive symptoms and inadequate rates of depression evaluation and treatment. The purpose of this qualitative study was to identify characteristics of effective recruitment ads for an Internet-based depression intervention for pregnant and parenting adolescents. METHODS Using focus group methods, participants (N = 35) were recruited and enrolled at a teen parent program, part of the public school system. Focus group sessions were analyzed for participant preferences, rationale for choices, key words, and the frequency of words within the videotapes and audiotapes. RESULTS Findings indicated that adolescent mothers preferred pictures in which everyone looked happy, narrative that clearly indicated cost and eligibility, and words that they would use in conversation. CLINICAL RELEVANCE The study filled an important gap in the literature by soliciting from pregnant and parenting adolescents their preferences regarding visual appeal, content adequacy, and message clarity of advertisements that would motivate them to visit an Internet intervention for depression. Results could be extrapolated to education of pregnant and parenting adolescents in clinical settings.
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Affiliation(s)
- M Cynthia Logsdon
- Professor, School of Nursing, University of Louisville, and Associate Chief of Nursing for Research, University of Louisville Hospital, Kentucky One Health, Louisville, KY, USA
| | - Vicki Hines Martin
- Professor, School of Nursing, University of Louisville, Louisville, KY, USA
| | - Reetta Stikes
- Professor, Department of Pediatrics, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Deborah Davis
- Advanced Practice Educator, University of Louisville Hospital, Kentucky One Health, Louisville, KY, USA
| | - Lesa Ryan
- Research Assistant, School of Nursing, University of Louisville, Louisville, KY, USA
| | - Iren Yang
- Postdoctoral Fellow, Nell Hodgson Woodruff School of Nursing School of Nursing, Emory University, Atlanta, GA, USA
| | - Jean Edward
- Assistant Professor, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jeff Rushton
- Director of Digital Media, University of Louisville, Louisville, KY, USA
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Abstract
Religion and spirituality are much studied coping mechanisms; however, their relationship to changes in behaviors, relationships, and goals is unclear. This study explored the impact of a breast cancer diagnosis on religion/faith and changes in behaviors, relationship, or goals. In this qualitative study, women, who participated in a larger, quantitative study, completed written responses to questions regarding the role of religion/faith in their lives, the impact of their diagnosis on their image of God and on faith/religious beliefs, and any changes in behaviors, relationships, or life goals were examined. Based on previous findings noting differences in psychological outcomes based on a higher (HE) or lesser (LE) engaged view of God, 28 (14 HE; 14 LE) women were included in the analysis. Awareness of life and its fleeting nature was common to all. Ensuing behaviors varied from a need to focus on self-improvement-egocentrism (LE)-to a need to focus on using their experiences to help others-altruism (HE). Study results suggest that seemingly small, but highly meaningful, differences based on one's worldview result in considerably different attitudinal and behavioral outcomes.
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Affiliation(s)
- Judith A Schreiber
- School of Nursing, University of Louisville, 555 S. Floyd St., #4057, Louisville, KY, 40292, USA,
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Glasbey JC, Edward J, Fitzgerald F, Beamish AJ, Harrison EM. An 8-year longitudinal cohort study into the impact of modernising medical careers on surgical training. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.08.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The growth in undocumented immigration in the United States has garnered increasing interest in the arenas of immigration and health care policy reform. Undocumented immigrants are restricted from accessing public health and social service as a result of their immigration status. The Patient Protection and Affordability Care Act restricts undocumented immigrants from participating in state exchange insurance market places, further limiting them from accessing equitable health care services. This commentary calls for comprehensive policy reform that expands access to health care for undocumented immigrants based on an analysis of immigrant health policies and their impact on health care expenditures, public health, and the role of health care providers. The intersectional nature of immigration and health care policy emphasizes the need for nurse policymakers to advocate for comprehensive policy reform aimed at improving the health and well-being of immigrants and the nation as a whole.
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Li XF, Edward J, Mitchell JC, Shao B, Bowes JE, Coen CW, Lightman SL, O'Byrne KT. Differential effects of repeated restraint stress on pulsatile lutenizing hormone secretion in female Fischer, Lewis and Wistar rats. J Neuroendocrinol 2004; 16:620-7. [PMID: 15214865 DOI: 10.1111/j.1365-2826.2004.01209.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stress activates the hypothalamic-pituitary-adrenocortical (HPA) axis and can suppress pulsatile luteinizing hormone (LH) secretion, resulting in reproductive dysfunction. The histocompatible inbred Fischer and Lewis rat strains exhibit marked phenotypic differences in the activity of the HPA axis, the former being more reactive. Using Fischer, Lewis and Wistar rats, we assessed effects of repeated restraint stress on pulsatile LH secretion. Adult rats were ovariectomized and fitted with cardiac catheters. Blood samples were collected at 5-min intervals for 3-5 h for detection of LH. Less frequent samples were collected for corticosterone measurement. After 2 h, rats were restrained for 60 min. The same regimen was repeated four times at 6-day intervals. The mean peak corticosterone levels achieved during the first restraint in Fischer rats were significantly higher than those in Lewis and Wistar rats. By the time of the fourth episode of restraint, there had been some adaptation of the corticosterone response in the Fischer, but not in the Lewis or Wistar rats. LH pulses were interrupted during the 1st restraint in all experimental groups, although only Fischer rats showed suppression of LH pulses during the subsequent 2-h postrestraint period. During the fourth restraint, LH pulse frequency was still reduced in Wistar, but not in Fischer and Lewis rats, both of which showed a complete habituation. These results suggest that differential control mechanisms underlie the response of the HPA and HPG axes to repeated restraint stress.
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Affiliation(s)
- X F Li
- Centre for Reproduction, Endocrinology and Diabetes, Kings College London, London, UK
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Abstract
To assist foreign-trained nurses to improve their nursing care and enhance outcomes in nursing practice, educators must have specific teaching strategies to build the nurses' self esteem, improve their openness to explore new ideas, and help them obtain new knowledge. The author discusses specific efforts and teaching strategies to facilitate this process.
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Affiliation(s)
- J Edward
- Mt. Sinai Hospital, Nursing Education, New York, New York, USA
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36
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Gehlsen GM, Shin DM, Edward J, Wang; YT. THE IMPACT ABSORPTION STRATEGY OF DROP-JUMP LANDING IN FEMALE HIGH SCHOOL ATHLETES. Med Sci Sports Exerc 1995. [DOI: 10.1249/00005768-199505001-00954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Christie JD, Edward J, Goolaman K, James BO, Simon J, Dugat PS, Treinen R. Interactions between St. Lucian Biomphalaria glabrata and Helisoma duryi, a possible competitor snail, in a semi-natural habitat. Acta Trop 1981; 38:395-417. [PMID: 6123247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In artificial drains similar to those used in banana culture on St. Lucia, Helisoma duryi, the rams-horn snail, controlled Biomphalaria glabrata, intermediate host of schistosomiasis on that island. Time required for elimination of B. glabrata depended on environmental temperature and numbers of H. duryi initially introduced in the drains. Best fit to the data was given by the equation for the logistic curve rather than by an equation for unlimited growth. Multiple regression analyses of natality and mortality rates of both species of snails indicated that populations of B. glabrata were regulated by temperature rather than by density-dependent means while numbers of H. duryi were strongly influenced by numbers of rams-horn snails already present in the drains. Fitting of snail shell growth to von Bertalanffy equations showed that H. duryi shell diameter was uninfluenced by environmental temperatures or presence of B. glabrata while growth of the intermediate host was strongly affected both by temperature and numbers of H. duryi.
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Edward J. Extending a hand to parents of disturbed children. Children 1967; 14:238-243. [PMID: 6060856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Edward J. Extracts from the Harveian Oration on the Progress of Medicine and Sanitation. West J Med 1889; 2:913-6. [DOI: 10.1136/bmj.2.1504.913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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