Search

People with epilepsy have various education needs and must adopt many self-management behaviors in order to control their condition. This study evaluates WebEase, an Internet-based, theory-driven, self-management program for adults with epilepsy. Thirty-five participants took part in a 6-week pilot implementation of WebEase. The main components of WebEase are My Log, a behavioral journal, and the Medication, Stress and Sleep Modules, which provide tailored information and feedback designed to prompt participants to assess their status with self-management behaviors, think about their behaviors and make a goal. In this article, we discuss the results of the feasibility, acceptability and usability assessments and the behavioral outcomes. The process results indicate that theoretical components that served as the program framework were successfully integrated into the program and that participants viewed WebEase as relevant, acceptable and easy to use. Additionally, participants showed some improvement in epilepsy self-management, adherence, sleep quality, self-efficacy and social support following the program. The initial results are encouraging and continued development of WebEase has the potential to facilitate education and self-management strategies among people with epilepsy. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to test an intervention to support antiretroviral medication adherence among primarily low-income men and women with HIV. The study was a randomized controlled trial (Get Busy Living) with participants assigned to treatment (Motivational Interviewing [MI]) and control groups. Participants were recruited from an HIV/AIDS clinic in Atlanta, Georgia, US. Of those referred to the study, 247 completed a baseline assessment and were enrolled with 125 randomized to the intervention group and 122 to the control group. Participants were patients beginning antiretroviral therapy or changing to a new drug regimen. The intervention consisted of five MI sessions delivered by registered nurses in individual counselling sessions. Participants were paid for each session attended. The intervention sought to build confidence, reduce ambivalence and increase motivation for ART medication-taking. Medication adherence was measured by the Medication Event Monitoring System (MEMS®) from the time of screening until the final follow-up conducted approximately 12 months following the baseline assessment. Participants in the intervention condition showed a trend towards having a higher mean percent of prescribed doses taken and a greater percent of doses taken on schedule when compared to the control group during the months following the intervention period. This effect was noted beginning at about the eighth month of the study period and was maintained until the final study month. Although the finding was weaker for overall percent of prescribed doses taken, the results for the percent of doses taken on schedule suggests that the MI intervention may be a useful approach for addressing specific aspects of medication adherence, such as adherrence to a specified dosing schedule. [ABSTRACT FROM AUTHOR]

Computer-assisted interviewing (CAI) has begun to play a more prominent role in HIV/AIDS prevention research. Despite the increased popularity of CAI, particularly audio computer-assisted self-interviewing (ACASI), some research teams are still reluctant to implement ACASI technology because of lack of familiarity with the practical issues related to using these software packages. The purpose of this report is to describe the implementation of one particular ACASI software package, the Questionnaire Development System (QDS; Nova Research Company, Bethesda, MD), in several nursing and HIV/AIDS prevention research settings. The authors present acceptability and satisfaction data from two large-scale public health studies in which they have used QDS with diverse populations. They also address issues related to developing and programming a questionnaire; discuss practical strategies related to planning for and implementing ACASI in the field, including selecting equipment, training staff, and collecting and transferring data; and summarize advantages and disadvantages of computer-assisted research methods. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the perceived role of African-American fathers in educating their sons about sex and HIV prevention. Given that some studies have shown a relationship between parent-adolescent sexual communication and adolescent sexual behavior, and the disproportionately high rates of teen pregnancy and HIV (and other STIs) among African-American youth, it is noteworthy that no previous study of parent-adolescent sexual communication has focused on African-American fathers. This study involved the qualitative analysis of focus group data obtained from 14 African-American fathers of adolescent boys between the ages of 11 and 14 years. The results of this analysis revealed three general themes, which were entitled: (1) 'Fathers Want to be Response-Able,' (2) 'What Would Michael Jordan Do?' and (3) 'Having Sex Could Mean Kissing Your Future Goodbye.' The findings show that African-American fathers place a high value on fatherhood and accept their roles as sex educators of their male children. Overall, the study's results have important implications for the design and implementation of effective HIV prevention programs for African-American adolescent boys. [ABSTRACT FROM AUTHOR]

This article describes the initial development and testing of the Antiretroviral Medication Complexity Index (AMCI), an instrument to measure complexity of antiretroviral medications and regimens. Data were derived from a pilot study and the main study of an intervention designed to promote adherence to antiretroviral medications. Interrater reliability coefficients ranged from .74 to 1.0 for project staff and from .33 to 1.0 for nurse clinicians. Test-retest coefficients ranged from .297 to .988 for forms completed by the same interviewer and from .200 to .922 for different interviewers. Strong relationships existed between rankings of the medications by clinical judgment and rankings of the medications using the AMCI, providing support for criterion validity. Complexity as measured by the AMCI was associated with some measures of adherence, providing partial support for construct validity. Results provide evidence for the reliability and validity of the AMCI when used for research purposes. [ABSTRACT FROM AUTHOR]

Little information exists on communication about sexuality between parents and preadolescent children. This study collected qualitative data on family sexuality communication from 3 focus groups conducted with African American mothers of 6-10 year old children. Two broad themes emerged from the data: 'Beyond the Birds and the Bees' and 'Let's Talk about Sex... But How?' These themes are discussed in terms of previous literature and implications for sexuality education and research. [ABSTRACT FROM AUTHOR]

The family plays an important and powerful role in the sexual socialization of children and adolescents. The information and messages that are (or are not) communicated between parents and children have the potential to shape sexual decision-making during adolescence, particularly related to HIV/AIDS risk behaviors. This paper presents a review and synthesis of three areas of the literature on parent-child communication about sexuality-content and process; predictors of parent-child communication; and behavioral outcomes associated with communication. Based on the review, gaps in the research and directions for future studies are discussed. [ABSTRACT FROM AUTHOR]

This report describes a pilot study of a nursing intervention to increase adherence to combination therapy. The intervention was based on motivational interviewing (MI). Participants completed a baseline assessment using the computer-administered self-interview with audio (ACASI) data collection method and then were randomly assigned to the MI intervention or control condition. Nurse counselors met with participants in the MI intervention group for three adherence sessions. Two months following baseline, participants completed a follow-up assessment. Mean scores on ratings of missed medications were lower for participants in the intervention group than those in the control group. Although there were no significant differences in the number of medications missed during the past 4 days, participants in the MI group reported being more likely to follow the medication regimen as prescribed by their health care provider. The pilot study provided useful information about the acceptability of ACASI and the adequacy of intervention procedures. The results of this pilot study show promise for the use of MI as an intervention to promote adherence to antiretroviral medications. [ABSTRACT FROM AUTHOR]

PURPOSE: To determine if the reactions of adolescents toward hypothetical situations that can lead to conflict and violence varied by parenting style of their mothers. METHODS: This study was part of a larger research project involving adolescents and their mothers participating in a longitudinal HIV-prevention program. Mothers and their adolescents were recruited from a community-based organization (CBO) and interviewed separately. Data were analyzed using the responses of 439 African-American adolescents ranging from ages 11 to 14 years. The responses of adolescents to questions about parenting were used to classify mothers into one of three parenting styles: authoritative, authoritarian, or permissive. The 'anticipated reactions to hypothetical situations' scale consists of 11 items with 6 response categories. The six responses were reclassified into three categories ranging from 'not at all violent' to 'extremely violent.' Higher scores indicate more violent reactions to the hypothetical situations. The parenting scale consists of two subscales: a 13-item parental involvement scale and a 13-item parental control scale. Items were rated on a 5-point Likert scale from 'strongly disagree' to 'strongly agree.' Analysis of variance was used to determine if the anticipated reactions of adolescents toward hypothetical situations varied by parenting style of their mothers. RESULTS: Adolescent participants who reported a more permissive parenting style expressed more intense negative reactions toward the hypothetical situations that can provoke conflict. Male adolescents also expressed more intense reactions than females to the situations. There was no difference in intensity of reaction by age after controlling for gender and parenting style. CONCLUSIONS: Parenting style is associated with adolescents' reactions to hypothetical situations that can provoke conflict. This finding highlights the importance of considering parents and their approach to child-rearing as a factor in the adolescent's ability to react to conflict. [ABSTRACT FROM AUTHOR]

In this article, the authors present the results of the analysis of the baseline data from Keepin' it R.E.A.L.!, an HIV prevention project developed for mothers and their adolescents. Six hundred twelve mostly male (60.6%) and African American (98.2%) adolescents completed baseline assessments. Eleven percent of the adolescent participants reported initiating sexual intercourse. Adolescent participants expressing higher levels of self-efficacy to resist peer pressure, more favorable outcome expectancies, less communication about sex with their mothers, higher levels of self-concept related to their behavior, lower levels of self-concept related to popularity, and less stress reported fewer types of intimate sexual behaviors. Adolescent participants who reported higher self-efficacy to resist peer pressure to have sex and lower levels of stress were less likely to have initiated sexual intercourse. Selected characteristics of mothers did not contribute to understanding factors associated with intimate sexual behaviors or initiation of sexual intercourse among adolescent participants. [ABSTRACT FROM AUTHOR]

HIV is a family disease. Family research in HIV is challenging because of complexities of family measurement, the range of family constellations across cultures, and the issues specific to HIV-affected families. A consortium of NIMH-funded investigators is conducting HIV research on families--defined as networks of mutual commitments. A procedure for identifying the 'family' is proposed. This article reviews assessment strategies from two research traditions, both of which have been greatly concerned with social context: family assessment tradition--family membership, parenting, and interactional dynamics; HIV/AIDS research tradition--HIV-relevant constructs generalized to minority families. Initially, a systematic procedure for defining family membership is provided. Constructs and measures derived from the family assessment tradition are described, including self-report and observational procedures. Constructs and measures of relevance to family research that originated in the HIV/AIDS research tradition are described: HIV knowledge, stigma, disclosure, and social support. Constructs presented derive from the Consortium's research on the role of families in prevention and adaptation to HIV/AIDS. Most of the research conducted by the Consortium has taken place with inner-city, minority, heterosexual families. By informing the selection of constructs and measures relevant to investigating the role of families in HIV prevention, and adaptation to living with HIV/AIDS, it is the Consortium's intention to enhance the quality and quantity of research at the intersection of families and HIV/AIDS. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine factors that are thought to promote communication about safer sex and HIV among college students in the United States of America and to determine the extent to which communication about safer sex is important in the use of condoms. A better understanding of factors associated with safer sex communication can be helpful in developing HIV and STD prevention programmes for college students. Following approval from the institutional review boards of the six participating colleges and universities, researchers collected data from a random sample of students. The study included participant responses if participants were 18-25 years of age, single and sexually active. For the sample of 1349 participants, the mean age was 20.6 years. Sixty-three per cent of the sample was female, 50.5% white, 42.3% African-American, and the remainder of other ethnic groups. Over 50% of respondents reported frequent condom use, with 28% noting that they used a condom every time and 30.6% reporting condom use almost every time they had sex. Only 9.6% indicated that they never used a condom. The results of hierarchical multiple regression analysis revealed that the perception of quality of general communication with parents, the perception of a partner's attitude towards communication, communication self-efficacy, and communication outcome expectancies, were associated with safer sex communication. However, the association between safer sex communication and condom use was weak, suggesting that other factors excluded from this study are important in determining condom use for this sample of respondents. The findings provide some implications for HIV interventions. Interventions that enhance self-efficacy and positive outcome expectancies related to communication about safer sex are likely to foster discussion with a sexual partner. However, they might not lead to actual condom use. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this article is to describe the self-generated coding procedures we used in a study of HIV prevention practices of college students; provide information on the success rate of matching; compare responses of participants for whom we could match data and for those whom we could not; and make suggestions on ways to improve matching. DESIGN: Longitudinal. SETTING: Not given. POPULATION: College students in a large southeastern metropolitan area. INTERVENTIONS: The data for this study were from a 3-year longitudinal study of HIV risk-reduction practices of college students. Questionnaires were sent in succeeding years. In order to determine which students had completed the questionnaires, they were asked to return the questionnaire along with the card with the study number on it or in a blank sealed envelope that was then sealed in the envelope with the study number. When received at the study coordinating center, the card or envelope with the study was immediately separated from the questionnaire. In order to match questionnaires over the 3-year study period, participants were asked to complete a self-generated identification form at each data collection point. MAIN OUTCOME MEASURE(S): In the second year of the project, we were able to successfully match 74.3% of the questionnaires to those returned during the first year using 6 to 8 of the code elements on the form, and in the third year, we were able to match 73% of questionnaires to those returned in the second year. Participants for whom questionnaires matched were more likely than participants with unmatched questionnaires to be white students enrolled as underclassmen. RESULTS/CONCLUSIONS: The results indicate that a substantial proportion of questionnaires can be successfully matched over a 12-month period using the self-generated identification form. However, the results also indicate that it might be unrealistic to expect close to 100% matching over this time period. The results indicate that investigators who use an anonymous coding form can expect to retain about 70% of their sample over a 1-year period. Efforts to build trust with participants might allay fear and suspicion about misusing the research data. Finally, although sample bias is a major concern in this area of research, we found no differences in social cognitive variables or most demographic characteristics. [CINAHL abstract] [ABSTRACT FROM AUTHOR]

In the past several years, the greatest proportionate increase in AIDS diagnoses has occurred among women. Yet, while the risk of HIV infection increases, female college students continue to report inconsistent HIV prevention behaviors. Past research on condom use among college women has focused on intrapersonal aspects of the behavior, and little is known about the influence of interpersonal factors on women's condom use. In this study we examined the relative salience of both intra and interpersonal factors on African American and white women's use of condoms. We found that interpersonal variables were particularly salient predictors of condom use. There were no ethnic differences in the effects of interpersonal variables; however, there were differences in the effects of self-efficacy on condom use. [ABSTRACT FROM AUTHOR]

Using a focus group approach, the investigators sought to explore the role of African American mothers in the education of their adolescents about sexuality including the provision of factual information and transmission of values. A focus group guide was developed and was used by a trained facilitator to direct discussions in three focus groups conducted during a 1-week period. Participants in the focus groups were mothers who had at least one adolescent between the ages of 13 and 15. A total of 29 mothers participated in the groups. All interview data were transcribed, and analysis was conducted using the constant comparative approach. Three major themes emerged from the analysis: 'The Big Talk,' 'Sex Is Killing Now,' and 'Don't Let Them Know It's Embarrassing.' The findings revealed that mothers felt they talked frequently with their adolescents about sexual issues, but felt that their sons were less likely than their daughters to discuss sexual concerns with them. Popular topics of discussion with daughters included menstruation and pregnancy; with boys, condom use. Participants expressed concern about the negative consequences of teen sex including pregnancy, contraction of sexually transmitted diseases, and the human immunodeficiency virus. [ABSTRACT FROM AUTHOR]

This descriptive study examined pregnancy nausea to determine whether nausea occurred more frequently during the morning hours than during other times of day and if certain patterns of nausea exist. The 19 women who participated in the study kept daily diaries of their nausea experiences over a 7-day period, noting the time of occurrence. Nausea was reported most frequently during waking hours, ranging from 40.3% of the time between 7 p.m. and 10 p.m. and 43.9% between 3 p.m. and 6 p.m. Most nausea reported by subjects was mild, although 18% of the nausea reported between 11 p.m. and 2 a.m. was severe. Four patterns of nausea were identified: morning peak, evening peak, bimodal, and all day. Whereas some women displayed fairly consistent daily patterns of nausea, others reported variations in the occurrence or severity of nausea over the 7-day period. [ABSTRACT FROM AUTHOR]

Women comprise the fastest growing group of persons with AIDS. They are often diagnosed later in the disease, when antiretroviral therapy (ART) is strongly indicated. Antiretroviral therapy has transformed the course of HIV/AIDS to a treatable, chronic illness. This article provides a profile of women with HIV/AIDS and describes ART. Selected research related to adherence and motivation is summarized. Psychosocial and economic concerns specific to women, ART, adherence, and motivation are presented. The article reviews challenges for risk reduction behaviors for HIV+ women, such as sexual activity and substance abuse. The authors discuss the Keeping Health and Active with Risk reduction and Medication Adherence (KHARMA) Project, a research project in progress that was designed to promote adherence to both ART and risk reduction behaviors in HIV+ women. The study includes two groups: a motivational group intervention based on motivational interviewing and a health promotion program control group tailored to the needs of HIV+ women. A description of the tailored intervention and project update is included. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify HIV prevention goals of college students, to determine if there are differences in goal setting between males and females, and to determine if an association exists between goal setting and behavior. The data are from a study designed to identify HIV prevention practices of college students. The results of the study showed that 71.4% of the respondents indicated that they had a goal to reduce their risk of contracting HIV. The primary goals identified were condom use, limiting number of partners, abstinence, and monogamy. Females were more likely to select abstinence as their first goal, and men, condom use. Females were more likely than males to write high specificity and definitely effective goals. Significant associations were also found between HIV prevention goals and sexual behaviors. When males and females stated abstinence as their goal, there was a significant association with reports of never having sex. This association was significant for both sexually experienced males and females when the goal of abstinence was compared with the occasions of sex in the last three months. For males, having a condom use goal was significantly associated with consistent condom use. However, no significant association was found between females' condom use goals and reported consistency of condom use. [ABSTRACT FROM AUTHOR]

Background: African Americans endure disproportionately high advanced cancer rates and also are disproportionately represented in the lower socioeconomic strata. These individuals work to manage symptoms in order to function and have a satisfactory quality of life., Objective: The purpose of this study was to discover what low-income African American adults with advanced cancer do on a day-to-day basis to relieve and manage symptoms. This study viewed the individuals as experts and asked them not what they are told to do, but rather what they actually do., Methods: A purposive sample of 27 individuals participated in semistructured interviews conducted by 2 research interviewers. This qualitative descriptive approach used content analysis to develop themes to describe symptom self-management., Results: Participants described 2 approaches: making continual adjustments and finding stability through spirituality. In seeking comfort from the distress of their symptoms, they were constantly altering their activities and fine-tuning strategies. They adjusted medical regimens and changed the speed and selection of daily activities, including comfort measures and diet modifications. In contrast, their spirituality was a consistent presence in their lives that provided balance to their unstable symptom experience., Conclusions: This study illustrates that people with advanced cancer actively engage in multiple complex self-management strategies in response to symptoms., Implications for Practice: As providers assess how individuals manage their symptoms, they must find ways to support those efforts. Providers then will recognize the challenges faced by advanced cancer patients in obtaining the best quality of life while managing multiple symptoms, activities, and family responsibilities.

Epilepsy is a chronic condition that significantly affects the lives of individuals with epilepsy and their support persons, though few studies have examined the experiences of both. To examine these experiences and explore the interpersonal relationships between dyad members, we conducted in-depth interviews with 22 persons with epilepsy and 16 support persons. Data analysis was guided by a grounded theory perspective. We developed a model that shows how epilepsy impacts the lives of both persons with epilepsy and their support persons and how the experiences of persons with epilepsy and supporters influence one another. The core model elements were seizure and treatment factors, relationship characteristics, self-management, seizure control, support provided, illness intrusiveness, and quality of life. Persons with epilepsy moved through the model in five trajectories depending on seizure control, relationship type, and gender. Support providers followed four trajectories based on seizure control, perception of burden, and support for themselves. Persons with epilepsy and their primary support providers have varied experiences in how epilepsy affects their lives. This model could serve as a basis for future research and intervention efforts focused on ways to reduce illness intrusiveness and improve quality of life for persons with epilepsy and their supporters., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Social support is an important mechanism for improving self-management, although little is known about its role in epilepsy self-management. We examined the type of support provided to people with epilepsy and its influence on self-management. We conducted in-depth interviews with 22 people with epilepsy and 16 support persons, representing 14 pairs and 10 unpaired individuals. We analyzed the data using principles of grounded theory. Supporters, who were mainly parents and spouses, aided people with epilepsy in every dimension of self-management. Support for self-management occurred along a continuum from person with epilepsy-led management to support person-led management. Where the pairs fell on the continuum depended on developmental stage, relationship type, and relationship dynamics. Seizure control shaped individuals' experiences with self-management and support within each group. The self-management continuum provides a new aspect that can be integrated into existing models of self- and family management., (© The Author(s) 2014.)

Social support is associated with improved self-management for people with chronic conditions, such as epilepsy; however, little is known about the perceived ease or difficulty of receiving and providing support for epilepsy self-management. We examined patterns of epilepsy self-management support from the perspectives of both people with epilepsy and their support persons. Fifty-three people with epilepsy and 48 support persons completed a survey on epilepsy self-management support. Of these individuals, 22 people with epilepsy and 16 support persons completed an in-depth interview. Rasch measurement models were used to evaluate the degree of difficulty of receiving or providing support often for nine self-management tasks. We analyzed model-data fit, person and item location along the support latent variable and differential person and item functioning. Qualitative methods were used to provide context and insight into the quantitative results. The results demonstrated good model-data fit. Help with seizures was the easiest type of support to receive or provide more often, followed by rides to a doctor's appointments and help avoiding seizure triggers. The most difficult types of support to receive or provide more often were reminders, particularly for taking and refilling medications. While most participants' responses fit the model, responses of several individuals misfit the model. Person misfit generally occurred because the scale items did not adequately capture some individuals' behaviors. These results could be useful in designing interventions that use support as a means of improving self-management. Additionally, the results provide information to improve or expand current measures of support for epilepsy self-management to better assess the experiences of people with epilepsy and their support persons., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The purpose of this qualitative study was to explore the meaning and use of spirituality among African American (AA), predominantly Christian women with HIV. A nonrandom sample of 20 AA women from a large infectious disease clinic in Metro-Atlanta participated in the study. The study used focus groups and individual interviews to interview women about their lived spiritual experience. Content analysis and NUDIST software were used to analyze transcripts. The findings revealed the spiritual views and practices of AA women with HIV. The following themes (and subthemes) emerged: Spirituality is a process/journey or connection (connection to God, higher power, or spirit and HIV brought me closer to God), spiritual expression (religion/church attendance, prayer, helping others, having faith), and spiritual benefits (health/healing, spiritual support, inner peace/strength/ability to keep going, and here for a reason or purpose/a second chance). Findings highlight the importance of spirituality in health and well-being among AA women with HIV/AIDS.

Social support is an important component in managing epilepsy; however little is known about support provided to people with epilepsy. This study examined whom people with epilepsy identify as supportive, and how those individuals support people with epilepsy's self-management efforts. Data come from the WebEase project, an effective online epilepsy self-management program. People with epilepsy who participated in the pilot (n=35) and efficacy trials (n=118) were included. A content analysis was conducted on responses to open-ended questions related to support. The majority of participants provided information about their supporters. The number of support providers ranged from 0 to 6, with about 12% indicating no support. Parents and significant others were most commonly listed as supporters. Support providers mainly offer emotional and instrumental support, reminders and aid for taking medication, and support for self-management strategies. These results could be useful for interventions aimed at bolstering support in order to improve self-management., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Unlabelled: The purpose of this study was to examine the prevalence and predictors of complementary and alternative medicine (CAM) use among rural patients with localized prostate cancer. The study also examined the participants' disclosure of CAM use to their physicians. Baseline and 6-month follow-up data were taken from a study examining the factors that influence treatment choice and quality of life among men diagnosed with and being treated for localized prostate cancer residing in rural southwest Georgia (N = 321). A total of 291 participants were interviewed at baseline and 6-month follow-up., Findings: At baseline, 26.4% reported ever using CAM. Among them, dietary supplements were the most commonly used (75%), and 56% of patients did not disclose their CAM use to their physicians. At 6-month follow-up, 11% of the study sample reported using CAM since starting treatment (half of these were new users). The proportions of CAM users who reported taking dietary supplements after treatment were significantly lower than the corresponding proportions before treatment. CAM use after treatment was more common among those who selected surgery and watchful waiting. While 44% of the sample disclosed using CAM to their doctors before treatment, 61% after treatment began (P = 0.05). We found that CAM use after cancer treatment in this population was markedly less common than in nationally reported data for cancer patients. In line with national patterns, younger and more educated rural patients were significantly more likely to have ever used CAM and to use it after treatment.

WebEase (Epilepsy Awareness, Support, and Education) is an online epilepsy self-management program to assist people with taking medication, managing stress, and improving sleep quality. The primary study aims were to determine if those who participated in WebEase demonstrated improvements in medication adherence, perceived stress, and sleep quality. Participants were randomized to a treatment (T) or waitlist control (WCL) group (n=148). At follow-up, participants in the T group reported higher levels of medication adherence than those in the WLC group. Analyses were also conducted comparing those who had completed WebEase modules with those who had not. Those who had completed at least some modules within the WebEase program reported higher levels of self-efficacy and a trend toward significance was observed for the group×time interactions for medication adherence, perceived stress, self-management, and knowledge. The results highlight the usefulness of online tools to support self-management among people with epilepsy., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The purpose of the study was to explore racial differences related to treatment-based beliefs (trust in physician, physician bias, access to care, and self-efficacy) and coping (religious coping and social support). The study was conducted in a 33-county area located in southwest Georgia (SWGA). Men living in SWGA and newly diagnosed with prostate cancer were invited to participate in the study. Men were also required to be 75 years of age or younger at the beginning of the study and free of dementia. In collaboration with the Georgia Cancer Registry, potentially eligible participants were identified through pathology reports. Participants completed three interviews during a 12-month period post-diagnosis. The 320 participants in this analysis ranged in age from 44 to 75 years with a mean age of 63 years, and 42% were African American. After controlling for confounders, African American participants were more likely to report physician bias, financial problems with access to care, and use of religious coping strategies. These results, based on a largely rural patient population, support those of other studies noting differences in perception of care, access to care, and coping strategies between African American and white men with prostate cancer.

Abstract The purpose of this study was to determine if there was a connection between adherence to antiretroviral therapy (ART) and use of risk reduction behaviors (RRB) in HIV-infected women who were prescribed antiretroviral therapy. The sample consisted of 193 predominately African American women with an average age of 44 who had been on ARV for approximately 9 years and had low annual incomes. All women were participating in a behavioral clinical trial focused on these dual outcomes. Using a risk index developed for this study, we examined the relationship of a composite of risk behaviors to electronically measured and self-reported adherence over the approximately 13-month study period. Women were categorized based on levels of adherence and risky behaviors, and we sought to determine if these classifications were associated with clinical outcomes of HIV viral load and CD4 counts. High levels of adherence were correlated with low risk behaviors (abstinence, consistent use of condoms, etc.). Those classified as high adherence and low-risk behavior (HALR) as well as those classified as high adherence and high-risk behavior (HAHR) had lower mean viral loads and higher CD4 counts than those in the other categories. Women in the low adherence and high-risk category (LAHR) had detectable viral loads and the lowest CD4 counts and are at higher risk for transmitting HIV to partners and unborn children. Our findings underscore the importance of addressing adherence to both ART and RRB in HIV clinical settings to improve clinical outcomes and reduce HIV transmission.

We present the results of a clinical trial that tested the efficacy of using motivational interviewing (MI) in a group format to promote adherence to antiretroviral medications and risk reduction behaviors (RRB) in 203 predominately African American HIV infected women. It was compared to a group health promotion program. Participants were followed for 9 months. Adherence was measured by MEMS(®); and RRB by self-report. Controlling for recruitment site and years on ART, no significant group by time effects were observed. Attendance (≥7/8 sessions) modified the effects. Higher MI attendees had better adherence at all follow-ups, a borderline significant group by time effect (p = 0.1) for % Doses Taken on Schedule, a significantly larger proportion who reported abstinence at 2 weeks, 6, and 9 months, and always used protection during sex at 6 and 9 months. Though not conclusive, the findings offer some support for using MI in a group format to promote adherence and some risk reduction behaviors when adequate attendance is maintained.

In 2007, the Neuroscience Nursing Foundation (NNF) convened a research panel to update NNF's research priorities used to guide funding. The research panel identified leaders in neuroscience nursing and conducted a review of neuroscience nursing research literature and an American Association of Neuroscience Nurses membership survey on research priorities. A workgroup of leaders in neuroscience nursing was then convened to draft and set priorities on the basis of the review of the literature and the membership survey. The updated priorities were submitted to the NNF Board of Trustees for approval. The revised document reviews the mission of NNF and outlines six strategies and five program areas (including specific subareas) that represent priorities for NNF research funding. The purpose of the updated priority document is to provide guidelines for the systematic development of knowledge in neuroscience nursing through the encouragement of selected neuroscience nursing research activities.

Many HIV-positive women regard spirituality as an important part of their lives and spirituality may have positive impact on their health-related quality of life (HRQOL). Particularly among African American women with HIV, spirituality may serve as a cultural and psychological resource. This descriptive, crosssectional study examined associations between spiritual well-being (SWB) and its components, existential well-being (EWB) and religious well-being (RWB), and dimensions of HRQOL among a non-random sample of 118 African American HIV-positive women. A secondary analysis of data from two similar, NIH-funded studies: The Get Busy Living (GBL) Project and the KHARMA Project, was conducted. Baseline data on women from both studies were combined into one database and statistical analyses, including descriptive, correlation and hierarchical regression analyses, were conducted. Existential well-being was significantly positively (β =.74; p=.014) associated with the physical composite of HRQOL and accounted for a significant amount of unique variance (10.0%) beyond that explained by socio-demographic variables, religious well-being (RWB), HIV medication adherence, CD4 cell count and percentage, HIV viral load, and depressive symptoms. EWB was also significantly positively (β =.57; p=.024) associated with the mental health composite of HRQOL. Depressive symptomatology was also significantly inversely (β =.40; p=.004) associated with mental HRQOL. EWB accounted for a significant amount of additional variance (6.3%) beyond that explained by other variables. Spirituality is an important factor in the lives and quality of life of African American women and women living with HIV/AIDS. Further research is needed to examine relationships between spirituality and HRQOL among HIV-positive African American women.

Objective: To analyze differences for prostate cancer by race and in rural areas., Methods: We studied 516 men younger than 75 years old with incident prostate cancer during 2005-08 in 33 counties in Southwest Georgia (SWGA), a rural area of 700,000 (40% African American). Treatment data were abstracted from medical records, and interviews conducted with 314 men. We also compared treatments in SWGA vs. Atlanta in 2005., Results: External radiation plus brachytherapy was the most common treatment in SWGA (31%), followed by external radiation alone (27%), and surgery (18%). Patients in SWGA had higher odds of external radiation vs. surgery than men in Atlanta (OR 2.66, 95% CI 1.85-3.81). African Americans had higher odds of choosing treatment other than surgery, compared with whites (OR 2.04, 95% CI 1.57-2.63), more so in SWGA (OR 3.51, 95% CI 1.92-6.41) than Atlanta (OR 1.76, 95% CI 1.32-2.35) (P = .05). Poor communication with their physician was reported by 13% of men in SWGA, more among African Americans than whites (OR 3.95, 95% CI 1.52-10.30), and more among those who had no treatment vs. some treatment (OR 5.77, 95% CI 1.88-11.46)., Conclusions: In both rural and urban Georgia, white men with prostate cancer had surgery more frequently than African Americans, although data suggest this may be caused more by income differences than race. Rural patients as opposed to urban patients were more likely to receive external radiation and less likely to receive brachytherapy alone or surgery. Poor communication with a physician, particularly prevalent among African Americans, was associated with choosing no treatment in SWGA., (Copyright © 2011 Elsevier Inc. All rights reserved.)

This study evaluated the efficacy of a newly developed, home-based depression intervention for people with epilepsy. Based on mindfulness-based cognitive therapy (MBCT), the eight-session, weekly intervention was designed for group delivery via the Internet or telephone. Forty participants were randomly assigned to intervention or waitlist. Depressive symptoms and other outcomes were measured at baseline, after intervening in the intervention group (~8 weeks), and after intervening in the waitlist group (~16 weeks). Depressive symptoms decreased significantly more in the intervention group than the waitlist group; Internet and telephone did not differ. This effect persisted over the 8 weeks when those waitlisted received the intervention. Knowledge/skills increased significantly more in the intervention than the waitlist group. All other changes, though not significant, were in the expected direction. Findings indicate that distance delivery of group MBCT can be effective in reducing symptoms of depression in people with epilepsy. Directions for future research are proposed., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The purpose of this study was to test a brief instrument to monitor the U.S. public's attitudes about mental illness. A SAMHSA and CDC-led panel reached consensus through an iterative process to identify generic, multidimensional measures to test using a representative sample of 5,251 adults. Exploratory factor analysis revealed two subscales (Negative Stereotypes [alpha = 0.66]; Recovery and Outcomes [alpha = 0.69]). Confirmatory factor analysis supported the convergent validity of the two subscales. Subscale scores differed by sex, race/ethnicity, and experience with mental illness. Inclusion of these brief subscales on existing population-based surveys can help states and others track attitudes about mental illness.

This article reports on the development and psychometric properties of the Antiretroviral General Adherence Scale (AGAS) in two National Institutes of Health-funded projects: the Get Busy Living Project, a behavioral clinical trial to promote consistent use of antiretroviral therapy, and the KHARMA (Keeping Healthy and Active with Risk Reduction and Medication Adherence) Project, which addressed issues of adherence and risk reduction behavior in women. AGAS assesses the ease and ability of participants to take antiretroviral therapy according to a health care provider's recommendations. Data were analyzed from completed baseline assessments of the two studies. The AGAS was internally consistent in both samples. Content, construct, and criterion validity were established using factor analysis and correlations of total AGAS scores with two measures of adherence: electronic drug monitoring and an Adult AIDS Clinical Trials Group adherence scale. Viral load, CD4 cell counts, and depression scores were also examined. Reliability and validity of the AGAS were supported in both samples., (Copyright 2010 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)