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Biomedical subjects

D Lauver

Publications and source records attributed to D Lauver.

At least 19 recordsLinked to original sources

Women's reasons for and barriers to seeking care for breast cancer symptoms.

Of note, these findings are based on women who did seek care for symptoms, rather than those who did not. However, the sample does include late care seekers; 23% of participants sought care after 3 months, and 3.6% waited more than a year. Delay often is defined as seeking care 3 months after symptoms are noted. Community health workers, such as public health nurses, may be able to document barriers among women who have symptoms but have not sought care. In this sample of predominantly low-income, minimally educated participants, women were motivated to seek care for their breast symptoms to obtain consultations and diagnoses, as well as to deal with their concerns about their symptoms and possible cancer diagnoses. Clinicians can recognize women's need to know the meaning of their symptoms, providing clarification as soon as possible and reassurance as appropriate. Clinicians and families can affirm that making time for women's symptom evaluations is a priority. Knowing that women's common barriers to accessing the health care system involve financial, time, and logistical considerations can direct health care administrators' agendas. Administrators, clinicians, and women can work for changes in health policies to assure universal coverage for preventive services for all women.

Adult↗

HIV risk status and preventive behaviors among 17,619 women.

OBJECTIVES: To document the percentage of women at high risk for human immunodeficiency virus (HIV) infection among primary care clients, identify their most prevalent risk factors for HIV infection, and examine the relationships between risk status and preventive behaviors for HIV infection. DESIGN: Cross-sectional. SETTING: Urban and nonurban primary care clinics. PARTICIPANTS: Female clients (N = 17,619) who voluntarily completed an HIV risk-assessment form. MAIN OUTCOME MEASURES: HIV risk status, condom use, and previous HIV testing. RESULTS: Using criteria from the Centers for Disease Control, the study found 14% of the sample to be at high risk for HIV infection. Prevalent risk factors were having sex with persons at high risk for AIDS, having sex with more than six persons in a year, and having more than two sexually transmitted diseases. Women at high risk were more likely to be older, urban, and black. Overall, rates of consistent condom use and HIV testing were low, 12% and 7%, respectively. Older women, coupled women, and women of color were least likely to use condoms consistently. Women at low risk were less likely to have had HIV tests. CONCLUSIONS: To prevent HIV infection, nursing interventions can target women of all ages, especially urban and black women. Nurses should use strategies and skills to promote condom use that are different from those they use to encourage HIV testing.

AIDS Serodiagnosis↗

Care-seeking behavior with breast cancer symptoms in Caucasian and African-American women.

Based on a theory of care seeking, the influences of psychosocial variables (anxiety, utility beliefs, norm, and habit) and facilitators (e.g., an identified practitioner) on care-seeking behavior with a breast cancer symptom were examined. Also, the influences of variables not identified by the theory (e.g., optimism and race) on care-seeking behavior were examined. Participants were Caucasian (n = 64) and African-American women (n = 71) with breast symptoms. Care seeking was measured by the days between symptom detection and contact with the health system. Habit was associated with promptness, utility beliefs were associated with delay, and anxiety interacted with having an identified practitioner to explain care seeking. Optimism and having a friend with a breast symptom also were associated with promptness. Race had neither direct nor interactive effects on care seeking.

Adult↗

Sum-of-products variables: a methodological critique.

Sum-of-products variables are integral to testing certain psychological theories (e.g., the theory of reasoned action). A sum-of-products variable is a total score computed by multiplying the scores for corresponding items from two scales and then adding the products. This type of variable is associated with methodological difficulties, however. The purpose of this article is to discuss certain methodological issues associated wtih the use of sum-of-products variables in health-related research.

Attitude↗

Women's expectations about seeking care for breast cancer symptoms.

Expectations about a particular health behavior can influence whether a person engages in that behavior. This study was conducted to identify women's expectations about seeking or not seeking prompt care for breast cancer symptoms. Guided by theory, interview questions elicited expected outcomes, advantages, and disadvantages of promptly seeking care or of adopting a "wait and see" approach. Forty participants between the ages of 26 and 73 who had no history of breast cancer were interviewed. Responses were categorized according to common themes. Outcomes and advantages of seeking care included receiving a diagnosis or treatment, as well as reassurance and knowledge; disadvantages included financial costs and undesirable interactions with physicians. Outcomes and disadvantages of waiting included a worsened condition and a lower chance of survival; advantages included financial savings and possible resolution of the condition.

Adult↗

A theory of care-seeking behavior.

Although much research has focused upon why people do and do not engage in recommended health behaviors, there is a need to develop more accurate theories to explain and predict engagement in health behaviors. Because health behaviors differ in important ways, it could be most fruitful to understand one type of health behavior, such as secondary prevention behavior. This paper proposes a theory of care-seeking behavior (CSB), based on a theory of general behavior by Triandis. Other popular theories about health behavior (i.e., Health Belief Model and Theory of Reasoned Action) also are reviewed. Empirical support for the variables identified in the theory of CSB is presented, drawing from the literature on secondary prevention for cancer. The theory of CSB is applied to the situation of seeking care for cancer symptoms. Directions for future research based upon this theory are delineated.

Health Behavior↗

Message framing, dispositional optimism, and follow-up for abnormal Papanicolaou tests.

The effects of alternatively framed messages and dispositional optimism on follow-up for abnormal Papanicolaou tests were studied. Participants (N = 116) had a mean age of 24; 94% were black, 67% had a high school education, and 82% received public assistance. A message about losses without follow-up or gains with follow-up was randomly given. Optimism was measured with the Life Orientation Test and attendance was defined as coming or not coming within 6 weeks of contact. Logistic regressions of attendance on framing and optimism did not reveal significant relationships. Exploratory analyses revealed that personal and familial history of disease were related to attendance. Explanations for the findings and implications for research are delineated.

Adolescent↗

Women's informational needs about colposcopy.

Questions asked by 36 women during colposcopy, a stressful medical procedure, were examined to determine their specific informational needs about the exam and its results. Of the 226 questions posed, 52 percent were exam related--on the sensations experienced, the nature of the procedure and self-care activities; 34 percent were results related and focused on the meaning of the results, treatment options and treatment procedures; 14 percent of the questions were incidental. The present research documents women's need for information about the medical procedure of colposcopy. The implications for nursing practice are outlined.

Adolescent↗

Overadherence with breast self-examination recommendations.

Overadherence with breast self-examination (BSE) was studied to seek explanations for this phenomenon and to suggest individualized interventions for the performance of BSE. In a descriptive study, women attending BSE instruction (N = 264) were interviewed regarding their beliefs as well as peer and professional interactions about breast self-examination. Of these women, 29 (11%) were overadherent; they had the highest rates of breast disease and the least professional instruction and encouragement for BSE. Ironically, some women perform BSE repeatedly because they lack sufficient knowledge and confidence. Clinicians should assess women's knowledge of BSE as well as their skill to provide individualized clarification.

Adult↗

Assessment and management of cervical intraepithelial neoplasia.

Although cervical intraepithelial neoplasia (CIN) once was thought to be a clinical problem primarily for older women, data reveal an alarming rise of this condition among younger women. The gains made in decreasing the incidence of cervical cancer have been tempered by the steadily increasing incidence of its precursor state, CIN. Because of increasing evidence of the association of the human papillomavirus (HPV) with cervical cancer and CIN, this virus is of particular concern. Colposcopy is a valuable method for evaluating CIN that has been indicated on Pap, as well as for identifying HPV. Since having an abnormal Pap and undergoing colposcopic examination may be stressful, the clinician can play a significant role in helping the client cope with the process of evaluation and treatment of abnormal Paps in addition to controlling cervical cancer.

Colposcopy↗

Instructional information and breast self-examination practice.

The effects of four interventions on frequency and thoroughness of breast self-examination (BSE) were compared. The interventions provided different types of information, as derived from a self-regulation framework, to promote BSE practice. Women seeking BSE instruction (N = 204) were randomly assigned to interventions. No intervention effects on frequency were observed. However, exam frequency increased from pre- to postintervention and remained constant over 3 and 6 months follow-up. Interaction effects observed on thoroughness suggested that a positive effect of sensory information about the breast was conditional upon having had prior experience with BSE. Implications for research, theory, and practice are drawn.

Adaptation, Psychological↗

Reducing the negative impact of radiation therapy on functional status.

The effect of an informational intervention that provided objective descriptions, in concrete terms, of the usual experiences during the various phases of radiation therapy was tested in a random clinical trial. The patients had Stage A, B, or C prostatic cancer. Forty-two control patients received the information routinely provided to all patients in the treatment setting. Forty-two experimental patients received, in addition, four informational messages during the course of radiation therapy. The first message described the experience of treatment planning; the second described the experience of receiving a radiation treatment; the third described side effects that usually occur, their onset, their characteristics, and activities to lessen their impact; and the fourth described the usual experiences during the months following radiation treatments. The experimental group of patients, compared with those in the control group, reported significantly less disruption in usual activities during and following radiation therapy. The amount of emotional disturbance was low and did not differ by study group. The results of this study, with respect to the interventions' effect on radiation therapy patients' quality of life, were consistent with prior research in other health care situations.

Adaptation, Psychological↗

Theoretical perspectives relevant to breast self-examination.

The disparity between women's knowledge and performance of breast self-examination (BSE) remains an unresolved clinical problem. As a screening behavior, BSE raises interesting issues about motivation. Adequate and useful theoretical perspectives are needed to guide research and to explain BSE performance. This article compares three perspectives of relevance to BSE--the health belief model, self-efficacy theory, and self-regulation theory--and cites empirical support in BSE research for each. A useful theoretical perspective to guide research on BSE is identified. Assumptions within each perspective are also addressed. Finally, future directions for BSE research are proposed.

Adaptation, Psychological↗

Nurse practitioner and physician roles: delineation and complementarity of practice.

Because of differences in education and role preparation, nurse practitioners (NPs) and physicians (MDs) may assume either complementary or substitutive roles in patient care. To describe role complementarity and similarity, the role perceptions of 15 NPs and 15MDs in joint practice were assessed. Ten NP and MD respondent pairs were selected from a variety of ambulatory primary care settings (urban, rural, public, private, and health maintenance organizations), and five NP-MD pairs were chosen at random. A questionnaire of nine patient vignettes was created; respondents rated the appropriateness of their role in managing the clients described in each vignette using an 8-point scale. Significant differences existed between NP and MD perceived roles for six vignettes, p less than .05. NPs identified as highly role appropriate those vignettes necessitating psychosocial support and health education; MDs identified as highly role appropriate vignettes representing high risk physical conditions. The differences in NP and MD role perception were complementary.

Adolescent↗

Assessment and management of vaginitis and cervicitis.

This article presents the assessment, management, client education, and psychosocial considerations related to trichomoniasis, candidiasis, Gardnerella vaginitis, and cervicitis due to Chlamydia trachomatis and Neisseria gonorrhea. The physiology of the vagina, approach to the history and physical exam, specimen collection, and laboratory diagnosis are included. Recommended treatment regimens and preventive behaviors are discussed in detail. The psychosocial impact to the client of having a discharge which may be a sexually transmitted disease is discussed.

Anti-Bacterial Agents↗