MAMMOGRAPHY BEHAVIORS IN MULTIPLE SCLEROSIS Mammography Screening Behaviors in Relation to the Expanded Health Belief Model in a Sample of Homebound Women with Multiple Sclerosis Karen K. Paraska, PhD, RN University of Pittsburgh, 2005 The purpose of this study was to determine the relationship between variables of the Expanded Health Belief Model (EHBM) including: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy, and modifying factors; and adherence to mammography screening in homebound women with Multiple Sclerosis (MS). The sample was derived from the National Multiple Sclerosis Society from a group of women in Allegheny County who received an intervention program titled Home-based Health Maintenance Program for Women with MS. The program provided home visits by a nurse midwife who educated women with MS and their partners about breast cancer, as well as provided an appointment for a mammogram. The correlational, descriptive design used a telephone interview for data collection. Due to the lack of subject accrual, the study was subsequently divided into two phases. Phase One was an analysis of 149 women who were approached to complete the intervention program through de-identified data sent by the National Multiple Sclerosis Society (NMSS). Phase Two was the dissertation study of homebound women consisting of a telephone interview measuring EHBM variables with the instruments chosen. The battery included the Breast Cancer Knowledge Test, the Benefits and Barriers Mammography Scale, Short Form-36, Beck Depression Inventory-II edition, Mini-Mental State Examination, the Mammography Screening Self-Efficacy Scale, and physician recommendation for mammogram. The de-identified data in Phase One revealed that out of 149 women approached, 108 women received the intervention program. None of these women had a mammogram in the last year. Only 7 (6%) women had a mammogram, none were diagnosed with breast cancer, and no correlation was found between smoking and mammography screening adherence. In Phase Two, out of all the EHBM variables analyzed, the data suggests bivariate association between perceived susceptibility, severity, benefits, and self-efficacy with mammography screening adherence. Due to the small sample size and sparse cell sizes, binary logistic regression was not able to investigate the joint associations of EHBM predictors. Mammography is the primary method used for breast cancer screening, yet in the sample of women with MS, adherence remains well below recommended levels. Women who did not adhere tended not to participate in the health care system, perceived themselves less susceptible to breast cancer, and valued mammography less. It was also evident that physician referral was not important in this study. The study had several limitations including a small sample size, the minimal data obtained from the NMSS, and the short study duration. Future recommendations include a longitudinal study design, incorporation of family caregivers, and an increase in recruitment strategies.

Homework (mutually agreed tasks for the patient to complete outside the therapy session) is an important component of Cognitive Behavioral Therapy (CBT). CBT homework disconfirms negative thoughts and beliefs; focuses subjective accounts to more objective detailed accounts; allows therapist and patient to review the past weeks activities; and helps the therapist to relate the session to specific tasks (Beck et al., 1979). Compliance with homework has been shown to improve the clinical results of CBT (Persons et al., 1988). At the present time there is no consensus as to the average rate of adherence in completing homework assignments (Detweiler & Whisman, 1999). The identification and reliable measurement of barriers affecting completion of homework assignments may improve the potency of CBT, thereby producing further reductions in depressive symptoms and improvement in ultimate clinical outcome. It may also assist researchers to identify factors related to variance in treatment outcome, thereby strengthening the generalizability of investigational findings for the clinical community. A two-phase study was conducted to develop an instrument that may assist CBT patients, therapists, and researchers to ascertain the barriers that may be preventing completion of homework assignments. Phase I involved the interview of 20 depressed patients and 20 therapists to elicit perceived barriers to homework completion in order to develop an item pool for the draft instrument. In Phase II, the draft instrument was administered to 56 subjects on 2 separate occasions. Factor Analysis revealed a 2-factor solution of Patient Factors and Therapist/Task Factors. Internal Consistency demonstrated Alpha Coefficients of the Subscale and Entire scales that ranged from .80 to .95. Test-Re-Test correlations demonstrated Pearson correlations of .72 to .95. The only consistent demographic predictors of levels of Barriers to CBT Homework Completion Scale scores were race and marital status. The Patient subscale was able to satisfactorily classify patients (75 to 79 %) with low and high adherence to homework assignments. There were no consistent predictors of assignment compliance. The Barriers to CBT Homework Completion Scale scores did correlate significantly with Assignment Compliance (.32 to .46). Sample size most likely limited the ability to fully evaluate the psychometric properties of this draft instrument. Future studies will expand upon this pilot study of the Barriers to CBT Homework Completion Scale.

PURPOSE: The study examined characteristics (sociodemographic and number and types of study-focused comorbidities) associated with health related quality of life and the relationships between general health-related (MOS SF-36) and diabetes specific (Diabetes Quality of Life Measure - DQOL) quality of life, and tested the revised Wilson and Cleary model proposed by Ferrans et al. utilizing the Structure Equation Modeling (SEM) in individuals with type-2 diabetes and hypertension and/or hyperlipidemia. Type-2 diabetes impairs health and quality of life with potentially devastating consequences occurring as a result of diabetes-related comorbidities. Wilson and Cleary proposed a comprehensive conceptual model for HRQoL. The model had not been tested in diabetes. METHODS: Three hundred twenty-one subjects with type-2 diabetes and hypertension and/or hyperlipidemia were included in this secondary data analysis. The parent study examined the impact of a problem-solving based, multi-component telephone intervention on adherence to multiple medications in subjects with type-2 diabetes and hypertension and/or hyperlipidemia. Baseline data from the parent study were utilized in the current study. RESULTS: Characteristics significantly related (p < .01) to general health related and/or diabetes specific quality of life included gender, age, income, marital status, household size, the number of study-focused comorbidities, peripheral vascular disease, renal disease, history of stroke/TIA, psychological problems and arthritis. Most correlations between SF-36 subscale and DQOL subscale/total scores were statistically significant (p < .01). Following considerable modifications to both the measurement and structural equation model (i.e., addition of correlated errors, omission of measured variables, and addition of new variables), the revised Wilson and Cleary model was valid for explaining the relationships between the selected observed variables and their relationship to overall quality of life ( = 203.986, CMIN/DF = 2.081, CFI = 0.952, SRMR = 0.0549 and RMSEA = 0.058 with 90% CI = 0.047 - 0.069). CONCLUSIONS: The SF-36 was more sensitive to sociodemographic variables and the presence of study-focused comorbidities than the DQOL. After data modifications, the revised Wilson and Cleary model provided a good fit to the data in these subjects with type-2 diabetes and hypertension and/or hyperlipidemia. These findings need to be confirmed in a larger independent study.

Purpose: The primary purpose of this study was to investigate the effect of two different bottle feeding positions on a preterm infants cardiorespiratory stability while feeding. Other factors associated with feeding success such as feeding duration, volume of consumption, gestational age, and day of life were also examined with respect to the feeding positions used. The long term objective for this line of investigation was to develop a neonatal intensive care unit feeding position protocol in order to decrease length of stay, improve oral feeding success, reduce health care costs, and prevent future feeding problems. Background: Of all live births in the United States, approximately 12% are to premature infants and of those born prematurely 90% will require admission to a neonatal intensive care unit (NICU). Although technological advances have improved preterm infant survival rates, they have failed to decrease medical costs and length of hospital stay. This is due mostly to the preterm infants failure to oral feed successfully. As a result, research efforts tend to focus on oral feeding skills, the transition period from nasogastric to oral feeding, oral feeding readiness, and oral feeding advancement. However, little attention has been given to bottle feeding positions used and the preterm infants cardiorespiratory stability. Methods: The study used a randomized, two-period, cross-over design to test Upright (45 degree head up) and Cradle (15 degree head up) feeding positions on cardiorespiratory stability. Feeding positions were administered by a NICU nurse on 12 medically stable, bottle feeding infants who were < 35 weeks gestational age. Results: Subject demographics were similar between each order grouping. Findings indicated that neither the Cradle nor the Upright feeding positions had a statistically significant effect on the preterm infants cardiorespiratory stability. No significant relationships were found between feeding positions, volume of consumption, gestational age, and day of life as well. However, results suggested that preterm infants experienced a somewhat slower heart rate (p = .005), higher oxygen saturation level (p = .02), and although non-significant, a slightly shorter feeding duration (p = .27) when held in an Upright position as compared to the Cradle position.

Purpose: To explore the relationships between smoking dependence behavior, depression, anger, and, anxiety in pregnant adolescents. Research hypotheses were: 1. Depression, anger, anxiety, and are mood states that are present in pregnant adolescents who smoke. 2. Depression, anger, and, anxiety are inter-related. 3. Depression, anger, and anxiety affect smoking dependent behavior of pregnant teens who began smoking prior to pregnancy. 4. Depression, anger, and, anxiety affect smoking consumption of pregnant teens who smoke. Methods: Secondary data analysis of baseline data from a longitudinal study, Nursing Intervention for Young Pregnant Smokers (PI: S. Albrecht, RO1 NR 03233) was performed. Of 224 eligible adolescents, 142 pregnant, smoker, adolescents signed an informed consent. One-hundred, eight complete and valid cases were analyzed for their responses to the following instruments: Modified State/Trait Anxiety Inventory (STAI), Modified Center for Studies of Depression (CES-D), Confidence and Temptation Scale, Fagerstrom Tolerance Nicotine Dependence Test (FTND). Results: Descriptive and exploratory data analyses were used to identify outliers, assess missing data, and verify assumptions. In the correlational analysis, anger, anxiety, and depression are correlated (p = .000). In additional analysis, self-efficacy was correlated with anger (p = .007), anxiety (p = .001), and FTND score (p= .002). Hierarchial Multiple Regression, controlling for covariates, revealed that self-efficacy significantly predicted smoking dependence behavior (p = .006). Depression, anger, and, anxiety were not realized as predictors in this sample. However, an exploratory analysis of self-efficacy, the confidence that the adolescent express that smoking cessation could be achieved, revealed an inverse relationship to smoking dependence behavior. Conclusions and Implications: Self-efficacy was inversely associated with smoking dependence behavior in this sample, while altered mood states did not influence smoking dependence behavior or smoking consumption. This analysis suggests that enhancing self-efficacy should be tested as a part of the intervention for smoking prevention and cessation programs in adolescents.

Health literacy has been shown to be related to multiple health outcomes and may be an issue of great importance in the management of a chronic and complicated disease like HIV. Functional health literacy (FHL) may be a factor that affects medication adherence in people living with HIV/AIDS. This study sought to describe FHL in people living with HIV/AIDS who are taking antiretroviral medication and to investigate functional health literacy and medication taking self-efficacy as possible predictors of HIV medication adherence. Additionally, the study explored the relationship between FHL and selected variables from SCT. This secondary data analysis was a cross-sectional descriptive study. The sample included 335 individuals living with HIV who were taking antiretroviral medications. Measures of central tendency and variance were used to describe continuous variables. Bivariate analyses and logistic regression were conducted to examine the univariate relationships between and among the key variables of interest. Multivariate logistic regression was used to jointly examine potential predictors of adherence. Overall, 10.4% (n=35) of the participants were classified as having inadequate/marginal FHL. Race, educational level, and the interaction between race and educational level predicted FHL in this sample. Sixty seven percent (n=223) of participants had adherence rates less than 85%, based on days with correct intake. In bivariate analysis, FHL was not significantly related to medication adherence, although there was a non-significant trend suggesting that people with lower FHL may demonstrate lower adherence (÷2 = 3.17, p=.075). FHL was also not related to self-efficacy beliefs. In multivariate logistic regression, non-white participants, people with lower self-efficacy beliefs, and younger individuals were more likely to demonstrate poorer adherence. Using multivariate logistic regression, medication adherence was significantly related to mental health functioning, role of state of mind in controlling illness, negative self-image related to HIV-stigma, and two interaction terms (mental health functioning and negative self-image related to HIV-stigma; personalized stigma and FHL), after controlling for race and age. The proportion of people with lower FHL was lower than expected. Further research is needed to fully understand the scope and breadth of FHL issues for people living with HIV. Further research is needed to understand the disparate findings related to FHL and treatment adherence. Finally, these results indicate that there remains much work to be done in identifying true predictors of medication adherence in people living with HIV.

Patient-Centered Care (PCC), also known as individualized care, focuses on the patient¡¯s right to have his/her values and beliefs respected as an individual. The purpose of this study was to examine the effect of PCC on a patient¡¯s level of satisfaction at discharge from an acute healthcare setting. The study examined the effect of PCC on patient satisfaction, the quality of patient care and the patient¡¯s perception of nursing care. Participants consisted of 116 patients scheduled to undergo gastric bypass surgery within a community hospital. Eligibility criteria included: a) age > 18 years, b) scheduled for bariatric surgery c) surgical procedure performed by one predefined surgeon; and d) expected hospital stay of ¡Ý 2 days. Exclusion criteria consisted of: a) prior admission to the study unit or b) bariatric surgery performed by a surgeon other than the predefined surgeon c) transfer off study unit, and d) scheduled for a LAP Band procedure. Subjects (aged 46 ¡À 12 years) were randomized to the experimental (n=58) or control (n=58) group. The experimental group was called 24 to 48 hours prior to the scheduled admission and cared for by nurses trained in providing PCC. The Control group received usual care. Both groups completed two questionnaires at discharge and were contacted 24 to 48 hours post discharge to complete a structured interview. There were no statistically significant differences between groups in age, gender, race or marital status, but a greater number of females were found in the PCC group (n=50) vs. usual care group (n=41), p= 0.07; there was no difference in LOS, p=.776; postoperative infection, p=1.0; falls, p=1.0 or post-op complications. When measuring overall satisfaction no statistically significant differences were found between groups, p=.247. Findings indicate that PCC did not significantly impact patient outcomes examined in the setting utilized in this study

Persons living with human immunodeficiency virus (HIV) are living longer and therefore are more likely to suffer significant morbidity due to potentially treatable liver diseases. Liver diseases alone have been shown to have a significant negative effect on ones health-related quality of life (HRQOL). Clinical evidence suggests that persons living with HIV and liver disease, a growing number of individuals, may have a poorer HRQOL than persons living with HIV who do not have liver disease. Thus, this study examined the multiple components of HRQOL by testing Wilson and Clearys model in persons with HIV and in persons living with HIV and liver disease using structural equation modeling. This secondary analysis used de-identified baseline and medical record review data from a parent study testing interventions to improve medication adherence in persons living with HIV (R01 NR04749). The Wilson and Cleary model components include: biological/physiological factors (HIV viral load, CD4 counts), symptom status (Beck Depression Inventory II, Medical Outcomes Study HIV Health Survey [MOS-HIV] mental function), functional status (missed appointments, MOS-HIV physical function), general health perceptions (Perceived burden visual analogue scale, MOS-HIV health transition), and overall QOL (Satisfaction with Life Scale, MOS-HIV overall QOL). Characteristics of the individual and environment were also explored. The Wilson and Cleary (1995) model was found to be useful in linking clinical indicators to patient-related outcomes. The findings provide the foundation for development and future testing of a targeted bio-behavioral nursing intervention to improve HRQOL in persons living with HIV and liver disease.

Background: Lifestyle factors are known contributors to chronic disease states, a major factor in increasing health care costs. Promoting healthier lifestyles is a current emphasis worldwide. Emerging adulthood is an important window of opportunity since lifestyle patterns are often set during this time period. Women are more likely to make family health care decisions. Understanding factors affecting lifestyle patterns in a population of emerging adult women will support the design of interventions aimed at prevention of chronic disorders in this population, which may additionally have positive effects on lifestyles in their families. Purpose: The purpose of this study was to investigate the factors that influence healthy lifestyle beliefs and behaviors in college women. Design: This study used the Health Belief Model as a framework and employed a mixed methods design including surveys, pedometers, and nominal group technique (NGT). Women, 18 to 25 years of age, were recruited from an urban, womens centered university in Pittsburgh, PA. Results: Analysis of 109 completed data sets demonstrated that health beliefs of perceived benefits and barriers related to eating behavior and physical activity were more predictive of healthy behaviors than beliefs of perceived susceptibility and seriousness. Perceived diet benefits accounted for over 15% of the variance seen in eating behavior. Perceived exercise barriers accounted for 35% of the variance, and exercise benefits explained 4% of the variance in physical activity. The association between health beliefs and behaviors was increased when the effect of modifying factors was considered. Socioeconomic factors including race, income, living environment, medical supervision, and knowledge moderated the relationship between health beliefs and health behaviors increasing variance explained from 15% to 30% in eating behaviors and from 39% to 49% in physical activity behaviors. NGT results suggested that mood, aesthetics, and practical issues such as cost and availability, were important factors in decision making related to healthy eating behaviors and participation in physical activity. Conclusions: Emerging adult (college) women are more motivated by higher perceived immediate benefits and lower perceived barriers to health behaviors. Framing interventions toward immediate benefit to the individual may be the most appropriate avenue in this population.

The purpose of this study is to evaluate the effect of a Tranquility Training program on reducing unit noise and changing nurses' perception of organizational culture, knowledge of noise awareness, noise reduction strategies, and unit noise levels. The study is a time series, prospective, quasi-experimental pilot study. The Tranquility Training Program was implemented on the Pulmonary Telemetry Unit {PTU} at a 300-bed community hospital. Another Intermediate Care Unit {IMC} in the same hospital with a similar architectural layout, patient population, and nurse staffing ratio served as a control group. Noise was measured at three separate time periods: pre-intervention, one month after the intervention, and six months after the intervention. Staff surveys were completed before the intervention and six months after the intervention. At the one-month post-intervention follow-up, participants in both units demonstrated a desire to reduce noise and felt empowered to make an impact in noise reduction. These perceptions were sustained through to the six month follow-up. Both units reduced noise levels at the one-month follow-up but did not approach the levels recommended by the Environmental Protection Agency for hospitals. Although there was an increase in noise at six months from levels observed at one month, both units sustained a quieter level than baseline. There were no group (education vs. no-education) differences in noise or staff perception measures. It appears that the process of measuring noise over time may have resulted in noise reduction on both units.