Publications

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    ABSTRACT: In preparation for a pilot study to evaluate the efficacy of a school nurse-delivered intervention, focus groups were conducted to gain insight into the perceptions of stakeholders regarding the design and implementation of the intervention. Fifteen focus groups at participating schools. One hundred subjects, including overweight and obese high school students, parents, high school nurses, and staff. Stakeholders' perceptions. Focus groups were audiotaped and transcribed verbatim. Theme instances related to the research aim were identified, coded, and sorted into theme categories. Major topics discussed included teen issues, family support, intervention implementation-related concerns, and curriculum content. Teen issues included dealing with peer pressure, avoiding emotional eating, and support from friends. Many participants thought it should be the teen's choice to involve parents. Confidentiality was the most commonly identified potential barrier to implementation. Recommendations for nutrition and physical activity curriculum content focused on concrete, practical strategies. Results of this research provided insight into stakeholder's needs and perceptions regarding the content and structure of a school nurse-delivered intervention to treat adolescent overweight and obesity. Findings were used in the design and implementation of intervention protocols and materials.
    Journal of nutrition education and behavior 09/2011; 44(1):46-54. · 1.36 Impact Factor
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    ABSTRACT: Evaluate a computer-assisted telephone counseling (CATC) decision aid for men considering a prostate specific antigen (PSA) test. Eligible men were invited by their primary care providers (PCPs) to participate. Those consenting received an educational booklet followed by CATC. The counselor assessed stage of readiness, reviewed booklet information, corrected knowledge deficits and helped with a values clarification exercise. The materials presented advantages and disadvantages of being screened and did not advocate for testing or for not testing. Outcome measures included changes in stage, decisional conflict, decisional satisfaction, perceived vulnerability and congruence of a PSA testing decision with a pros/cons score. Baseline and final surveys were administered by telephone. There was an increase in PSA knowledge (p<0.001), and in decisional satisfaction (p<0.001), a decrease in decisional conflict (p<0.001), and a general consistency of those decisions with the man's values. Among those initially who had not made a decision, 83.1% made a decision by final survey with decisions equally for or against screening. The intervention provides realistic, unbiased and effective decision support for men facing a difficult and confusing decision. Our intervention could potentially replace a discussion of PSA testing with the PCP for most men.
    Patient Education and Counseling 02/2011; 82(2):193-200. · 2.60 Impact Factor
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    ABSTRACT: BackgroundEffective interventions are needed for women long overdue for screening mammography. PurposeThe purpose of this study is to pilot test an intervention for motivating overdue women to receive a mammogram. MethodsSubjects aged 45–79 without a mammogram in ≥27months and enrolled in study practices were identified from claims data. The intervention included a mailed, educational booklet, computer-assisted barrier-specific tailored counseling and motivational interviewing, and facilitated, short-interval mammography scheduling. ResultsOf 127 eligible women, 45 (35.4%) agreed to counseling and data collection. Most were ≥3years overdue. Twenty-six (57.8%) of the counseled women got a mammogram within 12months. Thirty-one (72.1%) of 43 counseled women moved ≥1 stage closer to screening, based on a modified Precaution Adoption Process Model. ConclusionIt is feasible to reach and counsel women who are long overdue for a mammogram and to advance their stage of adoption. The intervention should be formally evaluated in a prospective trial comparing it to control or to proven interventions.
    Annals of Behavioral Medicine 01/2009; 37(3):343-349. · 4.20 Impact Factor
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    ABSTRACT: We present a clinimetric assessment of the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). The MDS-UDPRS Task Force revised and expanded the UPDRS using recommendations from a published critique. The MDS-UPDRS has four parts, namely, I: Non-motor Experiences of Daily Living; II: Motor Experiences of Daily Living; III: Motor Examination; IV: Motor Complications. Twenty questions are completed by the patient/caregiver. Item-specific instructions and an appendix of complementary additional scales are provided. Movement disorder specialists and study coordinators administered the UPDRS (55 items) and MDS-UPDRS (65 items) to 877 English speaking (78% non-Latino Caucasian) patients with Parkinson's disease from 39 sites. We compared the two scales using correlative techniques and factor analysis. The MDS-UPDRS showed high internal consistency (Cronbach's alpha = 0.79-0.93 across parts) and correlated with the original UPDRS (rho = 0.96). MDS-UPDRS across-part correlations ranged from 0.22 to 0.66. Reliable factor structures for each part were obtained (comparative fit index > 0.90 for each part), which support the use of sum scores for each part in preference to a total score of all parts. The combined clinimetric results of this study support the validity of the MDS-UPDRS for rating PD.
    Movement Disorders 12/2008; 23(15):2129-70. · 5.63 Impact Factor
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    ABSTRACT: Few studies have related stages of mammography screening nonadherence with the rationale used by overdue women. We used a grounded theory approach to obtain and analyze data from focus groups, telephone interviews, and surveys. Emergent specific themes were compared with emerging decision levels of nonadherence. Each decision level was then compared with the Precaution Adoption Process Model and the Transtheoretical Model. A total of 6 key themes influencing mammogram nonadherence emerged as did 6 decision levels. Variability within themes was associated with specific decision levels. The decision levels were not adequately classified by either stage model. Stage-based educational strategies may benefit by tailoring interventions to these 6 decision levels.
    Journal of Cancer Education 02/2008; 23(2):114-21. · 0.88 Impact Factor
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    Movement Disorders 01/2008; 23(15):2129–2170. · 4.56 Impact Factor
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    ABSTRACT: This article presents the revision process, major innovations, and clinimetric testing program for the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (UPDRS), known as the MDS-UPDRS. The UPDRS is the most widely used scale for the clinical study of Parkinson's disease (PD). The MDS previously organized a critique of the UPDRS, which cited many strengths, but recommended revision of the scale to accommodate new advances and to resolve problematic areas. An MDS-UPDRS committee prepared the revision using the recommendations of the published critique of the scale. Subcommittees developed new material that was reviewed by the entire committee. A 1-day face-to-face committee meeting was organized to resolve areas of debate and to arrive at a working draft ready for clinimetric testing. The MDS-UPDRS retains the UPDRS structure of four parts with a total summed score, but the parts have been modified to provide a section that integrates nonmotor elements of PD: I, Nonmotor Experiences of Daily Living; II, Motor Experiences of Daily Living; III, Motor Examination; and IV, Motor Complications. All items have five response options with uniform anchors of 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. Several questions in Part I and all of Part II are written as a patient/caregiver questionnaire, so that the total rater time should remain approximately 30 minutes. Detailed instructions for testing and data acquisition accompany the MDS-UPDRS in order to increase uniform usage. Multiple language editions are planned. A three-part clinimetric program will provide testing of reliability, validity, and responsiveness to interventions. Although the MDS-UPDRS will not be published until it has successfully passed clinimetric testing, explanation of the process, key changes, and clinimetric programs allow clinicians and researchers to understand and participate in the revision process.
    Movement Disorders 02/2007; 22(1):41-7. · 4.56 Impact Factor
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    Nancy R LaPelle, Jane Zapka, Judith K Ockene
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    ABSTRACT: Sustaining important public or grant-funded services after initial funding is terminated is a major public health challenge. We investigated whether tobacco treatment services previously funded within a statewide tobacco control initiative could be sustained after state funding was terminated abruptly. We found that 2 key strategies-redefining the scope of services being offered and creative use of resources-were factors that determined whether some community agencies were able to sustain services at a much higher level than others after funding was discontinued. Understanding these strategies and developing them at a time when program funding is not being threatened is likely to increase program sustainability.
    American Journal of Public Health 09/2006; 96(8):1363-9. · 3.93 Impact Factor
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    ABSTRACT: Movement towards evidence-based practices in many fields suggests that public health (PH) challenges may be better addressed if credible information about health risks and effective PH practices is readily available. However, research has shown that many PH information needs are unmet. In addition to reviewing relevant literature, this study performed a comprehensive review of existing information resources and collected data from two representative PH groups, focusing on identifying current practices, expressed information needs, and ideal systems for information access. Nineteen individual interviews were conducted among employees of two domains in a state health department--communicable disease control and community health promotion. Subsequent focus groups gathered additional data on preferences for methods of information access and delivery as well as information format and content. Qualitative methods were used to identify themes in the interview and focus group transcripts. Informants expressed similar needs for improved information access including single portal access with a good search engine; automatic notification regarding newly available information; access to best practice information in many areas of interest that extend beyond biomedical subject matter; improved access to grey literature as well as to more systematic reviews, summaries, and full-text articles; better methods for indexing, filtering, and searching for information; and effective ways to archive information accessed. Informants expressed a preference for improving systems with which they were already familiar such as PubMed and listservs rather than introducing new systems of information organization and delivery. A hypothetical ideal model for information organization and delivery was developed based on informants' stated information needs and preferred means of delivery. Features of the model were endorsed by the subjects who reviewed it. Many critical information needs of PH practitioners are not being met efficiently or at all. We propose a dual strategy of: 1) promoting incremental improvements in existing information delivery systems based on the expressed preferences of the PH users of the systems and 2) the concurrent development and rigorous evaluation of new models of information organization and delivery that draw on successful resources already operating to deliver information to clinical medical practitioners.
    BMC Public Health 02/2006; 6:89. · 2.08 Impact Factor
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    ABSTRACT: To identify potentially successful strategies, barriers, and facilitators for health promotion in preschool child care settings. We conducted 6 focus groups including each of the following: parents of children attending child care centers and home-based family child care (2 in English, 1 in Spanish) and directors of child care centers and family child care providers (2 in English, 1 in Spanish). Systematic thematic analysis was conducted to generate themes to address study questions. A total of 24 parents and 45 child care providers, serving predominantly urban, low-income children in Boston, participated. Parents and child care providers agreed that in-person group discussions would be the most effective strategy for providing health education information to parents. Several barriers that could affect implementation emerged. First, some providers expressed frustration toward parents' attitudes about child safety and health. Second, there was diversity of opinion among providers on whether conducting health promotion activities was consistent with their training and role. In addition, literacy, language, and cultural barriers were identified as potential barriers to health promotion in child care. In order to be successful, health promotion strategies in child care settings will need to overcome tensions between providers and parents, allow professional growth of child care providers to serve in a health promotion role, and better integrate external health resources and personnel. Group sessions and peer learning opportunities that are culturally and linguistically sensitive are potentially successful strategies for implementation of health promotion interventions for many parents.
    Ambulatory Pediatrics 01/2006; 6(6):342-6. · 1.60 Impact Factor
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    ABSTRACT: Background: Public health challenges can be better addressed if credible information about health risks and effective public health practices is readily available. The need for improved access to evidence-based public health information has been recognized by public health practitioners, researchers, policy makers, and librarians. Objective: To understand the information needs of the public health workforce and to improve access to credible and relevant information for public health practice.Methods: A qualitative study identified how public health professionals currently access information, what barriers they face, and what improvements they need. Nineteen individual interviews were conducted in two state health bureaus - communicable disease control and community health promotion. Follow-on focus groups were conducted to gather additional data on preferences for accessing information.Results: Public health professionals interviewed have a wide variety of needs and use different information sources depending on the areas of public health they work in and the diverse nature of their work. The types of information they use can be arranged in an information needs continuum ranging from early reports of disease outbreaks needed by those dealing with emerging diseases, to published reports, journal articles, systematic reviews, and evidence-based guidelines needed by those working on the prevention and control of well-known diseases and health threats. Information sources used by the participants include news resources, listservs, alert services, journal articles, conference proceedings, and email. The study revealed that public health practitioners face several barriers and limitations to accessing quality information for public health practice. These include lack to time and knowledge to find quality information; feeling bombarded with unfiltered and often duplicative information from listservs; and limited access to grey literature, systematic reviews, and full-text journal articles. Conclusion: Both groups expressed the need for access to information targeted towards their specific public health areas of interest and desired a way to filter information for more efficient access to relevant information. The research team developed a hypothetical model for the delivery and organization of credible and relevant public health information. Some of the participants were not aware of evidence-based public health resources currently available. An outcome of the project that is particularly beneficial to the public health workforce and information professionals is the project's website, http://library.umassmed.edu/ebpph, which provides free online access to public health journals, databases, and evidence-based public health resources identified by the research team. Presentation at the 2006 Medical Library Association Annual Meeting, Phoenix, AZ.
    Elaine Russo Martin. 01/2006;
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    ABSTRACT: In 1997, the Institute of Medicine called for reform, improved quality and expanded research in end-of-life care. Yet little empirical information about preferences of African Americans has been documented. A community-campus partnership was formed to guide a needs assessment related to end-of-life care in a Southern, urban, African American community. This paper presents focus group findings related to end-of-life and palliative care. A qualitative design of multiple-meeting focus groups was used to explore experiences, preferences, needs, and feelings expressed by family members with at least one relative who had died in a hospital (group 1) or at home (group 2). Sessions were taped and transcribed; themes were identified using systematic analytic procedures. Thematic analysis revealed key concerns related to health care provider communications about end-of-life care and dying. Positive communications empowered and showed respect for patients and family members and recognized the importance of their spiritual beliefs; informed them about resources available to assist dying at home; and, for patients dying in the hospital, treated them with nurturing, compassion, and diligent monitoring of the patient's medical status and needs. Other themes related to end-of-life care issues include preparation, planning, and access. A table of quotes from participants is available from the corresponding author. Findings suggest important clinical implications for clinicians and other health professionals. These voices from the community remind us of the heterogeneity in needs and preferences and challenge us to listen and tailor communication to each patient and their families.
    Journal of Palliative Medicine 07/2005; 8(3):585-92. · 1.89 Impact Factor
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    Nancy Lapelle
    Field Methods 02/2004; 16(1):85-108. · 1.11 Impact Factor

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