Beverly R Williams

U.S. Department of Veterans Affairs | VA · Office of Research and Development (ORD)

Lower urinary tract symptoms (LUTS) are common among adolescent girls. Physical activity (PA) has been implicated as both a risk (high-impact PA) and protective factor (low-impact, moderate to vigorous intensity PA) for LUTS in adult women, but its role in adolescent girls is unclear. This study investigated the prospective association between phys...

Objective: The purpose of this analysis was to explore adolescent and adult women's preferences for the content and delivery of public health messaging around bladder health. Materials and Methods: This was a directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and...

Objective: The purpose of this analysis was to explore adolescent and adult women's interest in public health messaging around bladder health and perceptions of its usefulness. Materials and Methods: Directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult wom...

The present study builds on prior research by examining the moderating relationships between different types of capital on physical functioning, emotional functioning, and depressive symptoms using a 2.5‐year longitudinal design with a national sample of African–American adults. Results indicated a significant T1 social capital × T1 religious capit...

Aims: This analysis explored and characterized the ideas adult women have about how the bladder works, the assumptions guiding their bladder-related behaviors, and the beliefs they hold about how their behaviors affect bladder health. Methods: This was a directed content analysis of qualitative data from the Study of Habits, Attitudes, Realities...

Background: Population-based research and community-based interventions are integral to occupational therapy’s scope of practice, yet they are underdeveloped in actual implementation. Therefore, this paper focuses on some health challenges facing the African American population, guided by the Person-Environment-Occupation-Performance Model. Method...

The present study investigates whether social support mediates the relationship between personality traits and physical functioning among African Americans over 2.5 years. Data were collected from a national probability sample of African American adults (analytic sample N = 312). Telephone surveys included measures of the five-factor model personal...

Background Lower urinary tract symptoms (LUTS) are common in children and adolescents. Non-invasive tests evaluating bladder function are generally preferred over invasive tests, yet few studies have explored the range of normative values for these tests in healthy, asymptomatic children. Objective To define normative reference ranges for non-inva...

Background: There is an ongoing need for interventions to improve quality of end-of-life care for patients in inpatient settings. Objective: To compare two methods for implementing a Comfort Care Education Intervention for Palliative Care Consultation Teams (PCCT) in Veterans Affairs Medical Centers (VAMCs). Design: Cluster randomized implemen...

Little is known about social processes shaping adolescent and adult women’s toileting behaviors. The “Study of Habits, Attitudes, Realities, and Experiences” (SHARE) examines adolescent and adult women’s experiences related to bladder health across the life course. Forty-four focus groups with 360 participants organized by six age groups were condu...

Few studies have specifically focused on meaning in life in African Americans and many important questions remain, including whether effects of meaning in life are direct or moderated by levels of stress. In a national sample of 909 African Americans, we tested meaning in life as a prospective predictor of changes in depressive symptoms and positiv...

The present study investigates whether social support mediates the relationship between personality traits and health among African Americans over a 5-year period, filling a gap in the literature on longitudinal tests of the personality-health association. Data were collected from a national probability sample of African American adults ( N = 200)....

Objective To explore the perspectives of normal bladder function among women with lower urinary tract symptoms (LUTS). Methods This was a secondary analysis of qualitative data from structured interviews with 50 adult women with LUTS. A directed content analysis of the transcripts explored women's perspectives on normal bladder function. Results...

Background: Little research to date has investigated the spectrum of bladder health in women, including both bladder function and well-being. Therefore, we expanded our previous baseline analysis of bladder health in the Boston Area Community Health (BACH) Survey to incorporate several additional measures of bladder-related well-being collected at...

We examined the gendered role of social and religious resources in the association between marital status and depressive symptoms among a national probability sample of predominantly midlife and older African American adults ( N = 800). Greater levels of depressive symptoms were found for unmarried compared to married. A significant three-way inter...

A growing body of research has examined modalities for delivering palliative care education; however, we know little about education and training preferences of VA interdisciplinary Palliative Care Consult Teams (PCCT). In the BEACON II study, we explored training preferences of PCCTs from 46 Veterans Affairs Medical Centers (VAMCs) participating i...

Aims: Although lower urinary tract symptoms (LUTS) may occur at different periods during the life course of women, a little research on LUTS has adopted a life course perspective. The purpose of this conceptual paper is to demonstrate how life course theory and life course epidemiology can be applied to study bladder health and LUTS trajectories....

Background: Recent years have seen increased interest in the role of neighborhood factors in chronic diseases such as cancers. Less is known about the role of neighborhood factors beyond individual demographics such as age or education. It is particularly important to examine neighborhood effects on health among African American men and women, con...

Aims: This analysis explored and characterized adolescent and adult women's lay language and discourse related to bladder health/function. Methods: Forty-four focus groups were conducted across seven United States research centers with 360 adolescents and adult women, organized by six age categories. Multilevel content analyses classified emerge...

Education has demonstrated consistent links with many aspects of physical health and is theorized to relate to a variety of behavioral and psychosocial antecedents of health that may ultimately account for these associations. However, many of these associations and the extent to which they manifest specifically for African Americans have not been t...

Though associations between personality and health have been previously observed, less is known about why such relationships exist. The present study examines whether social support mediated the relationship between personality traits and health among African Americans. We hypothesized that social support would help explain the relationship between...

The World Health Organization recognizes access to clean and safe toilets as crucial for public health. This study explored U.S. adolescent and adult cisgender women’s lived experiences accessing toilets in schools, workplaces, and public spaces. As part of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, we conducted 44 f...

Aim: The study purpose is to explore adolescent and adult women's experiences, perceptions, beliefs, knowledge and behaviors related to bladder health across the life course using a socioecological perspective. Lower urinary tract symptoms affect between 20-40% of young adult to middle-aged women, with symptoms increasing in incidence and severity...

The present longitudinal study examined religious beliefs and behaviors, spiritual health locus of control (SHLOC), and selected health-related behaviors and outcomes in a national sample of 766 African American adults. Participants were interviewed by telephone three times over a 5-year period. Results indicated that stronger religious beliefs and...

The present study examined the relationship between social capital and depressive symptoms and the moderating role of the Big Five personality constructs in a national sample of African American adults. Data were collected from a national probability sample of 803 African American men and women using a telephone survey including measures of the Big...

Cause of death information is a vital resource for family and public health, yet significant issues persist regarding its determination, documentation and communication. In this study, we aim to characterize cause of death attribution process from the perspective of next-of-kin of Veterans who died in Veterans Affairs (VA) Medical Centers. Using a...

Objective: The objective of this analysis was to examine the use of 11 non-essential medications in actively dying patients. Methods: This was a planned secondary analysis of data from the Best Practices for End-of-Life Care for Our Nation's Veterans trial, a multicentre implementation trial of an intervention to improve processes of end-of-life...

Using data from a sample of African-Americans, the present study examined the role of religious beliefs and behaviours in predicting changes in Spiritual Health Locus of Control (SHLOC), or beliefs about the role that God plays in a person’s health. A national sample of African-American adults was recruited using a telephone survey and re-contacted...

Research on religious coping has proliferated in recent years, but many key questions remain, including the independent effects of positive and negative religious coping styles on well-being over time. Further, little research on religious coping styles has been conducted with African Americans in spite of their documented importance in this popula...

Objectives: The purpose of this study was to examine the relationships between partner and parental status and self-reported weekly fruit and vegetable consumption and level of physical activity in African American adults. Methods: A national sample of 2,370 African Americans participated in a telephone survey. Demographic data were collected an...

Currently 28,000 Veterans die each year within Veterans Affairs Medical Centers. As Veterans age, the Department of Veterans Affairs faces a variety of issues, including the need for comprehensive end-of-life care. Appreciation of next of kin’s assumptions regarding Veterans’ care can inform the culture of end-of-life services in Veterans Affairs M...

The present study examined the relationship between religious capital and depressive symptoms and the moderating role of the Big Five personality constructs in a national sample of African American adults. Data were collected from a national probability sample of 803 African American men and women using a telephone survey including measures of the...

Background: Racial differences exist for a number of health conditions, services, and outcomes, including end-of-life (EOL) care. Objective: The aim of the study was to examine differences in processes of care in the last 7 days of life between African American and white inpatients. Methods: Secondary analysis was conducted of data collected i...

We explore changes in self-reported religious/spiritual identity in 313 African American adults over an average period of 2.5 years. Changes in religious and spiritual identity were reported by half of the participants and were associated with age, education, and income. The least stability was observed among respondents identifying as religious/no...

The purpose of this article is to describe participant demographic factors related to retention, and to report on retention strategies in a national study of African Americans re-contacted 2.5 years after an initial baseline telephone interview. The Religion and Health in African Americans (RHIAA) study was originally developed as a cross-sectional...

For family members of dying patients who have grown accustomed to providing daily body care, the transition from home to hospital is stressful. We used the experiences surrounding death for 78 U.S. Veterans who died in a VA hospital. The research is based on interviews conducted with the decedent's next-of-kin. Secondary qualitative analysis of pre...

Background: The use of physical restraints in dying patients may be a source of suffering and loss of dignity. Little is known about the prevalence or predictors for restraint use at end of life in the hospital setting. Objective: The objective was to determine the prevalence and predictors of physical restraint use at the time of death in hospital...

This study explored next-of-kin's retrospective accounts of hospice and palliative care discussions for hospitalized veterans. In-depth, face-to-face interviews were used to generate narrative accounts of 78 next-of-kin's experience of their loved one's hospital care during the last days of the patient's life. One-third of participants reported tak...

Using 2010 national data, we investigate the relationship between social integration and health insurance for African American adults. During the previous year 21.6% of men and 19.8% of women lacked continuous health insurance. The effect of marital status, income, and employment on insurance coverage differed by age and gender. Additionally, frequ...

Volunteers offer means through which social workers may extend their ability to support individuals with serious illnesses near the end of life. This study explored the experience of volunteers on teams organized initially as a grassroots movement in response to stigmatized and often socially isolated people with HIV/AIDS dying in the community. Vo...

Background: Although hospice emergency kits (HEKs) are provided by many home hospice agencies, little is known about their use, side effects, and perceived impact. Objective: To evaluate HEK medication utilization, side effects, and impact as perceived by home hospice patients and their caregivers. Methods: We conducted a prospective longitudi...

Researchers propose social support as one of the factors that may explain the positive relationship often observed between religious involvement and health outcomes. African-Americans are a population that tends to have higher than average levels of religious involvement and are also disproportionately impacted by most health conditions. The presen...

Objectives To analyze bereaved next of kin's suggestions for improving end-of-life (EOL) care in Veterans Affairs (VA) Medical Centers (VAMCs).DesignQualitative.SettingThis study was part of a larger study testing the effectiveness of a multimodal intervention strategy to improve processes of EOL care in six southeast U.S. VAMCs (Best Practices for...

Researchers have expressed growing interest in factors that may explain the relationship between religious involvement and health-related outcomes. Faith-based organizations are a significant institution in African American communities, both serving religious/spiritual needs and providing an important source of social capital. These communities oft...

Widespread implementation of palliative care treatment plans could reduce suffering in the last days of life by adopting best practices of traditionally home-based hospice care in inpatient settings. To evaluate the effectiveness of a multi-modal intervention strategy to improve processes of end-of-life care in inpatient settings. Implementation tr...

ABSTRACT A multi-component palliative care education-based intervention was implemented in six Veterans Affairs Medical Centers in the Southeast United States. The intervention comprised on-site staff training plus supporting written materials, installation of an electronic order set, and follow-up consultation. Training included large group didact...

As a patient approaches death, family members often are asked about their loved one's preferences regarding treatment at the end of life. Advance care directives may provide information for families and surrogate decision makers; however, less than one-third of Americans have completed such documents. As the U.S. population continues to age, many s...

We employed an auto-ethnography approach to explore the affective dimension of life review sessions with community-dwelling older military veterans with minor cognitive impairment (MCI) and early dementia. Using researchers' analytic memos, we identified facilitators' interactional strategies that fostered the participant's sense of personal identi...

Background: Although the provision of hospice emergency kits (HEKs) by home hospice agencies is thought to be widespread, little is known about their use, safety, and impact. Objective: This study evaluated HEK medication utilization, safety, diversion, and perceived impact. Design: Evaluation consisted of a retrospective patient chart abstrac...

Family presence is a vital component of quality end-of-life (EOL) care. We conducted face-to-face, in-depth interviews with next-of-kin of deceased veterans to explore perceptions of how hospital nursing staff supported and facilitated family presence during the actively dying phase, at the time of death, and immediately following the patient’s dea...

Patients with congestive heart failure (CHF) account for up to 12% of the hospice population and often experience significant symptoms related to volume overload. Diuretic therapy is the cornerstone of treatment but administration (PO) often becomes ineffective and (IV, IM) routes cause discomfort or may not be feasible to ameliorate symptoms. Subc...

Objectives: Religious social support may in part account for the relationship between religious involvement and health-related outcomes. African Americans, on average, tend to have relatively high levels of religious involvement, and suffer a higher burden of health conditions than other groups. This study aimed to examine whether religious social...

African American faith communities are an important source of social capital. The present study adapted a theory-based social capital instrument to result in religious (e.g., from organized worship) and spiritual (e.g., from relationship with higher power) capital measures. Data from a national sample of 803 African Americans suggest the instrument...

Context: Most patients with serious and life-limiting illness experience pain at some point in the illness trajectory. Objectives: To describe baseline pain management practices for imminently dying patients in Veterans Administration Medical Centers (VAMCs) and examine factors associated with these processes, including presence of opioid orders...

Spiritual and religious capital are forms of the broader construct of social capital. The present study, using probability-based sampling methods, surveyed a national sample of African American adults to examine the relative contributions of spiritual and religious capital to their physical and emotional functioning. Analyses were conducted to dete...

The purpose of this analysis was to describe the presence and timing of do-not-resuscitate (DNR) orders for imminently dying patients in VA Medical Centers, and to examine factors associated with these processes. Data on DNR orders in the last 7 days of life were abstracted from the medical records of 1,069 veterans who had died in one of six VA ho...

We examine how the passage of time since spousal loss varies by social and demographic characteristics, using data from the University of Alabama at Birmingham Study of Aging. In multivariate analyses, African American race, female sex, lower income, and higher risk of social isolation had significant and independent associations with variation in...

Historically, death took place at home where family held vigil around the dying patient. Today, family presence is an important feature of death and dying in hospital settings. We used hermeneutic phenomenology to explore experiences of being present at the hospital death of a loved one. We conducted in-depth, face-to-face interviews with 78 recent...

Widowhood is associated with increased mortality. However, to what extent this association is independent of other risk factors remains unclear. In the current study, we used propensity score matching to design a study to examine the independent association of widowhood with outcomes in a balanced cohort of older adults in the United States. We use...

Qualitative researchers who explore the individual's experience of health, illness, death, and dying often experience emotional stress in their work. In this article, we describe the emotional stress we experienced while coding semistructured, after-death interviews conducted with 38 next of kin of deceased veterans. Coding sensitive topic data req...

End-of-life discussions in critically-ill patients with acute surgical conditions may be rushed and occur earlier during hospitalization. This study explores the concept of sudden advanced illness (SAI) and its relevance to patients requiring Palliative and Surgical Critical Care. Semi-structured interviews were completed with 16 physicians, queryi...

For those of little or no means, leaving one's mark through financial assets, social connections, and human investment is difficult. Using secondary analysis of transcripts from face-to-face interviews with 33 terminally-ill patients from an outpatient clinic at a public hospital serving the disadvantaged in the southern United States, we examine t...

This article explores the experiences of older patients with cancer in phase 1 clinical trials. Conducting a case series of face-to-face, in-depth, open-ended interviews and using qualitative methods of analysis, we find that the psychosocial process of social comparison is relevant for understanding older adults' phase 1 clinical trial participati...

Social capital is defined as resources available to individuals by virtue of their affiliation and/or participation in social networks. Faith communities where people gather for worship are an important source of social capital in the US. This is particularly true in the African American community. The type of social capital generated by religious...

There is growing interest in the interface between palliative care and other medical specialties, yet little is known about decision-making processes characterizing such collaborations. At the University of Alabama at Birmingham (UAB), the trauma-burn surgery and neurosurgery services frequently request consults from the palliative care team for pa...

The purpose of this study was to evaluate the effects of a multicomponent palliative care intervention on choice and use of opioid pain medications for symptom control for patients dying in an acute care inpatient setting. A preintervention/postintervention trial was conducted between 2001 and 2003. Participants were physician, nursing, and ancilla...

Health and function vary by marital status across the life-course, but little is known about older adults approaching spousal loss (pre-widowed). To explore health and function by marital status focusing on the pre-widowed and to examine factors associated with shorter time to spousal loss. PARTICIPANTS, DESIGN, AND MEASUREMENTS: We used 3 years of...

After-death research with next-of-kin can enhance our understanding of end-of-life care and translate into better services for dying persons and their survivors. This article describes ethical and methodological issues that emerged in a pilot of a face-to-face interview guide designed to elicit next-of-kin's perceptions of end-of-life care. The pil...

Tracheotomy is performed on patients with airway obstruction or prolonged mechanical ventilation. Tracheotomy patients are increasingly being referred to hospice and palliative care. This case series describes a process for evaluating the ongoing need for tracheotomy and the impact of tracheotomy removal. A retrospective cohort design was used in w...

Low mobility is common during hospitalization and is associated with adverse outcomes. Understanding barriers to the maintenance or improvement of mobility is important to the development of successful interventions. To identify barriers to mobility during hospitalization from the perspectives of older patients and their primary nurses and physicia...