Family Caregiver Communication in the ICU: Toward a Relational View of Health Literacy

We interviewed 18 family caregivers about their communication experiences in the ICUs at an urban hospital. Analysis of their narratives suggests health literacy is important in family caregiver/healthcare provider communication, especially as complicated illnesses move the caregiver deeper into decision making. Using the domains of Yuen et al.’s conceptual model of caregiver health literacy (2015), we identified three themes within the context of ICU communication: agency, coordinated communication, and caregiver’s evolving role. We saw family caregivers negotiating domains of health literacy as they built upon knowledge of the patient’s needs, their rights as family caregivers, and the hierarchy of the professional staff. We found that these narratives represent co-created, or relational communication, rather than individual health literacy skills. Conceptualized in the transaction of relationship, health literacy is enacted; it is socially constructed and is the scaffolding upon which family caregivers make decisions, care for their loved one, and care for themselves.     

The Development of a Reliable Change Index and Cutoff for the Revised Dyadic Adjustment Scale

The Revised Dyadic Adjustment Scale (RDAS; Busby, Crane, Larson, & Christensen, 1995) is a measure of couple relationship adjustment that is often used to differentiate between distressed and non‐distressed couples. While the measure currently allows for a determination of whether group mean scores change significantly across administrations, it lacks the ability to determine whether an individual's change in dyadic adjustment is clinically significant. This study addresses this limitation by establishing a cutoff of 47.31 and reliable change index of 11.58 for the RDAS by pooling data across multiple community and clinical samples. An individual whose score on the RDAS moves across the cutoff changes by 12 or more points can be classified as experiencing clinically significant change.     

Gaining by giving? Peer research into service user and carer perceptions of inclusivity in Higher Education

Abstract

Service users and carers (SUAC) have made significant contributions to professional training in social work courses in Higher Education (HE) over the past decade in the UK. Such participation has been championed by government, academics and SUAC groups from a range of theoretical and political perspectives. Most research into the effectiveness of SUAC involvement at HE has come from the perspectives of academics and very little SUAC-led research exists. This qualitative peer research was led by two members of the University of Worcester’s SUAC group. Findings were that SUAC perceived their involvement brought benefits to students, staff, the University and the local community. Significant personal benefits such as finding a new support network, increased self-development and greater confidence to manage their own care were identified in ways that suggested that the benefits that can flow from SUAC involvement at HE are perhaps more far-reaching than previously recognised. Barriers to inclusion were less than previously reported in the literature and the humanising effects of SUAC involvement are presented as a partial antidote to an increasingly marketised HE culture.     

Keeping Surveys Valid,Reliable, and Useful: A Tutorial

This tutorial focuses on how to produce reliable and generalizable data from random‐digit‐dialing (RDD) landline and cell phone surveys. The article notes that RDD response rates have declined and explores the impact of this pronounced decline. The tutorial addresses order, response mode, and many other biases, sample size, cooperation and response rates, weighting, and hybrid designs‐all using examples from risk analysis to illustrate the key points. The article ends with a brief review of the advantages and disadvantages of major Internet and paper surveys tools, and how these can be molded and sometimes combined in repeated, longitudinal, and other designs to answer questions about risk preferences and perceptions.     

Risk-Reducing Legal Documents: Controlling Personal Health and Financial Resources

Every adult can eliminate the risk of losing control of personal health decisions and financial resources by having a last will and testament, health proxy, power of attorney, and living trust. Yet evidence suggests that less than a majority of adult Americans have these documents. We surveyed 900 adult Americans (25 plus years old) to determine what factors predict the possession of these risk-reducing documents. In total, 46% had a living will and testament, 32% a durable power of attorney, 30% a health proxy, and 18% a living trust. Events that prompt people with wealth to secure these documents, such as increasing age, getting married, having children, and experiencing a life-threatening event were the strongest predictors of having a will. These were also among the strongest predictors of having a health proxy, along with a personal history of being proactive, and a family history that fostered trust of attorneys. Affluence, age, and education were the strongest predictors of having a living trust, and the strongest correlate of having a durable power of attorney was having faced a life-threatening event, positive experiences with attorneys, and higher educational achievement.     

Relationships between Economics,Welfare, Social Network Factors,and Net Migration in the United States

By using economics, welfare and social network factors as frames of reference, this study aims to explore the relationship between these three factors and net migration to various US states. Adopting related variables collected from official aggregate data, this study first utilizes Logit Regression analysis to draw out seven variables that best explain net migration to the various states, then employs these variables in LISREL analyses to build a model explaining the factors influencing net migration to the various US states. Concretely, this research obtained the following findings: (1) the seven variables ‐‐ the average rate of net migrants of 2002–2005, Medicaid, federal aid, employment rate, non‐poverty population rate, and SSI subsidy ‐‐ all significantly affected (p < 0.01 or p < 0.05) net migration in 2006; (2) the main influences on net migration for the various states are, from highest to lowest, social network, economic, and welfare factors. More specifically, a better explanation is that, through the social network factor, economic and welfare factors exert an increased influence on the net number of migrants; and (3) as for the influence of social network factors on the number of net migrants, the social network factor for the previous year was found to best explain domestic migration flows, while the social network factor for the previous three‐to‐four years best explained international migration flows.     

Network Evening News Coverage of Environmental Risk

ABC, CBS, and NBC's carefully crafted and expensively produced evening news broadcasts devoted 1.7% of their air time to 564 stories about man-made environmental risks during the period from January 1984 to February 1986. Little relationship was found between amount of coverage and public health risk. Instead, the networks appeared to be using traditional journalistic determinants of news (timeliness, proximity, prominence, consequence, and human interest) plus the broadcast criterion of visual impact to determine the degree of coverage of risk issues. Government, industry, and citizens accounted for two-thirds of the sources cited by the networks. Experts and spokespersons for environmental advocacy groups were sparsely used as sources. Given the media's need for news pegs, acute and chronic risk stories were covered differently. Acute risk stories were reported in a clearly defined cycle, peaking on the second day with on-the-scene reports and film-clips of devastation. In keeping with a decrease in visual drama, later reports were shorter and emphasized legal and political considerations. Chronic risk coverage followed the release of new scientific, legal, or political information.