Self-Management and Transition Readiness Assessment: Development, Reliability, and Factor Structure of the STARx Questionnaire

INTRODUCTION

The Self-Management and Transition to Adulthood with Rx=Treatment (STARx) Questionnaire was developed to collect information on self-management and health care transition (HCT) skills, via self-report, in a broad population of adolescents and young adults (AYAs) with chronic conditions.

METHODS

Over several iterations, the STARx questionnaire was created with AYA, family, and health provider input. The development and pilot testing of the STARx Questionnaire took place with the assistance of 1219 AYAs with different chronic health conditions, in multiple institutions and settings over three phases: item development, pilot testing, reliability and factor structuring.

RESULTS

The three development phases resulted in a final version of the STARx Questionnaire. The exploratory factor analysis of the third version of the 18-item STARx identified six factors that accounted for about 65% of the variance: Medication management, Provider communication, Engagement during appointments, Disease knowledge, Adult health responsibilities, and Resource utilization. Reliability estimates revealed good internal consistency and temporal stability, with the alpha coefficient for the overall scale being .80. The STARx was developmentally sensitive, with older patients scoring significantly higher on nearly every factor than younger patients.

CONCLUSION

The STARx Questionnaire is a reliable, self-report tool with adequate internal consistency, temporal stability, and a strong, multidimensional factor structure. It provides another assessment strategy to measure self-management and transition skills in AYAs with chronic conditions.

Self-reported health behaviour change in adults: analysis of the Canadian Community Health Survey 4.1

Introduction

Knowledge of Canadians' experiences in making health behaviour changes (HBCs) in general, and among those at risk due to body mass index (BMI), would help inform health promotion / disease prevention programs. Selected self reported HBCs in the past 12 months by BMI category were examined in this secondary analysis of the Canadian Community Health Survey 4.1. These HBCs included increased sports/exercise, weight loss and improved eating habits. Barriers to HBC were also examined.

Methods

Descriptive analyses and forward stepwise logistic regression were completed on data from respondents 18 years and older. Self-reported BMI was corrected by the method of Connor Gorber et al. (2008).

Results

Our final sample was n = 111 449. Overall, 58% of respondents had made an HBC, with increased sports/exercise as the most important HBC in 29% of the sample, followed by improved eating habits (10%) and weight loss (7%). Half (51%) experienced barriers to HBC; lack of will power was most commonly cited, followed by work and family responsibilities. Obese respondents reported HBC more frequently than normal-weight respondents (60% vs. 55%), but the prevalence of increased sports/ exercise and improved eating habits was similar across BMI categories. Regression models accounted for only 6%-10% of the total variance.

Conclusion

That a majority of respondents had made at least one HBC bodes well for positively shifting population health. Additional work to further characterize the population, and to improve on population indicators, is needed to assess the impact of health promotion/disease prevention efforts. These findings provide important first population benchmarks for future work.

Self-reported health behaviour change in adults: analysis of the Canadian Community Health Survey 4.1

INTRODUCTION

Knowledge of Canadians' experiences in making health behaviour changes (HBCs) in general, and among those at risk due to body mass index (BMI), would help inform health promotion / disease prevention programs. Selected self reported HBCs in the past 12 months by BMI category were examined in this secondary analysis of the Canadian Community Health Survey 4.1. These HBCs included increased sports/exercise, weight loss and improved eating habits. Barriers to HBC were also examined.

METHODS

Descriptive analyses and forward stepwise logistic regression were completed on data from respondents 18 years and older. Self-reported BMI was corrected by the method of Connor Gorber et al. (2008).

RESULTS

Our final sample was n = 111 449. Overall, 58% of respondents had made an HBC, with increased sports/exercise as the most important HBC in 29% of the sample, followed by improved eating habits (10%) and weight loss (7%). Half (51%) experienced barriers to HBC; lack of will power was most commonly cited, followed by work and family responsibilities. Obese respondents reported HBC more frequently than normal-weight respondents (60% vs. 55%), but the prevalence of increased sports/ exercise and improved eating habits was similar across BMI categories. Regression models accounted for only 6%-10% of the total variance.

CONCLUSION

That a majority of respondents had made at least one HBC bodes well for positively shifting population health. Additional work to further characterize the population, and to improve on population indicators, is needed to assess the impact of health promotion/disease prevention efforts. These findings provide important first population benchmarks for future work.

Use of plasma clearance of inulin for estimating glomerular filtration rate in cats

OBJECTIVE

To evaluate utility of a method for estimating glomerular filtration rate after a single i.v. injection of inulin.

ANIMALS

Cats that were renal intact (n = 3) or had renal mass reduced by partial nephrectomy (n = 6).

PROCEDURE

Plasma clearance of inulin (PCln) was taken as the quotient of the administered dose of inulin (150 mg) divided by the area under the plasma inulin concentration versus time curve determined by 3 methods (PCln1-PCln3). Results for PCln were compared with simultaneously obtained values for urinary clearance of exogenous creatinine (CCr), an accepted method for the estimation of glomerular filtration rate (GFR) in cats.

RESULTS

Values for PCln were closely related (R2 ranged from 0.951 to 0.972, P < 0.0001 in all instances) to CCr. However, PCln3 provided an estimate of GFR that consistently overestimated CCr.

CONCLUSION

Determination of PCln by use of PCln1 and PCln2 provided a reliable estimate of GFR in cats of this study.

CLINICAL RELEVANCE

Determination of PCln appears to provide a reliable estimate of GFR in cats with early-stage renal disease and no evidence of derangement of body fluid status. In particular, PCln2, which requires only 3 determinations of plasma inulin concentration, should be considered when an estimate of GFR is sought in a cat with suspected early-stage renal disease.