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BackgroundOnly approximately half of patients with hypertension have their blood pressure controlled, due in large part to the tendency of primary care providers (PCPs) not to intensify treatment when blood pressure values are elevated. ObjectiveThis study tested the effect of an intervention designed to help patients ask questions at the point of care to encourage PCPs to appropriately intensify blood pressure treatment. MethodsPCPs and their patients with hypertension (N=500) were recruited by letter and randomized into 2 study groups: (1) intervention condition in which patients used a fully automated website each month to receive tailored messages suggesting questions to ask their PCP to improve blood pressure control, and (2) control condition in which a similar tool suggested questions to ask about preventive services (eg, cancer screening). The Web-based tool was designed to be used during each of the 12 study months and before scheduled visits with PCPs. The primary outcome was the percentage of patients in both conditions with controlled blood pressure. ResultsOf 500 enrolled patients (intervention condition: n=282; control condition: n=218), 418 (83.6%) completed the 12-month follow-up visit. At baseline, 289 (61.5%) of participants had controlled blood pressure. Most (411/500, 82.2%) participants used the intervention during at least 6 of 12 months and 222 (62.5%) reported asking questions directly from the Web-based tool. There were no group differences in asking about medication intensification and there were no differences in blood pressure control after 12 months between the intervention condition (201/282, 71.3%) and control condition (143/218, 65.6%; P=.27) groups. More intervention condition participants discussed having a creatinine test (92, 52.6% vs 49, 35.5%; P=.02) and urine protein test (81, 44.8% vs 21, 14.6%; P

BackgroundIntegrating online weight-loss programs into the primary care setting could yield substantial public health benefit. Little is known about primary care providers’ perspectives on online weight-loss programs. ObjectiveTo assess primary care providers’ perspectives on online weight-loss programs. MethodsWe conducted focus group discussions with providers in family medicine, internal medicine, and combined internal medicine/pediatrics in Texas and Pennsylvania, USA. Open-ended questions addressed their experience with and attitudes toward online weight-loss programs; useful characteristics of existing online weight-loss programs; barriers to referring patients to online weight-loss programs; and preferred characteristics of an ideal online weight-loss program. Transcripts were analyzed with the grounded theory approach to identify major themes. ResultsA total of 44 primary care providers participated in 9 focus groups. The mean age was 45 (SD 9) years. Providers had limited experience with structured online weight-loss programs and were uncertain about their safety and efficacy. They thought motivated, younger patients would be more likely than others to respond to an online weight-loss program. According to primary care providers, an ideal online weight-loss program would provide—at no cost to the patient—a structured curriculum addressing motivation, psychological issues, and problem solving; tools for tracking diet, exercise, and weight loss; and peer support monitored by experts. Primary care providers were interested in receiving reports about patients from the online weight-loss programs, but were concerned about the time required to review and act on the reports. ConclusionsPrimary care providers have high expectations for how online weight-loss programs should deliver services to patients and fit into the clinical workflow. Efforts to integrate online weight-loss programs into the primary care setting should address efficacy and safety of online weight-loss programs in clinic-based populations; acceptable methods of sending reports to primary care providers about their patients’ progress; and elimination or reduction of costs to patients.

Background: All 50 states have school-entry immunization requirements, and many also allow exemptions based on medical and non-medical reasons. School nurses are responsible for managing student immunization compliance based on state policies, but lack standardized resources and guidance. Methods: Pennsylvania school nurses (N = 21) participated in semi-structured interviews regarding their strategies for communication and management of student immunization information, along with resources needed for practice improvement. Data were analyzed using descriptive content analysis. Results: Nurses reported similarities in timelines used for communication of immunization requirements, but differences in mechanisms used to secure and manage immunization records. Nurses reported a need for clarity regarding exclusions and exemption policy implementation and requested standardized resources and guidance for navigating immunization compliance. Conclusions: A need exists for standardized processes that support immunization compliance. Furthermore, nurses highlighted a need for additional training and enhanced networks to develop creative strategies for promoting immunization uptake among families.

Studies have shown social support can promote weight loss, specifically when support is received online through forums on weight loss websites. The goal of this study was to explore the experiences of individuals using support forums on weight loss websites. We conducted a content analysis on web-administered survey responses from members of two weight loss websites (N = 340). The findings revealed three major themes: (1) receiving advice, strategies, and mantras are helpful with weight loss; (2) support forums provide a nonjudgmental environment for losing weight; and (3) receiving social support and inspiration from someone similar is helpful with weight loss. These findings suggest online support forums can benefit individuals attempting to lose weight by offering a place to receive nonjudgmental social support from other similar users.

Over the past decades, life expectancy of people with type 1 diabetes has increased considerably, which brings potential challenges due to the process of aging. Cognitive aging and dementia, as well as reductions in visual acuity, hearing and dexterity, can influence the frequency and quality of daily self-management activities, including medication taking and insulin dosing, glucose self-monitoring, and healthy eating. This can increase the risk for hypo- and hyperglycemic events, which, in turn, may contribute to cognitive decline. Because there is a gap in understanding the barriers and facilitators of self-management in older adults with type 1 diabetes and the relationship to cognitive functioning, the authors 1) review the available literature on cognitive aging and type 1 diabetes, 2) describe what self-management in later adulthood entails and the cognitive functions required for effective self-management behaviors, 3) analyze the interaction between type 1 diabetes, cognition, aging, and self-management behaviors, and 4) describe the barriers and facilitators for self-management throughout the life span and how they may differ for older people. Potential evidence-based practices that could be developed for older adults with type 1 diabetes are discussed. There is need for further studies that clarify the impact of aging on T1D self-management, ultimately to improve diabetes care and quality of life. [ABSTRACT FROM AUTHOR]

The purpose of this research was to develop an inclusive evaluation of "transformative learning theory" that encompassed varied perspectives of transformative learning. We constructed a validated quantitative survey to assess the potential outcomes and processes of how transformative learning may be experienced by college-educated adults. Based on a review of the rational/cognitive, extrarational, and social/emancipatory perspectives of transformation learning theory, the survey reflects the assumptions underlying these perspectives through survey items and allows the survey to be used in multiple contexts both inside and outside the formal classroom. Survey development included a comprehensive review of the literature, external review by experts in adult education, focus groups for clarification of the items, the calculation of interitem correlations for each scale and cross-scale correlations, and the calculation of Cronbach's a reliability coefficients. This survey has the potential to advance the study of transformative learning by being inclusive of several existing theoretical perspectives that have common outcomes.

Purpose: To evaluate whether medical student participation in TimeSlips (TS), a creative group-based storytelling program, with persons affected by dementia would improve student attitudes toward this patient population. Design and Methods: Fifteen fourth-year medical students from Penn State College of Medicine participated in a month-long regimen of TS sessions at a retirement community. Student course evaluations were analyzed at the conclusion of the program to examine perceived qualitative changes in attitude. Findings: Qualitative data revealed insights into the manner in which student attitudes toward a geriatric patient population became more positive. Implications: This is the first known pilot study to suggest that participation in a creative group-based storytelling program might improve medical student attitudes toward persons with dementia.

This action research study explores the meaning-making process using forms of creative expression for eight women with insulin-dependent diabetes. The study is theoretically informed by arts-based ways of knowing and aspects of feminist poststructuralism, and explains the process of creativity used in the action research process. The findings center on the role of the created images and (a) the layered processes of meaning around those images as imaginal, individual, and social, (b) the images as embedded in other life contexts, and (c) how creative expression deconstructs and complements medical knowledge. Focusing on the construction of knowledge and the process of creative expression, the article highlights the importance of attending to creative expression as a way of knowing in adult and health education. (Contains 1 table.)

This chapter describes the use of popular film and semiotics for the development of critical media literacy in a graduate-level education course entitled "Pop Culture as Pedagogy: The Role of Entertainment Media in Teaching for Critical Consciousness and Critical Media Literacy." The course focused on analysis of different forms of pop culture, specifically on film and television, as a way of revealing how social relations are based on structural issues of power. The chapter is divided into three sections: the authors' initial journeys from experience to analysis; the ways they constructed knowledge through class and online; and how to incorporate popular culture and media into practice.

Objective: To explore the experiences and care preferences of women with chronic pelvic pain, with or without a history of sexual trauma, seeking gynaecological care. Design: Qualitative study. Setting: Ambulatory endometriosis centre. Population or Sample: Women aged 18–55 years with chronic pelvic pain. Methods: Baseline demographics and sexual trauma history were obtained, and participants were assigned to focus groups according to a positive (four groups, 13 participants) or negative (two groups, nine participants) screen for a history of sexual trauma. The focus groups were led by a clinical psychologist and a gynaecological surgeon and consisted of semi‐structured interviews. The interviews were audio‐recorded and transcribed, and the transcripts were coded in NVivo 12. Main outcome measures: Content analysis was used to derive themes according to the participants' own words. Results: Participants with chronic pelvic pain, with or without a history of sexual trauma, experienced delay in diagnosis and repetitive dismissals by clinicians. Participants' experiences of dismissals included: clinicians not listening, insufficient allocation of time to appointments and perceived redundant medical testing (i.e. sexually transmitted infection testing, urine cultures, ultrasounds). Participants identified clinician interactions as pivotal in coping with both pelvic pain and sexual abuse. Participants also provided feedback regarding trauma‐informed practices and care delivery specific to patients with chronic pelvic pain. Conclusion: Patients with chronic pelvic pain, with or without a history of sexual trauma, report negative experiences when interacting with the healthcare system. They have clear needs and preferences regarding gynaecological care and provide feasible suggestions for improving care delivery. This article includes Author Insights, a video abstract available at: https://vimeo.com/775029350 [ABSTRACT FROM AUTHOR]