Patient-health Communication Research Articles

Health communication and shared decision-making between nurses and older adults in community setting: An integrative review.

To explore the role of health communication in Shared Decision-Making (SDM) between nursing staff and older people in the community setting. Society and healthcare services are marked by an exponentially ageing population, leading to a significant proportion of patients being older adults with highly demanding care needs. Scientific literature supports shared decision-making as a process that engages patients in their care. However, the increasing use of technology and the consequences of the COVID-19 pandemic have influenced how nurses communicate with older patients. Therefore, it is crucial to understand how to develop health communication to reach effective, shared decision-making processes. Whittemore and Knafl's integrative review method, the literature search comprised five databases: PubMed, CINALH, Web of Science, Scopus and PsycINFO. The 12 included studies were synthesised into three study patterns: (1) nurse-older patient health communication relationship, (2) older patients' perspectives and (3) nontherapeutic communication in end-of-life care. This review underscored the crucial role of effective health communication in shaping SDM dynamics between nursing staff and older people in the community setting. Key elements included transparent information exchange, establishing trust and maintaining communication channels with informal caregiving networks. SDM actions were aligned with preserving older people's autonomy, but communication challenges persisted, particularly in end-of-life situations. Advanced care planning was recommended to address these shortcomings and improve communication among older people, healthcare professionals and families. Implementing educational measures based on verbal and nonverbal health communication in nursing training could be beneficial. Nursing research could continue to develop and refine specific communication strategies adapted to the social determinants of health for diverse clinical situations regarding older adults in the community setting. The authors have adhered to relevant EQUATOR guidelines through the PRISMA 2020 checklist. No Patient or Public Contribution.

Heart disease symptoms and health-related quality of life in pediatric heart transplant recipients: A serial multiple mediator analysis.

A serial multiple mediator analysis was conducted to test the predictive effects of heart disease symptoms on pediatric heart transplant recipients health-related quality of life (HRQOL) from their perspective with patient-perceived cognitive problems, patient health communication, and treatment anxiety as hypothesized mediators. One hundred and nineteen pediatric heart transplant recipients aged 8-18 completed the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and the PedsQL Cardiac Module Heart Disease Symptoms Scale, Cognitive Problems Scale, Communication Scale and Treatment Anxiety Scale. The serial multiple mediator analysis tested the hypothesized sequential mediation of the cross-sectional association between patient-perceived heart disease symptoms and their perceived HRQOL. Heart disease symptoms indirect effects on HRQOL were sequentially mediated through cognitive problems, with cognitive problems' indirect effects mediated through patient health communication and treatment anxiety. A predictive analytics analysis consisting of age, gender, and time since transplant demographic covariates, demonstrated that heart disease symptoms, cognitive problems, patient health communication, and treatment anxiety accounted for 66 percent of the variance in patient-perceived HRQOL (p < .001), representing a large effect size. Patient-perceived heart disease symptoms indirect effects on HRQOL in pediatric heart transplant recipients was explained by patient-perceived cognitive problems, patient health communication, and treatment anxiety. Delineating heart disease symptoms indirect effects on HRQOL from the perspective of pediatric patients may inform targeted clinical interventions to improve daily functioning in pediatric heart transplant recipients.

Pain and health-related quality of life in Duchenne muscular dystrophy: A multiple mediator analysis.

The objective was to investigate the serial mediating effects of daily activities, patient health communication, and disease-specific worry in the relationship between pain intensity and overall generic health-related quality of life (HRQOL) in pediatric patients with Duchenne muscular dystrophy from the patient perspective. Pain Intensity Item, Daily Activities Scale, Communication Scale and Worry Scale from Pediatric Quality of Life Inventory (PedsQL) Duchenne Muscular Dystrophy Module and PedsQL 4.0 Generic Core Scales were completed by 110 pediatric patients with Duchenne muscular dystrophy ages 8-17. A serial multiple mediator model analysis was conducted to test the hypothesized sequential mediating effects of daily activities, patient health communication, disease-specific worry as intervening variables in the association between the pain intensity predictor variable and overall generic HRQOL. Pain predictive effects on overall generic HRQOL were serially mediated by daily activities, patient health communication, and disease-specific worry. In a predictive analytics model utilizing hierarchical multiple regression analysis with age demographic covariate, patient-reported pain intensity, daily activities, patient health communication, and disease-specific worry accounted for 47% of the variance in overall generic HRQOL (P<0.001), representing a large effect size. Pain intensity, daily activities, patient health communication, and disease-specific worry explain in part the mechanism of pain predictive effects on overall generic HRQOL in pediatric patients with Duchenne muscular dystrophy. Identifying the mediators of pain intensity on overall generic HRQOL from the patient perspective may inform targeted clinical interventions and future patient-centered clinical research to improve overall daily functioning.

Characterization of therapeutic programs headed at post-myocardial infarction patients or at risk of: a scoping review

Abstract Funding Acknowledgements Type of funding sources: None. Background Worldwide stays confirmed that more than 7 million people experience acute myocardial infarction, in which one-year mortality rates range from 10%. The consequences are more dramatic among patients who survived because they are 20% likely to suffer a second cardiovascular event in the first year and mostly occur in those with a previous hospital discharge. Evidence has shown that prevention after a myocardial infarction has been positively associated with an improvement in its prognosis. The European Society of Cardiology was determined to embrace this challenge, endorsing the crucial role of secondary programs. However, recent studies allow us to state some gaps between the correlation of some important variables, related to secondary programs and patients that should be considered to reinforce good intervention practices. Purpose To analyze data capable of characterizing therapeutic programs considering the correlation between variables such as quality indicators, settings of implementation, use of digital technology, health professionals/organization enrolled, and the program's overall length. Methods We performed the analyses in different electronic databases, including published studies from 2007 to September 2022 that reported health therapeutic programs headed post at post-myocardial infarction patients or at risk. After identifying 609 titles, and screening 131 articles, accepting 20 full-text for systematic analysis. Results 16 studies included outpatient presence requirements in the relationship with the health care provider; 4 studies used mobile phone/ digital applications in patient health communication; 3 programs included multi-professional collaboration, the other 7 studies were single-professional with relevance to psychologists and physiotherapists; only 3 studies were conducted in the community setting; Overall, the maximum of programs length ranged from 3 to 42 months; Only 4 studies evaluated the efficiency of the interventions, considering the cost to the organization of the programs and the hospitalized patients; 18 studies related their efficiency based on changes in patient's health behavior and biological parameters. Overall, in terms of the methodology outlined 60% of the studies used a quantitative design, 10% used a mixed plan, and 15% did not refer to it. Conclusions we confirmed the absence of prior guidelines for secondary programs' uniformization, which corroborate the need affirmed for the European Society of Cardiology of endorsing the crucial role and the impact of secondary programs on patient`s health path, tailored to patients needs. We highlight the importance of using mixed methodologies, and prospective design capable of capturing the whole phenomenon. We did not identify any study considering the interoperability of health organizations as a strategy capable of adding value.

Heart disease symptoms, cognitive functioning, health communication, treatment anxiety, and health-related quality of life in paediatric heart disease: a multiple mediator analysis.

The objective was to investigate the serial mediating effects of perceived cognitive functioning, patient health communication, and treatment anxiety in the relationship between heart disease symptoms and overall generic health-related quality of life in children with heart disease from the patient perspective. Heart Disease Symptoms, Cognitive Problems, Communication and Treatment Anxiety Scales from Pediatric Quality of Life Inventory™ (PedsQL™) Cardiac Module and PedsQL™ 4.0 Generic Core Scales were completed by 278 children with CHD ages 8-18. A serial multiple mediator model analysis was conducted to test the sequential mediating effects of perceived cognitive functioning, patient health communication, and treatment anxiety as intervening variables in the relationship between the heart disease symptoms predictor variable and overall generic health-related quality of life. Heart disease symptoms predictive effects on overall generic health-related quality of life were serially mediated in part by cognitive functioning, patient health communication, and treatment anxiety. In a predictive analytics model with age and gender demographic covariates, heart disease symptoms, perceived cognitive functioning, patient health communication, and treatment anxiety accounted for 67% of the variance in patient-reported overall generic health-related quality of life (p < 0.001), representing a large effect size. Perceived cognitive functioning, patient health communication, and treatment anxiety explain in part the mechanism of heart disease symptoms predictive effects on overall generic health-related quality of life in paediatric heart disease. Identifying the mediators of heart disease symptoms on overall generic health-related quality of life from the patient perspective may inform targeted clinical interventions and future patient-centred clinical research to improve overall daily functioning.

Online Health Information Seeking Among Patients With Chronic Conditions: Integrating the Health Belief Model and Social Support Theory.

Chronic diseases are the leading causes of death and disability. With the growing patient population and climbing health care expenditures, researchers and policy makers are seeking new approaches to improve the accessibility of health information on chronic diseases while lowering costs. Online health information sources can play a substantial role in effective patient education and health communication. However, some contradictory evidence suggests that patients with chronic conditions may not necessarily seek online health information. This study aims to integrate 2 theories (ie, the health belief model and social support theory) and a critical health literacy perspective to understand online health information seeking (OHIS) among patients with chronic conditions. We used the survey method to collect data from online chronic disease communities and groups on social media platforms. Eligible participants were consumers with at least 1 chronic condition and those who have experience with OHIS. A total of 390 valid questionnaires were collected. The partial least squares approach to structural equation modeling was employed to analyze the data. The results suggested that perceived risk (t=3.989, P<.001) and perceived benefits (t=3.632, P<.001) significantly affected patients' OHIS. Perceived susceptibility (t=7.743, P<.001) and perceived severity (t=8.852, P<.001) were found to influence the perceived risk of chronic diseases significantly. Informational support (t=5.761, P<.001) and emotional support (t=5.748, P<.001) also impacted the perceived benefits of online sources for patients. In addition, moderation analysis showed that critical health literacy significantly moderated the link between perceived risk and OHIS (t=3.097, P=.002) but not the relationship between perceived benefits and OHIS (t=0.288, P=.774). This study shows that the health belief model, when combined with social support theory, can predict patients' OHIS. The perceived susceptibility and severity can effectively explain perceived risk, further predicting patients' OHIS. Informational support and emotional support can contribute to perceived benefits, thereby positively affecting patients' OHIS. This study also demonstrated the important negative moderating effects of critical health literacy on the association between perceived risk and OHIS.

Patient Health Literacy and Communication with Providers Among Women Living with HIV: A Mixed Methods Study.

In this mixed-methods study, we examine the relationship between provider communication and patient health literacy on HIV continuum of care outcomes among women living with HIV in the United States. We thematically coded qualitative data from focus groups and interviews (N = 92) and conducted mediation analyses with quantitative survey data (N = 1455) collected from Women's Interagency HIV Study participants. Four qualitative themes related to provider communication emerged: importance of respect and non-verbal cues; providers' expressions of condescension and judgement; patient health literacy; and unclear, insufficient provider communication resulting in diminished trust. Quantitative mediation analyses suggest that higher health literacy is associated with higher perceived patient-provider interaction quality, which in turn is associated with higher levels of trust in HIV providers, improved antiretroviral medication adherence, and reduced missed clinical visits. Findings indicate that enhancing provider communication and bolstering patient health literacy could have a positive impact on the HIV continuum of care.

Cognitive functioning, patient health communication, and worry mediate pain predictive effects on health-related quality of life in youth with sickle cell disease.

The objective was to investigate the serial mediating effects of perceived cognitive functioning, patient health communication, and disease-specific worry in the relationship between pain and overall generic health-related quality of life (HRQOL) in youth with sickle cell disease (SCD) from the patient perspective. The pain, cognitive functioning, communication and worry scales from the Pediatric Quality of Life Inventory (PedsQL) Sickle Cell Disease Module and the PedsQL Multidimensional Fatigue Scale, and the PedsQL 4.0 Generic Core Scales were completed in a multisite national study by 233 youth with SCD of ages 5-18. Hierarchical multiple regression and serial multiple mediator model analyses were conducted to test the mediating effects of perceived cognitive functioning, health communication, and disease-specific worry as intervening variables in the association between the pain predictor variable and overall generic HRQOL. Pain predictive effects on overall generic HRQOL were serially mediated by cognitive functioning, health communication, and disease-specific worry. In predictive analytics models utilizing hierarchical multiple regression analyses with age and gender demographic covariates, pain, cognitive functioning, health communication, and worry accounted for 65% of the variance in patient-reported overall generic HRQOL (P<.001), representing a large effect size. Perceived cognitive functioning, patient health communication, and disease-specific worry explain in part the mechanism of pain predictive effects on overall generic HRQOL in youth with SCD. Identifying SCD-specific pain, perceived cognitive functioning, health communication, and disease-specific worry as predictor variables of overall generic HRQOL from the patient perspective may inform clinical interventions and future patient-centered clinical research.

How patient-generated health data and patient-reported outcomes affect patient-clinician relationships: A systematic review.

Introduction:Many patients use mobile devices to track health conditions by recording patient-generated health data. However, patients and clinicians may disagree how to use these data.Objective:To systematically review the literature to identify how patient-generated health data and patient-reported outcomes collected outside of clinical settings can affect patient–clinician relationships within surgery and primary care.Methods:Six research databases were queried for publications documenting the effect of patient-generated health data or patient-reported outcomes on patient–clinician relationships. We conducted thematic synthesis of the results of the included publications.Results:Thirteen of the 3204 identified publications were included for synthesis. Three main themes were identified: patient-generated health data supported patient–clinician communication and health awareness, patients desired for their clinicians to be involved with their patient-generated health data, which clinicians had difficulty accommodating, and patient-generated health data platform features may support or hinder patient–clinician collaboration.Conclusion:Patient-generated health data and patient-reported outcomes may improve patient health awareness and communication with clinicians but may negatively affect patient–clinician relationships.

Developing a Comprehensive Model for Improving Quality of Life in Individuals with Alzheimer Disease and Related Dementia and Their Informal Caregivers: Qualitative Study of AZL Forum Data

Background It is estimated that more than five million Americans are living with Alzheimer disease and related dementia (ADRD), and the population of people living with the disease is expected to triple by 2060. Most care for persons living with ADRD is provided by informal caregivers. However, current strategies to improve the quality of life for both people living with ADRD and their informal caregivers are not optimal, especially from a comprehensive approach. Social media and online forums have become increasingly popular tools for ADRD caregivers to manage the burden of caregiving. Objective This study was to 1) explore informal caregivers’ discussion topics by analyzing the caregiver online forum data, and 2) develop a comprehensive model based on their discussion topics, with the aim to improve quality of life for both persons living with ADRD and their informal caregivers. Methods Publicly available peer interactions of 4102 registered users, with 96% self-claimed as informal caregivers (67% as a child of a person with dementia, 13% as a partner/spouse, and 7% as a relative) on the Alzheimer’s Association ALZ Connected Caregivers Forum were extracted in January 2019 using computer programming. A total of 40,798 postings were collected. All authors agreed to use a triangular model to serve as the predetermined three major themes to categorize all codes. The three major themes were factors of caregivers, factors of individuals with ADRD, and factors of care context. Inductive coding was used to derive in vivo codes from the data, and the codes were further refined throughout the coding process. Two researchers independently coded postings until saturation was reached. Discrepancies were discussed among the two researchers to reach consensus. A third senior researcher’s opinion was referred to whenever necessary. Results For factors of caregivers, the most frequent subthemes were perceived caregiver burden, caregiver’s life balance, caregiving strategies, communication, expectations, personal health issues, poor relationship, and ineffective coping. Subthemes of factors of individuals with ADRD included changes in abilities and capacities, commodities, behaviors, health conditions, daily living function, disengagement, and ineffective coping. Lastly, for factors of care context, the most frequent themes were family support, financial support, informational support, professional support, length of care provided, living arrangement, activities and stimulation, patient health care coordination, unexpected situations, communication, and physical environment. One theme under one of the triangular factors may influence another theme under another triangular factor and vice versa. Conclusions By analyzing the discussions of informal caregivers on ALZ online forum, we found that taking care of a loved one with ADRD is challenging for informal caregivers. The challenges may affect the quality of life for both caregivers and the caregiver recipients; factors of care recipients, caregivers, and the care context interactively affect perceived challenges of caregivers. This study has identified a comprehensive model which may be used to help improve quality of life for both informal caregivers and people living with ADRD. Our next step is to use these manually determined codes to analyze all extracted postings via machine learning to improve this model.

Speech difficulties and patient health communication mediating effects on worry and health-related quality of life in children, adolescents, and young adults with Neurofibromatosis Type 1.

The objective was to investigate the serial mediating effects of speech difficulties, patient health communication, and disease-specific worry in the relationship between neurofibromatosis (NF) symptoms (pain and skin symptoms) and total generic health-related quality of life (HRQOL) in children, adolescents, and young adults with NF Type 1 (NF1) from the patient perspective. The Speech, Communication, Worry, Pain, Skin Itch Bother, and Skin Sensations Scales from the Pediatric Quality of Life Inventory (PedsQL) NF1 Module and the PedsQL 4.0 Generic Core Scales were completed in a multi-site national study by 305 patients ages 5-25 years. A serial multiple mediator model analysis was conducted to test the hypothesized sequential mediating effects of speech difficulties, health communication, and worry as intervening variables in the association between NF1 symptoms and HRQOL. Symptoms predictive effects on total generic HRQOL were serially mediated by speech difficulties, patient health communication, and worry. In predictive analytics models utilizing hierarchical multiple regression analyses with age and gender demographic covariates, the pain, skin itch bother, and skin sensations multiple mediator models accounted for 61%, 59%, and 56% of the variance in generic HRQOL (p < .001), reflecting large effect sizes. Speech difficulties, patient health communication, and disease-specific worry explain in part the mechanism of symptoms predictive effects on total generic HRQOL in pediatric patients with NF1. Identifying NF1-specific predictors and serial mediators of total generic HRQOL in pediatric patients with NF1 from the patient perspective enables a patient-centered comprehensive care approach for children, adolescents, and young adults with NF1.

The Hidden Health Crisis: What Family Caregivers Want You to Know

The Hidden Health Crisis: What Family Caregivers Want You to Know

Diabetes management mediating effects between diabetes symptoms and health-related quality of life in adolescents and young adults with type 1 diabetes.

The primary objective was to investigate the mediating effects of diabetes management in the relationship between diabetes symptoms and generic health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with type 1 diabetes. The secondary objective explored patient health communication and perceived treatment adherence barriers as mediators in a serial multiple mediator model. The PedsQL 3.2 Diabetes Module 15-item diabetes symptoms summary score, 18-item diabetes management summary score, and PedsQL 4.0 generic core scales were completed in a 10-site national field test study by 418 AYA aged 13 to 25 years with type 1 diabetes. Diabetes symptoms and diabetes management were tested for bivariate and multivariate linear associations with overall generic HRQOL. Mediational analyses were conducted to test the hypothesized mediating effects of diabetes management as an intervening variable between diabetes symptoms and generic HRQOL. The predictive effects of diabetes symptoms on HRQOL were mediated in part by diabetes management. In predictive analytics models utilizing multiple regression analyses, demographic and clinical covariates, diabetes symptoms, and diabetes management significantly accounted for 53% of the variance in generic HRQOL (P < 0.001), demonstrating a large effect size. Patient health communication and perceived treatment adherence barriers were significant mediators in an exploratory serial multiple mediator model. Diabetes management explains in part the effects of diabetes symptoms on HRQOL in AYA with type 1 diabetes. Patient health communication to healthcare providers and perceived treatment adherence barriers further explain the mechanism in the relationship between diabetes symptoms and overall HRQOL.

Perceived medication adherence barriers mediating effects between gastrointestinal symptoms and health-related quality of life in pediatric inflammatory bowel disease.

The primary objective was to investigate the mediating effects of patient-perceived medication adherence barriers in the relationship between gastrointestinal symptoms and generic health-related quality of life (HRQOL) in adolescents with inflammatory bowel disease (IBD). The secondary objective explored patient health communication and gastrointestinal worry as additional mediators with medication adherence barriers in a serial multiple mediator model. The Pediatric Quality of Life Inventory™ Gastrointestinal Symptoms, Medicines, Communication, Gastrointestinal Worry, and Generic Core Scales were completed in a 9-site study by 172 adolescents with IBD. Gastrointestinal Symptoms Scales measuring stomach pain, constipation, or diarrhea and perceived medication adherence barriers were tested for bivariate and multivariate linear associations with HRQOL. Mediational analyses were conducted to test the hypothesized mediating effects of perceived medication adherence barriers as an intervening variable between gastrointestinal symptoms and HRQOL. The predictive effects of gastrointestinal symptoms on HRQOL were mediated in part by perceived medication adherence barriers. Patient health communication was a significant additional mediator. In predictive analytics models utilizing multiple regression analyses, demographic variables, gastrointestinal symptoms (stomach pain, constipation, or diarrhea), and perceived medication adherence barriers significantly accounted for 45, 38, and 29 percent of the variance in HRQOL (all Ps<0.001), respectively, demonstrating large effect sizes. Perceived medication adherence barriers explain in part the effects of gastrointestinal symptoms on HRQOL in adolescents with IBD. Patient health communication to healthcare providers and significant others further explain the mechanism in the relationship between gastrointestinal symptoms, perceived medication adherence barriers, and HRQOL.

Patient Health Communication Mediating Effects Between Gastrointestinal Symptoms and Gastrointestinal Worry in Pediatric Inflammatory Bowel Disease.

To investigate the effects of patient health communication regarding their inflammatory bowel disease (IBD) to their health care providers and significant others in their daily life as a mediator in the relationship between gastrointestinal symptoms and gastrointestinal worry in pediatric patients. The Pediatric Quality of Life Inventory Gastrointestinal Symptoms, Gastrointestinal Worry, and Communication Scales, and Pediatric Quality of Life Inventory 4.0 Generic Core Scales were completed in a 9-site study by 252 pediatric patients with IBD. Gastrointestinal Symptoms Scales measuring stomach pain, constipation, or diarrhea and patient communication were tested for bivariate and multivariate linear associations with Gastrointestinal Worry Scales specific to patient worry about stomach pain or bowel movements. Mediational analyses were conducted to test the hypothesized mediating effects of patient health communication as an intervening variable in the relationship between gastrointestinal symptoms and gastrointestinal worry. The predictive effects of gastrointestinal symptoms on gastrointestinal worry were mediated in part by patient health communication with health care providers/significant others in their daily life. In predictive models using multiple regression analyses, the full conceptual model of demographic variables, gastrointestinal symptoms (stomach pain, constipation, or diarrhea), and patient communication significantly accounted for 46, 43, and 54 percent of the variance in gastrointestinal worry (all Ps < 0.001), respectively, reflecting large effect sizes. Patient health communication explains in part the effects of gastrointestinal symptoms on gastrointestinal worry in pediatric patients with IBD. Supporting patient disease-specific communication to their health care providers and significant others may improve health-related quality of life for pediatric patients with IBD.

A PILOT INVESTIGATION INTO THE READABILITY OF SESOTHO HEALTH INFORMATION PAMPHLETS

Printed patient health communication in South Africa is under pressure for various reasons, one being ignorance of the level of health literacy of patients. This pilot study investigated the readability of Sesotho pamphlets given to Sesotho-speaking patients with chronic diseases in the public health sector. Findings obtained through readability tests indicate that the reading level of pamphlets handed to patients is too high, requiring the reader to have had a reading education of approximately nine years or more. This means it is written on a level requiring secondary education, while many people did not complete primary education. The South African context dictates that material should not be written at a level higher than Grade 7 (seven years of schooling), since 21% of the inhabitants of the Free State province has a literacy level (based on years of schooling completed) of Grade 7 or lower.

Methods for using microblogs for health communication with a pharmacist-based account

ObjectiveTo implement and assess the effectiveness of using microblogging for health communication with a pharmacist-based account. MethodsWe created a private and public “iPharmacist” account on the Weibo microblogging platform using the “Brief, Evidence-based, Ethical, and Plain-language (BEEP)” principle to post messages and to interact with patients. From November 2012 to November 2013, a content analysis was performed of the original microposts by iPharmacist, as well as original messages directed to iPharmacist by other accounts, and private messages received by iPharmacist. ResultsA total of 598 original messages were posted by iPharmacist, which were reposted 34442 times with 6013 comments received; while 310 messages were posted by other Weibo users directed to the iPharmacist alone with 131 private messages. ConclusionsThe use of iPharmacist account allowed the provision of quality microposts to educate the Chinese public. The public messages were well disseminated. Practice implicationsMicroblogging could be an effective tool for patient education and health communication.

What Should We Include in a Cultural Competence Curriculum? An Emerging Formative Evaluation Process to Foster Curriculum Development

To identify, prioritize, and organize components of a cultural competence curriculum to address disparities in cardiovascular disease. In 2006, four separate nominal group technique sessions were conducted with medical students, residents, community physicians, and academic physicians to generate and prioritize a list of concepts (i.e., ideas) to include in a curriculum. Afterward, 45 educators and researchers organized and prioritized the concepts using a card-sorting exercise. Multidimensional scaling (MDS) and hierarchical cluster analysis produced homogeneous groupings of related concepts and generated a cognitive map. The main outcome measures were the number of cultural competence concepts, their relative ranks, and the cognitive map. Thirty participants generated 61 concepts; 29 were identified by at least two participants. The cognitive map organized concepts into four clusters, interpreted as (1) patient's cultural background (e.g., information on cultures, habits, values), (2) provider and health care (e.g., clinical skills, awareness of one's bias, patient centeredness, professionalism), communication skills (e.g., history, stereotype avoidance, health disparities epidemiology), (3) cross-culture (e.g., idiomatic expressions, examples of effective communication), and (4) resources to manage cultural diversity (e.g., translator guides, instructions, community resources). The MDS two-dimensional solution demonstrated a good fit (stress = 0.07; R² = 0.97). A novel, combined approach allowed stakeholders' inputs to identify and cognitively organize critical domains used to guide development of a cultural competence curriculum. Educators may use this approach to develop and organize educational content for their target audiences, especially in ill-defined areas like cultural competence.

Patient Narratives: Exploring the Fit of Uncertainty-Management Models of Health Care

Uncertainty-management theory has been studied and applied in multiple areas of health communication. To date, the majority of published research regarding uncertainty management has been limited to studies of patients with terminal or acute illnesses. Diabetes is a manageable, long-term illness that requires daily attention but has a variable trajectory and no cure. This metasynthesis explores previous qualitative studies of personal experiences of patients with diabetes, specifically coding for themes of uncertainty to explore the fit of existing models of uncertainty management to these patients' experiences. Patient responses of guilt, and maintenance of health and identity indicate a need for possible extension of the existing models of uncertainty management in patient health communication.

Behavioral interventions to increase HPV vaccination acceptability among mothers of young girls.

To determine the most effective ways to present human papillomavirus (HPV) vaccine risk and benefit information to mothers in Hispanic, African American, and White communities, to increase mothers' intentions to vaccinate their daughters against HPV. The study used a 3 x 2 between-subjects factorial design, involving 3 different risk presentation formats (graphical HPV statistics, nongraphical HPV statistics, or no-statistics control) and the presence or absence of rhetorical questions (RQ). Data were collected from a national sample of 471 mothers of girls ages 11-16. The primary outcome variable was mothers' intention to vaccinate their daughters against HPV. Secondary outcomes included mothers' self-reported message comprehension and perceptions of daughters' vulnerability to HPV infection, infection severity, vaccine efficacy, and obstacles to immunization. Results showed that both risk presentation format and RQs had an overall positive effect on mothers' intention to vaccinate their daughters. However, the interventions appear to be more effective when used separately than when used in combination. Each of these interventions is brief and could easily be implemented by health care providers as well as in patient health communication literature.