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“This needs to be told to everyone”: Content analysis of written immediate responses from an online experiment examining health warning messages about alcohol consumption and breast cancer risk

by Allison Anbari, Zachary Massey, Abigail Adediran, Na Wang, LaRissa Lawrie, Priscilla Martinez, Denis McCarthy

Alcohol consumption increases breast cancer risk. We evaluated the responses of 748 United States female participants ages 21–29 to health warning messages addressing the relationship between alcohol consumption and increased breast cancer risk. In an online experiment, participants were randomly assigned to view standalone health warning messages about alcohol, breast cancer, and breast cancer health effects with varying picture and text attributes. Participants then completed post-message exposure assessments that included an immediate open-ended response to the message prompt. We conducted a qualitative content analysis of the responses and coded deductively based on constructs from the Message Impact Framework including message reactions, attitudes and beliefs, and behavioral intentions. These constructs and corresponding variables were present in participants’ responses. Response type did not vary by participants’ demographics or the attributes of the health warning message they viewed. The code new information was applied to 20% of the responses, indicating that those participants had no prior knowledge of alcohol and breast cancer risk. Alcohol and breast cancer messaging could impact drinking behaviors. Given the frequency of responses indicating a lack of awareness, more work in cancer prevention and population health messaging is warranted.

Enhancing Engagement in Medication Communication for Rural Aged Care Residents: Moving From Consultation to Collaboration

ABSTRACT

Background

This Letter comments on the qualitative study by Dowling and Manias (2025) regarding medication communication for rural aged care residents.

Aims

To discuss sampling and cultural considerations, and propose strategies to enhance engagement from consultation to collaboration.

Conclusions

Staff training, interdisciplinary collaboration, and culturally tailored interventions are recommended to improve communication and transitional care quality.

The Psychological Status of Elderly Patients During the Acute Phase of Stroke: A Mixed Methods Analysis

ABSTRACT

Objective

This study aims to understand the experiences of elderly patients in the acute phase of stroke, to determine the factors that predict the level of psychological resilience, and to examine the moderating role of rumination between illness perception and psychological resilience.

Methods

A mixed-method of embedded design was employed in this study. In the qualitative study, 13 elderly patients with acute stroke were interviewed based on semi-structured interview guides and recordings. The data were transcribed, and thematic content analysis was conducted. In the quantitative study, a cross-sectional survey was conducted on 240 elderly acute stroke patients using paper-based questionnaires, and data analysis was performed using SPSS25.0 and AMOS24.0.

Results

From the qualitative analysis, we identified risk factors affecting the psychological status of elderly patients with acute stroke, which can be summarised into four major themes and six categories. The content of the four major themes is: lack of disease cognition, facing disease threats and challenges, prominent psychological issues, sense of disease gain. The content of the six categories is: lack of stroke-related disease knowledge and cognitive bias, single source of disease information; significant sequelae, concern about medical expenses; apparent symptoms of anxiety and depression, disease uncertainty and fear. In the Quantitative analysis, results indicated that illness perception had a direct effect on psychological resilience (β = −0.34, p < 0.01) and rumination (β = 0.51, p < 0.01). Also, rumination was directly related to psychological resilience (β = −0.24, p < 0.01). In addition, illness perception was indirectly related to psychological resilience (β = 0.51*−0.24 = −0.12, p < 0.01) mediated through rumination.

Conclusion

Improving the level of rumination in elderly patients with acute stroke can mitigate adverse Illness perception and enhance psychological resilience. This study provides a theoretical basis for developing relevant intervention measures.

Association Between Depression and Dyadic Self‐Care in Stroke Patient–Caregiver Dyads and Mediation of Self‐Efficacy: An Actor–Partner Interdependence Mediation Model

ABSTRACT

Aim

To examine the effects of depression on dyadic self-care in stroke patients and their caregivers, as well as the potential mediating role of self-efficacy in this relationship.

Design

A multi-centre cross-sectional study design was employed.

Methods

From May to September 2022, stroke patients and their caregivers were recruited from China using a multi-centre stratified sampling method. Data analysis was conducted using a structural equation model based on the Actor-Partner Interdependence Model extended to include mediation. Depression in patients and caregivers was assessed using the Patient Health Questionnaire-9. The self-care self-efficacy scale was utilised to measure patient self-efficacy, while the caregiver self-efficacy in contributing to patient self-care scale was used for caregivers. Patient self-care was evaluated with the Self-Care of Stroke Inventory and caregiver contributions to self-care were assessed using the Caregiver Contributions to Self-Care of Stroke Inventory.

Reporting Method

This study followed the STROBE checklist.

Results

306 patient-caregiver dyads were enrolled. The direct effect between depression and dyadic self-care was not confirmed in stroke patients and their caregivers (p > 0.05). Patient self-efficacy had significant indirect actor effects on self-care maintenance (β = −0.173, p < 0.001), monitoring (β = −0.146, p < 0.001) and management (β = −0.186, p < 0.001). Caregiver self-efficacy had an indirect actor effect on caregiver contributions to self-care maintenance (β = −0.096, p < 0.001), monitoring (β = −0.073, p < 0.001) and management (β = −0.106, p < 0.001). The partner effect analysis showed caregiver self-efficacy plays a potential mediating role in the relationship between patient depression and caregiver contributions to self-care maintenance (β = −0.037, p = 0.036), monitoring (β = −0.028, p = 0.032) and management (β = −0.040, p = 0.036). Caregiver depression reduced caregiver self-efficacy, lowering patient self-care monitoring (β = −0.040, p = 0.004) and management (β = −0.047, p = 0.002) levels.

Conclusion

The findings indicate interactive effects between depression, self-efficacy and dyadic self-care among stroke patients and their caregivers. Therefore, the development of targeted dyadic interventions to address depression and enhance self-efficacy in both patients and caregivers should be considered.

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