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BACKGROUND - Yoga is a behavioral practice that uses physical movement, breathing, and meditation to improve health and promote personal transformation. Ancient yoga philosophy proposed that an individual's confidence about yoga, a concept similar to self-efficacy, will affect the likelihood of improved health from yoga practice. The purpose of this study was to develop and examine the psychometric properties of a self-efficacy measure for yoga practice (the Yoga Self-Efficacy Scale; YSES).
METHODS - Yoga practitioners were recruited to evaluate the psychometric properties of YSES via a secure online survey. We collected data on additional measures to further examine construct validity. After two weeks, participants were invited to complete YSES items again to assess test-retest reliability.
RESULTS - A majority of participants (N = 309) were White (85%), female (82%), and yoga instructors (56%). The 12-item YSES is unidimensional with a Cronbach's alpha of 0.93. Test-retest reliability is r = 0.79 (n = 170). YSES scores are positively correlated with health competence, health-related quality of life, and years practicing yoga, supporting construct validity. Also, yoga teachers scored significantly higher on the YSES than non-teachers (p < 0.001). Non-significant relationships with education, income and sex supported discriminant validity. YSES maintained internal consistency and construct validity for all yoga styles surveyed.
CONCLUSION - YSES is a reliable and valid measure of self-efficacy for yoga practice that may provide insight into barriers to adopting and maintaining yoga as a health behavior.
OBJECTIVE - Diabetes patients with limited resources often experience suboptimal care. Less is known about the role of effective health communication (HC) in caring for low income diabetes patients.
METHODS - Ten health department clinics in TN participated in a trial evaluating a literacy-sensitive communication intervention. We assessed the quality of baseline HC and measured associations with diabetes outcomes. Assessments included: demographics, measures of HC, health literacy, self-care behaviors, self-efficacy, medication non-adherence, treatment satisfaction, and A1C. Unadjusted and adjusted multivariable regression models were used to test associations.
RESULTS - Participants (N=411) were 49.7±9.5 years, 61% female, uninsured (96%), with A1C 9.6±2.1. In unadjusted analyses, better communication, was associated with lower medication non-adherence (OR 0.40-0.68, all p<0.05), higher treatment satisfaction (OR 1.76-1.96, all p<0.01), portion size reduction (OR 1.43, p<0.05), diabetes self-efficacy (OR 1.41, p<0.05), and lower A1C (β=-0.06, p<0.01). In adjusted analyses, communication quality remained associated with lower medication non-adherence (AOR 0.39-0.68, all p<0.05), and higher treatment satisfaction (AOR 1.90-2.21, all p<0.001).
CONCLUSIONS - Better communication between low-income patients and providers was independently associated with lower medication non-adherence and higher treatment satisfaction.
PRACTICE IMPLICATIONS - Communication quality may be an important modifiable approach to improving diabetes care for vulnerable populations.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
OBJECTIVE - To assess the efficacy and acceptability of a group medical nutritional therapy (MNT) intervention, using motivational interviewing (MI). RESEARCH DESIGN & METHOD: African American (AA) women with type 2 diabetes (T2D) participated in five, certified diabetes educator/dietitian-facilitated intervention sessions targeting carbohydrate, fat, and fruit/vegetable intake and management. Motivation-based activities centered on exploration of dietary ambivalence and the relationships between diet and personal strengths. Repeated pre- and post-intervention, psychosocial, dietary self-care, and clinical outcomes were collected and analyzed using generalized least squares regression. An acceptability assessment was administered after intervention.
RESULTS - Participants (n = 24) were mostly of middle age (mean age 50.8 ± 6.3) with an average BMI of 39 ± 6.5. Compared to a gradual pre-intervention loss of HbA1c control and confidence in choosing restaurant foods, a significant post-intervention improvement in HbA1c (P = 0.03) and a near significant (P = 0.06) increase in confidence in choosing restaurant foods were observed with both returning to pre-intervention levels. 100% reported that they would recommend the study to other AA women with type 2 diabetes.
CONCLUSION - The results support the potential efficacy of a group MNT/MI intervention in improving glycemic control and dietary self-care-related confidence in overweight/obese AA women with type 2 diabetes.
OBJECTIVE - Problem solving is a critical diabetes self-management skill. Because of a lack of clinically feasible measures, our aim was to develop and validate a self-report self-management problem solving questionnaire for adolescents with type 1 diabetes (T1D).
METHODS - A multidisciplinary team of diabetes experts generated questionnaire items that addressed diabetes self-management problem solving. Iterative feedback from parents and adolescents resulted in 27 items. Adolescents from two studies (N=156) aged 13-17 were recruited through a pediatric diabetes clinic and completed measures through an online survey. Glycemic control was measured by HbA1c recorded in the medical record.
RESULTS - Empirical elimination of items using principal components analyses resulted in a 13-item unidimensional measure, the diabetes adolescent problem solving questionnaire (DAPSQ) that explained 56% of the variance. The DAPSQ demonstrated internal consistency (Cronbach's alpha=0.92) and was correlated with diabetes self-management (r=0.53, p<.001), self-efficacy (r=0.54, p<.001), and glycemic control (r=-0.24, p<.01).
CONCLUSION - The DAPSQ is a brief instrument for assessment of diabetes self-management problem solving in youth with T1D and is associated with better self-management behaviors and glycemic control.
PRACTICE IMPLICATIONS - The DAPSQ is a clinically feasible self-report measure that can provide valuable information regarding level of self-management problem solving and guide patient education.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
OBJECTIVE - To determine mediators of 12-month outcomes of Internet interventions for youth with type 1 diabetes transitioning to adolescence.
METHODS - In this multisite clinical trial, 320 youth were randomized to one of two Internet-based interventions: Coping skills (TEENCOPE™) or diabetes education (Managing Diabetes). Mediators of the interventions' effects on glycosylated hemoglobin and quality of life were examined. Data were collected at baseline and at 3, 6, and 12 months.
RESULTS - Self-efficacy mediated treatment effects on quality of life in both interventions. For TEENCOPE™, stress reactivity, primary control coping, and secondary control coping mediated treatment effects, whereas for Managing Diabetes, social acceptance mediated treatment effects. There were no significant effects of either intervention on glycosylated hemoglobin.
CONCLUSIONS - 2 Internet interventions for youth with type 1 diabetes resulted in improved quality of life by different mechanisms, suggesting components of both diabetes education and coping skills may help to achieve better outcomes in youth with type 1 diabetes.
Despite the important contribution increasing physical activity levels may play in reducing chronic disease morbidity and mortality, there is a paucity of interventions and research indicating how to improve physical activity levels in African American men. Men on the Move was a pilot study to increase African American men's levels of physical activity by improving access to age and ability-appropriate, male-focused physical activity opportunities and facilitating access to social support from male peers. Forty-one African American men ages 35 to 70 enrolled (mean age = 53.8). Groups of 5 to 10 men met once a week with a certified personal trainer for 10 weeks. Each meeting addressed barriers to physical activity, provided men with community resources, and incorporated activities that promoted flexibility, strength, balance, and conditioning. Improvements (p < .05) were detected for the following outcome measures: perceived self-efficacy to sustain physical activity, endurance, overall health status, and stress level. Physiological and fitness outcome measures improved, although not to significant levels. Whereas 40% of the men met the recommendation of 150 minutes of moderate or vigorous physical activity weekly at baseline, 68% of the men met this recommendation by the end of the project. These positive results attest to the feasibility of successfully engaging middle-aged and older African American men in a physical activity intervention, and our findings demonstrate the initial efficacy of this intervention approach. More research is needed that includes a more intensive intervention and one that helps motivate men to be physically active outside of the structured, small-group sessions.
The purpose of this study was to develop and validate two instruments: one to assess patient perceptions of control of the childbirth environment and the other, global satisfaction with the childbirth experience. Participants were 187 women recruited from obstetric clinics, breast-feeding support groups and online who had given birth in the past 4 months. Scale development involved item construction, exploratory factor analysis (EFA) of the Perceived Control in Childbirth Scale (PCCh), confirmatory factor analysis (CFA) of the Satisfaction with Childbirth Scale (SWCh), reliability analysis and construct validity analyses. EFA identified a single factor underlying a set of items reflecting the patient's belief that her actions influenced the birth environment (i.e. perceived control). CFAs supported a single-factor model reflecting the degree to which the birth experience met the patient's ideal (i.e. satisfaction). Perceived control was associated with childbirth self-efficacy. Childbirth satisfaction was associated with both affective reactions to birth and childbirth-related posttraumatic stress disorder (PTSD) symptoms. Results support the validity and reliability of two new scales that assess perceived control of the birth environment and global satisfaction with childbirth.
BACKGROUND - Juvenile primary fibromyalgia syndrome (JPFS) is a chronic condition characterized by widespread musculoskeletal pain and discrete tender points with no objective evidence of a muscle disease but with disordered central pain processing. Very little is known about the prevalence and treatment on inpatient psychiatric units.
OBJECTIVE - The purpose of this study was to determine the effect of an intervention for JPFS in adolescent females admitted to a psychiatric hospital.
METHODS - In total, 30 patients with JPFS were assigned to either the intervention (n = 15) or control group (n = 15). The intervention group attended a fibromyalgia seminar followed by an audio-guided total body relaxation exercise. The control group participated in a seminar on skin care. Both groups completed a visual analog scale for affective states and somatic sensations before and after the seminar.
RESULTS - Participants in the intervention group, but not the control group, demonstrated significant improvement in concentration, self-confidence, restfulness and comfort level (p < 0.001 to p < 0.05). They also reported a reduction in stress level, muscle tightness, stomach upset and feeling down (p < 0.001 to p < 0.05) immediately after the intervention.
CONCLUSIONS - This study provides evidence that a combined intervention can be used in the inpatient psychiatric setting to improve functioning and overall well-being of patients with comorbid psychiatric disorders and JPFS during acute hospitalization.
OBJECTIVE - To examine the mechanisms linking health literacy to physical activity and self-reported health.
METHODS - From 2005-2007, patients (N = 330) with hypertension were recruited from safety net clinics. Pathanalytic models tested the pathways linking health literacy to physical activity and self-reported health.
RESULTS - There were significant paths from health literacy to knowledge (r = 0.22, P < 0.001), knowledge to self-efficacy (r = 0.13, P < 0.01), self-efficacy to physical activity (r = 0.17, P < 0.01), and physical activity to health status (r = 0.17, P < 0.01).
CONCLUSIONS - Health education interventions should be literacy sensitive and aim to enhance patient health knowledge and self-efficacy to promote self-care behavior and desirable health outcomes.
Understanding the demographic, behavioural and psychosocial factors associated with partner referral for patients with sexually transmitted infections (STIs) is important for designing appropriate intervention strategies. A survey was conducted among STI clients in three government and three non-governmental organization-operated clinics in Dhaka and Chittagong city in Bangladesh. Demographic and psychosocial information was collected using a questionnaire guided by the Attitude-Social Influence-Self Efficacy model. Partner referral data were collected by verification of referral cards when partners appeared at the clinics within one month of interviewing the STI clients. Of the 1339 clients interviewed, 81% accepted partner referral cards but only 32% actually referred their partners; 37% of these referrals were done by clients randomly assigned to a single counselling session vs. 27% by clients not assigned to a counselling session (p < 0.0001). Among psychosocial factors, partner referral intention was best predicted by attitudes and perceived social norms of the STI clients. Actual partner referral was significantly associated with intention to refer partner and attitudes of the index clients. Married clients were significantly more likely to refer their partners, and clients with low income were less likely to refer partners. Intervention programmes must address psychosocial and socio-economic issues to improve partner referral for STIs in Bangladesh.
Copyright © 2010 Elsevier Ltd. All rights reserved.