Physical Activity Health Communication for Adults with Mood Disorders in the United States

Using national representative data, this study sought to examine receipt of physical activity communication and counseling among adults with mood disorders in comparison to the general population in the United States. The sample consisted of adult primary-care visits in the National Hospital Ambulatory Medical Care and National Ambulatory Medical Care Surveys. Multivariable logistic regression was used to examine the relationship between mental health status and receipt of physical activity communication and counseling. Overall, less than 20% of visits included physical activity communication and counseling. Controlling for covariates, visits for adults with a mood disorder diagnosis were associated with an increased odds of including physical activity communication and counseling, odds ratio = 1.25, 95% confidence interval = [1.08, 1.45]. Although adults with mood disorders were more likely to receive physical activity communication and counseling, most primary-care visits for adults in the United States did not include physical activity communication and counseling

Evaluating Motivational Interviewing in the Physician Assistant Curriculum

Purpose Motivational interviewing (MI) is an evidence-based technique that enables clinicians to help patients modify health behaviors. Although MI is an essential tool for physician assistants (PAs), the extent to which it is addressed in PA curricula in the United States is unknown. This study is a comprehensive description of MI education in PA programs in the United States. Methods Data are from the 2014 Physician Assistant Education Association Annual Program Survey. Descriptive statistics were conducted on de-identified data from all 186 PA programs in the United States. Results Of the 186 PA programs surveyed, 72.58% (n = 135) reported at least one course providing MI training. Availability of courses providing training in skills essential to the MI process varied. Having a course with verbal communication training was most frequently endorsed, and having a course with training in developing discrepancy was least frequently endorsed. The most popular teaching modality was lecture (84.95%, n = 158), whereas only 41.40% (n = 77) and 58.60% (n = 109) reported role play with evaluation and standardized patient exercises with evaluation, respectively. Conclusions More than 70% of programs included at least one course in their curriculum that provided training in MI, suggesting that PA programs recognize the importance of MI. Instruction in change talk was not provided in nearly half of the programs. Role-play and standardized patient exercises with evaluation were underused methods despite their proven efficacy in MI education. As the first comprehensive benchmark of MI education for PAs, this study shows that although most programs address MI, opportunities exist to improve MI training in PA programs in the United States

Adequacy of Depression Treatment in Spouses of Cancer Survivors: Findings From a Nationally Representative US Survey

Background Recent research suggests that mental health problems in spouses of cancer survivors are associated with worse mental health in the survivors themselves. Adequately treating spousal mental health problems therefore represents an opportunity to improve outcomes for both cancer survivors and their co-surviving family members. Objective Using nationally representative data, this study sought to determine how depression treatment differs between spouses of cancer survivors with depression compared to the general married population and assess rural/urban disparities in treatment. Design The design of the study is cross sectional. Participants Data are from the Medical Expenditures Panel Survey, a household-based survey of US adults; we concatenated data from 2004 to 2013. We identified spouses of cancer survivors (n = 225) and a comparison group of married adults (n = 3678). Main Measures Key measures included depression, guideline concordance of depression treatment (at least four prescriptions related to depression treatment, or at least eight psychotherapy or counseling visits), and sociodemographic characteristics. Logistic regressions evaluated the association between whether their spouse had cancer and receipt of guideline-concordant treatment, controlling for sociodemographic characteristics; secondary analyses included rurality as a moderator. Analyses were weighted to account for the complex sampling design. Key Results Spouses of cancer survivors were 33% less likely to receive guideline-concordant depression treatment than comparison spouses (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.45–0.99), controlling for covariates. Rural-urban disparities were observed: rural spouses of cancer survivors were 72% less likely to receive guideline-concordant treatment (OR 0.28, 95% CI 0.11–0.68) than rural comparison spouses. Spouses of cancer survivors and comparison spouses were no different in their receipt of any treatment versus no treatment. Conclusions Spouses of cancer survivors with depression may be at increased risk of non-guideline-concordant depression treatment, particularly in rural areas. The findings have implications for identifying and educating individuals with depression in primary care and other clinical areas

Disclosure of Depression in Primary Care: A Qualitative Study of Women’s Perceptions

Background Health care providers are better able to diagnose depression and initiate treatment when patients disclose symptoms. However, many women are reluctant to disclose depressive symptoms. Little is known about the experience of disclosing depression symptoms in primary care among racially and ethnically diverse women across the life course. We qualitatively explore experiences of disclosure of depressive symptoms to primary care providers among self-identified African American, Hispanic and non-Hispanic White women. Methods Twenty-four women with depression were recruited for open-ended interviews. We recorded, transcribed, and coded interviews using inductive content analysis. Findings Two distinct domains emerged: participant factors that hinder and facilitate disclosure and provider cues that encourage and dissuade discussing depression. Participants described perceptions about primary care not being the appropriate place, fear of not having a choice in treatment decisions, and the emotional cost of retelling as impediments to disclosure; perceiving an increased likelihood of getting help was described as a facilitator. Women identified provider behaviors of asking about depression and showing concern as facilitators, and provider time constraints as a barrier to disclosure. Conclusions Women perceive that primary care is not the appropriate place to disclose depression symptoms. Increased public education about behavioral health management in primary care, as well as more robust integration of the two, is needed. Efforts to improve depression disclosure in primary care must also encompass systematic use of depression screening tools and implementation of targeted interventions to cultivate provider empathy

Urban Partnerships to Address Health Literacy in High Need Populations

Low health literacy disproportionately affects racial and ethnic minority communities and lower-income socioeconomic groups. To address this critical determinant of health inequity, two nonprofit organizations, Repairers of the Breach, a day shelter for individuals experiencing homelessness, and Bread of Healing a neighborhood-based clinic serving individuals with low incomes, partnered with researchers at Marquette University to implement and evaluate an evidence-supported health literacy program. The partnership delivered the curriculum in seven one-hour sessions over seven weeks. The program attendees were predominantly African American men and women from 19–73 years old. Most participants had formal education ranging from elementary school to some college. Forty individuals attended at least one class and 14 attendees completed 4 or more classes. Program completers demonstrated gains in confidence and topic knowledge. Most interviewees reported a personal/family need for the program, acceptability of the group format, and the ability to learn the skills they needed for self-care. The project used a successful collaboration between community-based organizations serving vulnerable populations and an urban academic institution to demonstrate the necessity, feasibility, acceptability, and effectiveness of formal health literacy education in adults with low incomes or who are experiencing homelessness. Urban and metropolitan serving institutions can work in partnership with community to address low health literacy in high need populations

Favorable Ratings of Providers\u27 Communication Behaviors Among U.S. Women with Depression: A Population-based Study Applying the Behavioral Model of Health Services Use

Background Little is known about the relationships between sociodemographic characteristics and ratings of provider communication behavior among women with depression in the United States. This study uses the Andersen Behavioral Model to examine the relationships among predisposing, enabling, and need factors and ratings of perceived patient–provider communication in women with depression. Methods The sample consisted of women with depression who visited any provider in the previous 12 months in the 2002–2008 Medical Expenditure Panel Survey (n = 3,179; weighted n = 4,707,255). Multivariate logistic regression was used to examine the independent contribution of predisposing, enabling, and need factors on providers\u27 communication behavior measures. Findings Black (non-Hispanic) women were more likely to report that providers always listened carefully (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.01–1.94), explained so they understood (OR, 1.53; 95% CI, 1.10–2.11), and showed respect for what they had to say (OR, 1.39; 95% CI, 1.01–1.92). Women participating in the paid workforce and those without a usual source of care were at increased risk for less favorable experiences. Conclusions Participation in the paid workforce and lack of a usual source of care were associated with an increased likelihood of less optimal communication experiences. Implications for Practice and/or Policy Ensuring that women with depression have reliable access to a continuous source of care and expanding the availability of nonemergent, after-hours care may be instrumental for improving patient–provider communication in this population

The Impact of Patient–Provider Communication and Language Spoken on Adequacy of Depression Treatment for U.S. Women

Many women with depression are untreated or undertreated for their condition. The quality of patient–provider communication may impact the receipt of depression treatment. We examine the relationship between patient–provider communication and receipt of adequate treatment for depression among women. The study sample consisted of women with depression who visited a provider in the previous 12 months in the 2002–2008 Medical Expenditure Panel Survey (N = 3,179). Multivariate regression was used to examine the independent contribution of sociodemographic characteristics, health care factors, patient–provider communication, and respondent language on depression treatment status (none, some, adequate). We found that more than one-third of women with depression in the United States did not receive adequate treatment. Women reporting that providers usually or always listened carefully were more likely to receive adequate treatment (OR = 1.59; 95% CI = 1.10−2.30 and OR = 1.55; 95% CI = 1.07−2.23, respectively). Non-English-speaking women were 50% less likely to receive adequate treatment (OR = 0.49; 95% CI = 0.30−0.80). Having a usual source of care was associated with an increased likelihood of receiving some and adequate treatment (OR = 1.84; 95% CI = 1.24−2.73 and OR = 2.22; 95% CI = 1.61−3.05, respectively). Effective provider listening behaviors may help increase the number of U.S. women with depression who receive adequate treatment. Efforts to improve language access for limited English-proficient women are likely critical for improving treatment outcomes in this population. Additionally, ensuring that women with depression have consistent access to health care services is important for obtaining adequate depression care

Exploring Corporate Stakeholders’ Perspectives on Building Capacity for Employee Engagement in Workplace Wellness Initiatives

Engaging employees with chronic conditions as partners in designing, implementing, and evaluating workplace wellness activities is a promising approach for optimizing the impact of workplace health promotion programs. Yet, there is a need for information on how employees are engaged in this process. We conducted a process evaluation of activities of the Patient-Centered Outcomes Research for Employees (PCORE) project formed around building capacity for employee engagement in wellness initiatives. Individual interviews were conducted with the 11 project stakeholders to explore perspectives of the project\u27s participatory process and activities. Thematic categories emerging in the analysis were (1) Commitment and support, (2) Understanding purpose and roles, (3) Role of employees in wellness programming, and (4) Communication during meetings. This process evaluation provides insights from a model of stakeholder engagement in the corporate setting. Creating an environment that supports meaningfully engaging employees as partners in co-creating workplace wellness initiatives requires effectively addressing the unique aspects of the U.S. corporate culture such as the emphasis on productivity and the prevalent traditional top-down organizational structures

Influence of Social Class Perceptions on Attributions among Mental Health Practitioners

Objective: A vignette-based study assessed the influence of social class attributions toward a hypothetical client\u27s difficulty. Method: 188 licensed mental health professionals who were recruited through professional listservs completed an online survey after reviewing one of two versions of a vignette describing a hypothetical client that varied based on social class cues. Results: As expected, this sample of licensed mental health practitioners detected social class differences based on the descriptors of the hypothetical client across the two vignettes. These perceived social class differences, however, did not impact participants\u27 attributions toward the client for causing or solving her problems, level of Global Assessment of Functioning score ascribed to the client, or willingness to work with the client. Conclusions: There was no evidence that participants differentially ascribed attributions based on social class. Implications and directions for future research are provided