Recent Research Publications and Funding

  •  | June 2, 2015 4:00AM

    Objective: To compare three variants of a culturally relevant and theoretically based message to determine the most influential risk-framing approach for improving intention to place dental sealants for preschool children.

    Design and Sample: A convenience sample of adult, American Indian participants (n = 89) attending a community health fair were assigned to view a gain-framed, loss-framed, or mix-framed dental sealant message.

    Measures: We compared participants' scores on a 46-item survey to determine the relative effect of the frame assignment on seven indices of behavior change.

  •  | June 1, 2015 4:00AM

    Use of agency-employed supplemental nurses on nursing personnel costs was examined in 19 adult patient care units in a large academic medical center. Results indicated that the modest use of supplemental nurses was cost-efficient with regard to overall nursing personnel costs, but heavy reliance on supplemental nurses to meet staffing needs was not cost-efficient. In addition, there was no statistical difference in hourly personnel cost between the use of supplemental nurses and overtime worked by permanent nurses.

  •  | June 1, 2015 4:00AM

    Background

    Public health leaders lack evidence for making decisions about the optimal allocation of resources across local health department (LHD) services, even as limited funding has forced cuts to public health services while local needs grow. A lack of data has also limited examination of the outcomes of targeted LHD investments in specific service areas.

    Purpose: This study used unique, detailed LHD expenditure data gathered from state health departments to examine the influence of maternal and child health (MCH) service investments by LHDs on health outcomes.

    Methods: A multivariate panel time-series design was used in 2013 to estimate ecologic relationships between 2000–2010 LHD expenditures on MCH and county-level rates of low birth weight and infant mortality. The unit of analysis was 102 LHD jurisdictions in Washington and Florida.

    Results: Results indicate that LHD expenditures on MCH services have a beneficial relationship with county-level low birth weight rates, particularly in counties with high concentrations of poverty. This relationship is stronger for more targeted expenditure categories, with expenditures in each of the three examined MCH service areas demonstrating the strongest effects.

    Conclusions: Findings indicate that specific LHD investments in MCH have an important effect on related health outcomes for populations in poverty and likely help reduce the costly burden of poor birth outcomes for families and communities. These findings underscore the importance of monitoring the impact of these evolving investments and assuring that targeted, beneficial investments are not lost but expanded upon across care delivery systems.

  •  | May 26, 2015 4:00AM

    Background: Internationally, as the number of older adults increases, different types of care settings are evolving to address the care needs of this growing group of individuals.

    Aims and objectives: The purpose of this study was to describe and compare clinical outcomes of residents with moderate to severe cognitive impairment living in residential care facilities (RCFs) and nursing homes (NHs).

    Design: This was a secondary data analysis that included data from two studies testing a Function-Focused Care for Cognitively Impaired (FFC-CI) Intervention.

    Methods: A total of 96 participants were from RCFs and 103 were from NHs. Change scores over a 6-month period in RCF and NH residents were evaluated using a multivariate analysis of variance.

    Results: Residential care facilities residents had more agitation, better function and engaged in approximately twice as much physical activity as those in NH settings at baseline. Controlling for treatment status and baseline differences, over 6 months, RCF residents showed a decrease of −22.77 ± 41.47 kilocalories used in 24 hours while those in NHs increased to a mean of 10.49 ± 33.65 kilocalories used. With regard to function, residents in RCFs declined 10.97 ± 18.35 points on the Barthel Index, while those in NHs increased 10.18 ± 19.56 points.

    Conclusions: In this sample, NH residents were more likely to be African American, had more comorbidities, less cognitive impairment, engaged in less physical activity, were more impaired functionally and had less agitation than those in RCFs. Controlling for treatment group status and baseline differences in comorbidities, cognitive status and race, residents in RCFs declined more in terms of functional and physical activity over a 6-month period.

    aging, Dementia
  •  | May 21, 2015 4:00AM

    Background and Purpose: This study examines the underlying factor structure of the Self-Efficacy for Functional Abilities (SEFA) scale among older adults in long-term care settings. Methods: A secondary analysis of SEFA data for 568 residents in 16 long-term care facilities was applied. The sample was randomly split into 2 subsamples. A 2-level exploratory and confirmatory factor analysis adjusting for clustering effect of facilities was used to identify and determine the factor structures respectively. Results: There were 1- and 2-factor models that were identified. Both models demonstrated acceptably mixed model fit. The 2-factor model had poor discriminant validity with high correlation between factors (r = .92, p < .001). The single-factor model was considered valid with moderate correlation with function (r = .301, p < .001). Conclusions: The SEFA scale demonstrated a unidimensional construct among older adults in long-term care settings. Future testing is needed among other older adult populations.

  •  | May 21, 2015 4:00AM

    Objectives: I tested a social marketing intervention delivered in health department waiting rooms via digital signage technology for increasing radon program participation among priority groups.

    Methods: I conducted a tri-county, community-based study over a 3-year period (2010–2013) in a high-radon state by using a quasi-experimental design. We collected survey data for eligible participants at the time of radon test kit purchase.

    Results: Radon program participation increased at the intervention site (t38 = 3.74; P = .001; 95% confidence interval [CI] = 4.8, 16.0) with an increase in renters (χ21,228 = 4.3; P = .039), Special Supplementary Nutrition Program for Women, Infants, and Children families (χ21,166 = 3.13; P = .077) and first-time testers (χ21,228 = 10.93; P = .001). Approximately one third (30.3%; n = 30) attributed participation in the radon program to viewing the intervention message. The intervention crossover was also successful with increased monthly kit sales (t37 = 2.69; P = .01; 95% CI = 1.20, 8.47) and increased households participating (t23 = 4.76; P < .001; 95% CI = 3.10, 7.88).

    Conclusions: A social marketing message was an effective population-based intervention for increasing radon program participation. The results prompted policy changes for Montana radon programming and adoption of digital signage technology by 2 health departments.

  •  | May 15, 2015 4:00AM

    Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.

  •  | May 15, 2015 4:00AM

    Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.

  • Federal Policies Influence Access to Primary Care and Nurse Practitioner Workforce
     | May 13, 2015 4:00AM

    Although most nurse practitioners (NPs) are aware of state-level regulations that influence practice, many are unaware of the ways that federal policies affect NP workforce supply and the delivery of primary care. In this investigation we provide an overview of federal initiatives enacted through the Patient Protection and Affordable Care Act that impact the NP workforce. We explore how the law supports NP workforce supply and settings in which NPs provide care. We then describe challenges that may prevent full utilization of the NP workforce. Examining both federal policies and state-level regulations is essential to achieving an increased NP workforce supply and improved access to care.

  •  | May 7, 2015 4:00AM

    The purpose of this paper is to present the initial feasibility and acceptability of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a new intervention for loneliness. Loneliness is a significant stressor and known contributor to multiple chronic health conditions in varied populations. In addition, loneliness is reported as predictive of functional decline and mortality in large samples of older adults from multiple cultures. Currently, there are no standard therapies recommended as effective treatments for loneliness. The paucity of interventions has limited the ability of healthcare providers to translate what we know about the problem of loneliness to active planning of clinical care that results in diminished loneliness. LISTEN was developed using the process for complex intervention development suggested by the Medical Research Council (MRC) [1] [2].