Indiana University-Purdue University Indianapolis (IUPUI) / Purpose The experience of surgical patient decision-making for amputation, rotationplasty, or limb salvage surgery for the lower extremity was explored with osteosarcoma survivors and parents. Issues and patient concerns were examined prospectively in Facebook posts and retrospectively in personal interviews. Recommendations were sought for the development of a decision aid. Methods A qualitative inquiry was conducted in two studies: 1) a content analysis of 15 Facebook posts on the Osteosarcoma and Ewing’s Sarcoma Support Group about the surgical decision, and 2) a narrative analysis of 20 interviews with survivors and parents about their lived experience. The interview guide was informed by a knowledge translation theoretical model. In-person or video interviews included 29 parents or adolescent-young adults between the ages of 14-71 across 15 states. Results Participants were concerned about making the best decision for themselves or their child. Having little time to make the decision contributes to feeling overwhelmed and uninformed. The lack of information about options, potential limitations, prosthetic needs, and long-term functional outcomes impacts the decision-making process. Resources for finding information are limited. Shared decision-making approaches were preferred though many decisions were made by the surgeon. Patients felt unprepared for complications encountered after limb salvage. Conclusions Limb salvage surgery remains the gold standard for most providers; participants felt there was a bias on the surgeon’s part for salvage. Potential complications and uncertainties of each option were largely omitted in consultations; information about living with a prosthesis is an unmet need for decision-making. The decision affected their quality of life in ways they did not anticipate, resulting in additional decisions. Implications The findings of this study can be used in medical education for orthopedic surgeons to understand the long-term outcomes of limb salvage surgery. Patient preferences matter in the decision and patients who are involved in the decision are more satisfied if they are prepared for the unknown and potential complications. Recommendations for a decision aid include an online format, content that includes a discussion of uncertainties as well as complications of each option, patient stories for long-term outcomes, and resources for psychosocial support.

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Background: Obesity affects over 1 billion individuals across the world. In Canada, nearly 1 in 7 children and adolescents are obese. The risk of obesity is heightened for newcomer children due to their adoption of the Western diet and a sedentary lifestyle. While healthcare providers (HCPs) are the first point of contact upon health concerns, little is known about how HCPs approach HAL communication with newcomer families, with the goal of preventing childhood obesity. Objectives: This study aims to understand HCPs’ experiences with newcomer families relating to (1) HAL communication, (2) HAL promotion strategies, and (3) challenges with HAL promotion. Methods: 12 HCPs currently practicing in Hamilton and experienced in working with newcomer families completed 30–60-minute semi-structured interviews. Thematic analysis was used to identify key themes relating to HAL communication approaches, HAL promotion strategies, and challenges with promoting HAL among newcomer families. Results: Three themes emerged for HAL communication: 1) reactive approach, 2) patient-centered and culturally sensitive communication, 3) holistic health discussions. Four themes emerged for HAL promotion strategies: 1) tailored resource recommendations, 2) facilitating connections among newcomers, 3) family-centered approach, 4) referrals to additional support. Five themes emerged for challenges with HAL promotion: 1) time constraints, 2) difficulty to obtain buy-in, 3) limited resources awareness & availability, 4) navigating sensitivity and empathy, 5) ambiguity in role responsibilities. Conclusion: HCPs emphasized the influence of time limitations, limited resource awareness, and newcomer families’ competing priorities on limiting their ability to proactively promote HAL. Analyzing the data through the Commission on Social Determinants of Health (CSDH) framework revealed the various intersecting determinants of health that make HAL promotion an intricate task. With HCPs expressing reservations about their efficacy in promoting HAL proactively, investigation into collaborative approaches for proactive HAL promotion should be explored. / Thesis / Master of Science (MSc) / Obesity affects over 1 billion individuals across the world. In Canada, nearly 1 in 7 children and adolescents are obese. The risk of obesity is heightened for newcomer children due to their adoption of the Western diet and a sedentary lifestyle. While healthcare providers (HCPs) are the first point of contact upon health concerns, little is known about how HCPs communicate and promote the importance of healthy eating and daily physical activity to newcomer families, with the goal of preventing childhood obesity. Using a qualitative thematic analysis approach, semi-structured interviews were conducted with 12 HCPs. Their responses revealed that HCPs commonly only discuss health behaviours in response to evident weight concerns, tailor their recommendations to address newcomers’ circumstances, and are hindered by time constraints to discuss health behaviours. Acknowledging the limitations of their role capacity, HCPs advocated for collaborative approaches to proactively promote healthy active living to newcomer children.

Background: Much research consistently shows that there are disparities in healthcare delivery. Healthcare disparities affect individuals across a broad range of demographics such as gender, race or ethnicity, and it is also related to socioeconomic factors such as income levels, access to health benefits and insurance, and health literacy. Recent immigrants to Canada encounter a different and unfamiliar healthcare system. This situation presents challenges to the practice of health care delivery. Therefore, it is crucial that innovative strategies be identified to reduce disparities in health care to promote the overall quality of care and public health services. Purpose: The purpose of this dissertation research was two-fold: (1) to examine cultural competence strategies, if any, that are used by healthcare organizations to improve interaction and communication between healthcare providers and their immigrant patients with the purpose to reduce healthcare disparities; and specifically, (2) to explore the use of Information and Communications Technologies (ICTs) to improve communication between healthcare providers and immigrant patients with the objective of reducing healthcare disparities. Methods: This dissertation research employed a mixed methods approach for data collection and analysis. The research was carried out in three phases. In the first phase, a series of focus group discussions with a sample of recent immigrants was conducted. In the second phase, an online survey was conducted to gain insights from healthcare providers regarding the role of ICTs in improving communication with immigrant patients to help reduce healthcare disparities. In the third phase, healthcare providers who participated in the survey were invited to participate in face-to-face, in-depth semi-structured interviews to further reflect on and extend the survey responses. Campinha-Bacote's Cultural Competence Model and Unified Theory of Acceptance and Use of Technology were employed for this dissertation research as its theoretical framework. Results: The findings indicated that the absence of effective communication as well as cultural and language barriers were major issues related to communication between healthcare providers and immigrant patients. The findings also indicated that immigrant patients might need to improve their digital and health literacy skills in order to improve their communication with their healthcare providers. Further, the findings indicated that it was important for healthcare providers to have access to more demographic data on immigrant patients because such data will allow healthcare providers to be better informed on how to most effectively tailor their healthcare services to this population group. Conclusion: Findings obtained from this dissertation research shed light on cross cultural communication issues related to working with immigrant patients that may lead to disparities in health care. Healthcare organizations may use these findings to better inform their decision making with regard to effective patient-provider communication. Finally, the findings bear important implications for the line of research that examines patient-provider communication from immigrant patients' perspectives. They can inform the design of cultural competence strategies for healthcare organizations.

Effective patient-provider communication (PPC) involves conveying sufficient information to a patient such that the treatment is agreed upon and implemented accurately. Furthermore, a patient must feel adequately involved in the treatment process. With the advent of the COVID-19 pandemic, many clinical visits were shifted online. Although telemedicine was successful in meeting pandemic-specific goals, such as lowering personal contact, it changes the communicative context. Both patients and providers get less input from body language (nonverbal communication) and rely more on verbal communication. Furthermore, the number of telemedicine visits conducted remains elevated over pre-pandemic levels. Much of what is known about effective PPC is derived from studies in in-person contexts, with little information available in virtual contexts. Given that even occasional lapses in optimal PPC can have severe effects on patient outcomes, it is essential to understand PPC in various settings to optimize patient outcomes in the long run. This study was a secondary data analysis of the UCF Student Health Services Patient Satisfaction Questionnaire. A total of 6645 survey results from January 2021 to November 2022 were analyzed to compare patient perceptions of PPC variables and overall satisfaction with the clinical visit. The results indicated that there was no statistically significant difference in overall satisfaction and PPC variables between telemedicine and in-person visits. However, the results revealed that different PPC variables contributed to overall satisfaction with telemedicine and in-person visits. Keywords: patient-provider communication, telemedicine, telehealth, COVID-19, patient satisfaction, college

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<p><strong>OBJECTIVE: </strong>The aim of this study was to explore an alternative method of secure data exchange of patient information among physicians using their existing email.<strong></strong></p> <p><strong>METHODS: </strong>A four-step framework was designed to effectively conduct the research. It involved designing a prototype of a web-based system called ST-SecRx to simulate secure communication between physicians while exchanging sensitive patient data through email. The simulation achieved through the system was meant to determine and measure response of physicians to the use of secure email or similar communication tools for exchanging patient data. Physicians were invited to use ST-SecRx and subsequently participate in a survey to determine its acceptability and their perceptions about the usefulness of the software. Finally, the data collected from the survey were analyzed.</p> <p><strong>RESULTS:</strong> Data were collected from 22 physicians from various healthcare facilities in the province of Ontario, Canada. Eliminating questionnaires with no response resulted in 19 valid responses. Results revealed that 57.9% used email support provided by their organization for exchanging patient data. Over 70% acknowledged that factors such as: ease of use, not having to use an email different from the one provided by their employer, not having to create and remember new password every three to six months, and data transfer complying with privacy regulations would facilitate their use of ST-SecRx. More than 50% of the physicians felt that the simulated system as demonstrated to them was more secure and easier to use when compared to previously used methods of patient data exchange through email. The majority of the physicians (from 57.9% to 73.7%) agreed with all the six questions on behavioral intention to use ST-SecRx. Overall 42% were willing to pay between $5 and $20 per month for ST-SecRx. Additional analysis of data by age, sex and discipline did not reveal any substantial differences in their enthusiasm to use the system.</p> <p><strong>CONCLUSION: </strong>The current research was successful providing data on what is important to clinicians who want to exchange data on patients with other clinicians. Use of systems similar to the prototype ST-SecRx could be an improvement over conventional email, provided that they would ensure security using encrypted technology under public key infrastructure methods and systems. Overall the physicians were satisfied with ST-SexRx and found it simple, fast, easy to use, and secure, and they indicated that they intended to use it if it were made available and it conformed to privacy and security standards. Also, such a secure system would have the potential to reduce the overall cost of healthcare by reducing duplication of diagnostic tests and making patient- specific information exchange faster. More research needs to be conducted with a larger sample size to validate the findings of this study. The limitations, dissatisfaction, and concerns expressed by the physicians who used ST-SecRx could direct future research. Future studies could include other healthcare professionals in the exchange of sensitive clinical data.</p> / Master of Science (MSc)

In spite of a decline in HIV incidence rates among African American women, they still bear the most significant disease burden among U.S. women. Findings from numerous studies indicate probable explanations for the disparity, such as the impact of poverty, limited healthcare access, low literacy, and living in areas with high HIV rates. Additionally, many study results provide insight regarding prevention strategies. However, the aim of this study is to explore African American women’s perceptions regarding what HIV prevention communication, if any, occurred with their reproductive health providers (RHPs). In this study, 20 African American women with unknown HIV status participated in face-to-face interviews designed to explore their perceptions about HIV prevention communication with their RHPs. Audio-taped interviews were transcribed verbatim and coded using NVivo10 software. Guided by constructs of the Health Belief Model, inductive and deductive coding yielded four key themes: (1) patients’ lack of expectation to receive information; (2) failure of RHPs to initiate and offer information; (3) patients’ desire to receive information; and (4) patients’ recommendations regarding their preferred methods to receive HIV prevention communication. Results indicated that RHPs missed prime opportunities to initiate and offer HIV prevention information during routine reproductive health visits with women at greatest risk. These findings and recommendations for practice will be useful when designing, implementing and evaluating HIV prevention patient education protocols. The recommendations provide strategies to help RHPs seize every opportunity to address HIV prevention with this highly vulnerable population.

Several artifacts of federal policy address the connection between health literacy of patients and health outcomes. These laws include The Plain Writing Act, Health Information Technology for Economic and Clinical Health, and the Health Insurance Portability and Accountability Act. Even with this policy structure, little is known about how nurses' knowledge of health literacy may influence patient understanding of medical information and health outcomes. Using Knowles' principles of effective communication, the purpose of this mixed-methods study was to concurrently examine the relationship between nurse knowledge of health literacy and communication techniques used by nurses to identify any causal relationships in the provider-patient-interaction linking health literacy and health outcomes. Quantitative and qualitative data were gathered from 47 registered nurses in south Florida using an online survey. These data were analyzed using descriptive statistics and a content analysis procedure. Descriptive statistics revealed that there is a lack of health literacy knowledge among nurses and nurses rarely or never use Knowles' communication techniques to relay health information to patients. By contrast, content analysis of qualitative data revealed that nurses have a basic understanding of the complexities of health literacy. No correlation existed between a nurse's knowledge of health literacy and the use of appropriate and varied communication techniques when the data sets were merged. This finding suggests that there may be another root cause of low health literacy that requires additional research to fully explore. The positive social change implications stemming from this study include recommendations to policy makers to encourages changes to existing law and policy that supports patient communication training to nurses in order to improve health outcomes for patients.