A stress process model of family caregiver service utilization: factors associated with respite and counseling service use

This study examines whether caregivers' differential utilization of respite and counseling support services is associated with different situational stress processes. A multinomial regression analysis was conducted to compare respite users, counseling users, and those who used neither service, using data collected on a statewide random sample of 1,643 California caregivers providing assistance to individuals aged 50 or older. Compared with caregivers who used neither service, respite service users were more likely to have demanding care situations giving rise to physical symptoms of stress, and were more likely to use community services for the care recipient to augment their care. In contrast, counseling service users were more likely to be managing the meaning of their care situation by seeking out information about services and talking with a confidant about their situation, while coping with both emotional and physical symptoms of stress. Tailoring caregiver interventions to meet the support needs and coping strategies stemming from diverse caregiving situations and caregiver characteristics may increase the likelihood that those interventions will be effective in alleviating or preventing deleterious secondary stress frequently experienced by family caregivers.     

Randomized response multivariate designs for categorical data

Three approaches to multivariate estimation for categorical data using randomized response (RR) are described. In the first approach, practical only for 2×2 contingency tables, a multi-proportions design is used. In the second approach, a separate RR trial is used for each variate and it is noted that the multi­variate design matrix of conditional probabilities is given by the Kroneeker product of the univariate design matrices of each trial, provided that the trials are independent of each other in a certain sense. The third approach requires only a single randomization and thus may be viewed as the use of vector response. Finally, a special-purpose bivariate design is presented.     

Bayesian estimation of proportions with a cross-entropy prior

This paper suggests estimators of the frequencies (N₈) or proportions {N₈/N) of N distinguishable objects contained in S categories; given various types of information, We consider information in the form of exact constraints on the N₈, sample frequencies, and frequencies of related data, The analysis uses Bayesian methods, where the prior distribution is assumed to be a function of the cross-entropy between the N₈ and a reference distribution, We show the relationship between our estimator and the log-linear and logit models and also present a sampling experiment to compare our proposed estimator with the iterated proportional fitting estimator.     

Bareback sex and the law: the difficult issue of HIV status disclosure

1. Unsafe anal intercourse (bareback sex) is on the rise within the gay community. 2. Barebacking constitutes a sexual practice with strong HIV-related legal implications. Nurses need to be aware of public health laws to be able to protect clients from undue legal prosecution. 3. Nurses need to be aware of the components of HIV pretest counseling. 4. Adopting a nonjudgmental, matter-of-fact approach is essential in establishing effective therapeutic relationships with clients who engage in bareback sex.     

An introduction to methodological challenges in the evaluation of eHealth research: Perspectives from the Health e-Technologies Initiative

In February 2002 the Health e-Technologies Initiative (HETI), a program office of the Robert Wood Johnson Foundation^®, was created to advance discovery of scientific knowledge regarding the effectiveness of interactive eHealth applications. This article is the introduction to a series of seven articles written by grantees of HETI which address challenges, lessons learned, and proposed solutions as researchers implement eHealth projects. From this body of work it is clear that the overall process of conducting evaluation research in eHealth requires careful and detailed planning, recognition of the heightened sensitivity of IRBs, and institutions around the electronic collection and communication of personal health information, and a combination of tenacity and creativity to address the inevitable thorny methodological challenges to eHealth research. Use of established guidelines to help standardize the evaluation process, where feasible, is recommended.     

Distance as a barrier to using a fitness-program benefit for managed Medicare enrollees

This study evaluated the effect of distance on the likelihood of initiating and maintaining regular use of a fitness-program benefit in a population of managed Medicare seniors. We studied 8,162 participants and nonparticipants in a managed-care fitness-program benefit: a structured group exercise program or an unstructured health-club membership. Participants in both programs lived significantly closer to facilities than nonparticipants did (structured, p < .001; unstructured, p = .017). Participants living closer to unstructured-program sites attended more frequently than those farther away (p = .008). Distance was not correlated with frequency of use in the structured program (p = .49). Collectively, these analyses demonstrate that distance is related to uptake and, in some cases, continued use of a fitness-program benefit. Health systems providing fitness-program benefits as a way to increase physical activity levels of their plan members should consider location of program facilities in relation to members' home addresses to maximize use of the benefit.     

Concepts of Time and Temporality in the Storytelling and Sensemaking Literatures: A Review and Critique

A considerable body of literature exists on narratives and stories in explaining how individuals and groups make and give sense to their experiences in organizations. Classic Aristotelian narratives with a linear time structure (stories with a beginning, middle and end) are prominent in the storytelling literature, whereas retrospection, in drawing on the past in making sense of the present, is a temporal modality central to foundational concepts of sensemaking. In examining time and temporality in these related fields, the authors show how the conventional temporal sequence of a past, present and future dominates, with little consideration being given to time as a multiple rather than singular concept. The authors compare and contrast differences in the temporal aspects of mainstream theories and identify a growing interest in philosophical concepts of time. This review highlights how conventional explanations in these related fields of study are underpinned by linear conceptions of temporality (with an associated causality) and how there is growing recognition of fluidity in the way pasts and futures come together in temporal sensemaking of an emergent present. Although this movement towards explanations that engage with non‐linear modalities deepen insight, they do not explicitly address concepts of time. Time continues to receive scant attention, with temporal but ‘timeless’ theories taking precedence, ultimately constraining theoretical development. In building on this analysis, the authors characterize a range of temporal modalities from which they identify six pathways for charting out an agenda for future research in which multiple concepts of time and temporality are brought to the fore.