Thesis (M.A. (Industrial Psychology))--North-West University, Vaal Triangle Campus, 2006.

An estimated 50% of mortality from the 10 leading causes of death is due to behaviour. Individuals can make important contributions to their own health by adopting health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a counselling approach for behavioural change that builds on a patient empowerment perspective by supporting autonomy and self-efficacy. The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on general health care professionals’ learning and practice of MI. Specific aims are; study I was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies; study II was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services; study III was to evaluate the attitudes towards MI and clinical use of MI with children´s weight issues one year after child health care nurses’ participation in MI training; study IV was to systematically review studies that have evaluated the contents and outcomes of MI training for general health care professionals. Participants in study I were 15 community pharmacy pharmacists in Östergötland, Sweden. Participants in study II were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Data for both studies were obtained through focus group interviews. Study III, participants were 76 nurses from child health care centres in Östergötland, Sweden. 1-year after MI training they answered a survey. Study IV, the material was 10 empirical studies that have evaluated different aspects of MI training. MI training for general health care providers is generally of short duration and tends to focus on specific topics such as diabetes, smoking, and alcohol. The training seems to contain more training on phase I elements, such as clients’ inner motivation, than on phase II, which involves strengthening clients’ commitment to change. MI is seen as practical and useful in work with lifestyle and health promotion issues, especially with issues that may be perceived as sensitive, such as alcohol and obesity. General health care providers have positive attitudes to MI and view MI as being compatible with their values and norms about how they want to work. Clients’ resistance reactions are difficult to handle in the first stages of learning MI, and may lead to frustration. Strategies to avoid resistance are including in the final stages of learning MI. Learning and clinical use of MI for general health care providers is influenced by interactions with their environment (colleagues, staff and organization). Unlearning of old knowledge can be a problem for general health care providers in the learning and clinical use of MI.

Thesis (Ph.D.)--Brown University, 2008. / Vita. Advisor : James A. Morone.

Thesis (Ph.D.)--Brown University, 2008. / Vita. Includes bibliographical references.

Thesis (Ph.D.)--Lehigh University, 2009. / Adviser: Shin-Yi Chou.

<p> The United States (US) is plagued by a high-cost health care system producing lower than desired patient quality outcomes. In 2012, the Patient Protection and Affordable Care Act was enacted to financially incentivize cost-effective models of care that improve the health of US citizens. One emerging solution is engaging patients with chronic conditions in self-management practices. </p><p> Guided by Krieger's Eco-Social Theory, this study used semi-structured interviews, scales and a questionnaire to detect factors that facilitate patient activation of self-management in patients with type 2 diabetes. Managed and unmanaged participants were equally represented in the study sample. White participants and participants from two American Indian tribes located in Northeast Wisconsin were included in this study. Findings indicated the establishment of routine behavior and the ability to identify healthy alternatives when routines were disrupted support patient activation of self-management. Experiencing success such as weight loss was also identified as a factor in facilitating patient activation. Social roles and responsibilities challenged unmanaged patients. </p><p> The study concluded that community, culture and environment have both a negative and positive influence on patient activation of self-management of type 2 diabetes. The current epidemics of obesity and diabetes create an apathetic response to the type 2-diabetes diagnosis that affects subsequent treatment and self-management in the communities studied. Aspects of local cultures such as unhealthy regional and tribal foods, lack of options for menu items low in carbohydrates and sugar in restaurants, high consumption of soda and alcohol and holidays/tribal events provide significant challenges for unmanaged patients. Workplace policies surrounding health insurance premiums had an impact on attendance at educational events but not on sustaining self-management behaviors. Positive aspects of the workplace include the imposition of structure and routine and the emotional support of colleagues. Warm seasons were also found to activate self-management by providing an opportunity for outdoor exercise and healthier modes of food preparation. </p><p> Consistent with a previous study, high rates of childhood trauma were found among the study groups. However, findings did not support the hypothesis that levels of childhood trauma were linked to self-management. While some evidence of historical grief and loss along with associated symptoms was found among the American Indian populations, there was no correlation between managed condition and level of grief and loss. Further examination of the connection between childhood and historical trauma to the current obesity and diabetic epidemics in these communities is recommended. Recommendations for changes to public health and health care policy are included.</p>

<p> <b>Purpose:</b> Empirical evidence on impact of CABG report cards on the quality of CABG surgery is patchy, mixed and mainly comes from uncontrolled and short term studies. CABG report cards are associated with a small decline in mortality after controlling for an overall declining trend. Whether report card publication has caused this decline is not known. </p><p> <b>Methods:</b> I use difference-in-differences and difference-in-differences-in-differences with fixed and random effects in OLS, Logistic, FGLS and GMM regression frameworks in a quasi-experiment set up in State-level and patient-level HCUP data with risk-adjustment to assess long term impact of CABG report cards on CABG mortality and provider market share and volume. This study uses counterfactuals, and multiple States as treatment and control States. </p><p> <b>Results:</b> CABG shows steadier and 17% steeper decline in in-hospital mortality rate when compared with other equally complex surgeries, and 30% steeper improvement when compared with pneumonectomy. There is a strong secular and statistically significant trend of decreasing CABG mortality. States with and without report cards were similar in terms of CABG mortality at baseline. We do not see long term impact of CABG report cards, State-mandated or voluntary, on CABG in-hospital mortality. Nevertheless, report cards have caused a gain in market share of 6% and 5% for low mortality hospitals and surgeons respectively in face of a secular trend of rising market share of average mortality hospitals and surgeons. CABG report card policy was also associated with decrease in hospital volume by 152 surgeries and decrease in surgeon volume by 14 surgeries a year over and above the secular trend of declining CABG volumes. </p><p> <b>Conclusions:</b> Concurrent Society of Thoracic Surgeons intiative and spillover of effects across States may explain why we do not see impact of CABG report cards in long term on improvements in quality of CABG surgery. National and regional system interventions with State CABG report cards appear to have created a perfect storm leading to a rising tide of CABG quality which has benefitted all States. It appears the report cards are associated with a change in today's culture of medicine biased in favor of interventions and procedures.</p>

<p> This study examined the human needs of 445 adults admitted to hospital with the primary medical diagnosis of Type 2 Diabetes Mellitus [ICD-9CM 250.0-9] and compared the pattern of nursing diagnoses (human needs) with those of 5321 patients having Type 2 DM but admitted to hospital for other reasons and with the 78,480 inpatients with no DM. Length of hospital stay, intensive care unit use and discharge dispositions were examined, controlling for race, poverty, marital status and age, to determine if the nursing diagnosis variables were distinctive for any of the three patient groups. A subset of 14 nursing diagnoses was identified from the literature on the care of Type 2 DM to determine how they varied among the three groups. The 61 nursing diagnoses were also fitted in regression models to explain variances in patient length of stay and to explore patient diabetes status. A multinomial logistic (logit) regression model that included the predictor variables of patient age, race, marital status, socioeconomic position (insurance type), and sex was used to predict patient discharge disposition. </p><p> This study was a secondary analysis of data collected over a three-year period by nurses in the daily assessment and care of their hospitalized patients. Donabedian's structure, process, and outcome model of quality of care provided the conceptual framework for this study. The statistical software SAS (9.3) was used for the analysis. </p><p> Nursing diagnosis use pattern did not consistently distinguish patients with type 2 diabetes mellitus from other patients. Patient information gathered by nurses in the provision of care to their patients is qualitative in nature -with holistic perspective independent of International Classification of Diseases codes. Nursing diagnosis was related to patient length of stay. The number of different nursing diagnoses was the most important predictor of patient length of stay in a model that included patient age, sex, marital status and socioeconomic position. </p><p> Patient race, age, and socioeconomic position were predictive of patient discharge disposition (discharge to own home, discharge to home with home health services, discharge to nursing homes, or discharge to other healthcare facility) but not substantially related to patient length of stay. This methodological study has helped address two related questions in the negative; when the disease is known are the needs of the patient known and when the needs of the patient are known, is the disease known?</p>

<p> Mortality rates in the United States are higher for men than they are for women as a result of chronic diseases such as heart disease, cancer, and diabetes. Despite these disproportionate rates, few health interventions are targeted to men, and limited knowledge exists regarding the specific components needed to design technology health tools to appeal to men. The purpose of this quantitative study was to examine the relationship between the use of technology health tools and the role of self-efficacy in men and the influence on participation in healthy lifestyle behaviors. A quasi-experimental design was used to analyze data collected from the Health Information National Trends Survey (<i>N</i> = 990). A group of men (<i>n</i> = 323) who used technology health tools were compared to a control group of men (<i> n</i> = 667) who did not use technology health tools. Results from the regression analysis indicated that the use of technology health tools for self-management of health behavior had a significant effect on participation in healthy lifestyle behavior (<i>p</i> = .026). Self-efficacy was also found to mediate the relationship between technology health tools and participation in healthy lifestyle behavior (<i>p</i> = .018). This study supports the United States federal government's Healthy People 2020 objective to increase the proportion of people who use Internet health management tools. The implications for positive social change include knowledge for developing targeted technology health interventions to increase the participation of men in healthy lifestyle behavior, reduce the number of men with chronic diseases, improve chronic disease management, and reduce healthcare costs in the United States.</p>

<p> This study analyzes the relationship between participating in the Food Stamp Program (FSP) and being diagnosed with diabetes. Data for this study was based on participant's response to the 2011-2012 California Health Interview Survey (CHIS). This study predicted that participation in the FSP would increase the likelihood for participants to develop diabetes type-2. The variables under investigation in this study consisted of participation in the FSP, previously being diagnosed with diabetes, ability to afford and eat balanced meals, socioeconomic status (SES), and consumption rates of soda and fast food. The results of this study showed statistical significance between FSP participation and being diagnosed with diabetes, ability to afford and eat balanced meals and being part of the lower SES, as well as FSP participation and consumption rate of soda and fast food.</p>