Prevalence of self-reported memory problems in adults with type 2 diabetes mellitus and cancer in the USA.

PURPOSE: To determine the prevalence of memory problems in individuals with or without a history of DM and cancer and assess possible compounding effects of these diseases on self-reported memory problems (SRMP). METHODS: We used data from the 2009-2018 National Health and Nutrition Examination Survey. We conducted logistic regression analyses to determine the associations among DM, cancer, and SRMP, adjusting for age, sex, race/ethnicity, education, and poverty level. We examined the interaction effects of comorbid DM and cancer on SRMP. We compared participants with both DM and cancer to those with cancer only and to those with no DM or cancer. RESULTS: We included 26,842 adults ≥ 20 years old (N = 3374 with DM, N = 23,468 without DM) and 51.87% female. There were 10,434 Whites, 5730 Blacks, 6795 Hispanics, and 3883 other races/multiracial. More individuals with DM reported memory problems than those without DM (p < 0.0001). More individuals with cancer reported memory problems than those without cancer (p < 0.0001). Of those with both DM and cancer, 14.19% reported memory problems. More individuals with DM had cancer than those without DM (p < 0.0001). Of those with both diseases, 55.75% had DM before the cancer diagnosis. DM (odds ratio[OR] = 1.87, 95%CI, 1.55-2.26) and cancer (OR = 1.81, 95%CI, 1.43-2.30) predicted SRMP. The interaction between DM and cancer was significant, and the likelihood of having both diseases compared to having neither DM nor cancer was OR = 2.09, 95%CI, 1.41 - 3.11. CONCLUSION: Strategies to mitigate SRMP in individuals with comorbid DM and cancer history should consider the impact of both diseases.

The household and individual-level productive impacts of cash transfer programs in Sub-Saharan Africa.

Silvio Daidone is a economist and Benjamin Davis is a Strategic Program Leader, both with the Food and Agriculture Organization of the United Nations, Rome, Italy. Sudhanshu Handa is a professor at the University of North Carolina at Chapel Hill. Paul Winters is the Associate Vice-President of the Strategy and Knowledge Department, International Fund for Agricultural Development, Rome, Italy. The research presented in this article has been carried out under the auspices of the "From Protection to Production" (PtoP) project, a collaborative effort of the United Nations Children's Fund, the United Kingdom Department for International Development (DFID) and the Food and Agriculture Organization of the United Nations (FAO). The project has received funding from the DFID Research and Evidence Division, the European Union through the "Improved Global Governance for Hunger Reduction Programme", and the FAO Regular Fund. The authors would like to thank the following: two anonymous reviewers and the journal editor, who have provided excellent comments and significantly contributed to the improvement of the article; Alejandro Grinspun, Fabio Veras Soares, and Marco Knowles for technical review of previous drafts; Ervin Prifti and Noemi Pace for their useful suggestions and comments. The authors are also grateful to participants at the following conferences and workshops: 2017 APPAM International Conference, Brussels; 2016 Transfer Project workshop, Addis Ababa; 2016 IFAD-3IE Designing and implementing high-quality, policy-relevant impact evaluations, Rome; 2015 SASPEN Conference on Social Protection, Johannesburg; 2015 Global Food Security Conference, Ithaca; 2014 IPEA International Seminar "Social protection, entrepreneurship and labor market activation - Evidence for better policies", Brasilia; 2014 University of Florence, Department of Economics & Management Seminars, Florence; 2014 Africa Community of Practice (CoP) on Conditional Cash Transfers and Cash Transfers; 2014 African Union Expert Consultation on Children and Social Protection Systems, Cape Town; 2014 IDS Graduation and Social Protection Conference, Kigali. The authors would also like to remember Josh Dewbre, a founding member of the PtoP team, who passed away in April 2015, who had participated in the fieldwork and in the analysis of several programs included in this study. All mistakes and omissions are those of the authors.

Effect of patient navigation on satisfaction with cancer-related care.

PURPOSE: Despite growing popularity of patient navigation (PN) as a means to improve cancer care quality and reduce cancer-related disparities, there are few well-designed controlled trials assessing the impact of PN on patient outcomes like satisfaction with care. The present controlled study examined effect of PN on satisfaction with cancer-related care. METHODS: Patients who presented with a symptom or abnormal screening test (n = 1788) or definitive diagnosis (n = 445) of breast, cervical, colorectal, or prostate cancer from eight Patient Navigator Research Program sites were included in one of two groups: intervention (PN) or comparison (usual care or usual care plus cancer educational materials). Trained patient navigators met with intervention group participants to help them assess and identify resources to address barriers to cancer diagnostic or treatment care. Using a validated instrument, we assessed participants' satisfaction with their cancer diagnostic or treatment care up to 3 months after diagnostic resolution of a cancer-related abnormality or within 3 months of initiation of cancer treatment. RESULTS: Overall, patients reported high satisfaction with diagnostic care and cancer treatment. There were no statistically significant differences between PN and control groups in satisfaction with cancer-related care (p > 0.05). Hispanic and African American participants were less likely to report high satisfaction with cancer care when compared to White patients. Middle-aged participants with higher education, higher household income, private insurance, owning their own home, working full-time, and those whose primary language is English had higher satisfaction with cancer-related diagnostic care. CONCLUSIONS: PN had no statistically significant effect on patients' satisfaction with cancer-related care. Further research is needed to define the patient populations who might benefit from PN, content of PN that is most useful, and services that might enhance PN. TRIAL REGISTRATIONS: clinicaltrials.gov identifiers: NCT00613275 , NCT00496678 , NCT00375024 , NCT01569672.

Improving patient-centered communication while using an electronic health record: Report from a curriculum evaluation.

INTRODUCTION: Researchers and clinicians are concerned about the impact of electronic health record use and patient-centered communication. Training about patient-centered clinical communication skills with the electronic health record may help clinicians adapt and remain patient-centered. METHODS: We developed an interactive workshop eliciting challenges and opportunities of working with the electronic health record in clinical practice, introduction of specific patient-centered behaviors and mindful practice techniques, and video demonstrating contrasts in common behavior and "better practices." One hundred thirty-nine resident physicians and faculty supervisors in five residency training programs at the University of Rochester Medical Center participated in the workshops. Participants were asked to complete an 11-item survey of behaviors related to their use of the electronic health record prior to training and after attending training. We used paired t-tests to assess changes in self-reported behavior from pre-intervention to post-intervention. RESULTS: We trained 139 clinicians in the workshops; 110 participants completed the baseline assessment and 39 completed both the baseline and post-intervention assessment. Data from post-curriculum respondents found a statistically significant increase in "I told the patient when turning my attention from the patient to the computer," from 60% of the time prior to the training to 70% of the time after. DISCUSSION: Data from our program evaluation demonstrated improvement in one communication behavior. Sample size limited the detection of other changes; further research should investigate effective training techniques for patient-centered communication while using the electronic health record.

The exclusion from welfare benefits: Resentment and survey attrition in a randomized controlled trial in Mexico.

Public policy programs must often impose limits on who may be eligible for benefits. Despite research on the impact of exclusion in developed countries, there is little evidence on how people react to being excluded from benefits in developing societies. Utilizing repeated waves of data from an experimental evaluation of Mexico's foundational PROGRESA antipoverty program, we examine the impact of exclusion and distinguish two separate forms. "Statistical exclusion" occurs where determination of benefits is based on randomized assignment to a treatment and control group. "Needs-based exclusion" occurs when benefits programs are designed to be selective rather than universal, basing eligibility on characteristics, like relative poverty, that are difficult to measure simply and accurately. Focusing on temporal variation in survey non-response as our behavioral outcome, we show that needs-based exclusion has much greater negative effects on continued participation than statistical exclusion. We also show that these effects are concentrated among the wealthy, that is, those furthest from the eligibility cut-off line. These findings reinforce general concerns about the validity of evaluation studies when incentives are at work. We discuss both the behavioral explanations that might underlie these findings as well as some potential approaches to reduce threats to evaluation validity.

Do clinicians recommend aspirin to patients for primary prevention of cardiovascular disease?

BACKGROUND: The United States Preventive Services Task Force (USPSTF) released updated guidelines in 2009 recommending aspirin to prevent myocardial infarction among at-risk men and stroke among at-risk women. OBJECTIVE: Our aim was to examine clinician aspirin recommendation among eligible persons based on cardiovascular risk scores and USPSTF cutoffs. DESIGN: We used across-sectional analysis of a current nationally representative sample. PARTICIPANTS: Participants were aged 40 years and older, and in the National Health and Nutrition Examination Survey (NHANES) (2011-2012). MAIN MEASURES: We determined aspirin eligibility for cardiovascular disease (CVD) prevention for each participant based on reported and assessed cardiovascular risk factors. We assessed men's risk using a published coronary heart disease risk calculator based on Framingham equations, and used a similar calculator for stroke to assess risk for women. We applied the USPSTF risk cutoffs for sex and age that account for offsetting risk for gastrointestinal hemorrhage. We assessed clinician recommendation for aspirin based on participant report. RESULTS: Among men 45-79 years and women 55-79 years, 87 % of men and 16 % of women were potentially eligible for primary CVD aspirin prevention. Clinician recommendation rates for aspirin among those eligible were low, 34 % for men and 42 % for women. Rates were highest among diabetics (63 %), those 65 to 79 years (52 %) or those in poor health (44 %). In contrast, aspirin recommendation rates were 76 % for CVD secondary prevention. After accounting for patient factors, particularly age, eligibility for aspirin prevention was not significantly associated with receiving a clinician's recommendation for aspirin (AOR 0.99 %; CI 0.7-1.4). CONCLUSIONS: Despite an "A recommendation" from the USPSTF for aspirin for primary prevention of CVD, the majority of men and women potentially eligible for aspirin did not recall a clinical recommendation from their clinician.

Assessing Health Literacy in Deaf American Sign Language Users.

Communication and language barriers isolate Deaf American Sign Language (ASL) users from mass media, health care messages, and health care communication, which, when coupled with social marginalization, places them at a high risk for inadequate health literacy. Our objectives were to translate, adapt, and develop an accessible health literacy instrument in ASL and to assess the prevalence and correlates of inadequate health literacy among Deaf ASL users and hearing English speakers using a cross-sectional design. A total of 405 participants (166 Deaf and 239 hearing) were enrolled in the study. The Newest Vital Sign was adapted, translated, and developed into an ASL version (ASL-NVS). We found that 48% of Deaf participants had inadequate health literacy, and Deaf individuals were 6.9 times more likely than hearing participants to have inadequate health literacy. The new ASL-NVS, available on a self-administered computer platform, demonstrated good correlation with reading literacy. The prevalence of Deaf ASL users with inadequate health literacy is substantial, warranting further interventions and research.

Psychometric evaluation of the patient satisfaction with logistical aspects of navigation (PSN-L) scale using item response theory.

BACKGROUND: Patient navigation--the provision of logistical, educational, and emotional support needed to help patients "navigate around" barriers to high-quality cancer treatment offers promise. No patient-reported outcome measures currently exist that assess patient navigation from the patient's perspective. We use a partial independence item response theory model to report on the psychometric properties of the Patient Satisfaction with Navigation, Logistical measure developed for this purpose. METHODS: We used data from an ethnically diverse sample (n = 1873) from the National Cancer Institute Patient Navigation Research Program. We included individuals with the presence of an abnormal breast, cervical, colorectal, or prostate cancer finding. RESULTS: The partial independence item response theory model fit well. Results indicated that scores derived from responses provide extremely precise and reliable measurement between -2.5 SD below and 2 SD above the mean and acceptably precise and reliable measurement across nearly the entire range. CONCLUSIONS: Our findings provide evidence in support of the Patient Satisfaction with Navigation, Logistical. Scale users should utilize 1 of the 2 described methods to create scores.

Get screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening.

BACKGROUND: Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments. OBJECTIVE: To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice. DESIGN: Pragmatic randomized trial. PARTICIPANTS: Men and women aged 50-74 years past due for CRC screen and women aged 40-74 years past due for BC screening. INTERVENTIONS: We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call). MAIN MEASURES: Documentation of mammography or colorectal cancer screening at 52 weeks following randomization. KEY RESULTS: Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2-4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1-3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1-3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0-3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates. CONCLUSIONS: The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.

Randomized, controlled trial of a multimodal intervention to improve cancer screening rates in a safety-net primary care practice.

BACKGROUND: Cancer screening rates are suboptimal for low-income patients. OBJECTIVE: To assess an intervention to increase cancer screening among patients in a safety-net primary care practice. DESIGN: Patients at an inner-city family practice who were overdue for cancer screening were randomized to intervention or usual care. Screening rates at 1 year were compared using the chi-square test, and multivariable analysis was performed to adjust for patient factors. SUBJECTS: All average-risk patients at an inner-city family practice overdue for mammography or colorectal cancer (CRC) screening. Patients' ages were 40 to 74 years (mean 53.9, SD 8.7) including 40.8 % African Americans, 4.2 % Latinos, 23.2 % with Medicaid and 10.9 % without any form of insurance. INTERVENTION: The 6-month intervention to promote cancer screening included letters, automated phone calls, prompts and a mailed Fecal Immunochemical Testing (FIT) Kit. MAIN MEASURES: Rates of cancer screening at 1 year. KEY RESULTS: Three hundred sixty-six patients overdue for screening were randomly assigned to intervention (n = 185) or usual care (n = 181). Primary analysis revealed significantly higher rates of cancer screening in intervention subjects: 29.7 % vs. 16.7 % for mammography (p = 0.034) and 37.7 % vs. 16.7 % for CRC screening (p = 0.0002). In the intervention group, 20 % of mammography screenings and 9.3 % of CRC screenings occurred at the early assessment, while the remainder occurred after repeated interventions. Within the CRC intervention group 44 % of screened patients used the mailed FIT kit. On multivariable analysis the CRC screening rates remained significantly higher in the intervention group, while the breast cancer screening rates were not statistically different. CONCLUSIONS: A multimodal intervention significantly increased CRC screening rates among patients in a safety-net primary care practice. These results suggest that relatively inexpensive letters and automated calls can be combined for a larger effect. Results also suggest that mailed screening kits may be a promising way to increase average-risk CRC screening.

Item response theory analysis of the patient satisfaction with cancer-related care measure: a psychometric investigation in a multicultural sample of 1,296 participants.

BACKGROUND: We developed and validated a Patient Satisfaction with Cancer-Related Care (PSCC) measure using classical test theory methods. The present study applied item response theory (IRT) analysis to determine item-level psychometric properties, facilitate development of short forms, and inform future applications for the PSCC. METHODS: We applied unidimensional IRT models to PSCC data from 1,296 participants (73% female; 18 to 86 years). An unconstrained graded response model (GRM) and a Rasch Model were fitted to estimate indices for model comparison using likelihood ratio (LR) test and information criteria. We computed item and latent trait parameter estimates, category and operating characteristic curves, and tested information curves for the better fitting model. RESULTS: The GRM fitted the data better than the Rasch Model (LR = 828, df = 17, p < 0.001). The log-likelihood (-17,390.38 vs. -17,804.26) was larger, and the AIC and BIC were smaller for the GRM compared to the Rash Model (AIC = 34,960.77 vs. 35,754.73; BIC = 35,425.80 vs. 36,131.92). Item parameter estimates (IPEs) showed substantial variation in items' discriminating power (0.94 to 2.18). Standard errors of the IPEs were small (threshold parameters mostly around 0.1; discrimination parameters 0.1 to 0.2), confirming the precision of the IPEs. CONCLUSION: The GRM provides precise IPEs that will enable comparable scores from different subsets of items, and facilitate optimal selections of items to estimate patients' latent satisfaction level. Given the large calibration sample, the IPEs can be used in settings with limited resources (e.g., smaller samples) to estimate patients' satisfaction.

Patient navigation moderates emotion and information demands of cancer treatment: a qualitative analysis.

PURPOSE: Patient navigation is increasingly employed to guide patients through cancer treatment. We assessed the elements of navigation that promoted patients' involvement in treatment among patients with breast and colorectal cancer that participated in a navigation study. METHODS: We conducted qualitative analysis of 28 audiotaped and transcribed semi-structured interviews of navigated and unnavigated cancer patients. RESULTS: Themes included feeling emotionally and cognitively overwhelmed and desire for a strong patient-navigator partnership. Both participants who were navigated and those who were not felt that navigation did or could help address their emotional, informational, and communicational needs. The benefits of logistical support were cited less often. CONCLUSIONS: Findings underscore the salience of personal relationships between patients and navigators in meeting patients' emotional and informational needs.

Clinician-targeted intervention and patient-reported counseling on physical activity.

INTRODUCTION: Limited time and lack of knowledge are barriers to physical activity counseling in primary care. The objective of this study was to examine the effectiveness of a clinician-targeted intervention that used the 5As (Ask, Advise, Agree, Assist, Arrange) approach to physical activity counseling in a medically underserved patient population. METHODS: Family medicine clinicians at 2 community health centers were randomized to Group 1 or Group 2 intervention. Both clinician groups participated in 4 training sessions on the 5As for physical activity counseling; Group 2 training took place 8 months after Group 1 training. Both groups were trained to refer patients to a community exercise program. We used a pre-post analysis to evaluate the effectiveness of the intervention on clinician use of 5As. Eligible patients (n = 319) rated their clinicians' counseling skills by using a modified Physical Activity Exit Interview (PAEI) survey. Clinicians (n = 10) self-assessed their use of the 5As through a survey and interviews. RESULTS: Both patient and clinician groups had similar sociodemographic characteristics. The PAEI score for both groups combined increased from 6.9 to 8.6 (on a scale of 0-15) from baseline to immediately postintervention (P = .01) and was 8.2 (P = .09) at 6-month follow-up; most of the improvement in PAEI score was due to increased use of 5As skills by Group 2 clinicians. Group 1 reported difficulty with problem solving, whereas Group 2 reported ease of referral to the community exercise program. CONCLUSION: A clinician training intervention showed mixed results for 5As physical activity counseling.

Cash transfer programme, productive activities and labour supply: Evidence from randomized experiment in Kenya.

This paper reports analysis of the impact of Kenya's Cash Transfer for Orphans and Vulnerable Children Programme on the household decisions on productive activities using data from a randomized experimental design. Results show that the programme had a positive and significant impact on food consumption coming from home production, accumulation of productive assets, especially on the ownership of small livestock and on formation of nonfarm enterprise, especially for females. The programme has provided more flexibility to families in terms of labour allocation decisions, particularly for those who are geographically isolated. The programme was also found to have reduced child labour, an important objective of the programme. However we find very little impact of the programme on direct indicators of crop production.

Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers.

BACKGROUND: Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers. METHODS/DESIGN: The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years. DISCUSSION: The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes). TRIAL REGISTRATION: Clinical Trials Identifier: NCT01485627.

Do better-rated navigators improve patient satisfaction with cancer-related care?

Patient navigation has emerged as a promising strategy for addressing racial-ethnic and socioeconomic disparities in cancer-related care. However, little is known about the impact of patients' perception of the quality of navigation on patient outcomes. We examined the impact of better-rated navigators on patients' satisfaction with cancer-related care. The sample included 1,593 adults (85.8% with abnormal cancer screening and 14.2% with confirmed cancer diagnosis) who received patient navigation. We defined better-rated navigators as those scoring above the first quartile of mean scores on the Patient Satisfaction with Interpersonal Relationship with Navigator scale. We defined patient satisfaction based on scores above or below the median of the Patient Satisfaction with Cancer-Related Care (PSCC) scale. We controlled for patient and site characteristics using backward selection logistic regression analyses. Among patients with abnormal screening, having a better-rated navigator was associated with higher score on the PSCC (p < 0.05). After controlling for other bivariate predictors of satisfaction (e.g., age, race, income, and household size), navigation by better-rated navigators was associated with a greater likelihood of having higher patient satisfaction [odds ratio (OR), 1.38; 95% confidence interval (CI), 1.05-1.82]. Similar findings between better-rated navigators and score on the PSCC were found for participants with diagnosed cancer (OR, 3.06; 95% CI, 1.56-6.0). Patients navigated by better-rated navigators reported higher satisfaction with their cancer-related care.

Access to global wheat reserves determines country-level vulnerability to conflict-induced Ukrainian wheat supply disruption.

The Russia-Ukraine conflict reduced global wheat supplies, yet the food security implications vary across countries. We identify a 39% decrease in Ukrainian wheat exports in 2022 resulting in >70% import losses in some of the countries most vulnerable to these disruptions, with substantial impacts felt in Egypt, Oman, Saudi Arabia, Libya, Mauritania, Yemen and Lebanon. Differential impacts are a function of access to capital and international trade, suggesting the need for policy measures to defuse the impending food crisis.

Cross-cultural validation of a Patient Satisfaction with Interpersonal Relationship with Navigator measure: a multi-site patient navigation research study.

BACKGROUND: Patient navigators are trained to help patients effectively access and use healthcare resources in order to facilitate timely completion of recommended cancer screening, diagnostic care, and treatment. Patient navigators provide logistic, instrumental, and psychosocial support to cancer patients. Yet few studies have examined patient-navigator relationships, particularly for Spanish-speaking patients with low English proficiency. We aimed to validate a Spanish version of the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I-Sp) scale. METHODS: We translated and back-translated the PSN-I into Spanish and administered the resulting PSN-I-Sp to 222 Spanish-fluent participants. We conducted a principal components analysis and assessed Cronbach's coefficient alpha (α) to evaluate the latent structure and the internal consistency of the PSN-I-Sp. We also completed correlation analyses to examine divergence and convergence of the PSN-I-Sp with the Spanish version of the Patient Satisfaction with Cancer-Related Care (PSCC-Sp) and the patients' demographics. RESULTS: The principal components analysis revealed a one-dimensional PSN-I-Sp measure that explained 82.0% of the variance. The reliability assessment revealed high internal consistency (α = 0.97). The PSN-I-Sp demonstrated good face validity and adequate convergent and divergent characteristics as indicated by a moderate correlation with scores on the PSCC-Sp (all ps < 0.0001) and a non-statistically significant correlation with marital status (all p > 0.05). CONCLUSION: The PSN-I-Sp is a valid and internally consistent measure of satisfaction with interpersonal relationship with a patient navigator for Spanish-speaking participants.

Psychometric development and reliability analysis of a patient satisfaction with interpersonal relationship with navigator measure: a multi-site patient navigation research program study.

BACKGROUND: Patient navigation (PN) is a method for addressing racial-ethnic and socioeconomically based disparities in cancer-related care. Patient navigators provide logistic and emotional support to underserved patients to facilitate successful completion of diagnostic and treatment care. Yet, little is known about patient satisfaction with the relationship with a navigator due to a dearth of instruments measuring satisfaction. OBJECTIVE: The objective of this study was to validate the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I) measure for patients undergoing diagnostic and/or therapeutic cancer care. METHODS: We administered the PSN-I to 783 participants from the nine different sites of the National Cancer Institute sponsored Patient Navigation Research Program. We evaluated the latent structure and internal consistency of the PSN-I using principal components analysis (PCA) and Cronbach coefficient alpha (α), respectively. We used correlation analyses to examine divergence and convergence of the PSN-I with the Patient Satisfaction with Cancer-related Care (PSCC), the Rapid Estimate of Adult Literacy in Medicine (REALM) Long Form, and patients' demographics. RESULTS: The PCA revealed a coherent set of items that explicates 76.6% of the variance in PSN-I. Reliability assessment revealed high internal consistency (α ranging from 0.95 to 0.96). The PSN-I had good face validity as well as convergent and divergent validities as indicated by moderate correlations with score on the PSCC (all ps < 0.0001) and non-significant correlations with primary language, marital status, and scores on the REALM Long Form (all ps > 0.05). CONCLUSION: The PSN-I is a valid and suitable measure of satisfaction with a patient navigator for the present sample.