Understanding Health Literacy for People Living With HIV: Locations of Learning.

Health literacy, including people's abilities to access, process, and comprehend health-related information, has become an important component in the management of complex and chronic diseases such as HIV infection. Clinical measures of health literacy that focus on patients' abilities to follow plans of care ignore the multidimensionality of health literacy. Our thematic analysis of 28 focus groups from a qualitative, multisite, multinational study exploring information practices of people living with HIV (PLWH) demonstrated the importance of location as a dimension of health literacy. Clinical care and conceptual/virtual locations (media/Internet and research studies) were used by PLWH to learn about HIV and how to live successfully with HIV. Nonclinical spaces where PLWH could safely discuss issues such as disclosure and life problems were noted. Expanding clinical perspectives of health literacy to include location, assessing the what and where of learning, and trusted purveyors of knowledge could help providers improve patient engagement in care

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Perception and Sense of Control Over Eating Behaviors Among a Diverse Sample of Adults at Risk for Type 2 Diabetes

PURPOSE: The purpose of the study was to explore and understand knowledge and attitudes about food, diet, and weight control, focusing on barriers and motivators to reduce risk of developing type 2 diabetes. METHODS: Six focus groups were conducted in May and June 2010. The groups were stratified by sex. A total of 35 ethnically diverse samples with a high risk for type 2 diabetes participated. The average age was 51 ± 10.6 years, and 57% of the sample represented women. RESULTS: Four themes emerged from the focus groups: (1) demonstrated knowledge and source of knowledge, including participants’ basic understanding of “good” and “bad” food and what constitutes a “healthy diet” and trusted sources of information; (2) perceptions of food and diet, encompassing how participants expressed their perception of and interaction with food and diet; (3) sense of control over dietary intake, reflecting participants’ discussion of their perceived ability to control their eating patterns and food choices; and (4) eating behaviors, describing participants’ patterns of eating and perceived barriers to eating a healthy diet. CONCLUSIONS: Study findings demonstrate that eating healthy requires a complex interaction between individual perceptions of food and sense of control over eating patterns and socio-political and economic structural factors that restrict healthy eating options while promoting unhealthy ones. Programs for long-term eating behavioral change necessary to reduce type 2 diabetes and obesity need to incorporate strategies that address individual-level factors of perception of food and sense of control over eating patterns, as well as structural level factors such as poverty and food insecurity

Perception and Sense of Control Over Eating Behaviors Among a Diverse Sample of Adults at Risk for Type 2 Diabetes

PurposeThe purpose of the study was to explore and understand knowledge and attitudes about food, diet, and weight control, focusing on barriers and motivators to reduce risk of developing type 2 diabetes.MethodsSix focus groups were conducted in May and June 2010. The groups were stratified by sex. A total of 35 ethnically diverse samples with a high risk for type 2 diabetes participated. The average age was 51 ± 10.6 years, and 57% of the sample represented women.ResultsFour themes emerged from the focus groups: (1) demonstrated knowledge and source of knowledge, including participants' basic understanding of "good" and "bad" food and what constitutes a "healthy diet" and trusted sources of information; (2) perceptions of food and diet, encompassing how participants expressed their perception of and interaction with food and diet; (3) sense of control over dietary intake, reflecting participants' discussion of their perceived ability to control their eating patterns and food choices; and (4) eating behaviors, describing participants' patterns of eating and perceived barriers to eating a healthy diet.ConclusionsStudy findings demonstrate that eating healthy requires a complex interaction between individual perceptions of food and sense of control over eating patterns and sociopolitical and economic structural factors that restrict healthy eating options while promoting unhealthy ones. Programs for long-term eating behavioral change necessary to reduce type 2 diabetes and obesity need to incorporate strategies that address individual-level factors of perception of food and sense of control over eating patterns, as well as structural level factors such as poverty and food insecurity

Applying Natural Language Processing to Understand Motivational Profiles for Maintaining Physical Activity After a Mobile App and Accelerometer-Based Intervention: The mPED Randomized Controlled Trial.

BackgroundRegular physical activity is associated with reduced risk of chronic illnesses. Despite various types of successful physical activity interventions, maintenance of activity over the long term is extremely challenging.ObjectiveThe aims of this original paper are to 1) describe physical activity engagement post intervention, 2) identify motivational profiles using natural language processing (NLP) and clustering techniques in a sample of women who completed the physical activity intervention, and 3) compare sociodemographic and clinical data among these identified cluster groups.MethodsIn this cross-sectional analysis of 203 women completing a 12-month study exit (telephone) interview in the mobile phone-based physical activity education study were examined. The mobile phone-based physical activity education study was a randomized, controlled trial to test the efficacy of the app and accelerometer intervention and its sustainability over a 9-month period. All subjects returned the accelerometer and stopped accessing the app at the last 9-month research office visit. Physical engagement and motivational profiles were assessed by both closed and open-ended questions, such as "Since your 9-month study visit, has your physical activity been more, less, or about the same (compared to the first 9 months of the study)?" and, "What motivates you the most to be physically active?" NLP and cluster analysis were used to classify motivational profiles. Descriptive statistics were used to compare participants' baseline characteristics among identified groups.ResultsApproximately half of the 2 intervention groups (Regular and Plus) reported that they were still wearing an accelerometer and engaging in brisk walking as they were directed during the intervention phases. These numbers in the 2 intervention groups were much higher than the control group (overall P=.01 and P=.003, respectively). Three clusters were identified through NLP and named as the Weight Loss group (n=19), the Illness Prevention group (n=138), and the Health Promotion group (n=46). The Weight Loss group was significantly younger than the Illness Prevention and Health Promotion groups (overall P&lt;.001). The Illness Prevention group had a larger number of Caucasians as compared to the Weight Loss group (P=.001), which was composed mostly of those who identified as African American, Hispanic, or mixed race. Additionally, the Health Promotion group tended to have lower BMI scores compared to the Illness Prevention group (overall P=.02). However, no difference was noted in the baseline moderate-to-vigorous intensity activity level among the 3 groups (overall P&gt;.05).ConclusionsThe findings could be relevant to tailoring a physical activity maintenance intervention. Furthermore, the findings from NLP and cluster analysis are useful methods to analyze short free text to differentiate motivational profiles. As more sophisticated NL tools are developed in the future, the potential of NLP application in behavioral research will broaden.Trial registrationClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812 (Archived by WebCite at http://www.webcitation.org/70IkGagAJ)

Best research practices for using the Implicit Association Test

Interest in unintended discrimination that can result from implicit attitudes and stereotypes (implicit biases) has stimulated many research investigations. Much of this research has used the Implicit Association Test (IAT) to measure association strengths that are presumed to underlie implicit biases. It had been more than a decade since the last published treatment of recommended best practices for research using IAT measures. After an initial draft by the first author, and continuing through three subsequent drafts, the 22 authors and 14 commenters contributed extensively to refining the selection and description of recommendation-worthy research practices. Individual judgments of agreement or disagreement were provided by 29 of the 36 authors and commenters. Of the 21 recommended practices for conducting research with IAT measures presented in this article, all but two were endorsed by 90% or more of those who felt knowledgeable enough to express agreement or disagreement; only 4% of the totality of judgments expressed disagreement. For two practices that were retained despite more than two judgments of disagreement (four for one, five for the other), the bases for those disagreements are described in presenting the recommendations. The article additionally provides recommendations for how to report procedures of IAT measures in empirical articles

Best research practices for using the Implicit Association Test

Interest in unintended discrimination that can result from implicit attitudes and stereotypes (implicit biases) has stimulated many research investigations. Much of this research has used the Implicit Association Test (IAT) to measure association strengths that are presumed to underlie implicit biases. It had been more than a decade since the last published treatment of recommended best practices for research using IAT measures. After an initial draft by the first author, and continuing through three subsequent drafts, the 22 authors and 14 commenters contributed extensively to refining the selection and description of recommendation-worthy research practices. Individual judgments of agreement or disagreement were provided by 29 of the 36 authors and commenters. Of the 21 recommended practices for conducting research with IAT measures presented in this article, all but two were endorsed by 90% or more of those who felt knowledgeable enough to express agreement or disagreement; only 4% of the totality of judgments expressed disagreement. For two practices that were retained despite more than two judgments of disagreement (four for one, five for the other), the bases for those disagreements are described in presenting the recommendations. The article additionally provides recommendations for how to report procedures of IAT measures in empirical articles