Interpersonal processes and vasculitis management.
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Chronic Disease↗
Biomedical subjects
Robert F DeVellis
Publications and source records attributed to Robert F DeVellis.
Classical test theory.
Classical test theory (CTT) comprises a set of concepts and methods that provide a basis for many of the measurement tools currently used in health research. The assumptions and concepts underlying CTT are discussed. These include item and scale characteristics that derive from CTT as well as types of reliability and validity. Procedures commonly used in the development of scales under CTT are summarized, including factor analysis and the creation of scale scores. The advantages and disadvantages of CTT, its use across populations, and its continued use in the face of more recent measurement models are also discussed.
Data Collection↗
Encouraging patient adherence: primary care physicians' use of verbal compliance-gaining strategies in medical interviews.
Compliance-gaining strategies refer to subtle differences in ways people use language when their goal is to influence someone else's behavior. This stands in contrast to other kinds of persuasion aimed only at influencing others beliefs and attitudes. We have developed a new method of coding what physicians say when they are trying to influence patients' behaviors. This method applies theory and methods from the fields of interpersonal influence, linguistics and social psychology. We tested the reliability of this new method by randomly selecting 37 audiotaped medical interviews collected for an unrelated study [J. Gen. Int. Med., 9 (1994) 402] and having three coders independently identify physician compliance-gaining utterances and then independently apply one of 57 codes to each utterance. These codes also were categorized on two underlying dimensions reflecting whether the physician (1) framed the compliance-gaining utterance in a direct or indirect way, and (2) did or did not give a justification for that direct or indirect request. Reliability among coders and coders agreement with the final utterance identification and coding decisions, measured as per cent agreement among coders and/or, where appropriate, by Cohen's kappa were good to excellent. Most physicians' strategies were indirect and incomplete. For female patients, physicians used significantly more strategies, including more indirect strategies, complete strategies, "prescriptions" and "demands". For male patients, physicians used a greater percent of direct strategies, including "procedural demands". This method provides a reliable and promising new technique for observing naturally occurring physician compliance-gaining speech.
Adult↗
Factors associated with potentially inappropriate drug utilization in a sample of rural community-dwelling older adults.
BACKGROUND: Many medications present special risks when used by older adults (ie, those aged > or = 65 years) and are considered potentially inappropriate for this population. The Beers criteria are often used to identify such medications. Past research has documented that use of Beers drugs is common among older adults. OBJECTIVE: The aim of this work was to examine factors associated with potentially inappropriate drug use among rural community-dwelling older adults using a conceptual framework adapted from the Andersen-Newman behavioral model of health service use. METHODS: This was a population-based, cross-sectional survey. Data were collected via face-to-face home interviews between 2002 and 2004. Rural community-dwelling older adults residing in a single county in North Carolina were eligible. Potentially inappropriate drug use was operationalized using the Beers criteria. Data concerning predisposing (ie, age, sex, race, education, and marital status), enabling (ie, social support and insurance status), need (ie, disability and history of major depression, hypertension, osteoarthritis, back problems, or other comorbidities), and utilization factors (ie, number of medications used) were collected. RESULTS: Data were gathered from 892 people, with information on medication use available for 800. Two hundred thirteen of these 800 participants (26.6%) used > or = 1 Beers drug. Compared with individuals who used no Beers drugs, those who used > or = 1 Beers drug reported lower levels of social support (odds ratio [OR], 0.94; 95% CI, 0.90-0.99) and higher levels of disability (OR, 1.48; 95% CI, 1.11-1.97), used more medications (OR, 1.07; 95% CI, 1.01-1.13), and were more likely to have a history of major depression (OR, 1.67; 95% CI, 1.05-2.66), hypertension (OR, 1.58; 95% CI, 1.07-2.33), osteoarthritis (OR, 1.58; 95% CI, 1.09-2.29), and back problems (OR, 1.72; 95% CI, 1.19-2.47). CONCLUSION: As suggested by the Andersen-Newman model, the risk of potentially inappropriate drug use is highest among those with the greatest medication needs, as evidenced by poorer health status in this sample of rural community-dwelling older patients.
Adult↗
Patients' perceptions of primary care physicians' participatory decision-making style and communication about complementary and alternative medicine for arthritis.
OBJECTIVE: The purpose of this study was to examine: (1) which patient demographics were related to whether patients rated their family physicians as using a participatory decision-making style, and (2) whether arthritis patients who reported using complementary and alternative medicine (CAM) were more likely to report discussing CAM use with their providers if they saw family physicians rated with participatory decision-making styles. METHODS: A survey that asked about health status, demographics, physician use of a participatory decision-making style, and medical skepticism was sent to 2178 patients with arthritis who attended 16 different family practice sites that were part of a research network in rural and urban North Carolina. Generalized estimating equations were used to analyze the data. RESULTS: Younger and more educated patients were more likely to rate their family physicians as using participatory styles. In all, 71% of patients who reported having used one or more CAM strategy reported having discussed it with their physicians. Patients who rated their health as worse, reported using more categories of CAM, and rated their physicians as being using participatory styles were more likely to tell their physicians about their CAM use. CONCLUSION: Our findings suggest that if providers use more participatory styles with patients and involve them when making treatment decisions; patients will tell providers more about what they are doing for their health.
Adult↗
Cross-cultural adaptation and validation of the Brazilian Portuguese version of the short musculoskeletal function assessment questionnaire: the SMFA-BR.
BACKGROUND: This study was designed to translate, culturally adapt, and validate a Brazilian Portuguese version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-BR). METHODS: The SMFA was translated from English into Brazilian Portuguese. Translations were synthesized, translated back into English, and then submitted to a committee of clinical, psychometric, and language experts. The questionnaire was then administered to 220 trauma patients at a midsize hospital in southern Brazil. Test-retest reliability was examined at one and seven days. Scale reliability and validity were assessed, and factor structure was analyzed. RESULTS: Patients with only one region of dysfunction reported less dysfunction than did patients with two or three regions of dysfunction. Both the SMFA-BR dysfunction and the SMFA-BR bother scores had significant correlations with all Brazilian Short Form-36 (SF-36) subscales except for bodily pain. Test-retest reliabilities, as determined by intraclass correlation analyses, were 0.99 (95% confidence interval, 0.97, 1.00) at one day (n = 10) and 0.99 (95% confidence interval, 0.96, 1.00) at seven days (n = 17) for the dysfunction index and 0.99 (95% confidence interval, 0.98, 1.00) at one day (n = 10) and 0.97 (95% confidence interval, 0.97, 1.00) at seven days (n = 17) for the bother index. Cronbach alpha reliabilities were 0.95 (95% confidence interval, 0.93, 0.97) and 0.91 (95% confidence interval, 0.89, 0.94) for the dysfunction and bother indices, respectively. Minimal ceiling and floor effects were observed for the bother subscale only. Exploratory factor analysis yielded a three-factor structure: upper-extremity dysfunction, lower-extremity dysfunction, and bother. CONCLUSIONS: A reliable and valid Brazilian Portuguese version of the SMFA was developed. It will facilitate the examination of functional performance within a large patient population as well as allow cross-cultural comparisons.
Adolescent↗
Dietary patterns and prostate cancer risk in the National Health and Nutrition Examination Survey Epidemiological Follow-up Study cohort.
Ecological studies implicate a "Western" diet in prostate cancer development, but whether dietary patterns measured in individuals are associated with risk has not been studied previously. We examined this issue using prospective data from the nationally representative United States Health Examination Epidemiological Follow-up Study. Among 3,779 men followed from 1982-84 to 1992, 136 incident cases were identified. Using principal component analysis on responses to a 105-item dietary questionnaire, the following three distinct patterns were identified: a vegetable-fruit pattern; a red meat-starch pattern characterized by red meats, potatoes, cheese, salty snacks, and desserts; and a Southern pattern characterized by such foods as cornbread, grits, sweet potatoes, okra, beans, and rice. In adjusted proportional hazards models, prostate cancer risk was not associated with the vegetable-fruit or red meat-starch pattern, but higher intake of the Southern pattern showed a reduction in risk (3rd versus 1st tertile relative risk, 0.6; 95% confidence interval, 0.4-1.1; trend P = 0.08) that approached statistical significance. The inverse association was observed in black and non-black men and was not attributable to intake of any individual foods or nutrients. A Southern dietary pattern may reflect a history of living in the South and serve as an integrative marker of sunlight exposure and protection through 1,25-dihydroxyvitamin D production. Further evaluation and better characterization of the pattern would offer more information on potentially beneficial features of the diet or its associated lifestyle.
Diet↗
Health care preferences and priorities of adolescents with chronic illnesses.
BACKGROUND: Efforts to make health care for adolescents with chronic illnesses more patient-centered must be grounded in an understanding and clear measures of adolescents' preferences and priorities. OBJECTIVE: To develop a measure of health care preferences of adolescents with chronic illnesses and to determine demographic, developmental, and health factors associated with adolescents' preferences. DESIGN: Mixed-method questionnaire development and survey. SETTING: Subspecialty clinics of a tertiary care children's hospital. PARTICIPANTS: All adolescents (age: 11-19 years) with juvenile rheumatoid arthritis, sickle cell disease, inflammatory bowel disease, or cystic fibrosis of at least 2-year duration who were being treated at the participating center were eligible to participate, and 155 of 251 did so (62%). The participants had a mean age of 15.5 +/- 2.4 years, 45% were male, and 75% were white. INTERVENTION: None. MAIN OUTCOME MEASURES: Ratings of 65 items related to quality of care and 17 items related to physician-patient communication styles. RESULTS: An 82-item questionnaire, devised from qualitative analysis of focus group results, contained 65 Likert scale items that adolescents considered important for health care quality and 17 forced-choice items related to adolescents' preferences for communication. Among the first 65 items, the group of questions related to physician trust and respect had the highest rating of 5.24 +/- 0.62 of 6, followed by patient power and control (mean rating: 4.72 +/- 0.77) and then caring and closeness in the patient-doctor relationship (mean rating: 4.19 +/- 0.91). For the communication items, the adolescents, on average, preferred communication directly to them rather than to their parents and were nearly neutral regarding physicians' inquiries about personal issues. CONCLUSIONS: Participants rated aspects of interpersonal care (especially honesty, attention to pain, and items related to respect) as most important in their judgments of quality. As in most previous studies of adults, technical aspects of care were also rated highly, suggesting that adolescents understand and value both scientific and interpersonal aspects of care.
Adolescent↗
Critical review of arthritis self-management strategy use.
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Arthritis↗
Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review.
STUDY DESIGN: A systematic review was conducted. OBJECTIVE: To identify, evaluate, and compare standard scales for assessing neck pain or dysfunction. SUMMARY OF BACKGROUND DATA: The degree of a patient's neck pain or dysfunction can be evaluated using standardized scales at the time of a clinical encounter or during the performance of clinical research protocols. The choice of a scale with the most appropriate characteristics, however, is always a challenge to clinicians and researchers. METHODS: Articles concerning scales for functional evaluation of neck pain or dysfunction were identified by computer searching of MEDLINE (January 1966 to June 1999) and CINAHL (1985 to 2000), citation tracking using the Citation Index, hand searching of relevant journals, and correspondence with experts. RESULTS: Five standard scales were found. Three scales were remarkably similar in terms of structure and psychometric properties: the Neck Disability Index, the Copenhagen Neck Functional Disability Scale, and the Northwick Park Scale. However, only the first instrument has been revalidated in different study populations. The Neck Pain and Disability Scale provides a visual template for collection of information, but its usefulness is limited if the questionnaire must be read to the patient. The Patient-Specific Functional Scale is very sensitive to functional changes in individual patients, but comparisons between patients are virtually impossible. CONCLUSIONS: The five scales identified in this study have similar characteristics. The Neck Disability Index, however, has been revalidated more times for evaluation of patient groups. For individual patient follow-up evaluation, the Patient-Specific Functional Scale has high sensitivity to change, and thus represents a good choice for clinical use. The final choice should be tailored according to the target population and the purpose of the evaluation.
Disability Evaluation↗
Measurement adequacy of the CES-D among a sample of older African-Americans.
This manuscript examines the measurement adequacy of the CES-D when applied in older African-Americans (n=227). The response distribution was skewed towards less symptomatology on all items, and the internal consistency of the CES-D was acceptable (alpha=0.86). An exploratory factor analysis revealed four underlying factors of depressive symptomatology: (1) depressive/somatic; (2) positive; (3) interpersonal; and (4) social well-being. The primary factor was a combination of depression and somatic symptoms, a commonly reported uni-dimensional factor among ethnic groups. Additionally, a fourth factor emerged that has not previously been identified, labeled 'social well-being'. This factor consisted of three items that may tap into the social interactions of the elderly: appetite, hopeful, and talk. These findings contribute to the growing body of evidence on the unique measurement properties of the CES-D across diverse populations.
Black or African American↗
Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction.
PURPOSE: Evidence concerning the effect of circumcision on sexual function is lacking. Men circumcised as adults are potentially in a unique position to comment on the effect of a prepuce on sexual intercourse. We examine sexual function outcomes in men who have experienced sexual intercourse in the uncircumcised and circumcised states. MATERIALS AND METHODS: Men 18 years old or older when circumcised were identified by billing records during a 5-year period at an academic medical center. Medical charts were reviewed for confirmation of the procedure and to identify the indication(s). These men were surveyed to assess erectile function, penile sensitivity, sexual activity and overall satisfaction. Data were analyzed using paired t tests to compare category scores before and after circumcision. RESULTS: A total of 123 men were circumcised as adults. Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised. CONCLUSIONS: Our findings may help urologists better counsel men undergoing circumcision as adults. Prospective studies are needed to better understand the relationship between circumcision and sexual function.
Adult↗
The relationship between STD locus of control and STD acquisition among adolescent girls.
This longitudinal study examined adolescent girls' perception of control over sexually transmitted disease (STD) acquisition. Participants were asked questions regarding their perception of their STD locus of control (internal control; control by parents, partners, peers, and health care providers; and chance) at two waves of data collection. Of the 116 participants (mean age = 17 years), 82% were African-American and 18% were Caucasian. Responses to the measure of locus of control were significantly correlated across a 6-month interval. The responses regarding internal control, control by partner, and chance were not related to the acquisition of an STD in the next 6 months. Further, they were not influenced by an STD in the preceding 6 months. These results indicate that responses to a locus of control measure were stable over a 6-month period, and internal, partner, and chance locus of control perceptions seem to be neither determined by STD experience nor directly related to future STD acquisition. However, understanding an individual's locus of control may be helpful in providing appropriate counseling. Future research could examine how adolescent girls form their perceptions of control over STD acquisition.
Adolescent↗
Reliability and validity of a measure of perceived diabetes and dietary competence in African American women with type 2 diabetes.
PURPOSE: A general measure of perceived diabetes and dietary competence (PDDC) was developed to assess a person's sense of confidence and perceived behavioral control in diabetes and dietary self-management. Internal structure, reliability, and construct validity were evaluated. METHODS: There were 2 samples of African American women with type 2 diabetes; 226 patients in the development sample and 225 patients in the validation sample. Factor analysis, Cronbach's coefficient alpha, and correlation analysis were used to assess reliability and validity of the PDDC measure. RESULTS: Three subscales were empirically determined by factor analysis: positive competence, negative dietary competence, and negative control. Cronbach's alphas for all subscales were good. Predicted relationships with measures of perceived health competence, self-efficacy, social support, and perceived dietary barriers were largely supported in construct validation. CONCLUSIONS: This study provides initial support for the internal reliability and validity of a perceived diabetes and dietary competence measure. Further research is needed to determine its validity in other samples of African Americans with type 2 diabetes and its clinical utility in evaluating diabetes self-management training.
Adult↗