Measuring the processes of change for increasing blood donation in black adults

Background: Blacks have significantly lower blood donation rates than whites. Many views, experiences, and behaviors associated with blood donation are unique to black culture. Evidence suggests that culturally tailored health promotion programs help with increasing black blood donation. To be effective, tailored interventions should be based on valid and reliable measures. The Transtheoretical Model\u27s (TTM) Processes of Change (POC) construct provides an assessment of participants\u27 covert and overt activities and experiences in blood donation. This study describes development and validation of POC for increasing blood donation tailored to blacks. Student Design and Methods: Cross‐sectional measure development with online survey dissemination was used in 566 blacks in the Northeastern United States. Factor analytic structural modeling procedures were used to examine validity of the POC measure. Blood donation POC were examined in participants representing a range of blood donation history and intentions (nondonors, sometimes donors, regular donors) based on an established algorithm. Results: Confirmatory analyses replicated the theoretically expected structure of POC scales which is a 10‐factor, fully correlated best‐fit model. Expected POC patterns by Stages of Change based on theoretical and empirical predictions were confirmed. The range of effect sizes for 10 POC were η2 = 0.04 to 0.25, indicating that TTM POC are strong strategies in blood donation decision making for blacks and can be applied to interventions to increase blood donation for a minority population. Conclusion: POC measure was internally and externally valid in a sample of blacks. Interventions can utilize the POC measure to guide stage‐matched interventions to encourage use of relevant experiential and behavioral strategies to increase blood donation

Disease Prevention without Relapse: Processes of Change for HPV Vaccination

Background: Human papillomavirus is the most prevalent sexually transmitted infection in the United States and is associated with 70% of cervical cancers as well as over 90% of genital warts. Although the HPV vaccine appears in the US immunization schedule during adolescence, a large percentage of women reach adulthood without being vaccinated. The Transtheoretical Model’s (TTM) Processes of Change (POC) construct provides an assessment of participants’ experiences with HPV vaccination and is a central component of computer-tailored interventions designed to increase compliance with medical recommendations, such as vaccination. This study describes development and validation of a POC measure for increasing HPV vaccination among young adult women. Methods: Cross-sectional measurement development was conducted using an online survey to reach a sample of 340 female college students representing vaccinated and unvaccinated women. Factor analytic structural equation modeling as well as evaluations of the stage by POC were used to evaluate the validity of the POC measure. Results: Confirmatory analyses supported the theoretically expected ten-factor, fully correlated model as the best fit for the data. Expected Stage of Change to POC relationships were also confirmed insofar as each POC was significantly associated with Stage of Change, with the exception of dramatic relief. Follow-up analyses suggested that individuals in the Precontemplation stage used all POC less frequently than individuals in all other stages. Conclusions: The POC measure was found to be internally and externally valid in a sample of college-attending women. The POC measure developed may be used to tailor stage-matched interventions that increase use of experiential and behavioral strategies important for increasing HPV vaccination in this high-risk population

Your Path to Transplant: A randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant

Background: Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients’ knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention. Methods/Design: Nine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients’ transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach. Discussion: At the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings. Trial Registration: ClinicalTrials.gov, number NCT02181114

Adolescent Substance Use Initiation: Correlates of the Profiles of Prevention

Using cluster analysis, 717 students who reported that they had never smoked and the nondrinking 292 students who reported that they had never drank alcohol were classified into four profile groups based on their Pros and Cons of not using and temptation to use. Profiles were labeled Most Protected, Least Positive, Most Negative, and Most Tempted. Profile groups differed significantly on peer pressure, family communication, and use of 11 Transtheoretical Model (TTM) processes of prevention, and applied experiential and behavioral strategies to prevent the onset of smoking and alcohol use. The largest and most consistent differences were on the processes with the Most Protected using more than the Least Positive and Most Tempted groups. Being more actively engaged with the processes of prevention helps to explain why the Most Protected group has had the least amount of substance use over time while the Most Tempted and Least Positive groups had the highest rates of substance use. The consistency and size of differences on the processes support the hypothesis that Most Protected youth may be those who proactively protect themselves from substance use initiation

Motivation for HPV Vaccination among Young Adult Men: Validation of TTM Decisional Balance and Self-Efficacy Constructs

Purpose. In the United States, 36% of human papillomavirus (HPV)-related cancers occur among men. HPV vaccination can substantially reduce the risk of HPV infection; however, the vast majority of men are unvaccinated. This study developed and validated transtheoretical model-based measures for HPV vaccination in young adult men. Design. Cross-sectional measurement development. Setting. Online survey of young adult men. Subjects. Three hundred twenty-nine mostly college-attending men, ages 18 to 26. Measures. Stage of change, decisional balance (pros/cons), and self-efficacy. Analysis. The sample was randomly split into halves for exploratory principal components analysis (PCA), followed by confirmatory factor analyses (CFA) to test measurement models. Multivariate analyses examined relationships between scales. Results. For decisional balance, PCA revealed two uncorrelated five-item factors (pros α =.78; cons α =.83). For the self-efficacy scale, PCA revealed a single-factor solution (α =.83). CFA confirmed that the two-factor uncorrelated model for decisional balance and a single-factor model for self-efficacy. Follow-up analyses of variance supported the theoretically predicted relationships between stage of change, pros, and self-efficacy. Conclusion. This study resulted in reliable and valid measures of pros and self-efficacy for HPV vaccination that can be used in future clinical research

Acceptability and Feasibility of a Culturally Tailored Internet-Delivered Intervention to Promote Blood Donation in Blacks

Introduction. A pilot test of a computer-tailored intervention designed to promote blood donation among Blacks was conducted. Method. Intervention content, based on the transtheoretical model, offered participants individually and culturally tailored information on blood donation with emphasis on need specific to race (e.g., sickle-cell disease). Black adults (N = 150) with a diversity of blood donation experience were recruited from a blood center and a survey recruitment website. Posttest assessment included a 14-item evaluation and transtheoretical model questions. Results. Participants rated the program positively (81.3% to 98.7% of participants agreeing or strongly agreeing with evaluation items). For example, 98.7% of respondents reported that the program gave sound advice and that personal feedback was easily understood, and 87.3% felt the program was designed for people like themselves. Ninety-five percent of participants reported that they would recommend the program to others. There were no significant differences in ratings based on demographics. Qualitative responses support program acceptability. Furthermore, pre- and postprogram assessments indicated an increase in intention to donate, t(149) = 3.56, p =.001, d =.29. Discussion. With acceptability and feasibility confirmed, the next steps are to test efficacy and cost-effectiveness for use to increase blood donation, particularly in priority populations

Measuring kidney patients’ motivation to pursue living donor kidney transplant: Development of Stage of Change, Decisional Balance and Self-Efficacy measures

While educational interventions to increase patient motivation to pursue living donor kidney transplant have shown success in increasing living donor kidney transplant rates, there are no validated, theoretically consistent measures of Stage of Change, a measure of readiness to pursue living donor kidney transplant; Decisional Balance, a weighted assessment of living donor kidney transplant's advantages/disadvantages; and Self-Efficacy, a measure of belief that patients can pursue living donor kidney transplant in difficult circumstances. This study developed and validated measures of these three constructs. In two independent samples of kidney patients (N 1 = 279 and N 2 = 204), results showed good psychometric properties and support for their use in the assessment of living donor kidney transplant interventions

Measuring kidney patients' motivation to pursue living donor kidney transplant: development of stage of change, decisional balance and self-efficacy measures.

While educational interventions to increase patient motivation to pursue living donor kidney transplant have shown success in increasing living donor kidney transplant rates, there are no validated, theoretically consistent measures of Stage of Change, a measure of readiness to pursue living donor kidney transplant; Decisional Balance, a weighted assessment of living donor kidney transplant's advantages/disadvantages; and Self-Efficacy, a measure of belief that patients can pursue living donor kidney transplant in difficult circumstances. This study developed and validated measures of these three constructs. In two independent samples of kidney patients (N 1 = 279 and N 2 = 204), results showed good psychometric properties and support for their use in the assessment of living donor kidney transplant interventions

Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant.

BackgroundBecause of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients' knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention.Methods/designNine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients' transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach.DiscussionAt the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings.Trial registrationClinicalTrials.gov, number NCT02181114