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Biomedical subjects

J A Earp

Publications and source records attributed to J A Earp.

At least 37 records · Page 2Linked to original sources
PubMed1996

Effect of organization-level variables on differential employee participation in 10 federal worksite health promotion programs.

Guided by a conceptual model, the authors used both qualitative data (e.g., individual interviews, focus groups) and quantitative data from an employee survey (N = 3,388) in 10 federal agencies to investigate whether organization context and implementation process affected participation in worksite health promotion and disease prevention (HPDP) activities among demographic subgroups. Overall, employees on average participated in fewer than two agency-supported health-related activities per year (17% in fitness, 40% in health risk assessment activities). Employees participated more where coworkers endorsed such programs. Minority employees and employees in lower level positions were more likely to participate in fitness activities when organizations had a more comprehensive program structure, engaged in more marketing strategies, gave time off to employees to participate, or had on-site facilities. Management support for the program was related to participation by employees who were male, white, and had upper level positions. The data supported the proposed model; also confirmed was two predicted relationships between model constructs, which provided a better understanding of differential participation by employee groups.

Accidents, Occupational↗
PubMed1995

The North Carolina Breast Cancer Screening Program: foundations and design of a model for reaching older, minority, rural women.

Breast cancer screening programs do not reach all women at the same rate. Screening mammography use varies according to sociodemographic characteristics; mammography utilization is highest among women in their fifties but then decreases with age. In North Carolina, breast cancer is a particular burden for Black and lower-income women. Black women are more likely to be diagnosed with late stage disease, and their rate of breast cancer mortality is higher than it is for White women even though the incidence in White women is greater. Older, Black, and low-income women are less likely to obtain screening by mammography and clinical breast examination. The Black-White gap is even more pronounced among rural women, in part because they are more likely to be poor. The North Carolina Breast Cancer Screening Program (NC-BCSP) was established to increase the rate of regular mammography screening by an absolute 20% in 3 years among older Black women ages 50 and older in five rural counties in the eastern part of the state. In this paper, we describe the genesis of this comprehensive community intervention model, highlighting the behavioral science constructs, health education principles, and theories of behavioral and organizational change that form its conceptual foundation. NC-BCSP's theoretical foundations include the social ecological perspective, the PRECEDE model of health promotion, the Health Belief Model of individual change, and the "stages of change" transtheoretical model. We also review the experiences and lessons learned from two previous outreach initiatives in North Carolina that provided valuable "lessons" in the development of the NC-BCSP intervention model. In the second half of the paper, we describe the actual NC-BCSP interventions, activities, and evaluation tools, citing specific examples of how the underlying theories are implemented. NC-BCSP's goal goes beyond individual behavior change to raise low mammography screening rates among Black women in rural North Carolina. Its ultimate objective is to create linkages across agencies, and between agencies and communities, that will endure after the research project ends.

Adult↗
PubMed1995

Measuring battering: development of the Women's Experience with Battering (WEB) Scale.

Measuring only the physical markers of violence (e.g., slapping, beating) fails to capture the chronic vulnerability and gendered nature of battered women's experiences. Instruments that measure only observable discrete events may mask the continuous nature of battering and the relation between events and experience. Our approach to measuring battering operationalizes the experiences of battered women rather than the abusive behaviors they encounter. This alternative approach emphasizes the meanings battered women attach to the violence and to battering as an enduring presence in their lives. Focus groups with 22 battered women generated qualitative data for developing scale items (Smith, Tessaro, & Earp, 1995) and a known-groups survey with 185 battered and 204 nonbattered women determined the final scale items. Factor analysis of 40 initial items revealed a strong single-factor solution. The resulting 10-item Women's Experiences with Battering (WEB) Scale demonstrated high internal consistency reliability, was significantly correlated with known-group status, exhibited good construct validity, and was not significantly correlated with a measure of social desirability. The WEB Scale provides researchers with a valid and concise measure for studying relations between battering and health or health behavior, as well as evaluating the impact of interventions on battered women or prevalence.

Adult↗
PubMed1994

Patient education for sickle cell disease: a national survey of health care professionals.

Despite emphasis on including patient and parent education in sickle cell comprehensive clinical care, literature on the use of such materials is scarce. To discover the availability of, satisfaction with, use of and interest in patient and parent education materials for sickle cell disease, we surveyed, with a 176-item self-administered questionnaire, 209 sickle cell professionals nationwide. Respondents came from 74 sickle cell programs, were 63.4% female and 37.7% African American, and represented many health professions. We found that materials about patient behavior and psycho-social issues, as opposed to those about the disease and treatment, were more often unavailable and, when available, more often unsatisfactory and less frequently used. When available, use of materials was unrelated to satisfaction and perceptions of patient problems for most topics. For each of 10 topics, over 90% of the respondents were interested in materials covering the topic. Future research should examine the low to moderate use of psycho-social and behavioral materials with sickle cell patients, and should assess the appropriateness and effectiveness of existing and new materials.

Adult↗
PubMed1994

Gynecologists' sex, clinical beliefs, and hysterectomy rates.

This study determined how gynecologists' sex, beliefs, appropriateness ratings, and practice characteristics influence hysterectomy rates in North Carolina. Gynecologists who performed hysterectomies at higher rates were further from training, practiced in areas with fewer gynecologists, and had more patients with abnormal bleeding or cancer. Male gynecologists performed 60% more hysterectomies than female gynecologists, but this may have been because they were further from their training. Appropriateness ratings were affected by gynecologists' attitudes toward surgery, recency of training, and practice case mix, and by patients' expressed desire to avoid surgery, but they did not predict hysterectomy rates. To decrease their chances of undergoing hysterectomy, patients should express their preferences and possibly seek the opinion of more recently trained gynecologists.

Adult↗
PubMed1993

Increasing mammography utilization: a controlled study.

BACKGROUND: Despite the effectiveness of breast cancer screening for women older than 50 years of age, only about one third of these women in the United States receive annual mammography. PURPOSE: This study was designed to determine if a community-wide intervention could increase use of mammography screening for breast cancer. Secondary end points were determination of changes in women's knowledge and attitudes toward mammography and physicians' self-reported screening practices. METHODS: We conducted a controlled study from January 1987 through January 1990 in two eastern North Carolina communities--New Hanover County (the experimental community) and Pitt County (the control community). Before development and implementation of the intervention program in New Hanover County and after the program had been in operation for 1 year, 500 women of ages 50-74 years and all primary-care physicians in each community were interviewed by telephone. In these interviews, we determined the use of mammography for breast cancer screening and the knowledge and attitudes about it. We also established the number of screening mammograms performed in 1987 and 1989 in each county and reviewed medical records to determine the percentage of women the physicians had referred for mammograms. RESULTS: The percentage of women who reported receiving a mammogram in the previous year increased from 35% to 55% in the experimental community and from 30% to 40% in the control community (difference of differences, 10%; P = .03 after adjustment for race, education, age, and having a regular doctor; 95% confidence interval, 1%-18%). Increases were greater in New Hanover County regardless of age, race, income, and education. However, the increase was less for Black women than for White women, both overall and in most demographic subgroups. The total number of mammograms performed increased 89% in the experimental community and 45% in the control community. Women's knowledge about mammography changed little, but the intention to get a mammogram increased 30% in New Hanover County, compared with a 17% increase in Pitt County--a statistically significant difference (P < .01). Physician reports and medical record reviews in the two communities showed similar increases in the number of mammograms ordered. CONCLUSIONS: A community-wide effort to increase use of breast cancer screening was successful, but more work must be done to reach the National Cancer Institute's goal of annual mammograms for 80% of women of ages 50-74.

Age Factors↗
PubMed1993

The effect of training staff in office-based smoking cessation counseling.

A role for office staff members in smoking cessation counseling has recently been recognized and encouraged. We studied the impact of physician-staff team training in office-based smoking cessation counseling on staff members in 35 practices in Raleigh, North Carolina. Staff members who attended an educational meeting were compared with two groups: other staff members in their practices who did not attend the meeting and staff in other practices in which no one attended the meeting. Baseline attitudes toward and participation in smoking cessation activities were not significantly different among the three groups. Four months after the training, staff who had personally attended the meeting reported greater involvement in counseling activities than either of the two comparison groups. Attitudes toward involvement in counseling activities did not change significantly over the study period. Training staff members in office-based smoking cessation counseling may be a useful step toward increasing staff participation in these activities.

Counseling↗
PubMed1992

Factors associated with pediatricians' participation in Medicaid in North Carolina.

OBJECTIVE: To describe the relative importance of factors influencing pediatricians' participation in Medicaid in North Carolina. DESIGN: Questionnaire survey. SETTING AND PARTICIPANTS: Nonacademic primary care pediatricians in direct patient care at least 50% of the time; 332 (85%) of the 389 eligible pediatricians responded. MAIN OUTCOME MEASURES: Proportion of pediatricians who restricted Medicaid patients' access to their practices. The association between restricting access and the following factors was assessed: Medicaid reimbursement, pediatricians' demographic characteristics, knowledge of the Medicaid program, attitudes toward Medicaid patients and the Medicaid program, and beliefs about whether other physicians were available to care for Medicaid patients. RESULTS: Twenty-nine percent of pediatricians restricted Medicaid patients' access to their practices. The proportion of pediatricians restricting access was 62% in cities, 13% in medium-sized towns, and 12% in small towns (P less than .001), but the proportion of pediatricians in cities who restricted access varied from 87% to 22%. Pediatricians who received a higher proportion of their usual fee were less likely to restrict Medicaid patients' access. The relationship between Medicaid payment and restricted access was substantially weakened after controlling for the following factors: (1) the size of the community, (2) pediatricians' attitudes toward Medicaid payment, (3) their perceptions that they were too busy to care for Medicaid patients, and (4) whether there were other resources for the care of Medicaid patients. At comparable levels of payment, rural pediatricians were about six times less likely than urban pediatricians to restrict access. Pediatricians who knew less about Medicaid reimbursement also restricted access more often. Whether or not they restricted access to new Medicaid patients, pediatricians provided acute, preventive, hospital, and emergency care to the Medicaid patients who were already in their practices. CONCLUSIONS: Existing resources for the care of Medicaid patients, pediatricians' economic dependence on Medicaid, and the local norms of practice may be important factors in pediatricians' decision to participate in Medicaid. Increasing reimbursement will have only modest effects on Medicaid participation. Strategies to improve participation should also address pediatricians' knowledge of the Medicaid program and enlist the support of community physicians.

Attitude of Health Personnel↗
PubMed1992

Measuring the use of mammography: two methods compared.

Population studies often estimate mammography use using women's self-reports. In one North Carolina county, we compared self-report surveys with a second method--counting mammograms per population--for 1987 and 1989. Estimates from self-reports (35% in 1987, 55% in 1989) were considerably higher than those from mammogram counts (20% in 1987, 36% in 1989). We then confirmed 66% of self-reports in the past year. Self-reported use is more accurate regarding whether a woman has had a mammogram than when she had it, but self-reports accurately measure change over time.

Aged↗
PubMed1991

Mammography and age: are we targeting the wrong women? A community survey of women and physicians.

To determine mammography use among women with a broad range of ages, the authors surveyed women aged 30 to 74 years and physicians practicing primary care in two eastern North Carolina counties. Twenty-five percent of women in their 30s had ever had a mammogram, and 34% intended to have one in the coming year. From 45% to 52% of women in their 40s, 50s, and 60s had ever had a mammogram, and 55% to 57% intended to have one in the next year. Thirty-seven percent of women aged 70 to 74 years had ever had a mammogram, and 40% intended to have one in the following year. Nineteen percent of physicians reported screening nearly all women aged 30 to 39 years, and 14% screened few women aged 50 to 74 years. Younger women were more worried about breast cancer than older women and assessed their risk as higher, attitudes that were generally associated with higher mammography utilization. These community surveys suggest that mammography use may be excessive among younger women; older women continue to be underscreened.

Adult↗
PubMed1991

Conceptual models for health education research and practice.

Although conceptual models are frequently used to illustrate research questions under investigation, there is a paucity of articles about how to develop conceptual models or their importance to health education research and practice. A number of uses of the term model exist. Therefore, we describe a conceptual model developed to guide health education research or practice as a diagram of proposed causal linkages among a set of concepts believed to be related to a specific public health problem. Although informed by the multicausal models of public health, the conceptual models we describe differ from those models in that they do not incorporate all factors correlated with an endpoint of interest. Rather they show only the small part of the causal web selected for study. Conceptual models differ from theory in that they are not usually concerned with global classes of behavior but with specific types of behavior in specific contexts. They often are informed by more than one theory, as well as by empirical findings. Because of the usefulness of conceptual models in narrowing both research questions and the targets of intervention, we advocate the inclusion of the model development process in public health education research methods courses.

Concept Formation↗
PubMed1991

Disease experience and psychosocial adjustment in children with juvenile rheumatoid arthritis: children's versus mothers' reports.

Adjustment in children with juvenile rheumatoid arthritis (JRA) has been evaluated most frequently by parental or teacher reports and with reference to disease severity. In this study, 38 children, ages 7 to 13 with JRA, and their mothers were interviewed. Modest correlations were found between children and mothers in their assessments of children's perceived competence in several domains (i.e., athletic competence, social acceptance, physical attractiveness, and global self-worth) and in their perceptions of how JRA is experienced by children and families. Children's perceptions of the disease experience were significantly correlated with the four measures of perceived competence, even after controlling for disease severity. The results highlight the importance of cross-validating parental reports with children's self-reports, and demonstrate the need to consider variables other than disease severity--in particular how JRA is interpreted by children--in predicting their adjustment.

Adaptation, Psychological↗
PubMed1991

AIDS education and incarcerated women: a neglected opportunity.

Attitudes and perceptions about health, AIDS, and the need for AIDS education were explored among inmates in a women's prison in the southeastern U.S. Forty short-term inmates participated in a series of focus group interviews. A separate sample of sixteen women completed a 103-item questionnaire. Focus group participants expressed concern about AIDS within prison, sexual activity between inmates, and the institution's policy of housing seropositive women with the general inmate population. Close to half (44%) of the survey respondents believe that they were likely to be exposed to HIV in prison; most (81%) felt that AIDS education programs should discuss female homosexual activity, and nearly all respondents (94%) felt that inmates should be given an HIV antibody test upon entering prison. The study's findings confirm the need for tailoring AIDS education and prevention activities for incarcerated women.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Physicians' reactions to uncertainty in patient care. A new measure and new insights.

Although variations in physicians' practice patterns and use of resources are well documented, the reasons for these variations are less well understood. The uncertainty inherent in patient care may be one explanation. Existing measures of intolerance to uncertainty, developed in contexts outside of patient care, fail to explain these variations. To address this limitation, the Physicians' Reactions to Uncertainty scale was developed. A questionnaire containing an initial pool of 61 items was mailed to a random sample of 700 physicians in North Carolina and Oregon, stratified by specialty. The items covered nine areas of physicians' reactions to uncertainty derived from interviews with physicians and a definition of the concept affective reactions to uncertainity in patient care. Factor analysis of the 428 responses received yielded two primary factors that accounted for 58% of the common variance among the 61 items. Items with unambiguous loadings on these factors defined two reliable and readily interpretable subscales: Stress from Uncertainty (Cronbach's alpha = 0.90, 13 items) and Reluctance to Disclose Uncertainty to Others (alpha = 0.75, 9 items). By virtue of its clarity and good psychometric properties, this new measure promises insights into the role that uncertainty plays in physicians' resource utilization and practice patterns.

Adaptation, Psychological↗
PubMed1989

Firearm ownership among nonurban adolescents.

Firearm injury is the second leading cause of death among teenagers. In this study we examined firearm acquisition and ownership in a biracial cohort of 664 teenagers (313 male and 351 female). Ownership was prevalent among male adolescents (48%) and rare among female adolescents (4%). Among these suburban and rural teenagers, the ownership rate was highest for white male adolescents (56%). Handgun ownership was more frequent among male school dropouts (22%) than enrollees (7%). The first firearm was typically acquired by late childhood or early adolescence (median age, 12.5 years). An adult male family member (eg, father, grandfather, uncle) was the primary source. The prevalence, developmental timing, and sociodemographic correlates of firearm acquisition should be useful for informing preventive clinical practice and interventions.

Adolescent↗