<p> Problem: Adolescent obesity has reached epidemic proportions globally. Motivational interviewing (MI) is an emerging intervention for adolescent health risk behavior that has promise. Despite its potential fit in primary health care contexts, primary care providers tend to express reticence in learning or adopting MI practices. This program evaluation project assessed the usefulness of Motivational Interviewing (MI) by primary care providers with adolescents in school based health centers that was implemented by a large randomized clinical trial (RCT) in southwest United States high schools. </p><p> Methods: As part of the RCT, the primary care providers were required to do MI sessions with 66, 45, 25, and 91 youth participants respectively at their School-based site. It was anticipated that providers would be increasingly comfortable with MI between their first and final participant and that youth would be increasingly satisfied as provider comfort increased. To evaluate this, as part of the RCT, a set of primary care providers working with youth in school based health centers were trained through didactic sessions, homework, and role-play. School-based providers were provided an introductory training in MI, MI reading materials, a study manual, and were required to participate in bimonthly tele-coaching to ensure treatment integrity and fidelity. Primary care provider and adolescent participant survey data from session 1 of the RCT was analyzed to determine provider comfort with MI and adolescent satisfaction with MI.</p><p> Summary of findings: Despite the standard training practices, providers showed a range of interest in comfort with the intervention. However, as anticipated, overall primary care providers became significantly more comfortable with MI on the final day of the MI sessions with increased use (p &lt; 0.01). Adolescent participants overall were highly satisfied with MI regardless of time with no significant differences over time.</p><p> Implications for Practice: Primary care providers have not embraced MI as it is perceived as time consuming and challenging, yet over time the primary care providers in this project became significantly more comfortable with MI while youth were highly satisfied independent of provider comfort. Integrating MI into clinical practice has promising implications to get more effective treatment to high-need and underserved youth.</p>

Thesis (M.S.)--University of Wisconsin--Madison, 1935. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

<p> <b>Background:</b> Exposure to household air pollution from cooking fires using biomass fuels (e.g., wood, charcoal, dung) is a leading cause of death and disability worldwide. Household air pollution (HAP) is one of the greatest environmental health risks in low-income and middle-income countries where the majority of people use biomass fuels to cook and heat their homes each day. Worldwide, approximately three billion people cook with biomass fuels; most often, these people cook inside homes with poor ventilation and use traditional stoves without chimneys. Even when clean-burning stoves and fuels are introduced in communities using HAP-producing cooking systems, adoption of these systems is often limited, and the use of clean-burning systems is not exclusive or sustained. To date, despite the need to understand behaviors related to smoke from cooking and heating sources, few investigators have used a behavioral theory or framework as a foundation for their investigation. </p><p> <b>Methods:</b> This qualitative exploratory study using open-ended interviews was conducted in Aleto Wondo, a rural area in southern Ethiopia. This research used grounded theory methodology and the theory of symbolic interaction to investigate the symbolic meaning that motivates actions related to exposures to household air pollution from cooking fire smoke. The target population was women who had children in the home and who primarily used biomass fuels for cooking.</p><p> <b>Results:</b> Themes that emerged during the analysis process and that are grounded in the data were (a) Awareness, Knowledge, and Interpretation; (b) Traditional Way; (c) Perceived Powerless and Lack of Agency; (d) Opportunities for Clarification and Education; (e) Access and Poverty; and (f) God&rsquo;s Will. These themes summarized the major factors in the participants&rsquo; social world&mdash;factors that influence the participant&rsquo;s symbolic meanings and interpretations that affected actions related to smoke from cooking fires.</p><p> <b>Conclusions:</b> Using the theoretical and methodological tools of grounded theory and symbolic interaction helped delineate how the themes identified in this research may each interrelate. Relative to household kitchen fire smoke exposure, human action is not overpoweringly affected by a single factor (e.g., God&rsquo;s will, gender roles) Relative to household kitchen fire smoke exposure, human action cannot be ascribed to a single factor (e.g., God&rsquo;s will, gender roles) or even a unique combination of known factors. These factors can be considered immutable or mutable based on an individual&rsquo;s symbolic meanings and interpretive processes.</p><p>

<p> Chronic disease is costly and requires a different approach to care than acute illness. Preventing chronic disease may improve health outcomes. This qualitative, explanatory case study explains the experiences of eight participants, from a suburban internal medicine practice in Fairfield County, CT, who used activity trackers/applications to adhere to diet and exercise. Daily email logs, information from the activity tracker/application and an exit interview provided detailed information about the participant used technology and what was most important to maintain lifestyle changes. The use of NVivo 11^&reg; assisted with data analysis to identify common themes that emerged including accountability, awareness, challenges, and knowledge. Each participant&rsquo;s information offered a unique perspective into how they viewed their responsibility to participate in their treatment plan. The use of technology assisted the participants to become actively involved in their disease management and development of new skills and strategies to support their lifestyle changes. Furthermore, the participant&rsquo;s described difficulties adhering to the lifestyle changes within their daily lives. Since most of the management of any chronic condition occurs outside of a provider&rsquo;s office, understanding the challenges and problems encountered by those with an early chronic disease, pre-diabetes, may assist providers to develop collaborative goals with their patients. Primary Care Providers, who understand the daily struggles of those Pre-diabetics, can offer realistic strategies for an individual to develop the necessary self-management skills to prevent diabetes.</p><p>

<p> African-American girls experience disparate rates of pregnancy and acquisition of sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV), when compared to their non-Hispanic, white counterparts. Among African-American girls, current pregnancy rates are equal to the national crisis levels of teen pregnancy reported in 1990 (Guttmacher Institute, 2013; National Teen Pregnancy Prevention Campaign, 2015). This qualitative elicitation study was conducted to gain insight into the ways in which African-American mothers and their daughters between the ages of 9 and 14 communicate about sexual health. Early sexual health communication between mothers and daughters is known to enhance the sexual health outcomes of girls. A series of four focus groups and three in-depth interviews were conducted between July and September of 2014. The Theory of Planned Behavior (TPB) was the organizing framework. Theoretical constructs that guided this study were: attitudes, perceived behavioral control, and subjective norms. Results showed that what African-American mothers share with their daughters about sexual health stems from the mother&rsquo;s personal faith, values, and experiences. The information and way that mothers convey the importance of talking about these topics forms a daughter&rsquo;s future subjective norms towards how they will view these topics in the future. Findings from this study can inform interventions to provide support for this understudied population. Moreover, there are implications for health care providers, particularly school nurses, who are in an ideal position to help mothers learn how to be confident so they can engage in sexual health conversations with their young daughters.</p><p>

This study examined the effects of a walking program with and without cultural modification among older Chinese American immigrants with hypertension. The study framework was based on Self-Efficacy Theory, Stages of Change Model, and Culture Care Theory and used a two-group, pretest-posttest, quasi-experimental design. Subjects (N = 128) were assigned to a non-culturally modified (n = 70) or culturally modified (n = 58) walking group. The first group received an 8-week walking program adapted from a protocol by Jitramontree (2001). The second group received the same 8-week walking program but culturally modified for Chinese Americans. The hypotheses were that stages of change and participation in a walking program with/without cultural modification would affect the dependent variables: perceived barriers, self-efficacy, blood pressure, and duration of walking. The results showed no interaction between stages of change and groups in the dependent variables. In addition, no main effects of stages on dependent variables were found except for duration of walking. These results revealed that individuals in the maintenance stage walked longer than those in the preparation stage. Main effects of the walking program were found on self-efficacy and barriers of social influences, lack of willpower, and lack of skill, but not on blood pressure and duration of walking. Participants in the non-culturally modified walking program had fewer barriers of social influence, lack of willpower, and lack of skill, and their confidence increased compared to those in the culturally modified walking program. Duration of physical activity at pretest was found to significantly affect posttest measures of diastolic blood pressure, self-efficacy, and the barriers of lack of willpower and lack of skill. Moreover, participants who walked more than 210 minutes/week had fewer barriers and were more confident in walking than those who walked less than 210 minutes/week. These results suggest that this walking protocol, when translated into Chinese and when accompanied by a weekly telephone reminder and other interactions with a Chinese-speaking nurse, is appropriate to use without additional cultural modification in older Chinese American immigrants with hypertension. Future research needs to examine other components of Chinese culture or to apply this protocol to Chinese Americans with other chronic diseases.

The high teen birth rate in Holyoke, Massachusetts is a complex problem. The teen birth rate is over five times the state‘s rate and nearly three times the national rate. Since a majority of these births are to Latinas of Puerto Rican descent it is important to include the perceptions of Puerto Rican teens in approaches to prevent teen pregnancy and reduce the birth rate. Although there is a plethora of research on the topic of teen pregnancy and births, there is scarcity in the area of perceptions held by teens of Puerto Rican descent about teen pregnancy and births, future consequences faced by teen parents, contributing and protective factors of teen pregnancy, and potential preventive interventions. This qualitative study used a series of eight focus groups to gather data and examine perceptions held by Puerto Rican teens living in Holyoke about teen pregnancy and birth. The Ecological Model of Health Behavior provided the theoretical framework. Findings indicate that Puerto Rican teens in Holyoke perceive that: teen pregnancy is largely unintentional and a problem with negative outcomes, a lack of information on sexual health and reproduction contributes to this problem, sexual and reproductive health education should be provided to all teens, social factors may either contribute to or prevent teen pregnancy teens, and they want their ideas heard. These findings suggest that teen pregnancy and birth is a complex public health problem in need of a comprehensive approach recognizing that interventions focused on individuals are not likely to have powerful or sustained effects. Rather a combination of interventions addressing individual, interpersonal, community and societal levels are needed for risk reduction and effective behavior change.

Purpose. This feasibility study evaluated all phases of the planned main study. The study tested the effect of self-selected distraction on acute pain perception in adolescents undergoing allergy skin testing. Distraction is a cognitive-behavioral nonpharmacologic nursing intervention used to divert attention from painful stimuli, which is supported by the gate control theory and distraction framework. A developmental model of adolescence provided a framework for testing self-selected distraction with adolescents for whom choice and control are important developmental concerns. Specific aims. What is the effect of distraction on acute procedural pain perception in adolescents? Specifically, what is the effect of self-selected distraction, rather than nurse-selected distraction, on acute procedural pain perception? What is the relationship between level of engagement with the distraction and perception of pain? How does anxiety interact with the effect of distraction on pain perception? Method. The study utilized a post-test, experimental design with random assignment to three groups: self-selected distraction, nurse-selected distraction, and usual care. Adolescents in the self-selected group chose a videotape, music CD, or book-on-cassette from a researcher-developed media library. The sample included 32 adolescents ages 11 to 17 years. Pain perception was measured by the Adolescent Pediatric Pain Tool and the FACES pain scale. Investigator-developed pre- and post-allergy testing questionnaires measured demographic data, “needle” anxiety, engagement in the distraction, and perceived effectiveness of distraction. Pre-testing anxiety was measured by the Spielberger State Anxiety Inventory. Results. The feasibility study piloted the analysis planned for the main study. No statistically significant differences were found among the three groups on pain perception. An unanticipated finding resulted in a trend toward the highest pain ratings for the self-selected distraction group during the more painful allergy testing phase. Greater level of engagement in the distraction was related to lower pain ratings. Higher levels of anxiety were correlated with higher pain ratings. Implications. The planned main study was not conducted based on the results of the feasibility study. The small effect size increased the proposed sample size. Matching coping style with choice of nonpharmacologic interventions is recommended for future research.

The process of mastery of major stressors in children has been much less studied than similar processes in adults. The purpose of this pilot study was to develop and to conduct beginning testing of a new psychological measure to assess the construct of cognitive mastery of stressful events in children, i.e., the Child Cognitive Mastery Scale (CCMS). First, 22 situations involving forced-choice responses were developed around three previously-identified domains: safety and security, just and controllable world, and self-view and pictures portraying these situations were drawn. Then, 56 children, ages 6 to 11 were tested with the CCMS and a depression measure. Twenty-one children were re-tested 7 to 10 days later with the CCMS. Teachers provided ratings of school achievement and parents provided information regarding stressful life events and the child's overall behavior. Results showed evidence of overall test-retest reliability and beginning evidence of inter-administrator reliability. The results also identified some initial "hints" at discriminative and construct validity and seemed, for the most part, to confirm the projective assumption that the childrens' responses would reflect their own views of the world and of themselves. This initial pilot study provided some encouraging information regarding the psychometric properties of the CCMS as well as information regarding needed revisions and some directions for further evaluation and development.

Little research has been done on the phenomenon of caring. Although health professionals express concern about the care they provide to patients, caring has not received the same degree of scholarly inquiry as the study of cures. This study attempts to shed some light on the phenomenon of caring from the patient's perspective. The primary purpose was to discover those experiences that hospital patients perceived to be caring and non-caring. The secondary purposes were to (1) determine if there was a gender difference in patient perception of caring and non-caring experiences, (2) determine if severity of illness was a variable in how patients perceive caring and non-caring, and (3) discover if patients perceive a difference in caring and non-caring in the past five or more years. This study followed an interpretive paradigm of research and analysis. It attempted to both describe human experiences as it appeared, and to understand the significance of the experience to the individual. The interpretation and analysis of findings are presented using metaphors (Chapter 5). Five metaphors are used to describe patients expressions of caring, and four are used to express patients descriptions of non-caring. All patients had some thoughts and ideation about loss, death and dying, regardless of their diagnosis. Findings suggest that nurses may underestimate the patient's desire for frequent surviellance. Care providers who demonstrated a holistic view of the patient and an understanding of the patient's personal needs were perceived to be caring. The emergence of a hierarchy of nursing care and medical care needs are suggested by the data. Patients appear to have a different hierarchy for nursing than for medical care. Although this was not part of the research question, it seems important and worthy of further research.