
Kenneth A WallstonVanderbilt University | Vander Bilt · School of Nursing
Kenneth A Wallston
PhD
About
262
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Introduction
Publications
Publications (262)
Background
The relative contributions of common patient-reported social determinants of health on 30- and 90-day post-discharge outcomes among patients with acute coronary syndromes (ACS) is unclear.
Objective
The aim of this article is to examine the independent associations of social determinants with readmission or death, accounting for medical...
Background:
Breast cancer is the most common tumor among women throughout the world. Diagnosis and treatment of breast cancer are associated with stress and depression. Self-efficacy is one of the most important personal characteristics, studied in cancer, and is correlated with depression and immunity. The aim of the study is as follows: 1. Exami...
Purpose:
Cardiac rehabilitation (CR), a program of supervised exercise and cardiovascular risk management, is widely underutilized. Psychological factors such as perceived health competence, or belief in one's ability to achieve health-related goals, may play a role in CR initiation. The aim of this study was to evaluate the association of perceiv...
Increasing home dialysis prevalence is an international priority. Many patients start peritoneal dialysis, then transition to hemodialysis after complications. New strategies are needed to support modality persistence. Health mindset refers to individual belief about capacity to change to improve health. Mindset was measured in a cross-section of 1...
Background:
My Diabetes Care (MDC) is a novel, multifaceted patient portal intervention designed to help patients better understand their diabetes health data and support self-management. MDC uses infographics to visualize and summarize patients' diabetes health data, incorporates motivational strategies, and provides literacy level-appropriate ed...
Objective
To determine at which phase in the recruitment process for participation in clinical research studies do health literacy and other patient characteristics influence recruitment outcomes.
Patients and Methods
Using a sample of 5872 patients hospitalized with cardiovascular disease approached for participation in the Vanderbilt Inpatient C...
Objective:
Text messaging interventions have high potential for scalability and for reductions in health disparities. However, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention.
Research design and methods:
Adults with type 2 diabetes participated in a parallel...
Amid increasing interest in improving the patient-centeredness of research, new forms of engagement are emerging that enable researchers to get input from community members on research goals, methods, and implementation. This input often includes stories, which are useful for understanding lived experiences of illness and encounters with health car...
Background:
The ability to understand another's emotions and act appropriately, empathy, is an important mediator of relationship function and health intervention fidelity. We adapted the Interpersonal Reactivity Index (IRI) - an empathy scale - among seroconcordant expectant couples with HIV in the Homens para Saúde Mais (HoPS+) trial - a cluster...
Background
Family and friends have both helpful and harmful effects on adults’ diabetes self-management. Family-focused Add-on to Motivate Self-care (FAMS) is a mobile phone-delivered intervention designed to improve family/friend involvement, self-efficacy, and self-care via monthly phone coaching, texts tailored to goals, and the option to invite...
Context
Psychological distress is associated with adverse health outcomes in serious illness and magnified among patients of low socioeconomic status. Aspects of one’s culture, such as religion and spirituality, can influence these patients’ coping response to distress. Advanced chronic kidney disease (CKD) is a serious illness that disproportionat...
Diabetes stigma is an emerging determinant of behaviors and outcomes. The theoretically-informed validated Comprehensive Diabetes Stigma Scale (CDSS), evaluates diabetes stigma and includes four subscales measuring enacted, perceived and self-stigma and concealment. This study tested associations between CDSS scores, medication adherence and HbA1c...
Background:
Recent studies indicate the immune dysfunction in cancer patients in comparison with healthy individuals. The quality and quantity of this dysfunction are not equal in all patients even with similar cancer type.
Aim:
This study aims to correlate health locus of control (HLC) beliefs with CD4+ helper T (Thelper) cells, T regulatory (T...
Background
Effective type 2 diabetes care remains a challenge for patients including those receiving primary care in safety net settings.
Objective
The Partnership to Improve Diabetes Education (PRIDE) trial team and leaders from a regional department of health evaluated approaches to improve care for vulnerable patients.
Design
Cluster randomize...
Background:
Religiosity, encompassing spirituality and religious practices, is associated with reduced disease incidence among individuals of low socioeconomic status and who self-identify as Black. We hypothesized that religiosity associates with reduced end-stage kidney disease (ESKD) risk among Black but not White adults of low socioeconomic st...
This cross-sectional study of 56 dialysis providers from 3 dialysis clinics examined providers’ attitudes and perception of autonomy support for patients’ medication adherence behaviors. Respondents completed surveys assessing attitudes and perception of autonomy support. Compared to all other provider types, physicians and nurse practitioners (MD/...
Objective
Lack of trust toward medical research is a major barrier to research participation, particularly among some population groups. Valid measures of trust are needed to develop appropriate interventions. The study purpose was to compare two previously validated scales that measure trust in biomedical research – one developed by Hall et al. (H...
Introduction:
Among patients with type 2 diabetes, racial disparities are prevalent across a variety of outcomes; however, inconsistent disparities in determinants of outcomes warrants exploring the impact of other, related factors. This study sought to examine whether disparities in health literacy, numeracy, self-care behaviors, and HbA1c persis...
Purpose:
The purpose of this study was to evaluate the effect of evidence-based practice (EBP) courses on nursing students' attitudes, perceived support from their professional network, self-efficacy, knowledge, and implementation of EBP.
Design:
This study utilized a two-group, pre- and posttest design with 190 Masters of Science in Nursing (MS...
The desire for control of healthcare is a significant moderator of outcomes related to childbirth. Researchers have shown that a sense of control of healthcare during childbirth is strongly correlated with postpartum maternal well‐being. The aims of this study were to examine (a) the psychometric characteristics of an instrument to assess women's d...
In the original publication of the article, the majority of changes stem from misclassification of “medium adherence” when using the Morisky Medication Adherence Scale (MMAS-8) and not using the correct scoring algorithm for one of the responses when calculating MMAS-8 total scores.
Background:
The All of Us Research Program is building a national longitudinal cohort and collecting data from multiple information sources (e.g., biospecimens, electronic health records, and mobile/wearable technologies) to advance precision medicine. Participant-provided information, collected via surveys, will complement and augment these infor...
Objective:
Develop and evaluate a measure assessing helpful and harmful family/friends' involvement in adults' type 2 diabetes (T2D) self-management.
Methods:
Prior mixed-methods research, cognitive interviews, and expert input informed measure development. We administered the measure in two studies (N = 392 and N = 512) to evaluate its factor s...
Background
There is much attention to recruitment of diverse populations in research, but little is known about the influence of health literacy and numeracy skills.
Objective
To determine if health literacy and numeracy affect individuals’ interest to participate in research studies.
Design
Cross-sectional survey data were pooled from 3 large st...
Background
Identifying potential mechanisms that link depressed mood with worse health behaviors is important given the prevalence of depressed mood in patients with coronary heart disease (CHD) and its relationship with subsequent mortality. Perceived health competence is an individual’s confidence in his/her ability to successfully engineer solut...
Background:
Since 2014 the Patient Centered Outcomes Research Institute (PCORI) has funded 13 Clinical Data Research Networks (CDRNs) around the country to support large-scale comparative effectiveness research and pragmatic clinical trials. To provide guidance for future recruitment efforts among CDRNs this study described differential willingnes...
Depression affects 1 in 7 women during the perinatal period. Women with vitamin D deficiency may be at an increased risk for depression. This study investigated the relationship between maternal and cord blood 25-hydroxyvitamin D (25OHD) and maternal depressive symptoms over the perinatal period. Study objectives were to examine variations and rela...
Objective:
To test theorized patient-level mediators in the causal pathway between health literacy (HL) and 1-year mortality in adults with cardiovascular disease (CVD).
Patients and methods:
A total of 3000 adults treated at Vanderbilt University Hospital from October 11, 2011, through December 18, 2015, for acute coronary syndrome or acute dec...
This paper investigates how social support differentially benefits self-rated health among men and women hospitalized with heart disease. Using cross-sectional data about patients admitted to a university hospital, we examine the extent to which gender moderates effects for the frequency of contact with family, friends, and neighbors on health and...
Title
Body Mass Index and Health Related Quality of Life
Objective
There is conflicting data regarding the association between body mass index (BMI) and Health‐Related Quality of Life (HRQoL), especially among certain population sub‐groups and for mental and physical health domains.
Methods
This study analyzed the relationship between BMI and HRQ...
This study aimed to develop a self-efficacy measure for mindfulness meditation practice (Self-efficacy for Mindfulness Meditation Practice scale). The scale was developed through a process of expert consensus, cognitive interviewing, and evaluation among 199 mindfulness meditation practitioners who completed an online survey. The 9-item Self-effica...
Aims:
Medication nonadherence is a prevalent and costly problem among patients with type 2 diabetes. Applications of theory can inform and improve adherence promotion interventions. We used a new assessment based on the Information-Motivation-Behavioral skills (IMB) model of adherence to assess patient-reported barriers and test the theoretical mo...
Self-efficacy, or perceived competence, has been identified as an important factor in self-management behaviors and health outcomes in patients with chronic disease. Measures of self-management self-efficacy are currently available for multiple forms of chronic disease. One established measure is the 8-item Perceived Medical Condition Self-Manageme...
Objective
Social comparisons (ie, self-evaluation in comparison with others) influence patients’ perspectives of their disease and may impact motivation and health behavior; however, little is known about patients’ perspectives toward receiving such information in a clinical context (eg, from their doctor’s office or health system). This study aims...
Stigma related to health conditions has been linked to poor medication adherence and health outcomes. With input from patients living with diabetes, diabetes clinicians, and stigma researchers, we designed the Comprehensive Diabetes Stigma Scale (CDSS). We hypothesized that higher diabetes stigma would be associated with worse medication adherence,...
Background:
Nonadherence to self-care is common among patients with type 2 diabetes (T2D) and often leads to severe complications. Moreover, patients with T2D who have low socioeconomic status and are racial/ethnic minorities disproportionately experience barriers to adherence and poor outcomes. Basic phone technology (text messages and phone call...
Background:
Numeracy, health literacy, and cognition are important for chronic disease management. Prior studies have found them to be associated with poorer selfcare and worse clinical outcomes, but limited data exists in the context of heart failure (HF), a condition that requires patients to monitor their weight, fluid intake, and dietary salt,...
Physical activity is highly associated with mortality, especially in patients with coronary heart disease. We evaluated the effect of perceived health competence, a patient's belief in their ability to achieve health-related goals, on cumulative physical activity levels in the Mid-South Coronary Heart Disease Cohort Study (MCHDCS). The MCHDCS consi...
Background:
Health apps and Web-based interventions designed for patients with diabetes offer novel and scalable approaches to engage patients and improve outcomes. However, careful attention to the design and usability of these apps and Web-based interventions is essential to reduce the barriers to engagement and maximize use.
Objective:
The ai...
This study examined reported post-traumatic stress disorder symptoms in adults with poorly controlled type 2 diabetes who had no history of psychiatric diagnosis or treatment (n = 184, MHbA1c = 9.13%, standard deviation = 1.68). Participants reported moderate to severe intensity of post-traumatic stress disorder symptoms (M = 19.17, SD = 17.58). To...
Objectives Childhood obesity prevention and treatment depends, in part, on parents acting as agents of change for their children. Our objective was to measure the associations between parenting self-efficacy, parent depressive symptoms, and preschool child behaviors that support healthy growth. Methods We performed a cross-sectional analysis of bas...
Chronic Kidney Disease (CKD) is a major burden on patients and the health care system. Treatment of CKD requires dedicated involvement from both caretakers and patients. Self-efficacy, also known as perceived competence, contributes to successful maintenance of patient's CKD self-management behaviors such as medication adherence and dietary regulat...
Background:
Patients with diabetes and of lower socioeconomic status have difficulty adhering to dietary recommendations. Practical and effective tools assessing self-management behaviors are needed to help evaluate interventions tailored to the needs of individual patients or population groups. This study examined the psychometric properties of a...
Background
Validation studies of existing health literacy or numeracy tools among racial/ethnic minorities are limited.
Objective
This study assessed the validity of the Subjective Numeracy Scale (SNS), the Diabetes Numeracy Test (DNT-5), the Brief Health Literacy Screen (BHLS), and the Short Test of Functional Health Literacy in Adults (S-TOFHLA)...
Objective: Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL.
Design: Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and...
Objective:
To identify eating styles from 6 eating behaviors and test their association with body mass index (BMI) among adults.
Design:
Cross-sectional analysis of self-report survey data.
Setting:
Twelve primary care and specialty clinics in 5 states.
Participants:
Of 11,776 adult patients who consented to participate, 9,977 completed surv...
Non-traditional indicators of socioeconomic status (SES; e.g., home ownership) may be just as or even more predictive of health outcomes as traditional indicators of SES (e.g., income). This study tested whether financial strain (i.e., difficulty paying monthly bills) predicted medication non-adherence and worse self-rated health. Research assistan...
This study was designed to assess dialysis subjects' perceived autonomy support association with phosphate binder medication adherence, race and gender. A multi-site cross-sectional study was conducted among 377 dialysis subjects. The Health Care Climate (HCC) Questionnaire assessed subjects' perception of their providers' autonomy support for phos...
Modified social learning theory (MSLT) applied to health predicts that health behavior is a multiplicative function of health value and perceptions of control over health. The self-management behaviors of persons with Type 2 diabetes mellitus, internal diabetes locus of control (IDLC), diabetes self-efficacy (DSE), and health value (HV) were assess...
Lifestyle change is recommended as treatment for adults at risk for metabolic syndrome (MetS), although adoption of new behavioral patterns is limited. In addition, most existing lifestyle interventions do not address psychological stress or quality of life, both of which impact the burden of MetS. Yoga, a form of physical activity that incorporate...
Patient–provider communication is modifiable and is linked to diabetes outcomes. The association of communication quality with medical mistrust is unknown. We examined these factors within the context of a low-literacy/numeracy-focused intervention to improve diabetes care, using baseline data from diverse patients enrolled in a randomized trial of...
BacgroundResilience has been defined as the capacity or the ability to rebound from and positively adapt to significant stressors, despite experiences of significant adversity or trauma. To capture to what extent an individual copes with stress in a resilient fashion the Brief Resilient Coping Scale (BRCS) was developed. This tool was validated in...
Background:
Among adults with type 2 diabetes mellitus (T2DM), adherence to recommended self-care activities is suboptimal, especially among racial and ethnic minorities with low income. Self-care nonadherence is associated with having worse glycemic control and diabetes complications. Text messaging interventions are improving the self-care of ad...
Overestimation of patients’ health literacy skills is common among nurses and physicians. At Vanderbilt University Hospital, nurses routinely ask patients the 3 Brief Health Literacy Screen (BHLS) questions. Data from 2 studies that recruited patients at Vanderbilt University Hospital—the Health Literacy Screening (HEALS) study and the Vanderbilt I...
Objective:
Evaluate the effect of perceived health competence, a patient's belief in his or her ability to achieve health-related goals, on health behavior and health-related quality of life.
Methods:
We analyzed 2063 patients hospitalized with acute coronary syndrome and/or congestive heart failure at a large academic hospital in the United Sta...
Little is known about the role of stress on the psychological well-being of patients after cardiac hospitalization or about factors that protect against or exacerbate the effects of stress. We use prospective data from 1542 patients to investigate the relationship between post-discharge stress and changes in depressive symptoms, and whether the lev...
Posttraumatic depression rates are increasing in the United States, and there is a great need to identify malleable factors that could moderate posttraumatic depression levels. The purpose of this study was to examine whether resilient coping moderates the effects of trauma exposure on depression, while controlling for neuroticism-an established pr...
Introduction: Physical inactivity is strongly associated with morbidity and mortality, especially in patients with coronary heart disease (CHD). Low levels of health self-efficacy, or a patient’s belief in his ability to engage in behaviors to improve his health, may serve as a barrier to regular physical activity in CHD patients. We evaluated the...
Medication nonadherence increases the risk of hospitalization and poor outcomes, particularly among patients with cardiovascular disease. The purpose of this study was to examine characteristics associated with medication nonadherence among adults hospitalized for cardiovascular disease. Patients in the Vanderbilt Inpatient Cohort Study who were ad...
Food insecurity is the 'limited or uncertain availability of nutritionally adequate and safe foods'. Our objective was to examine the association between food insecurity, diabetes self-care and glycaemic control.
We conducted a cross-sectional analysis of baseline data from adult patients with Type 2 diabetes who were enrolled in a randomized trial...
Combating the stigma of mental illness is critical to improving the quality of life of persons with mental health disorders and that of their family associates and to reducing barriers to help-seeking. There is concern that stigma toward mental health problems is even more of a barrier in rural communities. However, little research exists and measu...
Background
There is a need for a survey instrument to measure arthralgia (joint pain) that has been psychometrically validated in the context of existing reference instruments. We developed the 16-item Patient-Reported Arthralgia Inventory (PRAI) to measure arthralgia severity in 16 joints, in the context of a longitudinal cohort study to assess ar...
This study examined the association between attributing self-reported discrimination to weight and diabetes outcomes (glycemic control, diabetes-related distress, and diabetes self-care). A community dwelling sample of 185 adults (mean age 55.4; 80 % White/Caucasian 65 % female) with poorly controlled type 2 diabetes (HbA1c level ≥7.5 %) provided d...
The human papillomavirus (HPV) vaccine could assist in reducing the cervical cancer disparity existing between Black and White women. Understanding factors influencing Black maternal intentions to vaccinate their daughter is essential in improving vaccination uptake. However, existing instruments do not comprehensively assess factors (e.g., culture...
Health literacy is associated with important outcomes among patients with kidney disease, but widely used measures of health literacy can be burdensome. In an effort to make a practical assessment available, we compared the performance of the three-item brief health literacy screen (BHLS) to other widely used measures of health literacy among patie...
Background
People living with HIV who maintain a positive outlook on their future may manage stress better than those who do not, leading to improved coping behaviors and better health outcomes.
Methods
While studying 125 HIV+ adults participating in two clinical trials of expressive writing we assessed their HIV-specific meaningfulness of life wi...
Aims and objectivesTo explore health value and perceived control over health in relation to self-management behaviours in adults with Type 2 diabetes mellitus.Background
Helping people to modify health related behaviour in diabetes is complex due to a multitude of factors. Exploring the meaning of the constructs of Modified Social Learning Theory c...
Hyperphosphatemia is common in end-stage renal disease and associates with mortality. Phosphate binders reduce serum phosphorus levels; however, adherence is often poor. This pilot study aims to assess patients' self-motivation to adhere to phosphate binders, its association with phosphorus control, and potential differences by race.
Cross sectiona...
Efficiency in scale design reduces respondent burden. A brief but reliable measure of numeracy may provide a useful research tool eligible for integration into large epidemiological studies or clinical trials. Our goal was to validate a 3-item version of the Subjective Numeracy Scale (SNS-3).
We examined 7 separate cross-sectional data sets: patien...
Failures of communication are a major contributor to perioperative adverse events. Transitions of care may be particularly vulnerable. We sought to improve postoperative handovers.
We introduced a multimodal intervention in an adult and a pediatric postanesthesia care unit (PACU) to improve postoperative handovers between anesthesia providers (APs)...
There is little consensus about which of the many validated human immunodeficiency virus (HIV) stigma scales should be regularly used, with few being re-validated in different contexts or evaluated for how they compare to other, existing HIV stigma scales. The purpose of this exploratory study was to re-validate the Van Rie HIV/AIDS-Related Stigma...
One of the most frequently used measures to assess parents’ assessment of their parenting ability is the Parenting Sense of Competence (PSOC) Scale. However, there is limited psychometric evaluation of the measure with samples of mothers of infants. This paper examines the psychometric properties of the PSOC in a heterogeneous sample of mothers of...
Diabetes patients with limited resources often experience suboptimal care. Less is known about the role of effective health communication (HC) in caring for low income diabetes patients.
Ten health department clinics in TN participated in a trial evaluating a literacy-sensitive communication intervention. We assessed the quality of baseline HC and...
Objective
Problem solving is a critical diabetes self-management skill. Because of a lack of clinically feasible measures, our aim was to develop and validate a self-report self-management problem solving questionnaire for adolescents with type 1 diabetes (T1D).
Methods
A multidisciplinary team of diabetes experts generated questionnaire items tha...
Little research has examined the association of health literacy and numeracy with patients' preferred involvement in the problem-solving and decision-making process in the hospital. Using a sample of 1,249 patients hospitalized with cardiovascular disease from the Vanderbilt Inpatient Cohort Study (VICS), we assessed patients' preferred level of in...
The aim of the present study was to provide evidence of validity of the Brief Resilient Coping Scale for use in Spanish young population. A total of 365 university students responded to the Spanish version of the BRCS as well as to other tools for measuring personal perceived competence, life satisfaction, depression, anxiety, negative and positive...