Motivational interviewing to explore culturally and linguistically diverse people's comorbidity medication self-efficacy.

AIMS AND OBJECTIVES: To examine the perceptions of a group of culturally and linguistically diverse participants with the comorbidities of diabetes, chronic kidney disease and cardiovascular disease to determine factors that influence their medication self-efficacy through the use of motivational interviewing. BACKGROUND: These comorbidities are a global public health problem and their self-management is more difficult for culturally and linguistically diverse populations living in English-speaking communities. Few interventions have been tested in culturally and linguistically diverse people to improve their medication self-efficacy. DESIGN: A series of motivational interviewing telephone calls were conducted in the intervention arm of a randomised controlled trial using interpreter services. METHODS: Patients with these comorbidities aged ≥18 years of age whose preference it was to speak Greek, Italian or Vietnamese were recruited from nephrology outpatient clinics of two Australian metropolitan hospitals in 2009. RESULTS: The average age of the 26 participants was 73·5 years. The fortnightly calls averaged 9·5 minutes. Thematic analysis revealed three core themes which were attitudes towards medication, having to take medication and impediments to chronic illness medication self-efficacy. A lack of knowledge about medications impeded confidence necessary for optimal disease self-management. Participants had limited access to resources to help them understand their medications. CONCLUSION: This work has highlighted communication gaps and barriers affecting medication self-efficacy in this group. Culturally sensitive interventions are required to ensure people of culturally and linguistically diverse backgrounds have the appropriate skills to self-manage their complex medical conditions. RELEVANCE TO CLINICAL PRACTICE: Helping people to take their medications as prescribed is a key role for nurses to serve and protect the well-being of our increasingly multicultural communities. The use of interpreters in motivational interviewing requires careful planning and adequate resources for optimal outcomes.

Providing community education: lessons learned from Native Patient Navigators.

Native Navigators and the Cancer Continuum (NNACC) was a community-based participatory research study among five American Indian organizations. The intervention required lay Native Patient Navigators (NPNs) to implement and evaluate community education workshops in their local settings. Community education was a new role for the NPNs and resulted in many lessons learned. NPNs met quarterly from 2008 through 2013 and shared lessons learned with one another and with the administrative team. In July 2012, the NPNs prioritized lessons learned throughout the study that were specific to implementing the education intervention. These were shared to help other navigators who may be including community education within their scope of work. The NPNs identified eight lessons learned that can be divided into three categories: NPN education and training, workshop content and presentation, and workshop logistics and problem-solving. A ninth overarching lesson for the entire NNACC study identified meeting community needs as an avenue for success. This project was successful due to the diligence of the NPNs in understanding their communities' needs and striving to meet them through education workshops. Nine lessons were identified by the NPNs who provided community education through the NNACC project. Most are relevant to all patient navigators, regardless of patient population, who are incorporating public education into navigation services. Due to their intervention and budget implications, many of these lessons also are relevant to those who are developing navigation research.

Less body fat improves physical and physiological performance in army soldiers.

The purpose of this study was to compare physical and physiological fitness test performance between Soldiers meeting the Department of Defense (DoD) body fat standard (< or = 18%) and those exceeding the standard (> 18%). Ninety-nine male 101st Airborne (Air Assault) Soldiers were assigned to group 1: < or = 18% body fat (BF) or group 2: > 18% BE. Groups 1 and 2 had similar amounts of fat-free mass (FFM) (66.8 +/- 8.2 vs. 64.6 +/- 8.0, p = 177). Each subject performed a Wingate cycle protocol to test anaerobic power and capacity, an incremental treadmill maximal oxygen uptake test for aerobic capacity, isokinetic tests for knee flexion/extension and shoulder internal/external rotation strength, and the Army Physical Fitness Test. Results showed group 1: < 18% BF performed significantly better on 7 of the 10 fitness tests. In Soldiers with similar amounts of FFM, Soldiers with less body fat had improved aerobic and anaerobic capacity and increased muscular strength.

A randomized trial to reduce smoking among American Indians in South Dakota: The walking forward study.

BACKGROUND: Lung cancer is an important public health issue, particularly among American Indians (AIs). The reported decline in tobacco use for most racial/ethnic groups is not observed among AIs. This project was designed to address the research question, "Why don't more Northern Plains American Indians alter tobacco use behaviors known to increase the risk of cancer?" METHODS: Guided by the Theory of Planned Behavior, a multi-component intervention study was implemented. Adult AIs, age 18 years or older and currently smoking, were enrolled. Eligible subjects were randomized to one of 15 groups and exposed to either a MINIMAL or an INTENSE level of 4 intervention components. The intervention was delivered face-to-face or via telephone by Patient Navigators (PN). The primary outcome was self-reported abstinence from smoking verified by carbon monoxide measurement. RESULTS: At 18 months post-quit date, 88% of those who were still in the study were abstinent. This included 6% of all participants who enrolled in the study (14/254) and 13% of those who made it to the quit date (14/108). No intervention groups were found to have significant proportions of participants who were abstinent from smoking at the quit date (visit 5) or primary outcome visit (18 months post-quit date, visit 11), but use of pharmacologic support for abstinence was found to be an effective strategy for individuals who continued participation throughout the study. Those who remained in the study received more visits and were more likely to be abstinent. CONCLUSIONS: Use of NRT increased the odds of not smoking, as assessed at the 18-month follow-up visit, but no other interventions were found to significantly contribute to abstinence from smoking. Although the intervention protocol included numerous points of contact between CRRs and participants (11 visits) loss to follow-up was extensive with only 16/254 remaining enrolled. Additional research is needed to improve understanding of factors that influence enrollment and retention in smoking cessation interventions for AI and other populations.

Validation of the children's OMNI RPE scale for stepping exercise.

PURPOSE: The stepping pictorial format of the Children's OMNI Perceived Exertion Scale (0-10) was validated for female (N = 20) and male (N = 20) children, 8-12 yr old with a peak (step) oxygen consumption of 46.1 +/- 5.3 mL.kg(-1).min(-1). METHODS: Ratings of perceived exertion for the overall body (RPE-O), legs (RPE-L), and chest (RPE-C) were determined by the OMNI-Step Scale. Concurrent scale validity was examined by regressing OMNI-Step RPE against oxygen consumption (VO(2); mL.kg(-1).min(-1),) and heart rate (HR, beats.min(-1)). Construct scale validity was examined by regressing OMNI-Step RPE (i.e., conditional metric) against OMNI-Cycle RPE (i.e., criterion metric). Variables were measured at the end of each 2-min stage during load-incremented step and cycle exercise. RESULTS: The range of responses over the test stages for the combined female and male sample was VO(2): 9.1-38.6 mL.kg(-1).min(-1); HR: 88.0-168.2 beats.min(-1); and RPE-O, RPE-L, and RPE-C: 1.0-9.1. Using concurrent regression models, RPE-O, RPE-L, and RPE-C distributed as positive linear functions of both VO(2) and HR (r = 0.81-0.94 P < 0.05). Construct regression models indicated a strong linear function between OMNI-Step and OMNI-Cycle RPE for females and males. Differences in RPE (O, L, and C) were not found when females and males used pictorials depicting the same or opposite gender. RPE-L was higher (P < 0.05) than RPE-C at all test stages. CONCLUSION: Responses established concurrent and construct validity of the Children's OMNI-Step Scale over a wide intensity range. The OMNI-Step Scale is not influenced by pictorials' gender and is effective in assessing both undifferentiated and differentiated RPE in young children.

Patients' satisfaction and wait times at Guelph General Hospital Emergency Department before and after implementation of a process improvement project.

OBJECTIVE: A process improvement program (PIP) was implemented in the emergency department (ED) at Guelph General Hospital in July 2009. The purpose of this study was to examine patients' satisfaction and wait times by level of Canadian Triage and Acuity Scale (CTAS) score before and 6 months after implementation of this program. METHODS: Two samples were recruited: one was recruited before implementation of the PIP, January to June 2009 (T1), and one was recruited 6 months after implementation, January to June 2010 (T2). Patients were contacted by telephone to administer a survey including patient satisfaction with quality of care. Time to physician initial assessment, numbers left without being seen, and length of stay (LOS) were obtained from hospital records to compare wait times before and 6 months after implementation of the PIP. RESULTS: Patients (n = 301) reported shorter wait times after implementation (e.g., 12% reported seeing a physician right away at T1 compared to 29% at T2). Time to physician initial assessment improved for patients with CTAS scores of III, IV, and V (average decrease from 2.1 to 1.7 hours), fewer patients (n = 425) left without being seen after implementation, and the mean and 90th percentile of LOS decreased for all patients except the mean LOS for discharged patients with a CTAS score of I. Total time spent in the ED for admitted patients decreased from 11.11 hours in the 2009 period to 9.95 in the 2010 period, and for nonadmitted patients, the total time decreased from 3.94 to 3.29 hours. The overall satisfaction score improved from a mean of 3.17 to 3.4 (of 4; p < 0.001). CONCLUSION: Implementation of the ED PIP corresponded with decreased wait times, increased patient satisfaction, and improved patient flow for patients with CTAS scores of III, IV, and V.

Warrior Model for Human Performance and Injury Prevention: Eagle Tactical Athlete Program (ETAP) Part I.

INTRODUCTION: Physical training for United States military personnel requires a combination of injury prevention and performance optimization to counter unintentional musculoskeletal injuries and maximize warrior capabilities. Determining the most effective activities and tasks to meet these goals requires a systematic, research-based approach that is population specific based on the tasks and demands of the warrior. OBJECTIVE: We have modified the traditional approach to injury prevention to implement a comprehensive injury prevention and performance optimization research program with the 101st Airborne Division (Air Assault) at Ft. Campbell, KY. This is Part I of two papers that presents the research conducted during the first three steps of the program and includes Injury Surveillance, Task and Demand Analysis, and Predictors of Injury and Optimal Performance. METHODS: Injury surveillance based on a self-report of injuries was collected on all Soldiers participating in the study. Field-based analyses of the tasks and demands of Soldiers performing typical tasks of 101st Soldiers were performed to develop 101st-specific laboratory testing and to assist with the design of the intervention (Eagle Tactical Athlete Program (ETAP)). Laboratory testing of musculoskeletal, biomechanical, physiological, and nutritional characteristics was performed on Soldiers and benchmarked to triathletes to determine predictors of injury and optimal performance and to assist with the design of ETAP. RESULTS: Injury surveillance demonstrated that Soldiers of the 101st are at risk for a wide range of preventable unintentional musculoskeletal injuries during physical training, tactical training, and recreational/sports activities. The field-based analyses provided quantitative data and qualitative information essential to guiding 101st specific laboratory testing and intervention design. Overall the laboratory testing revealed that Soldiers of the 101st would benefit from targeted physical training to meet the specific demands of their job and that sub-groups of Soldiers would benefit from targeted injury prevention activities. CONCLUSIONS: The first three steps of the injury prevention and performance research program revealed that Soldiers of the 101st suffer preventable musculoskeletal injuries, have unique physical demands, and would benefit from targeted training to improve performance and prevent injury.

Warrior Model for Human Performance and Injury Prevention: Eagle Tactical Athlete Program (ETAP) Part II.

INTRODUCTION: Physical training for United States military personnel requires a combination of injury prevention and performance optimization to counter unintentional musculoskeletal injuries and maximize warrior capabilities. Determining the most effective activities and tasks to meet these goals requires a systematic, research-based approach that is population specific based on the tasks and demands of the Warrior. OBJECTIVE: The authors have modified the traditional approach to injury prevention to implement a comprehensive injury prevention and performance optimization research program with the 101st Airborne Division (Air Assault) at Fort Campbell, KY. This is second of two companion papers and presents the last three steps of the research model and includes Design and Validation of the Interventions, Program Integration and Implementation, and Monitor and Determine the Effectiveness of the Program. METHODS: An 8-week trial was performed to validate the Eagle Tactical Athlete Program (ETAP) to improve modifiable suboptimal characteristics identified in Part I. The experimental group participated in ETAP under the direction of a ETAP Strength and Conditioning Specialist while the control group performed the current physical training at Fort Campbell under the direction of a Physical Training Leader and as governed by FM 21-20 for the 8-week study period. RESULTS: Soldiers performing ETAP demonstrated improvements in several tests for strength, flexibility, performance, physiology, and the APFT compared to current physical training performed at Fort Campbell. CONCLUSIONS: ETAP was proven valid to improve certain suboptimal characteristics within the 8-week trial as compared to the current training performed at Fort Campbell. ETAP has long-term implications and with expected greater improvements when implemented into a Division pre-deployment cycle of 10-12 months which will result in further systemic adaptations for each variable.