Nina Gomez | ANU - Academia.edu (original) (raw)

Papers by Nina Gomez

Research paper thumbnail of Illness-specific and general perceptions of social relationships in adjustment to rheumatoid arthritis: the role of interpersonal expectations

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, Jan 1, 2004

Background: Adjustment to rheumatoid arthritis (RA) may be made more difficult when patients are ... more Background: Adjustment to rheumatoid arthritis (RA) may be made more difficult when patients are unable to meet the expectations of family and friends about how well they are coping. Purpose: This study investigated the influence of illness-specific interpersonal expectations and general indices of social interactions on depressive symptoms among 39 women with RA (M age = 46.9 years; M disease duration = 11.2 years).Methods: Female patients with RA and their spouses were recruited from an outpatient rheumatology clinic at an urban university hospital. Participants completed questionnaires at home and returned them to the research staff in prepaid, stamped envelopes.Results: Results showed a significant correlation between spousal expectations and patients’ perceived inability to meet them. Further, hierarchical regression analyses indicated that even when controlling for disease severity and traditional measures of social interactions (e.g., social support, perceived criticism, and general quality of the dyadic relationship), patient’s perceived inability to meet spousal expectations contributed unique variance in depressive symptoms.Conclusions: These results suggest that adjustment to RA is not due entirely to the general features of social relationships, but additionally reflect specific aspects of the chronic illness milieu where spousal expectations and the patient’s perceived inability to meet them are also related to adjustment.

Research paper thumbnail of Reducing and eliminating health disparities: a targeted approach

Journal of the National Medical Association, Jan 1, 2005

Health disparities have dominated recent discourse among public health and medical researchers. E... more Health disparities have dominated recent discourse among public health and medical researchers. Ever since the United States began to compile health statistics, differences in health status have been noted between majority and nonmajority populations. Myriad approaches have been undertaken in an aftempt to reduce or eliminate racial and ethnic disparties in health. However, the disparties continue to persist. We are at a point in our history where innovative strategies must be explored that will be more effective in addressing racial and ethnic disparties in health. In large part, health disparties exist as a result of inequitable distribution of goods, resources, services and power in Amenca. We have learned that improvements in health cannot come about solely through primary and secondary interventions but rather through an examination of the availability of resources that would allow individuals to improve their health. The goal of this paper is to provide an overview of the contextual factors that affect health disparties, to integrate theory to address disparities and to provide recommendations to encourage systematic changes to eliminate health disparties. It is hoped that this paper will brng about a national discussion relating to addressing the real issues we face in reducing and ultimately eliminating health disparties.

Research paper thumbnail of Health care provider attitudes toward patients with acute vaso-occlusive crisis due to sickle cell disease: development of a scale

Patient education and counseling, Jan 1, 2009

Research paper thumbnail of The association of provider communication with trust among adults with sickle cell disease

Journal of general internal medicine, Jan 1, 2010

Background Adults with sickle cell disease often report poor interpersonal healthcare experiences... more Background Adults with sickle cell disease often report poor interpersonal healthcare experiences, including poor communication with providers. However, the effect of these experiences on patient trust is unknown. Objective To determine the association between patient ratings of the previous quality of provider communication and current trust in the medical profession among adults with sickle cell disease. Research design Cross-sectional survey. Participants A total of 95 adults with sickle cell disease. Measurements The four-item Provider Communication Subscale from the Consumer Assessment of Healthcare Plans and Systems Survey; The five-item Wake Forest Trust in the Medical Profession Scale. Main results Better ratings of previous provider communication were significantly associated with higher levels of trust toward the medical profession. A 10% increase in provider communication rating was associated with a 3.76% increase in trust scores (p < 0.001, 95% CI [1.76%, 5.76%]), adjusting for patient-level demographic, clinical, and attitudinal characteristics. Conclusions Poorer patient ratings of provider communication are associated with lower trust toward the medical profession among adults with sickle cell disease. Future research should examine the impact of low trust in the medical profession on clinical outcomes in this population of patients.

Research paper thumbnail of Examining the characteristics and beliefs of hydroxyurea users and nonusers among adults with sickle cell disease

American journal of hematology, Jan 1, 2011

The attitudes of patients with sickle cell disease (SCD) toward the use of hydroxyurea (HU) thera... more The attitudes of patients with sickle cell disease (SCD) toward the use of hydroxyurea (HU) therapy may contribute to the underutilization of HU in the United States, yet our understanding of these attitudes is limited. We examined the attitudes and beliefs of 94 adult SCD patients, comparing those who never used HU (n = 37), formerly used HU (n = 23), and were currently using HU (n = 34). Seventy percent of current HU users reported some level of improvement from the drug ("average" or "very much") and 80% reported little or no trouble from side effects. Fiftyseven percent of former users reported taking HU for less than 6 months, with "doctor's recommendation," or "not liking the way it made me feel" given as the most commonly reported reasons for stopping HU. Fifty percent of the never users reported receiving no information about HU from any source, and 85% of the never users thought that they would receive no improvement if they were to take HU. A deeper understanding of patient perspectives toward HU utilization is required as part of multipronged efforts to combat its underutilization in the treatment of SCD.

Research paper thumbnail of Hospital self-discharge among adults with sickle-cell disease (SCD): associations with trust and interpersonal experiences with care

Journal of hospital medicine : an official publication of the Society of Hospital Medicine

BACKGROUND:Patient self-discharge from hospitals has been associated with a number of negative cl... more BACKGROUND:Patient self-discharge from hospitals has been associated with a number of negative clinical outcomes. Research suggests that low patient trust and poor quality interpersonal experiences with care may be associated with hospital self-discharge. Although adults with sickle-cell disease (SCD) often report poorer quality healthcare experiences, research examining hospital self-discharge and its associations with both patient trust and quality of healthcare experiences is lacking for this patient population.Patient self-discharge from hospitals has been associated with a number of negative clinical outcomes. Research suggests that low patient trust and poor quality interpersonal experiences with care may be associated with hospital self-discharge. Although adults with sickle-cell disease (SCD) often report poorer quality healthcare experiences, research examining hospital self-discharge and its associations with both patient trust and quality of healthcare experiences is lacking for this patient population.OBJECTIVE:To examine the association of interpersonal experiences with care and trust in the medical profession with hospital self-discharge history among patients with SCD.To examine the association of interpersonal experiences with care and trust in the medical profession with hospital self-discharge history among patients with SCD.DESIGN:Cross-sectional study.Cross-sectional study.SETTING:A large, urban academic medical center.A large, urban academic medical center.PATIENTS:Adults (age 18+ years) with SCD seeking outpatient or inpatient care.Adults (age 18+ years) with SCD seeking outpatient or inpatient care.MEASUREMENTS:We compared patient characteristics, patient perceptions of the quality of interpersonal experiences with care, and levels of trust between patients with and without a history of hospital self-discharge.We compared patient characteristics, patient perceptions of the quality of interpersonal experiences with care, and levels of trust between patients with and without a history of hospital self-discharge.RESULTS:Adjusted analyses indicated that having a history of hospital self-discharge was associated with more negative interpersonal experiences and lower levels of trust.Adjusted analyses indicated that having a history of hospital self-discharge was associated with more negative interpersonal experiences and lower levels of trust.CONCLUSIONS:Hospital self-discharge may be an important indicator of the quality of care received by adults with SCD. Further research is needed to better understand this phenomenon so that effective interventions can be designed to prevent its occurrence. Journal of Hospital Medicine 2010;5:289–294. © 2010 Society of Hospital Medicine.Hospital self-discharge may be an important indicator of the quality of care received by adults with SCD. Further research is needed to better understand this phenomenon so that effective interventions can be designed to prevent its occurrence. Journal of Hospital Medicine 2010;5:289–294. © 2010 Society of Hospital Medicine.

Research paper thumbnail of Religious coping and hospital admissions among adults with sickle cell disease

Journal of behavioral medicine, Jan 1, 2011

Although a well-established literature implicates religiosity as a central element of the African... more Although a well-established literature implicates religiosity as a central element of the African American experience, little is known about how individuals from this group utilize religion to cope with specific health-related stressors. The present study examined the relation between religious coping and hospital admissions among a cohort of 95 adults with sickle cell disease—a genetic blood disorder that, in the United States, primarily affects people of African ancestry. Multiple regression analyses indicated that positive religious coping uniquely accounted for variance in hospital admissions after adjusting for other demographic and diagnostic variables. Specifically, greater endorsement of positive religious coping was associated with significantly fewer hospital admissions (β = −.29, P < .05). These results indicate a need for further investigation of the roles that religion and spirituality play in adjustment to sickle cell disease and their influence on health care utilization patterns and health outcomes.

Research paper thumbnail of Problematic hospital experiences among adult patients with sickle cell disease

Journal of health care for the poor and underserved, Jan 1, 2010

Background-Adults with sickle cell disease (SCD) have often reported difficulties obtaining care ... more Background-Adults with sickle cell disease (SCD) have often reported difficulties obtaining care during vaso-occlusive crisis (VOC) in qualitative studies.

Research paper thumbnail of Predictors of employment status among African Americans with sickle cell disease

Journal of health care for the poor and underserved, Jan 1, 2010

Adults living with sickle cell disease (SCD) have extremely high rates of unemployment; however, ... more Adults living with sickle cell disease (SCD) have extremely high rates of unemployment; however, very little is known about factors that contribute to their vocational outcomes. This study examined demographic, illness perception, and psychological variables as predictors of employment status among 115 adult respondents who completed a cross-sectional survey as part of the Cooperative Study of Sickle Cell Disease. Logistic regression analysis indicated that gender, assertiveness, and perceived impact of SCD were unique predictors of employment status. Women were 2.88 times more likely to be employed than men, and the odds of being employed increased by a factor of 2.47 for each one unit decrease in assertiveness. More favorable perceptions of SCD were also associated with a two-fold increase in employment. The results suggest that demographic and psychosocial factors may play a more important role in predicting employment outcomes in adults with SCD than previously recognized.

Research paper thumbnail of Race and social attitudes about sickle cell disease

Ethnicity & health

Objective. Sickle cell disease is perhaps the most racialized condition in the history of modern ... more Objective. Sickle cell disease is perhaps the most racialized condition in the history of modern medicine, yet very little research has focused on how racial perceptions influence social attitudes about the disease. Subsequently, the implications of these perceptions for public health prevention efforts and the provision of clinical care are not well known. Design. In this brief commentary, we posit that social cognitive and media framing theories provide useful approaches for assessing relations between race and social attitudes about sickle cell disease. Conclusion. Such inquiries might lead to more rigorous study of mechanisms that shape perceptions about sickle cell risk, interpersonal empathy toward patients, and public support for sickle cell-related policies.

Research paper thumbnail of Illness-specific and general perceptions of social relationships in adjustment to rheumatoid arthritis: the role of interpersonal expectations

Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, Jan 1, 2004

Background: Adjustment to rheumatoid arthritis (RA) may be made more difficult when patients are ... more Background: Adjustment to rheumatoid arthritis (RA) may be made more difficult when patients are unable to meet the expectations of family and friends about how well they are coping. Purpose: This study investigated the influence of illness-specific interpersonal expectations and general indices of social interactions on depressive symptoms among 39 women with RA (M age = 46.9 years; M disease duration = 11.2 years).Methods: Female patients with RA and their spouses were recruited from an outpatient rheumatology clinic at an urban university hospital. Participants completed questionnaires at home and returned them to the research staff in prepaid, stamped envelopes.Results: Results showed a significant correlation between spousal expectations and patients’ perceived inability to meet them. Further, hierarchical regression analyses indicated that even when controlling for disease severity and traditional measures of social interactions (e.g., social support, perceived criticism, and general quality of the dyadic relationship), patient’s perceived inability to meet spousal expectations contributed unique variance in depressive symptoms.Conclusions: These results suggest that adjustment to RA is not due entirely to the general features of social relationships, but additionally reflect specific aspects of the chronic illness milieu where spousal expectations and the patient’s perceived inability to meet them are also related to adjustment.

Research paper thumbnail of Reducing and eliminating health disparities: a targeted approach

Journal of the National Medical Association, Jan 1, 2005

Health disparities have dominated recent discourse among public health and medical researchers. E... more Health disparities have dominated recent discourse among public health and medical researchers. Ever since the United States began to compile health statistics, differences in health status have been noted between majority and nonmajority populations. Myriad approaches have been undertaken in an aftempt to reduce or eliminate racial and ethnic disparties in health. However, the disparties continue to persist. We are at a point in our history where innovative strategies must be explored that will be more effective in addressing racial and ethnic disparties in health. In large part, health disparties exist as a result of inequitable distribution of goods, resources, services and power in Amenca. We have learned that improvements in health cannot come about solely through primary and secondary interventions but rather through an examination of the availability of resources that would allow individuals to improve their health. The goal of this paper is to provide an overview of the contextual factors that affect health disparties, to integrate theory to address disparities and to provide recommendations to encourage systematic changes to eliminate health disparties. It is hoped that this paper will brng about a national discussion relating to addressing the real issues we face in reducing and ultimately eliminating health disparties.

Research paper thumbnail of Health care provider attitudes toward patients with acute vaso-occlusive crisis due to sickle cell disease: development of a scale

Patient education and counseling, Jan 1, 2009

Research paper thumbnail of The association of provider communication with trust among adults with sickle cell disease

Journal of general internal medicine, Jan 1, 2010

Background Adults with sickle cell disease often report poor interpersonal healthcare experiences... more Background Adults with sickle cell disease often report poor interpersonal healthcare experiences, including poor communication with providers. However, the effect of these experiences on patient trust is unknown. Objective To determine the association between patient ratings of the previous quality of provider communication and current trust in the medical profession among adults with sickle cell disease. Research design Cross-sectional survey. Participants A total of 95 adults with sickle cell disease. Measurements The four-item Provider Communication Subscale from the Consumer Assessment of Healthcare Plans and Systems Survey; The five-item Wake Forest Trust in the Medical Profession Scale. Main results Better ratings of previous provider communication were significantly associated with higher levels of trust toward the medical profession. A 10% increase in provider communication rating was associated with a 3.76% increase in trust scores (p < 0.001, 95% CI [1.76%, 5.76%]), adjusting for patient-level demographic, clinical, and attitudinal characteristics. Conclusions Poorer patient ratings of provider communication are associated with lower trust toward the medical profession among adults with sickle cell disease. Future research should examine the impact of low trust in the medical profession on clinical outcomes in this population of patients.

Research paper thumbnail of Examining the characteristics and beliefs of hydroxyurea users and nonusers among adults with sickle cell disease

American journal of hematology, Jan 1, 2011

The attitudes of patients with sickle cell disease (SCD) toward the use of hydroxyurea (HU) thera... more The attitudes of patients with sickle cell disease (SCD) toward the use of hydroxyurea (HU) therapy may contribute to the underutilization of HU in the United States, yet our understanding of these attitudes is limited. We examined the attitudes and beliefs of 94 adult SCD patients, comparing those who never used HU (n = 37), formerly used HU (n = 23), and were currently using HU (n = 34). Seventy percent of current HU users reported some level of improvement from the drug ("average" or "very much") and 80% reported little or no trouble from side effects. Fiftyseven percent of former users reported taking HU for less than 6 months, with "doctor's recommendation," or "not liking the way it made me feel" given as the most commonly reported reasons for stopping HU. Fifty percent of the never users reported receiving no information about HU from any source, and 85% of the never users thought that they would receive no improvement if they were to take HU. A deeper understanding of patient perspectives toward HU utilization is required as part of multipronged efforts to combat its underutilization in the treatment of SCD.

Research paper thumbnail of Hospital self-discharge among adults with sickle-cell disease (SCD): associations with trust and interpersonal experiences with care

Journal of hospital medicine : an official publication of the Society of Hospital Medicine

BACKGROUND:Patient self-discharge from hospitals has been associated with a number of negative cl... more BACKGROUND:Patient self-discharge from hospitals has been associated with a number of negative clinical outcomes. Research suggests that low patient trust and poor quality interpersonal experiences with care may be associated with hospital self-discharge. Although adults with sickle-cell disease (SCD) often report poorer quality healthcare experiences, research examining hospital self-discharge and its associations with both patient trust and quality of healthcare experiences is lacking for this patient population.Patient self-discharge from hospitals has been associated with a number of negative clinical outcomes. Research suggests that low patient trust and poor quality interpersonal experiences with care may be associated with hospital self-discharge. Although adults with sickle-cell disease (SCD) often report poorer quality healthcare experiences, research examining hospital self-discharge and its associations with both patient trust and quality of healthcare experiences is lacking for this patient population.OBJECTIVE:To examine the association of interpersonal experiences with care and trust in the medical profession with hospital self-discharge history among patients with SCD.To examine the association of interpersonal experiences with care and trust in the medical profession with hospital self-discharge history among patients with SCD.DESIGN:Cross-sectional study.Cross-sectional study.SETTING:A large, urban academic medical center.A large, urban academic medical center.PATIENTS:Adults (age 18+ years) with SCD seeking outpatient or inpatient care.Adults (age 18+ years) with SCD seeking outpatient or inpatient care.MEASUREMENTS:We compared patient characteristics, patient perceptions of the quality of interpersonal experiences with care, and levels of trust between patients with and without a history of hospital self-discharge.We compared patient characteristics, patient perceptions of the quality of interpersonal experiences with care, and levels of trust between patients with and without a history of hospital self-discharge.RESULTS:Adjusted analyses indicated that having a history of hospital self-discharge was associated with more negative interpersonal experiences and lower levels of trust.Adjusted analyses indicated that having a history of hospital self-discharge was associated with more negative interpersonal experiences and lower levels of trust.CONCLUSIONS:Hospital self-discharge may be an important indicator of the quality of care received by adults with SCD. Further research is needed to better understand this phenomenon so that effective interventions can be designed to prevent its occurrence. Journal of Hospital Medicine 2010;5:289–294. © 2010 Society of Hospital Medicine.Hospital self-discharge may be an important indicator of the quality of care received by adults with SCD. Further research is needed to better understand this phenomenon so that effective interventions can be designed to prevent its occurrence. Journal of Hospital Medicine 2010;5:289–294. © 2010 Society of Hospital Medicine.

Research paper thumbnail of Religious coping and hospital admissions among adults with sickle cell disease

Journal of behavioral medicine, Jan 1, 2011

Although a well-established literature implicates religiosity as a central element of the African... more Although a well-established literature implicates religiosity as a central element of the African American experience, little is known about how individuals from this group utilize religion to cope with specific health-related stressors. The present study examined the relation between religious coping and hospital admissions among a cohort of 95 adults with sickle cell disease—a genetic blood disorder that, in the United States, primarily affects people of African ancestry. Multiple regression analyses indicated that positive religious coping uniquely accounted for variance in hospital admissions after adjusting for other demographic and diagnostic variables. Specifically, greater endorsement of positive religious coping was associated with significantly fewer hospital admissions (β = −.29, P < .05). These results indicate a need for further investigation of the roles that religion and spirituality play in adjustment to sickle cell disease and their influence on health care utilization patterns and health outcomes.

Research paper thumbnail of Problematic hospital experiences among adult patients with sickle cell disease

Journal of health care for the poor and underserved, Jan 1, 2010

Background-Adults with sickle cell disease (SCD) have often reported difficulties obtaining care ... more Background-Adults with sickle cell disease (SCD) have often reported difficulties obtaining care during vaso-occlusive crisis (VOC) in qualitative studies.

Research paper thumbnail of Predictors of employment status among African Americans with sickle cell disease

Journal of health care for the poor and underserved, Jan 1, 2010

Adults living with sickle cell disease (SCD) have extremely high rates of unemployment; however, ... more Adults living with sickle cell disease (SCD) have extremely high rates of unemployment; however, very little is known about factors that contribute to their vocational outcomes. This study examined demographic, illness perception, and psychological variables as predictors of employment status among 115 adult respondents who completed a cross-sectional survey as part of the Cooperative Study of Sickle Cell Disease. Logistic regression analysis indicated that gender, assertiveness, and perceived impact of SCD were unique predictors of employment status. Women were 2.88 times more likely to be employed than men, and the odds of being employed increased by a factor of 2.47 for each one unit decrease in assertiveness. More favorable perceptions of SCD were also associated with a two-fold increase in employment. The results suggest that demographic and psychosocial factors may play a more important role in predicting employment outcomes in adults with SCD than previously recognized.

Research paper thumbnail of Race and social attitudes about sickle cell disease

Ethnicity & health

Objective. Sickle cell disease is perhaps the most racialized condition in the history of modern ... more Objective. Sickle cell disease is perhaps the most racialized condition in the history of modern medicine, yet very little research has focused on how racial perceptions influence social attitudes about the disease. Subsequently, the implications of these perceptions for public health prevention efforts and the provision of clinical care are not well known. Design. In this brief commentary, we posit that social cognitive and media framing theories provide useful approaches for assessing relations between race and social attitudes about sickle cell disease. Conclusion. Such inquiries might lead to more rigorous study of mechanisms that shape perceptions about sickle cell risk, interpersonal empathy toward patients, and public support for sickle cell-related policies.