Adherence to medical regimens in low-income adults with Type 2 diabetes: the influence of perceived control constructs

Individuals with Type 2 diabetes often do not adhere to their treatment regimens (e.g., exercise, diet, medication, glucose monitoring). Non-adherence results in poor metabolic control, further morbidity and mortality, and increased health care utilization and costs. One common thread among many health-behavior-theories that attempt to explain non-adherence behaviors is the importance of perceived control. This psychosocial variable has most often been conceptualized as ‘health locus of control,’ which refers to the belief that one has the ability to influence or change one’s health outcomes. Inconsistent findings have been reported regarding the relationship of health locus of control and medical regimen adherence in individuals with Type 2 diabetes. These inconsistencies may be related to a need for further research focused on the interaction of internal locus with other perceived control constructs (e.g., self-efficacy and outcome expectancy) as well as other types of external loci of control. The present study examined the relationship between internal locus of control, self-efficacy, and outcome expectancy on medical regimen adherence behaviors in low-income adults with Type 2 diabetes. It also investigated the influence of four types of external loci of control, independent and when combined with internal locus of control, on medical regimen adherence in Type 2 diabetic patients. A biological marker, HbA1c, which is considered the most reliable medical indicator for medical regimen adherence behaviors of diabetic patients, was used to measure medical regimen adherence. Multiple regression analyses demonstrate that though self efficacy, in its solidarity, was the best predictor of medical regimen adherence, as indicated by HbA1c levels, the interaction of high internal locus of control and high outcome expectancy was also meaningfully linked to medical regimen adherence. Further, results suggest that high internal locus of control and low chance locus of control beliefs are significantly related to medical regimen adherence in this sample of low-income patients with Type 2 diabetes

When an event sparks behavior change: an introduction to the sentinel event method of dynamic model building and its application to emergency medicine

Experiencing a negative consequence related to one\u27s health behavior, like a medical problem leading to an emergency department (ED) visit, can promote behavior change, giving rise to the popular concept of the teachable moment. However, the mechanisms of action underlying this process of change have received scant attention. In particular, most existing health behavior theories are limited in explaining why such events can inspire short-term change in some and long-term change in others. Expanding on recommendations published in the 2009 Academic Emergency Medicine consensus conference on public health in emergency medicine (EM), we propose a new method for developing conceptual models that explain how negative events, like medical emergencies, influence behavior change, called the Sentinel Event Method. The method itself is atheoretical; instead, it defines steps to guide investigations that seek to relate specific consequences or events to specific health behaviors. This method can be used to adapt existing health behavior theories to study the event-behavior change relationship or to guide formulation of completely new conceptual models. This paper presents the tenets underlying the Sentinel Event Method, describes the steps comprising the process, and illustrates its application to EM through an example of a cardiac-related ED visit and tobacco use

Understanding smoking after acute illness: An application of the sentinel event method

The sentinel event theory provides a stepwise approach for building models to understand how negative events can spark health behaviour change. This study tested a preliminary model using the sentinel events method in a sample (N = 300) of smokers who sought care for acute cardiac symptoms. Patients completed measures on: smoking-related causal attribution, perceived severity of the acute illness event, illness-related fear and intentions to quit smoking. Patients were followed up one week after the health event and a seven-day timeline follow back was completed to determine abstinence from tobacco. Structural equation models were performed using average predictor scale scores at baseline, as well as three different time anchors for ratings of illness severity and illness-related fear. Quit intentions, actual illness severity and age were the consistent, positive and independent predictors of seven-day point prevalence abstinence. Additional research on the influences of perceptions and emotional reactions is warranted

The Polaris Oncology Survivorship Transition (POST) System: A Patient- and Provider-Driven Cancer Survivorship Planning Program

BACKGROUND: It is strongly recommended that individuals ending treatment for cancer have a survivorship plan, and new standards require survivorship planning for accreditation, However, a comprehensive plan is often neglected. OBJECTIVE: To present the development and field test results of a web-based, breast cancer survivorship care planning system. METHODS: The Polaris Oncology Survivorship Transition (POST) blends input from the electronic health record (EHR), oncology care providers (OCPs), and patients to create a survivorship care plan (SCP). The content of the POST program was created with the assistance of end-user input (patients, oncologists, and primary care providers (PCPs)) and the full program was piloted on women ending treatment for breast cancer. This paper presents the pilot study that field-tested the POST In a clinical setting. Patients were recruited from outpatient care clinics and chemotherapy units in a comprehensive care center. The study included 25 women ending treatment for breast cancer in the past year, 4 OCPs, and PCPs. Patients received the POST computepized assessment and a tailored SCP. RESULTS: The POST assists providers in crafting efficient and comprehensive SCPs and was rated highly satisfactory by all end-users. DISCUSSION: The POST program can be used as a cancer survivorship planning program to assist OCPs in care planning for their patients ending treatment for breast cancer. CONCLUSION: This study provides support for Incorporating computerized SCP programs into clinical practice. Use of the POST in clinical practice has the potential to improve survivorship planning

Initial Development of the Mental Health Assessment and Dynamic Referral for Oncology (MHADRO)

The Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) is a program that conducts a computerized assessment of physical, psychological, and social functioning related to oncology treatment, prints personalized summary reports for both the patient and the provider, and for those who provide consent, faxes a referral and assessment summary report to a matched mental health treatment provider (i.e., dynamic referral). The functionality, feasibility, and end user satisfaction of the MHADRO were tested in a comprehensive care center. Of the 101 participants enrolled, 61 (60%) exhibited elevated distress on at least one of the mental health indices, and, of these, 12 (20%) chose a dynamic referral for mental health services. Patients and health care providers exhibited high levels of satisfaction with the program. The MHADRO has potential for assisting in meeting the psychosocial needs faced by individuals with cancer and should be tested further for its facilitation of mental health treatment initiation

Changes in smoking associated with an acute health event: theoretical and practical implications

BACKGROUND: Experiencing a serious adverse behavior-related consequence may motivate behavior change. PURPOSE: To examine how a sentinel health event is associated with changes in smoking. Methods: We used a prospective cohort design. Adult emergency department (ED) patients provided demographic data, a smoking history, ratings of quit intentions, and endorsement of self-identified smoking-related health problems. A chart review collected data on acuity, ED disposition, and medical diagnoses. Smoking was reassessed 1 month postvisit. Hierarchical regression analyses were conducted to predict (a) intention to quit, (b) any quit attempt of 24 hr or more, and (3) 7-day abstinence. RESULTS: Of 717 smokers enrolled, 189 (26%) intended to quit within the next month. Of the 253 participants reached 1 month postvisit, 126 (50%) reported they had attempted to quit, with 44 (19%) reporting 7-day abstinence. After controlling for other predictors, several event-related variables, such as having a smoking-related ED visit and being admitted to the hospital, were strong predictors of outcomes. CONCLUSION: Compared to community-based estimates, many more smokers in our sample attempted to quit and achieved 7-day abstinence. This was especially true among smokers who attributed their ED visit to a smoking-related health problem and who were admitted to the hospital. We discuss the implications for tobacco intervention design in medical settings

The relationship between breast cancer anxiety and mammography: Experiential avoidance as a moderator

Although mammography can aid in the early detection and prevention of breast cancer, many women do not receive annual mammograms. It remains unclear whether anxiety about breast cancer inhibits or promotes mammography rates. The way in which women regulate their anxiety (ie, level of experiential avoidance) may play a role in predicting mammography adherence. A community sample of women (N = 84) completed a questionnaire which assessed mammography rates, experiential avoidance, and breast cancer anxiety. The results suggest that, while controlling for breast cancer anxiety, experiential avoidance (β =.31, p \u3c.01) significantly predicted mammography rates. When examining experiential avoidance as a moderator, a multiple regression analysis approached significance (R 2Δ =.04, p =.07), suggesting that a woman\u27s level of experiential avoidance influences the relationship between anxiety and mammography. These findings will help enable health care practitioners to better identify women at risk of non-adherence to mammography recommendations. © 2011 Copyright Taylor and Francis Group, LLC

Predictors of psychological distress and interest in mental health services in individuals with cancer

Identifying risk factors for psychological distress in patients with cancer may help providers more efficiently screen, identify, and manage distress. This article presents predictors of psychological distress in a large heterogeneous sample of cancer patients. In total, 836 patients were enrolled in a large randomized control trial and completed computerized psychosocial assessments Mental Health Assessment and Dynamic Referral for Oncology. Multivariate regressions examined predictors of distress and interest in mental health services. Final models suggest that psychological distress was related to six variables, and interest in mental health services was related to previous history of mental health counseling, total number of cancer-related symptoms, and race/ethnicity. Results may be used to identify high-risk patients who may benefit from proactive psychosocial interventions

Randomized control trial to test a computerized psychosocial cancer assessment and referral program: Methods and research design

The National Cancer Coalition Network, National Cancer Institute, and American College of Surgeons all emphasize the need for oncology providers to identify, address, and monitor psychosocial needs of their patients. The Mental Health Assessment and Dynamic Referral for Oncology (MHADRO) is a patient-driven, computerized, psychosocial assessment that identifies, addresses, and monitors physical, psychological, and social issues faced by oncology patients. This paper presents the methodology of a randomized controlled trial (RCT) that tested the impact of the MHADRO on patient outcomes at 2, 6, and 12 months. Patient outcomes including overall psychological distress, depression, anxiety, functional disability, and use of psychosocial resources will be presented in future publications after all follow-up data is gathered. Eight hundred and thirty six cancer patients with heterogeneous diagnoses, across three comprehensive cancer centers in different parts of the United States, were randomized to the MHADRO (intervention) or an assessment-only control group. Patients in the intervention group were provided detailed, personalized reports and, when needed, referrals to mental health services; their oncology provider received detailed reports designed to foster clinical decision making. Those patients who demonstrated high levels of psychosocial problems were given the option to authorize that a copy of their report be sent electronically to a best match mental health professional. Demographic and patient cancer-related data as well as comparisons between patients who were enrolled and those who declined enrollment are presented. Challenges encountered during the RCT and strategies used to address them are discussed

Intentions to quit smoking: causal attribution, perceived illness severity, and event-related fear during an acute health event

BACKGROUND: Experiencing a serious consequence related to one\u27s health behavior may motivate behavior change. PURPOSE: This study sought to examine how causal attribution, perceived illness severity, and fear secondary to an acute health event relate to intentions to quit smoking. METHODS: Using a cross-sectional survey design, adult emergency department patients who smoked provided demographic data and ratings of nicotine dependence, causal attribution, perceived illness severity, event-related fear, and intentions to quit smoking. RESULTS: A linear regression analysis was used to examine the relations between the independent variables and quit intentions. We enrolled 186 participants. After adjusting for nicotine dependence, smoking-related causal attribution and event-related fear were associated with intentions to quit (beta = 0.26, p \u3c 0.01 and beta = 0.21, p \u3c 0.01, respectively). Perceived illness severity was correlated with event-related fear (r = 0.46, p \u3c 0.001) but was not associated with intentions to quit (beta = -0.08, p = 0.32). CONCLUSION: While causal attribution and event-related fear were modestly associated with quit intentions, perceived illness severity was not. Longitudinal studies are needed to better explicate the relation between these variables and behavior change milestones