PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-9 (9)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
Document Types
1.  “If it Tastes Good, I’m Drinking It”: Qualitative Study of Beverage Consumption among College Students 
Purpose
This study examined how college students choose beverages and whether behavioral interventions might reduce their heavy consumption of sugar-sweetened beverages.
Methods
From April to June 2010, 90 students participated in 12 focus groups at 6 colleges in Massachusetts and Louisiana. The study team undertook a group content analysis of the verbatim focus group transcripts using the immersion-crystallization method.
Results
The mean age of participants was 19 years. 50% were white, and 47% were black. Several themes emerged in focus groups: taste is paramount; price is important but secondary; health and nutritional content of beverages are of limited interest; juice has a “health halo”; and water is consumed primarily for hydration. Students were often highly fixated on favorite sugar-sweetened beverages. Price was uniquely important for good-tasting beverages costing less than one dollar. Some students reported calorie content as important for food choices, but most had no awareness of beverage calorie content. Students’ negative perceptions of sugar-sweetened beverages focused largely on the “dangers” of sugar and chemicals in sodas. They expressed particular concern about soda’s corrosive chemical properties or diet soda causing cancer. The health halo for juice persisted even with some recognition of high sugar content. Students thought shocking educational messages would be necessary to get them to reduce consumption of sugar-sweetened beverages.
Conclusions
Among college students, taste and price were the most important factors in choosing beverages. Interventions using shocking visual images or providing low-cost or free water may conquer taste and brand preference to reduce sugar-sweetened beverage intake.
doi:10.1016/j.jadohealth.2012.11.017
PMCID: PMC3657589  PMID: 23415754
obesity; nutrition; soft drinks; adolescence; young adults; qualitative research
2.  Perspectives of Colorectal Cancer Risk and Screening among Dominicans and Puerto Ricans: Stigma and Misperceptions 
Qualitative health research  2009;19(11):1559-1568.
Colorectal cancer is the second most common cancer among Latinos, but a lower percentage of Latinos are screened than Whites and Blacks. Along with recognized economic barriers, differences in knowledge and perceptions might impede colorectal screening among Latinos. We conducted 147 individual, qualitative interviews with Dominicans and Puerto Ricans in the northeastern United States to explore their explanatory models for colorectal cancer and screening barriers. Many participants had not previously heard of colorectal cancer. The most commonly mentioned cause of colorectal cancer was anal sex. Also considered risks were “bad food,” digestion leading to constipation, and strained bowel movements. Screening barriers included stigma, misperceptions, embarrassment, and machismo. Progress toward increasing colorectal cancer screening requires normalization of this screening among Latinos. Higher patient familiarity, along with improved physician counseling and referral, might contribute to reducing stigma and other barriers, and to enhancing knowledge and Latino community support of colorectal cancer screening.
doi:10.1177/1049732309349359
PMCID: PMC3584335  PMID: 19776255
cancer, screening; Caribbean people; communication, doctor-patient; ethnicity; health behavior; immigrants; interviews, semistructured; Latino/Hispanic people; lay concepts and practices; risk, perceptions
3.  Coping Styles, Health Status and Advance Care Planning in Patients with Hematologic Malignancies 
Leukemia & lymphoma  2011;52(12):2342-2348.
This study evaluated if measures of psychological well-being, including coping style are associated with advance care planning (ACP). Data were from the HEMA-COMM study, a prospective observational study of physician-patient communication in patients with hematologic malignancies. ACP was defined as having a living will, having a health care proxy, discussing life support with family or friends, and discussing life support with a doctor or nurse. 293 patients participated: only 45 (15%) had all the elements of ACP, 215 (73%) had at least 1 element of ACP, while 33 (11%) did not engage in ACP. In multivariate analysis, specific coping styles but not other measures of psychosocial well being were associated with having written ACP. Verbal ACP was associated with patient-reported health and physician estimate of life expectancy. Our study suggests that tailoring ACP discussions to a patient’s coping style may increase engagement in ACP.
doi:10.3109/10428194.2011.601474
PMCID: PMC3972814  PMID: 21851220
Advance care planning; Coping; Health Status; Hematological Cancer
4.  The study design and rationale of the randomized controlled trial: translating COPD guidelines into primary care practice 
BMC Family Practice  2013;14:56.
Background
Chronic obstructive pulmonary disease (COPD) is a progressive, debilitating disease associated with significant clinical burden and is estimated to affect 15 million individuals in the US. Although a large number of individuals are diagnosed with COPD, many individuals still remain undiagnosed due to the slow progression of the disorder and lack of recognition of early symptoms. Not only is there under-diagnosis but there is also evidence of sub-optimal evidence-based treatment of those who have COPD. Despite the development of international COPD guidelines, many primary care physicians who care for the majority of patients with COPD are not translating this evidence into effective clinical practice.
Method/Design
This paper describes the design and rationale for a randomized, cluster design trial (RCT) aimed at translating the COPD evidence-based guidelines into clinical care in primary care practices. During Phase 1, a needs assessment evaluated barriers and facilitators to implementation of COPD guidelines into clinical practice through focus groups of primary care patients and providers. Using formative evaluation and feedback from focus groups, three tools were developed. These include a computerized patient activation tool (an interactive iPad with wireless data transfer to the spirometer); a web-based COPD guideline tool to be used by primary care providers as a decision support tool; and a COPD patient education toolkit to be used by the practice team. During phase II, an RCT will be performed with one year of intervention within 30 primary care practices. The effectiveness of the materials developed in Phase I are being tested in Phase II regarding physician performance of COPD guideline implementation and the improvement in the clinically relevant outcomes (appropriate diagnosis and management of COPD) compared to usual care. We will also examine the use of a patient activation tool - ‘MyLungAge’ - to prompt patients at risk for or who have COPD to request spirometry confirmation and to request support for smoking cessation if a smoker.
Discussion
Using a multi-modal intervention of patient activation and a technology-supported health care provider team, we are testing the effectiveness of this intervention in activating patients and improving physician performance around COPD guideline implementation.
Trial registration
ClinicalTrials.gov, NCT01237561
doi:10.1186/1471-2296-14-56
PMCID: PMC3651367  PMID: 23641803
COPD; Guidelines; Randomized Clinical Trial; Primary care
5.  Information giving and receiving in hematological malignancy consultations† 
Psycho-Oncology  2011;21(3):297-306.
Purpose
Little is known about communication with patients suffering from hematologic malignancies, many of whom are seen by subspecialists in consultation at tertiary-care centers. These subspecialized consultations might provide the best examples of optimal physician–patient communication behaviors, given that these consultations tend to be lengthy, to occur between individuals who have not met before and may have no intention of an ongoing relationship, and which have a goal of providing treatment recommendations. The aim of this paper is to describe and quantify the content of the subspecialty consultation in regards to exchanging information and identify patient and provider characteristics associated with discussion elements.
Methods
Audio-recorded consultations between 236 patients and 40 hematologists were coded for recommended communication practices. Multilevel models for dichotomous outcomes were created to test associations between patient, physician and consultation characteristics and key discussion elements.
Results
Discussions about the purpose of the visit and patient’s knowledge about their disease were common. Other elements such as patient’s preference for his/her role in decision-making, preferences for information, or understanding of presented information were less common. Treatment recommendations were provided in 97% of the consultations and unambiguous presentations of prognosis occurred in 81% of the consultations. Unambiguous presentations of prognosis were associated with non-White patient race, lower educational status, greater number of questions asked, and specific physician provider.
Conclusion
Although some communication behaviors occur in most consultations, others are much less common and could help tailor the amount and type of information discussed. Approximately half of the patients are told unambiguous prognostic estimates for mortality or cure.
doi:10.1002/pon.1891
PMCID: PMC3377472  PMID: 21294221
communication; physician–patient encounters; oncology; hematology; prognosis; cancer
6.  Racial Discrimination and Physical Activity Among Low Income–Housing Residents 
Background
While discrimination has been identified as a potential determinant of existing racial/ethnic health disparities, no studies have investigated whether racial discrimination contributes to disparities in physical activity.
Purpose
The primary aim of the current study was to examine the association between interpersonal racial discrimination and physical activity.
Methods
Baseline data were collected during 2004–2005 among a predominately black and Hispanic sample of adult residents living in 12 low income–housing sites in Boston, Massachusetts (n=1055). Residents reported experiences of lifetime racial discrimination during interview-administered surveys and wore a pedometer for 5 days to measure physical activity. For analyses, performed in 2009, linear regression models with a cluster design were conducted to predict physical activity, measured as steps per day.
Results
Nearly 48% of participants reported ever experiencing racial discrimination, and discrimination was most commonly experienced on the street or in a public setting. No association was found between discrimination and physical activity, when examined in bivariate, multivariable, or race-stratified models.
Conclusions
The current results indicate that self-reported racial discrimination is not a key determinant of physical activity among residents living in lower-income housing. However, additional research is warranted to address current limitations of this study.
doi:10.1016/j.amepre.2009.07.018
PMCID: PMC2818664  PMID: 19944922
7.  Patients’ Reflections on Communication in the Second-Opinion Hematology-Oncology Consultation 
OBJECTIVE
The nature of communication between patients and their second-opinion hematology consultants may be very different in these one-time consultations than for those that are within long-term relationships. This study explored patients’ perceptions of their second-opinion hematology oncology consultation to investigate physician-patient communication in malignant disease at a critical juncture in cancer patients’ care and decision-making.
METHODS
In-depth telephone interviews with a subset of 20 patients from a larger study, following their subspecialty hematology consultations.
RESULTS
Most patients wanted to contribute to the consultation agenda, but were unable to do so. Patients sought expert and honest advice delivered with empathy, though most did not expect the consultant to directly address their emotions. They wanted the physician to apply his/her knowledge to the specifics of their individual cases, and were disappointed and distrustful when physicians cited only general prognostic statistics. In contrast, physicians’ consideration of the unique elements of patients’ cases, and demonstrations of empathy and respect made patients’ feel positively about the encounter, regardless of the prognosis.
CONCLUSIONS
Patients provided concrete recommendations for physician and patient behaviors to enhance the consultation.
PRACTICE IMPLICATIONS
Consideration of these recommendations may result in more effective communication and increased patient satisfaction with medical visits.
doi:10.1016/j.pec.2008.11.016
PMCID: PMC2812020  PMID: 19135824
physician-patient cancer communication; oncology consultations; qualitative research; focus groups; patients’ recommendations to patients; patients’ recommendations to physicians
8.  Effect of Language on Colorectal Cancer Screening Among Latinos and Non-Latinos 
BACKGROUND
Language barriers among some Latinos may contribute to the lower rates of colorectal cancer (CRC) screening between Latinos and non-Latino Whites. The purpose of this study was to examine the relationship between language and receipt of colorectal cancer screening tests among Latinos and non-Latinos using a geographically diverse, population-based sample of adults.
METHODS
Cross-sectional analysis of the Behavioral Risk Factor Surveillance System (BRFSS) survey. Analysis included adults 50 years of age and older, who completed the 2006 BRFSS in a state that recorded data from English and Spanish-speaking participants.
RESULTS
The primary outcome measure was receipt of colorectal screening tests (fecal occult blood testing within prior 12 months and/or lower endoscopy within 10 years). Of the 99,895 respondents included in the study populations, 33% of Latinos responding-in-Spanish reported having had CRC testing, while 51% of Latinos responding-in-English and 62% of English-speaking non-Latinos reported test receipt. In multivariable analysis, compared to non-Latinos, Latinos responding-in-English were 16% less likely (OR,0.84, 95 % CI, 0.73-0.98), and Latinos responding-in-Spanish were 43% less likely to have received colorectal cancer testing (OR,0.57, 95% CI, 0.44-0.74). Additionally, compared to Latinos responding-in-English, Latinos responding-in-Spanish were 36% less likely to have received CRC testing (OR, 0.64; 95% CI, 0.48-0.84)
CONCLUSION
Latinos responding to the 2006 BRFSS survey in Spanish had a significantly lower likelihood of receiving CRC screening tests compared to non-Latinos and to Latinos responding-in-English. Based on this analysis, Spanish language use is negatively associated with CRC screening and may contribute to disparities in CRC screening.
doi:10.1158/1055-9965.EPI-07-2692
PMCID: PMC2568081  PMID: 18708410
Colorectal cancer; Screening; Latino/Hispanic; Language; BRFSS

Results 1-9 (9)