This pilot study used a quasi-experimental pretest-posttest design to examine if participation in a chronic disease self-management program (CDSMP) improved self-efficacy, self-efficacy health, and self-management behaviors in an underserved, poor, rural population. The sample, recruited from two clinics in a south central state, consisted of 48 adults (59.70 +/- 11.22 years) and was 79.2% Caucasian (n = 38) and 20.8% (n = 10) African American. Trained lay leaders with chronic illnesses directed the interactive CDSMP based on Bandura's self-efficacy theory that included strategies for personal exercise program development, cognitive symptom management, problem solving, and communication skills. Program-specific paper-and-pencil instruments were completed prior to and immediately after completion of the 6-week program. Significant improvements (p<.10) in self-efficacy, self-efficacy health, and self-management behaviors occurred. Results underscore the need to evaluate intervention programs for specific populations and for a new paradigm that focuses on patient-provider partnerships that can improve health outcomes in underserved, poor, rural populations.

Among the country’s 25 largest cities, the breast cancer mortality disparity is highest in Memphis, Tennessee, where African American women are twice as likely to die from breast cancer as White women. This qualitative study of African-American breast cancer survivors explores experiences during and post treatment that contributed to their beating the high odds of mortality. Using a semi-structured interview guide, a focus group session was held in 2012 with 10 breast cancer survivors. Thematic analysis and a deductive a priori template of codes were used to analyze the data. Five main themes were identified: family history, breast/body awareness and preparedness to manage a breast cancer event, diagnosis experience and reaction to the diagnosis, family reactions, and impact on life. Prayer and family support were central to coping, and survivors voiced a cultural acceptance of racial disparities in health outcomes. They reported lack of provider sensitivity regarding pain, financial difficulties, negative responses from family/friends, and resiliency strategies for coping with physical and mental limitations. Our research suggested that a patient-centered approach of demystifying breast cancer (both in patient-provider communication and in community settings) would impact how women cope with breast cancer and respond to information about its diagnosis.

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Persons with end-stage renal disease have an accelerated risk for cardiovascular (CV) morbidity and mortality. Unfortunately, their accelerated CV risk persists even after kidney transplantation associated with pretransplant and post-transplant vascular disease. number of rejections treated with high-dose steroids, prolonged use of immunosuppressive therapy post-transplant, effects of comorbid chronic conditions and male gender. Unhealthy, modifiable lifestyle practices often augment their CV risk. The purpose of this study was to examine health-related lifestyle behaviors and estimate CV risks of men 1 year following kidney transplantation. Using the Healthier People Network Health Risk Appraisal (HPN-HRA), we examined CV risk characteristics of 34 men (M age=47.3 years) enrolled in an urban, mid-southern transplant center. Participants were assessed via self-administered paper-and-pencil questionnaires and medical record review provided biological data for analyses. HPN-HRA software was used to analyze biological and behavioral characteristics to compute CV risk estimates. Data were analyzed using descriptive, inferential and correlational analyses. The majority of participants reported smoke cessation (n= 19) or never having smoked (n = 8), and consumption of one or less alcoholic drinks per week (n=28). On the other hand, increased risk for heart attack and stroke were associated with advancing age (P<0.0001), white race (P<0.05) and higher systolic blood pressure (P<0.01). While risk for heart attack was associated with current cigarette smoking (P<0.01), risk for stroke was not. Conversely, risk for stroke was associated with higher BMI (P<0.05), risk for heart attack was not. Thus, the study provides evidence that male kidney transplant survivors exhibit a significant number of non-modifiable and modifiable characteristics that contribute to their posttransplant CV risk.

Social support can have great influence on health, well-being, and general quality of life To promote awareness of the social network that surrounds each transplant recipient, transplant social workers are now using the Social Network Map as an intervention. Because perceptions of availability and accessibility of support are key elements in the use of social network resources, awakening an individual's awareness of available resources is a significant first step in enhancing social support and, ultimately, quality of life. The Social Network Map is used to establish dialogue regarding individuals' needs and sources of support, and then how the support system can meet those needs. Transplant social workers thus foster active use of those people in transplant recipients' networks who can meet the particular needs recipients identify.

This exploratory study examines differences in health risk characteristics and perceived health by caregiver status in two groups of Black women, 37 informal caregivers and 20 noncaregivers, transitioning from welfare to work. Health risk characteristics were assessed with the Center for Epidemiologic Studies Depression Scale and Healthier People Network Health Risk Appraisal-Version 6. Body mass index (BMI) calculations were based on the standard Centers for Disease Control formula. Perceived health status was assessed using a single-item Cantril ladder. Results show no statistically significant between-group differences in perceived health status, depressive symptoms, frequency of lifestyle behaviors, or BMI. Clinically significant proportions of participants in both groups rated their health as poor or fair; reported mild to severe depressive symptoms; smoked cigarettes; did not perform monthly self-breast exams; were physically inactive, overweight, or obese; and consumed high-fat diets. Black women receiving welfare show increased risk for premature chronic health problems, which warrants development of effective community-based risk-reduction programs.

Mission:The Permanente Journal is published for physicians, practitioners, and nurses to create and to deliver superior health care through the principles and benefits of Permanente Medicine.Permanente Medicine is preventive, innovative, evidence-based, population care practiced by a multispecialty group, using an electronic health and medical record, and focused on patient relationships and outcomes.

These data on southern black nursing home residents provide evidence that among older black nursing home residents, women have greater care needs than men. Findings illustrate the need to consider gender in planning nursing home care of black older residents, black women may be at greater risk for health status alterations and require more frequent health status monitoring and intervention.