We developed a questionnaire for the evaluation of patient satisfaction with telemedicine. Items related to patient satisfaction with telemedicine were identified through a review of the literature. The internal consistency and the intraclass correlation coefficient were used to evaluate the reliability of the proposed instrument. Content validity was examined using a panel of experts. The predictive validity of the proposed instrument was assessed by correlating scores on the Telemedicine Satisfaction Questionnaire (TSQ) with haemoglobin A(1c) levels and adherence to self-management activities among 38 patients with type 2 diabetes, after they had completed a four-session interactive diabetes tele-education programme. A principal-components analysis with varimax rotation was performed to reduce the number of questionnaire items from 15 to 14, and the scree test was used to select significant factors. There were three components with eigenvalues over 1.0, which together explained 68% of the total variance. These were: quality of care provided, similarity to face-to-face encounter and perception of the interaction. The TSQ demonstrated preliminary reliability and validity but more extensive testing will be required before it can be considered generally applicable.
BACKGROUND.Colorectal cancer (CRC) is a leading cause of cancer mortality in the US. Surveys reveal low CRC screening levels among Asians in the US, including Chinese Americans.METHODS.A randomized controlled trial was conducted with Chinese patients to evaluate a clinic‐based, culturally and linguistically appropriate intervention promoting fecal occult blood test (FOBT) screening. The multifaceted intervention included a trilingual and bicultural health educator, bilingual materials (a video, a motivational pamphlet, an informational pamphlet, and FOBT instructions), and three FOBT cards. Patients in the control arm received usual care. Our primary outcome measure was FOBT screening within 6 months after randomization. The proportion of FOBT completion in the intervention and control arms was compared by using a chi‐square test, and logistic regression analysis was performed to adjust for the effects of sociodemographic variables and prior screening history. Potential effect modifications were also tested by using logistic regression models.RESULTS.Our intervention had a strong effect on FOBT completion (intervention group, 69.5%; control group, 27.6%), and the adjusted odds of FOBT slightly increased to over 6‐fold greater in the intervention arm compared with the control arm. No effect modification by age, gender, language, insurance, or prior FOBT was found.CONCLUSIONS.The authors' multifaceted, culturally appropriate intervention significantly increased FOBT screening in a group of low‐income and less‐acculturated minority patients. Given the large effect size, future research should determine the effective core component(s) that can increase CRC screening in both the general and minority populations. Cancer 2006. © 2006 American Cancer Society.
Chinese Americans are 10 times more likely to be diagnosed with hepatocellular carcinoma (HCC) than their white counterparts. About 80% of HCC's among Asian immigrants are associated with hepatitis B virus (HBV) infection. We used data from in-person interviews of Chinese residents in Seattle to examine factors associated with HBV testing. The survey was completed by 206 men and 236 women (cooperation rate: 58%). Less than one-half (48%) of respondents had been tested for HBV. Factors associated (p < 0.01) with ever having tested in bivariate comparisons included knowing that Chinese are more likely to be infected with HBV than Whites; individuals can be infected with HBV for life; HBV infection can cause liver cancer; not believing that HBV can be prevented by having a positive attitude; having a family member, friend, or medical doctor recommend testing; asking for testing from a medical doctor; and not needing interpreter services. In multiple regression analyses, the following factors were independently associated with testing: believing that Chinese were more likely than Whites to get HBV (p = 0.004), having a doctor recommend testing (p = 0.001), asking a doctor for the test (p < 0.001) and not needing an interpreter for doctors visits (p = 0.002). Intervention programs to improve HBV testing rates in Chinese Americans should include strategies to improve knowledge about the risk of HBV and encourage effective communication with health care providers about HBV testing.
The objective was to learn about the hepatitis prevention behavior of relatively unacculturated North American Chinese adults, along with their knowledge, beliefs, and perceptions with regard to hepatitis, screening, and vaccination. Forty Chinese men and women, aged 18-64, were recruited from immigrant communities in Seattle, Washington, and Vancouver, British Columbia. Semi-structured interviews (Cantonese or Mandarin) were audiotaped, translated, transcribed verbatim, and coded. Open coding, axial coding, constant comparison methods, and QSR NUD*IST 5 software was used for analysis. Findings were validated using eight focus groups. Findings indicated that many interviewees lack accurate knowledge with regard to hepatitis, often confusing the different types. Perceived causes of hepatitis included potentially harmful food (e.g., fried foods or potentially contaminated foods), alcohol, contact with infected individuals, stress, and inadequate rest. Preventive strategies associated with Chinese health beliefs included the use of Chinese herbal medicine, maintaining a stress-free mind, strengthening the body's natural defenses, and getting enough sleep. Other preventive strategies were the practice of good hygiene, vaccination, and the avoidance of contact with infected persons. Vaccination was not seen as primary, as 65% of those who had heard of hepatitis vaccination did not cite it as a means for hepatitis prevention until asked. Also, participants lacked information about the types and purposes of hepatitis vaccination and were worried about side effects. In conclusion, any attempt to promote hepatitis testing and vaccination among the North American Chinese should take traditional beliefs and practices into consideration.
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