Disentangling the characteristics of narratives comprising evidence: outcomes of osteoporosis narrative evidence for young women

Health communication scholars are charged with seeking ways to convey health information in credible and reliable ways for audiences. In the context of osteoporosis, the challenge becomes how to communicate risk and prevention to young women, as prevention behaviors started early in life can help decrease osteoporosis diagnosis later in life. Evidence has been shown to be one message tool that can increase comprehension of information presented and influence outcomes. Previous research has found that statistical evidence to be associated with systematic processing, or careful attention to messages, whereas narrative evidence evokes heuristic processing, or a reliance on heuristics. Yet, the benefits of narratives, and the sharing and telling of experiences has been shown to aid comprehension and behaviors for a variety of health contexts. Specifically, that the emotions conveyed and aroused after reading a narrative can influence understanding, and message effectiveness. Guided by the Heuristic-Systematic Model (HSM), this study examined outcomes associated with the use of different narrative evidence types and expressions of emotion within narrative evidence for arousal of discrete emotions, comprehension, dominant cognitions, heuristic and systematic processing, perceived evidence quality, perceived message effectiveness, behavioral intentions, and the osteoporosis prevention behaviors of calcium and vitamin D consumption. Formative research led to the creation of narrative evidence and selection of positive and negative emotions expressed. A 4x3 between subjects pretest-post-test with follow-up 24-hour dietary recall was used to test the outcomes of the narrative evidence types. Results indicated that both heuristic and systematic processing of narrative evidence does simultaneously occur for osteoporosis content, and positive relationships between comprehension, judgments of evidence quality and perceptions of message effectiveness predict behavioral intentions towards osteoporosis prevention. Specifically, the emotions of fear and hope serve as heuristics for the processing of osteoporosis narrative evidence. No significant differences emerged for narrative evidence type and the behaviors of calcium and vitamin D, however, results imply that different message strategies are needed for these behaviors. Implications of these findings for osteoporosis health messages are discussed

Nurses Communicating Risk: Strategies from the Literature

Risk communication interventions can provide benefits at both the individual and population level, however, there is a paucity of research that explores the effectiveness of risk communication strategies by nurses. A literature search yielded twelve studies that investigated the components and effectiveness of risk communication by nurses. This article presents some of the key theories used in risk communication, current nursing science exploring risk communication strategies, and recommendations for future research and practice

Quitters referring smokers: a quitline chain-referral pilot study

BACKGROUND: Telephone counseling Quitlines can support smoking cessation, but are under-utilized. We explored the use of smoker peer-referrals to increase use of a Quitline in Mississippi and Alabama. FINDINGS: Collaborating with the Alabama and Mississippi Quitline, we piloted peer-referrals to Quitlines. Successful \u27quitters\u27 who had used the Quitline were contacted at routine follow-up and recruited to participate as a peer-referrer and refer their friends and family who smoked to the Quitline. Peer-referrers completed a training session, received a manual and a set of Quitline brochures a peer-referral forms. These peer-referral forms were then returned to the Quitline telephone counselors who proactively called the referred smokers. Of the initial potential pool of 96 who quit using the Quitline, 24 peer-referrers (75% Women, 29% African-American, and high school graduates/GED 67%) were recruited and initially agreed to participate as peer-referrers. Eleven of the 24 who initially agreed were trained, and of these 11, 4 (4%) actively referred 23 friends and family over 2 months. From these 23 new referrals, three intakes (100% Women, 66% African-American) were completed. Of the initial pool of 96, 4 (4%) actively participated in referring friends and family. Quitline staff and peer-referrers noted several barriers including: time-point in which potential peer-referrers were asked to participate, an \u27overwhelming\u27 referral form to use and limited ways to refer. CONCLUSIONS: Though \u27quitters\u27 were willing to agree to peer-refer, we received a minority of referrals. However, we identified several areas to improve this new method for increasing awareness and access to support systems like the Quitline for smokers who want to quit

Health Information Seeking on Behalf of Others: Characteristics of ‘Surrogate Seekers’

Understanding the health information seeking behaviors of surrogate seekers (those who seek health information for others) may guide efforts to reach disadvantaged populations. We used 2011-2012 data from the Health Information National Trends Survey to describe the behaviors of online surrogate seekers. Respondents were asked about their use of the Internet for surrogate seeking over the prior 12 months. Data were weighted to calculate population estimates. Compared to those who sought health information online for only themselves, surrogate seekers were more likely to live in households with others (weighted percent 89.4% vs. 82.5% of self-seekers; p \u3c 0.05); no significant differences in gender, race, income or education were observed. Surrogate seekers were more likely to report: visits to social networking sites to read and share about medical topics; participation in online health support groups and downloading of health information to electronic devices. On multivariate analysis, those who had looked online for a healthcare provider were more likely to be surrogate seekers (OR 1.67, 95% CI 1.08-2.59). Our results offer insight for leveraging health communication efforts to reach populations who rely upon surrogate seekers for health information

Information Source’s Influence on Vaccine Perceptions: An Exploration into Perceptions of Knowledge, Risk and Safety

Background: College-age students are a particularly important population regarding establishing beliefs about vaccines that carry on into later adulthood. One of the primary ways these beliefs can be influenced is via the source of information that students turn to concerning vaccine information. Method: We administered a survey to 180 college-age students based on the WHO Report of the SAGE Working Group on Vaccine Hesitancy (2014). Questions focused on vaccine beliefs, perceived knowledge, perceived safety and perceived risk. Participants were also measured on sources they would use to obtain information on vaccines (e.g. healthcare providers, news media, government official, social media, friends, and parents). Results: Based on regression analyses, vaccine beliefs were significantly impacted by safety (β = .44) and risk perceptions (β = .29) at the expense of knowledge perceptions. Furthermore, various information sources influenced perceptions of safety (healthcare provider (β = .24)), risk (social media (β = −.19)), and knowledge (social media (β = −.20) and healthcare providers (β = .16)). Specifically, increases in social media source usage resulted in more negative vaccine beliefs. Conversely, utilization of healthcare providers resulted in more positive vaccine beliefs. Conclusion: Results suggest, in cases of college-age students, vaccine information should focus on issues dealing with students’ perceptions of risk and safety, not their level of knowledge. Additionally, while parents and friends may act as a primary information sources, more attention needs to be paid to the negative impact of social media and the positive impact of healthcare providers

Crave-Out: A Distraction/Motivation Mobile Game to Assist in Smoking Cessation

BACKGROUND: Smoking is still the number one preventable cause of death. Cravings-an intense desire or longing for a cigarette-are a major contributor to quit attempt failure. New tools to help smokers\u27 manage their cravings are needed. OBJECTIVE: To present a case study of the development process and testing of a distraction/motivation game (Crave-Out) to help manage cravings. METHODS: We used a phased approach: in Phase 1 (alpha testing), we tested and refined the game concept, using a Web-based prototype. In Phase 2 (beta testing), we evaluated the distraction/motivation potential of the mobile game prototype, using a prepost design. After varying duration of abstinence, smokers completed the Questionnaire of Smoking Urge-Brief (QSU-Brief) measurement before and after playing Crave-Out. Paired t tests were used to compare pregame and postgame QSU-Brief levels. To test dissemination potential, we released the game on the Apple iTunes App Store and tracked downloads between December 22, 2011, and May 5, 2014. RESULTS: Our concept refinement resulted in a multilevel, pattern memory challenge game, with each level increasing in difficulty. Smokers could play the game as long as they wanted. At the end of each level, smokers were provided clear goals for the next level and rewards (positive reinforcement using motivational tokens that represented a benefit of quitting smoking). Negative reinforcement was removed in alpha testing as smokers felt it reminded them of smoking. Measurement of QSU-Brief (N=30) resulted in a pregame mean of 3.24 (SD 1.65) and postgame mean of 2.99 (SD 1.40) with an overall decrease of 0.25 in cravings (not statistically significant). In a subset analysis, the QSU-Brief decrease was significant for smokers abstinent for more than 48 hours (N=5) with a pregame mean of 2.84 (SD 1.16) and a postgame mean of 2.0 (SD 0.94; change=0.84; P =.03). Between December 22, 2011, and May 29, 2014, the game was downloaded 3372 times from the App-Store, with 1526 smokers visiting the online resource www.decide2quit.org linked to the game. CONCLUSIONS: Overall, playing the game resulted in small, but nonsignificant decreases in cravings, with changes greater for those had already quit for more than 48 hours. Lessons learned can inform further development. Future research could incorporate mHealth games in multicomponent cessation interventions. TRIAL REGISTRATION: Clinicaltrials.gov NCT00797628; https://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6hbJr6LWG)

Narratives to enhance smoking cessation interventions among African-American smokers, the ACCE project

BACKGROUND: Low-income, African-American smokers are less likely to have resources to aid in quitting smoking. Narrative communication may provide an enhancement to traditional smoking cessation interventions like NRT, medications, or behavioral treatments for this audience. After extensive pilot testing of stories and personal experiences with smoking cessation from African-Americans from a low-income community, we conducted a randomized control trial using stories to augment routine inpatient treatment among African-Americans at an urban Southern hospital (N = 300). RESULTS: Differences in smoking cessation outcomes between the intervention (stories DVD + routine clinical treatment) and control (routine clinical treatment) arms were compared using self-report and carbon monoxide measurement at 6-months. Compared to control, individuals who viewed the intervention stories DVD reported greater intentions to quit. Although continuous quitting marginally favored the intervention, our main result did not reach statistical significance (p = 0.16). CONCLUSION: Narrative communication via storytelling to promote smoking cessation among African-Americans in the South is one method to communicate smoking cessation. Results suggest this may not be sufficient as a stand-alone augmentation of routine clinical treatment for continuous smoking cessation. Smoking cessation efforts need to continually assess different means of communicating to smokers about quitting. CLINICAL TRIALS REGISTRATION: The ClinicalTrials.gov Identifier is NCT00101491. This trial was registered January 10, 2005

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging

BACKGROUND: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. OBJECTIVE: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. METHODS: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. RESULTS: Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. CONCLUSIONS: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members

Cluster-randomized trial of a web-assisted tobacco quality improvement intervention of subsequent patient tobacco product use: A national dental PBRN study

ABSTRACT: BACKGROUND: Brief clinician delivered advice helps in tobacco cessation efforts. This study assessed the impact of our intervention on instances of advice given to dental patients during visits on tobacco use quit rates 6 months after the intervention. METHODS: The intervention was cluster randomized trial at the dental practice level. Intervention dental practices were provided a longitudinal technology-assisted intervention, oralcancerprevention.org that included a series of interactive educational cases and motivational email cues to remind dental provides to complete guideline-concordant brief behavioral counseling at the point of care. In all dental practices, exit cards were given to the first 100 consecutive patients, in which tobacco users provided contact information for a six month follow-up telephone survey. RESULTS: A total of 564 tobacco using dental patients completed a six month follow-up survey. Among intervention patients, 55% reported receiving advice to quit tobacco, and 39% of control practice patients reported receiving advice to quit tobacco (p \u3c 0.01). Six-month tobacco use quit rates were not significantly between the Intervention (9%) and Control (13%) groups, (p = 0.088). CONCLUSION: Although we increased rates of cessation advice delivered in dental practices, this study shows no evidence that brief advice by dentist\u27s increases long-term abstinence in smokers.Trial registration: ClinicalTrials.gov NCT00627185

Structure-Based Predictive Models for Allosteric Hot Spots

In allostery, a binding event at one site in a protein modulates the behavior of a distant site. Identifying residues that relay the signal between sites remains a challenge. We have developed predictive models using support-vector machines, a widely used machine-learning method. The training data set consisted of residues classified as either hotspots or non-hotspots based on experimental characterization of point mutations from a diverse set of allosteric proteins. Each residue had an associated set of calculated features. Two sets of features were used, one consisting of dynamical, structural, network, and informatic measures, and another of structural measures defined by Daily and Gray [1]. The resulting models performed well on an independent data set consisting of hotspots and non-hotspots from five allosteric proteins. For the independent data set, our top 10 models using Feature Set 1 recalled 68–81% of known hotspots, and among total hotspot predictions, 58–67% were actual hotspots. Hence, these models have precision P = 58–67% and recall R = 68–81%. The corresponding models for Feature Set 2 had P = 55–59% and R = 81–92%. We combined the features from each set that produced models with optimal predictive performance. The top 10 models using this hybrid feature set had R = 73–81% and P = 64–71%, the best overall performance of any of the sets of models. Our methods identified hotspots in structural regions of known allosteric significance. Moreover, our predicted hotspots form a network of contiguous residues in the interior of the structures, in agreement with previous work. In conclusion, we have developed models that discriminate between known allosteric hotspots and non-hotspots with high accuracy and sensitivity. Moreover, the pattern of predicted hotspots corresponds to known functional motifs implicated in allostery, and is consistent with previous work describing sparse networks of allosterically important residues