• An empirical investigation of practical reasoning in the construction of beliefs regarding medication by arthritis patients

      Wilkin, Noel Edman; Beardsley, Robert S. (1996)
      Patient drug consumption behavior has an impact on the outcomes, effectiveness, and costs associated with therapy. Patients' beliefs influence their health behaviors and little is known about how patients form beliefs. Therefore, an understanding of belief formation will assist professionals in developing interventions that effectively influence health behaviors. This study used the model of belief processing proposed by Smith, Benson, and Curley (1991) to examine the belief formation used by arthritis patients regarding their medication. Study subjects included arthritis patients from a health maintenance organization population. Forty-six subjects were randomly assigned to four groups. Three groups received different levels of information about a drug and were asked about their beliefs regarding its helpfulness. Subjects in the final group were asked about their beliefs regarding the helpfulness of nabumetone, a drug they were currently taking. Verbal protocols were independently coded by three coders using operational definitions from the literature and constructs in the model. The codes were tallied and the hypotheses were tested using ANOVA and MANOVA. Subjects used more practical reasoning than judgments or calculation to form their beliefs. Most subjects used responses that corresponded with two or more modules of the model. Contrary to expectations, providing more information did not influence the use of practical reasoning or judgments. Amount of information also did not influence subjects' use of most argument types. These findings suggest that (1) patients use practical reasoning rather than formal logical reasoning to form beliefs about the helpfulness of medications; (2) the "expectancy x value" approach is not appropriate in modeling the reasoning patients use to form beliefs about their medications; (3) the Smith, Benson, and Curley model contains constructs used by patients to form beliefs; (4) experience decreases the use of authoritative arguments in forming beliefs; and (5) increased information may influence beliefs, but it does not seem to influence the processing used to form beliefs.
    • The relationship of acculturation to health outcomes among African immigrant adults: A life-course perspective

      Okafor, Maria-Theresa C.; Picot, Sandra J. (2010)
      Statement of the Problem: Acculturation has been shown to relate both positively and negatively to health outcomes in Hispanic and Asian immigrant populations. However, little is known about the relationship of acculturation to health outcomes among African immigrant adults over their life-course. Summary of Methods: A cross-sectional, mixed methods design using secondary baseline data from the African immigrant adult subsample (n=763) of the 2003 New Immigrant Survey (NIS) was employed. Key variables in the study were: current self-rated health and health behavior (outcomes), English proficiency and dietary change (primary acculturation predictors), country of origin (Ethiopia, Nigeria, "Other Sub-Saharan Africa"), duration of residence in U.S. (DOR), age at immigration, gender, education, marital status, (potential effect modifiers), age, pre-migration self-rated health and chronic disease (potential confounders), and food/beverages consumed pre-/post- immigration (qualitative data). Multivariate logistic regression and contextual content analysis were used to analyze the data. Results: Limited English proficiency (LEP) immigrants had higher odds of rating their health good/fair/poor (OR: 0.282, 95%CI: 0.158-0.503, p<.0001) and engaging in poor health behavior than English proficient immigrants (OR: 0.310, 95%CI: 0.165-0.585), p<.0003). English proficient women had lower odds of engaging in poor health behavior than English proficient men (OR: 0.3446, 95%CI: 0.2129-0.5576, p<.0001). Immigrants reporting moderate dietary change had higher odds of rating their current health as good/fair/poor than those with low dietary change (OR: 1.903, 95%CI: 1.143-3.170), p=0.0134). Immigrants residing in the U.S. > 5 years had higher odds of engaging in poor health behavior than those in the U.S < 5 years (OR: 2.030 95%CI: 1.314-3.135, p=0.0014). Immigrants > 41 years of age at immigration had higher odds of rating their health as good/fair/poor than those who arrived at a younger age (OR: 4.293, 95%CI: 1.830-10.071, p=0.0008). Immigrants with chronic disease had higher odds of rating their health as good/fair/poor current than those without chronic disease (OR: 4.173, 95%CI: 2.525-6.897, p<.0001). Conclusions: LEP, moderate/high dietary change, increased DOR, older age at immigration, being male, poor pre-migration health and chronic disease were associated with increased risk for poor health outcomes. More culturally/linguistically competent health promotion and interventions in this population are needed.