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Biesecker B.B.,National Human Genome Research Institute | Erby L.H.,Health Behavior and Society | Woolford S.,Bentley University | Adcock J.Y.,Greater Baltimore Medical Center | And 6 more authors.
Patient Education and Counseling | Year: 2013

Objective: We introduce The Psychological Adaptation Scale (PAS) for assessing adaptation to a chronic condition or risk and present validity data from six studies of genetic conditions. Methods: Informed by theory, we identified four domains of adaptation: effective coping, self-esteem, social integration, and spiritual/existential meaning. Items were selected from the PROMIS "positive illness impact" item bank and adapted from the Rosenberg self-esteem scale to create a 20-item scale. Each domain included five items, with four sub-scale scores. Data from studies of six populations: adults affected with or at risk for genetic conditions (N= 3) and caregivers of children with genetic conditions (N= 3) were analyzed using confirmatory factor analyses (CFA). Results: CFA suggested that all but five posited items converge on the domains as designed. Invariance of the PAS amongst the studies further suggested it is a valid and reliable tool to facilitate comparisons of adaptation across conditions. Conclusion: Use of the PAS will standardize assessments of adaptation and foster understanding of the relationships among related health outcomes, such as quality of life and psychological well-being. Practice implications: Clinical interventions can be designed based on PAS data to enhance dimensions of psychological adaptation to a chronic health condition or risk. © 2013.

Hacker K.,Harvard University | Goldstein J.,Harvard University | Link D.,Harvard University | Sengupta N.,Dimock Health Center | And 3 more authors.
Journal of Developmental and Behavioral Pediatrics | Year: 2013

Objective: Validated behavioral health (BH) screens are recommended for use at well-child visits. This study aimed to explore how pediatricians experience and use these screens for subsequent care decisions in primary care. Methods: The study took place at 4 safety net health centers. Fourteen interviews were conducted with pediatricians who were mandated to use validated BH screens at well-child visits. Interview questions focused on key domains, including clinic BH context, screening processes, assessment of screening scores, and decision making about referral to mental health services. Qualitative analysis used the Framework Approach. Results: A variety of themes emerged: BH screens were well accepted and valued for the way they facilitated discussion of mental health issues. However, screening results were not always used in the way that instrument designers intended. Providers' beliefs about the face validity of the instruments, and their observations about performance of instruments, led to discounting scored results. As a result, clinical decisions were made based on a variety of evidence, including individual item responses, parent or patient concerns, and perceived readiness for treatment. Additionally, providers, although interested in expanding their mental health discussions, perceived a lack of time and of their own skills to be major obstacles in this pursuit. Conclusions: Screens act as important prompts to stimulate discussion of BH problems, but their actual scored results play a variable role in problem identification and treatment decisions. Modifications to scheduling policies, additional provider training, and enhanced collaboration with mental health professionals could support better BH integration in pediatric primary care. Copyright © 2013 Lippincott Williams & Wilkins.

Ameling J.M.,Johns Hopkins University | Ameling J.M.,Welch Center for Prevention | Ephraim P.L.,Johns Hopkins Healthcare LLC | Bone L.R.,Health Behavior and Society | And 22 more authors.
Family and Community Health | Year: 2014

African Americans suffer disproportionately poor hypertension control despite the availability of efficacious interventions. Using principles of community-based participatory research and implementation science, we adapted established hypertension self-management interventions to enhance interventions' cultural relevance and potential for sustained effectiveness among urban African Americans. We obtained input from patients and their family members, their health care providers, and community members. The process required substantial time and resources, and the adapted interventions will be tested in a randomized controlled trial. Copyright © 2014 Wolters Kluwer Health Lippincott Williams & Wilkins.

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