ABSTRACT Background Germline pathogenic and likely pathogenic variants (GPV) in cancer susceptibility genes may guide medical care. However, inaccurate recall of test results by patients may impact the uptake of appropriate medical care, underscoring the importance of accurate recall of results. Methods Among individuals with a confirmed cancer susceptibility GPV that alters cancer risk management, individuals were categorized based on their accuracy of recall. Multiple logistic regression was performed to determine demographic and psychosocial factors associated with recall of test results. Results Of 807 participants, 91 (11%) failed to accurately recall their test results, including 22 who did not remember being tested and 69 whose cancer risk management could be impacted due to inaccurate recall of test result details. Compared to those with accurate recall of test results, those who failed to accurately recall their results were significantly more likely to have a history of cancer [OR = 2.24, p = 0.009] and lack a college degree [OR = 2.42, p < 0.029]. Additionally, based on standardized survey responses, failure to accurately recall was associated with positive feelings about their results [OR = 1.73, p < 0.001], lower emotional distress [OR = 0.65, p = 0.004], lower knowledge about hereditary cancer [OR = 0.67, p < 0.001], and lower satisfaction with family communication and support related to testing [OR = 0.62, p < 0.001]. Participants with GPVs in high‐risk or moderate‐risk breast cancer genes were substantially less likely to demonstrate inaccurate recall (both OR = 0.18, p < 0.001) compared to those with GPVs in other actionable cancer genes. Discussion Given 11% of participants failed to remember being tested or failed to accurately recall their result, this highlights the importance of documentation and accessibility of test results by both patients and providers to ensure patients receive appropriate care.

BACKGROUND:Cervical cancer screening rates are declining in the United States and below the Healthy People 2030 goal of 79.2%. Alternative screening methods to the Pap test (e.g., at-home human papilloma virus [HPV] testing) need to be explored to determine if they are feasible for those unscreened and underscreened. The purpose of this study was to determine the relative importance of Health Belief Model constructs on intention to use at-home HPV testing and explore possible moderation by a person's decision-making style. METHODS:A total of 300 women aged 30-65 in the United States were recruited via a survey panel, Prolific, to complete an online survey assessing their decision-making styles (analytic or intuitive), relative importance of various health beliefs, and intention to use at-home HPV testing, if such an option were available to them. Constructs of the Health Belief Model were included as predictors of intention in a regression model, with decision-making styles included as potential moderators of the relative importance. RESULTS:Participants' mean age was 40.9 ± 8.9; most were white (79.3%) and had graduated college (66.3%). The mean intention to use at-home HPV testing score was 3.9 (standard deviation = 1.1) out of 5, indicating generally positive agreement. Perceived general benefits, cues to action with family and friends, and self-efficacy related to the test were significantly positively associated with intention, whereas misunderstanding related to need for HPV testing was negatively associated with intention. Self-efficacy was the strongest predictor (β = .69, p < .001). Neither decision-making style was significantly associated with the outcome and there was no evidence of moderation. CONCLUSIONS:As self-efficacy related to at-home HPV testing is the strongest predictor of intention to use it, effective messaging that ensures users' self-efficacy and confidence in their ability to correctly complete the test is needed.

Low back pain is a widespread health concern in the United States. Traditional measures used for low back pain may lack meaningfulness to patients and be unable to capture patient’s individual experience. This study aimed to examine the feasibility of a goal attainment scaling application for chronic low back pain patients (GAS-Back) and the nature of goals identified by patients with chronic low back pain (cLBP) receiving physical therapist (PT) care. This feasibility study consists of a single-group, longitudinal, preliminary study with variation in baseline, intervention, and follow-up for each participant. It was conducted at the University of South Florida Health Physical Therapy Center (USF PT Center) in Tampa, FL. Convenience sampling was used to recruit potential participants. Thirty-three participants (n = 33) with cLBP, ranging from 21 to 64 years old, were enrolled in this study and completed GAS-Back in PT care. The primary outcomes of this study were GAS-Back training time (hours), GAS-Back implementation time (minutes and seconds), PT adherence (percent adherence to protocol), interrater reliability, and patient satisfaction and engagement. Secondary outcomes were the domain and subdomain for the nature of goals identified (percentages) according to the International Classification of Functioning, Disability and Health (ICF) categorization. GAS-Back clinician training time (7 h) and the average GAS-Back implementation time (9 min 9 s) were both considered to be efficient. Clinician adherence (89

Opioids are often the first-line approach to treat moderate to severe cancer-related pain. However, opioids can cause conflict and distress to cancer survivors when prescribed for pain. The objective of this multi-methods study was to explore the psychosocial factors that affect the use or refusal of opioids among breast cancer survivors. We recruited 20 breast cancer survivors treated with opioids to participate in a free-listing exercise and semi-structured interview. Results revealed that survivors felt unprepared for the intensity of pain following cancer treatments, which contributed to the use of opioids. The adverse side effects often influenced their decision to discontinue them from their pain management strategy. Finally, the addictive properties of the medication affected survivors' use of the medication. Findings identify and recognize clinicians and researchers can promote safer, more personalized approaches to pain management to inform interventions that integrate behavioral health support and improve patient-provider communication.

Non-traditional providers and healthcare settings (e.g., dental offices, pharmacies) provide an opportunity to increase human papillomavirus (HPV) vaccine accessibility; however, they remain underutilized. The purpose of this study was to examine United States (U.S.) parents' perceptions of healthcare provider recommendations for the HPV vaccine and perceived convenience and likelihood of vaccination across healthcare settings. Parents' perceptions were assessed and compared according to the Transtheoretical Model stages of change (action: adolescent already vaccinated; preparation: intend-to-vaccinate; contemplation: unsure of intention). Parents of adolescents ages 11-12 from across the U.S. were recruited to participate in an online survey via Qualtrics that measured their perceptions of HPV vaccination by healthcare provider type and setting. The convenience and likelihood of vaccinating in different settings and the importance of provider recommendation were evaluated for those in the preparation and contemplations groups using one-way repeated measures ANOVAs. Participants across all stages of change were similar in their perceptions of vaccination across healthcare settings, rating family practice and pediatric offices as the most convenient and most likely settings for vaccination. Dental offices were perceived as the least convenient and least likely settings, and dental provider recommendations were rated as the least important. Among those in the contemplation stage, pharmacies were also rated lower in convenience and likelihood. There is a missed opportunity for HPV vaccination in non-traditional settings, including dental offices and pharmacies. Increasing education on HPV and availability of the vaccine in alternative settings can encourage vaccine uptake and move parents towards preparation and action.

PURPOSE:To explore how insight into illness affects the relationship between self-stigma and perceived dignity among individuals with schizophrenia. METHOD:We conducted a cross-sectional study involving a convenience sample of 202 participants with schizophrenia at two psychiatric hospitals in eastern Taiwan. Data were collected via a structured questionnaire, including the Perceived Psychiatric Stigma Scale, Dignity Instrument, and item G12 from the Positive and Negative Syndrome Scale to assess perceived stigma, dignity, and insight into illness, respectively. The moderation regression model was analyzed. RESULTS:Findings revealed that self-stigma was negatively associated with perceived dignity among individuals with chronic schizophrenia. Moreover, insight into illness played a conditional moderating role in the relationship between self-stigma and perceived dignity. CONCLUSION:Findings indicate that the impact of self-stigma on perceived dignity varies depending on the level of insight into illness.

Background/Objective: The COVID-19 pandemic resulted in unprecedented societal changes globally and negatively impacted the psychosocial health of pregnant women. This study aimed to explore how direct, indirect, and unrelated factors associated with the COVID-19 pandemic influenced stress levels among pregnant women. Methods: This interpretivist qualitative study employed open-ended survey questions to capture the lived experiences of 313 pregnant women in the third trimester residing in Florida between January and March 2022, during the Omicron surge. Thematic analysis was conducted, guided by the Stress and Coping Theory and the Stress Buffering Theory. Results: Participants described a range of stressors directly and indirectly related to the COVID-19 pandemic that affected pregnant women. Themes related to increased stress were (1) fear, worry, and anxiety related to COVID-19 infection, (2) fear, worry, and anxiety related to preparedness for birth/baby due to pandemic restrictions, (3) prevention concerns associated with COVID-19, (4) lack of social support, (5) return to normalcy, (6) health-related social needs, (7) physical health issues, and (8) navigating conflict and grief. Conversely, stress-reducing factors were (1) preventive measures during the pandemic, (2) coping strategies, (3) not having to work, and (4) social support. Conclusions: Pregnant women experienced heightened stress due to a complex interplay of factors related directly or indirectly to the COVID-19 pandemic. It is important that maternity care, mental health and health-related social needs screenings and referrals, and tailored interventions are integrated into public health crises preparedness plans to limit the stress that pregnant women experience and support their well-being.

To investigate the association between lifestyle and atypical antipsychotic drug use in patients with schizophrenia and the risk of constipation and to assess the impact of anxiety and depressive symptoms on constipation risk. Cross-sectional convenience sampling was employed, and 271 participants aged 20–65 were enrolled. Data were collected via a structured questionnaire comprising participants’ demographic data, medication information, dietary behavior assessment, and the Baecke Physical Activity Questionnaire, Beck Depression Inventory-II, and Beck Anxiety Inventory. IBM SPSS 24.0 with multivariate logistic regression was used for data analysis. We performed a subgroup analysis of anticholinergic drugs via multivariate logistic regression. In total, 180 participants had functional constipation; risk factors included female sex, anxiety symptoms, depressive symptoms, and quetiapine and aripiprazole use. Patients who drank more than 3,000 cc of water daily or used risperidone were less likely to have functional constipation. Depressive and anxiety symptoms were risk factors even after adjusting for sex, use of anticholinergics and laxatives, consuming two servings of fruit, consuming three servings of vegetables, consuming more than 3,000 cc of water daily, physical activity, medical comorbidity, chlorpromazine equivalent dose, and atypical antipsychotic use. Similar associations were found for two affective symptoms and functional constipation in the subgroup analysis of anticholinergic drugs. The prevalence of functional constipation in patients with schizophrenia was 66.4

Although the human papillomavirus (HPV) vaccine is effective at preventing infection and certain types of cancer, uptake is suboptimal. HPV vaccine requirements for school entry are an underutilized strategy to increase HPV vaccine uptake among adolescents. The purpose of this study was to understand the factors that are predictive of parents' attitudes toward schools requiring the HPV vaccine for entry into middle school. Parents of adolescents ages 11-12 y were recruited to participate in an online survey via Qualtrics. Descriptive frequencies were obtained, and sequential regression analyses were conducted controlling for demographic characteristics. A total of 1,046 participants were included in the analysis. The mean age was 40.3 y (SD = 6.3) and the majority of participants were White (74.4%) and had some college education or higher (80.9%). Participant's gender, political affiliation, urban/rural setting, and education level were significantly associated with attitudes toward school entry requirements. Adding psychosocial items related to perceptions of benefits, risks, and social norms significantly increased the amount of variance explained in the model [(Delta R2 = .312, F(5, 1036) = 132.621)]. Perceived social norms was the strongest predictor of attitudes [beta = 0.321]. The results of this study can be used to inform policy changes around school-entry requirements in the United States. Further studies are needed to assess the influence of perceived social norms in vaccine hesitant groups.

Suicide management skills are essential for nursing students, as they are often the initial healthcare contact for individuals at risk of suicide. Recognising signs of suicidal ideation and behaviour is critical for initiating timely interventions. This study aimed to develop and access the psychometric evaluation of the Suicide Management Competency Scale (SMCS) for nursing students. A first draft of the SMCS was initially developed following literature and focus group, and a scale containing 28 items was constructed. We recruited 216 participants from two nursing schools. Construct validity was evaluated with exploratory factor analysis (EFA). Internal consistency reliability was determined with Cronbach's alpha, and test-retest reliability was examined with intra-class correlation. After four rounds of EFA and item analysis, we reduced the number of items to 16. We deleted 12 items, including 4 items for communalities less than 0.40, 3 items for cross-loading, 3 items for factor loading less than 0.40, and 2 items for low corrected item-total correlation. The final 16-item SMCS resulted in three subscales, which explained 55.813% of the total variance: emotional challenges in suicide risk assessment, delivering suicide interventions, and suicide risk nursing competence and confidence. Cronbach's alpha was 0.854 for the total score and 0.748 to 0.847 for the subscales. The newly developed SMCS was found to have good reliability and validity, suggesting that this scale could be used to evaluate nursing students' perceived competency in managing suicide, which might help cultivate competence in nurses' ability to effectively manage and prevent suicide, thus contributing to saving lives.

The current quasi-experimental study explored the effects of Baduanjin qigong on body mass index (BMI) and five metabolic indexes in people with schizophrenia. Inclusion criteria were body mass index >25 kg/m(2) or metabolic syndrome. Twenty-two service users were recruited from a psychiatric center and were assigned to the experimental group (EG) or control group (CG) using blocked randomization. The EG performed Baduanjin qigong lasting 1 hour for 12 weeks three times per week, whereas the CG received routine care. Generalized estimating equations showed that the EG achieved a greater decrease in BMI and waist circumference (WC) than the CG post-intervention. Baduanjin qigong may provide an effective nonphar-macological approach to reducing BMI and WC in people with schizophrenia. This study showed that performing Baduanjin qigong for 12 weeks is a feasible and effective strategy for improving the body shape of individuals with chronic schizophrenia, thus providing results that can serve as a reference for health professionals working in psychiatry departments. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.]

OBJECTIVE:To examine the utility of a novel sexual risk index (SRI) to better use National College Health Assessment (NCHA) sexual health-related questions. METHODS:The first phase included discussions, testing, and recoding of the initial set of items. In the second phase, a correlation analysis was run; items were systematically removed to achieve a Cronbach's alpha of .714. RESULTS:All currently enrolled students in Spring 2020 at medium-sized, 4-year public university in Florida were recruited (n = 4,850) for the NCHA. Of the 441 total respondents, 223 students were included in the SRI analyses. Most had very low SRI scores, indicating few sexual risks. Nontraditional students were half as likely to experience academic challenges as compared to traditional students (TS; OR = .487, p = .033), while increasing SRI scores (OR = 1.182, p = .022) and decreasing GPA scores (OR = -1.975, p < .001) were associated with an increased likelihood of self-reporting academic challenges. CONCLUSIONS:Results suggest high utility and reliability of the SRI. The use of the SRI provides a better overall picture of sexual risk-taking through a score rather than comparison of individual NCHA items.

Background and Purpose:Establishing measurement invariance (MI) is important in the questionnaire validation process. This study examined the MI of the Hospice Quality of Life Index-14 (HQLI-14) when comparing hospice patients with lung cancer and those with nonlung cancers.Methods:The HQLI-14 contains 14 items to measure multidimensional concepts of quality of life. A series of confirmatory factor analyses were performed to test configural, metric, and scalar invariance.Results:The MI of the HQLI-14 was supported by increasing equality constraints on item parameters between groups. Although the configural and metric invariances were both supported, one item regarding breathlessness was noninvariant between the groups with lung and nonlung cancers.Conclusions:The HQLI-14 shows early evidence of meeting the requirements for configural, metric, and partial scalar invariance. It may be used to make meaningful comparisons between patients with lung cancer and nonlung cancers.

ABSTRACT Background The Gratitude at Work Scale, originally developed by American scholars, has been widely administered to mental health professionals and human service workers to explore gratitude in the workplace. No Chinese-language instrument is currently available for assessing workplace gratitude. Purposes The aims of this study were to (a) translate the original English version of the Gratitude at Work Scale into a traditional Chinese version (TC-GAWS), confirm its factor structure, and analyze its psychometric properties among newly employed nurses and (b) develop and evaluate the psychometric properties of the TC-GAWS short form. Methods A psychometric study using a cross-sectional web-based design was conducted in Taiwan. Three hundred twenty-two employed nurses completed a battery of self-administered online questionnaires that included a demographic datasheet, the Gratitude Questionnaire–Six-Item Form, the Connor–Davidson Resilience Scale-10, and the Thoughts of Quitting Scale. IBM SPSS 24.0 and AMOS 28.0 were used for data analysis, and Cronbach's alpha and Pearson's correlation were used to assess reliability and concurrent validity. Exploratory factor analysis and confirmatory factor analysis (CFA) were conducted. Results The internal consistency and stability of the TC-GAWS total scale were .88 and .91, respectively. The exploratory factor analysis showed a satisfactory Kaiser–Meyer–Olkin value of .88 and a Bartlett's test value of 654.01 ( p < .001), suggesting that 64.55% of the total variance was explained by the two-factor TC-GAWS. After item reduction, the CFA of the six remaining items of the TC-GAWS short form revealed adequate fit statistics for a two-factor structure and a second-order factor. Strong correlations were found between the 10-item and six-item TC-GAWS ( r > .94) in the two samples, suggesting good concurrent validity. The overall scores for the 10-item and six-item TC-GAWS had similar convergent validity, with moderate-to-strong correlations for the Gratitude Questionnaire–Six-Item Form ( r = .45 and .540), Connor–Davidson Resilience Scale-10 ( r = .49 and .51), and Thoughts of Quitting Scale ( r = −.57 and −.53). The CFA yielded a two-factor, six-item model that exhibited good fit with the latent constructs of χ 2 / df = 11.06/8 = 1.38, p = .198, comparative fit index = .996, goodness-of-fit index = .979, root mean square error of approximation = .045, root mean square residual = .030, and standardized root mean squared residual = .023. Conclusions/Implications for Practice Both the 10- and six-item TC-GAWS instruments demonstrated good reliability and validity in nurse participants. The TC-GAWS may be used to measure gratitude in nurses in the workplace. This instrument has the potential to facilitate a better understanding of gratitude in nurses, which may be applied to the improvement of nursing management, research, and education.

AbstractBackgroundFatigue is frequently co-existing with other symptoms and is highly prevalent among patients with cancer and geriatric population. There was a lack of knowledge that focus on fatigue clusters in older adults with cancer in hospice care.ObjectivesTo identify fatigue-related symptom clusters in older adult hospice patients and discover to what extent fatigue-related symptom clusters predict functional status while controlling for depression.MethodThis was a cross-sectional study in a sample of 519 older adult hospice patients with cancer, who completed the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression, Boston Short Form Scale, and the Palliative Performance Scale. Data from a multi-center symptom trial were extracted for this secondary analysis using exploratory factor analysis and hierarchical multiple regression analysis.ResultsData from 519 patients (78 ± 7 years) with terminal cancer who received hospice care under home healthcare services revealed that 39% of the participants experienced fatigue-related symptom clusters (lack of energy, feeling drowsy, and lack of appetite). The fatigue cluster was significantly associated positively with depression (r = 0.253, p < 0.01), and negatively with functional status (r = −0.117, p < 0.01) and was a strong predictor of participants’ low functional status. Furthermore, depression made a significant contribution to this predictive relationship.ConclusionOlder adult hospice patients with cancer experienced various concurrent symptoms. The fatigue-specific symptom cluster was identified significantly associated with depression and predicted functional status. Fatigue should be routinely monitored in older adults, especially among hospice cancer patients, to help reduce psychological distress and prevent functional decline.

Objective: To identify theory-based innovation characteristics associated with the adoption of consumer-based self-sampling methods for sexually transmitted infection screening. Participants: Guided by the Diffusion of Innovation, survey data from people assigned female at birth (AFAB) (n = 92) were analyzed. Methods: Forward regression models and a path analysis were used to predict adoption by characteristics, using maximum likelihood estimation. Measures included acceptability, comfort, addresses healthcare needs, willingness to adopt self-sampling methods, and innovation characteristics. Results: Predictors of willingness to adopt were no clinic visit (relative advantage), convenient pick-up (relative advantage), and low cost. Variables with direct effects on adoption included: addresses healthcare needs, comfort, acceptability, and no clinic visit. Conclusions: Relative advantage was a salient factor and prioritizing this construct in intervention development may facilitate adoption. Results can guide the development of an innovative, theory-based intervention that promotes adoption of self-sampling methods, ultimately improving STI screening rates.

PurposeEffectiveness of message tactics in social marketing projects often varies across groups of individuals, which suggests the importance of tailoring communication approaches to maximize the success of promotional strategies. This study aims to contribute in this direction by using an innovative approach to promote targeted human papillomavirus vaccination, applying conjoint analysis to understand parental preferences for social media content features. Design/methodology/approachAn online purpose-built quantitative survey was administered to a group of parents meeting eligibility criteria. The survey questions were designed based on inputs from formative qualitative research conducted in a previous phase of the study. FindingsIn the overall sample of 285 parents, responses show that image was the most important feature of social media posts overall, followed by source and text. Cluster analysis identified eight segments in the sample based on parental preferences for content features. Significant differences across segments were identified in terms of need for cognition, vaccine hesitancy, parental gender, concerns around side effects, trust in medical providers, information sharing behaviors on social media and information seeking online. Originality/valueThe application of conjoint analysis to promotional content allows to assess which features of the content are most important in persuading different individuals and provide insights on how people process the information, ultimately to inform targeted promotion based on preferences. Conjoint analysis has been widely used in consumer research to explore audience preferences for products or services, but only a few applications of conjoint analysis to the design and testing of promotional content are found in the literature.

Oropharyngeal cancer (OPC) has the highest incidence of any cancer caused by human papillomavirus (HPV). Oral health providers are urged to support the use of the HPV vaccine, which was approved by the US Food and Drug Administration for the prevention of OPC in 2020. This study evaluated the preferences of dental patients regarding 11 modalities for learning about HPV-related topics from their oral health providers. An online survey was administered to US adults aged 18 to 45 years (n = 285) to assess their communication modality preferences, prior experience discussing HPV with oral health providers, and demographic characteristics. Multiple items were combined to obtain preference scores for each modality. Preference scores were compared using 2 × 3 mixed analysis of variance. Age, sex, income, and HPV vaccination status were assessed as potential confounders. One-on-one discussions were the most preferred modality for learning about HPV-related topics; however, the preference scores differed based on whether the patient had prior HPV-related discussions with oral health providers (partial η2 = 0.054). Patients who had prior discussions showed a weaker preference for one-on-one discussions than did patients who had not had prior discussions. Oral health providers are called on to promote HPV vaccination, which will require increasing communication on this subject with patients. To assure greater acceptance of their recommendations, providers will need to match their communication styles to those desired by their patients. As part of a comprehensive HPV prevention strategy that includes administration of the vaccine, oral health providers should be educated on how to confidently discuss HPV-related issues with their patients.

BACKGROUND:Poor oral health during pregnancy has significant implications across the life course, including increased risk for adverse pregnancy, birth outcomes, and the development of early childhood caries. In efforts to improve perinatal oral health in the United States, a set of national interprofessional guidelines were developed that include recommended practice behaviors for both oral health providers and prenatal providers. The purpose of this study was to examine guideline awareness, familiarity, beliefs, and practice behaviors among both provider types.METHODS:Prenatal providers and oral health providers in Florida were recruited via random and convenience sampling to complete an online survey guided by the Consolidated Framework for Implementation Research (CFIR) and the Cabana Framework. The present analysis focused on the Individuals Involved domain (CFIR), awareness and familiarity with the guidelines (Cabana Framework), confidence, and practice behaviors as recommended by prenatal oral health guidelines (assess, advise, refer, share/coordinate). Data were analyzed using chi-square tests, independent samples t-tests, Pearson correlation coefficients, and one-way analysis of variance (ANOVA) and analyses were conducted in SPSS.RESULTS:Prenatal and oral health providers did not differ significantly in their awareness of the guidelines, but awareness was significantly associated with three of the four practice behaviors for prenatal providers. Familiarity with the guidelines was significantly higher among oral health providers and was associated with all four practice behaviors for both provider types. Five out of ten oral health belief items were significantly associated with practicing the guidelines among prenatal providers, but only two among oral health providers. Confidence in performing the practice behaviors was significantly associated with guideline implementation among both groups. Years in practice was significantly associated with performing practice behaviors for prenatal providers, but not for oral health providers.CONCLUSIONS:Our findings highlight the importance of professional organizations and the role of clinical guidelines on practice behaviors. Although provider education is a key implementation strategy, organizational and policy-level system changes could also be critical in supporting practice behaviors.