Efficacy of DVD Technology in Chronic Obstructive Pulmonary Disease Self- Management Education of Rural Patients

Despite the efficacy of pulmonary rehabilitation programs which assist patients in managing chronic obstructive pulmonary disease (COPD), the high costs and lack of availability of such programs pose considerable barriers for underserved COPD patients, such as those living in rural communities. Because of this, patients are encouraged to actively self-manage COPD. Unfortunately, COPD patients have reported dissatisfaction with the self-management education they are provided. This mixed methods study assessed the self-management learning needs of COPD patients treated at a Certified Federal Rural Health Clinic through conducting focus group interviews (n = 2) to inform the development a targeted self-management education DVD. The effectiveness of 3 distinct educational treatments (DVD vs. Pamphlet vs. DVD Pamphlet) was evaluated by comparing outcomes related to informational needs, self-management self-efficacy, and generic/lung-specific HRQoL in a randomly-assigned, multiple-group pretestposttest design with a control group (n = 41). Focus group data was analyzed using three qualitative analysis tools. Findings from the interviews indicated that patients viewed self-management as simply taking prescribed medications and reducing activity. Patients reported a lack of knowledge and skill development related to rehabilitative activities such as controlled breathing and stress reduction. A multivariate analysis of covariance was conducted to determine the effect of 3 educational treatments on multiple outcome measures. Three nontrend orthogonal planned contrasts were tested to determine selected contrast effects. The data analysis revealed that participants receiving a DVD reported statistically significantly higher levels of lung-specific physical functioning as compared to those in the Pamphlet group. Additionally, the DVD group revealed clinically significant improvements on the physical ( 19.01) and emotional ( 10.74) functioning dimensions of lung-specific HRQoL; whereas, no such improvement occurred within the Pamphlet and control groups. Results also suggested that providing patients with a Pamphlet alone was more effective than providing participants with both interventions concurrently to increase self-management self-efficacy. The simultaneous provision of both interventions did, however, enhance generic HRQoL more so than the provision of one of the two treatments alone. Finally, any type of self-management education as compared to usual care did not statistically significantly improve outcome variables among this small sample of rural patients

Proposing a Transactional Model of eHealth Literacy: Concept Analysis

Background: Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts. Objective: The objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC. Methods: Walker and Avant's concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC. Results: Systematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of "communication" in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions. Conclusions: The Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of "noise" (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply)

The Perceived Availability of Online Social Support: Exploring the Contributions of Illness and Rural Identities in Adults with Chronic Respiratory Illness

Joining an online social support group may increase perceived membership to a community, but it does not guarantee that the community will be available when it is needed. This is especially relevant for adults with Chronic Obstructive Pulmonary Disease (COPD), many of whom reside in rural regions and continually negotiate their illness identity. Drawing from social support literature and communication theory of identity, this cross-sectional study explored how COPD illness and geographic identities interact to influence patients’ perceived availability of online social support. In April 2018, 575 adults with a history of respiratory symptoms completed an online survey. Patients with a COPD diagnosis reported greater availability of online support. This was partially mediated by a positive degree of COPD illness identity (i.e., being diagnosed with COPD, a history of tobacco use, severe respiratory symptoms, high disease knowledge, and low income but high education). The relationship between COPD illness identity and the availability of online support was strongest among those with low rural identity; however, at lower levels of COPD illness identity, participants with high rural identity reported the greatest degree of available online support. Results have important implications for tailored education approaches across the COPD care continuum by illness and geographic identities

Measuring Health Information Seeking Challenges in Chronic Disease: A Psychometric Analysis of a Brief Scale

Information seeking is a cornerstone of patient activation in chronic disease self-management. To date, there are few brief and literacy-sensitive tools to measure intrinsic barriers of health information seeking. The Health Information National Trends Survey includes four items from the Information Seeking Experiences scale to measure frustration, effort, concern, and comprehension of information sought during a recent medical/health information search. Limited evidence exists for its construct validity and use in primary data collection in chronic disease. This measurement study examines the psychometric properties of the scale. Qualtrics Panelists with at least one chronic disease (N = 684) participated in an online survey. The average score was M = 12.85 (SD = 3.97), indicating a moderate degree of health information seeking challenges. Confirmatory factor analysis of data collected using this scale supported unidimensionality (RMSEA = .03; CFI/TLI = .99/.99). There was adequate scale (ω = .83) and item (value = .98) reliabilities. Rasch analyses showed optimal measurement error and response predictability with item-fit (values = .80–1.20). Response option “agree” was less likely to be selected than any other response option, although not posing a threat to scale reliability. Results demonstrate that this brief scale has sufficient measurement properties for its use as a measure of intrinsic health information seeking barriers among patients with chronic disease

Using screen video capture software to aide and inform cognitive interviewing

Web-based surveys are a salient tool in the repertoire of social and behavioral scientists. The increase in web-based surveys is understandable considering the distinct advantages offered, including: (a) lower costs and reduced labor time, (b) ability to directly transfer data into statistical packages (reducing coding errors), (c) customization options enabling more attractive presentation, (d) ability to reduce respondent burden by embedding skip patterns, and (e) access to larger sample sizes in different geographic regions. It is important to note, however, that administering web-based surveys also introduces distinct sources of error (e.g., coverage, sampling and non-response). Regardless of format (e.g., paper-and-pencil or web-based), specific, prescribed steps must be followed when constructing an instrument in order to reduce survey error and lend credence to the data collected before subsequent analysis is performed. One of those crucial stages integral to the pretesting process is cognitive interviewing. Cognitive interviewing is a qualitative process, encompassing two main techniques: think aloud interviewing and verbal probing. Collectively, these two methods seek to (a) produce information on what the respondent is thinking while answering the questions, (b) the cognitive processes used to answer the questions, and (c) how the respondent answers the questions. The purpose of this article is to provide a practical guide outlining how Camtasia, a screen video capture software, can aide and inform the cognitive interview process

Entrepreneurship in health education and health promotion: Five cardinal rules

Abstract: The nature of health education and health promotion (HE/HP) offers a fertile ground for entrepreneurial activity. As primary prevention of chronic diseases becomes a more central component of the health and/ or medical care continuum, entrepreneurial opportunities for health educators will continue to expand. The process used to design, implement, and evaluate health promotion and disease prevention has clear articulation with entrepreneurial, marketing management, and other business processes. Thus, entrepreneurs in HE/HP must be able to utilize business process to facilitate creative, new HE/HP business ideas, The purpose of this article is to weave theory and practical application into a primer on entrepreneurial applications in HE/HP. More specifically, the authors meld their prospective experiences and expertise to provide background thoughts on entrepreneurship in HE/HP and develop a framework for establishing an entrepreneurial venture in HE/HP. Five Cardinal Rules for Entrepreneurs in HE/HP are proposed

Strategies for Designing a Distance Education Course/Program

Abstract: The past decade has brought about a rapid growth of distance education (DE) courses and programs; this is particularly evident in the field of health education and promotion. This article provides an overview of strategies utilized in designing DE courses and programs. The process of designing DE courses, called Instructional Systems Design (ISD), mirrors the process used by health educators and promoters in their everyday practice. The authors take the reader through each step of the ISD, as it relates to the health education process, and provides additional resources for DE course and program development for interested readers

American Association for Health Education (AAHE) 2011 Membership Survey: Summary of Findings

The American Association for Health Education (AAHE), a national health education organization with the mission of advancing the profession of health education, launched the 2011 AAHE membership survey between October 13, 2011 and November 1, 2011, under the leadership of the AAHE Board of Directors and AAHE Staff. The primary objective of the survey was to provide insight into the perspectives of AAHE members on several important issues facing the organization including: AAHE exiting its parent organization, the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) and the proposed modified merger with the Society for Public Health Education (SOPHE), another national health education organization. A total of 240 AAHE members completed the survey. A majority of respondents were university members in health education, and results provide keen insight into AAHE members\u27 perspectives on the AAHE-SOPHE modified merger

Pregaming: A Field-Based Investigation of Alcohol Quantities Consumed Prior to Visiting a Bar and Restaurant District

Background: Investigations examining the association between pregaming, or the consumption of alcohol prior to attending a social gathering or drinking establishment, and blood alcohol concentrations (BAC) have primarily relied on estimations (i.e., Widmark equation), rather than objective biologic samples, such as breath alcohol concentration (BrAC). Objectives: The current study assessed: (1) pregaming, using quantity-based measures, among a sample of college and non-college affiliated bar patrons, (2) associations between pregaming intensity/status and participant intoxication (BrAC), and (3) whether participants who pregamed were more likely to identify as a hazardous drinker. Methods: 548 bar patrons provided data on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and a single pregaming item assessing quantity of alcohol consumed prior to visiting a bar/restaurant district in 2015. BrAC samples were collected post interview. We used hierarchical linear regression models, respectively, to assess whether pregaming significantly impacted BrAC and whether presence of hazardous drinking predicted pregaming behavior. Results After controlling for sex, race/ethnicity, age, student status, and Greek affiliation, the linear regression model explained 32.3% (R2 =.323) of the variance of BrAC levels (F(12)= 21.162, p<0.001), with 4.30% of the variance explained solely by pregaming (β =0.014; p<0.001). The linear regression model to assess if harzardous drinking behavior (AUDIT-C) significantly predicted pregaming explained 31.2% (R2 =.312) of the variance of pregaming behavior (F(18)= 13.276, p<0.001), with 4.2% of the variance explained solely by AUDIT-C scores (β =0.280; p<0.001). Conclusion: Findings further highlight pregaming as a harmful risk behavior linked to elevated levels of hazardous drinking and intoxication

Transactional eHealth Literacy: Developing and Testing a Multi-Dimensional Instrument

Theoretically informed measures of eHealth literacy that consider the social affordances of eHealth are limited. This study describes the psychometric testing of a multi-dimensional instrument to measure functional, communicative, critical, and translational eHealth literacies, as informed by the Transactional Model of eHealth Literacy (TMeHL). A 3-phase rating scale construction process was conducted to engage eHealth experts and end-users. In Phase 1, Experts (N = 5) and end-users (N = 25) identified operational behaviors to measure each eHealth literacy dimension. End-users (N = 10) participated in think-aloud interviews to provide feedback on items reviewed and approved by experts. A field test was conducted with a random sample of patients recruited from a university-based research registry (N = 283). Factor analyses and Rasch procedures examined the internal structure of the scores produced by each scale. Pearson’s r correlations provided evidence for external validity of scores. The instrument measures four reliable (ω = .92-.96) and correlated (r= .44-.64) factors: functional (4 items), communicative (5 items), critical (5 items), and translational (4 items). Researchers and providers can use this new instrument as a theory-driven instrument to measure four eHealth literacies that are fundamental to the social affordances of the eHealth experience