Health decisions for others : an extension of the Health Belief Model

The Health Belief Model (HBM) is a widely-used theory to understand why individuals engage in certain health behaviors. With its focus on perceived benefits and barriers as major contributors to behavior change, the HBM is also noted as a valuable framework in health communication research and practice. The overarching purpose of this study is to consider an outward focus to the HBM, adding to its already strong explanatory power of how individuals make health decisions for not only themselves, but for others as well. The findings of this research may have practical implications in healthcare settings, between health professionals and patients, and may add value to health promotion campaigns so they resonate better with intended audiences. This study will first discuss the HBM; its history and its early uses in health behavior research. It will then discuss the limited research that attempts to use the HBM in the context of ‘others’, and theories from interpersonal communication that have also touched on the subject – such as communal coping. Locus of control and fatalism are also taken in to account as potential modifiers to how people go about making health-related decisions for others. The conceptual background for this study is in the context of prenatal/pregnancy health. Maternal and infant health research is the investigator’s focus and fits well in to the idea of making health decisions for others and the potential expansion of the HBM. A review of prenatal health promotion, both from an interpersonal and mass communication perspective is also given. A sample of graduate students and members of the community (N=21) were interviewed for this study. The methods, results, discussion, and implications of the findings are provided in the following chapters.Advertisin

Engaging Men in Prenatal Health Promotion: A Pilot Evaluation of Targeted e-Health Content

Pregnancy outcomes in the United States continue to rank among the worst in the developed world. Traditional maternal–child health promotion tends to focus exclusively on women, leaving men out of programs that can affect family health. Scholars advocate including men in prenatal health to reduce maternal and infant mortality and morbidity. This study explored the perceived role of men in prenatal health, the use of an e-health application, and participant-suggested ways of improving the application moving forward. This study interviewed men in a large Southwestern U.S. city with an average age of 26.0 years (N = 23). The sample was 52% White, 26% Hispanic, 9% Asian, 9% multiracial or other, and 4% Black. Participants were asked about pregnancy health and used a pregnancy-related e-health application on a tablet computer. Participants provided opinions on content, ease of use of tablets, and recommendations for a stronger application. Despite perceived barriers such as time constraints, financial burdens, and an unclear role, men believe it is important to be involved in pregnancy health. Most found the application to contain useful and interesting information. Participants recommended the addition of videos and interactive modules to make the application stronger. This study explored the use of a targeted e-health application to introduce men to prenatal health education. Results indicate men feel favorable to this type of intervention. Additional refinement of the application could include interactive tools or “push content” to further engage men in this important topic

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Promoting Multivitamins to Hispanic Adolescents and Mothers

Neural tube defects (NTDs) can be reduced by 50% to 70% with sufficient periconceptional intake of folic acid. Hispanic women are up to 3 times more likely than non-Hispanics to have a child affected by NTDs. This disparity is complicated by health literacy, as women impacted by this disparity are also at-risk for low health literacy. The purpose of this project was to pilot advertisements to promote multivitamins, increasing folic acid consumption, among Hispanic adolescents. The advertisements for Hispanic adolescents and their mothers focused on broad benefits of a multivitamin, downplaying folic acid’s role in prenatal health. Participants were Hispanic mothers ( n = 25) and adolescents ( n = 25) at a clinic in the Southwestern United States. Likert-type survey items and an open-ended question were used to assess attitudes toward multivitamins and advertisements. The Newest Vital Sign (NVS) was used to assess participants’ health literacy. Participants’ impressions of the ads were positive. Both groups expressed the intent to start taking a daily multivitamin after viewing the ads—adolescents for themselves and mothers to start their daughters on a daily multivitamin. There was no relationship between participants’ health literacy and perceptions of the advertisements or intentions to begin a multivitamin habit. This research illustrates the potential of messages that rely on peripheral health benefits to overcome communication barriers posed by health literacy and address serious health problems such as NTDs

Motivations to tweet: a uses and gratifications perspective of Twitter use during a natural disaster

On April 27, 2011, Tuscaloosa, Alabama, was struck by an EF-4 tornado. This research investigates how students at The University of Alabama used Twitter during the warning, impact and recovery stages of the disaster. The warning stage refers to the time before the disaster. The impact stage refers to the time during the disaster, and the recovery stage refers to the time after the disaster. Specifically, this research studies four motivations to use Twitter-- social, entertainment, status seeking, and information. Each category was studied to understand when people who were motivated by the need to socialize, to entertain, to gain status or to gather information were actively tweeting in connection with the tornado. By using a mixed design ANOVA, the researcher found that students were tweeting significantly more during the recovery stage, which included Twitter use, during the weeks after the tornado. The researcher was interested in knowing which motivation produced the most Twitter use. The social, entertainment, and information motivations produced roughly the same amount of Twitter use. The status motivation did not produce as much Twitter use during the natural disaster. The results suggest that those motivated by social, entertainment or information needs tweet more during the impact and recovery stage. The most Twitter use occurs in the weeks after the disaster during the recovery stage. (Published By University of Alabama Libraries