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Janz NK, Friese CR, Katz SJ. Correlates of decline in emotional well-being over time in breast cancer survivors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e19673] [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: 11/20/2022] Open
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Janz NK, Hawley ST, Mujahid MS, Graff J, Hamilton AS, Katz SJ. Correlates and mediators of worry about breast cancer recurrence. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9098] [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: 11/20/2022] Open
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Davis RE, Couper MP, Janz NK, Caldwell CH, Resnicow K. Interviewer effects in public health surveys. Health Educ Res 2010; 25:14-26. [PMID: 19762354 PMCID: PMC2805402 DOI: 10.1093/her/cyp046] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 07/27/2009] [Indexed: 05/04/2023]
Abstract
Interviewer effects can have a substantial impact on survey data and may be particularly operant in public health surveys, where respondents are likely to be queried about racial attitudes, sensitive behaviors and other topics prone to socially desirable responding. This paper defines interviewer effects, argues for the importance of measuring and controlling for interviewer effects in health surveys, provides advice about how to interpret research on interviewer effects and summarizes research to date on race, ethnicity and gender effects. Interviewer effects appear to be most likely to occur when survey items query attitudes about sociodemographic characteristics or respondents' engagement in sensitive behaviors such as substance use. However, there is surprisingly little evidence to indicate whether sociodemographic interviewer-respondent matching improves survey response rates or data validity, and the use of a matched design introduces possible measurement bias across studies. Additional research is needed to elucidate many issues, including the influence of interviewers' sociodemographic characteristics on health-related topics, the role of within-group interviewer variability on survey data and the simultaneous impact of multiple interviewer characteristics. The findings of such research would provide much-needed guidance to public health professionals on whether or not to match interviewers and respondents on key sociodemographic characteristics.
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Affiliation(s)
- R E Davis
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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Mujahid M, Hawley S, Janz NK, Hamilton A, Graff J, Katz SJ. Racial/ethnic differences in treatment delay in a multiethnic sample of women with breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6503] [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: 11/20/2022] Open
Abstract
6503 Background: Factors contributing to racial/ethnic variation in breast cancer treatment delay remain understudied, especially in multi-ethnic population-based samples. Methods: 3,252 women with non-metastatic breast cancer diagnosed between 6/05–2/07 and reported to the Los Angeles County and Detroit, Surveillance Epidemiologic and End Results (SEER) registries were surveyed after initial treatment (mean time from diagnosis = 8.9 months). Latina and African American (AA) women were over- sampled (n=2260, eligible response rate 72.1%). Treatment delay was defined as the patient's report of the duration between when breast cancer was first diagnosed and first surgical procedure (< 1month, 1–3months, ≥4 months) . Multinomial logistic regression models were used to estimate the relative odds of treatment delay by race/ethnicity before and after adjustment for sociodemographics (age, education, income, marital status), clinical factors (number of co-morbidities, health status at diagnosis), and access barriers (difficulty: finding doctors to treat cancer, scheduling surgical procedure, getting to doctor's office). Results: Of the 2195 women who had a surgical procedure, 6.9 % experienced treatment delay of ≥4 months (10.4% Latina, 9.3% AA, 5.5% white women). Latina and AA women were more likely to experience longer treatment delay than white women [OR for ≥4 months/1–3 months vs. < 1 month: 2.18/1.77 for Latinas; 1.78/1.50 for AA (p<.001)] (Table). Racial/ethnic differences persisted after adjustment for sociodemographic, clinical factors, and access barriers [OR for ≥4 months/1–3 months vs. < 1 month: 1.31/1.79 for Latinas; 1.64/1.55 for AA, (p<.001)] (Table), although Latina vs. white differences were no longer statistically significant. Conclusions: Our results confirm that racial/ethnic minorities are vulnerable to delay in receipt of breast cancer treatment in a large population based sample of breast cancer patients. Further work is needed to evaluate the underlying causes of this delay. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- M. Mujahid
- Harvard University, Boston, MA; University of Michigan Health System, Ann Arbor, MI; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - S. Hawley
- Harvard University, Boston, MA; University of Michigan Health System, Ann Arbor, MI; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - N. K. Janz
- Harvard University, Boston, MA; University of Michigan Health System, Ann Arbor, MI; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - A. Hamilton
- Harvard University, Boston, MA; University of Michigan Health System, Ann Arbor, MI; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - J. Graff
- Harvard University, Boston, MA; University of Michigan Health System, Ann Arbor, MI; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - S. J. Katz
- Harvard University, Boston, MA; University of Michigan Health System, Ann Arbor, MI; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
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Hawley ST, Janz NK, Hamilton AS, Katz SJ. Decision involvement and mastectomy use among racially/ethnically diverse breast cancer patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6511] [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: 11/20/2022] Open
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Mujahid MS, Janz NK, Hamilton AS, Katz SJ. Racial/ethnic differences in job loss for women with breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6513] [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: 11/20/2022] Open
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Janz NK, Mujahid MS, Hawley ST, Hamilton AS, Katz SJ. Racial/ethnic differences in quality of life and fear of recurrence after diagnosis of breast cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mujahid M, Janz NK, Hawley ST, Hamilton A, Katz SJ. Patterns and consequences of missed work after diagnosis of breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9015] [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: 11/20/2022] Open
Abstract
9015 Background: Work loss is a potential adverse consequence of cancer. However, there is little research on patterns and correlates of paid work from diagnosis through initial treatment and the impact of missed work on family and finances. Methods: 2,030 women with non-metastatic breast cancer diagnosed from 8/05–5/06 and reported to the Los Angeles County SEER registry were identified and mailed a survey shortly after receipt of surgical treatment. Latina and African American (AA) women were over-sampled. Outcome measures included missed paid work (<1 month, =1 month, stopped all together) and impact on finances (difficulty paying bills or cutting down on general expenses). We report results on a 50% respondent sample (N=742) which will be updated based on a final respondent sample of 1,400 patients (projected response rate, 72%). Results: Of the 440 women (59%) that worked prior to breast cancer, 35%, 26%, and 39% missed <1month, =1month, or stopped working, respectively. African Americans and Latinas (especially those who primarily speak Spanish) were more likely to stop working as compared to whites [OR for stop working vs. missed <1month: 3.5 (p<.001); 4.0 (p<.001) respectively]. Women receiving chemotherapy were also more likely to stop working after adjusting for other sociodemographic and treatment factors [ORs for stopped working vs. missed <1month: 8.4 (p <.001)]. Having sick leave and a flexible work schedule available through work was protective against work stoppage [ORs for stopped working vs. missed <1month: 0.2 (p<.001), 0.1 (p<.001) respectively)] after adjusting for sociodemographic and treatment factors. Women who stopped work were more likely to report both difficulty paying bills, and the need to cut down on expenses compared to women who missed <1month [ORs: 3.3 (p=.002); 3.6 (p<.002) respectively]. Conclusions: Many women stop working altogether after a diagnosis of breast cancer, particularly if they receive chemotherapy, have limited resources, or are employed in vulnerable work settings. These women face adverse economic consequences. Clinicians and staff need to be aware of these adverse consequences of diagnosis and initial treatment particularly in ethnic minorities and low-income patients. No significant financial relationships to disclose.
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Affiliation(s)
- M. Mujahid
- University of Michigan, Ann Arbor, MI; University of Southern California, Los Angeles, CA
| | - N. K. Janz
- University of Michigan, Ann Arbor, MI; University of Southern California, Los Angeles, CA
| | - S. T. Hawley
- University of Michigan, Ann Arbor, MI; University of Southern California, Los Angeles, CA
| | - A. Hamilton
- University of Michigan, Ann Arbor, MI; University of Southern California, Los Angeles, CA
| | - S. J. Katz
- University of Michigan, Ann Arbor, MI; University of Southern California, Los Angeles, CA
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Janz NK, Mujahid M, Hawley S, Hamilton A, Katz S. Racial/ethnic differences in adequacy of information and peer support for women with breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9085] [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: 11/20/2022] Open
Abstract
9085 Background: Existing disparities in quality of care for women with breast cancer suggest the need to explore the adequacy of information and care support provided to patients. This study investigated whether racial/ethnic variation existed in receipt and usefulness of cancer-related information and availability of peer support. Methods: 2,030 women diagnosed with non-metastatic breast cancer and reported to the Los Angeles County, Surveillance Epidemiologic and End Results registry between 8/05–5/06, were identified and mailed a survey shortly after initial treatment. Latina and African American (AA) women were oversampled. Outcomes included self-reported receipt and perceived usefulness of treatment-related (recovery from surgery, radiation, chemotherapy) and survivorship-related (sexual functioning, relationships, nutrition, anxiety) information and experiences with other women with breast cancer. We report results on a 50% respondent sample (N=742) that will be updated based on a final sample of 1,400 women (projected response rate, 72%). Results: More women received information and found it useful regarding treatment than survivorship issues. After adjusting for age and education, a higher percentage of Latina women, compared to white and AA women, desired more information on treatment-related issues and survivorship-related issues (p<.01). A higher percentage of Latina women also reported having no contact with other women with breast cancer, either through the health care system or a family/friend (p<.001), and reported a desire for more contact as compared to white or AA women (42%, vs. 15% and 29%, respectively). Overall, women rated the benefit of talking to other women high, particularly in helping with emotional issues and few endorsed potentially negative consequences. Conclusions: Women with breast cancer expressed the need for more useful information and care support, especially about managing survivorship concerns. Particular focus is warranted with Latina women to provide desired information and greater opportunities for peer contact. No significant financial relationships to disclose.
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Affiliation(s)
- N. K. Janz
- University of Michigan, Ann Arbor, MI; University of Michigan, School of Public Health, Ann Arbor, MI; University of Southern California, Los Angeles, CA
| | - M. Mujahid
- University of Michigan, Ann Arbor, MI; University of Michigan, School of Public Health, Ann Arbor, MI; University of Southern California, Los Angeles, CA
| | - S. Hawley
- University of Michigan, Ann Arbor, MI; University of Michigan, School of Public Health, Ann Arbor, MI; University of Southern California, Los Angeles, CA
| | - A. Hamilton
- University of Michigan, Ann Arbor, MI; University of Michigan, School of Public Health, Ann Arbor, MI; University of Southern California, Los Angeles, CA
| | - S. Katz
- University of Michigan, Ann Arbor, MI; University of Michigan, School of Public Health, Ann Arbor, MI; University of Southern California, Los Angeles, CA
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Fitzgerald MP, Janz NK, Wren PA, Wei JT, Weber AM, Ghetti C, Cundiff GW. Prolapse severity, symptoms and impact on quality of life among women planning sacrocolpopexy. Int J Gynaecol Obstet 2007; 98:24-8. [PMID: 17477927 DOI: 10.1016/j.ijgo.2007.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 03/12/2007] [Accepted: 03/15/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore the relationship between severity of pelvic organ prolapse (POP), symptoms of pelvic dysfunction and quality of life using validated measures. METHOD Baseline data from 314 participants in the Colpopexy And Urinary Reduction Efforts (CARE) trial were analyzed. Pelvic symptoms and impact were assessed using the Pelvic Floor Distress Inventory (PFDI) and the Pelvic Floor Impact Questionnaire (PFIQ). PFDI and PFIQ scores were compared by prolapse stage and history of incontinence or POP surgery. Regression analyses were performed to identify other predictors of symptoms and impact. RESULTS Women were predominantly (90%) Caucasian and had mean age of 61 years. Women with stage II POP, especially those with prior surgery, reported more symptoms and impact than women with more advanced POP. There were no other significant predictors of symptoms or life impact. CONCLUSIONS Women planning sacrocolpopexy with stage II prolapse and prior pelvic surgery reported more symptoms and quality of life impact than those with more advanced prolapse.
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Katz SJ, Hofer TP, Hawley S, Lantz PM, Janz NK, Schwartz K, Liu L, Deapen D, Morrow M. Correlates of patient referral to surgeons for treatment of breast cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6032] [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: 11/20/2022] Open
Abstract
6032 Background: Characteristics of surgeons and their practice settings have been associated with cancer treatments and outcomes. Yet, there is little information about factors that are associated with referral pathways to surgeons and treatment settings. Methods: We merged and analyzed tumor registry and survey data from all women with DCIS and a 20% random sample of women with invasive breast cancer diagnosed in 2002 and reported to the Detroit and Los Angeles SEER registries (N = 1,844, response rate 77.4%,) and their surgeons (N = 365, response rate 80.0%). Results: About half of the patients (54.2%) reported that they were referred to their surgeon by another provider or health plan; 20.3% reported that they selected their surgeon; 21.9% reported that they both were referred and were involved in selecting their surgeon; and the remaining patients (4.9%) reported that they had a prior relationship with their surgeon primarily through previous surgery. Selecting their surgeon based on reputation was more frequently reported by white patients (36.5% vs 26.5%, p < .001), and more highly educated patients (40.0% and 21.6%, respectively for highest and lowest education categories, p < .001). Patients who selected their surgeon based on reputation were more likely to have received treatment from a high volume surgeon (adjusted odds ratio 2.3; 95% CI 1.7, 3.2) and more likely to have been treated in an American College of Surgeon approved cancer program or NCI-designated cancer center (adjusted odds ratio 1.8; 95% CI 1.1, 2.8; 3.0 95% CI 1.6, 5.3, respectively). Patients who were referred to their surgeon were less likely to be treated in an NCI-designated cancer center (adjusted OR 0.4; 95% CI 0.2, 0.8). Conclusions: Women with breast cancer who actively participate in the surgeon selection process are more likely to be treated by more experienced surgeons and in hospitals with approved cancer programs. Patients should be aware that provider or health plan-based referral may not connect them with the most experienced surgeon or comprehensive practice setting in their community. An active patient role in the surgeon selection process has important implications for both the type of treatment received and where care is delivered. No significant financial relationships to disclose.
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Affiliation(s)
- S. J. Katz
- University of Michigan, Ann Arbor, MI; Wayne State University, Detroit, MI; University of Southern California, Los Angeles, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - T. P. Hofer
- University of Michigan, Ann Arbor, MI; Wayne State University, Detroit, MI; University of Southern California, Los Angeles, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - S. Hawley
- University of Michigan, Ann Arbor, MI; Wayne State University, Detroit, MI; University of Southern California, Los Angeles, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - P. M. Lantz
- University of Michigan, Ann Arbor, MI; Wayne State University, Detroit, MI; University of Southern California, Los Angeles, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - N. K. Janz
- University of Michigan, Ann Arbor, MI; Wayne State University, Detroit, MI; University of Southern California, Los Angeles, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - K. Schwartz
- University of Michigan, Ann Arbor, MI; Wayne State University, Detroit, MI; University of Southern California, Los Angeles, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - L. Liu
- University of Michigan, Ann Arbor, MI; Wayne State University, Detroit, MI; University of Southern California, Los Angeles, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - D. Deapen
- University of Michigan, Ann Arbor, MI; Wayne State University, Detroit, MI; University of Southern California, Los Angeles, CA; Fox Chase Cancer Center, Philadelphia, PA
| | - M. Morrow
- University of Michigan, Ann Arbor, MI; Wayne State University, Detroit, MI; University of Southern California, Los Angeles, CA; Fox Chase Cancer Center, Philadelphia, PA
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Morrow M, Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Deapen D, Salem B, Lakhani I. Surgeon perspectives on local therapy for breast cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.601] [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: 11/20/2022] Open
Affiliation(s)
- M. Morrow
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
| | - S. J. Katz
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
| | - P. M. Lantz
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
| | - N. K. Janz
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
| | - A. Fagerlin
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
| | - K. Schwartz
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
| | - L. Liu
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
| | - D. Deapen
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
| | - B. Salem
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
| | - I. Lakhani
- Fox Chase Cancer Ctr, Philadelphia, PA; Univ of Michigan, Ann Arbor, MI; Wayne State Univ, Detroit, MI; Univ of Southern CA, Los Angeles, CA
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Lantz PM, Janz NK, Fagerlin A, Mujahid M, Salem B, Katz SJ. Surgical treatment satisfaction among women with breast cancer: The role of preferences regarding shared decision making. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6033] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - B. Salem
- University of Michigan, Ann Arbor, MI
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Janz NK, Mujahid M, Lantz PM, Fagerlin A, Salem BO, Katz SJ. A population-based study of quality of life in women with breast cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8126] [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: 11/20/2022] Open
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Affiliation(s)
- S. J. Katz
- University of Michigan, Ann Arbor, MI; Northwestern University, Chicago, IL
| | - P. M. Lantz
- University of Michigan, Ann Arbor, MI; Northwestern University, Chicago, IL
| | - N. K. Janz
- University of Michigan, Ann Arbor, MI; Northwestern University, Chicago, IL
| | - A. Fagerlin
- University of Michigan, Ann Arbor, MI; Northwestern University, Chicago, IL
| | - B. Salem
- University of Michigan, Ann Arbor, MI; Northwestern University, Chicago, IL
| | - I. Lakhani
- University of Michigan, Ann Arbor, MI; Northwestern University, Chicago, IL
| | - M. Morrow
- University of Michigan, Ann Arbor, MI; Northwestern University, Chicago, IL
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Janz NK, Wren PA, Lichter PR, Musch DC, Gillespie BW, Guire KE, Mills RP. The Collaborative Initial Glaucoma Treatment Study: interim quality of life findings after initial medical or surgical treatment of glaucoma. Ophthalmology 2001; 108:1954-65. [PMID: 11713062 DOI: 10.1016/s0161-6420(01)00874-0] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To present interim quality of life (QOL) findings in the Collaborative Initial Glaucoma Treatment Study (CIGTS) using all available follow-up through 5 years from treatment initiation. DESIGN Randomized controlled clinical trial. PARTICIPANTS Six hundred seven newly diagnosed patients with open-angle glaucoma from 14 clinical centers. INTERVENTION Patients were randomly assigned to either initial medical therapy or initial trabeculectomy. After treatment initiation and early follow-up, patients received clinical and QOL evaluations at 6-month intervals. QOL assessments were administered by telephone at a centralized interviewing center. MAIN OUTCOME MEASURES The CIGTS collected comprehensive QOL information that included both generic and vision-specific QOL measures. This article focuses on initial treatment group differences related to symptom reporting, as measured by a Symptom and Health Problem Checklist, and changes in daily visual functioning, as measured by the Visual Activities Questionnaire (VAQ). RESULTS Across both treatment groups, there was an overall decline in the percent of participants reporting symptoms over time. Of 43 possible symptoms, 12 symptoms were reported with greater frequency by the surgically treated group and 7 symptoms more frequently by the medically-treated group. The surgical patients reported more total Symptom Impact Glaucoma (P = 0.005) and, in particular, more bother related to local eye symptoms. Very few treatment group differences were noted in visual functioning, although surgical patients reported more problems with activities related to their visual acuity (P = 0.024). The percentage of patients across treatment groups reporting worry about blindness was 50% at baseline but declined to approximately 25% over time. CONCLUSIONS Overall, the QOL impact reported by the two treatment groups as measured by instruments used in this study is remarkably similar, with relatively few significant study group differences observed after up to 5 years of follow-up in the CIGTS. When significant differences in visual function have been detected using the VAQ, they are consistent with the clinical outcomes. To date, the most persistent QOL finding is the increased impact of local eye symptoms reported by the surgical group compared with the medical group. Although no changes are recommended in the treatment of newly diagnosed glaucoma patients at the time of this interim report, further follow-up will allow for more definitive answers to the QOL impact of these two treatment approaches.
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Affiliation(s)
- N K Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109-2029, USA
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Lichter PR, Musch DC, Gillespie BW, Guire KE, Janz NK, Wren PA, Mills RP. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology 2001; 108:1943-53. [PMID: 11713061 DOI: 10.1016/s0161-6420(01)00873-9] [Citation(s) in RCA: 784] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To report interim outcome data, using all available follow-up through 5 years after treatment initiation, in the Collaborative Initial Glaucoma Treatment Study (CIGTS). DESIGN Randomized clinical trial. PARTICIPANTS Six hundred seven newly diagnosed glaucoma patients. METHODS In a randomized clinical trial, 607 patients with newly diagnosed open-angle glaucoma were initially treated with either medication or trabeculectomy (with or without 5-fluorouracil). After treatment onset and early follow-up, patients were evaluated clinically at 6-month intervals. In addition, quality of life telephone interviews were conducted at similar frequency to the clinical visits. Patients in both arms of CIGTS were treated aggressively in an effort to reduce intraocular pressure (IOP) to a level at or below a predetermined target pressure specific for each individual eye. Visual field (VF) scores were analyzed by time-specific comparisons and by repeated measures models. MAIN OUTCOME MEASURES VF loss was the primary outcome variable in CIGTS. Secondary outcomes of visual acuity (VA), IOP, and cataract were also studied. RESULTS On the basis of completed follow-up through 4 years and partially completed through 5 years, VF loss did not differ significantly by initial treatment. Over the entire period of follow-up, surgical patients had a greater risk of substantial VA loss compared with medical patients. However, by 4 years after treatment, the average VA in the two groups was about equal. Over the course of follow-up, IOP in the medicine group has averaged 17 to 18 mmHg, whereas that in the surgery group averaged 14 to 15 mmHg. The rate of cataract requiring removal was greater in the surgically treated group. CONCLUSIONS Both initial medical or initial surgical therapy result in about the same VF outcome after up to 5 years of follow-up. VA loss was greater in the surgery group, but the differences between groups seem to be converging as follow-up continues. When aggressive treatment aimed at substantial reduction in IOP from baseline is used, loss of VF can be seen to be minimal in general. Because 4 to 5 years of follow-up in a chronic disease is not adequate to draw treatment conclusions, these interim CIGTS outcomes do not support altering current treatment approaches to open-angle glaucoma.
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Affiliation(s)
- P R Lichter
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, The University of Michigan, Ann Arbor, Michigan 48105, USA
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Abstract
BACKGROUND Better understanding of factors influencing the quality of life (QOL) of cardiac patients can guide treatment decisions. OBJECTIVES To describe the impact of clinical and psychosocial factors on the QOL of older women with heart disease. RESEARCH DESIGN Baseline and 12-month data from women participating in an intervention study. SUBJECTS Eligible participants, identified from medical records, were female, > or = 60 years of age, and diagnosed with cardiac disease. A volunteer sample of 570 women (87% white) completed baseline interviews, with 485 women completing the 12-month assessment. MEASURES Utilizing Wilson and Cleary's conceptual framework (1995), measures of clinical, psychosocial, and functional status were examined for their associations with QOL. RESULTS At baseline, General Health Perceptions and Symptom Status accounted for 38% and 26%, respectively, of the variation in the QOL rating. Using logistic regression models, seven measures were significant predictors (P < 0.05) of maintenance/improvement versus decline in QOL over 12 months: baseline QOL rating; baseline value and change in satisfaction with social activities over 12 months; change in satisfaction with physical activities; change in satisfaction with mental activities; and baseline value and change in perceived stress. For women who maintained or improved their satisfaction with social activities, the odds for also maintaining or improving QOL were 4.5 times the odds for women whose satisfaction with social activities deteriorated. CONCLUSIONS Satisfaction with social activities and perceived stress are important predictors of subsequent QOL. Consideration of the impact of treatments on these factors may help to prevent deterioration of QOL among older female cardiac patients.
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Affiliation(s)
- N K Janz
- Department of Health Education, School of Public Health, University of Michigan, USA.
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Mills RP, Janz NK, Wren PA, Guire KE. Correlation of visual field with quality-of-life measures at diagnosis in the Collaborative Initial Glaucoma Treatment Study (CIGTS). J Glaucoma 2001; 10:192-8. [PMID: 11442181 DOI: 10.1097/00061198-200106000-00008] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the relationship between various clinical measures of visual field and patient-reported measures of symptoms and health status in a large cohort of patients with glaucoma at the time of diagnosis. PATIENTS AND METHODS The 607 patients in the Collaborative Initial Glaucoma Treatment Study received standardized examinations of visual field at enrollment. In addition, they completed a telephone-administered, health-related quality-of-life questionnaire, which included the Visual Activities Questionnaire (VAQ) and a symptom and health problem checklist. RESULTS The Visual Activities Questionnaire total and subscale scores, particularly the peripheral vision subscale, correlated weakly but significantly with global visual field scores. Symptoms attributed to glaucoma also correlated weakly but significantly to visual field scores. Correlations with other visual field measures, including only central and pericentral test locations in the scores, did not strengthen the association, and simulating binocular visual field scores produced only slightly stronger correlations. CONCLUSIONS At diagnosis, most patients were relatively free of glaucoma-related impairments. Various visual field measures derived from clinical visual field test data were only modestly associated with patients' perceptions of health-related quality of life. As the Collaborative Initial Glaucoma Treatment Study population is followed up longitudinally, it will be important to see whether these pertinent associations become stronger.
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Affiliation(s)
- R P Mills
- Department of Ophthalmology, University of Kentucky College of Medicine, Lexington 40536, USA
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Janz NK, Wren PA, Lichter PR, Musch DC, Gillespie BW, Guire KE. Quality of life in newly diagnosed glaucoma patients : The Collaborative Initial Glaucoma Treatment Study. Ophthalmology 2001; 108:887-97; discussion 898. [PMID: 11320018 DOI: 10.1016/s0161-6420(00)00624-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The Collaborative Initial Glaucoma Treatment Study (CIGTS) was designed to determine whether patients with newly diagnosed open-angle glaucoma are better treated initially by medicine or immediate filtering surgery. This paper describes the quality-of-life (QOL) measurement approach, instruments included, and the CIGTS participants' QOL findings at the time of diagnosis. DESIGN Baseline results from a randomized, controlled clinical trial. PARTICIPANTS Six hundred seven patients from 14 clinical centers were enrolled. INTERVENTION Patients randomized to initial medication received a stepped medical regimen (n = 307). Those randomized to initial surgery underwent a trabeculectomy (n = 300). The baseline interview was conducted before treatment initiation. All baseline and posttreatment QOL assessments were conducted by telephone from a centralized interviewing center. MAIN OUTCOME MEASURES The primary outcome measure described in this paper was QOL. The QOL instrument is multidimensional and incorporates both disease-specific and generic measures, including the Visual Activities Questionnaire, Sickness Impact Profile, and a Symptom and Health Problem CHECKLIST: RESULTS The correlations between QOL measures and clinical outcomes were in the expected direction, but relatively weak. At initial diagnosis, difficulty with bright lights and with light and dark adaptation were the most frequently reported symptoms related to visual function, whereas visual distortion was the most bothersome. Approximately half of the patients reported at least some worry or concern about the possibility of blindness. Within the Visual Activities Questionnaire, higher scores on the Peripheral Vision subscale were associated with more field loss (P < 0.01). In regression analyses controlling for sociodemographics and nonocular comorbidities, increased visual field loss was significantly associated with higher dysfunction among five disease-specific QOL measures (P < 0.05). CONCLUSIONS Newly diagnosed glaucoma patients reported experiencing some visual function symptoms at the time of diagnosis that would not be intuitively expected based on clinical testing. Some discussion about the association between clinical presentation and worry about blindness may reduce unnecessary concern. These results provide the basis for long-term comparisons of the QOL effects of initial medical and surgical treatment for open-angle glaucoma.
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Affiliation(s)
- N K Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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Forthofer MS, Janz NK, Dodge JA, Clark NM. Gender differences in the associations of self esteem, stress and social support with functional health status among older adults with heart disease. J Women Aging 2001; 13:19-37. [PMID: 11217183 DOI: 10.1300/j074v13n01_03] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study explored and compared the role of self esteem, stress and social support in maintenance or improvement in physical and psychosocial functioning over 12 months in older men and women with cardiovascular disease. Data from 502 adults over 60 years of age showed that self esteem and stress were both significantly associated with functioning when demographic and clinical factors were controlled. Men were significantly more likely than women to maintain or improve in functioning. Self esteem, stress, compliance with medication regimens, and marital status were significantly associated with maintenance or improvement of functioning among women. Only age and stress were significantly associated with maintenance or improvement in functioning among men. Findings indicated that: (1) stress and self esteem were stronger predictors of functioning, especially among women, than demographic and clinical factors; and (2) women in the highest quartile of the self esteem distribution were approximately five times as likely to maintain or improve their functioning as women in the lowest quartile.
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Affiliation(s)
- M S Forthofer
- Department of Community and Family Health, University of South Florida College of Public Health, 13201 Bruce B. Downs Boulevard (MDC 56), Tampa, FL 33612-3805, USA
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22
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Janz NK, Clark NM, Dodge JA, Schork MA, Mosca L, Fingerlin TE. The impact of a disease-management program on the symptom experience of older women with heart disease. Women Health 2000; 30:1-24. [PMID: 10881755 DOI: 10.1300/j013v30n02_01] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study describes the symptom experience of 570 older women with heart disease and evaluates a disease-management program's impact on symptoms over time. Women were randomly assigned to either usual care or a 4-week program ("Women take PRIDE") designed to improve self-regulation skills by focusing on increasing physical activity. At 4 months follow-up, program women, compared to controls, reported fewer total symptoms (p = 0.01) and decreased symptom frequency (p = 0.02) and bothersomeness (p = 0.02). By 12 months, positive intervention effects emerged within the common cardiac and sleep and rest symptom categories. Program group women reported more improvements in symptoms likely to be affected by increasing physical activity at both follow-ups (p < 0.05).
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Affiliation(s)
- N K Janz
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor 48109-2029, USA
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23
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Clark NM, Janz NK, Dodge JA, Schork MA, Fingerlin TE, Wheeler JR, Liang J, Keteyian SJ, Santinga JT. Changes in functional health status of older women with heart disease: evaluation of a program based on self-regulation. J Gerontol B Psychol Sci Soc Sci 2000; 55:S117-26. [PMID: 10794196 DOI: 10.1093/geronb/55.2.s117] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study involving 570 women aged 60 years or older with heart disease, assessed the effects of a disease management program on physical functioning, symptom experience, and psychosocial status. METHODS Women were randomly assigned to control or program groups. Six to eight women met weekly with a health educator and peer leader over 4 weeks to learn self-regulation skills with physical activity as the focus. Evaluative data were collected through telephone interviews, physical assessments, and medical records at baseline and 4 and 12 months post baseline. RESULTS At 12 months, compared with controls, program women were less symptomatic (p < .01), scored better on the physical dimension of the Sickness Impact Profile (SIP; p < 0.05), had improved ambulation as measured by the 6-minute walk (p < 0.01), and lost more body weight (p < .001). No differences related to psychosocial factors as measured by the SIP were noted. CONCLUSION A self-regulation-based program that was provided to older women with heart disease and that focused on physical activity and disease management problems salient to them, improved their physical functioning and symptom experience. Psychosocial benefit was not evident and may be a result of measurement error or due to insufficient program time spent on psychosocial aspects of functioning.
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Affiliation(s)
- N M Clark
- University of Michigan School of Public Health, Ann Arbor 48109-2029, USA.
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24
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Herman WH, Janz NK, Becker MP, Charron-Prochownik D. Diabetes and pregnancy. Preconception care, pregnancy outcomes, resource utilization and costs. J Reprod Med 1999; 44:33-8. [PMID: 9987737] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To describe and compare pregnancy outcomes, resource utilization and costs among women with diabetes who receive and do not receive preconception care. STUDY DESIGN A multicenter, prospective, observational study of women with type 1 diabetes who received preconception care (PC), became pregnant and delivered (PC women) and women with type 1 diabetes who received prenatal care (PC) only and delivered (PN women). RESULTS As compared to PN women (n = 74), PC women (n = 24) were seen earlier in gestation and had significantly lower glycosylated hemoglobin levels. The combined number of outpatient visits for PC women was not greater than for PN women. PC women were hospitalized significantly less during pregnancy and tended to have shorter inpatient stays. The mean length of stay after delivery was significantly shorter for PC women. Intensity of care tended to be lower and length of stay shorter for infants of mothers who received PC care. The net cost saving associated with PC care was approximately $34,000 per patient. CONCLUSION PC achieves its major intended health benefits and is associated with reduced resource utilization and substantially reduced costs. For both health and economic reasons, clinical practice and public policy should embrace PC.
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Affiliation(s)
- W H Herman
- Department of Internal Medicine, School of Public Health, University of Michigan, Ann Arbor.
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25
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Mangione CM, Berry S, Spritzer K, Janz NK, Klein R, Owsley C, Lee PP. Identifying the content area for the 51-item National Eye Institute Visual Function Questionnaire: results from focus groups with visually impaired persons. Arch Ophthalmol 1998; 116:227-33. [PMID: 9488276 DOI: 10.1001/archopht.116.2.227] [Citation(s) in RCA: 255] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To identify the content area for a questionnaire designed to measure vision-targeted health-related quality of life and to determine whether problems with vision-related functioning are qualitatively similar across different common eye diseases. DESIGN Twenty-six condition-specific focus groups were conducted with 246 patients from 5 geographic regions to identify the content area for a questionnaire for use among persons with diabetic retinopathy, glaucoma, macular degeneration, cytomegalovirus retinitis, and cataract. A standard protocol was used to structure each focus group discussion. Sessions were audiotaped, transcribed, and coded in preparation for a content analysis. SETTINGS Five university-based ophthalmology practices and 1 nonprofit eye care foundation. PARTICIPANTS Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. All eligible persons were older than 21 years, spoke English, and had sufficient cognitive function to provide informed consent. RESULTS Among the 246 participants, 2623 problems with vision-related functioning were mentioned. The mean number of problems per person ranged from 13.5 for those with diabetic retinopathy to 7.9 for persons with glaucoma. For the sample overall, reading problems were mentioned most frequently, followed by driving, general problems with seeing clearly, and mental health complaints caused by vision. Although the proportion of persons who reported each problem varied by condition, at least some persons with each eye disease reported each problem. The 3 most common descriptors associated with each problem were difficulty or ease of performance (13%), psychological distress associated with performance of the activity (11%), and complete inability to participate in a visual activity (11%). CONCLUSION An item-generation strategy for a new questionnaire using a standardized focus group method identified content areas and aspects of visual disability that are not included in currently available vision-specific instruments that assess the impact of common eye diseases on visual functioning in every-day life. Although participants mentioned problems that were unique to their disease, across conditions the problems mentioned were similar. These findings provide empirical evidence of content validity for a vision-targeted, health-related quality-of-life survey designed for use across conditions.
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Affiliation(s)
- C M Mangione
- RAND Health Program, RAND, Santa Monica, Calif 90401, USA
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26
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Abstract
PURPOSE The purpose of this study was to identify the factors that contributed to intervention effectiveness in acquired immunodeficiency syndrome (AIDS) prevention projects targeting youth. METHODS Eleven AIDS prevention projects funded by the Robert Wood Johnson Foundation whose target populations consisted of at least 60% youth were studied. A blended methodology resulted in quantitative data (i.e., survey responses) from all 11 projects supplemented with qualitative data (i.e., open-ended interviews) drawn from in-depth site visits to six projects. RESULTS Projects reported using a mean of 16.6 intervention activities (selected from a list of 30). Six activities were used by all 11 projects. Small group discussions were rated as one of three most effective activities by 72.7% of the projects that used them. Project staff identified three elements of effective interventions: involvement of peer educators, recognition of the role of adults (e.g., parents, teachers), and use of structured settings to gain access to the target population (e.g., schools, clubs). CONCLUSIONS The most powerful strategies described by project staff for reaching adolescents at risk for human immunodeficiency virus (HIV) transmission also bring considerable challenges. Opportunity costs associated with using peer educators, gatekeeper support, and structured settings may include limited control of the message, impaired credibility, and failure to reach those youth at greatest risk of HIV infection, respectively. Health educators will do well to consider the advantages and disadvantages of these factors when developing, implementing, and evaluating AIDS prevention programs for youth.
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Affiliation(s)
- P A Wren
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA
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27
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Janz NK, Schottenfeld D, Doerr KM, Selig SM, Dunn RL, Strawderman M, Levine PA. A two-step intervention of increase mammography among women aged 65 and older. Am J Public Health 1997; 87:1683-6. [PMID: 9357355 PMCID: PMC1381136 DOI: 10.2105/ajph.87.10.1683] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study evaluated a two-step intervention for mammography screening among older women. METHODS Four hundred and sixty women, identified from physician practices, were randomized to a control or a two-step intervention (physician letter and peer counseling call) group. Women in the intervention group who obtained a mammogram received a grocery coupon. RESULTS Over the 12 months of the study, more women in the intervention group than in the control group obtained mammograms (38% vs 16%). The most dramatic difference was in the higher odds that women in the intervention group would obtain a mammogram within 2 months (odds ratio = 10.5). CONCLUSIONS The intervention significantly increased screening mammography. Future efforts must be multifaceted and incorporate the unique concerns of older women.
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Affiliation(s)
- N K Janz
- School of Public Health, University of Michigan-Ann Arbor 48109-2029, USA
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Abstract
PURPOSE To determine the extent to which commonly used clinical measures of corneal transplantation outcome are related to aspects of visual function and health-related quality of life. METHODS In a cross-sectional validation study, ophthalmic examination information was collected by chart review of, and health-related quality of life information was collected by telephone contact with, patients (n = 77) undergoing routine follow-up examinations at least 1 year after corneal transplantation. A questionnaire that included the VF-14 and SF-36 instruments was completed for each participant. Associations between clinical and questionnaire outcomes were evaluated using analysis of variance and regression analyses. RESULTS When the best-corrected visual acuity of both eyes was evaluated, there was a positive association (P < .0001) of visual acuity with the VF-14 score and with the following SF-36 scales: role limitations because of emotional problems (P = .04), emotional well-being (P = .08), and social functioning (P = .02). Those with a high degree of keratometric astigmatism showed an impact on social functioning (P = .005). Upon regression analysis, the single most important factor associated with the patients' reported visual function was their visual acuity in the better eye, followed by the extent of keratometric astigmatism. CONCLUSIONS These findings demonstrate a high degree of criterion validity in using the VF-14 instrument to assess the outcome of corneal transplantation. Application of the more generic SF-36 measure shows effects of visual disability on other aspects of corneal transplant patients' health status, including their emotional and social functioning.
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Affiliation(s)
- D C Musch
- Department of Ophthalmology, University of Michigan, Ann Arbor 48105, USA.
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29
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Abstract
BACKGROUND To increase the proportion of women who receive the recommended follow-up for mammographic abnormalities, factors which inhibit follow-up must be identified. Patient and health care delivery related factors were evaluated, stratified by type of follow-up recommendation, to determine reasons for inadequate follow-up. METHODS All Caucasian and African American women at the Henry Ford Medical Group, in southeastern Michigan, with an abnormal screening mammogram result between January 1, 1992 and July 31, 1992 were identified. All women with inadequate follow-up, and a random sample of women with adequate follow-up, were invited to participate in a telephone interview that assessed three major dimensions of the Health Belief Model (susceptibility, benefits, and barriers), general health and health behaviors, and related characteristics. The relationship between these factors and inadequate follow-up was evaluated separately for women with immediate and 6-month follow-up recommendations, using univariate and multivariate analyses. RESULTS A total of 555 women were invited to participate in the study (219 with inadequate follow-up and 336 with adequate follow-up). Interviews were completed for 418 women (75.3%). Women who were not notified of their mammographic abnormality were excluded from this study, leaving 399 women available for analysis. Among the women who had the recommended immediate follow-up, those who reported difficulty in obtaining medical appointments were 4 times more likely to have inadequate follow-up (95% confidence interval [CI] 1.5, 11.3), after adjusting for other variables. Among the women with six-month follow-up recommended, those who received fewer mammograms in the past 5 years were more likely to have inadequate follow-up (odds ratio [OR] = 4.0; 95% CI 1.6, 10.4). In this group, sociodemographic characteristics were not associated with inadequate follow-up, although women with transportation problems were at a higher risk (crude OR = 5.2; 95% CI 1.6, 16.7; adjusted OR = 3. 1; 95% CI 0.5, 18.3). Among women with 6-month follow-up recommended, those who perceived their health as poor or fair (crude OR = 2.4; 95% CI 1.2, 5.1; adjusted OR = 2.3; 95% CI 0.8, 6.8) and those who did not examine their own breasts frequently (crude OR = 2.3; 95% CI 1.0, 5.4; adjusted OR = 2.7; 95% CI 0.5, 18.3) were also more likely to have inadequate follow-up. CONCLUSIONS Results from this study demonstrate that the relative importance of factors associated with inadequate follow-up of abnormal mammograms differs according to the type of follow-up recommended. For both types of recommendations, the factors identified are noteworthy because they are amenable to intervention. Efforts should be made to facilitate appointment scheduling for follow-up of abnormal mammograms, and information about previous mammography screening should be obtained to identify women who are at a high risk for inadequate follow-up.
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Affiliation(s)
- B D McCarthy
- Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
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Janz NK, Zimmerman MA, Wren PA, Israel BA, Freudenberg N, Carter RJ. Evaluation of 37 AIDS prevention projects: successful approaches and barriers to program effectiveness. Health Educ Q 1996; 23:80-97. [PMID: 8822403 DOI: 10.1177/109019819602300106] [Citation(s) in RCA: 53] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In 1988, the Robert Wood Johnson Foundation awarded grants to 54 AIDS prevention and service projects. This article presents the results from a survey of the 37 projects that contained a substantial prevention effort and embellishes these findings with qualitative data from in-depth site visits to 12 projects. Survey respondents reported conducting a mean of 19 different intervention activities. Small-group discussion, outreach to populations engaged in high-risk behaviors, and training peers and volunteers were the intervention activities rated most effective by project staff. Qualitative analysis identified eight factors facilitating intervention effectiveness. Three site-visited projects were chosen to exemplify the ways in which these facilitating factors contributed to the perceived effectiveness of small-group discussions, outreach, and the training of peer educators. Recommendations to guide the development and delivery of future community-based AIDS prevention projects are presented.
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Affiliation(s)
- N K Janz
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor 48109-2029, USA.
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Janz NK, Wren PA, Israel BA. Staff stress in AIDS prevention and service organizations: implications for health education practice. Health Educ Res 1995; 10:163-177. [PMID: 10160228 DOI: 10.1093/her/10.2.163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The purpose of this study was to identify the frequency of staff stressors and their association with programmatic factors in 51 AIDS prevention and service projects funded by the Robert Wood Johnson Foundation. The methodology included both quantitative (i.e. closed-ended survey questions) and qualitative (i.e. in-depth, open-ended interviews) data to identify the important sources of staff stress. The findings suggest that staff working in AIDS prevention and service projects perceive significant levels of stress regardless of project focus. The most frequently reported staff stresses were too much work, rapid organizational growth, burnout, and problems with staff retention and communication. Among the issues rarely reported as a source of staff stress were too little work, discomfort with the target population and personal health risk concerns. The programmatic factor most often associated with staff stress was obtaining additional funding. Health education interventions need to take a comprehensive approach that includes altering the psychosocial-environmental conditions that give rise to stressors and strengthening the individual and organizational factors that may modify the effects of stress on the AIDS workforce.
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Affiliation(s)
- N K Janz
- Health Behavior and Health Education Department, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA
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Janz NK, Herman WH, Becker MP, Charron-Prochownik D, Shayna VL, Lesnick TG, Jacober SJ, Fachnie JD, Kruger DF, Sanfield JA. Diabetes and pregnancy. Factors associated with seeking pre-conception care. Diabetes Care 1995; 18:157-65. [PMID: 7729291 DOI: 10.2337/diacare.18.2.157] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.7] [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: 02/03/2023]
Abstract
OBJECTIVE To define sociodemographic characteristics, medical factors, knowledge, attitudes, and health-related behaviors that distinguish women with established diabetes who seek pre-conception care from those who seek care only after conception. RESEARCH DESIGN AND METHODS A multicenter, case-control study of women with established diabetes making their first pre-conception visit (n = 57) or first prenatal visit without having received pre-conception care (n = 97). RESULTS Pre-conception subjects were significantly more likely to be married (93 vs. 51%), living with their partners (93 vs. 60%), and employed (78 vs. 41%); to have higher levels of education (73% beyond high school vs. 41%) and income (86% > $20,000 vs. 60%); and to have insulin-dependent diabetes mellitus (IDDM) (93 vs. 81%). Pre-conception subjects with IDDM were more likely to have discussed pre-conception care with their health care providers (98 vs. 51%) and to have been encouraged to get it (77 vs. 43%). In the prenatal group, only 24% of pregnancies were planned. Pre-conception patients were more knowledgeable about diabetes, perceived greater benefits of pre-conception care, and received more instrumental support. CONCLUSIONS Only about one-third of women with established diabetes receive pre-conception care. Interventions must address prevention of unintended pregnancy. Providers must regard every visit with a diabetic woman as a pre-conception visit. Contraception must be explicitly discussed, and pregnancies should be planned. In counseling, the benefits of pre-conception care should be stressed and the support of families and friends should be elicited.
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Affiliation(s)
- N K Janz
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor 48109-2029, USA
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Clark NM, Janz NK, Dodge JA, Garrity CR. Managing heart disease: a study of the experiences of older women. J Am Med Womens Assoc (1972) 1994; 49:202-6. [PMID: 7829821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- N M Clark
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
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Dodge JA, Janz NK, Clark NM. Self-management of the health care regimen: a comparison of nurses' and cardiac patients' perceptions. Patient Educ Couns 1994; 23:73-82. [PMID: 21207905 DOI: 10.1016/0738-3991(94)90044-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This study compared perceptions of 129 elderly cardiac patients regarding their health status and self-management skills with corresponding assessments by outpatient nursing staff members. Nurse-patient perceptions were most congruent on general questions regarding the heart condition. Differences were most apparent regarding how aware patients were of being asked to follow a regimen for managing their heart problems; what specific components comprised the regimens the patients were to follow; and how much confidence patients had in their ability to comply with specific components of the regimen. Congruence in perceptions of nurses and patients varied by the sex of the patient. Findings suggest that careful and continuous assessment of patients' perceptions about their condition and ongoing instruction regarding specifics of the therapeutic regimen are key elements in efforts to enhance elderly patients' self-management skills.
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Affiliation(s)
- J A Dodge
- School of Public Health, University of Michigan, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA
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35
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Abstract
Social cognitive theory, in particular, the construct of self-regulation was the basis for developing an educational program for older adults with heart disease. This paper discusses the theoretical principles utilized and describes the program activities based on them. Data from an evaluation conducted with 246 older heart patients who took part in the education are used to illustrate how social cognitive theory constructs operated empirically.
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Affiliation(s)
- N M Clark
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor 48109-2029
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Clark NM, Janz NK, Becker MH, Schork MA, Wheeler J, Liang J, Dodge JA, Keteyian S, Rhoads KL, Santinga JT. Impact of self-management education on the functional health status of older adults with heart disease. Gerontologist 1992; 32:438-43. [PMID: 1427244 DOI: 10.1093/geront/32.4.438] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This paper presents findings from the evaluation of a self-management education program based on self-regulation principles. Older men and women (N = 324) were randomly assigned to program and control groups. Outcomes were measured using the Sickness Impact Profile. Twelve months following baseline data collection, psychosocial functioning of program participants was significantly better than that of controls. Different program effects were noted when results were analyzed by participant gender.
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Affiliation(s)
- N M Clark
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor 48109-2029
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Abstract
Findings are presented from an exploratory study of differences in the impact and management of heart disease between men and women aged 60 and over (N = 323). The sample consisted of ambulatory, non-institutionalized, cardiac patients who had agreed to participate in a self-management intervention study. Differences between men and women were found regarding symptom experience, physical functioning, exercise compliance, use of prescribed drugs, and physician/clinic visits. Differences in emotional well-being and psychosocial functioning were not found; however, women reported more stress and limitation in the area of household management. Implications for future research and practice are discussed.
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Affiliation(s)
- P A Sharpe
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan
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Affiliation(s)
- M H Becker
- University of Michigan School of Public Health, Ann Arbor 48109-2029
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Becker MH, Janz NK, Band J, Bartley J, Snyder MB, Gaynes RP. Noncompliance with Universal Precautions Policy: why do physicians and nurses recap needles? Am J Infect Control 1990; 18:232-9. [PMID: 2403215 DOI: 10.1016/0196-6553(90)90164-n] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In 1987 the Centers for Disease Control published a Universal Precautions Policy establishing blood and body fluid procedures to be used consistently with all patients. An important and unequivocal Universal Precautions Policy recommendation with regard to avoidance of needlestick injuries is that needles should never be recapped. We examined the recapping-related attitudes and behaviors of physicians and nurses at four large teaching hospitals with patients with acquired immunodeficiency syndrome and with Universal Precautions Policy in-service training programs. Compliance was found to be considerably less than optimal. According to unannounced needle counts in disposal boxes, the percentage of recapped needles was always greater than 25% and exceeded 50% in four instances. Recapping was related to inadequate knowledge, concerns about personal risk, forgetfulness, being "too busy" to follow the Universal Precautions Policy, and the misperception that recapping is a way to avoid needlestick injury. Strategies are suggested to improve and supplement traditional in-service education.
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Affiliation(s)
- M H Becker
- Department of Health Behavior and Health Education, School of Public Health, Ann Arbor 48109-2029
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Janz NK, Becker MH, Haefner DP, Rutt WM, Weissfeld LA. Determinants of breast self-examination after a benign biopsy. Am J Prev Med 1990; 6:84-92. [PMID: 2363954] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although breast self-examination (BSE) continues to be recommended as an adjunct to clinical screening techniques for the early detection of breast cancer, little is known about events that might negatively influence long-term adherence. The primary aim of this investigation was to determine if regularity of BSE would decline after a benign breast biopsy. Analyses are based on 655 women: 83 women who self-discovered the breast problem by BSE, 179 women in whom the problem was discovered by the health care system, and a control group of 393 women who had no history of breast problems. Frequency of BSE was assessed over two six-month periods and collapsed into three categories--nonpractitioner, irregular practitioner, and regular practitioner. Results indicated that the percentage of women in the self-discovered group who reported decreased regularity of BSE was over three times higher than that found in the control group. The largest percentage increase in BSE frequency was evidenced by the health care-discovered group. Logistic regressions revealed that the biopsy experience was a more powerful indicator of subsequent BSE practice than either sociodemographic characteristics or whether one engaged in other preventive health behaviors. The data provide substantial evidence that a benign biopsy can affect BSE practice, with the direction and magnitude of the change influenced by mode of discovery of the breast problem, perceived degree of confidence in ability to perform BSE, and level of practice before the biopsy. Postbiopsy educational strategies incorporating these findings and targeted at specific subgroups are outlined.
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Affiliation(s)
- N K Janz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor 48109-2029
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Janz NK. The Health Belief Model in understanding cardiovascular risk factor reduction behaviors. Cardiovasc Nurs 1988; 24:39-41. [PMID: 3203353] [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: 01/04/2023]
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Becker MH, Janz NK. Behavioral science perspectives on health hazard/health risk appraisal. Health Serv Res 1987; 22:537-51. [PMID: 3679842 PMCID: PMC1065455] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Health-promotion efforts often employ HRA as a device for providing an individual with quantitative information about the consequences of personal health-related behaviors and as an attempt to motivate the client to adopt recommendations directed at establishing a healthier lifestyle. From a behavioral science perspective, the HRA approach and process contain elements that (at least in retrospective analysis) appear to be founded in relevant bodies of theory. First, HRA seems to be a reasonably efficient mechanism for transmitting information relative to associations between personal health behaviors and mortality risks. Moreover, while general knowledge and advice about the untoward consequences of risk factors (such as smoking, obesity, high blood pressure, etc.) are currently widespread, HRA provides new and specific information: the client's own relative risks. Some individuals who voluntarily participate in HRA bring to the experience an already high level of readiness to take action; for them, the technique may constitute the final necessary stimulus or "cue to action" [12]. Referring to a "borrowing from the future" phenomenon, Green points out that "some educational efforts are really only triggers to behavior that would have changed eventually anyway" [44, p. 159]. Thus, where motivation is sufficiently high, receipt of HRA feedback information may by itself be capable of inducing behavior change. Second, the focus on awareness and personalization of mortality risk fits well with most theoretical formulations concerning attitudes and beliefs involved in health-related decision making. Although the emphasis on mortality and often distant negative outcomes is problematic, increasing the client's perception of personal vulnerability is a psychologically defensible approach, and fear arousal can generate attitude change (although questions of appropriate level, duration of effects obtained, acceptability, etc. still need to be resolved). Third, HRA might be expected to enhance the client's perception of the benefits associated with lifestyle modifications and may even increase personal belief in his or her ability to undertake such changes in behavior. However, in light of the fact that the behaviors to be altered are complex, usually well-established and repetitive, and require different skills to extinguish, the provision of typical HRA feedback should not (on a theoretical basis) ordinarily be expected to accomplish much beyond information transmission, belief or attitude change, and the induction of some level of motivation.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- M H Becker
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor 48109-2029
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Janz NK, Becker MH, Kirscht JP, Eraker SA, Billi JE, Woolliscroft JO. Evaluation of a minimal-contact smoking cessation intervention in an outpatient setting. Am J Public Health 1987; 77:805-9. [PMID: 3592033 PMCID: PMC1647206 DOI: 10.2105/ajph.77.7.805] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We examined the ability of a provider-initiated, minimal-contact intervention to modify the smoking behavior of ambulatory clinic patients. Smokers at two outpatient sites were assigned to one of three groups: provider intervention only (PI); provider intervention plus self-help manual (PI/M); and usual care (control) group (C). The physician message emphasized the patient's personal susceptibility, the physician's concern, and the patient's ability to quit (self-efficacy). The nurse consultation concentrated on benefits and barriers associated with stopping, and on strategies for cessation. Telephone interviews were conducted with the 250 participants within a few days of their clinic visit and again at one and six months. Both PI and PI/M proved to be superior to usual care in motivating attempts to quit at both one-month and six-month follow-ups, and logistic regression analyses indicated that participants receiving the self-help manual in addition to the health provider message were between two and three times more likely to quit smoking during the study period than were participants in either of the other study groups.
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Kirscht JP, Janz NK, Becker MH, Eraker SA, Billi JE, Woolliscroft JO. Beliefs about control of smoking and smoking behavior: a comparison of different measures in different groups. Addict Behav 1987; 12:205-8. [PMID: 3630808 DOI: 10.1016/0306-4603(87)90029-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study investigated several measures of beliefs about controlling smoking as predictors of cessation and reduction at one and six months after a medically-based control program. Smokers (n = 250 total) attending general medicine clinics at University and Veterans Administration facilities received advice to quit from both physicians and nurses. Beliefs about difficulty resisting urges to smoke in 15 situations, their frequency of occurrence, and general level of difficulty were assessed at baseline. For the University group of patients, significant relationships were found between both general and specific indexes and both cessation and reduction at one month. Although a greater change in smoking was seen at six months, few belief measures remained predictive. At one month, global measures were as useful as specific ones, although difficulty in situations of negative emotion was a consistent and strong predictor. Marked differences between the two sites were found; virtually no measure of difficulty proved predictive for the VA group.
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Abstract
Since the last comprehensive review in 1974, the Health Belief Model (HBM) has continued to be the focus of considerable theoretical and research attention. This article presents a critical review of 29 HBM-related investigations published during the period of 1974-1984, tabulates the findings from 17 studies conducted prior to 1974, and provides a summary of the total 46 HBM studies (18 prospective, 28 retrospective). Twenty-four studies examined preventive-health behaviors (PHB), 19 explored sick-role behaviors (SRB), and three addressed clinic utilization. A "significance ratio" was constructed which divides the number of positive, statistically-significant findings for an HBM dimension by the total number of studies reporting significance levels for that dimension. Summary results provide substantial empirical support for the HBM, with findings from prospective studies at least as favorable as those obtained from retrospective research. "Perceived barriers" proved to be the most powerful of the HBM dimensions across the various study designs and behaviors. While both were important overall, "perceived susceptibility" was a stronger contributor to understanding PHB than SRB, while the reverse was true for "perceived benefits." "Perceived severity" produced the lowest overall significance ratios; however, while only weakly associated with PHB, this dimension was strongly related to SRB. On the basis of the evidence compiled, it is recommended that consideration of HBM dimensions be a part of health education programming. Suggestions are offered for further research.
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Abstract
Researchers and practitioners have expressed considerable interest in contingency contracting as a promising intervention strategy for enlisting patient cooperation, particularly with regard to long-term treatment regimens. After brief examination of the theoretical background, the authors summarize advantages of contracting, describe elements essential to the development of a contract, and enumerate those ingredients in the contracting process thought to be critical for achieving optimal results. They review relevant research efforts in terms of their designs, methods, target and contracted health-related behaviors, contingencies employed, and initial and follow-up results. On the basis of this review, current issues regarding contingency contracting are raised, and practical considerations for large-scale application are noted along with recommendations for future research.
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