The evaluation of motivation for sexual health among women.

This study conducted a psychometric evaluation of the construct validity of the Health Self-Determinism Index-Sexual (HSDI-S). The instrument was modified to measure motivation related to sexual health rather than motivation of general health in the Health Self-Determinism Index (HSDI). The HSDI-S was completed by 260 conveniently selected women (between the ages of 18 and 44) attending primary-care clinics in the southeastern United States. Confirmatory factor analysis using LISREL did not validate the four subscales of the original HSDI. Subsequent exploratory and confirmatory factor analysis isolated a single-factor model composed of eight items: four judgment items and four external/internal cues items. This finding is suggestive that changes in wording appear to have shifted the responses from motivation for sexual health to that of women's perception of their role in intimate relationships. The eight extrinsically worded items isolate a single-factor model of social and cultural influences of child-bearing-age women's intimate relationships.

Drinking problems of nursing students.

A sample of 315 nursing students in yearly cohorts (1988-1992) completed the Michigan Alcoholism Screening Test (MAST). A simple and quick instrument with established reliability and validity, the MAST had a reliability coefficient of .78 with this sample. The MAST scores of the nursing students indicated that 21.5% had probable alcoholism or were alcoholic. Drinking problems among these nursing students were similar to those of other nursing students and college students in general. Implications for nurse educators include recognition that nursing students need continuing self-assessment and monitoring to avoid drinking problems as a student and future practitioner. Alcoholism self-screening is an excellent introduction to client assessment for drinking problems. Implications for future research include identifying correlates and determinants of problem drinking behaviors and ultimately developing and testing educational interventions to eliminate the problem.

Development of an instrument to measure community acceptance of nurse practitioners and physician assistants.

The purpose of this study was to identify the significant dimensions of the concept of community acceptance of nurse practitioners/physician's assistants and to construct a reliable and valid instrument which would reflect these dimensions. The methodological approach included: conceptualization of categories, development of items for each category, development of the tool, administration of the tool, and psychometric analysis of results. Community input through focus-group interviews and post-administration questions provided qualitative data. The survey tool, consisting of items in four conceptualized categories (knowledge, access, competence, and trust), was administered in five rural communities. The responses of 967 residents were analyzed through factor analysis. The criterion, eigenvalue > or = 1.0, resulted in seven factors. Oblique rotation was applied to the seven factors and marker variables (loadings > .70) facilitated the identification of the underlying dimensions of each factor. Overall, 98% of the items assigned to the original categories were maintained after factor analysis. The identification of these dimensions helped to simplify the description and understanding of community acceptance of nurse practitioners and physicians' assistants. Community acceptance of these advanced health care providers is a necessary precursor to use of services.

Condom use and fertility among divorced and separated women.

Sexually active divorced and separated women constitute a significant population at risk for sexually transmitted diseases. With components of the Interaction Model of Client Health Behavior (IMCHB) used as the conceptual framework, a convenience sample (N=254) of women--mostly educated, White, and in their 30s (20 to 49 years)--was examined relative to condom use and individual and social context characteristics. To explore the effect of fertility on condom use, the sample was divided into fertile and infertile subsamples. The IMCHB explained 49% of the variance in infrequent condom use by the fertile women (n=93) and 21% of the variance in less frequent condom use by the infertile women (n=161).

PIP: In response to stress during marital separation, many women have sexual relationships with multiple male partners. In so doing, they place themselves at risk for contracting and transmitting sexually transmitted diseases (STD). While divorced, women have more sexual partners over time than women in any other marital category. Moreover, White, college-educated divorced and separated women have more sex partners than other educational or racial groups. Components of the Interaction Model of Client Health Behavior (IMCHB) were used in the study of a convenience sample of 254 women relative to condom use and individual and social context characteristics. The subjects were mainly White, educated, and in their 30s. To explore the effect of fertility on condom use, the sample was divided into fertile and infertile subsamples. Women were considered fertile if they reported the use of barrier methods, withdrawal, rhythm, or no method of contraception at the time of the study. They were considered currently infertile if they reported that they were temporarily or permanently incapable of pregnancy due to the use of oral contraception, tubal ligation, hysterectomy, and/or menopause. The IMCHB explained 49% of the variance in infrequent condom use by the 93 fertile women and 21% of the variance in less frequent condom use by the 161 infertile women. This sample of divorced and separated women was at high risk for STDs due to their sexual involvement with a variety of new partners, and without condom use. Fertile women used condoms more often than did infertile women.

The Health Self-Determinism Index for Children.

A convenience sample of 501 children 7 to 13 years old completed the newly developed Health Self-Determinism Index for Children (HSDI-C), a measure of intrinsic motivation in health behavior. Construct validity was supported through the factorial isolation of four theory-consistent subscales, and the correlation of the total HSDI-C (r = .36, p less than or equal to .009) with a general measure of intrinsic motivation. Alpha coefficients in three separate trials ranged between .79 and .88 for the total scale, and .78 to .88, .87 to .92, .78 to .86, and .63 to .77 on the respective subscales. Test-retest reliability for the total scale was .83 at 2 weeks and .48 at 1 year. A nominated population of 21 third- through seventh-grade children known to practice positive health promotion behaviors had an HSDI-C mean score of 106.5 versus 76.5 in the general sample of children.

Acceptance of nurse practitioners and physician assistants in meeting the perceived needs of rural communities.

Nurse practitioners and physician assistants have provided a partial solution to the shortage of primary care services in medically underserved rural areas. This paper describes the results of a study exploring community acceptance of nurse practitioners and physician assistants in rural medically underserved areas. Community acceptance in the context of this study implies not only satisfaction with care received, but also willingness of the community to support NP/PA practice through its infrastructure and encourage members to initially seek and continue to receive care from an NP or PA. Five focus groups were conducted in each of five rural medically underserved communities. The two most pervasive findings were the lack of previous exposure to NPs and PAs and the general belief that NPs and PAs would be accepted in these communities if certain conditions could be met. The theme of conditional acceptance included both personal and system factors. Personal factors included friendliness, competence, willingness to enter into the life of the community, and the ability to keep information confidential. System factors considered critical for acceptance included service type, integration with the existing health care system, cost, geographic proximity, and availability. The results of this study offer insight into community attitudes and suggest marketing strategies for those who plan to introduce NP or PA services into rural communities.