Biomedical subjects

Joan L Bottorff

Publications and source records attributed to Joan L Bottorff.

At least 19 recordsLinked to original sources

PubMed2006

Validation of the Dimensions of Tobacco Dependence Scale for adolescents.

The purpose of this study was to refine the Dimensions of Tobacco Dependence Scale (DTDS) - a measure of tobacco dependence for adolescents - by removing poorly discriminating items, testing the measurement structure of the remaining items and examining the predictive utility of the resulting scale in terms of its ability to explain the average number of cigarettes smoked per day (CPD). A total of 1425 current smokers (mean age 16 years) completed the questionnaire. Confirmatory factor analyses of the DTDS items supported a 4-factor model composed of social, emotional, nicotine and sensory related dimensions of tobacco dependence. Predictive utility and incremental validity of the DTDS was evident in the many sizable correlations between the DTDS and CPD as well as measures of self-rated addiction after controlling for scores on several other commonly used measures of nicotine dependence. The results indicate that the DTDS is a reliable and valid measure of tobacco dependence for adolescents that has the potential to enhance our understanding of the complex processes driving the emergence of tobacco dependence and cigarette smoking.

Adolescent↗

PubMed2006

The influence of significant others in complementary and alternative medicine decisions by cancer patients.

Individuals living with cancer are faced with numerous treatment decisions that encompass both conventional therapies and complementary and alternative medicine (CAM). Although a beginning body of research has explored the CAM decision-making process by cancer patients, the social context of these treatment decisions has been largely ignored. As a part of a larger grounded theory research project exploring CAM decision-making processes of cancer patients living in British Columbia, Canada, the purpose of this secondary inquiry was to explore how significant others were involved in patients' decisions related to CAM. In total, 61 patients with early and advanced-stage breast and prostate cancer and 31 significant others participated in semi-structured interviews. Using constant comparative analysis, four main types of decisional involvement by significant others were identified: creating a safe place for the patient to make a decision, "becoming a team": collaborative decision-making, moving the patient towards a decision, and making the decision for the patient. Significant others were often found to engage in more than one type of decision involvement as a consequence of several key factors. Within the types of decisional involvement, nine distinct roles in the CAM decision-making process were described by the significant others. The findings of this inquiry extend previous research by highlighting the importance of significant others in cancer patients' CAM decisions and challenge past conceptualizations of autonomy in treatment decision making.

Aged↗

PubMed2006

Distance art groups for women with breast cancer: guidelines and recommendations.

To overcome barriers that prevent women with breast cancer from attending support groups, innovative formats and modes of delivery both need to be considered. The present study was part of an interdisciplinary program of research in which researchers from counseling psychology, psycho-oncology, nursing, computer science, and fine arts have explored art making as an innovative format and telehealth as a mode of delivery. For this study, we conducted focus groups and interviews with 25 people with expertise about breast cancer, art, art therapy, and distance delivery of mental health services to generate guidelines for distance art-based psychosocial support services to women with breast cancer. A qualitative analysis of the focus group and interview data yielded guidelines for developers and facilitators of distance art groups for women with breast cancer pertaining to (a) emotional expression, (b) emotional support, (c) emotional safety, and (d) accommodating individual differences, plus special considerations for art therapy groups. Further research is needed pertaining to the use of computers, involvement of art therapists, and screening out vulnerable clients.

Art Therapy↗

PubMed2006

Men's constructions of smoking in the context of women's tobacco reduction during pregnancy and postpartum.

Men's smoking is largely under-examined despite research that has consistently linked partner smoking to pregnant women's smoking and smoking relapse in the postpartum. An on-going qualitative study involving 31 couples in Canada exploring the influence of couple interactions on women's tobacco reduction provided the opportunity to examine men's smoking in the context of women's tobacco reduction or cessation during pregnancy and postpartum. Individual open-ended interviews with 20 men who smoked were conducted at 0-6 weeks following the birth of their infants and again at 16-24 weeks postpartum. Constant comparative methods were used along with social constructivist perspectives of fatherhood and gender to guide data analysis and enhance theoretical sensitivity. Four themes emerged in men's accounts of their tobacco use: (1) expressing masculinity through smoking, (2) reconciling smoking as a family man, (3) losing the freedom to smoke, and (4) resisting a smoke-less life. Men's reliance on and commitment to dominant ideals of masculinity seemed to preclude them from viewing their partner's tobacco reduction or cessation for pregnancy as an opportunity for cessation. Expectant and new fathers who smoke, however, may be optimally targeted for cessation interventions because it is a time when men experience discomfort with their smoking and when discontinuities in everyday life associated with the transition to fatherhood and presence of a new baby provide opportunities for establishing new routines. Implications for gender-sensitive smoking cessation interventions are discussed.

Adult↗

PubMed2006

Couple dynamics during women's tobacco reduction in pregnancy and postpartum.

Smoking cessation during pregnancy is often temporary; many women relapse postpartum. To develop strategies for supporting successful long-term smoking cessation, we conducted a qualitative study to explore the influence of couple interactions on women's tobacco reduction within the context of pregnancy and the postpartum period. A total of 28 women who quit or reduced smoking for pregnancy and their partners were interviewed following delivery and at 3-6 months postpartum. Open-ended, individual interviews elicited the challenges posed by the women's tobacco reduction and how their partners influenced their cessation efforts. The use of constant comparative analytic strategies focusing on women's processes, experiences, and responses revealed that unquestioned expectations for pregnant women's cessation created the social context of compelled tobacco reduction. Women's engagement in tobacco reduction in this context fundamentally altered couples' previously established tobacco-related routines. The intensity of these changes varied depending on the couples' established interaction patterns with respect to tobacco (i.e., disengaged, conflictual, or accommodating) and was a source of conflict for some couples. The findings offer novel ways to understand smoking cessation during pregnancy that provide new directions for research and for tailoring smoking cessation interventions.

Adult↗

PubMed2006

Levels of commitment: exploring complementary therapy use by women with breast cancer.

OBJECTIVES: Previous research on complementary therapy use in populations of patients with breast cancer has failed to differentiate among the different types of therapies and utilization patterns, resulting in wide discrepancies in prevalence rates. The purpose of this study was to develop more refined and rigorous estimates of the prevalence of complementary therapy use in women with breast cancer and their level of commitment to complementary therapy. DESIGN AND SAMPLE/SETTING: Using a cross-sectional, retrospective survey design, a random sample of 334 women with breast cancer was drawn from a Canadian provincial cancer registry. Using an intensive therapy inventory, women were asked to indicate the therapies and practices they had used since cancer diagnosis, frequency of use, amount of effort associated with using each therapy, and financial cost of therapy use. RESULTS: A substantial proportion of women with breast cancer were found to be using complementary therapies, with between 19.5% (most conservative estimate) and 79.9% (liberal estimate) of the women reporting the use of at least one complementary therapy following diagnosis. While the majority of therapies were used on a daily basis, a minimal amount of effort and finances was expended on complementary therapy use. Using two-way cluster analysis, two homogenous groups of complementary therapy users were identified based on level of commitment to complementary therapy use. Women with a low commitment to complementary therapy use comprised 73.9% of the sample and were more likely to be older and report less education than women with a moderate-to-high commitment to complementary therapy use. CONCLUSIONS: The use of complementary therapies by women with breast cancer warrants more precise measurement to accurately capture the types of complementary therapies used and the level of commitment to complementary therapy use. The findings of this study point to the value of the concept of commitment in identifying individuals willing to commit substantial time, energy and financial resources to complementary therapy use.

Adult↗

PubMed2006

An ethnographic study of tobacco control in hospital settings.

BACKGROUND: Tobacco control in hospital settings is characterised by a focus on protection strategies and an increasing expectation that health practitioners provide cessation support to patients. While practitioners claim to have positive attitudes toward supporting patient cessation efforts, missed opportunities are the practice norm. OBJECTIVE: To study hospital workplace culture relevant to tobacco use and control as part of a mixed-methods research project that investigated hospital-based registered nurses' integration of cessation interventions. DESIGN: The study was conducted at two hospitals situated in British Columbia, Canada. Data collection included 135 hours of field work including observations of ward activities and designated smoking areas, 85 unstructured conversations with nurses, and the collection of patient-care documents on 16 adult in-patient wards. RESULTS: The findings demonstrate that protection strategies (for example, smoking restrictions) were relatively well integrated into organisational culture and practice activities but the same was not true for cessation strategies. An analysis of resources and documentation relevant to tobacco revealed an absence of support for addressing tobacco use and cessation. Nurses framed patients' tobacco use as a relational issue, a risk to patient safety, and a burden. Furthermore, conversations revealed that nurses tended to possess only a vague awareness of nicotine dependence. CONCLUSION: Overcoming challenges to extending tobacco control within hospitals could be enhanced by emphasising the value of addressing patients' tobacco use, raising awareness of nicotine dependence, and improving the availability of resources to address addiction issues.

Adult↗

PubMed2006

A narrative view of art therapy and art making by women with breast cancer.

Art therapy (with an art therapist) and art making (without an art therapist) show promise as avenues for psychosocial support for women with breast cancer. The purpose of this study was to gain an in-depth understanding of how 17 women with breast cancer in Canada and the USA used art therapy and their own art making to address their psychosocial needs, focusing particularly on meaning making. Narrative analysis of interviews yielded four storylines: Art and Art Therapy as a Haven; Getting a Clearer View; Clearing the Way Emotionally; and Enhancing and Enlivening the Self. The storylines show existence being affirmed, confirmed and proclaimed through visual artistic expression and meaning making being achieved through physical acts of making.

Adaptation, Psychological↗

PubMed2005

Unraveling smoking ties: how tobacco use is embedded in couple interactions.

The purpose of this research was to explore couple interactions related to tobacco use prior to pregnancy, as part of a larger grounded theory project focused on couple interactions related to tobacco use. Interviews with 28 women who quit or reduced smoking for pregnancy and their partners were conducted. Analysis of retrospective accounts of pre-index pregnancy interactions resulted in the identification of tobacco-related routines related to: (a) regulation of smoking; (b) practices related to the acquisition, use and handling of tobacco; (c) communication about tobacco use; and (d) responding to slips and lapses. Variations in the enactment of routines were captured in three tobacco-related interaction patterns: (a) disengaged; (b) conflictual; and (c) accommodating. Findings provide insights into the role tobacco plays in relationships and resistance to behavior change.

Adult↗

PubMed2005

Development of a multidimensional measure of tobacco dependence in adolescence.

The objective of this research was to develop a multidimensional measure of tobacco dependence, sensitive to signs of incipient dependence and relevant to adolescents. A cross-sectional survey was conducted of students attending randomly selected high schools in two regions of British Columbia, Canada. Of the 3280 adolescents who completed the survey, 17% (n=562) indicated that they had smoked at least once in the month preceding the survey and were classified as "smokers." Ninety-one percent of the smokers (n=513) completed all or most of the items and comprised the sample for the analysis. The survey included a number of items related to smoking status and nicotine dependence, including the newly developed Dimensions of Tobacco-Dependence Scale (DTDS), a 54-item multidimensional measure of tobacco dependence. Exploratory factor analyses using MINRES was used to examine the dimensions of the DTDS. The measure was found to include four dimensions: social reinforcement, emotional reinforcement, sensory reinforcement, and physical reinforcement. All subscales had adequate reliability (Cronbach's alpha coefficients >.70).

Adolescent↗

PubMed2005

"Becoming the real me": recovering from anorexia nervosa.

We investigated the process of recovery from anorexia nervosa using grounded theory. Open-ended interviews conducted with 9 women who had recovered from anorexia nervosa revealed that recovery focused on rediscovery and redefinition of the self and included the following: (1) seeing the dangers, (2) inching out of anorexia, (3) tolerating exposure without anorexia, (4) gaining perspective by changing the anorexia mindset, and (5) discovering and reclaiming self as "good enough." The process of recovery described in this study may provide a useful framework for helping women understand their own process of recovery efforts. The findings also support therapies that foster therapeutic alliance, acknowledge readiness for change, and promote a senses of autonomy.

Adult↗

PubMed2005

Mothers who smoke: confessions and justifications.

Interviews with mothers who smoke were analyzed to examine the influence of social discourses. Women presented themselves as knowledgeable about the health risks of tobacco, confessed guilt and shame, attempted to deflect accusations of neglect for smoking or exposing their children to tobacco, provided rationalization that they smoked for the sake of their children, and, although they were all smokers, demonstrated an antismoking stance. The findings indicate that mothers are in a "bind" when it comes to smoking and fulfilling societal expectations of a good mother. Health professionals must be cognizant of how discourses constrain women's choices in relation to tobacco.

Adult↗

PubMed2005

The educational needs and professional roles of Canadian physicians and nurses regarding genetic testing and adult onset hereditary disease.

OBJECTIVE: To investigate the knowledge, professional involvement and confidence of Canadian nurses and physicians in providing genetic services for adult onset hereditary disease. METHODS: 1,425 physicians and 1,425 nurses received a mailed questionnaire with reminders. The response rates were 50% (n = 543) and 79% (n = 975), respectively. RESULTS: Forty-eight percent of physicians and 31% of nurses lacked formal education in genetics. Respondents reported being involved in caring for people at risk for adult onset hereditary disease. Their levels of confidence that they could perform tasks, such as counselling about predictive genetic tests, however, were lower than their levels of expectation that it would be important for them to provide these services. CONCLUSIONS: The expected roles and educational needs of Canadian nurses and physicians have broad areas of overlap suggesting the possibility of combined professional education programs and multiple ways of organizing teams to provide genetic services to people at risk for adult onset hereditary disease.

Age Factors↗

PubMed2005

Tobacco use in intimate spaces: issues in the study of couple dynamics.

Few guidelines exist for using qualitative research to examine couple dynamics in contexts complicated by strong social stigmas and wide-ranging patterns of interpersonal relationships. The purpose of this article is to describe the methodological and ethical issues that arose in an ongoing qualitative study focused on tobacco reduction in the context of couple relationships, and the strategies undertaken to deal with these challenges. The authors discuss their experiences with the following: recruitment in the context of social stigma and the potential for intracouple coercion, data collection and the implications of uncovering intimate dimensions of couples' lives, the impact of the research process on mothers' vulnerability, and the challenges of capturing shared, "dyad" experiences. These issues point to unique challenges in conducting qualitative research with couples and families and provide a useful base for similar studies.

Data Collection↗

PubMed2005

The influence of family on immigrant South Asian women's health.

The purpose of this study was to examine the influence of family members on immigrant South Asian women's health and health-seeking behavior. This qualitative study was part of a larger study that examined the health-seeking practices of immigrant South Asian women living in the Lower Mainland of British Columbia, Canada. Using ethnographic methods, data were collected through face-to-face interviews with women who had lived in Canada for 10 months to 31 years. Analysis of translated and transcribed data revealed that women made decisions about their health in consultation with family members. Overall, family members were perceived to be supportive and provided direct and indirect assistance to women in ways that influenced their health. Expected roles and responsibilities often had detrimental influences on women's health. Health care for immigrant South Asian women needs to take into account women's relationships with family members and the influence of family on women's health.

Adult↗

PubMed2005

Canadian nursing in the genomic era: a call for leadership.

With developments in genomics, there is an urgent need for Canadian nurses in all settings to be informed and involved in the incorporation of this new knowledge into healthcare. The purpose of this paper was to synthesize the literature on genetic nursing roles to provide a foundation for Canadian nursing leaders as they take on the challenges of nursing in the genomic era. A comprehensive review of 98 articles published between 1994 and 2004 revealed strong support for genetic nursing roles and recommendations for levels of genetic nursing practice. The few studies on genetic nursing roles suggested that nurses and other health professionals support the integration of genomics into nursing practice. Issues that need to be addressed related to nursing practice, education and research are offered to engage nursing leaders in advocating for the incorporation of genomics into nursing in Canada.

Canada↗

PubMed2005

Nurse-patient communication in dementia: improving the odds.

This study investigates the use of a range of conversational strategies in a nurse-led socialization group with long-term care residents who have dementia. Eight residents whose Mini-Mental State Examination (MMSE) scores ranged from 0 to 19 participated in weekly group sessions for 10 weeks. All sessions were tape recorded and transcribed verbatim. Analysis of transcribed sessions resulted in two taxonomies: a taxonomy of nurse conversational strategies (clarifying, exploring, moderating, validating, rescuing, and general discourse markers) and a taxonomy of patient responses (discourse markers, limited engagement, expanded responses, personalized response, self-initiated participation, and disconnected or fragmented participation). The effectiveness of the nurse conversational strategies was reflected in the encouraging level of resident participation rates. The findings of this study suggest that with effective support and prompting, patients with advanced dementia are able to engage in social conversations beyond what would be expected given their diagnosis and MMSE scores.

Aged↗

PubMed2005

Methodological issues in researching palliative care nursing practice.

The purpose of this integrative review was to describe the research conducted by nurses since the mid-1990s on nursing practice in the context of palliative/end-of-life care, identify promising methodological developments as well as methodological challenges, and propose strategies to support the development of this field of nursing research. A search of databases resulted in 121 research reports published between 1995 and 2003. Studies were included if the lead author was a nurse and the focus was nursing practice or nurses' attitudes about providing palliative or end-of-life care. Relatively few studies included patients, there were limitations in the data-collection methods used, and there was a lack of studies evaluating palliative care nursing. An emphasis on the interdisciplinary nature of palliative care may be hindering nurses from examining the effectiveness of nursing interventions. Increased attention should be given to examining the efficiency and effectiveness of nursing interventions to ensure the best outcomes for patients and their families.

Humans↗