The simultaneous analysis of patient, physician and group practice influences on annual mammography performance.

The current study examined the relationship of several variables at the patient (n = 2780), physician (n = 166), and group practice (n = 45) levels for predicting receipt of annual mammography screening. Patient-level variables included constructs from the Triandis Model of Choice; physician-level variables included measures of barriers and receptivity to prevention, as well as demographic information. Hierarchical modeling demonstrated that variables at the patient and physician level reliably predict annual mammography screening, while frequency of screening did not vary across group practices after accounting for patient and physician variables. Patient-level predictors included social norms, perceived consequences and perceived barriers. The only physician-level predictor identified was annual mammography recommendation. These findings add to data which emphasize the importance of public education and social support in health maintenance activities.

Frequency and determinants of screening for breast cancer in primary care group practice.

BACKGROUND: Many studies reporting the frequency of breast cancer screening have been based only on physician and patient surveys or on data from quality assurance studies and do not assess the reliability of information obtained from these various sources. METHODS: To obtain more complete data we studied mammography performed in a 3-year period, 1988 through 1991, in 24 nonacademic primary care group practices by both auditing the medical records and obtaining questionnaire responses from 1819 women aged 53 to 62 years and from their 98 physicians in the nonmetropolitan Midwest. RESULTS: Medical record data indicated that mammography was performed in all 3 years in 16.7%, in at least two of 3 years in 49.8%, and in at least one of 3 years in 81.7% of women. While patient reports of a family history of breast cancer, health insurance coverage for mammography, and greater annual household income were each significant predictors, a patient report that a clinic staff member had discussed mammography was the strongest predictor of greater frequency of mammography. CONCLUSIONS: In this study of self-selected physicians and their patients, record-documented mammographic examinations were considerably more frequent than has been reported in some studies, but occurred at rates consistent with quality assurance data for the region. These data suggest that clinic staff initiatives with screening mammography have a large impact.

Living with a heart transplant: long-term adjustment.

The number of heart transplants performed worldwide has increased greatly in the past 10 years, and survival rates will continue to improve with the introduction of new immunosuppressive therapies. With this improved lifespan outlook, the experience of living with a heart transplant needs to be understood as a chronic condition. Twenty-nine recipients who were a minimum of 5 months post-transplantation (mean 22 months) and 23 significant others were interviewed twice 6 months apart using close-ended and open-ended questions developed from the Common Sense Model of health beliefs. Results suggest that although life improved for the majority post-transplantation, recipients continue to experience work problems, financial burdens, family role changes, lifestyle changes, and side effects associated with long-term drug treatment.

Responses to threat information.

Using the Common Sense Model to examine responses to health risk information, a laboratory study was conducted. Subjects were assigned randomly to one of four groups by manipulating information about high or normal blood glucose (BG) and a low or high threat message about the controllability of Type II diabetes. Subjects in the high BG groups reported more diabetes-related symptoms and stronger intentions to change certain behaviors. Subjects reading a high-threat message expressed stronger intentions to see a health professional than did those reading a low-threat message. The results suggest that perceptions of one's risk status and the degree of threat associated with an illness effects symptom perceptions and behavioral intentions.

Education in nursing diagnosis: evaluating clinical outcomes.

This article describes the development, implementation, and evaluation of an educational program to update the knowledge and skills of nurses in the use of the nursing process and nursing diagnoses. Results 1 year later suggest improvement in participants' knowledge of the phases of the nursing process. Chart audits demonstrated this knowledge was more specifically applied to improved documentation of nursing diagnoses.

Processes of self-care: monitoring sensations and symptoms.

One of the most basic processes in self-care has to do with how people monitor changes in their bodies, that is, how people identify and evaluate sensations and symptoms. This article reviews evidence from three research programs that have focused on the study of sensation/symptom processing using a shared conceptual framework, the Common Sense Model. The model is described first; a summary of findings from each series of studies is then provided. The article concludes with a discussion of the findings' contribution to knowledge of self-care, implications of the findings for nursing practice, and suggested directions for future research.

An experiment in common sense: education at blood pressure screening.

This study compared the impact of three educational messages about hypertension used at a worksite blood pressure screening program. The messages sought to change beliefs and health behaviors related to hypertension. Each participant who had either been previously diagnosed as hypertensive or had an elevated blood pressure at screening was randomly assigned to view one of three slide/tape messages about high blood pressure: (1) a standard (control) message, and one of two experimental messages; (2) a standard message combined with action plans or (3) a standard plus action plan message combined with information on "wellness thinking" as opposed to relying on the presence of symptoms to monitor blood pressure level. Self-report measures obtained immediately after viewing the slide/tapes, 1 week and 9 months later included intentions to change behavior, reports of changes made in health behaviors, and beliefs about the reliance on symptoms to monitor blood pressure level. Both experimental messages containing action plan information led to stronger reported intentions and reported behavior change up to 9 months later, but few differences were statistically significant. Subjects who received "wellness thinking" information were less likely to attribute symptoms to high blood pressure up to one week later, but these differences disappeared at the nine month follow-up. Results suggest that effective education about hypertension should include specific information on strategies for reducing blood pressure.

Illness representations and matching labels with symptoms.

Three studies are reported that show that health-relevant information (e.g., blood pressure [BP] or symptoms) initiates an active cognitive search process that results in the construction of an illness representation. Study 1 showed that informing subjects that their BP was elevated affected two attributes of illness representation: identity (label and symptoms), and time line or expected chronology of the health threat. Subjects given a high-BP reading reported symptoms commonly associated with high BP, especially if they attributed the high-BP reading to stress. Study 2 showed that the active search process uses causal information (a third attribute of representations) to give meaning to symptoms. Specifically, subjects used environmental cues to interpret whether familiar, unfamiliar, and ambiguous symptoms were due to illness or to stress. In Study 3 we showed that the constructive process, initiated by a high-BP reading, is directed by prior beliefs about the time line for developing high BP and by the presence of external cues about the stressfulness of the subject's daily life. Subjects who believed BP was labile and that they were under high daily stress or who believed BP was stable and that they were under low daily stress reported more symptoms. The significance of these findings for understanding how people process diagnostic labels and symptom information involved in the construction of illness representations is discussed.

The effects of health information in a worksite hypertension screening program.

Two studies assessed the potential impact of health education messages at worksite blood pressure screenings. The messages sought to: motivate hypertensives to enter or return to treatment, motivate normotensives to improve health habits and discourage inappropriate use of blood pressure screening by normotensives. A total of 473 participants in the two studies viewed slide/tape shows about blood pressure and/or health promotion. Individuals with elevated readings at screening viewed either a show containing standard blood pressure information or an experimental show which emphasized the asymptomatic nature of high blood pressure and which described some concrete strategies for coping with high blood pressure. In both studies, individuals with normal readings at screening viewed a standard show or an experimental show which emphasized coping strategies for preventing high blood pressure. In addition, in Study 2, some normotensive individuals viewed one of several experimental shows which focused on health promotion. Results indicate that the experimental programs were significantly more effective than the standard programs in achieving appropriate followup of screening results for both normotensives and hypertensives. Implications for worksite blood pressure screenings are discussed.

"I can tell when my blood pressure is up, can't I?".

Forty-four insurance company employees were measured on blood pressure, moods, symptoms, and predictions of their blood pressures, twice daily for 10 days. Twenty subjects had elevated blood pressure and 24 did not. The measures were correlated within-subjects to determine if blood pressure predictions were associated with moods, symptoms, or blood pressure readings, and if moods and symptoms were related to blood pressure. Predictions of pressure were expected to be correlated with symptoms and moods, but not with blood pressure. No strong relationship was expected when blood pressure was compared to symptoms or to moods. The data showed that self-predictions of blood pressure were most strongly associated with reported symptoms, next with reported moods, and least with actual blood pressure. A comparison of subjects who were accurate in predicting their blood pressure with those who were not showed no differences in blood pressure levels, systolic blood pressure variation, self-esteem, or private body-consciousness. Subjects' beliefs that they could monitor blood pressure were little influenced by contrary information. The results suggest it would be an error to encourage subjects to believe they can successfully treat blood pressure elevations by monitoring symptoms related to blood pressure change.