Biomedical subjects
Barbara Resnick
Publications and source records attributed to Barbara Resnick.
Educational competencies to strengthen tuberculosis curricula in undergraduate nursing programs.
Worldwide, at least two million people die annually from tuberculosis (TB), with projections of 36 million more global deaths between the years 2003 and 2020. To help nursing faculty strengthen TB curricula and standardize TB content in national and international undergraduate nursing programs, the Nurse Discipline Group of the National Tuberculosis Curriculum Consortium (NTCC) has developed comprehensive TB core competencies and specific student objectives for the classroom setting. These core competencies address the knowledge, ability, and/or skills required for an undergraduate nursing student to provide qualified holistic care for patients, families, and communities impacted by TB. The NTCC is comprised of a team of multidisciplinary health care educators in the United States, with the primary mission to instill knowledge, skills, and appropriate attitudes in the management of active and latent TB among undergraduate health care students.
Motivating minority older adults to exercise.
The purpose of this qualitative study was to explore with minority older adults their experience in the Senior Exercise Self-Efficacy Pilot Program (SESEP) and establish what aspects of the SESEP helped the participants engage in exercise and what decreased their willingness to exercise. A total of 148 older adults from 12 Senior Centers participated. The majority of the participants were African American (77%), and female (79%) and the average age was 72.9+/-8.0. Analysis of the semi-structured interviews revealed 36 codes which were categorized and reduced to 13 major themes. Eleven of these themes focused on factors that facilitated participation in exercise and two themes included factors that decreased willingness to participate in exercise. Findings support the use of the theory of self-efficacy to change behavior among minority older adults, and future research should focus on identifying culturally specific interventions that will strengthen these beliefs and thereby increase exercise behavior.
Interdisciplinary care for older adults with complex needs: American Geriatrics Society position statement.
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Outcomes research: you do have the time!
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Testing of the SEE and OEE post-hip fracture.
The purpose of this study was to test the reliability and validity of the Self-Efficacy for Exercise (SEE) and the Outcome Expectations for Exercise (OEE) scales in a sample of 166 older women post-hip fracture. There was some evidence of validity of the SEE and OEE based on confirmatory factor analysis and Rasch model testing, criterion based and convergent validity, and evidence of internal consistency based on alpha coefficients and separation indices and reliability based on R2 estimates. Rasch model testing demonstrated that some items had high variability. Based on these findings suggestions are made for how items could be revised and the scales improved for future use.
A taxonomy and economic consequences of nursing home falls.
BACKGROUND: Falls are a primary cause of injury and disability in the nursing home environment and can be costly to treat. We propose a taxonomy of nursing home falls that accounts for both the severity of fall consequences and the duration of the treatment episode. No other systematic approach of this kind has been previously described. METHODS: We defined a 9-level taxonomy of fall types and outcomes. Components of each fall category include resource use during the acute, convalescent, and long-term phases of treatment. Three variants of each category describe typical, best-case and worst-case fall episodes. Treatment costs were estimated for each fall category by applying unit costs from national databases and published sources to projected medical resource utilisation. Long-term costs reflect adjustment in Medicare per diem reimbursement rates associated with change in patient status subsequent to the fall. RESULTS: The most common and least costly fall category was category 1 -- non-injurious, which accounted for 30% of falls and a 1-year cost of US dollars 319 per event (range US dollars 71-550). The least common and most costly was fall category 9 -- multiple injuries, which accounted for 1% of falls and a 1-year cost of US dollars 22,368 (range US dollars 9,969-64,382). CONCLUSIONS: The falls taxonomy represents a unique approach to estimating the cost of nursing home falls and offers a tool for evaluating the cost-effectiveness of fall prevention strategies. A validation study should be performed to confirm the magnitude of fall frequency and cost estimates.
Pilot testing of the Restorative Care Intervention: impact on residents.
The purpose of this pilot study was to test the feasibility and effectiveness of a two-tiered motivational intervention, the Res-Care Intervention, on nursing home residents. Twenty-one residents consented to participate in the study. The residents were 88.3 (+/- 4.9) years of age, had lived in the facility 1.6 (+/- 3.4) years, were women (93%), White (93%), and unmarried (85%). Although there were some positiv trends, there was not a statistically significant difference in any of the resident outcomes following implementation of the Res-Care Intervention. The findings have been used to revise the Res-Care Intervention to include additional education needs for the nursing assistants, revisions in the motivational intervention for the nursing assistants and nurses, clarification of documentation and motivational techniques to improve documentation, and implementation of a more comprehensive treatment fidelity plan.
Development and pilot-testing of the perceived health Web Site usability questionnaire (PHWSUQ) for older adults.
With an increasing number of older adult online users, the Internet has become recognized as an efficient medium to disseminate health information to these individuals. Usability of health Web sites is particularly important for older adults who have unique Web design needs. Although several Web usability questionnaires have been developed for younger adults, there is a lack of such measure for older adults. In this study, based on prior research findings and consultation with usability experts, a 12-item Perceived Health Web Site Usability Questionnaire (PHWSUQ) was developed for older adults. The preliminary reliability and validity of this measure was assessed in a study that tested the usability of three health Web sites employing 10 older adult online users. The findings provided some evidence of internal consistency and construct validity for the PHWSUQ. The major limitation of this study was its small sample size, hence further psychometric testing is needed with larger samples.
Older adults' perspectives on screening prior to initiating an exercise program.
The purpose of this study was to explore the experiences of older adults with screening prior to starting an exercise program (structured or unstructured), and the impact this had on their willingness to engage in physical activity. This was a qualitative study using a focus group methodology. Focus groups were conducted in regionally dispersed sites in which exercise programs were ongoing or had been offered. A total of 122 older adults were included in this study, the majority of whom were African American (72%) with ages ranging from 50s to the 80s. An interview guide was used to facilitate each of the focus groups. Seventeen codes were identified and were reduced to 4 major themes: (1) Description of screening experienced; (2) Perception of purpose or need for screening; (3) Benefits of screening; and (4) Screening as a barrier to exercise. The participants indicated that there were some benefits associated with screening, such as safety assurances, although screening was also noted to be a barrier to exercising. Older adults who were already active, or had regular health care, believed that "screening" was not necessary. Pre-activity screening has different meanings for older adults depending on their own personal situations, resulting in potentially different motivational implications for adopting more active lives. For many, screening increased their sense of confidence and served as a positive motivator. Others felt that screening was irrelevant and actually hindered one's ability to join an activity group. We conclude with recommendations for refocusing future screening guidelines and suggestions for future research.
A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research.
A. Bellg, B. Borrelli, et al. (2004) previously developed a framework that consisted of strategies to enhance treatment fidelity of health behavior interventions. The present study used this framework to (a) develop a measure of treatment fidelity and (b) use the measure to evaluate treatment fidelity in articles published in 5 journals over 10 years. Three hundred forty-two articles met inclusion criteria; 22% reported strategies to maintain provider skills, 27% reported checking adherence to protocol, 35% reported using a treatment manual, 54% reported using none of these strategies, and 12% reported using all 3 strategies. The mean proportion adherence to treatment fidelity strategies was .55; 15.5% of articles achieved greater than or equal to .80. This tool may be useful for researchers, grant reviewers, and editors planning and evaluating trials.
The Exercise Plus Program for older women post hip fracture: participant perspectives.
PURPOSE: The purpose of this study was to explore the experiences of older women post hip fracture who were exposed to a motivational intervention, the Exercise Plus Program, intended to increase adherence to exercise. DESIGN AND METHODS: This study used a naturalistic inquiry. We interviewed a total of 70 older women, 12 months post hip fracture, using an interview guide asking about issues related to willingness to exercise. All interviews were tape recorded and transcribed verbatim. RESULTS: Analysis of the semi-structured interviews revealed 44 codes that were categorized and reduced to 14 major themes. Eleven of these themes focused on components that facilitated participation in exercise and included: (a) real and expected benefits; (b) visual cues and knowing what to do; (c) simplicity; (d) individualized care; (e) verbal encouragement to exercise; (f) regular schedule; (g) confidence (i.e., self-efficacy); (h) determination; (i) social support; (j) reciprocity; and (k) goal identification. The remaining three themes reflected what decreased the participants' willingness to exercise: (a) unpleasant sensations; (b) constraints to exercise; and (c) getting back to baseline. IMPLICATIONS: The findings provide some support for the benefit of the Exercise Plus Program. Lessons learned in the Exercise Plus Program can be translated to the development of other motivational interventions to help engage older adults in exercise, particularly those individuals who recently experienced an acute event, such as a hip fracture.
Reliability and validity of the Outcome Expectations for Exercise Scale-2.
Development of a reliable and valid measure of outcome expectations for exercise for older adults will help establish the relationship between outcome expectations and exercise and facilitate the development of interventions to increase physical activity in older adults. The purpose of this study was to test the reliability and validity of the Outcome Expectations for Exercise-2 Scale (OEE-2), a 13-item measure with two subscales: positive OEE (POEE) and negative OEE (NOEE). The OEE-2 scale was given to 161 residents in a continuing-care retirement community. There was some evidence of validity based on confirmatory factor analysis, Rasch-analysis INFIT and OUTFIT statistics, and convergent validity and test criterion relationships. There was some evidence for reliability of the OEE-2 based on alpha coefficients, person- and item-separation reliability indexes, and R(2)values. Based on analyses, suggested revisions are provided for future use of the OEE-2. Although ongoing reliability and validity testing are needed, the OEE-2 scale can be used to identify older adults with low outcome expectations for exercise, and interventions can then be implemented to strengthen these expectations and improve exercise behavior.
Screening, safety, and adverse events in physical activity interventions: collaborative experiences from the behavior change consortium.
Researchers who conduct physical activity (PA) intervention studies provide an invaluable opportunity to further the prevention science knowledge base for implementing and delivering PA programs. Despite recommendations that screening is important to increase patient safety, the specific screening criteria best suited for different community applications are unknown. To add to the limited knowledge base, we examined the screening procedures and the occurrence of adverse events among more than 5,500 participants from 11 diverse PA interventions participating in a trans-National Institutes of Health (NIH) collaborative known as the Behavior Change Consortium (BCC). Numerous adverse events occur in sedentary, chronically ill, or older populations, although few are attributed to activity/exercise interventions. No serious study-related adverse events (SRAEs) were reported across different screening practices, interventions, and/or populations. Relatively few minor SRAEs were reported (primarily musculoskeletal injuries), emphasizing the need to be aware of potential musculoskeletal sequelae during exercise interventions. One common characteristic of these studies is that they recommended "start low and go slow" strategies, with moderate intensity PA as the goal behavior. Recommendations to reframe the meaning and use of screening criteria to initiate PA in the community are discussed. Although we were unable to conduct generalizable quantitative analyses from our data, the combined experience of the BCC studies provides a unique opportunity to examine PA-related screening and safety issues across diverse populations, settings, and intervention programs.
Examples of implementation and evaluation of treatment fidelity in the BCC studies: where we are and where we need to go.
Treatment fidelity plays an important role in the research team's ability to ensure that a treatment has been implemented as intended and that the treatment has been accurately tested. Developing, implementing, and evaluating a treatment fidelity plan can be challenging. The treatment fidelity workgroup within the Behavior Change Consortium (BCC) developed guidelines to comprehensively evaluate treatment fidelity in behavior change research. The guidelines include evaluation of treatment fidelity with regard to study design, training of interventionists, delivery and receipt of the intervention, and enactment of the intervention in real-life settings. This article describes these guidelines and provides examples from four BCC studies as to how these recommended guidelines for fidelity were considered. Future work needs to focus not only on implementing treatment fidelity plans but also on quantifying the evaluations performed, developing specific criteria for interpretation of the findings, and establishing best practices of treatment fidelity.
Across the aging continuum: motivating older adults to exercise.
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Falls in a community of older adults: findings and implications for practice.
The purpose of this study was to describe the falls that occurred over a 5-year period in a group of older adults living in a continuing care retirement community (CCRC) and to test two models, one mediating whether or not the individual fell and the second the number of falls the individual experienced. Of the 312 participants, 177 (57%) residents experienced at least one fall. There were a total of 594 falls with the mean number of falls per person being 1.9 (SD = 3.0), and the range of falls from 1 to 19. Age, gender, and neurologic disease significantly influenced whether or not a fall occurred. Mental health, regular use of alcohol, and neurologic problems all significantly influenced the number of falls that occurred.