Adolescent health care and perceptions in a provincial hospital in Papua New Guinea

OBJECTIVES

Adolescents make up an estimated 22 % of the 11.8 million population of Papua New Guinea (PNG), yet, as in many low and middle income countries, there are limited specific services for adolescents, who in traditional health service design fall between paediatric and adult patients. With more survivors of chronic illnesses, including tuberculosis and HIV, congenital and acquired heart disease, epilepsy and cerebral palsy, diabetes, cancer and other chronic conditions, there are gaps in the care of such young people, and in their eventual transition to adult services. Moreover, traditional health service design rarely addresses many adolescent health concerns - mental health, self-esteem, substance use, and adolescent-friendly sexual and reproductive health. This study, amongst a cohort cared for in a provincial hospital in Milne Bay Province, Papua New Guinea, aimed to explore the perceptions of adolescents on the health care they receive, and their views on their health priorities.

METHODS

A qualitative study was carried out from April to August 2022, amongst adolescents (persons aged 10-19 years) attending or admitted to Alotau Provincial Hospital. Data were collected via semi-structured wide-ranging interviews, and contextual data obtained from their medical charts. Thematic data analysis was done.

RESULTS

Fifty-four adolescents were interviewed. Adolescents were generally content with the care they received, although many raised concerns regarding feeling out of place in a ward with older adults or infants, and staff attitudes towards them including not directly communicating. Forty four adolescents preferred an adolescent-friendly setting, as opposed to the adult or children's wards, stating that it would allow for positive peer-interaction, improve their experience in the hospital, and improve the quality of health care received. Many adolescents with chronic illnesses had concerns regarding loneliness and isolation, and uncertainty of their future. Pregnant adolescents highlighted the lack of education on sexual and reproductive health, and experiences of gender-based violence.

CONCLUSIONS

This study shows that adolescents can perceive the need for adolescent-friendly health services and advocate for improvement in the quality of health care they receive, and the breadth of adolescent health care concerns.

Development and validation of a new questionnaire to assess perceptions regarding DWELL: Design for WELLness

Designing home environments for health and wellness is a crucial strategy for disease prevention and health promotion. Yet, there is not a tool to evaluate perceptions regarding home design for health and wellness. This study aimed to develop and validate a new instrument to measure people's perceptions regarding the concept of DWELL: Design for WELLness in the home environment. We developed a short 5-item online questionnaire to detect changes in knowledge, awareness, engagement and self-efficacy regarding DWELL. The instrument was validated in an online study. Of the 613 mothers who answered the questionnaire initially, 397 answered the questionnaire a second time. Factor analysis and Cronbach's alpha indicated that all five DWELL questions load into one single factor (the model explained 61.84% of total variance), and measure a reliable scale of the same construct, with high levels of internal consistency (Cronbach's α = 0.85) at both first and second administrations. Spearman correlations between DWELL first and second administrations of the questionnaire indicated moderate-to-high test-retest reliability (0.55-0.70, p < 0.001). DWELL was found to be a valid tool which fills a gap in the public health literature. This measure serves as a free and convenient online instrument to gain insights regarding the effect of modifying environments for disease prevention and health promotion. The tool may be used to assess perceptions in the conditions leading wellness promotion in the home.

Levels and Determinants of COVID-19 Vaccination at a Later Phase among Chinese Older People Aged 60 Years or Older: A Population-Based Survey

The early attainment of high COVID-19 vaccination rates can minimize avoidable hospitalizations/deaths. The fifth wave COVID-19 outbreak in Hong Kong caused >9000 deaths, and most of them were unvaccinated older people. This study hence investigated determinants of taking the first dose vaccination at a later phase (Phase 3: during the fifth wave outbreak, i.e., February-July 2022) versus two earlier phases (Phase 1: first six months since vaccine rollout, i.e., February-July 2021; Phase 2: six months prior to the outbreak, i.e., August 2021-January 2022) via a random telephone survey among 386 ever-vaccinated Hong Kong older people aged ≥60 (June/July 2022). A total of 27.7%, 51.1%, and 21.3% took the first dose at Phase 1, Phase 2, and Phase 3, respectively. Unfavorable perceptions related to COVID-19/vaccination, exposure to conflicting/counter-information about the suitability of older people's vaccination from various sources, unsupportive family influences prior to the outbreak, and depressive symptoms were significantly associated with taking the first dose at Phase 3 instead of Phase 1 and Phase 2. To speed up COVID-19 vaccination and avoid unnecessary deaths, the government and health professionals should rectify misinformation, provide clear/consistent information for older people and their family members, and focus on those having depressive symptoms at an earlier stage of the pandemic.

Commitment and Wellbeing: The Relationship Dilemma in a Two-Wave Study

There has been little consensus around the sequential relationship between organizational affective commitment and workers' wellbeing. In line with the Conservation of Resources Theory, results of this two-wave study with a contact center employee sample (N = 483) showed that organizational affective commitment decreases work ill-being (i.e., burnout) and increases work wellbeing (i.e., work-engagement). Furthermore, in keeping with the loss spiral assumption of this theory, the mediating role of burnout in the affective commitment-health relationship was supported in this study. However, in accordance with the Job Demand-Resources, work engagement was found not to prevent effects on health. The findings have implications for the organizational affective commitment theory, as well as for organizational occupational health policies and interventions.

Parent's self-reported indoor environment-related symptoms and health worry increase symptom reports among their children at school-Study in two independent populations

Little is known whether parent's indoor environment quality (IEQ)-related symptoms or health perceptions influence the risk of self- or parent-reported symptoms in their children. We assessed (i) the association of parents' IEQ-related symptoms with IEQ-related symptoms in their children at school and (ii) whether parental IEQ-related health worry increases the risk for children's symptoms. We used two Finnish studies: a national, population-based survey of indoor air and related health problems (n = 611 parents) and a subset of survey for all primary school pupils (grade 3-6) and their parents in Helsinki, which also included school IEQ-related symptoms reported by children (n = 1617 parent-child dyads). In the school survey, parent's own symptoms increased strongly their reporting of their children's symptoms at school (aOR 4.0, 95% CI 2.7-6.0 for parents experiencing a lot of symptoms) and also symptoms reported by the child itself (aOR 2.2, 95% CI 1.5-3.1). Similar, but slightly weaker associations were seen with parental IEQ-related health worries. Results remained unchanged when adjusted for the IEQ of school buildings or parental and children's allergic diseases. Similar associations were seen in the national survey between parent's symptoms at work and child's symptoms at school. The results suggest that parents' health perceptions may increase the reporting of children's IEQ-related symptoms even more than is typically seen for many indoor air contaminants.

Effects of Patient Portal Use on Patient Satisfaction: Survey and Partial Least Squares Analysis

Background

With digital delivery of health care services gaining prominence, patient portals have become a mainstay of many health care organizations. Despite the importance of patient portals, inconclusive data exist regarding the effect of patient portal use on patient satisfaction.

Objective

The aim of this study is to understand the relationship between the postadoptive use of patient portals and patient satisfaction outcomes.

Methods

Postadoptive use of patient portals has a positive relationship with the 3 dimensions of patient satisfaction, mediated by gratification, health self-awareness, and health perceptions. A total of 504 valid patient portal user responses were collected, and partial least squares analysis was performed to analyze the data.

Results

Patient satisfaction was captured using three dimensions: care team interaction, atmosphere, and instruction effectiveness. The results show that postadoptive use of patient portals has a positive influence on all 3 dimensions of patient satisfaction through the mediating variables of gratification, health self-awareness, and health perceptions. Specifically, postadoptive use had significant positive influence on gratification, health self-awareness, and health perceptions. Each of the 3 patient perceptions had significant positive influence on all 3 dimensions of patient satisfaction: care team interaction, atmosphere, and instruction effectiveness. Specifically, our model explained 31.8% of the care team interaction, 40.6% of the atmosphere, and 39.1% of the instruction effectiveness.

Conclusions

Our model shows that patient portal use can influence patient satisfaction through the mediating effects of gratification, health self-awareness, and health perception. Patient satisfaction is an important outcome for health care organizations. Therefore, by promoting effective patient portal use and fostering patient perceptions, health care organizations can improve patient satisfaction.

Khat use and perceived health problems among African migrants in Australia: an exploratory study

Background

The chronic use of khat, a plant with psychostimulant properties, has been associated with physical and mental health problems. Previous research found that non-khat users were more likely than khat users to perceive its use to be associated with poor health.

Aims

We aimed to identify differences in the perception of specific khat-associated health problems between khat users and non-users.

Methods

In 2012, 133 adults (≥ 18 years) from African migrant communities in 4 state capital cities in Australia completed questionnaires to ascertain their perception of whether specific health problems were associated with khat use. Multivariable log-linked Poisson regression was used to compare the perceptions of the 2 groups and identify differences, adjusting for sociodemographic factors, tobacco use and years living in Australia.

Results

Overall, 58 (44%) and 75 (56%) participants reported current khat use and no use respectively. Adjusted log-linked Poisson regression showed that people who use khat were less likely than non-users to perceive certain health and related problems were associated with khat use, including, poor health in general [prevalence risk ratio (PRR) = 0.86; 95% CI: 0.75, 1.00]; laziness (PRR = 0.86; 95% CI: 0.75, 0.99); stomach and throat problems (PRR = 0.83; 95% CI: 0.72, 0.96); and teeth, gum and mouth problems (PRR = 0.81; 95% CI: 0.67, 0.99).

Conclusions

Khat users are less likely to perceive use being associated with health problems than non-users. Providing information on the health problems associated with khat use may be an important component of health promotion strategies and interventions aimed at minimising khat-related harm.

Why do parents refuse childhood vaccination? Reasons reported in Finland

AIMS

This article examines the reasons for partial and complete refusal of childhood vaccination as reported by parents in Finland. It analyzes perceptions and experiences central in vaccination decisions.

METHODS

The analysis is based on 38 in-depth interviews with Finnish parents who have refused all or several vaccines for their children. The interviews were analyzed using qualitative content analysis.

RESULTS

Three categories of reasons were identified in the analysis: 1) risks and effects of vaccination - concern about and/or experiences of possible side-effects was the most important reason for avoiding vaccines; 2) distrust - participants did not trust vaccination recommendations made by health officials and medical professionals due to perceived bias in medical research, ties between health officials and the pharmaceutical industry, and personal experiences of (suspected) adverse effects and the way these concerns were received in healthcare institutions; 3) health perceptions and practices - parents supported their vaccination choices with complementary and alternative medicine treatments and alternative health understandings. Many stated that contracting vaccine-preventable illnesses would provide longer lasting and more 'natural' immunity than vaccination, and possibly other health benefits.

CONCLUSIONS

A loss of trust in medical and public health actors was central to the process in which parents came to question, contest, and eventually refuse childhood vaccination. The adverse effects of the Pandemrix vaccine in 2009-2010 have been important in leading to distrust and contestation. Distrust may relate to personal experiences of (suspected) adverse effects or to broader concerns over the neutrality of health authorities and the trustworthiness of medical research.

JUUL the heartbreaker: Twitter analysis of cardiovascular health perceptions of vaping

INTRODUCTION

The public most frequently associates tobacco use solely with pulmonary health risks, despite heart disease being the leading cause of death in smokers. The health perceptions of e-cigarettes, especially cardiovascular health, have not been well studied. We aimed to evaluate the prevalence and health perceptions of tweets related to cardiovascular, pulmonary, and brain health – three organ systems for which tobacco use is a major disease risk factor.

METHODS

We examined the cardiovascular, pulmonary, and brain health perceptions of vaping and JUUL on Twitter, followed by a content analysis of tweets pertaining to the cardiovascular risks. A Twitter firehose API scraped about 6.2 million publicly available tweets from 2015–2019 that contained vaping-related terms, and a separate dataset of about 1.9 million tweets that contained the term JUUL. A quantitative content analysis (n=2145) of tweets was subsequently conducted to assess the health perceptions of vaping and JUUL. Two trained coders independently assessed the posts and Twitter profiles to determine age (<18 or ≥18 years), sex, race, sentiment towards JUUL, and vaping-related topics.

RESULTS

The majority of tweets containing vaping or JUUL-related terms did not also contain cardiovascular, pulmonary, or brain health terms (97.99% and 96.67%, respectively). Multiple linear regression analysis showed that youth (<18 years), females, non-White individuals, mention of a flavor, and mention of cardiovascular health harm words were associated with more positive sentiments towards JUUL. Pearson’s chi-squared analyses indicated that youth were more likely to mention a JUUL flavor. Females and youth were more likely to reference cardiovascular terms with humor.

CONCLUSIONS

The cardiovascular health risks of vaping are not fully recognized by the public. Vulnerable populations such as youth and females reference JUUL with cardiovascular-related words that downplay the severity of tobacco as a major risk factor for cardiovascular disease.

Positive Psychology in Context of Peacekeeping Militaries: A Mediation Model of Work-Family Enrichment

Based on the work-family enrichment theory, this study analyzes the contribution of work-family and family-work enrichment to explain the military’s well-being during a peacekeeping mission. The data used were collected in a sample of 306 Brazilian soldiers, who were married and/or had children, during the phase named “employment of troops” (i.e., when peacekeepers had been in the Haitian territory and, as a result, away from their families, for between three to five months). Data analysis was performed using the Structural Equations Model. It was observed that the military’s perception of their spouses’ support for their participation during the mission had a positive relationship with both family-to-work enrichment and work-to-family enrichment, and the work-to-family enrichment mediated the relationship between the perception of the spouses’ support and the military’s health perception and general satisfaction with life. Theoretical and practical implications were discussed and limitations and suggestions for future research were presented.

Health Perceptions in Relation to Child Health and Mortality in a Rural Context, Sierra Leone: A Mixed Method Study

Child survival and wellbeing remain a global health challenge despite vast development within the area and a significant decline in mortality rates of children under five years of age. This study investigates the perceived causes of ill health and childhood mortality in the context of five villages located in the Tonkolili district of Sierra Leone. Mixed method methodology was applied in this study consisting of both quantitative and qualitative data contribution. The quantitative part consisted of a household survey on child health, where 341 households, equivalent to 50.6% of the total number of households in the five villages, participated with a response rate of 100%. The qualitative part consisted of six semi structured interviews-one with a health care worker and five with mothers from each village. The main perceived reason for child morbidity was inadequate care of children related to personal hygiene of the child, hygiene and safety in the environment, in-sufficient nutrition, inadequate supervision and poor healthcare seeking behavior. Additionally, reasons given for disease included supernatural forces such as witchcraft. In relation to the survey, the perceived causes of child mortality for ill children in the villages were mainly malaria (33.6%), diarrhea (11.6%), pneumonia (8.6%), and unknown (26%). The observed symptoms of illness among children were fever (43.7%), cough and difficulty breathing (10.7%), frequent watery stool (10.3%) and no symptoms (20.3%). The perception of ill health in children was mainly associated with the parent's ability to cater for the child's physical needs, but also associated with external factors such as witchcraft and "God's will". In addition, biomedical causes for disease and supernatural causes for disease were seen to coexist.

Mediating Effect of Sports Participation on the Relationship between Health Perceptions and Health Promoting Behavior in Adolescents

The aim of this study was to verify the structural relationship between health perceptions, sports participation, and health promoting behavior in adolescents. A total of 507 adolescents living in Seoul, Republic of Korea, in 2020, participated in this study. This study was conducted using a preliminary survey and a main survey. In the preliminary survey, the reliability and validity of the scales used in this study were analyzed, and in the main survey, the relationships between individual variables were verified. Specifically, descriptive statistical analysis, path analysis, and mediating effect analysis were conducted in the main survey. The results of the study are as follows: first, health perceptions were found to have a positive effect on sports participation (p < 0.001). Furthermore, health perceptions were found to have no direct effect on health promoting behavior (p = 0.554), while sports participation was found to have a positive effect on health promoting behavior (p < 0.001). Additionally, sports participation completely mediated the relationship between health perceptions and health promoting behavior. Based on the results of this study, suggestions are presented on how to enhance health perceptions in adolescents who are in a critical period for forming healthy life habits, and to prepare measures to encourage sports participation.

Factors Affecting Health-Promoting Behaviors among Nursing Students

Health-promoting behaviors help prevent chronic illness. Health-promoting behaviors of nursing students can affect not only their own health, but also the health of their future patients, for whom they can act as role models. Nursing students should participate in health-promoting behaviors; however, nursing students often have unhealthy behaviors. This study aimed to investigate the factors affecting health-promoting behaviors in nursing students. A descriptive, self-report survey of 304 nursing students from three universities in South Korea was conducted. Subjects' general characteristics, health perceptions, health concerns, and health-promoting behaviors were collected. Of the total participants, 90.1% were female and the mean age was 20.4 years. The mean score for health-promoting behaviors was 2.47, higher than the midpoint. The mean for the subscale of physical activity among health-promoting behaviors was the lowest. The main factors affecting health-promoting behaviors were gender, health perceptions, health concern, and time per week spent searching online for health-related information. The main factors affecting physical activity were gender, health concern, and time per week spent searching online for health-related information. Based on the study findings, it is recommended that a program to empower nursing students to perform health-promoting behaviors be incorporated into the nursing education curriculum with regard to unique needs based on gender. Specifically, it would be effective to develop programs that are easily accessible via the Internet.

Intra-familial health polarisation: how diverse health concerns become barriers to health behaviour change in families with preschool children and emerging obesity

In a disadvantaged rural area in Denmark, severe challenges have been identified concerning overweight and obesity in families with preschool-age children. The present paper examines how families with young children and emerging obesity issues perceive 'healthy living' and barriers to practising it. Using data from qualitative workshops with families and professionals working with them, we reveal health perceptions and related family dynamics. Drawing on P. Bourdieu's theory of habitus and 'tastes of necessity', K.L. Frohlich et al.'s notion of 'collective lifestyles' and E. Lindbladh and C. H. Lyttken's theory of preconditions for health behaviour change and reactions to risk-related information, we analyse how risk perceptions and related health practices within the families are influenced by the local contexts in the disadvantaged area under study. Despite shared perceptions of 'healthy living', we found that diverse health-risk perceptions created family dynamics in which parents performed opposed health behaviours, which became a huge barrier to becoming a healthier family. Based on our theoretical approach, we propose that risk perceptions and reactions are highly context dependent, as illustrated in both micro-contexts (family dynamics) and the macro-context (the disadvantaged area).

Use of Antimalarial Agents is Associated with Favourable Physical Functioning in Patients with Systemic Lupus Erythematosus

Impaired health-related quality of life (HRQoL) is a major problem in patients with systemic lupus erythematosus (SLE). Antimalarial agents (AMA) are the cornerstone of SLE therapy, but data on their impact on HRQoL are scarce. We investigated this impact using baseline data from the BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) trials (n = 1684). HRQoL was self-reported using the Medical Outcomes Study short-form 36 (SF-36), functional assessment of chronic illness therapy (FACIT)-Fatigue and 3-level EuroQoL 5-Dimension (EQ-5D) questionnaires. Patients on AMA (n = 1098/1684) performed better with regard to SF-36 physical component summary, physical functioning, role physical, bodily pain, FACIT-Fatigue, EQ-5D utility index and EQ-5D visual analogue scale scores. The difference in SF-36 physical functioning (mean ± standard deviation (SD): 61.1 ± 24.9 versus 55.0 ± 26.5; p < 0.001) exceeded the minimal clinically important difference (≥5.0). This association remained significant after adjustment for potential confounding factors in linear regression models (standardised coefficient, β = 0.07; p = 0.002). Greater proportions of AMA users than non-users reported no problems in the mobility, self-care, usual activities and anxiety/depression EQ-5D dimensions. AMA use was particularly associated with favourable HRQoL in physical aspects among patients with active mucocutaneous and musculoskeletal disease, and mental aspects among patients with active renal SLE. These results provide support in motivating adherence to AMA therapy. Exploration of causality in the relationship between AMA use and favourable HRQoL in SLE has merit.

Health is not all about salads: An ethnographic study on health perceptions and health behavior among socially marginalized Danish men

BACKGROUND

The effects of social marginalization and health are well-documented, revealing a complex association between health perceptions and health behavior. This is especially evident among socially marginalized men.

OBJECTIVE

This study aims to explore health perceptions and health behaviors influencing overall health among socially marginalized men who seem to not benefit from existing municipal health care in a large Danish municipality. These men have varying health challenges and engage in risky health behaviors, such as alcohol drinking, tobacco smoking, and lack of physical activity.

DESIGN AND SAMPLE

This was an ethnographic study including 200 hr of participant observations and 25 interviews with socially marginalized men aged 45-65.

RESULTS

Health was perceived as related to the ability to participate in daily life activities, such as getting around effortlessly and the ability to work. Alcohol drinking appeared to be part of a complex approach in managing everyday life, including various personal physical and mental health challenges and admission to social networks.

CONCLUSION

Overall, the results provide important insight into how health perceptions and health behaviors are embedded in the men's everyday lives. This knowledge may be used by public health nurses and other health professionals in providing and developing health services.

The Impact of Perceived Etiology, Treatment Type, and Wording of Treatment Information on the Assessment of Gastritis Treatments

How patients assess the suitability of a certain therapy for treating a disease depends on a variety of influencing factors. Three key factors are people's subjective perceptions of a disease, the type of treatment, and the kind of communication used to convey information. The study presented here was a randomized controlled experiment in which we examined these three factors. We used a mixed design where we manipulated perceived etiology of gastritis (biopsychosocial vs. biomedical) as a between-group factor, and treatment type (behavioral vs. pharmacological) and wording of treatment information (holistic vs. scientific) as within-group factors. We found that gastritis treatments that matched the perceived etiology of the illness were assessed to be more effective. Moreover, treatments that matched the perceived etiology enhanced participants' intention to undergo the treatment themselves and their willingness to recommend it to a person close to them. Finally, participants' intention to undergo the treatment was also enhanced when the wording of the treatment information matched the perceived etiology. We discuss the implications of our findings in terms of health communication and patient education.

Resilience, health perceptions, (QOL), stressors, and hospital admissions-Observations from the real world of clinical care of unstable health journeys in Monash Watch (MW), Victoria, Australia

RATIONALE, AIMS, AND OBJECTIVES

Monash Watch (MW) aims to reduce potentially preventable hospitalisations in a cohort above a risk "threshold" identified by Health Links Chronic Care (HLCC) algorithms using personal, diagnostic, and service data. MW conducted regular patient monitoring through outbound phone calls using the Patient Journey Record System (PaJR). PaJR alerts are intended to act as a self-reported barometer of stressors, resilience, and health perceptions with more alerts per call indicating greater risk.

AIMS

To describe predictors of PaJR alerts (self-reported from outbound phone calls) and predictors of acute admissions based upon a Theoretical Model for Static and Dynamic Indicators of Acute Admissions.

METHODS

Participants: HLCC cohort with predicted 3+ admissions/year in MW service arm for >40 days; n = 244. Baseline measures-Clinical Frailty Index (CFI); Connor Davis Resilience (CD-RISC): SF-12v2 Health Survey scores Mental (MSC) and Physical (PSC) and ICECAP-O. Dynamic measures: PaJR alerts/call in 10 869 MW records. Acute (non-surgical) admissions from Victorian Admitted Episode database.

ANALYSIS

Logistic regression, correlations, and timeseries homogeneity metrics using XLSTAT.

FINDINGS

Baseline indicators were significantly correlated except SF-12_MCS. SF12-MSC, SF12-PSC and ICECAP-O best predicted PaJR alerts/call (ROC: 0.84). CFI best predicted acute admissions (ROC: 0.66), adding CD-RISC, SF-12_MCS, SF-12_PCS and ICECAP-O with two-way interactions improved model (ROC: 0.70). PaJR alerts were higher ≤10 days preceding acute admissions and significantly correlated with admissions. Patterns in PaJR alerts in four case studies demonstrated dynamic variations signifying risk. Overall, all baseline indicators were explanatory supporting the theoretical model. Timing of PaJR alerts and acute admissions reflecting changing stressors, resilience, and health perceptions were not predicted from baseline indicators but provided a trigger for service interventions.

CONCLUSION

Both static and dynamic indicators representing stressors, resilience, and health perceptions have the potential to inform threshold models of admission risk in ways that could be clinically useful.

Assessing the Perceptions of Inspiratory Muscle Training in Children With Cystic Fibrosis and Their Multidisciplinary Team: Mixed-Methods Study

BACKGROUND

Little is known about the opinions or perceived benefits of an inspiratory muscle training intervention in patients with cystic fibrosis and their multidisciplinary team.

OBJECTIVE

The aim of this qualitative study was to examine patients' and multidisciplinary teams' views on inspiratory muscle training to inform and tailor future interventions.

METHODS

Individual, semistructured interviews were conducted to evaluate participants' perspectives of a 4-week inspiratory muscle training intervention. In this study, 8 of 13 individuals involved in the inspiratory muscle training program (5 children aged 11-14 years; 2 physiotherapists; and 1 respiratory physician) participated. Interviews were transcribed verbatim, analyzed using thematic analyses, and then coded into relevant themes.

RESULTS

Four key themes emerged: acceptability, facilitators, barriers, and recommendations. While fun, enjoyment, and improved perceived physical ability were reported by children and their multidisciplinary team following the inspiratory muscle training program, the multidisciplinary team identified factors such as time and cost as key barriers.

CONCLUSIONS

A short inspiratory muscle training program was perceived to have positive effects on the physical ability and psychosocial health of children with cystic fibrosis. These findings highlight the importance of obtaining participants' and multidisciplinary teams' perceptions and recommendations to ensure the efficacy and optimal design of future inspiratory muscle training protocols.

Changing Neighborhoods and Residents' Health Perceptions: The Heart Healthy Hoods Qualitative Study

Cities, and therefore neighborhoods, are under constant change. Neighborhood changes may affect residents’ health in multiple ways. The Heart Healthy Hoods (HHH) project studies the association between neighborhood and residents’ health. Focusing on a middle–low-socioeconomic neighborhood in Madrid (Spain), our aim was to describe qualitatively its residents’ perceptions on the urban changes and their impacts on health. We designed a qualitative study using 16 semi-structured interviews including adult residents and professionals living or working in the area. Firstly, we described the perceived main social and neighborhood changes. Secondly, we studied how these neighborhood changes connected to residents’ health perceptions. Perceived major social changes were new demographic composition, new socio–cultural values and economic changes. Residents’ negative health perceptions were the reduction of social relationships, increase of stress and labor precariousness. Positive health perceptions were the creation of supportive links, assimilation of self-care activities and the change in traditional roles. Neighborhood changes yielded both negative and positive effects on residents’ health. These effects would be the result of the interrelation of different elements such as the existence or absence of social ties, family responsibilities, time availability, economic resources and access and awareness to health-promoting programs. These qualitative research results provide important insight into crafting urban health policies that may ultimately improve health outcomes in communities undergoing change.

Changes in Health Perceptions of Male Prisoners Following a Smoking Cessation Program

The aim was to explore the changes in health perceptions of men in prison following a smoking cessation program. Interviews, lung age tests, and a quality-of-life questionnaire were carried out with prisoners. Four main themes emerged from the interviews: the increase in exercise tolerance with improvements in general health, an ability to taste food again, an acknowledgment of stress, and the reasoning behind beginning smoking. Lung age tests showed most prisoners had a lung age older than their chronological age. The quality-of-life survey showed that mean normalized results for physical functioning, general health, vitality, social functioning, and mental health were above 50%. Helping prisoners to remain smoke-free once they leave prison is a new challenge for health providers.

Changes in Health Perceptions among Older Grandparents Raising Adolescent Grandchildren

This research study explores health perceptions before and after becoming a primary caregiver among older grandparents raising adolescent grandchildren. Qualitative, in-depth face-to-face interviews were conducted with grandparents age 40 and older (N = 15) who were raising adolescent grandchildren age 12 and older. Most grandparents were female, had some college education, White/Non-Hispanic, were married, had an average age of 65 years, and reported never attending a grandparent support group. Before assuming the primary caregiver role, older grandparents described their physical health as good, filled with physical activity, and reasonably free of health conditions. After entering the primary caregiving role, older grandparents of adolescents described functional restrictions and visible changes in physical health requiring intensive medical interventions. In terms of mental health, older grandparent caregivers experienced anxiety, worry, depression, sadness, and frustration. These findings highlight the complex caregiving circumstances encountered by older grandparents raising adolescents and the need for health education and policy development to increase comprehensive supportive services targeting this population.

Adolescents' smokeless tobacco susceptibility by perceived professional baseball players' use

OBJECTIVE

Measure associations between adolescent baseball players' perceptions of smokeless tobacco (ST) use by professional baseball players and those adolescents' actual ST use and susceptibility.

METHODS

Male baseball players (N = 360) at 25 rural California high schools completed tobacco behavior surveys and reported how likely they believed it was their favorite major league baseball player used ST. We compared ST use and, among ST never-users, willingness and expectations to use ST, according to perceived favorite player's use.

RESULTS

Adolescents responding that their favorite player definitely or probably used ST were significantly more likely to use ST themselves. High school ST never-users who perceived that their favorite player definitely used ST were 2.5 to 3-times more likely to be susceptible to ST initiation than participants responding that their favorite player definitely did not use ST.

CONCLUSIONS

Adolescents' ST behaviors and intentions were correlated with their perceptions of professional baseball players' ST use.

Oral health-related quality-of-life scores differ by socioeconomic status and caries experience

OBJECTIVES

(i) Quantify the relative association between child dental caries experience and maternal-reported child oral health-related quality of life (OHRQoL); (ii) examine whether that association differed according to family socioeconomic status (SES); and (iii) explore whether absolute OHRQoL varied by family SES at similar levels of child caries experience.

METHODS

This study was a cross-sectional analysis of children in southern Brazil (n=456, mean age: 38 months) participating in an existing health centre-based intervention study. OHRQoL impact was quantified as mean score on the Brazilian Early Childhood Oral Health Impact Scale (ECOHIS) and compared over categories of caries experience (dmft: 0, dmft: 1-4, dmft: ≥5). Adjusted ECOHIS ratios between caries categories were calculated using regression modelling, overall and within socioeconomic strata defined by maternal education, social class and household income.

RESULTS

Caries prevalence (dmft >0) was 39.7%, mean ECOHIS score was 2.0 (SD: 3.5), and 44.3% of mothers reported OHRQoL impact (ECOHIS score >0). Increasing child caries experience was associated with worsening child and family quality of life: ECOHIS scores were 3.0 times greater (95% CI: 2.0, 4.4) for children with dmft ≥5 vs dmft=0, a pattern that persisted regardless of family socioeconomic status (P for interaction: all >0.3). However, adjusted for dental status and sociodemographic characteristics, mean ECOHIS scores were lower when reported by mothers of less educational attainment (ratio: 0.7; 95% CI: 0.5, 1.0), lower social class (ratio: 0.7; 95% CI: 0.5, 1.0) or in lower income households (ratio: 0.8; 95% CI: 0.6, 1.3).

CONCLUSION

Dental caries was associated with negative child and family experiences and lower OHRQoL across all social groups; yet, families facing greater disadvantage may report lesser quality-of-life impact at the same level of disease experience. Thus, subjective quality-of-life measures may differ under varying social contexts, with possible implications for service utilization, evaluating oral health interventions, or quantifying disease morbidity in low-SES groups.

Depressive Symptoms: Mediator of Event-Free Survival in Patients With Heart Failure

Depressive symptoms and poor health perceptions are predictors of higher hospitalization and mortality rates (heart failure [HF]). However, the association between depressive symptoms and health perceptions as they affect event-free survival outcomes in patients with HF has not been studied. The purpose of this secondary analysis was to determine whether depressive symptoms mediate the relationship between health perceptions and event-free survival in patients with HF. A total of 458 HF patients (61.6 ± 12 years, 55% New York Heart Association Class III/IV) responded to one-item health perception question and completed the Patient Health Questionnaire-9. Event-free survival data were collected for up to 4 years. Multiple regression and Cox proportional hazards regression analysis showed that depressive symptoms mediated the relationship between health perceptions and event-free survival. Decreasing depressive symptoms is essential to improve event-free survival in patients with HF.

Forming ideas about health: a qualitative study of Ontario adolescents

Adolescence is a crucial period of child development during which one's ideas about health are formed. However, little is known about the different contexts, experiences, and potential other factors that contribute to shaping the health ideas of adolescent populations, particularly when they are not seeking out the information for a particular purpose. In this Ontario-based qualitative study, grounded theory methods were used to explore ways that health knowledge is obtained in adolescents (age 10–16). A purposeful, criterion-based sampling strategy was used, and data were collected through seven focus groups (n=40). Findings indicate that while young people get their ideas about health through both didactic and organic learning contexts, the significant impact of organic learning is often overlooked. Categories of organic learning that emerged include self-reflective experience, the experience of close contacts, casually observing others, and common discourse. This study suggests that one central way that young people get their ideas about health is from living life: from the people they watch, the conversations that they have, and the experiences they live. Findings support the development of effective health promotion messages and also contribute to considering the place of some aspects of organic learning in the development of health-related resources that target adolescent populations.

Agency, access, and Anopheles: neighborhood health perceptions and the implications for community health interventions in Accra, Ghana

Background

Social and environmental factors are increasingly recognized for their ability to influence health outcomes at both individual and neighborhood scales in the developing urban world. Yet issues of spatial heterogeneity in these complex environments may obscure unique elements of neighborhood life that may be protective or harmful to human health. Resident perceptions of neighborhood effects on health may help to fill gaps in our interpretation of household survey results and better inform how to plan and execute neighborhood-level health interventions.

Objective

We evaluate differences in housing and socioeconomic indicators and health, environment, and neighborhood perceptions derived from the analysis of a household survey and a series of focus groups in Accra, Ghana. We then explore how neighborhood perceptions can inform survey results and ultimately neighborhood-level health interventions.

Design

Eleven focus groups were conducted across a socioeconomically stratified sample of neighborhoods in Accra, Ghana. General inductive themes from the focus groups were analyzed in tandem with data collected in a 2009 household survey of 2,814 women. In-depth vignettes expand upon the three most salient emergent themes.

Results

Household and socioeconomic characteristics derived from the focus groups corroborated findings from the survey data. Focus group and survey results diverged for three complex health issues: malaria, health-care access, and sense of personal agency in promoting good health.

Conclusion

Three vignettes reflecting community views about malaria, health-care access, and sense of personal agency in promoting good health highlight the challenges facing community health interventions in Accra and exemplify how qualitatively derived neighborhood-level health effects can help shape health interventions.

How religiosity shapes health perceptions and behaviors of Latina immigrants: is it an enabling or prohibitive factor?

The study examines how religiosity shapes the health perceptions and health-related behaviors of 50 Latina immigrants from El Salvador, Guatemala, Mexico and Bolivia. Between May and August 2011, focus groups were conducted with participants representing each country of origin. Qualitative content analysis was the analytic strategy adopted in the study. The meta-theme, Religiosity Contributes to Positive Perceptions of Health and Health-Promoting Behaviors, is associated with six emerging themes: (1) Religiosity promotes a sense of personal responsibility for one's health; (2) Religiosity promotes a holistic view of health; (3) Religiosity promotes the view that health is a priority; (4) Religiosity promotes the view that health enables one to perform necessary tasks; (5) Religiosity promotes health-seeking behavior; and (6) Religiosity provides intrinsic health benefits. Findings do not follow the clear-cut dichotomy of the health locus of control model and challenge simplified notions that Latinas hold a purely external health locus of control toward their health and health care. Latinas rely on both God and themselves in managing their health and engaging in health-promoting actions, which are prompted in large part by their religiosity. Implications for culturally appropriate health communication and interventions are discussed.

What weekday? How acute? An analysis of reported planned and unplanned GP visits by older multi-morbid patients in the Patient Journey Record System database

RATIONALE, AIMS AND OBJECTIVES

Timely access to general practitioner (GP) care is a recognized strategy to address avoidable hospitalization. Little is known about patients seeking planned (decided ahead) and unplanned (decided on day) GP visits. The Patient Journey Record System (PaJR) provides a biopsychosocial real-time monitoring and support service to chronically ill and older people over 65 who may be at risk of an avoidable hospital admission. This study aims to describe reported profiles associated with planned and unplanned GP visits during the week in the PaJR database of regular outbound phone calls made by Care Guides to multi-morbid older patients.

METHODS

One hundred fifty consecutive patients with one or more chronic condition (including chronic obstructive pulmonary disease, heart/vascular disease, heart failure and/or diabetes), one or more hospital admission in previous year, and consecutively recruited from hospital discharge, out-of-hour care and GP practices comprised the study sample. Using a semistructured script, Care Guides telephoned the patients approximately every 3 week days, and entered call data into the PaJR database in 2011. The PaJR project identified and prompted unplanned visits according to its algorithms. Logistic regression modelling and descriptive statistics identified significant predictors of planned and unplanned visits and patterns of GP visits on weekdays reported in calls.

RESULTS

In 5096 telephone calls, unplanned versus planned GP visits were predicted by change in health state, significant symptom concerns, poor self-rated health, bodily pain and concerns about caregiver or intimates. Calls not reporting visits had significantly fewer of these features. Planned visits were associated with general and medication concerns, reduced social participation and feeling down. Planned visits were highest on Monday and trended downwards to Fridays. Unplanned visits were reported at the same rate each weekday and more frequently when the interval between calls was ≥3 days. The PaJR project Care Guides advised patients to make unplanned visits in 6.3% of calls and advised planned GP visits in 2.5% of calls.

CONCLUSION

Unplanned GP visits consistently indicated a significant change to worse health with planned visits presenting less acuity in this study of older multi-morbid patients in general practice, when monitored by regular calls at about every 3 days. The PaJR study actively prompted GP visits according to its algorithms. Assessing and predicting acuity in older multi-morbid patients appears to be a promising strategy to improve access to primary care, and thus to reducing avoidable hospital utilization. Further research is needed to investigate the topic on a wider scale.

Baseline health perceptions, dysphagia, and survival in patients with head and neck cancer

BACKGROUND

In head and neck cancer patients prior to treatment, dysphagia noted by patients is more common than aspiration on formal swallow studies. The authors hypothesized that patient-reported dysphagia impacts multiple domains of quality of life (QOL) and predicts disease recurrence and disease-related death.

METHODS

The Swal-QOL, a dysphagia-specific, swallowing-related, QOL measure, and the EuroQOL-5D-3L were administered to 159 patients before treatment with curative intent in this prospective cohort study. Logistic regression analysis evaluated associations among clinical and subjective measures. Multivariable competing risk regression tested the impact of clinical, tumor, and patient-reported measures on survival.

RESULTS

Baseline dysphagia, pain, and diminished patient-reported health state were found to be closely associated with weight loss before treatment and advanced T classification. However, only 58% of patients (23 of 40 patients) reporting dysphagia experienced > 5% weight loss. Dysphagia was found to be associated with pain and/or diminished patient-reported health state, independent of weight loss. Female patients were more likely to report pain and dysphagia, whereas male patients reported dysphagia alone. Dysphagia was found to be predictive of disease recurrence and disease-related death, adjusting for T and N classifications, ECOG performance status, smoking status, and weight loss, and accounting for competing risks of death (recurrence-free survival: hazards ratio, 3.8 [95% confidence interval, 1.7-8.4; P = .001] and disease-related death: hazards ratio, 4.2 [95% confidence interval, 1.04-5; P = .004]).

CONCLUSIONS

Baseline dysphagia affects multiple domains of QOL and general health perceptions in patients with head and neck cancer prior to treatment. A dysphagia measure captures the effort of maintaining nutrition, and identifies patients predisposed to disease recurrence and disease-related death.

Body esteem, peer difficulties and perceptions of physical health in overweight and obese urban children aged 5 to 7 years

OBJECTIVE

To determine whether there is an association between body mass index (BMI) and body esteem in young overweight and obese urban children, and to test peer relationship difficulties and perceived physical health as mediators of this relationship.

METHODS

Child self-reported body esteem, and parent-reported child peer relationship difficulties (being bullied by peers and peer rejection) and physical health perceptions were obtained from 218 overweight and obese children aged 5-7 years (81% racial/ethnic minority, M BMI = 25.3) and their primary caregivers.

RESULTS

Higher BMI was associated with lower body esteem for both girls and boys. This relation was mediated by poor physical health for boys but not for girls. Peer relationship difficulties did not mediate the observed association between BMI and body esteem in either group; however, girls with higher BMI experienced more bullying and being bullied by peers was associated with lower body esteem in girls.

CONCLUSIONS

Intervening with perceptions of physical health may buffer overweight and obese boys from developing low body esteem in early childhood.

Pathological gambling: relationship to obesity, self-reported chronic medical conditions, poor lifestyle choices, and impaired quality of life

BACKGROUND

Pathological gambling (PG) is an important public health problem that is prevalent, costly to society, and associated with substance misuse, depression, domestic violence, crime, and suicide. Despite these challenges, little is known about the physical health and medical correlates of PG. The goal of this project was to assess self-reported chronic medical conditions, medication usage, lifestyle choices, health care utilization, quality of life variables, and body mass index (BMI) in persons with and without PG.

METHODS

Subjects with PG and community controls were systematically assessed for their medical health, lifestyle choices, medication usage, and health care utilization. We administered the Medical Outcome Study Short-Form 36 Health Survey to assess perceived health and quality of life. BMI was calculated for all subjects. Obesity was defined as having a BMI≥30kg/m(2).

RESULTS

We compared 95 subjects with DSM-IV PG (South Oaks Gambling Screen [SOGS] score≥5) and 91 control subjects without PG (SOGS≤2) selected through random digit dialing from the general community. PG subjects and controls were similar in age and gender. Persons with PG had more medical and mental health conditions than controls, and were more likely to avoid regular exercise, smoke≥1 pack/day, drink≥5 servings of caffeine daily, and watch television≥20hours/week. They had more emergency department visits for physical and mental health conditions, were more likely to have been psychiatrically hospitalized in the past year, and were more likely to take psychotropic medication. They were less likely to have had regular dental visits and were more likely to put off medical care due to financial problems. Severity of gambling was positively correlated with number of medical conditions. Persons with PG had poorer self-reported health perceptions on all but one SF-36 subscale. Importantly, persons with PG had a higher BMI than controls and were more likely to be obese.

CONCLUSIONS

PG is associated with obesity, chronic medical conditions, poor lifestyle choices, worse quality of life, and the use of costly forms of medical care. Pathological gamblers are less likely to receive regular dental care and are more likely to be unable to pay for medical care. The implications of the findings are discussed.

Asthma outcomes: quality of life

BACKGROUND

"Asthma-related quality of life" (QOL) refers to the perceived impact that asthma has on the patient's QOL.

OBJECTIVE

National Institutes of Health institutes and other federal agencies convened an expert group to recommend standardized measures of the impact of asthma on QOL for use in future asthma clinical research.

METHODS

We reviewed published documentation regarding the development and psychometric evaluation; clinical research use since 2000; and extent to which the content of each existing QOL instrument provides a unique, reliable, and valid assessment of the intended construct. We classified instruments as core (required in future studies), supplemental (used according to the study's aims and standardized), or emerging (requiring validation and standardization). This work was discussed at an National Institutes of Health-organized workshop convened in March 2010 and finalized in September 2011.

RESULTS

Eleven instruments for adults and 6 for children were identified for review. None qualified as core instruments because they predominantly measured indicators of asthma control (symptoms and/or functional status); failed to provide a distinct, reliable score measuring all key dimensions of the intended construct; and/or lacked adequate psychometric data.

CONCLUSIONS

In the absence of existing instruments that meet the stated criteria, currently available instruments are classified as either supplemental or emerging. Research is strongly recommended to develop and evaluate instruments that provide a distinct, reliable measure of the patient's perception of the impact of asthma on all of the key dimensions of QOL, an important outcome that is not captured in other outcome measures.

Health disparities between Appalachian and non-Appalachian counties in Virginia USA

The examination of health disparities among people within Appalachian counties compared to people living in other counties is needed to find ways to strategically target improvements in community health in the United States of America (USA).

METHODS

A telephone survey of a random sample of adults living in households within communities of all counties of the state of Virginia (VA) in the USA was conducted.

FINDINGS

Health status was poorer among those in communities within Appalachian counties in VA and health insurance did not make a difference. Health perception was significantly worse in residents within communities in Appalachian counties compared to non-Appalachian community residents (30.5 vs. 17.4% rated their health status as poor/fair), and was worse even among those with no chronic diseases. Within communities in Appalachian counties, black residents report significantly better health perception than do white residents.

CONCLUSION

Residents living in communities in Appalachian counties in VA are not receiving adequate health care, even among those with health insurance. More research with a larger ethnic minority sample is needed to investigate the racial/ethnic disparities in self-reported health and health care utilization within communities.

Thermal patterns and health perceptions

INTRODUCTION

Thermal pattern analysis is thought to be an indicator of health. However, the validity of this concept has not been established. To further investigate the relationship between thermal pattern analysis and health perceptions, thermal scans were assessed in conjunction with results from the SF-12 health survey.

METHODS

Sixty-eight chiropractic students were recruited to receive two paraspinal thermal scans, 5 minutes apart, on three visits that were 1 week apart. Each scan produces three graphs or channels; one for each of left and right sides of the spine and a delta or difference between left and right. The scans were imported into a thermal pattern calculator (TPC) providing a percent similarity between the two. The TPC percent were compared with to their corresponding SF-12 scores.

RESULTS

There were no significant findings in the left or delta channel. For the right channel, there was a decrease in mental health perception in participants having a TPC percent of 70.8 or higher (32.3% of all visits).

CONCLUSION

Participants in this study who had right channel TPC percent of 70.8 or higher were associated with lower mental health perception scores. The study is considered a preliminary inquiry only due to the small sample size.