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PubMed2002

The decision to accept treatment for osteoporosis following hip fracture: exploring the woman's perspective using a stage-of-change model.

Despite the availability of medications that reduce fracture risk, most women who sustain a hip fracture are not evaluated or treated for osteoporosis. While a number of studies have attributed this to a lack of physician awareness, no studies have evaluated this problem from the patient's perspective. To explore the process a woman negotiates when deciding to accept pharmacologic treatment for osteoporosis after hip fracture, we used a stage-of-change model to characterize a consecutive series of 70 postmenopausal women (mean age 85 years) admitted to a tertiary care hospital with an acute low-impact hip fracture between May 2000 and August 2000. We measured stage-of-change using a modified form of the Weinstein Precaution Adoption Process Model (PAPM). The majority of patients (65%) were ineligible because of dementia or delirium; only 29 were eligible and 21 were enrolled. Most women (62%) were in stages 1 or 2 of the PAPM, indicating that they were unaware of osteoporosis or had never considered pharmacologic treatment for it. The only factors associated with a more advanced PAPM stage (indicating active consideration or currently taking treatment) were a previous bone mineral density (BMD) evaluation ( p = 0.007) and a diagnosis of osteoporosis ( p = 0.001). Although 48% of women had a previous fragility fracture and osteoporosis knowledge was poor overall (mean score 52% correct), neither was associated with a more advanced PAPM stage in this sample. In conclusion, women evaluated after hip fracture were not ready to accept pharmacologic treatment for osteoporosis; they were unaware that they had osteoporosis or had never considered treatment for it. For a woman to advance through the behavior change process, she must first be made aware of the problem that requires a change in behavior. Physicians play a crucial role in promoting awareness of the diagnosis of osteoporosis after fracture, which in turn is associated with patient advancement through the behavior change process and the decision to accept pharmacologic intervention. The large number of cognitively impaired patients in this population, however, will certainly make efforts to improve osteoporosis awareness, diagnosis and intervention more challenging.

Aged↗
PubMed2005

Dark lumen MR colonography based on fecal tagging for detection of colorectal masses: accuracy and patient acceptance.

BACKGROUND: Magnetic resonance colonography (MRC) with fecal tagging has recently been investigated in clinical studies for the detection of polyps. We assessed fecal tagging MRC in a field trial. METHODS: Forty-two patients in a private gastroenterologic practice underwent MRC with barium-based fecal tagging (150 mL of 100% barium at each of 6 main meals before MRC) and conventional colonoscopy. Diagnostic accuracy of MRC and patient acceptance were assessed and compared with the respective results of conventional colonoscopy. RESULTS: Eighteen percent of all MRC examinations showed a remaining high stool signal in the colon that impeded a reliable inclusion or exclusion of polyps. On a lesion-by-lesion basis, sensitivities for polyp detection were 100% for polyps larger than 2 cm (n = 1), 40% for polyps between 10 and 19 mm, 16.7% for polyps between 6 and 9 mm, and 9.1% for polyps smaller than 6 mm. The main reason for the low acceptance of MRC was the barium preparation, which was rated worse than the bowel cleaning procedure with conventional colonoscopy. CONCLUSION: MRC with fecal tagging must be further optimized. The large amount of barium resulted in poor patient acceptance, and barium according to this protocol did not provide sufficient stool darkening. Other strategies, such as increasing the hydration of stool, must be developed.

Adult↗
PubMed2002

Pelvimetry and patient acceptability compared between open 0.5-T and closed 1.5-T MR systems.

Our objective was to compare maternal pelvimetry and patient acceptability between open low-field (0.5-T) and closed 1.5-T MR systems. Thirty women referred for pelvimetry (pregnant: n=15) were scanned twice in the supine position, once in the vertical open system and once in the closed system. Each patient completed a comfort and acceptability questionnaire. Pelvimetric and questionnaire data were compared between systems. Total scan time was double in the open system (7:52+/-1:47 vs 3:12+/-1:20 min). Poor image quality in the open system prevented assessment of interspinous and intertuberous diameters in one woman and all measurements in another, both pregnant, with abdominal circumferences >120 cm. The open system was much more acceptable in terms of claustrophobia and confinement (both p<0.01). Claustrophobia interrupted one closed examination. Thirty-three percent of pregnant women in both systems reported fear of fetal harm. Sixty percent of all women preferred the open system, 7% the closed system, and 33% had no preference. Limits of agreement of 3-5% from the mean for all diameters confirmed good pelvimetric reproducibility. Women's preference for open-system MR pelvimetry is feasible with abdominal circumferences <or=120 cm.

Abdominal Cavity↗
PubMed2006

Acceptance of flexible sigmoidoscopy as a screening examination for colorectal cancer in an outpatient clinic.

BACKGROUND AND STUDY AIM: Flexible sigmoidoscopy (FS) is a feasible examination technique and a suitable tool for population-based screening, but very little is known about determinants of endoscopic screening participation. The aim of this study was to determine the acceptance rate and the factors influencing the decision of participating in a screening program for patients in an outpatient clinic. MATERIALS AND METHODS: In this prospective study, a colorectal cancer screening by FS was offered to 631 patients older than 40 years. Three strategies were available, (1) to have the endoscopy on the same day, (2) to make an appointment for another day, or (3) to take time to think about if they wanted the procedure. The reasons for refusal of the FS were documented. RESULTS: 419 of the 631 (66.4%) patients had no interest to take part in the screening program during their outpatient visit. Two hundred twelve (33.6%) patients were primarily interested on FS, but only 110 of them were finally examined. In total, 102 patients did not make an appointment for FS or did not appear for the endoscopy. The participation rate was therefore 17.4% (110/631) of all patients. Of the patients who agreed to receive an on-site examination, 78.3% were examined compared to 18.8% of patients who fixed the appointment for another day or after taking time to reflect upon the FS procedure. More male than female patients accepted the FS screening. Recommended colonoscopy was finally performed in 76%. Thirty-three polyps were found during the screening program of which 18 were larger than 0.5 cm. No CRC was detected. All patients agreed to repeat the FS every 5 years. CONCLUSIONS: This study demonstrates that a screening examination will be most likely performed if it is done as an on-site examination. In contrast, the participation rate is low if the patient has to make an appointment by himself. Acceptance of FS screening is also dependent on the patient's gender and family history of cancer. Additional strategies are needed to further improve participation.

Ambulatory Care Facilities↗
PubMed2005

A framework for examining the sustained acceptability of microbicides.

The concept of acceptability involves a complex set of individual, couple and socio-cultural factors. Within a specific focus on microbicides, this article sets forth the relevant behavioral issues demanding attention as scientists and product developers strive to identify microbicides that will be used in a sustained, long-term fashion to prevent HIV/AIDS. The paper re-conceptualizes long-term acceptability within the ARRM framework, reviews the basic issues and research related to microbicide acceptability, discusses couple relationships (especially the nature of intimate relationships), and identifies related gender and power factors. The importance of the cultural context within various international settings pervades all of these issues. Finally, a set of challenges is discussed for those contemplating such research.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Acceptability of male circumcision for prevention of HIV infection in Malawi.

Numerous epidemiological and biological studies report male circumcision (MC) to have a significant protective effect against HIV-1 acquisition. This study assesses the acceptability of MC in four districts in Malawi, a country with high HIV-1 prevalence and low prevalence of MC. Thirty-two focus group discussions were conducted with 159 men and 159 women ages 16-80 years. Acceptability was lower in the north where the practice was little known, higher in younger participants and higher in central and southern districts where MC is practiced by a minority Muslim group (Yao). Barriers to circumcision included fear of infection and bleeding, cost, and pain. Facilitators included hygiene, reduced risk of STI, religion, medical conditions, and enhanced sexual pleasure. If MC services are introduced in Malawi, acceptance is likely to vary by region, but many parents and young men would use the services if they were safe, affordable and confidential.

Adolescent↗
PubMed1988

Patient acceptance of prefilled disposable vaginal applicator.

Patient acceptance of a new, compact, prefilled disposable vaginal applicator was tested in an open study in which 2% butoconazole cream was used for the treatment of vulvovaginal candidiasis. Twenty nonpregnant patients with clinical signs and symptoms of candidiasis and microscopic identification of Candida in wet smear were treated for 3 days and then asked to rate the convenience of and their acceptance of the prefilled vaginal applicator. No adverse events were reported. All of the patients readily accepted the idea of a prefilled applicator and judged the shape and surface of the test applicator to be comfortable and the applicator to be easily inserted. Patients judged this applicator to be the most convenient and least messy when compared with other commercially available, reusable, or prefilled disposable applicators.

Administration, Intravaginal↗
PubMed1990

Acceptability of fear reduction procedures with children.

The present study investigated the acceptability and perceived effectiveness of alternative fear reduction procedures used with children and adolescents. Descriptions of fear reduction procedures were evaluated by secondary school students, parents, and professionals. Of all the treatments, systematic desensitisation was rated as the most acceptable and effective. Presumably because of its confronting and potentially aversive nature, flooding was generally unacceptable and seen to be ineffective. In contrast to previous research findings, a clear pattern failed to emerge between the evaluations of the various groups. A strong positive relationship was found between acceptability and perceived effectiveness ratings.

Adolescent↗
PubMed1979

Use and acceptance of the "paper pill". A novel approach to oral contraception.

A randomized, crossover study comparing the acceptance of and attitudes towards two dosage forms of the same oral contraceptive product - a paper presentation and the conventional tablet, was carried out in a network of rural and suburban research centers in the State of Durango, México. The results failed to show any significant advantage (in terms of acceptability or continuation) of the paper formulation. Although two-thirds of the participants indicated a preference for the conventional tablet, there was a high degree of acceptance of the paper formulation among new oral contraceptive acceptors.

Adolescent↗
PubMed1982

The Prentif contraceptive cervical cap: acceptability aspects and their implications for future cap design.

Patients in a private gynecological practice were offered the Prentif contraceptive cervical cap. The first 413 acceptors were sent a questionnaire covering in detail many of the aspects of their experience. The 371 responses contained a wealth of information concerned with safety, effectiveness and acceptability. Safety and effectiveness are dealt with in the companion article preceding, while the less serious risk factors that reduce the acceptability of the Prentif cap are presented and discussed herein. In order of descending frequency, these factors include: odor; difficulty removing; discomfort to partner; difficulty inserting; dislike of spermicide; discomfort to self; urinary discomforts; vaginal infections; vaginal discharge; and vaginal itching. The most attractive features of the cap, as compared with the diaphragm, were: increased convenience; greater safety; less interference with spontaneity; increased frequency of intercourse; and increased libido. Despite multiple problems with Prentif caps, 67.4% of the cap recipients were still using their caps after one year. However, this was among a select group of highly motivated women of above-average intelligence. The causes of cap acceptability problems are discussed along with probable future improvements in cap design that may solve them.

Adult↗
PubMed1994

Acceptability of the once-a-month injectable contraceptives Cyclofem and Mesigyna in Egypt.

A study of the acceptability of two once-a-month injectable contraceptives, Cyclofem and Mesigyna, in Egypt included 1091 women participating in the clinical trial of the two methods carried out during the period from November 1989 to July 1992. The acceptability of the two contraceptives proved to be high when measured by the rate of continuation at 12 months of injectable use, by method satisfaction, service satisfaction, rec recommending use to others, intent of future use, as well as willingness to pay for them when the injectables are marketed. The most important determinants of use discontinuation were young age, large family size, first time contraceptive use, previous experience with menstrual problems, dissatisfaction with clinic services, lack of counseling, lack of social support, as well as the husband's negative attitude towards contraceptive use. Side effects were more frequently reported by discontinuers; however, continuers appeared to be more tolerant of the same side effects. This study provided in-depth information about the social aspects affecting the acceptability of monthly injectable contraceptives in the different Egyptian localities, in addition to its being useful in monitoring activities in the clinical setting during these trials.

Attitude↗
PubMed1994

Norplant contraceptive acceptability among women in five Asian countries.

An analysis of 1,882 Asian acceptors of Norplant implants indicates that method acceptability remained high among the 882 women who used the method for five years. Women who discontinued early from the study were, on average, younger than those who completed five years of use. Also, they had fewer live births and were more likely to desire additional children. Overall, about 70% of the women in these countries found the Norplant implant method to be very favorable. The majority (> 40%) of the women found the ease and duration of use of the method to be most attractive, while menstrual disturbances were the least-liked aspect of the method. Although it was apparent that there are still some potential obstacles to Norplant implant acceptance, most noticeably concerns about menstrual irregularities, interest in continuing the method after five years of use is high. Further research of issues related to Norplant implant acceptability may improve continuation rates and overall client satisfaction.

Adult↗
PubMedDate not supplied

Community based distribution of ivermectin in eastern Sudan: acceptability and early post-treatment reactions.

A study to monitor ivermectin acceptability and post-treatment reactions during mass community distribution was carried out in eastern Sudan, where severe reactive onchodermatitis is prevalent. Of 1081 individuals eligible for treatment, 1076 (99.5%) accepted the ivermectin. Post-treatment reactions were monitored by self reporting, 5 d after a single dose of about 150 micrograms/kg (range 103-200 micrograms/kg); 230 persons reported adverse events (21.4%). No reaction was rated as severe. The most common problem was itching with cutaneous papular eruptions (16.2%). Local oedematous swelling was the second most common and the most slowly resolving complaint (5.4%), followed by musculoskeletal pain. There was a high acceptance rate of the treatment and remarkable tolerance of the post-treatment effects, probably due to efforts made to prepare the community to expect reactions to ivermectin, widespread awareness of the beneficial effects of treatment by villagers who had participated in clinical trials previously, and the encouragement we gave to the population to become involved in improvement of their health care services. Single doses of ivermectin resulted in good clinical responses and created much goodwill among villagers. Improvements in physical fitness, ability to work, and freedom from musculoskeletal pain were reported at the 3 months' follow-up. We recommend that, during mass distribution of ivermectin, community involvement in planning overall health improvement should be included, since the treatment initiates the process well. In areas where sowda syndrome is prevalent, medical surveillance for 3 d or more should be considered.

Adolescent↗
PubMed1996

Do primary care patients accept psychological treatments?

Most individuals seeking care for psychological distress go to primary care physicians rather than to mental health professionals. Many have symptoms of distress that do not meet criteria for psychiatric disorders; pharmacotherapies are generally not available for these subsyndromal problems. Preliminary studies suggest that psychosocial therapies may be useful. The aim of this paper was to learn whether medical patients would accept psychological treatments for 1) depression, an explicit psychopathology; 2) stress, a nonpathological, but psychological, problem; and 3) medical problems, a nonpsychological issue. Respondents were 131 primary care patients at San Francisco General Hospital, a public sector hospital. The results show that most of the patients (107 of 131) found psychological interventions acceptable. In addition, the vast majority were willing to have the treatments focus on psychological issues such as depression and stress. This study demonstrates that primary care patients find psychological interventions acceptable.

Adult↗
PubMed1983

Acceptance of hepatitis B vaccine among high-risk health care workers.

During a recent hepatitis B vaccination program among high-risk health care workers, the major sources of information about the vaccine were an in-service informational program, discussion with co-workers, and professional journals. Little or no information was obtained from the lay media or the product brochure. Two thirds of the personnel to whom the vaccine was offered accepted the vaccine. The major reason for accepting the vaccine was a perceived high-risk of contracting hepatitis B. In contrast, one third of the high-risk individuals offered the vaccine declined the opportunity. The major reason for not accepting the vaccine was concern with potential side effects. This information would have been helpful during the planning phase of the program.

Female↗
PubMed1995

Acceptance and perception of percutaneous endoscopic gastrostomy by patients with upper aerodigestive tract cancer.

Surgeons have identified a role for percutaneous endoscopic gastrostomy (PEG) in selected patients with upper aerodigestive tract cancer, but little is known about the patient's acceptance and perception of PEG. Nineteen patients with upper aerodigestive tract cancer had placement of a PEG and were asked about their perceptions via a series of descriptors and associated questions. The 13 patients who had PEG placement under local anaesthesia and intravenous midazolam were questioned 12-16 h later and reported that the procedure was comfortable and not as bad as expected. These patients together with a further 6 patients who had placement under general anaesthesia were questioned about their acceptance of the PEG tube after 10 days. Comfort, ease of use and maintenance, and coverage by clothing confirms that PEG is an acceptable delivery system for enteral nutrition in patients with upper aerodigestive tract cancer.

Adult↗
PubMed2004

A pilot study on the acceptability of levonorgestrel-releasing intrauterine device by young, single, nulliparous Chinese females following surgical abortion.

This study investigated the acceptability of the levonorgestrel-releasing intrauterine device (LNG-IUS) as contraception among young, single women after termination of pregnancy. Twenty subjects, with a median age of 21 years, had LNG-IUS inserted immediately after suction termination of first-trimester pregnancy. The subjects were followed-up at 6 weeks, 3 months, 6 months and 12 months. Fifteen subjects (75%) had other pregnancies terminated in the past. There were no serious complications or pregnancies. The acceptability of the LNG-IUS was generally above 86% during each follow-up visit. A total of seven (35%) subjects were lost to follow-up at different periods of the study. Overall, four subjects (22%) had the LNG-IUS removed. Nine subjects were seen at the end of the 1-year study period and all continued with the LNG-IUS for contraception. Side effects were commonly observed and irregular vaginal bleeding was the most common. We conclude that the LNG-IUS may be an acceptable method among selective young, single, nulliparous clients after termination of pregnancy and could be offered as an option of contraception to them. However, the small sample size and the high lost-to-follow-up rate are the major limitations of this study.

Abortion, Induced↗
PubMed2005

Acceptability and clinical performance of a copper-containing frameless IUCD in Hong Kong.

This is the first study conducted in Hong Kong to evaluate the acceptability and clinical performance of a copper-containing frameless intrauterine contraceptive device (IUCD; GyneFix/Ji Ni). Sixty-two women chose to use the frameless IUCD for contraception. A learning curve was demonstrated in the insertion technique of this new device. Pain associated with insertion was acceptable. No pregnancy was reported during the 1-year trial period. Objectively, the amount of menstrual loss did not change and dysmenorrhea improved, but the duration of menstrual flow was slightly prolonged during the use of this device. However, there was a 10.7% request rate for removal of the device because of its side effects. The expulsion rate during the first year was 5.3%, and the continuation rate at the end of the first year was 76.7%. It was found that 85% of the 40 subjects interviewed upon the completion of the 1-year trial period wished to replace the same device after the product expiration date and that 92.5% would recommend this device to their friends. In summary, the clinical performance of the frameless IUCD was comparable to its framed counterparts. The device was considered acceptable to a majority of the women.

Adult↗