The importance of careful measurement in health education research, theory and practice.
Explore the source record for details and available documents.
Health Education↗
Biomedical subjects
R F DeVellis
Publications and source records attributed to R F DeVellis.
Appraisal of and coping with arthritis-related problems in household activities, leisure activities, and pain management.
PURPOSE: We examined whether or not there are systematic differences in how people appraise different types of illness-related problems and in how they cope with these problems. METHODS: Two hundred thirty-five adults with recently diagnosed rheumatoid arthritis completed a mailed questionnaire followed by a telephone interview. A series of stress appraisal and coping variables were assessed in relation to three areas: household activities, leisure activities, and pain management. RESULTS: Pain differed significantly from household and leisure activities with regard to several appraisal and coping variables. Participants reported the least control over problems with pain, while attaching the most importance to pain control. Leisure activities also stood out as unique on several variables. Participants perceived greater ability and were more satisfied with their ability in relation to leisure activities. CONCLUSION: These findings show that, at least early in the disease, appraisal and coping strategies differ across the areas of household activities, leisure activities, and pain management.
Activities of Daily Living↗
Measuring health status among survivors of burn injury: revisions of the Burn Specific Health Scale.
This study examined the reliability of a revised version of the Burn Specific Health Scale (BSHS). Two hundred fifty-four former patients recruited from eight burn centers in the southeastern United States participated in the study. Data were collected via chart review and mailed questionnaire. Factor analyses were used to identify seven subscales containing a total of 31 items. Subsequent analyses provided strong support for the reliability and validity of the revised measure. Each subscale exhibited a high level of reliability (Cronbach's alpha ranged from 0.82 to 0.94). Each subscale also correlated in a predictable manner with measures used for validation. The revised measure should improve the ability of both researchers and clinicians to assess the impact of non-fatal burn injury accurately and comprehensively.
Adult↗
Improving dietary behavior: the effectiveness of tailored messages in primary care settings.
OBJECTIVES: To achieve the Healthy People 2000 objectives, public health professionals must develop effective dietary interventions that address psychosocial and behavioral components of change. This study tested the effect of individually computer-tailored messages designed to decrease fat intake and increase fruit and vegetable intake. METHODS: Adult patients from four North Carolina family practices were surveyed at baseline and then randomly assigned to one of two interventions or to a control group. The first intervention consisted of individually computer-tailored nutrition messages; the second consisted of nontailored nutrition information based on the 1990 Dietary Guidelines for Americans. Patients were resurveyed 4 months postintervention. RESULTS: The tailored intervention produced significant decreases in total fat and saturated fat scores compared with those of the control group (P < .05). Total fat was decreased in the tailored group by 23%, in the nontailored group by 9%, and in the control group by 3%. Fruit and vegetable consumption did not increase in any study group. Seventy-three percent of the tailored intervention group recalled receiving a message, compared with 33% of the nontailored intervention group. CONCLUSIONS: Tailored nutrition messages are effective in promoting dietary fat reduction for disease prevention.
Adult↗
Physician-based diet counseling for cholesterol reduction: current practices, determinants, and strategies for improvement.
BACKGROUND: Physicians face increasing pressure to counsel their hypercholesterolemic patients about diet. To design effective physician-based treatment programs, a better understanding of current dietary counseling practice and its determinants is needed. METHODS: Using a survey previously tested for reliability and validity, we examined the relationship of dietary knowledge, attitudes, beliefs, organizational barriers, and treatment practices for cholesterol management among 60 resident and attending physicians practicing in the general medicine clinic of a university medical center that serves primarily rural and disadvantaged patients. The survey was administered in October of 1988 prior to the release of the National Cholesterol Education Program Guidelines. RESULTS: The response rate was 100%. Ninety-two percent of physicians surveyed believe that dietary treatment effectively lowers cholesterol and 68% feel responsible for providing such therapy. However, most (72%) feel ill-prepared to give diet counseling, lack confidence in their ability to help patients make meaningful dietary changes (95%), and cite organizational barriers, such as limited time (72%) or inadequate educational materials (47%). Physicians were more likely to report behaviorally focused diet counseling practices if they felt prepared to counsel (r = 0.42, P < 0.001), were confident in their counseling skills (r = 0.39, P < 0.01), or reported personally following a prudent diet (r = 0.36, P < 0.01). We discuss the implications of these findings and how they should guide the design of physician-based dietary interventions for cholesterol reduction.
Counseling↗
Psychological and educational interventions to reduce arthritis disability.
The extent of disability attributable to arthritis is briefly summarized and the World Health Organization's (WHO) classification scheme for progression from pathology to disability described. The types of outcomes that have been examined in evaluations of psychological and educational interventions aimed at preventing arthritis disability are described and classified according to the WHO scheme where appropriate. Next, the most common components included in psychological and educational interventions for arthritis are reviewed. These are (1) providing general information, (2) teaching illness self-management skills, (3) training in biofeedback, (4) applying cognitive-behavioural techniques, (5) using other psychotherapeutic techniques, and (6) enhancing social support. This is followed by a discussion of issues pertinent to assessing the efficacy of various intervention components, citing specific examples of intervention research. Finally, the conclusion that certain types of psychological interventions appear to be effective in mitigating arthritis disability is drawn and the contribution of social science theory to intervention efficacy acknowledged.
Arthritis, Rheumatoid↗
Development and validation of the Parent Health Locus of Control scales.
We describe the development and validation of the Parent Health Locus of Control (PHLOC) scales. Using factor analytic and item analytic methods, 30 items comprising six scales were extracted from a pool of 84 items. The individual scales correspond to beliefs in Child, Divine, Fate, Media, Parental, and Professional Influence over child health. Results were compared for six samples totalling 822 parents. Internal consistency reliabilities were above .70 for all scales with all samples. Test-retest correlations based on a separate sample were all above .60. Validity was assessed by means of a known groups strategy that made use of presumed differences among the six samples studied. The results generally agreed with predicted differences, offering good initial evidence of the validity for the PHLOC scales.
Adult↗
A brief measure of helplessness in rheumatic disease: the helplessness subscale of the Rheumatology Attitudes Index.
A short 5-item unifactorial form of the Rheumatology Attitudes Index was demonstrated to constitute an acceptable scale of helplessness for research or for clinical screening purposes. These items are the exact counterparts of the Arthritis Helplessness Index items that were identified as constituting a helplessness factor. These brief measures appear to be superior to their longer counterparts because they are conceptually less ambiguous and more convenient.
Attitude to Health↗
Psychological well-being among people with recently diagnosed rheumatoid arthritis. Do self-perceptions of abilities make a difference?
OBJECTIVE: Satisfaction with abilities and perceived importance of abilities are 2 factors involved in the process of self-evaluation. We examined the role that these factors play in adjustment to rheumatoid arthritis (RA). METHODS: Data were collected, via telephone interview and mailed questionnaire, from 234 individuals with recently diagnosed RA. Disease severity information was obtained from participants' physicians. RESULTS: Consistent with study hypotheses, satisfaction was associated with psychological well-being only among those who viewed as very important the abilities being evaluated. CONCLUSION: These findings increase understanding of the conditions under which low levels of satisfaction are likely to be associated with psychological distress.
Adaptation, Psychological↗
Nutrition education for cardiovascular disease prevention among low income populations--description and pilot evaluation of a physician-based model.
Low income Americans are at greatest risk for coronary heart disease but have least access to health promotion programs for life style modification. Primary care physicians may represent one of the few sources of preventive care available to the poor. However, the majority of physicians feel unprepared to help patients achieve dietary change, and few existing nutrition intervention programs address the special needs of low literacy populations. The Food for Heart Program was developed to facilitate dietary counseling experienced by primary care physicians who care for low literacy patients and to overcome barriers to behavior change faced by patients. The program consists of three components: (1) a validated dietary risk assessment that rapidly identifies atherogenic eating habits and requires no nutritional expertise to administer or interpret, (2) a structured diet treatment program that is culturally specific for a southern patient population and links practical behavior change recommendations with results of the diet assessment, and (3) a system for monitoring and reinforcement that prompts physicians to review progress, reinforce prior messages, and reward positive change. Behavior change theory is used to guide the intervention and readability of the material has been assessed at the 5-6th grade level. An evaluation study of the Food for Heart Program suggests that it has a positive impact on physician counseling and that patients are responding favorably to these efforts.
Cardiovascular Diseases↗
Rheumatoid arthritis and depression: an overview.
Clearly, the determinants of depression in RA are complex and multifaceted. As with the disease itself, there is no simple cure for the depression that often accompanies it. Knowledge in this area is growing rapidly, however. Increasingly effective interventions are being developed to help those having difficulty adjusting to RA. As our understanding of the determinants of depression in RA increases, these therapies will continue to evolve. Ultimately, they may provide the long-term benefits desired by clinicians and patients alike.
Adaptation, Psychological↗
A brief dietary assessment to guide cholesterol reduction in low-income individuals: design and validation.
Low-income Americans are at greatest risk for coronary heart disease. Dietary assessment methods are needed that can efficiently and effectively guide diet counseling to reduce serum cholesterol in this population. The Dietary Risk Assessment is a brief food frequency questionnaire designed to guide an intervention program for cholesterol reduction. It can easily be administered and scored in 10 to 15 minutes by persons who are not trained in nutrition. The assessment is culturally specific for a low-income southern population, identifies positive as well as problematic dietary behaviors, is easily interpreted, and measures potential barriers to dietary change. The assessment was validated against 3 days of dietary recall data in a sample of 42 low-income individuals recruited from the waiting room of an ambulatory care clinic. A Keys score, which measures the serum-cholesterol-raising potential of the diet, was calculated for each patient from their recall data. The Keys and Dietary Risk Assessment scores were significantly correlated (r = .60, P less than .001). We conclude that the Dietary Risk Assessment can rank individuals by level of dietary atherogenic risk adequately to guide a dietary treatment program for low-income patients, an underserved population with a high prevalence of diet-induced elevations in serum cholesterol.
Cholesterol↗
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↗
Validity of the Center for Epidemiological Studies Depression Scale in arthritis populations.
Using data from 3 studies of patients with rheumatoid arthritis, we examined the extent to which responses to items in the Center for Epidemiological Studies Depression Scale (CES-D) are influenced by aspects of the disease process other than depression. Our findings suggested that 4 CES-D items (i.e., "I felt that everything I did was an effort," "I felt hopeful about the future," "My sleep was restless," and "I could not get going") may be influenced by aspects of the disease process and, thus, are not necessarily indicative of depression among persons with arthritis. The impact that these items have on the interpretation of CES-D scores was assessed in relation to 2 research issues: estimation of the prevalence and severity of depression in arthritis populations and identification of the determinants of depression among individuals with arthritis. Our results suggest that the original CES-D may overestimate the prevalence and severity of depression among patients with arthritis. The magnitude of this bias is modest, however. The results also suggest that in studies designed to identify the determinants of depression among individuals with arthritis, inclusion of the 4 items identified is unlikely to have any effect on study findings.
Adult↗
Effects of modeling on patient communication, satisfaction, and knowledge.
This experimental study investigated the efficacy of two modeling procedures on enhancing patient communication. A pretreatment interview assessed knowledge, assertiveness, and other concomitant variables. A total of 150 subjects were randomly assigned to one of three treatment conditions. The two modeling conditions were videotaped presentations of a health educator interacting with a patient (i.e., model) who either asked questions or revealed problems. The control videotape included only the educator's presentation; no patient was shown. A subsequent standardized face-to-face patient education session was used to assess the impact of the intervention on patient communicative behaviors. A posttreatment interview assessed knowledge and satisfaction. Subjects who viewed a modeling videotape spoke more than subjects who viewed a control videotape. The bulk of our findings indicated that a question-asking model was generally more effective than a disclosive model in eliciting communicative behaviors. Knowledge scores were found to increase after the intervention, regardless of subjects' verbal participation. Subjects in either of the modeling conditions who spoke more indicated higher affective satisfaction.
Adult↗
Continuing education for health professionals.
Although continuing education in the health professions is an important endeavor, it has been largely neglected in the professional literature. Few studies have been done on (a) conceptual models to guide the design and implementation of continuing education and (b) the use of such models in continuing education. To fill this gap, two such models are described in this article: (a) instructional development and (b) community development. Combining and using these models can lead to more effective continuing education with more enduring effects. Principles to guide the implementation of these models are presented. An arthritis continuing education project based on the instructional and community development models is used to illustrate these principles. This continuing education project focused on occupational and physical therapists in clinical practice.
Arthritis↗
Development and validation of the Attitude Toward Arthritis Patients Scale (ATAPS).
The development and validation of a four-item scale, the ATAPS, measuring attitude toward working with arthritis patients is described. Three separate samples of occupational and physical therapists were surveyed. Data from the first random sample were used to select a reliable subset of items from a larger pool and to provide a baseline for comparison with the second sample. The second sample comprised arthritis workshop attendees and confirmed the scale's reliability and its ability to differentiate between therapists with an active interest in arthritis and a group with no special interest in the disorder. The third stratified random sample further confirmed the scale's reliability and demonstrated that the ATAPS scores were associated with the number of arthritis patients in therapists' practices but not with measures of professional experience unrelated to arthritis.
Arthritis↗
Effects of information on patient stereotyping.
The influence of information on nurse attitudes and behavior toward a member of a stereotyped group was investigated. Responsibility for the decision to be childless and the intelligence of the person making that decision were manipulated. Student nurses individually interacted with a hypothetical, childless, female patient, presented via audiotape, who was about to undergo surgery for sterilization. The patient was described (a) as seeking sterilization either voluntarily or because of medical necessity, and (b) as either retarded or not classified intellectually. It was hypothesized that the patient who freely chose childlessness would be viewed and treated less positively when thought to be of normal intelligence. When the patient was mildly retarded or seeking sterilization out of medical necessity, however, more positive attitudes and behavior were expected. Both of these hypotheses were supported. The results of this study support the importance of contextual variables on perceptions of patients.
Adult↗