Biomedical subjects

P D Mullen

Publications and source records attributed to P D Mullen.

At least 19 recordsLinked to original sources

PubMed1992

A meta-analysis of controlled trials of cardiac patient education.

Because of the heavy burden of morbidity and mortality exacted by coronary heart disease and the role of behavior in secondary prevention, patient education is a crucial part of cardiac care. Yet evaluations of such programs have not been synthesized to assess the average effects nor which program characteristics have greatest impact. This study used the quantitative methods of meta-analysis to answer these questions, with 28 controlled studies measuring behavioral and clinical outcomes. Results indicate that cardiac patient education programs have demonstrated a measurable impact on blood pressure, mortality, exercise, and diet, other parameters are positively affected, although less consistently. Type of communication channel did not influence outcome; adherence to educational principles did. Thus, cardiac programs should use reinforcement, give feedback, offer opportunity for individualization, facilitate behavior change through skills and resources, and be relevant to patients' needs and abilities.

Adult↗

PubMed1992

Characteristics of controlled studies of patient education and counseling for preventive health behaviors.

To determine characteristics of controlled studies (quasi-experimental and randomized) of clinical patient education/counseling for behavior change to prevent disease, we conducted an extensive literature review of published and unpublished studies from 1971 to 1989. Sixty-four studies with 101 intervention groups met specific criteria for relevance and scientific acceptability. We examine these studies in terms of prevention area, subject source, intervention characteristics, and use of educational principles. Findings reveal many controlled clinical studies in smoking cessation, nutrition, and weight control but sparcity in other areas (injury prevention, exercise, stress, drug and alcohol misuse, STD prevention); an emphasis on communication by a single clinical practitioner; and varied use of educational principles. We recommend adhering to educational principles to enhance likelihood of success.

Adolescent↗

PubMed1991

Improving disclosure of smoking by pregnant women.

Smoking is a major modifiable risk factor in pregnancy, and low-cost interventions have been developed and tested in diverse populations of pregnant smokers. Successful intervention depends on identification, however, and nondisclosure can be a problem. This randomized study compared rates of disclosure with two response formats--multiple choice, in which the patient is able to describe herself as having "cut down," and the usual history question, "Do you smoke?," in which she is forced to answer simply "yes" or "no". Each format was tested in both oral and written channels with a multiethnic adult prenatal population (n = 1078) entering care in a multispecialty group. Study results indicate that the multiple choice question improved disclosure, regardless of channel (oral versus written), by 40%. This effect was observed across racial and ethnic groups. Biochemical tests of urine samples from reported nonsmokers indicated smoking in only 3%. Eleven percent of the "nonsmokers" in the experimental groups refused consent for the urine test, however, and many of these were probably smokers.

Adolescent↗

PubMed1991

Identifying pregnant women who drink alcoholic beverages.

This randomized 2 x 2 study compared disclosure rates of alcohol use with two response formats (multiple choice and dichotomous) and two communication channels (oral and written) in an adult prenatal population (N = 1078). The multiple choice question improved disclosure, regardless of channel, by 40% across white, African-American, and Hispanic subgroups.

Adult↗

PubMed1991

Assessing the congruence between physician behavior and expert opinion in smoking cessation counseling.

This study examines the degree of transfer of smoking cessation innovation from research to health care settings by comparing frequency-of-practice ratings by a national sample of family practice physicians (n = 903, response rate = 70%) and importance ratings by smoking cessation and prevention experts (n = 58, response rate = 84%) for 14 counseling techniques. The physician survey elicited a profile that combines traditional and behavioral techniques--discussing smoking with patients, encouraging goal setting, suggesting specific steps for quitting, and presenting pamphlets. They refer to others infrequently and rarely report planning for follow-up about smoking. The experts rated these selected techniques as moderately to highly important. They favored a behavioral approach coupled with active follow-up. The major differences between physician and expert rankings were that the experts placed higher priority on planned follow-up and a lower priority on pamphlets. The uneven quality of counseling reported by physicians suggests that weighting their responses according to expert opinion would provide a more sensitive profile. Scaled weighting produced scores that may help researchers define a composite quality-quantity measure of activity.

Adult↗

PubMed1991

Women who stop smoking spontaneously prior to prenatal care and predictors of relapse before delivery.

This study explores the experience of pregnant women who quit smoking prior to initiating prenatal care. These "spontaneous quitters" comprised 41% of a socioeconomically and ethnically diverse population of prepregnancy smokers enrolled in a health maintenance organization. Compared to women who were smoking at the start of prenatal care, spontaneous quitters had been lighter smokers, were less likely to have another smoker in their household, indicated a stronger belief in the harmful effect of maternal smoking, had a history of fewer miscarriages, and entered prenatal care earlier. Biochemical validation of smoking status over the course of pregnancy found that 21% of the spontaneous quitters relapsed prior to delivery. Characteristics reported at the first prenatal visit that were associated with maintenance included having achieved cessation for a longer period of time without smoking even a puff, higher self-efficacy for maintenance, stronger belief in the harmful effect of maternal smoking, primigravida, and greater frequency of nausea. The identification of spontaneous quitters and selected intervention for those at greatest risk of relapse is recommended for inclusion in routine prenatal care.

Adult↗

PubMed1990

Identifying families at high risk of cardiovascular disease: alternative work site approaches.

By examining coverage, concordance, and costs, this project evaluated four methods of cardiovascular disease (CVD) risk screening at a work site with 1821 central office employees of an energy company in Houston, Tex. Screening methods included a health risk appraisal mail questionnaire (HRA), an HRA plus brief physical assessment, an analysis of medical claims data, and an analysis of absenteeism data. Coverage ranged from 99% of employees for the absenteeism method to about 30% for the HRA method. Combining the first three screening methods, 18% of families had at least one member with a CVD or related diagnosis or one of four major CVD risk factors. The absenteeism method yielded 12.1% of the central office employees with 9 or more days absent. Although the absenteeism method identified high-cost families, only 9% had a heart disease or related diagnosis. This lack of concordance also occurs with other methods. For example, only 9.4% of families identified with the claims data were also identified by the HRA. Therefore, the methods identify different groups of high-risk families. Findings are discussed in relation to costs and other factors important to firms' selection of screening methods.

Absenteeism↗

PubMed1990

Maintenance of nonsmoking postpartum by women who stopped smoking during pregnancy.

This paper describes self-reported maintenance of nonsmoking at six months postpartum by women whose abstinence was verified beginning before the 20th week of pregnancy and continuing through delivery (n = 134). The overall maintenance rate of 37 percent was not related to sociodemographic characteristics, smoking and obstetric history, the time when quitting occurred, or a prenatal smoking cessation program. Although this rate is encouraging, more attention should be directed to sustaining prenatal abstinence from smoking beyond delivery.

Adult↗

PubMed1989

Patterns of counseling techniques used by family practice physicians for smoking, weight, exercise, and stress.

Members of the American Academy of Family Physicians (nonfederal, continental U.S.) were surveyed regarding their involvement in health-habit modification (response rate = 70.4%, n = 903). Frequency and indications for use of specific counseling techniques were assessed in each of four health-habit areas: smoking, exercise, weight control, and stress management. Factor analysis of responses produced clusters of techniques labeled "traditional teaching," "behavioral," "interpersonal with follow-up," and "referral." The dominant style varied by health-habit area. The factors were less clear for stress than for the other three areas. Results indicated no relationships or weak relationships between counseling approaches and physician gender, year of graduation, board status, region, community size, practice type, average visit length, and selected patient characteristics. Study findings suggest that family physician counseling varies with the health habit and that background and practice variables are not associated with counseling approach.

Attitude of Health Personnel↗

PubMed1989

A randomized trial of a serialized self-help smoking cessation program for pregnant women in an HMO.

We report the results of a population-based randomized clinical trial that tested the effectiveness of a prenatal self-help smoking cessation program. The intervention consisted predominantly of printed materials received through the mail. The population (n = 242) consisted of a socioeconomically and ethnically diverse group of pregnant women enrolled in a large health maintenance organization (HMO) who reported they were smoking at the time of their first prenatal visit. Biochemical confirmation of continuous abstinence achieved prior to the 20th completed week of pregnancy and lasting through delivery revealed 22.2 per cent of the women in the eight-week serialized program quit versus 8.6 per cent of controls with usual care. The adjusted odds ratio was 2.80 (95 per cent CI = 1.17, 6.69). We conclude that a low-cost prenatal self-help intervention can significantly affect the public health problem of smoking during pregnancy and its associated risks for maternal and child health.

Adolescent↗

PubMed1989

Cardiovascular mortality trends in Harris County, Texas: 1980 to 1986.

Cardiovascular diseases are the leading causes of death in Texas and in the United States. This study determines the trend in mortality rates attributed to cardiovascular diseases in Harris County from 1980 to 1986. The region of the county that does not include the City of Houston was specifically studied. Mortality of cardiovascular diseases in these two areas follow patterns similar to that of the United States in the same time period. Both the entire county and Harris County excluding Houston show declines in cardiovascular mortality rates in the 7-year period. The populations were divided into four ethnic categories (white, black, Hispanic and "other"), and each ethnic group reported significant declines in overall cardiovascular mortality except in the "other" population, which showed an increase in the male group. Significant downward trends were noticed in the white and Hispanic population in the two major subcategories of cardiovascular diseases: diseases of the heart and cerebrovascular diseases. The black population in each geographic area studied was consistently higher in cardiovascular mortality than the other three ethnic groups observed (white, Hispanic and "other"). Knowledge of cardiovascular disease mortality rates by ethnicity, sex, and age as well as temporal changes in mortality rates within Harris County are important for health planners in continuing and implementing programs aimed at awareness, prevention, and treatment of cardiovascular diseases.

Cardiovascular Diseases↗

PubMed1988

Predictors of safety belt initiative by primary care physicians. A social learning theory perspective.

Even with the passage of state safety belt laws, primary care physicians can contribute to their patients' safety by brief interventions. The present study explores the prevalence of such action with adult patients and tests the power of constructs taken from social learning theory to explain physicians' behavior. These constructs included self-efficacy, personal behavior (self-modeling) and three outcome expectations--expectation of patient follow-through, health impact, and impact of health promotion on the practice. Data were taken from a survey of Texas family physicians prior to enactment of the state law (n = 209). History-taking and advising were combined to form a single scale, "safety belt action." Prevalence of safety belt action was low. Overall, only 5% said they ask routinely about safety belts; 58.1% do not advise or discuss the risk even when they are aware of nonuse. Social learning theory variables accounted for 34% of the variance in safety-belt action after controlling for year of graduation in a hierarchical regression analysis. Self-efficacy was entered first, and it predicted 25% of the variance. The other social learning variables were entered together, and they predicted the additional 9% of the variance after controlling for year of graduation and self-efficacy. Of these other variables, only health impact was significant, however. These findings suggest several avenues for improving safety belt action and add evidence for the importance of outcome expectations over and above self-efficacy.

Adult↗

PubMed1988

Health promotion and patient education benefits for employees.

One step that employers can take to assure that employees receive such education services is pursuing coverage of education as a separate service. For some time now, insurers have shown interest in patient education services (15-17, 61), but patient education "integral to care" is typically covered only as a part of the "per diem" in the case of hospitals or as part of the visit fee in the case of outpatient visits. Education for patients with diabetes is being covered experimentally as a separate service in at least 17 states. Physicians whose practice is composed largely of "cognitive services" rather than "procedures" are also interested in education as a reimbursable service. The same arguments as described in relation to coverage of risk reduction services generally apply to this case. Education programs for employees who are under medical care can improve their adherence to the recommended regimen and hence can improve the effectiveness of care. Education and counseling prior to surgical and other stressful procedures decrease stress and the need for pain medications, and they can shorten the length of hospital stays. Education is an important component of programs to substitute home care for hospital care or expensive outpatient care. Currently, however, a patient cannot rely on usual providers of medical care to offer adequate education. Reimbursement for patient education on a selected, experimental basis is probably warranted for chronic conditions requiring complex adjustments and regimens. Cases of asthma where there is a history of hospitalization or emergency room visits is an excellent possibility. The experience of covering diabetes education should be monitored to help resolve the debate.

Group Processes↗

PubMed1988

Selected allied health professionals' self-confidence in health promotion counseling skills and interest in continuing education programs.

Mail surveys of samples of dental hygienists (n = 90, 36% response), registered dietitians (n = 262, 52% response), and physician assistants (n = 289, 89% response) in Texas and certified nurse midwives (n = 143, 57% response) in the US provided data regarding their confidence that they possess skills and knowledge to counsel patients about selected areas of health promotion (self-efficacy). Also, the surveys gathered information regarding respondents' beliefs that patients will follow through on their recommendations (adherence expectation), and their interest in continuing education programs. Overall, respondents displayed highest self-efficacy with regard to counseling patients about blood pressure and smoking. Confidence was lowest in illicit drug abuse and mental health areas. Certified nurse midwives and physician assistants indicated confidence in many more areas than the other two groups. Respondents consistently expressed less certainty about patient adherence than about their own skills and knowledge. They generally indicated a high degree of interest in continuing education across the several health promotion topics. Modest relationships were observed between self-efficacy and interest in continuing education programs for physician assistants and registered dietitians, indicating that those with greater self-efficacy had a greater interest in building their skills. A similar pattern was observed among physician assistant respondents with respect to adherence expectations.

Allied Health Personnel↗

PubMed1987

Health behavior models compared.

This study compares the health belief, Fishbein/Ajzen, and PRECEDE models to predict changes in smoking, exercise, and consumption of sweet and fried foods over an eight-month interval. Data were collected from a panel of 326 adults in two large cities of the western United States. The PRECEDE model accounted for more variance in behavior than both the Fishbein/Ajzen and health belief models, but it required far more questions. Fishbein/Ajzen and PRECEDE provide a limited theoretical basis for selecting specific types of beliefs or predisposing factors without turning to the health belief model, making the health belief model complementary to either Fishbein/Ajzen or PRECEDE.

Adolescent↗

PubMed1987

Patients' substance abuse and the primary care physician: patterns of practice.

The Social Learning Theory concepts of self-efficacy and outcome expectations were used to study physician practice regarding patients' smoking, alcohol problems, OTC drug problems, and illicit drug use in a random sample of Texas primary care physicians. The highest proportion of physicians took histories and counseled patients regarding the abuse of cigarettes, followed by alcohol, OTC drugs, and illicit drugs. Outside referral was most likely for illicit drugs, followed by alcohol, OTC drugs, and smoking. Multivariate discriminant analysis showed year of graduation, specialty, self-efficacy, and outcome expectation for patient compliance to be predictive of many of the behavior/practice level combinations. More recently trained physicians, internists, and family practice specialists were more likely to practice in the substance abuse areas. Self-efficacy and outcome expectation were positively related to history-taking and counseling and negatively related to outside referral. Interventions to increase physicians' self-efficacy and expectations for patient compliance and to provide more realistic expectations for treatment "success" are needed, especially for physicians who are not recently trained. Further research to clarify the process by which physicians' cognitions of self-efficacy and outcome expectations influence their practice behavior is also recommended.

Alcoholism↗

PubMed1987

Health promotion and disease prevention beliefs and behaviors of dietetic practitioners.

Fifty-three percent of a random sample of 500 members of the Texas Dietetic Association responded to a survey designed to determine their personal health behavior, beliefs, and patient counseling practices related to health promotion and disease prevention. This article reports the responses of the 180 practitioners involved in direct patient care in order to depict the health promotion/disease prevention beliefs and behaviors of that particular group. Health habits (e.g., smoking, physical activity, and dietary patterns) of dietetic practitioners were better than those of the general female population. Personal health habits related to not smoking and to getting regular exercise were significantly associated with belief in the importance of that behavior for others. Although most of the dietetic practitioners indicated that the identified health behaviors were important to the health of the average person, only a few practitioners gave them routine attention in their practice. Respondents generally expressed a lack of confidence in their ability to educate clients about specified health behaviors, with the exception of weight control, high-fat diets, elevated blood pressure, and exercise patterns. The practitioners' confidence in their counseling skills was significantly correlated with intensity of counseling (p less than or equal to .001) and the likelihood of client compliance, except in the area of weight control. The majority of the dietitians strongly agreed that health promotion will be more important in the future.

Attitude of Health Personnel↗

PubMed1987

Efficacy of psychoeducational interventions on pain, depression, and disability in people with arthritis: a meta-analysis.

Meta-analysis is a technique which combines data from several properly and similarly designed controlled studies so as to increase the power of the relevant statistical analysis. Fifteen studies on the effects of psychoeducational interventions on disability, pain and depression in individuals with chronic rheumatoid arthritis or osteoarthritis were analyzed by this method. The results indicate that patient education can indeed contribute to improving the health status of such patients.

Adult↗