Be Wise: A complementary and alternative medicine health literacy skill-building programme.

BACKGROUND: Health literacy has been found to be the strongest predictor of health status; and without adequate health literacy, consumers may not understand/adequately evaluate the myriad of choices available. Older rural residents tend to use self-prescribed complementary and alternative medicine (CAM) therapies and glean information about these therapies primarily by word of mouth/media. OBJECTIVES: The purpose of this article is to describe the Be Wise health literacy skill building programme and the participants' evaluation of the programme. DESIGN: The programme involved four sessions delivered over 7 weeks at seniors' centres in rural communities. METHOD: Data were collected initially (N = 127), at the end of the sessions (N = 67) and after 5 months (N = 52). SETTING: Participants were primarily rural Caucasian women, mean age 76 years, and most had an associate/baccalaureate degree. RESULTS: Questions were worded to ascertain satisfaction with the programme, usefulness of the information provided, willingness to recommend the programme, and the likelihood of using the programme. All scores were most favourable ranging from 3.35 to 4.41 on a 5-point scale. A question regarding the usefulness of the Be Wise programme in managing health received at mean score of 3.55 on a 5-point scale. Written comments on the questionnaires were overwhelmingly favourable. CONCLUSION: Delivering programmes to older adults in small rural communities has special challenges and rewards. Participants were enthusiastic about learning more about making informed health care choices. There is a compelling need for continued programme development and long-term outcomes evaluation.

Bee SAFE, a Skill-Building Intervention to Enhance CAM Health Literacy: Lessons Learned.

The purpose is to describe a feasibility study of a skill-building intervention to enhance health literacy about complementary and alternative (CAM) therapies among older rural adults and share lessons learned. A study was designed to examine the feasibility of an intervention to enhance CAM health literacy. The theme was "Bee SAFE" for Be a wise user of CAM, Safety, Amount, From where, and Effect. Modules were presented face to face and by webinar with older adults at a senior center in one small rural community. The team achieved its purpose of designing, implementing, and evaluating the intervention and assessing if it could be implemented in a rural community. The implementation challenges encountered and lessons learn are discussed. By improving CAM health literacy, older rural adults with chronic health conditions can make well-reasoned decisions about using CAM for health promotion and illness management. The goal is to implement the Bee SAFE intervention in other rural communities; thus team members were attentive to lessons to be learned before investing time, effort, and expense in the larger intervention. It is hoped that the lessons learned can be instructive to others planning projects in rural communities.

Computer Intervention: Illness Self-Management/Quality of Life of Rural Women.

The Women To Women project, a computer-based support and educational research intervention, was designed to help rural women better understand and manage their chronic illnesses. Its impact on psychosocial adaptation has been reported elsewhere. This article reports on the effect of a computer intervention on chronic illness self-management skills and quality of life. Using a parallel 2-group study design, the researchers randomized 309 middle-aged rural women with chronic conditions to either a computer-based intervention or a control group. They collected data on self-management of chronic illness and quality of life indicators at baseline and at the end of the intervention. Women in the intervention group reported significantly more self-efficacy in managing their chronic disease than those in the control group and the observed effect was of moderate size. Women in the intervention group also reported statistically significant gains in quality of life; effect sizes were small but consistent. Select chronic illness self-management skills and quality of life can be positively influenced by a well-designed computer intervention.

Le projet « Women To Women ¼, une initiative de soutien par ordinateur et de recherche en intervention éducative, a été conçu pour aider les femmes en région rurale à mieux comprendre et gérer les maladies chroniques dont elles souffrent. Son impact sur l'adaptation psychosociale a été rapporté dans une publication antérieure. L'article qui suit fait état de l'effet d'une intervention par ordinateur sur les capacités d'autogestion de maladies chroniques et de la qualité de vie. Menant une étude parallèle auprès de deux groupes, les chercheurs ont randomisé 309 femmes d'âge moyen vivant en région rurale et atteintes de maladies chroniques, les assignant à un groupe bénéficiant d'une intervention par ordinateur ou à un groupe de contrôle. Ils ont recueilli des données sur les indicateurs d'autogestion des maladies chroniques et de la qualité de vie au début et à la fin de l'intervention. Les femmes du groupe ayant eu accès aux interventions ont dit être beaucoup plus efficaces en ce qui a trait à la gestion de leurs maladies chroniques, comparativement à celles du groupe de contrôle, et l'effet observé était d'ampleur modérée. Les femmes du premier groupe ont aussi signalé des gains statistiquement significatifs quant à la qualité de vie; les valeurs des effets observés étaient faibles mais cohérentes. Une intervention par ordinateur bien conçue peut exercer une influence positive sur les habiletés d'autogestion de maladies ciblées et sur la qualité de vie.

Instrument to measure health literacy about complementary and alternative medicine.

BACKGROUND AND PURPOSE: Health literacy is an essential skill for today's health care consumers. The growth in use of complementary and alternative medicine (CAM) adds to the complexity of being sufficiently health literate. The purpose of this article is to describe the initial psychometric evaluation of the "Montana State University (MSU) CAM Health Literacy Scale," a newly developed instrument to measure an individual's health literacy about CAM. METHODS: Exploratory factor analyses, reliabilities, and conceptual considerations were used. RESULTS: The outcome is a 21-item instrument with Cronbach's alpha of .753 and 42.27% explained variance. Convergent validity assessments revealed weak but significant correlations between the scale and measures of general health literacy. CONCLUSIONS: The MSU CAM Health Literacy Scale has promise for use in future research and clinical endeavors.

The Montana State University conceptual model of complementary and alternative medicine health literacy.

This article aims to present and describe a model of complementary and alternative medicine (CAM) health literacy. The model is the conceptual basis for CAM health literacy, which is operationally defined as the information about CAM needed to make informed self-management decisions regarding health. Improving health literacy is a national priority, and widespread use of CAM has added to the complexity of this task. There are no currently available models or measures of health literacy regarding CAM. The authors developed the model using an iterative process of deriving concepts, constructs, and empirical indicators from the literature and the author's prior work, review and critique by experts, and revision. The model of CAM health literacy can serve as the basis for future research on the use and efficacy of CAM and the constructs and concepts within it can be used to identify points of intervention for research or for clinical practice. It is anticipated that the model will have scientific and clinical application for assessing health literacy in other self care decision-making situations.

An online approach to providing chronic illness self-management information.

The purpose of this article was to describe an online approach to providing chronic illness self-management information to rural women with chronic illness. To self-manage chronic illness, individuals require information about their conditions. For those in rural areas who have limited access to health services, computer-based interventions are a means of providing this information. Participants were randomly assigned either to an 11-week computer intervention in which they completed nine online self-study health teaching units related to self-management, or to a control group. The health teaching units were positively rated as being helpful in managing their chronic illnesses, with scores ranging from 4.09 to 4.84 on a six-point scale. Perceptions of computer skills increased significantly for the intervention group, with no increase in the control group. Computer-based programs can be an effective approach to providing health information to rural women with chronic conditions that will assist them in their self-management efforts.

Computer intervention impact on psychosocial adaptation of rural women with chronic conditions.

BACKGROUND: Adapting to living with chronic conditions is a life-long psychosocial challenge. OBJECTIVE: The purpose of this study was to report the effect of a computer intervention on the psychosocial adaptation of rural women with chronic conditions. METHODS: A two-group study design was used with 309 middle-aged, rural women who had chronic conditions, randomized into either a computer-based intervention or a control group. Data were collected at baseline, at the end of the intervention, and 6 months later on the psychosocial indicators of social support, self-esteem, acceptance of illness, stress, depression, and loneliness. RESULTS: The impact of the computer-based intervention was statistically significant for five of six of the psychosocial outcomes measured, with a modest impact on social support. The largest benefits were seen in depression, stress, and acceptance. DISCUSSION: The women-to-women intervention resulted in positive psychosocial responses that have the potential to contribute to successful management of illness and adaptation. Other components of adaptation to be examined are the impact of the intervention on illness management and quality of life and the interrelationships among environmental stimuli, psychosocial response, and illness management.

Spousal support experiences of rural women living with chronic illness.

From an examination of the spousal support experiences of rural women with chronic conditions who participated in a research-based, online support intervention, indications were that health care providers must recognize the need for and provide appropriate support/information related to the emotional, psychosocial, sexual, and relational impacts of chronic illness.

Where Have They Gone? Recruiting and Retaining Older Rural Research Participants.

ISSUE: Rural-dwelling elderly have been shown to suffer from health disparities when compared to the general population. Research involving these individuals is important, and to have meaningful results, sample sizes must be adequate. Recruiting and retaining these individuals pose significant challenges. CONTEXT: Nurse researchers in the rural northwestern United States conducted a 4-part educational intervention aimed at increasing general and complementary and alternative health care literacy of older rural dwellers. Significant challenges were faced in both recruiting and retaining participants over the 6-month study period. Despite careful planning and community selection, the team had to double the number of communities in which they carried out the project to meet recruitment goals. Retention was also a challenge. Of 127 participants initially enrolled in the study, only 52 remained to the end. LESSONS LEARNED: Challenges of recruiting and retaining are complex and compounded when the target population is rural, older and the study is longitudinal. Recruitment challenges included reaching older adults, offering a compelling program, and offering it in an acceptable format at a convenient time and place. A variety of outreach activities were conducted including in-person presentations, advertising or public interest stories in local newspapers or radio stations, and flyers on bulletin boards in restaurants, clinics, churches, community centers, and libraries. A project champion, an individual well known and connected within the community and committed to the success of the proposed study, is a major asset. Retention strategies included developing relationships with the participants and maintaining contact with them over the course of the study through such mechanisms as appointment cards, e-mail or regular mail, telephone reminders, and thank you cards. Oversampling was important as factors beyond the control of the researcher occurred; for example, illness, death, family crises, unexpected relocations, and weather events that prevented travel to scheduled research events.

Community-based Skill Building Intervention to Enhance Health Literacy Among Older Rural Adults.

The purpose of this article is to report the outcomes of a skill building intervention to improve general health literacy and health literacy about complementary and alternative therapies (CAM) among older rural adults. The intervention was implemented in eight rural communities. Descriptive statistics and general linear modeling were used for analysis. A total of 127 older adults completed the initial session and Time 1 questionnaire, 67 (51%) completed the intervention sessions and Time 2 questionnaire, and 52 (40.9%) completed the Time 3 questionnaire five months later. CAM health literacy scores and scores on one general health literacy measure were significantly higher at Time 2 compared to Time 1 and 3. The decline in scores over time suggests a need for continuing strategies to support older adults' health literacy. Assisting older adults to make safe health care choices is a critical role for investigators, nurses, and other health care providers.

Development of My Health Companion to enhance self-care management of chronic health conditions in rural dwellers.

Appropriate self-management support is needed to help individuals and their families meet the challenges of living with chronic health conditions. Such support is characterized by productive interactions between informed, active individuals, and their health care providers. The purposes of this paper are to describe the challenges to achieving self-management support and a tool, My Health Companion (MHC), which was developed to meet that challenge. The MHC is a paper personal health record designed to help rural women with chronic health conditions to better manage and understand their health information. The selection of content for the MHC was based on the literature, input from health care experts, and chronically ill individuals, and its development incorporated principles of personal health record and clear communication. The MHC was anecdotally shown to be useful to rural women with chronic health conditions in preparing for and enhancing their visits with health care providers. As a source of information, the MHC had potential for: being beneficial to providers in recommending appropriate treatment; contributing to more informed health decision making by ill individuals; and serving as a vehicle for the establishment of more productive interactions that contributed to the achievement of true client-provider partnerships in health care.

Are all abstracts created equal??

The preparation of a strong, convincing abstract is a necessary professional skill and prized art form for nurse scientists and clinical scholars. The power and the role of an abstract are often overlooked. Abstracts are used in a variety of scholarly forums including articles submitted for publication, research proposals, and responses to "calls for abstracts" for presentations at scientific conferences. The purpose of this article is to emphasize the highlights of the "art" rather than the "cookbook" details associated with preparing an abstract. Each of the critical stages of abstract development is explored-planning, drafting, reviewing, peer reviewing, editing, and packaging. Likewise, a few, hopefully helpful, hints on developing the six key elements-background, purpose, sample, methods, results, and implications-of the scientific abstract are given. Polishing, the essential skill of preparing an abstract, takes time and persistence and will pay off in the long run. The well-crafted abstract is an initial step in the process of getting research and scholarly pursuits noticed and accepted.

Testing protocols: care of biological samples in a rural setting.

The purpose of this study is to evaluate collection, transport, and storage protocols of urine and air allergen samples from infants in a rural setting. Infant urine and aeroallergen samples (n = 21) are collected in the home setting in rural areas where time and distance to the central laboratory is a consideration. Urine samples are analyzed using ELISA tests after being transported using three different techniques: (a) ambient temperature, (b) dry ice, and (c) packaged on dry ice and shipped commercially. Following initial ELISA testing for levels of cytokines, urine samples are frozen at -70 degrees Celsius for 6 months. Samples are then reanalyzed for levels of cytokines. Dust samples are analyzed for levels of aeroallergens, stored at 4 degrees for 6 months, and reanalyzed. The integrity of samples varies by biomarker, shipment temperature, and storage time, creating a high degree of variability in results.

Rural public health policy models to address an evolving environmental asbestos disaster.

The health-related dangers of asbestos exposure were recognized early in the 20th century when occupational exposure was found to be associated with excess pneumoconiosis among asbestos industry workers. Today, the epicenter for examining the public health effects and the human toll that this toxin has had on a population is located in the rural community of Libby, MT. Rurality and multideterminants of health frame both the history of asbestos-related disease and the service/policy challenges within a community dealing with chronic illness and designation as a Superfund clean-up site. Despite efforts by public health advocates to address the lingering aftermath of an environmental disaster in this community, policy gaps exist that continue to impact the population's health. The purpose of this paper is to describe the history and outcomes of asbestos exposure in a rural community and discuss 3 models that provide public health policy insights related to rural health and health care for a community affected by both a sentinel and ongoing environmental event.

Negotiating three worlds: academia, nursing science, and tribal communities.

PURPOSE: The purpose of this article is to use a cross-cultural model to guide the exploration of common issues and the dynamic interrelationships surrounding entrée to tribal communities as experienced by four nursing research teams. METHOD: Members of four research teams discuss the primary lessons learned about successful strategies and challenges encountered during their projects' early stages. RESULTS: Understanding the cultural values of relationship and reciprocity is critical to the success of research projects conducted in Native American communities. DISCUSSION: Conducting cross-cultural research involves complex negotiations among members of three entities: academia, nursing science, and tribal communities. The lessons learned in these four research projects may be instructive to investigators who have the opportunity to conduct research with tribal communities.

Psychometric evaluation of the MSU CAM health literacy scale.

BACKGROUND/PURPOSE: The rise in the use of alternative health care approaches (CAM) increases the need for adequate health literacy. The MSU Health Literacy Scale was developed to measure CAM health literacy. Psychometric evaluation of the scale is presented in this article. METHODS: A test retest design was utilized and data from this instrument evaluation research project were used to explore the validity and several forms of reliability of the MSU Health Literacy Scale. The data analysis was based on the scores of 241 individuals at the T1 data collection and the scores of 188 at the T2 administration of the instrument. RESULTS: There were significant correlations between the MSU CAM Health Literacy Scale and Newest Vital Sign (r = 0.330 p = .000) and with a single question health literacy measure (r = .255 (p = .000). Cronbach's alphas were adequate for each administration of the scale (T1 = .774 and T2 = .754). The correlation of scores between the T1 administration and the T2 administration were significant (r = .696 (p = .000). CONCLUSIONS: This psychometric evaluation provides confirmation of convergent validity and stable reliability. The scale can be used in future research and clinical endeavors.

Evolution of a conceptual model for adaptation to chronic illness.

PURPOSE: To describe the evolution of "The Women to Women Conceptual Model for Adaptation to Chronic Illness." DESIGN: A three-phase, computer-based research intervention to provide support and health information to chronically ill middle-aged women living in rural areas of the intermountain West. EVOLUTION OF A CONCEPTUAL MODEL: The path of the conceptualization of the WTW project was traced from a single concept to its present explanatory, multiconcept model consisting of three major adaptation constructs (environmental stimuli, psychosocial response, illness management) with related middle-range theoretical concepts (focal, contextual, and residual stimuli, psychosocial adaptation, chronic illness self-management, and quality of life) including empirical indicators and measures for each. CLINICAL RELEVANCE: As the computer-based intervention is maturing, we are demonstrating its efficacy in helping rural women to better manage chronic illness. At the completion of this study, the intervention should be adequately tested so that it could be adapted for use by advanced practice nurses especially those working with people in isolated rural areas.

Rural women, technology, and self-management of chronic illness.

The objective of this study was to determine the differences in the psychosocial status of 3 groups of chronically ill rural women participating in a computer intervention. The 3 groups were: intense intervention, less-intense intervention, and control. At baseline and following the intervention, measures were taken for social support, self-esteem, empowerment, self-efficacy, depression, stress, and loneliness. ANCOVA results showed group differences for social support and self-efficacy among the overall group. The findings differed for a vulnerable subgroup, with significant between-group differences for social support and loneliness. It was concluded that a computer-delivered intervention can improve social support and self-efficacy and reduce loneliness in rural women, enhancing their ability to self-manage and adapt to chronic illness.

Health knowledge acquisition by rural women with chronic health conditions: a tale of two Web approaches.

OBJECTIVES: To determine the differences in health knowledge acquisition and the perceived impact on self-management of chronic illness provided by two approaches to providing Web-based information. DESIGN: Repeated-measure questionnaire administered at four time points: baseline, 11, 23 and 53 weeks; a post-computer intervention survey. SETTING AND PARTICIPANTS: One hundred and seventy-six chronically ill women (aged 32-68 years) living in rural areas. MAIN OUTCOME MEASURES: Scores on knowledge questions within repeated measures; participant ratings on perceptions of abilities to self-manage. INTERVENTION: The 22-week computer-based intervention provided online support and health information. Women were randomly assigned to an intense intervention (n = 54), less-intense intervention (n = 58) or control group (n = 64). RESULTS: Both computer intervention groups gained significantly in health knowledge with little differential effect at intervention conclusion or after 6 months, when there was a drop-off in health knowledge retention of about one-third (intense - baseline mean = 0.54, week 23 = 0.69, week 53 = 0.65; less intense - 0.58, 0.68, 0.65). Control remained about the same (0.51, 0.51, 0.53). Using an anova analysis, there was no appreciable difference between intervention groups in perceptions of ability to self-manage illness (intense - mean = 4.02 (on a scale of 1-6), standard deviation = 0.99); less intense - (mean = 3.85, standard deviation = 1.00), t(107) = 0.90, P = 0.37). CONCLUSIONS: A less-intense intervention can be as effective as a more complex, labour-intensive and costly intervention in assisting chronically ill rural women to acquire health knowledge they consider to be moderately helpful in managing their chronic conditions.

Drawing on wisdom from the past: an elder abuse intervention with tribal communities.

PURPOSE: The Family Care Conference (FCC) is an elder-focused, family-centered, community-based intervention for the prevention and mitigation of elder abuse. It is based on a family conference intervention developed by the Maori people of New Zealand, who determined that Western European ways of working with child welfare issues were undermining such family values as the definition and meaning of family, the importance of spirituality, the use of ritual, and the value of non-interference. The FCC provides the opportunity for family members to come together to discuss and develop a plan for the well-being of their elders. DESIGN AND METHODS: Using a community-based participatory research approach, investigators piloted and implemented the FCC in one northwestern Native American community. The delivery of the FCC intervention has grown from having been introduced and facilitated by the researchers, to training community members to facilitate the family meetings, to becoming incorporated into a Tribal agency, which will oversee the implementation of the FCC. RESULTS: To date, families have accepted and appreciated the FCC intervention. The constructive approach of the FCC process helps to bring focus to families' concerns and aligns their efforts toward positive action. IMPLICATIONS: The strength-based FCC provides a culturally anchored and individualized means of identifying frail Native American elders' needs and finding solutions from family and available community resources.