Material and social deprivation and health and social services utilisation in Québec: a local-scale evaluation system.

Very few studies have employed local-scale analyses to evaluate how well primary health care and social services reach the most socially and economically deprived individuals. This paper describes a project, conducted in close partnership with decision-makers and practitioners at selected local community service centres (in French, CLSCs) in Quebec, Canada, that developed a system for assessing primary care and social services utilisation by applying deprivation levels defined at the local scale (i.e., according to the distribution of deprivation in individual CLSC service areas). More than 25 years ago, Québec started setting up a province-wide network of publicly financed CLSCs whose mission was to offer first-line health and social services at the local level. Now approximately one Quebecer in four receives at least one service a year from a CLSC. The evaluation system presented in this article is built on deprivation profiles for each CLSC service area and comprises maps, relative indices of service utilisation, and an interpretation framework that facilitates the integration of new data into the decision-making and services planning processes. Study results show that deprivation levels, when defined using local perspectives, correspond more closely to decision-makers' perceptions, that relative indices are sensitive to key determinants of services provision and utilisation, and that the interpretation framework is useful for reassessing intervention strategies.

Impressions of breastfeeding information and support among first-time mothers within a multiethnic community.

The purpose of this study was to document mothers' perceptions of breastfeeding information and support received from hospital- and community-based health professionals within a multiethnic community. A telephone survey was conducted to assess: mothers' impressions of professional support for breastfeeding, whether recommended breastfeeding practices were followed by health professionals, and the nature and sources of breastfeeding information received. An ethnically diverse sample of 108 first-time breastfeeding mothers was surveyed at 3 weeks postpartum. Overall, the mothers' evaluations of professional support for breastfeeding were positive, even though they reported breastfeeding practices that fell short of recommended standards. Immigrant mothers were found more likely to experience hospital practices detrimental to breastfeeding success than Canadian-born mothers, but were also found more likely to receive professional breastfeeding support in the community. Significant differences were also found between immigrant and Canadian-born mothers in the sources of their breastfeeding information. The findings underscore the key role of nurses in ensuring the promotion and optimal support of breastfeeding.

[Health education programs: elements of critiquing]. / L'éducation pour la santé: éléments d'une critique.

Health education programs don't always meet expectations. This article analyzes the factors that contribute to their failure, including complexity or underutilization of theoretical models, and poor articulation of research. Another factor is the disparity in approaches to understanding and intervening in the health experiences of the public. The author briefly describes three main approaches to health education--the individual, the ecological and the interactional--to suggest new avenues for work, deliberation and assessment. Also discussed is the need to clarify limits, foundations and objectives of health education. Finally, the role of the nurse in practical and research activities is examined. These activities are challenging and demanding and require informed, determined commitment.

[French validation of the "Exercise of self-care agency" scale for heart patients]. / Validation Française de l'échelle du "exercise of self-care agency" auprès de patients cardiaques.

Self-care agency is the practice of health-related activities that individuals deliberately initiate and perform in order to maintain life, health and well-being (OREM, 1987). A tool measuring self-care agency is useful to nurses for identifying patients lacking knowledge, motivation, and for those with limited self-care agency. KEARNEY and FLEISCHER (1979) have developed the Exercise of Self-care Agency (ESCA) scale to asses the extent to which individuals take action toward their health care. Several studies suggest that the ESCA scale possesses adequate psychometric properties (KEARNEY & FLEISCHER, 1979; LUCAS, MORRIS & ALEXANDER, 1988; MCBRIDE, 1987; RIESCH & HAUCK, 1988). The lack of a validated tool measuring self-care agency among french speaking populations, led us to translate the ESCA scale and to examine its psychometric properties in a sample of French Canadian individuals who have survived a recent non-complicated myocardial infarction (MI). At 8 and 14 weeks after their MI, 83 subjects aged 52 +/- 10 years with a 1,857 +/- 1,605 U/L MI and an ejection fraction of 51 +/- 10% completed the french-ESCA scale. Mean scores were 112.6 +/- 13.3 at 8 weeks and 117.9 +/- 14.0 at 14 weeks post-MI. Internal consistency coefficients of the french-ESCA scale (at 8 and 14 weeks post-MI) are acceptable (0.84 and 0.88, respectively). Internal consistency coefficients are similar to those obtained in previous studies whereas mean scores on the ESCA scale are somewhat higher (RIESCH & HAUCK, 1988). Cronbach alphas for the french-ESCA scale's sub-scales are generally lower: Self-concept (0.57 and 0.69), Initiative/responsibility (0.72 and 0.80), Knowledge/information seeking (0.80 and 0.79), and Taking actions (0.49 and 0.62). The french-ESCA scale appears stable within the 6 weeks period (r = 0.77, p < 0.001). We recommend to further assess the french-ESCA scale's psychometric properties using larger samples of subjects with or without various health problems.

Moderators of psychological recovery from benign cancer screening results.

OBJECTIVE: The sudden confrontation of a potential health threat such as cancer, even after the diagnosis turns out to be benign, can have enduring adverse psychological consequences, including persistent anxiety, cancer fears, and other manifestations of psychological distress. The present study examines factors that potentially moderate psychological recovery among women who face a breast cancer threat. DESIGN: Participants were adult women had just received a benign outcome from a breast cancer diagnostic procedure that had been conducted because of suspicion of breast cancer (a non-conclusive mammography or ultrasonography result, a referral from their doctor because of pain or family history, detection of a lump, a 6-month follow-up appointment after a breast abnormality from a previous screening or diagnostic procedure, or a fluid leak from one or both breasts). We measured several psychological traits at Time 1 (right after receipt of the "no cancer" feedback) and then each month for the next 3 months. Analyses examined the factors that hindered or facilitated psychological recovery from the cancer threat. RESULTS: Results showed that trait anxiety and family history of cancer hindered recovery and that older age and optimism facilitated recovery and lessened adverse psychological consequences. Self-regulatory strategies such as planful problem-solving, positive reappraisal, and mastery facilitated recovery. CONCLUSIONS: Our findings shed light on the factors that are implicated in psychological recovery from a benign breast cancer outcome after a diagnostic procedure (ultrasonography, repeat or initial mammography, stereotactic biopsy, fine-needle aspiration, or ultrasound-guided biopsy). Those factors could be used to identify women who may experience prolonged psychological distress, so as to assist them when they face stressful diagnostic concerns.

Toronto Alexithymia Scale: relationships with measures of patient self-disclosure and private self-consciousness.

The construct validity of the Toronto Alexithymia Scale (TAS) was tested by correlations with the Patient Self-Disclosure instrument and the Private Self-Consciousness scale in a study of 333 students at a large midwestern university. The TAS was found to be internally consistent and to yield a replicable factor structure. Scores on the TAS correlated negatively with both overall ratings of the importance of such disclosure and scores on the PSC, and positively with perceived difficulty of patient self-disclosure. Results support construct validity of the TAS and suggest a more generally restrictive communicative style among alexithymic individuals than previously thought.