Kenneth Wallston - Academia.edu (original) (raw)

Papers by Kenneth Wallston

Kidney international, Jan 18, 2017

Chronic Kidney Disease (CKD) is a major burden on patients and the health care system. Treatment ... more 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 regulations. Despite a clear association between self-efficacy and improved CKD outcomes, there remains a lack of validated self-report measures of CKD self-efficacy. To address this gap, the Perceived Kidney/Dialysis Self-Management Scale (PKDSMS) was adapted from the previously validated Perceived Medical Condition Self-Management Scale. We then sought to validate this using data from two separate cohorts: a cross-sectional investigation of 146 patients with end-stage renal disease receiving maintenance hemodialysis and a longitudinal study of 237 patients with CKD not receiving dialysis. The PKDSMS was found to be positively and significan...

Journal of Health Communication, 2016

Overestimation of patients&amp;#39; health literacy skills is common among nurses and phy... more Overestimation of patients&amp;#39; 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 Inpatient Cohort Study (VICS)-were analyzed to compare the BHLS score recorded by nurses during clinical care with the score recorded by trained research assistants during the same hospitalization. Logistic regression models determined which patient characteristics were associated with nurses documenting higher health literacy scores than research assistants. Overall, the majority (60%) of health literacy scores were accurate, though nurses recorded meaningfully higher health literacy scores in 28.4% of HEALS patients and 35.6% of VICS patients. In the HEALS cohort, patients who were male and had less education were more likely to have higher health literacy scores recorded by nurses (odds ratio [OR] = 1.93, 95% confidence interval [CI] [1.24, 3.00]; and OR = 0.80, 95% CI [0.74, 0.88], respectively). In the VICS cohort, patients who were older, were male, and had less education were more likely to have higher health literacy scores recorded by nurses (OR = 1.01, 95% CI [1.003, 1.02]; OR = 1.49, 95% CI [1.20, 1.84]; and OR = 0.87, 95% CI [0.83, 0.90], respectively). These findings suggest that health literacy scores recorded by nurses for male patients and patients with less education could be overestimated. Thus, health care professionals should be aware of this tendency and should verify the results of routine health literacy screening tests, especially in certain patient groups.

Journal of health communication, Jan 23, 2016

Patient-provider communication is modifiable and is linked to diabetes outcomes. The association ... more 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 a health communication intervention. Demographics, measures of health communication (Communication Assessment Tool [CAT], Interpersonal Processes of Care survey [IPC-18]), health literacy (Short Test of Functional Health Literacy in Adults), depression, medical mistrust, and glycemic control were ascertained. Adjusted proportional odds models were used to test the association of mistrust with patient-reported communication quality. The interaction effect of health literacy on mistrust and communication quality was also assessed. A total of 410 patients were analyzed. High levels of mistrust were observed. In multivariable modeling, patien...

Ethnicity Disease, 2009

OBJECTIVES: Race concordance occurs when the race of a patient matches the race of his/ her physi... more OBJECTIVES: Race concordance occurs when the race of a patient matches the race of his/ her physician and discordance occurs when races do not match. Previous research has suggested an association between race concordance and measures of patient satisfaction and health outcome. In this study, we examined the relationship between race concordance and perceived quality of care, self-reported general health, and the SF-12 measures of physical and mental health in a community-based sample of 2001 adults.DESIGN: Telephone interviews were conducted with randomly selected households sampled from commercial lists of phone numbers.ANALYSIS: The association of concordance with the outcomes was analyzed separately for African American (n = 1,125) and White (n = 876) respondents using bivariate analysis and multiple linear regression.RESULTS: After controlling for age, sex, income, education, insurance status, and type of insurance, we found that race concordance was only associated with general health for White respondents (P < .006). Whites with insurance were more likely to be concordant than Whites without insurance and African Americans without insurance were more likely to be concordant than African Americans with insurance.CONCLUSIONS: Settings that employ a larger number of African American physicians in Nashville, Tennessee are places that people without insurance are more likely to seek health care. For health satisfaction and perceived health status, socioeconomic status and access to quality health care are likely more important than whether one's physician is of a similar or dissimilar race.

Annals of Internal Medicine, Aug 1, 2006

Inadequate blood pressure control is a persistent gap in quality care. To evaluate provider and p... more Inadequate blood pressure control is a persistent gap in quality care. To evaluate provider and patient interventions to improve blood pressure control. Cluster randomized, controlled trial. 2 hospital-based and 8 community-based clinics in the Veterans Affairs Tennessee Valley Healthcare System. 1341 veterans with essential hypertension cared for by 182 providers. Eligible patients had 2 or more blood pressure measurements greater than 140/90 mm Hg in a 6-month period and were taking a single antihypertensive agent. Providers who cared for eligible patients were randomly assigned to receive an e-mail with a Web-based link to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) guidelines (provider education); provider education and a patient-specific hypertension computerized alert (provider education and alert); or provider education, hypertension alert, and patient education, in which patients were sent a letter advocating drug adherence, lifestyle modification, and conversations with providers (patient education). Proportion of patients with a systolic blood pressure less than 140 mm Hg at 6 months; intensification of antihypertensive medication. Mean baseline blood pressure was 157/83 mm Hg with no differences between groups (P = 0.105). Six-month follow-up data were available for 975 patients (73%). Patients of providers who were randomly assigned to the patient education group had better blood pressure control (138/75 mm Hg) than those in the provider education and alert or provider education alone groups (146/76 mm Hg and 145/78 mm Hg, respectively). More patients in the patient education group had a systolic blood pressure of 140 mm Hg or less compared with those in the provider education or provider education and alert groups (adjusted relative risk for the patient education group compared with the provider education alone group, 1.31 [95% CI, 1.06 to 1.62]; P = 0.012). Follow-up blood pressure measurements were missing for 27% of study patients. The study could not detect a mechanism by which patient education improved blood pressure control. A multifactorial intervention including patient education improved blood pressure control compared with provider education alone.

Health is one of the many areas in which there has been a significant amount of interest in relat... more Health is one of the many areas in which there has been a significant amount of interest in relating locus of control (LOCI beliefs to a variety of relevant behaviors. Much of the earlier work in this area has already been reviewed and is available elsewhere (see Strickland, 1978; ...

Joint Commission Journal on Quality and Patient Safety Joint Commission Resources, Jun 1, 2007

A cross-sectional content analysis nested within a randomized, controlled trial was conducted to ... more A cross-sectional content analysis nested within a randomized, controlled trial was conducted to collect information on provider responses to computer alerts regarding guideline recommendations for patients with suboptimal hypertension care. Participants were providers who cared for 1,017 patients with uncontrolled hypertension on a single antihypertensive agent within Veterans Affairs primary care clinics. All reasons for action or inaction were sorted into a framework to explain the variation in guideline adaptation. The 184 negative provider responses to computer alerts contained explanations for not changing patient treatment; 76 responses to the alerts were positive, that is, the provider was going to make a change in antihypertensive regimen. The negative responses were categorized as: inertia of practice (66%), lack of agreement with specific guidelines (5%), patient-based factors (17%), environmental factors (10%), and lack of knowledge (2%). Most of the 135 providers classified as inertia of practice indicated, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Continue current medications and I will discuss at the next visit.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; The median number of days until the next visit was 45 days (interquartile range, 29 to 78 days). Clinical inertia was the primary reason for failing to engage in otherwise indicated treatment change in a subgroup of patients. A framework was provided as a taxonomy for classification of provider barriers.

Aids and Behavior, 2010

This study explored the effects of expressive writing on positive and negative outcomes related t... more This study explored the effects of expressive writing on positive and negative outcomes related to perceived psychosocial and health status among persons with HIV. This was the first study to examine the moderating effects of cognitive adaptability--consisting of dispositional optimism coupled with perceived competence--on outcomes of expressive writing. Thirty-seven participants wrote about either traumatic experiences or trivial topics in four 20-min sessions. Dependent measures obtained at baseline were repeated 1 month later. Although no main effects for group were found, baseline levels of cognitive adaptability were differentially associated with changes in a positive outcomes index, and a pain and physical functioning index in those assigned to the two groups. No moderating effects of cognitive adaptability were found for changes in a negative outcomes index. Findings underscore the importance of identification of moderating variables in understanding the impact of expressive writing interventions among individuals with HIV or other conditions.

Diabetes Educator, 1992

There is evidence that an individual's health beliefs influence performance of health beh... more There is evidence that an individual's health beliefs influence performance of health behaviors. The purpose of this study was to determine whether health beliefs in persons with diabetes could be modified during a clinical education program and whether the health beliefs were related to adherence to self-care instructions and metabolic control of diabetes. Health beliefs and HbA1c were measured at baseline in 189 adult outpatients with diabetes. Diabetes educators then attempted to modify health beliefs that were not conducive to positive health behaviors. Following education, some health beliefs were modified in a positive direction. Modest, but statistically significant increases in perceived severity of diabetes, perceived ability to carry out recommended behaviors, and perceived benefits of treatment were observed. Although HbA1c improved significantly in a subgroup of patients, this improvement could not be directly associated with any health belief or with self-reported adherence by the measures used in this study.

The purpose of this study was to develop and validate two instruments: one to assess patient perc... more The purpose of this study was to develop and validate two instruments: one to assess patient perceptions of control of the childbirth environment and the other, global satisfaction with the childbirth experience. Participants were 187 women recruited from obstetric clinics, breast-feeding support groups and online who had given birth in the past 4 months. Scale development involved item construction, exploratory factor analysis (EFA) of the Perceived Control in Childbirth Scale (PCCh), confirmatory factor analysis (CFA) of the Satisfaction with Childbirth Scale (SWCh), reliability analysis and construct validity analyses. EFA identified a single factor underlying a set of items reflecting the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s belief that her actions influenced the birth environment (i.e. perceived control). CFAs supported a single-factor model reflecting the degree to which the birth experience met the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s ideal (i.e. satisfaction). Perceived control was associated with childbirth self-efficacy. Childbirth satisfaction was associated with both affective reactions to birth and childbirth-related posttraumatic stress disorder (PTSD) symptoms. Results support the validity and reliability of two new scales that assess perceived control of the birth environment and global satisfaction with childbirth.

Http Dx Doi Org 10 1521 Jscp 1986 4 4 375, Jan 26, 2011

The Diabetes Educator, Feb 24, 2009

Diabetes self-management education is an important component of comprehensive diabetes care. Pati... more Diabetes self-management education is an important component of comprehensive diabetes care. Patients with low health literacy and numeracy may have difficulty translating information from traditional diabetes educational programs and materials into effective self-care. To address this potential barrier to successful diabetes teaching and counseling, the authors developed the Diabetes Literacy and Numeracy Education Toolkit (DLNET). The DLNET is composed of 24 interactive modules covering standard diabetes care topics that can be customized to individual patient needs and used by all members of the multidisciplinary diabetes care team. The material&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s content and formatting aims to improve the ease of use for diabetes patients with low literacy and numeracy by adhering to a lower text reading level, using illustrations for key concepts, and color-coding and other accommodations to guide patients through instructions for self-care. Individual sections of the DLNET may be provided to patients for initial teaching, as well as for reinforcement. Although designed for lower literacy and numeracy skills, the DLNET provides unique materials to facilitate diabetes education for all patients.

Journal of Behavioral Medicine, Aug 1, 2011

There is increasing evidence that patient centered care, including communication skills, is an es... more There is increasing evidence that patient centered care, including communication skills, is an essential component to chronic illness care. Our aim was to evaluate patient centered primary care as a determinant of medication adherence. We mailed 1,341 veterans with hypertension the Short Form Primary Care Assessment Survey (PCAS) which measures elements of patient centered primary care. We prospectively collected each patient's antihypertensive medication adherence for 6 months. rPatients were characterized as adherent if they had medication for [80%. 654 surveys were returned (50.7%); and 499 patients with complete data were analyzed. Antihypertensive adherence increased as scores in patient centered care increased [RR 3.18 (95% CI 1.44, 16.23) bootstrap 5000 resamples] for PCAS score of 4.5 (highest quartile) versus 1.5 (lowest quartile). Future research is needed to determine if improving patient centered care, particularly communication skills, could lead to improvements in health related behaviors such as medication adherence and health outcomes.

Nursing Research, 1975

To test a methodology that used role-playing responses by nurses to simulated patient disclosures... more To test a methodology that used role-playing responses by nurses to simulated patient disclosures, a three-part investigation was carried out at Vanderbilt University, Nashville, Tennessee. Four simulated patients-with diagnoses of diabetes mellitus, alcoholism with bleeding ulcer, ulcerative colitis, and cancer of the large intestine-tape recorded 20- to 30-second segments on 12 topics pertaining to their illness. Six topics dealt with the patients' physical problems; six with psychological aspects of the problems. In the tests for nurses' willingness both to listen and to pass along information to the next nurse, the 48 tape-recorded segments of patient information were played for 16 volunteer nurses in a laboratory set up for the purpose. Although the nurses had an option of listening or preparing a medication, they were expected to listen to at least 16 of the 48 segments. Following this, they were asked to tape record a report on the patient for the nurse who would follow them. The nurses, on average, listened to 29 of the 48 segments. The diabetic patient was listened to least; the cancer and the colitis patients each received a similar amounts of attention. The nurses gave substantial amounts of information as well as interpretive data about the patients so that the methodology seemed to prove that nurses could become sufficiently involved in a simulated patient setting.

Journal of Behavioral Medicine, 2016

This study was designed to assess dialysis subjects&amp;amp;amp;#39; perceived autonomy s... more This study was designed to assess dialysis subjects&amp;amp;amp;#39; 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&amp;amp;amp;#39; perception of their providers&amp;amp;amp;#39; autonomy support for phosphate binder use, and adherence was assessed by the self-reported Morisky Medication Adherence Scale. Serum phosphorus was obtained from the medical record. Regression models were used to examine independent factors of medication adherence, serum phosphorus, and differences by race and gender. Non-white HCC scores were consistently lower compared with white subjects&amp;amp;amp;#39; scores. No differences were observed by gender. Reported phosphate binder adherence was associated with HCC score, and also with phosphorus control. No significant association was found between HCC score and serum phosphorus. Autonomy support, especially in non-white end stage renal disease subjects, may be an appropriate target for culturally informed strategies to optimize mineral bone health.

Http Dx Doi Org 10 1207 S15324834basp0103_4, Jun 7, 2010

Http Dx Doi Org 10 1080 10810730 2011 604388, Sep 27, 2011

De data werden geanalyseerd met aan de hand van padanalytische modellen met gestandaardiseerde co... more De data werden geanalyseerd met aan de hand van padanalytische modellen met gestandaardiseerde coëfficiënten. Dit is een analysemethode die linken legt tussen variabelen en gebaseerd is op meervoudige regressie. Padanalyse gaat uit van samenhang tussen twee of meer variabelen, het effect dat ze op elkaar hebben en de mate van het effect dat ze samen en ieder apart hebben op de afhankelijke variabele. Het risico bij deze methodiek is het over het hoofd zien van een variabele die ook een rol speelt, maar niet herkend is.