An integrative review of adolescent trust in the healthcare provider relationship.

AIM: To conduct an integrative review of empirical studies examining factors affecting trust in the healthcare provider (HCP) relationship among adolescents. DESIGN: An integrative review was conducted. DATA SOURCES: The keywords adolescent, trust, healthcare provider and related words were searched in multiple online research databases. The results were limited to research published between 2004 and 2019. Seventeen primary sources were identified and synthesized in the final review. REVIEW METHOD: Guided by the Whittemore and Knafl integrative review method, a data-based convergent synthesis design was used to explore the key research question in both qualitative and quantitative research. RESULTS: This integrative review found that health care provider behaviours, such as confidentiality, honesty, respect, and empathy, promote adolescent's trust of the HCP. Notable gaps in the literature were also identified, including a lack of diversity among adolescent samples and HCP types and underdeveloped measures of adolescent trust of HCP. CONCLUSION: This integrative review informed the development of a new conceptual definition of adolescent trust of HCP, which embodies the key findings of the importance of HCP confidentiality, honesty, respect, and empathy. This definition can be used to develop instruments, interventions and policies that promote HCP trust among adolescents. Future research is needed to develop instruments to measure adolescents' trust of HCPs, evaluate trust of HCPs among diverse samples of adolescents and evaluate adolescent trust of HCPs with a variety of HCP types. IMPACT: The new conceptual definition of adolescent trust of HCP can be used to enhance nursing practice and design behavioural interventions to improve trust of HCP. To foster adolescent trust of HCP, policies should be enacted in healthcare institutions to explain confidentiality, provide notification of reporting mandates and formalize consent, assent and dissent for adolescents seeking health care.

Diminished Trust of Healthcare Providers, Risky Lifestyle Behaviors, and Low Use of Health Services: A Descriptive Study of Rural Adolescents.

The purpose of our study was to determine the extent to which individual characteristic variables predict trust of healthcare provider (HCP), lifestyle behaviors, and use of health services among adolescents attending public high school in rural Indiana. The sample included 224 individuals surveyed in 9th grade or 12th grade required courses. Trust of HCP and lifestyle behaviors were predicted using hierarchical multiple regression; number of HCP visits and emergency department (ED) visits in the past 12 months were predicted using negative binomial regression. This sample of adolescents living in a rural area reported riskier lifestyle behaviors than another sample of adolescents, lower trust of HCP than adults in general, and fewer HCP and ED visits than adolescents in general. Our study supports the need for school-based health services in rural areas and the opportunity for school nurses to act as care coordinators for marginalized youth.

Psychosocial determinants of physical activity in children attending afterschool programs: a path analysis.

BACKGROUND: Physical activity (PA) is important for controlling childhood obesity, but a comprehensive PA model for school-aged children is lacking. OBJECTIVES: Guided by the youth PA promotion (YPAP) model, this study estimated the direct and indirect effects of self-efficacy, enjoyment, parental influence, and environment on self-reported PA and pedometer steps. A secondary purpose was to explore the association between self-reported PA and pedometer steps. METHODS: An observational and prospective study was conducted among 133 children, aged 8-11 years old, from 10 elementary schools with afterschool programs in a Midwestern U.S. school district from August through October 2013. PA was assessed by a 7-day recall scale and pedometers. Other variables were assessed by validated questionnaires. RESULTS: Approximately 65 (49%) children were overweight or obese-only 17 (13%) met national PA recommendations-and body mass index z-score was negatively correlated with pedometer steps (r = -.18 p = .04). A path analysis showed that self-efficacy had a direct effect on self-reported PA and pedometer steps, enjoyment had only a direct effect on self-reported PA, and parental influence had a direct effect on pedometer steps and an indirect effect on self-reported PA through self-efficacy and enjoyment. The association between self-reported PA and pedometer steps was not significant. DISCUSSION: Because this study only partially supports the YPAP model, studies with a larger sample size and longitudinal design are essential to further examine this model. The nonsignificant relationship of self-reported PA with pedometer steps may be due to the systematic error resulting from a common method artifact of self-report. Given the importance of parental influence, enjoyment, and self-efficacy, targeting these three determinants in future interventions to increase PA among children is recommended.

Preliminary assessment of a school-based healthy lifestyle intervention among rural elementary school children.

BACKGROUND: Childhood obesity has become a national public health crisis in America. Physical inactivity and unhealthy eating behaviors may contribute to the childhood obesity epidemic. School-based healthy lifestyle interventions play a promising role in preventing and controlling childhood obesity. A comprehensive school-based healthy lifestyle intervention was implemented in 4 rural elementary schools in Kentucky. METHODS: The intervention included 4 goals: improving physical education, health education, family/community involvement, and school wellness policies. Children's physical activity was assessed by pedometer, and nutrition was assessed by a previous day recall survey in January (baseline), February (t1), March (t2), April (t3), and May (t4) of 2011. RESULTS: The intervention had significant effects on increasing the percentages of children meeting physical activity (1% vs 5%, p < .01) and nutrition (15% vs 26%, p < .01) recommendations. The effects of the intervention on physical activity and nutrition depended on school, grade, and age of the children. There was an increasing linear trend of physical activity and an increasing quadratic trend of nutrition over time among children. CONCLUSIONS: The intervention had beneficial effects in improving healthy behaviors among children. Further studies are needed to assess its long-term effects and cost-effectiveness.

Understanding systems and rhythms for minority recruitment in intervention research.

We describe one approach for recruitment and retention of minority individuals in intervention research using a systematic environmental perspective based on Bronfenbrenner's ecological systems (BES) model and the construct of temporality. An exemplar in a physical activity intervention study with low-income and primarily African American women is presented. The exemplar illustrates application of BES and temporality to enhance recruitment and retention in research focused on understanding and accommodating environmental influences. Using this theory based approach resulted in successful recruitment and a high level of participant retention.

An environmental intervention aimed at increasing physical activity levels in low-income women.

BACKGROUND: Regular physical activity is a health promotion and disease prevention behavior. Of all demographic groups, low-income women report the lowest levels of physical activity. RESEARCH OBJECTIVE: The purpose of this study was to test an intervention aimed at reducing community environmental barriers to physical activity in low-income women. METHODS: The research design was mixed methodology: (1) quantitative (quasi-experimental, pretest-posttest, cohort design in which no treatment partitioning was possible) and (2) qualitative (focus groups). The setting was a church-sponsored community center centrally located in a low-income urban neighborhood. The comparison group was recruited first followed by the intervention group to control for setting. The sample consisted of 104 women (comparison group, n = 53; intervention group, n = 51) between the ages of 18 and 63 years who were residents of neighborhoods served by the community center. RESULTS: No between-group differences were found for physical activity behavior. Significant between-group differences in cholesterol (P = .007) and perception of physical activity (P = .033) were observed. Significant intervention group increases from pretest to posttest were found related to advanced registered nurse practitioner support, friend support, and more positive physical activity environment at the community center. Qualitative data supported and enriched the quantitative data. CONCLUSIONS: Physical activity levels were not significantly different between the groups. In a sample of low-income women who have multiple barriers, improving attitudes, expanding their knowledge of community resources, and providing physical activity opportunities in their neighborhoods are important intermediate steps toward initiation and maintenance of regular physical activity.

Self-reported physical activity validated by pedometer: a pilot study.

OBJECTIVE: The objective was to validate self-reported physical activity based on a daily activity record (DAR) with concurrent pedometer and 7-day physical activity-recall questionnaire data. DESIGN: The design was a one-group descriptive correlational study. SAMPLE: The sample consisted of 25 working women with a mean age of 39.8 years, 92% Caucasian, and 63% with a combined family income of 60,000 dollars or greater. MEASUREMENTS: Three instruments: (a) DAR, a self-reported record of moderate or higher intensity physical activities including household, exercise, leisure, and occupational. Metabolic equivalent unit (MET) scores were calculated from the self-report data, (b) 7-day physical activity recall, and (3) Yamax pedometers (SW-701) measured number of steps. RESULTS: MET scores based on the DAR (n=22) were strongly associated with both pedometer data (Spearman's rho=0.607, p=0.003) and 7-day physical activity-recall data (Spearman's rho=0.542, p=0.009). CONCLUSION: The results of this validation study indicated a statistically significant correlation of self-reported physical activity (DAR) with pedometer values and 7-day physical activity-recall data. The DAR may be useful for measuring physical activity in community health programs and in community-based research.

Maintaining regular physical activity in women: evidence to date.

Physical activity is well established as a primary health promotion and cardiovascular disease prevention behavior, yet over 60% of the population does not participate in regular physical activity. Maintenance of regular physical activity is a complex behavior influenced by variables from several domains. This review includes studies of the relationship between physical activity in women and psychological, social environmental, demographic, physiologic, health status, and physical activity variables. A key issue in physical activity research is development of interventions for maintaining a physically active lifestyle. Interventions for maintenance of regular physical activity that have a strong theoretical basis will be beneficial to women in primary care settings, occupational settings, wellness centers as well as public health departments and other organizations that address the needs of women.

Undergraduate community health in the first semester: opportunities and challenges.

In the current health care environment, there is a trend for care to move from acute hospital settings to community settings. The Pew Health Professions Commission and the American Association of Colleges of Nursing identified a need to modify health care professional education to meet the needs of the changing health care system and diverse demographics in the United States. In traditional baccalaureate nursing programs, the community health nursing course typically is taken in the last year, after students have completed medical-surgical nursing courses. This article describes a curriculum that begins with the community health nursing course. Many opportunities and challenges related to this placement are described.

From exercise to physical activity.

Recommendations for regular exercise have been evident in the nursing literature since the early 1900s. Health professionals and popular media have promoted vigorous exercise for positive health benefits since the 1960s. The concept of exercise as it appeared in the nursing literature during the early part of the 20th century is closer to the concept of physical activity of today--regular, moderate-intensity activities that become part of one's lifestyle. Nurses are in a unique position to counsel individuals, families, and communities on the importance of regular physical activity and to correct misconceptions that only vigorous exercise has health benefits.