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Biomedical subjects

John P Allegrante

Publications and source records attributed to John P Allegrante.

At least 19 recordsLinked to original sources
PubMed2006

Health behaviour and academic achievement in Icelandic school children.

Interest in the relationship between health behaviours and academic achievement has recently intensified in the face of an epidemic of childhood and adolescent obesity and converging school reforms in the United States and other nations with advanced economies. Epidemiologic research has demonstrated that poor diet and lack of adequate physical activity place children at risk for being overweight and obese and thus influence future health status. Additional research has also shown that children and adolescents whose diets are nutritious and whose participation in physical activity is high tend to perform better on various measures of cognitive performance and academic achievement. We analysed cross-sectional survey data from 5810 Icelandic school children to explore the relationship between selected health behaviours and academic achievement. Body mass index, diet and physical activity explained up to 24% (P < 0.01) of the variance in academic achievement when controlling for gender, parental education, family structure and absenteeism. Variance explained increases to 27% when depressed mood (P < 0.05) and self-esteem (P < 0.01) are added to the model, but confounds the role of physical activity. Although not robust, these findings are consistent with previous work and affirm the complexity of the relationship of health to academic achievement.

Achievement↗
PubMed2006

An RCT of the effect of motivational interviewing on medication adherence in hypertensive African Americans: rationale and design.

BACKGROUND: Hypertension disproportionately affects African Americans compared to whites, and it is the single most common explanation for the disparity in mortality between African Americans and whites. Adherence with antihypertensive medications can help reduce risk of negative hypertension-related outcomes. Motivational interviewing is a promising patient-centered approach for improving adherence in patients with chronic diseases. In this paper we describe the rationale and design of an ongoing randomized controlled trial testing the effectiveness of motivational interviewing versus usual care in improving medication adherence among 190 African American uncontrolled hypertensive patients, who receive care in a primary care setting. METHODS: The usual care group receives standard medical care, while those in the intervention group receive standard care plus four sessions of motivational interviewing at 3-month intervals for a period of 1 year. This technique consists of brief, patient-driven counseling sessions to facilitate initiation and maintenance of behavior change. The primary outcome is adherence to prescribed antihypertensive medication, assessed with the electronic medication events monitoring system (MEMS) and the Morisky self-report adherence questionnaire. Secondary outcomes are within-patient changes in blood pressure, self-efficacy, and intrinsic motivation between baseline and 12 months. We report the baseline sociodemographic and clinical characteristics of the participants. CONCLUSIONS: Despite the potential utility of motivational interviewing, little is known about its effectiveness in improving medication adherence among hypertensive patients, especially African Americans. In addition to the baseline data this study has generated, this trial should provide data with which we can assess the effectiveness of this approach as a behavioral intervention.

Black or African American↗
PubMed2005

Chronic osteoarthritis and adherence to exercise: a review of the literature.

Osteoarthritis (OA) is a chronic disease that disables many aging adults. People with OA are often asked to adhere to prescribed exercise regimens that must be undertaken in the presence of pain and other disease-related symptoms. We conducted a review of literature that focused on what is known about exercise adherence and the factors that influence exercise adherence among people with OA. Results revealed multiple determinants of exercise adherence; however, these determinants have not been carefully studied in the context of exercise adherence and OA. Almost all studies of exercise adherence among people with OA are short-term and do not use validated measures of adherence. Moreover, poor adherence is the most compelling explanation for the declining impact of the benefits of exercise over time. We conclude that interventions to enhance self-efficacy, social support, and skills in long-term monitoring of progress are necessary to foster exercise adherence among people with OA.

Exercise Therapy↗
PubMed2005

A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part I).

Disability and poor quality of life attributable to chronic diseases such as arthritis, diabetes, and heart disease constitute challenging public health problems for American society. In the absence of any effective cure for these conditions, the secondary prevention of complications and improving quality of life and functional capacity through better disease self-management becomes critical and are key objectives of Healthy People 2010. The organizing focus of such disease self-management should be on improving coping, communication, and control by enhancing self-efficacy. Part I of this two-part article describes the common clinical features of chronic diseases and the diverse disease management strategies used for alleviating pain and preventing disability associated with these and reviews the role of self-efficacy as a theoretical framework for successful self-management interventions. Part II identifies and synthesizes the key research evidence for educational interventions designed to enhance individual self-efficacy perceptions and presents implications for practice in patient education.

Chronic Disease↗
PubMed2005

A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II).

Chronic diseases such as arthritis, diabetes, and heart disease that cause pain, functional impairment, social and emotional dysfunction, and premature loss of wage earnings constitute a challenging problem for American society. In the absence of any effective cure for these frequently progressive conditions, the secondary prevention of complications, which requires a high degree of communication and cooperation between patient and clinician, and improving quality of life and functional capacity through better disease self-management becomes critical and are key objectives of Healthy People 2010. Part I of this two-part article described the common clinical features of chronic disease, the diverse disease management strategies used for alleviating pain and preventing disability, and the role of self-efficacy as a framework for intervention. This companion article identifies and synthesizes the key research evidence for educational interventions designed to enhance individual self-efficacy perceptions and presents implications for improving practices in patient education for chronic diseases.

Chronic Disease↗
PubMed2004

A comparison of self-reported hip symptomatology in hip replacement patients and a population-based sample of medicare beneficiaries.

BACKGROUND: There exists variation over geographic areas in the use of total hip arthroplasty. This variation is not explained by the variation in the density per unit area of surgeons. The objective was to compare the severity of hip symptoms between a population-based sample of community-dwelling Medicare beneficiaries and a hospital-based sample of patients undergoing total hip replacement surgery. MATERIAL/METHODS: Population-based survey data on 113 community residents were compared to data from an independent sample of 157 hospital-based patients who underwent total hip replacement surgery, all of whom were 65 years and older. Severity of symptoms in both groups was rated using the Hip Rating Questionnaire (HRQ). RESULTS: The average population sample HRQ score was 63+/-9.0; overall arthritis impact 12+/-5, pain 14+/-6, walking 18+/-4, function 19+/-4. The average patient sample HRQ score was 56+/-14; overall arthritis impact 10+/-7, pain 11+/-4, walking 15+/-4, function 20+/-3. CONCLUSIONS: Community-dwelling individuals report symptoms as severe as patients who have undergone total hip arthroplasty. Further research is necessary to identify the reasons for the low incidence of treatment for those living in the community.

Activities of Daily Living↗
PubMed2004

Falls-prevention programs for older ambulatory community dwellers: from public health research to health promotion policy.

OBJECTIVES: Falls result in significant morbidity and mortality among the elderly. The purpose was to review the public health research literature on falls prevention among community-dwelling older adults and derive evidence-based implications for health promotion policy. METHODS: CINAHL, COCHRANE, EMBASE, MEDLINE, and PUBMED databases were used to search the research literature concerning falls epidemiology, injury mechanisms, and falls-prevention strategies published during 1966-2003. RESULTS: Falls affect one in three older adults living in the community and result in significant fall-related injuries that constitute an important and costly public health problem. There are numerous, but potentially modifiable, determinants of falls. Several community falls-prevention programs have been shown to reduce the incidence of falls and fall-related injuries. CONCLUSIONS: The review suggests that there is compelling evidence from public health research to support health promotion policy for making societal investments in community falls-prevention programs.

Accidental Falls↗
PubMed2004

Preferences for arthritis care among urban African Americans: "I don't want to be cut".

Despite greater disability from knee osteoarthritis among Blacks, Whites are 3-5 times more likely to have total knee replacement (TKR). The authors explored whether beliefs among Blacks about arthritis and surgery contribute to this disparity. Ninety-four Blacks, ages 50 to 89, with knee arthritis underwent semistructured qualitative interviews regarding disability, beliefs about arthritis, beliefs about TKR, and treatment preferences. Content analyses yielded 6 themes: preference for natural remedies, negative expectations of surgery, beliefs about God's control, preference for continuing in their current state, relationships with specialists, and fear of surgery or death. Given its high levels of disability, this cohort had low expectations of TKR. Culturally sensitive educational programs might improve patient altitudes and beliefs regarding TKR, ultimately increasing appropriate usage.

Black or African American↗
PubMed2004

Toward a unified system of accreditation for professional preparation in health education: final report of the National Task Force on Accreditation in Health Education.

During the past 40 years, health education has taken significant steps toward improving quality assurance in professional preparation through individual certification and program approval and accreditation. Although the profession has begun to embrace individual certification, program accreditation in health education has been neither uniformly available nor universally accepted by institutions of higher education. To further strengthen professional preparation in health education, the Society for Public Health Education (SOPHE) and the American Association for Health Education (AAHE) established the National Task Force on Accreditation in Health Education in 2001. The 3-year Task Force was charged with developing a detailed plan for a coordinated accreditation system for undergraduate and graduate programs in health education. This article summarizes the Task Force's findings and recommendations, which have been approved by the SOPHE and AAHE boards, and, if implemented, promise to lay the foundation for the highest quality professional preparation and practice in health education.

Accreditation↗
PubMed2004

Barriers and facilitators of medication adherence in hypertensive African Americans: a qualitative study.

OBJECTIVE: This study explored the perspectives of hypertensive African-American patients, in 2 primary care practices, regarding the factors they perceived as barriers or facilitators of adherence to prescribed antihypertensive medications. DESIGN: This qualitative study used a grounded theory methodology with data collection occurring through in-depth individual patient interviews. SETTING AND PARTICIPANTS: One hundred and six hypertensive African-American patients followed at 2 urban primary care practices participated in the open-ended interviews. METHODS: During interviews, patients' experiences taking antihypertensive medications and their perceptions of the challenges they face in adhering to their medications as prescribed were explored. Patients were also asked about the situations that make it easy or difficult for them to take their antihypertensive medications as prescribed and the skills they thought were necessary for patients to adhere to their medications as prescribed. All responses were recorded verbatim and analyzed using grounded theory methodology. RESULTS: Fifty-eight percent of participants were women, mean age was 56 years, and 60% had uncontrolled hypertension. Four categories of barriers and 5 categories of facilitators were identified. The barriers included patient-specific, medication-specific, logistic, and disease-specific barriers. The facilitators included use of reminders, having a routine, knowledge about hypertension, its treatment and complications, having social support and good doctor-patient communication. CONCLUSION: This study provides a framework for investigating issues of medication adherence in hypertensive African Americans by describing a taxonomy of barriers and facilitators of adherence identified by patients.

Black or African American↗
PubMed2004

Expectations of blood pressure management in hypertensive African-American patients: a qualitative study.

In patients with chronic diseases, expectations of care are associated with clinical outcomes. Using open-ended interviews, we elicited the expectations of treatment in 93 hypertensive African-American patients. During routine clinic visits, patients were asked, "What are your expectations of the treatment your doctor prescribed for your high blood pressure?" Their responses were explored with the probes: Do you expect to take your blood pressure medications for the rest of your life? Do you expect to take your medications daily regardless of symptoms? Do you expect a cure for your high blood pressure? Using standard qualitative techniques, patients' responses were grouped into a taxonomy of three categories of expectations reflecting patients' role, physicians' role, and medication effects. They expected to take active role in their treatment, especially as it relates to adoption of healthy behaviors. They expected their physicians to educate them about blood pressure treatment, and they expected medications to lower their blood pressure and prevent heart attack, stroke, and kidney failure. Despite such appropriate expectations, a considerable proportion of patients had nonbiomedical expectations of their treatment-38% expected a cure, 38% did not expect to take their medications for life and 23% take medications only with symptoms. The taxonomy of patient expectations outlined in this study may serve as a useful framework for patient education and counseling about hypertension and its management in this patient population.

Black or African American↗
PubMed2003

Grounding a new information technology implementation framework in behavioral science: a systematic analysis of the literature on IT use.

Many interventions to improve the success of information technology (IT) implementations are grounded in behavioral science, using theories, and models to identify conditions and determinants of successful use. However, each model in the IT literature has evolved to address specific theoretical problems of particular disciplinary concerns, and each model has been tested and has evolved using, in most cases, a more or less restricted set of IT implementation procedures. Functionally, this limits the perspective for taking into account the multiple factors at the individual, group, and organizational levels that influence use behavior. While a rich body of literature has emerged, employing prominent models such as the Technology Adoption Model, Social-Cognitive Theory, and Diffusion of Innovation Theory, the complexity of defining a suitable multi-level intervention has largely been overlooked. A gap exists between the implementation of IT and the integration of theories and models that can be utilized to develop multi-level approaches to identify factors that impede usage behavior. We present a novel framework that is intended to guide synthesis of more than one theoretical perspective for the purpose of planning multi-level interventions to enhance IT use. This integrative framework is adapted from PRECEDE/PROCEDE, a conceptual framework used by health planners in hundreds of published studies to direct interventions that account for the multiple determinants of behavior. Since we claim that the literature on IT use behavior does not now include a multi-level approach, we undertook a systematic literature analysis to confirm this assertion. Our framework facilitated organizing this literature synthesis and our analysis was aimed at determining if the IT implementation approaches in the published literature were characterized by an approach that considered at least two levels of IT usage determinants. We found that while 61% of studies mentioned or referred to theory, none considered two or more levels. In other words, although the researchers employ behavioral theory, they omit two fundamental propositions: (1) IT usage is influenced by multiple factors and (2) interventions must be multi-dimensional. Our literature synthesis may provide additional insight into the reason for high failure rates associated with underutilized systems, and underscores the need to move beyond the current dominant approach that employs a single model to guide IT implementation plans that aim to address factors associated with IT acceptance and subsequent positive use behavior.

Attitude to Computers↗
PubMed2003

Self-efficacy in management of osteoarthritis.

Self-efficacy, a psychologic construct defined as one's confidence in performing a particular behavior, is a significant predictor of psychologic well-being, adherence to prescribed treatments, and pain coping mechanisms in persons who have arthritis. This article reviews the theory of self-efficacy, describes application of self-efficacy to the management of osteoarthritis (OA), and presents approaches to enhancing the patient's self-efficacy in management of OA and prevention of OA-related disability.

Humans↗
PubMed2003

Development and evaluation of a medication adherence self-efficacy scale in hypertensive African-American patients.

Self-efficacy, a known predictor of a wide range of health behaviors, has not been investigated in studies of adherence to antihypertensive medications. A medication adherence self-efficacy scale was developed and evaluated in ambulatory hypertensive African-American patients in two sequential phases. For the item-generation phase, open-ended interviews with 106 patients were used to elicit their experiences with taking antihypertensive medications. Using qualitative techniques, responses were recorded verbatim, coded, and sorted into nine categories of barriers and facilitators of medication adherence. Concepts from categories were formatted into an initial 43-item self-efficacy questionnaire, which was administered to another group of 72 patients for the item analyses phase. Twenty-six items were retained for the final self-efficacy scale based on item-to-total correlation coefficient >0.5, kappa >0.4, and clinical relevance of individual items. Clinicians and researchers can use this scale to identify situations in which patients have low self-efficacy in adhering to prescribed medications.

Adult↗
PubMed2003

Hip fractures among the elderly: causes, consequences and control.

This review examines all pertinent literature sources published in the English language between 1966 to the present concerning hip fracture epidemiology, hip fracture injury mechanisms, and hip fracture management strategies. These data reveal hip fractures have several causes, but among these, the impact of falls and muscle weakness, along with low physical activity levels seems to be the most likely explanation for the rising incidence of hip fracture injuries. Related determinants of suboptimal nutrition, drugs that increase fall risk and lower the safety threshold and comorbid conditions of the neuromuscular system may also contribute to hip fracture disability. A number of interventions may help to prevent hip fracture injuries, including, interventions that optimize bone mass and quality, interventions that help prevent falls and falls dampening interventions. Rehabilitation outcomes may be improved by comprehensive interventions, prolonged follow-up strategies and ensuring that all aging adults enjoy optimal health.

Aged↗