Publications
CRN-CCRC Personnel Publications
Human Interaction Research Institute (HIRI)
Center for Assistive Technology (CAT)
Publication Highlight
Susana Peinado is one of the fifteen doctoral students who attended the Health Communication Doctoral Fellows Seminar in Denver this summer. Her paper will be presented at the 2012 International Communication Association conference. Click here to read an earlier version of her paper.
CRN-CCRC Personnel Publications
Aiello Bowles EJ, Tuzzio L, Wiese CJ, Kirlin B, Greene SM, Clauser SB, Wagner EH. Understanding high-quality cancer care: a summary of expert perspectives. Cancer 2008; 112(4): 934-42.
Background: The Institute of Medicine (IOM) report Crossing the
Quality Chasm proposed 6 aims for high-quality healthcare:
effective, safe, timely, efficient, equitable, and
patient-centered, and emphasized care coordination. Through
interviews with nationally recognized experts in healthcare
quality, perspectives on barriers and facilitators to achieving
these aims for cancer patients were elicited.
Methods: In all, 23 peer-nominated experts with diverse backgrounds
in policy, healthcare, patient advocacy, and research were
individually interviewed. They were asked about barriers and
facilitators to achieving high-quality cancer care, and information
technology or other innovations that might improve the quality of
cancer diagnosis, treatment, and surveillance. Interviews were
tape-recorded and transcribed. Two analysts independently reviewed
and coded each transcript using ethnographic software to elucidate
key themes.
Results: The major perceived barrier to providing high-quality
cancer care was unnecessary variation in cancer care because of
lack of standardization or adherence to guidelines during
diagnosis, treatment, and surveillance. Additional barriers
included insufficient teamwork and communication among
multidisciplinary care teams, lack of patient awareness and
empowerment, diagnostic delays during provider transitions, and
excessive reimbursement for treatment. Experts suggested improving
cancer patients' experiences by standardizing care, adhering to
guidelines, and using ''patient navigators'' and an interoperable
electronic medical record accessible to patients and providers at
multiple facilities.
Conclusions: Some of these solutions have been developed and
tested, whereas others have not. It is hoped that these suggestions
provide impetus for new research, accelerating progress toward
achieving the IOM's vision for high-quality cancer care.
Alexander, Gwen, McClure J., Calvi J., Divine G., Stopponi M., Rolnick S., Heimendinger J., Tolsma D., Resnicow K., Campbell M., Strecher V., and Johnson C. A randomized clinical trial evaluating online interventions to improve fruit and vegetable consumption. AM J Public Health 2010; 100:319-326.
Objectives. We assessed change in fruit and vegetable intake in
a populationbased sample, comparing an online untailored program
(arm 1) with a tailored behavioral intervention (arm 2) and with a
tailored behavioral intervention plus motivational
interviewing-based counseling via e-mail (arm 3).
Methods. We conducted a randomized controlled intervention trial,
enrolling members aged 21 to 65 years from 5 health plans in
Seattle, Washington; Denver, Colorado; Minneapolis, Minnesota;
Detroit, Michigan; and Atlanta, Georgia. Participants reported
fruit and vegetable intake at baseline and at 3, 6, and 12 months.
We assessed mean change in fruit and vegetable servings per day at
12 months after baseline, using a validated self-report fruit and
vegetable food frequency questionnaire.
Results. Of 2540 trial participants, 80% were followed up at 12
months. Overall baseline mean fruit and vegetable intake was 4.4
servings per day. Average servings increased by more than 2
servings across all study arms (P<.001), with the greatest
increase (+2.8 servings) among participants of arm 3 (P=.05,
compared with control). Overall program satisfaction was
high.
Conclusions. This online nutritional intervention was well
received, convenient, easy to disseminate, and associated with
sustained dietary change. Such programs have promise as
population-based dietary interventions.
Alexander G., Anderson J., Calvi J., Cross W., Davis R., Resnicow K., Strecher V., Tolsma D., Wiese C., Zhang N. Tailoring a fruit and vegetable intervention on ethnic identity: results of a randomized study. Health Psychology 2009, Vol. 28(4), 394-403.
Objective: Many targeted interventions have been developed and
tested with African Americans (AA); however, AAs are a highly
heterogeneous group. One characteristic that varies across AAs is
Ethnic Identity (EI). Little research has been conducted on how to
incorporate EI into the design of health messages and
programs.
Design: We tested whether tailoring a print-based fruit and
vegetable (F & V) intervention on EI would enhance program
impact. AA adults were recruited from two integrated healthcare
delivery systems and then randomized to receive three newsletters
focused on F & V behavior change over three months. One set of
newsletters was tailored only on demographic and social cognitive
variables (control condition), whereas the other (experimental
condition) was additionally tailored on EI.
Main Outcome Measures: The primary outcome for the study was F
& V intake, assessed at baseline and three months later using
the composite of two brief self-report frequency measures.
Results: A total of 560 eligible participants were enrolled, of
which 468 provided complete 3-month follow-up data. The
experimental group increased their daily mean F & V intake by
1.1 servings compared to .8 servings in the control group (p=.13).
Afrocentric experimental group participants showed a 1.4 increase
in F&V servings per day compared to a .43 servings per day
increase among Afrocentric controls (p=.05).
Conclusions: Although the overall between-group effects were not
significant, tailoring dietary messages on ethnic identity may
improve intervention impact for some AA subgroups.
Apker, Julie, Propp, Kathleen M., Ford, Wendy S., and Hofmeister, Nancee. Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions. Journal of Professional Nursing, Vol 22, No 3 (May- June), 2006: pp 180-189.
This study explored how nurses communicate professionalism in interactions with members of their health care teams. Extant research show that effective team communication is a vital aspect of a positive nursing practice environment, a setting that has been linked to enhanced patient outcomes. Although communication principles are emphasized in nursing education as an important component of professional nursing practice, actual nurse interaction skills in teambased health care delivery remain understudied. Qualitative analysis of interview transcripts with 50 participants at a large tertiary hospital revealed four communicative skill sets exemplified by nursing professionals: collaboration, credibility, compassion, and coordination. Study findings highlight specific communicative behaviors associated with each skill set that exemplify nurse professionalism to members of health care teams. Theoretical and pragmatic conclusions are drawn regarding the communicative responsibilities of professional nurses in health care teams. Specific interaction techniques that nurses could use in nurse-team communication are then offered for use in baccalaureate curriculum and organizational in-service education.
Clauser, Steven B., Wagner, Edward H., Bowles, Erin J., Tuzzio, Leah, and Greene, Sarah M. Improving modern cancer care through information technology. Am J Prev Med 2011;40(5S2):S198-S207.
The cancer care system is increasingly complex, marked by multiple hand-offs between primary care and specialty providers, inadequate communication among providers, and lack of clarity about a "medical home" (the ideal accountable care provider) for cancer patients. Patients and families often cite such diffıculties as information defıcits, uncoordinated care, and insuffıcient psychosocial support. This article presents a review of the challenges of delivering well coordinated, patient-centered cancer care in a complex modern healthcare system. An examination is made of the potential role of information technology (IT) advances to help both providers and patients. Using the published literature as background, a review is provided of selected work that is underway to improve communication, coordination, and quality of care. Also discussed are additional challenges and opportunities to advancing understanding of how patient data, provider and patient involvement, and informatics innovations can support high-quality cancer care.
Dearing, James W. Applying diffusion of innovation theory to intervention development. Research on Social Work Practice September 2009; 19(5): 503-518.
Few social science theories have a history of conceptual and empirical study as long as does the diffusion of innovations. The robustness of this theory derives from the many disciplines and fields of study in which diffusion has been studied, from the international richness of these studies, and from the variety of new ideas, practices, programs, and technologies that have been the objects of diffusion research. Early theorizing from the beginning of the 20th century was gradually displaced by post hoc empirical research that described and explained diffusion processes. By the 1950s, diffusion researchers had begun to apply the collective knowledge learned about naturalistic diffusion in tests of process interventions to affect the spread of innovations. Now, this purposive objective has given form to a science of dissemination in which evidence-based practices are designed a priori not just to result in internal validity but to increase the likelihood that external validity and diffusion both are more likely to result. Here, I review diffusion theory and focus on seven concepts-intervention attributes, intervention clusters, demonstration projects, societal sectors, reinforcing contextual conditions, opinion leadership, and intervention adaptation-with potential for accelerating the spread of evidencebased practices, programs, and policies in the field of social work.
Dearing, James W., Greene, Sarah W., Stewart, Walter F. and Williams, Andrew E. If we only knew what we know: principles for knowledge sharing across people, practices, and platforms. Behav. Med. Pract. Policy Res. 2011; 1(1): 15-25.
The improvement of health outcomes for both individual patients
and entire populations requires improvement in the array of
structures that support decisions and activities by healthcare
practitioners. Yet, many gaps remain in how even sophisticated
healthcare organizations manage knowledge. Here we describe the
value of a trans-institutional network for identifying and
capturing how-to knowledge that contributes to improved outcomes.
Organizing and sharing on-the-job experience would concentrate and
organize the activities of individual practitioners and subject
their rapid cycle improvement testing and
refinement to a form of collective intelligence for subsequent
diffusion back through the network. We use the existing Cancer
Research Network as an example of how a loosely structured
consortium of healthcare delivery organizations could create and
grow an implementation registry to foster innovation and
implementation success by communicating what works, how, and which
practitioners are using each innovation. We focus on the principles
and parameters that could be used as a basis for infrastructure
design. As experiential knowledge from across institutions builds
within such a system, the system could ultimately motivate rapid
learning and adoption of best practices. Implications for research
about healthcare IT, invention, and organizational learning are
discussed.
Dearing JW, Gaglio B, Rabin BA. Community organizing research approaches. In: Parrott R, Nussbaum JF, Thompson TL (Eds), Handbook of Health Communication, Second Edition. Taylor and Francis. 2011
Gallagher, Thomas H. A 62-year-old woman with skin cancer who experienced wrong-site surgery: review of medical error. JAMA 2009; 302(6): 669-677.
After a life-threatening complication of an injection for neck
pain several years ago,MsWexperienced a wrong-site surgery to
remove a squamous cell lesion from her nose, followed by pain,
distress, and shaken trust in clinicians. Her experience highlights
the challenges of communicating with patients after errors. Harmful
medical errors occur relatively frequently. Gaps exist between
patients' expectations for disclosure and apology and physicians'
ability to deliver disclosures well. This discrepancy reflects
clinicians' fear of litigation, concern that disclosure might harm
patients, and lack of confidence in disclosure skills. Many
institutions are developing disclosure programs, andsomeare
reporting success
in coupling disclosures with early offers of compensation to
patients. However,much has yet to be learned about effective
disclosure strategies. Important future developments include
increased emphasis on institutions' responsibility for disclosure,
involving trainees and other team members in disclosure, and
strengthening the relationship between disclosure and quality
improvement.
Madrid SD, Dearing JW, Glasgow RE, Rabin BA, Mazor K, Wagner EH. The CRN Cancer Communication Research Center. Clinical Medicine and Research, 2010;8(1): 34.
Mazor KM, Greene SM, Roblin D, Lemay CA, Firneno CL, Calvi J, Prouty CD, Horner K, Gallagher TH. More Than Words: Patients' Views on Apology and Disclosure When Things Go Wrong in Cancer Care. Patient Education and Counseling, Aug 2011.
Objective: Guidelines on apology and disclosure after adverse events and errors have been in place for over 5 years. This study examines whether patients consider recommended responses to be appropriate and desirable, and whether clinicians' actions after adverse events are consistent with recommendations.
Methods: Patients who believed that something had gone wrong during their cancer care were identified. During in-depth interviews, patients described the event, clinicians' responses, and their reactions.
Results: 78 patients were interviewed. Patients' valued apology and expressions of remorse, empathy and caring, explanation, acknowledgement of responsibility, and efforts to prevent recurrences, but these key elements were often missing. For many patients, actions and evidence of clinician learning were most important.
Conclusion: Patients' reports of apology and disclosure when they believe something has gone wrong in their care suggest that clinicians' responses continue to fall short of expectations.
Practice implications: Clinicians preparing to talk with patients after an adverse event or medical error should be aware that patients expect their actions to be congruent with their words of apology and caring. Healthcare systems need to support clinicians throughout the disclosure process, and facilitate both system and individual learning to prevent recurrences.
Metzger, M.J., Flanagin, A.J. Using Web 2.0 Technologies to Enhance Evidence-Based Medical Information. Jounral of Health Communication, 2011, 16:45-58.
This article invokes research on information seeking and evaluation to address how providers of evidence-based medical information can use Web 2.0 technologies to increase access to, enliven users' experiences with, and enrich the quality of the information available. In an ideal scenario, evidence-based medical information can take appropriate advantage of community intelligence spawned by Web 2.0 technologies, resulting in the ideal combination of scientifically sound, high-quality information that is imbued with experiential insights from a multitude of individuals. To achieve this goal, the authors argue that people will engage with information that they can access easily, and that they perceive as (a) relevant to their informationseeking goals and (b) credible. The authors suggest the utility of Web 2.0 technologies for engaging stakeholders with evidence-based medical information through these mechanisms, and the degree to which the information provided can and should be trusted. Last, the authors discuss potential problems with Web 2.0 information in relation to decision making in health contexts, and they conclude with specific and practical recommendations for the dissemination of evidence-based health information via Web 2.0 technologies.
Patel, Minal R., Coffman JM, Tseng CW, Clark NM, and Cabana MD. Physician communication regarding cost when prescribing asthma medication to children. Clinical Pediatrics.
Children with asthma require multiple medications, and cost may be a barrier to care. The purpose of this study was to determine how often physicians ask about cost when prescribing new asthma medication and to identify factors influencing queries. We surveyed pediatricians and family physicians and asked whether they asked about cost when prescribing new asthma medication and if cost was a barrier to prescribing. One third of physicians (35%) reported that concern for cost to the family was a barrier to prescribing. Half reported not asking their patients about drug costs. Pediatricians were less likely to ask about cost (odds ratio [OR] = 0.43; 95% confidence interval [CI] = 0.20-0.92) when compared with family physicians. For every 10% increase in the number of privately insured patients, a physician was less likely to ask about cost (OR = 0.83; 95% CI = 0.74-0.94). Communication about medication costs should be included in childhood asthma management.
Price, David. Continuing medical education, quality improvement, and organizational change: implications of recent theories for twenty-first-century CME. Medical Teacher, Vol. 27, No. 3, 2005, pp. 259-268.
Healthcare providers and systems are being asked to measure and improve the quality of care delivered to their patients. Additionally, the American Board of Medical Specialties now requires physicians to participate in systems-based practice and practice-based learning and improvement activities as part of maintenance of specialty board certification. These changing paradigms provide opportunities for continuing medical education to become more aligned with health system goals and help prepare clinicians to practice in this new environment. Organizational change and quality improvement principles have much in common with continuing medical education planning processes. Medical education can play a role in helping organizations improve. Continuing medical education must move beyond delivering content to individual clinicians towards becoming a facilitator of organizational improvement. Research is needed to determine the effect of integrating continuing medical education with organizational change approaches on professional competence, organizational processes and patient outcomes.
Rabin BA, Brownson RC, Kerner JF, Glasgow RE. Methodological challenges in the dissemination of evidence-based physical activity interventions. Am J of Prev Med, 2006;31(4S):S24-S34.
Rabin BA, Brownson RC, Haire-Joshu D, Kreuter MW, Weaver NL. A glossary for dissemination and implementation research in health. J Public Health Man, 2008;14(2):117-123.
Dissemination and implementation (D&I) Research is increasingly Recognized as an important function of academia and is a growing priority for major health-related funders. Because D&I Research in the health field has emerged from Research traditions in diverse disciplines Ranging from agriculture to education, there are inconsistencies in the use and meaning of terms and main concepts. This glossary provides definitions for the key concepts and terms of D&I Research in health (in both public health and clinical settings). Definitions are organized under five major sections: (1) foundation concepts; (2) types of Research; (3) models, theories, and frameworks; (4) factors influencing the D&I processes; and (5) measurement/evaluation of the D&I process. The aim of this glossary is to aid in the development of more standardized and established terminology for D&I Research, facilitate the communication across different stakeholders, and ultimately contribute to higher-quality D&I Research.
Rabin BA, Glasgow RE, Kerner JF, Klump MP, Brownson RC. Dissemination and implementation research on community-based cancer prevention: a systematic review. Am J of Prev Med, 2010; 38(4):443-456.
Context: An extensive array of effective interventions for the prevention of cancer exists, suggesting that evidence is ready for widespread use. However, few of these approaches have been extensively utilized in real-world settings. Further, little is known on how to best disseminate and implement evidence-based interventions for the primary prevention of cancer in community settings.
Evidence Acquisition: A systematic review of the dissemination and implementation literature was conducted between 2006 and 2008 in the topic areas of smoking, healthy diet, physical activity, and sun protection. English-language peer-reviewed articles published between 1980 and 2008 that met the inclusion criteria were classified by suitability of study design (i.e., greatest, moderate, least); quality of execution (i.e., good, fair, limited); and effectiveness (i.e., substantial, some, or little/no evidence of effectiveness) and were abstracted for dissemination- and implementation-related content.
Evidence Synthesis: Twenty-five unique dissemination and implementation studies were identified. The majority of included studies were conducted in the U.S., in schools, and with children as the ultimate target population, had the least suitability of study design, had fair or limited execution, and used a theoretic framework, active dissemination and implementation approaches, and multimodal strategies. There was considerable heterogeneity across studies in reported mediators, moderators, and outcomes.
Conclusions: Key implications from this review include the need for uniform language, studies targeting various populations and settings, valid and reliable measures, triangulation of and more practice-based evidence, standardized reporting criteria, and active and multimodal strategies.
Rabin BA, Boehmer TK, Brownson RC. Cross-national comparison of obesity and its environmental and policy correlates in Europe. Eur J Public Health, 2007;17(1):53-61.
Background: Despite the growing agreement that modern environments fuel increased food consumption and decreased physical activity, few studies have addressed environmental and policy correlates of obesity. This study describes obesity patterns across Europe and identifies macroenvironmental factors associated with obesity prevalence at a national level.
Methods: Data on obesity prevalence and indicators of the physical, economic, and policy environment were assembled from international databases for 24 European countries. Coefficient estimates between overall, male, and female obesity prevalence and each independent variable were calculated using linear regression.
Results: The obesity prevalence varied widely across countries and between genders with higher values in Central and Eastern European countries and lower values in France, Italy, and some Scandinavian countries. Statistically significant inverse associations were observed between overall and female obesity prevalence and variables from the following domains: economic (real domestic product), food (available fat), urbanization (urban population), transport (passenger cars, price of gasoline, motorways), and policy (governance indicators). There was also a negative association between overall obesity and available fruits/vegetables, and between female obesity and single-member households. Male obesity was inversely associated with available fruits/vegetables and density of motorways. The magnitude of the coefficient estimates suggests stronger associations for female obesity than for male obesity in all cases.
Conclusions: This exploratory study suggests a need to conduct additional research examining the role of obesogenic environments in European countries, with a special focus on policy-related variables, and to further study gender-specific differences in obesity and its correlates.
Rabin BA, Nehl E, Elliott T, Deshpande AD, Brownson RC, Glanz K. Individual and setting level predictors of the implementation of an effective intervention to prevent skin cancer: a multilevel analysis. Implementation Science, 2010;5:40.
Background: To achieve widespread cancer control, a better understanding is needed of the factors that contribute to successful implementation of effective skin cancer prevention interventions. This study assessed the relative contributions of individual- and setting-level characteristics to implementation of a widely disseminated skin cancer prevention program.
Methods: A multilevel analysis was conducted using data from the Pool Cool Diffusion Trial from 2004 and replicated with data from 2005. Implementation of Pool Cool by lifeguards was measured using a composite score (implementation variable, range 0 to 10) that assessed whether the lifeguard performed different components of the intervention. Predictors included lifeguard background characteristics, lifeguard sun protection-related attitudes and behaviors, pool characteristics, and enhanced (i.e., more technical assistance, tailored materials, and incentives are provided) versus basic treatment group.
Results: The mean value of the implementation variable was 4 in both years (2004 and 2005; SD = 2 in 2004 and SD = 3 in 2005) indicating a moderate implementation for most lifeguards. Several individual-level (lifeguard characteristics) and setting-level (pool characteristics and treatment group) factors were found to be significantly associated with implementation of Pool Cool by lifeguards. All three lifeguard-level domains (lifeguard background characteristics, lifeguard sun protection-related attitudes and behaviors) and six pool-level predictors (number of weekly pool visitors, intervention intensity, geographic latitude, pool location, sun safety and/or skin cancer prevention programs, and sun safety programs and policies) were included in the final model. The most important predictors of implementation were the number of weekly pool visitors (inverse association) and enhanced treatment group (positive association). That is, pools with fewer weekly visitors and pools in the enhanced treatment group had significantly higher program implementation in both 2004 and 2005.
Conclusions: More intense, theory-driven dissemination strategies led to higher levels of implementation of this effective skin cancer prevention program. Issues to be considered by practitioners seeking to implement evidence-based programs in community settings, include taking into account both individual-level and setting-level factors, using active implementation approaches, and assessing local needs to adapt intervention materials.
Rabin BA, Glasgow RE. Dissemination of interactive health communication programs. In: Noar SM, Harrington NG (Eds). Interactive Health Communication Technologies: Promising Strategies for Health Behavior Change, First Edition. Routledge. (In Press.)
Rabin BA, Brownson, RC. A glossary for dissemination and implementation research. In: Brownson RC, Colditz G, Proctor E (Eds). Dissemination and Implementation Research in Health: Translating Science to Practice, First Edition. Oxford University Press. (In Press.)
Ridpath, Jessica R., Wiese, Cheryl J., and Greene, Sarah M. Looking at research consent forms through a participant-centered lens: the PRISM readability toolkit. Am J Health Promot 2009;23[6]:371-375.
Communicating in lay language is an underdeveloped skill among
many researchers-a limitation that contributes to low readability
among research consent forms and may hinder participant
understanding of study procedures and risks. We present the Project
to Review and Improve Study Materials (PRISM) and its centerpiece,
the PRISM Readability Toolkit. The toolkit provides strategies for
creating study materials that are readable and participant
centered, focusing on consent forms but also addressing other
participant materials. Based on plain language principles, this
free resource includes a flexible menu of tools, such as an editing
checklist, before and after examples, easy-to-read template
language,
and a list of alternative words. Among PRISM's ongoing goals is to
test the toolkit with populations groups.
Scharff DP, Rabin BA, Cook RA, Wray RJ, Brownson RC. Bridging research and practice through competency-based public health education. J Public Health Man, 2008; 14(2):131-137.
Reducing the gap between research and practice is gaining much needed attention. Schools of public health can play a role by ensuring that students are taught the necessary knowledge and skills to translate research into practice and to effectively disseminate research and other public health information. Competency-based education is one mechanism by which this can occur. In this article, we introduce a set of competencies specific to translation and dissemination. We describe the process used to develop the set as well as the ways in which we have begun to use these competencies for curriculum review and development. In this way, other schools and training programs in public health can begin to design curricula that will prepare their students to reduce the gap between research and practice. Graduate students will thus be effectively prepared to respond to the changing demands of the field of public health.
Scheirer MA, Dearing JW. An Agenda for Research on the Sustainability of Public Health Programs. Am J of Public Health 2011;101(11):2059-2067.
Funders of programs in public health and community health are increasingly concerned about the sustainability of changes they initiate. Despite a recent increase in sustainability research and evaluation, this literature has not developed a widely used paradigm for conducting research that can accumulate into generalizable findings. We provide guidance for research and evaluation of health program sustainability, including definitions and types of sustainability, specifications and measurements of dependent variables, definitions of independent variables or factors that influence sustainability, and suggestions for designs for research and data collection. We suggest viewing sustainability research as a further stage in the translation or dissemination of research-based interventions into practice. This perspective emphasizes ongoing relationships with earlier stages of a broader diffusion framework, including adoption and implementation processes.
Solberg, Leif I., Enstad, Chris J., Boyle, Raymond G., and Nelson, Winnie W. Physician-patient interaction for smoking cessation medications: a dance of mutual accommodation? J Am Board Fam Med 2006;19:251-7.
Objective: To study physician-smoker interactions around the
receipt of smoking cessation medication prescriptions to better
understand the low rates of reported assistance and
follow-up.
Methods: A stratified random sample of smokers recently filling
prescriptions for cessation medications was identified for a phone
interview about the quitting experience. The transcriptions of
those portions of 50 interviews that addressed cessation contacts
with clinicians were reviewed by the coauthors and analyzed for
quantifiable data, observations, and themes.
Results: Although there were low levels of reported physician
adherence to the Assist and Arrange recommendations of the Public
Health Service 5As clinical guideline for smoking cessation, 27
(55%) of these smokers were quit at 1 to 3 months after the
medication fill. Smoker descriptions of the contacts with their
physicians about smoking cessation suggested nonconfrontational,
collaborative, and satisfying interactions that were flexibly
dominated by either party. Physician assistance predominantly
concerned use of the medication (66%).
Conclusions: These physician-smoker interactions seemed to be
mutually accommodative. Given the apparent high quit rates and
limited evidence of smoker interest in other forms of assistance,
perhaps a physician-dominant encounter is not as common or as
necessary as has been thought.
Wagner EH, Aiello Bowles EJ, Greene SM, Tuzzio L, Wiese CJ, Kirlin B, Clauser SB. The quality of cancer patient experience: perspectives of patients, family members, providers and experts. Qual Saf Health Care 2010 Dec; 19(6): 484-9.
Background: Anecdotes and limited evidence suggest that a
significant percentage of cancer patients encounter troublesome
problems in the course of their care.
Methods: The authors collected data about barriers to and
facilitators of high-quality cancer care and innovative solutions
to improve quality from three sources: focus groups with patients,
family members of cancer patients and providers; site visits to
cancer care providers and organisations in three American
communities; and expert interviews.
Results: The authors' respondents consistently described a similar
list of problems facing the individual with a suspicion or
diagnosis of cancer and his/her family: delays in and lack of
coordination of care, patient information gaps and passivity,
inadequate attention to emotional and social problems, and
difficulty accessing services because of inadequate insurance,
limited financial resources or rural residence. The fragmentation
and uncertain accountability of cancer care contribute to these
issues. Respondents recommended linking patients with a care
navigator or manager, using computer technology to better inform
and support patients and connect providers, and reforming provider
reimbursement to encourage more patient-centred care.
Conclusions: Cancer patients and their families have urgent needs
for information and support especially early in their course. To
meet these needs, early cancer care must be better organised,
integrated, and patient centred. The Institute of Medicine's Model
for the Delivery of Psychosocial Services appears to provide a
relevant guide to delivering cancer care that better meets patient
and family needs.
2009 Publications
Khanna N, Nesbitt L, Roghmann MC, Tacket C. Translation of clinical research into practice: defining the clinician scientist. Fam Med. 2009 Jun. 41(6):440-3.
Family medicine has evolved into a specialty deeply rooted in clinical service. Because of high demands for clinical practice productivity, family physicians have drifted away from participation in scientific inquiry. There is even an effort in some institutions to reinvent family medicine as a community-based ambulatory specialty, resulting in a further "disconnect" between research and family physicians. A new movement for the efficient translation of laboratory science into clinical applications in the community supports the need for trained community-based clinician scientists. This translational science seeks to take the findings from bench research and clinical trials and study their introduction and dissemination into community-based clinical practice. There is an opportunity for family physicians to become involved in translational research. But, to develop a cadre of translational researchers within the family medicine community, education programs need to train and develop those researchers. Residency education may be an ideal time to begin that training and development.
Kijsanayotin B, Pannarunothai S, Speedie SM. Factors
influencing health information technology adoption in Thailand's
community health centers: applying the UTAUT model. Int J Med
Inform. 2009 Jun;78(6):404-16. Epub 2009 Feb 3.
One of the most important factors for the success of health
information technology (IT) implementation is users' acceptance and
use of that technology. Thailand has implemented the national
universal healthcare program and has been restructuring the
country's health IT system to support it. However, there is no
national data available regarding the acceptance and use of health
IT in many healthcare facilities, including community health
centers (CHCs). This study employed a modified Unified Theory of
Acceptance and Use of Technology (UTAUT) structural model, to
understand factors that influence health IT adoption in community
health centers in Thailand and to validate this extant IT adoption
model in a developing country health care context.
Murray CE. Diffusion of Innovation Theory: A Bridge for
the Research-Practice Gap in Counseling. Journal of Counseling
& Development Volume 87, Number 1 / Winter 2009 (108 -
116).
This article presents a diffusion of innovation theory-based
framework for addressing the gap between research and practice in
the counseling profession. The author describes the nature of the
research-practice gap and presents an overview of diffusion of
innovation theory. On the basis of the application of several major
postulates of diffusion of innovation theory to the
research-practice gap, several theory-based research practices and
questions are proposed.
Steinbrook R. Health Care and the American Recovery and Reinvestment Act. N Engl J Med. 2009 Mar 12;360(11):1057-60. Epub 2009 Feb 17.
On February 17, 2009, four weeks after his inauguration, President Barack Obama signed into law a $787 billion economic stimulus package. The economic impact of the American Recovery and Reinvestment Act of 2009, as the measure is officially known, will not be apparent for months. Nonetheless, the bill's approval--even before any new senior officials of the Department of Health and Human Services (DHHS) were in place--has jump-started the Obama administration's plans for health care.
2008 Publications
Farr AC, Ames N. Using Diffusion of Innovation Theory to
Encourage the Development of a Children's Health Collaborative: A
Formative Evaluation. J Health Commun. 2008
Jun;13(4):375-88.
Lack of access to medical treatment and preventive care affects
children's immediate well-being and has potential consequences for
their physical and mental health as adults. The study reported in
this article was designed as the first step in planning and
implementing a communitywide collaborative to work on improving
medically underserved children's access to health care. The authors
used a two-stage, census-based telephone survey to identify
organizations that had contact with medically underserved children
and to assess the status of the communication network among them.
Although there was no evidence of a functioning network among the
organizations surveyed, the results indicate that many
organizations would participate in a network and suggest
possibilities for developing an organizational network aimed at
improving children's access to health care.
Scheffler, Richard, Ph.D., Thomas Bodenheimer, M.D.,
Paul Lombardo, M.P.S., R.P.A.C., Barbara Starfield, M.D., M.P.H.,
Walter Morris, M.D., Katharine Treadway, M.D., Grattan Woodson,
M.D., Allan H. Goroll, M.D., Alan Hartstein, M.D., and Thomas H.
Lee, M.D. The Future of Primary Care - The Community Responds.
N Engl J Med. 2008 Dec 18;359(25):2636-9.
In a collection of Perspective articles published in the November
13 issue of the Journal and a videotaped roundtable discussion
posted online, experts in the field discussed the current crisis in
primary care in the United States and possible solutions. Readers
and viewers were invited to contribute their ideas in an online
forum. What follows is a small selection of these comments, with
responses from the roundtable participants, Thomas Bodenheimer,
M.D., Barbara Starfield, M.D., M.P.H., Katharine Treadway, M.D.,
Allan H. Goroll, M.D., and Thomas H. Lee, M.D. The video of the
roundtable and all the comments can be viewed at www.nejm.org.
2007 Publications
McCannon CJ, Berwick DM, Massoud MR. The science of large-scale change in global health. JAMA. 2007 Oct 24;298(16):1937-9.
Innovation in health care includes important challenges: to find or create technologies and practices that are better able than the prevailing ones to reduce morbidity and mortality and tomakethose improvements ubiquitous quickly. In many respects in the pursuit of global health, the second challenge-the rapid spread of effective changes-seems to be the greater. Many sound (even powerful) solutions exist, such as new medicines and innovations in health care delivery, but their adoption is unreliable and slow. Often, they remain hidden in pockets around the globe, flourishing locally without reliably reaching those in need elsewhere. Some such solutions come from biomedical research, but even more take shape at the point of care, in settings where local problem solvers create effective new approaches to problems that others who live far away face as well. Failure to deploy improved technologies and practices widely and quickly is a form of waste that donors, researchers, clinicians, and, most of all, communities in developing nations cannot afford. It behooves those who sponsor biomedical science to make commensurate investments in operational sciences that can inform and energize the active dissemination of new solutions. This is a crucial, but as yet largely neglected, global project: to rapidly spread effective prototypes to entire populations. Scaling up should become a major and sustained enterprise in the global health community. It has its own scientific foundations.
Neuwirth EB, Schmittdiel JA, Tallman K, Bellows J.
Understanding Panel Management: A Comparative Study of an Emerging
Approach to Population Care.
The Permanente Journal, Summer 2007/Vol. 11,
No.3
Panel management is an innovative approach for population care that
is tightly linked with primary care. This approach, which is
spreading rapidly across Kaiser Permanente, represents an important
shift in population-care structure and emphasis, but its potential
and implications have not been previously studied.
Human Interaction Research Institute
The Human Interaction Research Institute (HIRI) helps nonprofits, funders and communities handle the challenges of innovation and change, using behavioral science strategies. Founded in 1961, the nonprofit Institute is based in Los Angeles. Its work ranges from research, to technical assistance on systems change, to disseminating innovations or helping others to do so. The emphasis in all these activities is on the complex human dynamics of change - how to get people personally committed to change and feel rewarded for their involvement, and how to address people's fears and resistances about change.
Current priority areas are: (1) nonprofit capacity building, (2)community collaborations and (3) philanthropy, along with longstanding interests in dissemination and health communication. HIRI's more than 160 projects range across the fields of health, human services and the arts. Examples include national evaluations of youth violence prevention programs, a national research study of strategies for partnerships in the arts, Capitol Hill hearings for Congressional staff on the needs of people with mental illness in the criminal justice system, and a national study of advisors to wealthy donors and their impact on donor philanthropic strategies.
Products from these projects are disseminated in both print and electronic formats. The Institute's work is supported by Federal and State agencies, foundations, and the corporate sector.
To read examples of the work being done by HIRI, please click on one of the article titles listed below.
Implementation of Evidence-Based Interventions: Key Research Issues
The Failure of Success: Challenges of Disseminating Effective Substance Abuse Prevention Programs
Center for Assistive Technology
The Center for Assistive Technology (CAT), the University at Buffalo, announces the publication of a special Focused Issue of Assistive Technology Outcomes and Benefits (ATOB): State of the Science on Technology Transfer. This issue presents the findings from work carried out in the last cycle of the Rehabilitation Engineering Research Center on Technology Transfer (T2RERC).
This special issue offers a forum for discussion and makes recommendations for action. Authors of the five papers presented are T2RERC staff members who represent more than 60 years experience in technology transfer, assistive technology development, and product commercialization.
The first paper, entitled "At the Confluence of Academic Research and Business Development - Merging Technology Transfer with Knowledge Translation to Deliver Value" is by Joseph P. Lane, Director of the CAT and the Center on Knowledge Translation for Technology Transfer (KT4TT). It describes how linking technology transfer to knowledge translation "will increase the relevance and impact of academic research on private sector development and production" (Bodine, Bauer, and Parette, 2010). Dr. John Westbrook, Director of the National Center for the Dissemination of Disability Research (NCDDR) and the new Center on Knowledge Translation for Employment Research (KTER), provides the content review for this paper.
Download the paper: www.atia.org/files/public/ATOBV6N1ArticleTwo.pdf
Dr. Cathy Bodine, Director of the RERC for the Advancement of Cognitive Technologies (AT Partners and the University of Colorado School of Medicine) served as Focused Issue Editor for Volume 6, Number 1 (Summer 2010).
Link to: Focused Issue - State of the Science on Technology Transfer
Assistive Technology Outcomes and Benefits (ATOB) is a peer-reviewed, cross-disability, transdisciplinary journal that publishes articles related to the benefits and outcomes of assistive technology (AT) across the lifespan. ATOB is produced by the Assistive Technology Industry Association (ATIA) in partnership with the Special Education Assistive Technology (SEAT) Center at Illinois State University.
Link to: Assistive Technology Outcomes and Benefits
