Information processes of health communication and fruit and vegetable consumption: a multi-sample structural equation modeling approach by intervention and colon cancer status groups

A diet low in fruits and vegetables has been associated with increased risk for colorectal cancer. Health communications with Tailored Print Communication (TPC) and Telephone Motivational Interviewing (TMI) have been shown to be effective in promoting fruits and vegetable consumption (FVC). This study explored the mechanisms underlying TPC and TMI effectiveness among colon cancer survivors and colon cancer-free individuals, guided by the Information Processing Theory. The data come from the North Carolina Strategies to Improve Diet, Exercise, and Screening study (NC STRIDES). NC STRIDES tested the efficacy of TPC and TMI to promote FVC among a population-based sample of 735 participants (36% colon cancer survivors and 64% colon cancer-free individuals) who were randomized to control, TPC, TMI, or combined (TPC+TMI) groups. Information processes were perception of message relevance, trust, and recall. Multi-sample structural equation models were constructed. Among colon cancer survivors, the relationship between health communication and FVC was mediated by information processes but only in those who received the TPC+TMI. The model fit resulted in x2(27, N =266) =31.52, CFI =.99, TLI =.99, RMSEA =.025, and SRMR =.027. Receiving a combination of TPC+TMI was associated with perception of message relevance (p =.05). Greater relevance was associated with trust (p <.001), and higher trust was related to FVC (p <.05). In the colon cancer-free group, the relationship between health communication and FVC was mediated by information processes among those who received the TMI intervention only and TPC+TMI. The model had a good fit with x2(28, N =469) =68.11, CFI =.98, TLI =.97, RMSEA =.055, and SRMR =.036. TMI had an indirect effect on FVC through message relevance. TPC+TMI influenced FVC through two paths. In the first path, message relevance was associated with trust (p <.001) and greater trust was related to recall (p <.05). More recall influenced FVC (p <.05). In the second path, message relevance was associated with recall (p <.001), and more recall with FVC (p <.05). Given the significant finding that information processes mediate the relationship between health communication and FVC, a promising direction for developing interventions would be to enhance information processes in future interventions

The role of giving and receiving emotional support in depressive symptomatology among older couples: An application of the actor-partner interdependence model

The present study investigated whether perception of receiving emotional support mediates the relationship between one partner’s giving of emotional support and the other partner’s depressive symptomatology using a population-based sample of 423 couples from the Changing Lives of Older Couples study. A path model was used guided by the Actor-Partner Interdependence Model. Results indicated that spouses’ giving emotional support was related to the degree to which their spouse reported receiving emotional support. Perception of receiving emotional support, in turn, was related to lower depressive symptomatology of the support recipient. Both husbands and wives can benefit from emotional support through their perception of receiving emotional support, and spouses’ perceptions, as well as their actions, should be considered in support transactions

“It Turned My World Upside Down”: Latino Youths’ Perspectives on Immigration

Few studies have examined the migration and acculturation experiences of Latino youth in a newly emerging Latino community, communities that historically have had low numbers of Latino residents. This study uses in-depth interview data from the Latino Adolescent, Migration, Health, and Adaptation (LAMHA) project, a mixed-methods study, to document the experiences of Latino youth (ages 14–18) growing up in one emerging Latino community in the South – North Carolina. Using adolescent’s own words and descriptions, we show how migration can turn an adolescent’s world upside down, and we discover the adaptive strategies that Latino immigrant youth use to turn their world right-side up as they adapt to life in the U.S

Development of a Practical Model for Targeting Patient Decision Support Interventions to Promote Colorectal Cancer Screening in Vulnerable Populations

We sought to develop a practical model for predicting probability of colorectal cancer (CRC) screening completion in a diverse safety-net population and a subsequent framework for targeting screening promotion interventions. Data used to construct the models was prospectively collected from a CRC screening intervention. Models were cross-validated by randomly splitting the data into training and validation samples. The predicted probabilities of screening completion from the final model were trichotomized into framework groups and cross-validated by defining cut-points in the training sample, applying them to the validation sample, and comparing across samples for homogeneity. The final model included demographic and simple psychosocial measures and predicted screening behavior adequately (AUROC=0.63). The framework groups (cut-points 0.62 (low), 0.74 (medium), and 1.0 (high)) were homogeneous across the two samples. The model and framework may be useful for designing and delivering targeted interventions to promote CRC screening. Future research should validate the framework groups

Information Processing Versus Social Cognitive Mediators of Weight Loss in a Podcast-Delivered Health Intervention

Podcasting is an emerging technology, and previous interventions have shown promising results using theory-based podcast for weight loss among overweight and obese individuals. This study investigated whether constructs of social cognitive theory and information processing theories (IPTs) mediate the effect of a podcast intervention on weight loss among overweight individuals. Data are from Pounds off Digitally, a study testing the efficacy of two weight loss podcast interventions (control podcast and theory-based podcast). Path models were constructed (n = 66). The IPTs—elaboration likelihood model, information control theory, and cognitive load theory—mediated the effect of a theory-based podcast on weight loss. The intervention was significantly associated with all IPTs. Information control theory and cognitive load theory were related to elaboration, and elaboration was associated with weight loss. Social cognitive theory constructs did not mediate weight loss. Future podcast interventions grounded in theory may be effective in promoting weight loss

Feasibility and acceptability of home delivery of water for dental caries control in latinx children — “sediento por una sonrisa,” thirsty for a smile : single-arm feasibility study

Background: Outcomes of surgical treatments under general anesthesia for early childhood caries of young children from low-income groups are poor requiring retreatment within 2 years. Dietary sugar is an ideal intervention target given that it is the most prominent risk factor for dental caries and there is increasing evidence of successful interventions to reduce its intake. Our aim is to investigate the feasibility and acceptability of the Thirsty for a Smile intervention, designed to promote consumption of water in lieu of sugar sweetened beverages, among children who underwent surgery for early childhood caries and their caregivers, mostly from Latino heritage. Methods: A single-arm feasibility study was conducted in a dental practice from a community health center in eastern Washington State. Bottled water was delivered to the participants’ homes and caregivers received patientcentered counseling for setting goals to increase children’s water intake and reduce sugar sweetened beverages consumption. We assessed the feasibility and acceptability of the intervention and study procedures through participation rates, interviews and a questionnaire completed by the caregivers. Data was analyzed and themes and descriptive statistics presented. Results: Twenty-two dyads of caregivers and their children between 2 and 9 years old who recently had surgical treatment for early childhood dental caries were enrolled. All study assessments were completed by more than 90% of participants, except for the final 24-h dietary recall (73%). Dietary counseling, both in person and brief telephone calls, was highly acceptable to the caregivers, and they also reported their children enjoyed and used the water bottles. On a scale from 1 to 10, the average rating for the helpfulness of the dietary counseling component for changing child’s drinking habits was 9.62 and for the water delivery component, 8.86. Conclusions: This study tested the feasibility of conducting a trial in a dental practice setting, and the acceptability among caregivers of young children who underwent surgery for early childhood caries. It demonstrated that the Thirsty for a Smile intervention and study processes were feasible and acceptable. The study provides useful information for implementation of a two-arm randomized controlled trial in this setting and may also benefit other researchers attempting to test similar interventions

Mediators of fruit and vegetable consumption among colorectal cancer survivors

Due to early detection and treatment, survival from colorectal cancer (CRC) diagnosis has been steadily increasing. A CRC diagnosis could be considered a “teachable moment,” a time when interventionists might successfully promote dietary changes. CRC interventions with tailored print communication (TPC) and telephone motivational interviewing (TMI) have been shown to be effective in promoting fruit and vegetable consumption (FVC) among CRC survivors. However, little is known about how these interventions work to exert their effect. This study investigated whether information processes mediate the relationship between a CRC intervention and FVC among CRC survivors

Cultural and Linguistic Adaptation of a Multimedia Colorectal Cancer Screening Decision Aid for Spanish-Speaking Latinos

As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse and most vulnerable populations. Latinos also have the lowest colorectal (CRC) screening rates of any ethnic group in the U.S. To address such disparities, health communication interventionists are often faced with the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. We describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish language version of an evidenced-based (English language) multimedia CRC screening decision aid. Our multi-step process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. We integrated these findings in the creation of the new adapted intervention. We describe how we used this process to identify and integrate socio-cultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish language decision aid

Information Processes Mediate the Effect of a Health Communication Intervention on Fruit and Vegetable Consumption

Health communication interventions have been effective in promoting fruit and vegetable consumption (FVC). To explore mechanisms underlying health communication effectiveness, we investigated whether information processes mediated the relationship between health communication and FVC, using data from NC STRIDES. NC STRIDES tested the efficacy of two health communication strategies to promote FVC among a diverse population-based sample of older adults. Participants were randomized to one of four groups: control, tailored print communication (TPC), telephone motivational interviewing (TMI), or combined (TPC+TMI). Multi-sample structural equation models were constructed to analyze data from 469 participants. Information processes mediated the effect of TMI and TPC+TMI on FVC. TMI had an indirect effect on FVC through relevance of the communications. TPC+TMI influenced FVC through perceived relevance of the communications, trust in the communications, and dose recall via two paths. In the first path, relevance was associated with trust. Trust was associated with recall, and greater recall predicted FVC. In the second path, relevance was associated with dose recall, and more recall predicted FVC. Thus, we found that key information processes mediated the relationship between a health communication intervention and FVC. Further research should investigate ways to enhance relevance, trust, and recall during the delivery of interventions

Testing a Spanish-language colorectal cancer screening decision aid in Latinos with limited English proficiency: Results from a pre-post trial and four month follow-up survey

Abstract Background Compared with non-Latinos, Latinos in the US have low rates of colorectal cancer (CRC) screening and low rates of knowledge regarding CRC screening tests and guidelines. Spanish speaking Latinos have particularly low CRC screening rates and screening knowledge. Our purpose was twofold: (1) to evaluate the effect of a computer-based, Spanish-language CRC screening decision aid on screening knowledge, intent to obtain screening, and screening self-efficacy in a community sample of Latinos with limited English proficiency (LEP); and (2) to survey these decision aid viewers at four months to determine their rates of CRC discussions with a health care provider as well as their rates of screening test completion. Methods We recruited 50-75 year old Latinos with LEP who were not current with CRC. Participants screening viewed a 14 minute multimedia decision aid that addresses CRC screening rationale, recommendations, and options. We conducted an uncontrolled (pre-post) study in which we assessed screening knowledge, self-efficacy, and intent at baseline and immediately after decision aid viewing. We also conducted a follow-up telephone survey of participants at four months to examine rates of patient-provider screening discussions and test completion. Results Among n = 80 participants, knowledge scores increased from 20% (before) to 72% (after) decision aid viewing (absolute difference [95%CI]: 52% [46, 59]). The proportion with high screening self-efficacy increased from 67% to 92% (25% [13, 37]); the proportion with high screening intent increased from 63% to 95% (32% [21, 44]). We reached 68 (85%) of 80 participants eligible for the follow-up survey. Of these 36 (53%) reported discussing screening with a provider and 13 (19%) completed a test. Conclusion Viewing a Spanish-language decision aid increased CRC screening knowledge, self-efficacy, and intent among Latinos with LEP. Decision aid viewing appeared to promote both CRC screening discussions with health care providers and test completion. The decision aid may be an effective tool for promoting CRC screening and reducing screening disparities in this population