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Open Access Publications from the University of California

Scholarly Works (29 results)

  • Article
  • Peer Reviewed
UC Davis Previously Published Works (2023)
BACKGROUND: Heart failure (HF) prevalence has risen for more than a decade. Effective patient and family education strategies for HF are needed on a global scale. One widely used method of education is the teach-back method, where learners are provided information, then their understanding assessed by teaching it back to the educator. PURPOSE: This state-of-the-art review article seeks to examine the evidence focusing on the teach-back method of patient education and patient outcomes. Specifically, this article describes (1) the teach-back process, (2) teach-backs effect on patient outcomes, (3) teach-back in the context of family care partners, and (4) recommendations for future research and practice. CONCLUSIONS: Study investigators report the use of teach-back, but few describe how teach-back was utilized. Study designs vary widely, with few having a comparison group, making conclusions across studies challenging. The effect of teach-back on patient outcomes is mixed. Some studies showed fewer HF readmissions after education using teach-back, but different times of measurement obscure understanding of longitudinal effects. Heart failure knowledge improved across most studies after teach-back interventions; however, results related to HF self-care were mixed. Despite family care partner involvement in several studies, how they were included in teach-back or the associated effects are unclear. CLINICAL IMPLICATIONS: Future clinical trials that evaluate the effect of teach-back education on patient outcomes, such as short- and long-term readmission rates, biomarkers, and psychological measures, are needed, as patient education is the foundation for self-care and health-related behaviors.
    Cover page: A State-of-the-Art Review of Teach-Back for Patients and Families With Heart Failure: How Far Have We Come?
    • Article
    Cardiovascular Medicine (2023)
    Coronary heart disease (CHD) is the most common type of cardiovascular disease (CVD), affecting 7.2% of adults ≥ 20 years of age in the United States (U.S.). CHD prevalence is disproportionately high amongCalifornia’s (CA) racial and ethnic minority populations. Social determinants of health (SDOH) play a significant role in CHD and CVD risk factors, which have a higher prevalence among Hispanics and Blacks. Among the key SDOH that drive disparities in CHD is access to nutritious food. There are barriers to the availability of foods that support healthy eating patterns, such as living in a “food desert,” or low-income areas where nutritious food sources are limited. Other SDOH associated with CHD outcomes include socioeconomic (SES) factors, such as education andhealth insurance status.
      Cover page: A Zip Code Tabulation Area-Level Analysis of Food Insecurity and Social Determinants of Coronary Heart Disease in California
      • Article
      • Peer Reviewed
      UC Davis Previously Published Works (2018)
      BACKGROUND: Patients knowledge about heart failure (HF) contributes to successful HF self-care, but less is known about shared patient-caregiver knowledge. OBJECTIVES: The purpose of this analysis was to: 1) identify configurations of shared HF knowledge in patient-caregiver dyads; 2) characterize dyads within each configuration by comparing sociodemographic factors, HF characteristics, and psychosocial factors; and 3) quantify the relationship between configurations and patient self-care adherence to managing dietary sodium and HF medications. METHODS: This was a secondary analysis of cross-sectional data (N = 114 dyads, 53% spousal). Patient and caregiver HF knowledge was measured with the Atlanta Heart Failure Knowledge Test. Patient dietary sodium intake was measured by 3-day food record and 24 h urine sodium. Medication adherence was measured by Medication Events Monitoring System caps. Patient HF-related quality of life was measured by the Minnesota Heart Failure Questionnaire; caregiver health-related quality of life was measured by the Short Form-12 Physical Component Summary. Patient and caregiver depression were measured with the Beck Depression Inventory-II. Patient and caregiver perceptions of caregiver-provided autonomy support to succeed in heart failure self-care were measured by the Family Care Climate Questionnaire. Multilevel and latent class modeling were used to identify dyadic knowledge configurations. T-tests and chi-square tests were used to characterize differences in sociodemographic, clinical, and psychosocial characteristics by configuration. Logistic/linear regression were used to quantify relationships between configurations and patient dietary sodium and medication adherence. RESULTS: Two dyadic knowledge configurations were identified: Knowledgeable Together (higher dyad knowledge, less incongruence; N = 85, 75%) and Knowledge Gap (lower dyad knowledge, greater incongruence; N = 29, 25%). Dyads were more likely to be in the Knowledgeable Together group if they were White and more highly educated, if the patient had a higher ejection fraction, fewer depressive symptoms, and better autonomy support, and if the caregiver had better quality of life. In unadjusted comparisons, patients in the Knowledge Gap group were less likely to adhere to HF medication and diet. In adjusted models, significance was retained for dietary sodium only. CONCLUSIONS: Dyads with higher shared HF knowledge are likely more successful with select self-care adherence behaviors.
        Cover page: Shared heart failure knowledge and self-care outcomes in patient-caregiver dyads.
        • Article
        • Peer Reviewed
        UC Davis Previously Published Works (2023)
        Over the past decade, there has been substantial growth in heart failure (HF) research that focuses on persons with HF and their care partners (family members or other close friends that provide unpaid support) as an interdependent team, or care dyad. In this state-of-the-art review, we use a dyadic lens to identify and summarize current research on HF care dyads, from qualitative studies, to nonexperimental quantitative studies, to randomized controlled trials. Although much work has been done, this literature is younger and less well-developed than care dyad literatures from other conditions (eg, cancer, Alzheimers disease). We discuss the substantial challenges and limitations in this body of work, with an eye toward addressing common issues that impact rigor. We also look toward future directions, and discuss the promise dyadic research holds for improving patient, care partner, and relationship health.
          Cover page: Person with Heart Failure and Care Partner Dyads: Current Knowledge, Challenges, and Future Directions: State-of-the-Art Review.Creative Commons 'BY' version 4.0 license
          • Thesis
          • Peer Reviewed
          UC Davis Electronic Theses and Dissertations (2024)

          AbstractBackground: Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in the United States and globally. Guidelines recommend a nutrient-rich, heart-healthy diet for managing cardiovascular disease (CVD), but this can be challenging for those experiencing food insecurity. Limited knowledge exists on how food insecurity impacts diet quality in individuals with CVD. Objectives: To address this gap, this dissertation work has three specific aims. The overall goal of Aim 1 was to examine the relationship between food insecurity and dietary quality in adults living with CVD using data from the National Health and Nutrition Examination Survey (NHANES). In Aims 2 and 3, we used the California Health Interview Survey (CHIS) to compare the prevalence of food insecurity between rural and urban low-income Californians with CVD (Aim 2) and examine whether rural residence modifies the relationship between food insecurity and dietary quality (Aim 3). Methods: This two-part study uses a cross-sectional design. In the first part of the study, we utilized 5 cycles of NHANES data (2009-2020). Participants aged ≥18 with self-reported CVD were included. Dietary intake was measured with nutrients such as sodium, potassium, polyunsaturated and monounsaturated fats, fiber, and total sugars. Multivariable linear regression models were used to quantify relationships between food insecurity and diet quality. In the second part of the study, we used the Chi Square Test of Independence to compare the prevalence of food insecurity between rural and urban Californians with cardiovascular disease (CVD). Multivariable logistic regression was used to assess whether the relationship between food insecurity and dietary quality varied between rural and urban participants. Results: Consistent with our hypotheses for Aim 1, higher food insecurity levels were significantly associated with poorer diet quality in key nutrients: potassium, polyunsaturated fats, monounsaturated fats, fiber, and total sugars. In Aims 2 and 3, no differences were found in the prevalence of food insecurity between rural and urban participants, no significant differences were found in the daily intake of fruits and vegetables between rural and urban participants, and no significant effect modification was found for the relationship between dietary quality and rural status. Conclusion: In a nationally representative sample from NHANES, we found that food-insecure individuals struggle to meet essential nutrient requirements. However, our analyses using CHIS data did not yield significant results among low-income Californians, and we found no significant differences in food insecurity or dietary quality by rural/urban status. Notably, despite abundant access to fresh produce in California, CHIS participants failed to meet recommended fruit and vegetable intake. Our study underscores the need for further research, especially in the post-COVID-19 era, to address the impact of food insecurity on dietary quality and health outcomes.

          Keywords: NHANES, CHIS, Diet, Cardiovascular health, food security, rural, urban

            Cover page: Relationships between Dietary Quality and Food Insecurity in Persons with Cardiovascular Disease: Urban-Rural Comparisons
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2021)
            BACKGROUND: Vital components of communicating goals of care and preferences include eliciting the patient and caregivers definition of quality of life, understanding meaningful activities and relationships, and exploring wishes for care at the end of life. Although current literature suggests framing conversations regarding end of life through the lens of meaning and quality of life, there is limited literature exploring dyadic congruence surrounding these important constructs among patients with ventricular assist devices (VADs) and their caregivers. OBJECTIVES: The purpose of this study was to explore congruence of VAD patient and caregiver perspectives regarding end of life, definitions of quality of life, and meaning in life while managing the uncertainty of living with a VAD. METHODS: We used thematic analysis to analyze semistructured qualitative interviews of 10 patient-caregiver dyads 3 to 12 months after VAD implantation. RESULTS: Three major themes were identified: (1) differing trajectories of uncertainty and worry, (2) a spectrum of end-of-life perspectives, and (3) enjoying everyday moments and independence. Overall, patients and caregivers had differing perspectives regarding uncertainty and end of life. Within-dyad congruence was most evident as dyads discussed definitions of meaning or quality of life. CONCLUSIONS: Dyadic perspectives on end of life, meaning in life, and quality of life can inform how palliative care and VAD teams approach conversations about planning for the end of life. Findings from this study can inform future shared decision-making interventions for patients living with VADs and their caregivers.
              Cover page: Talking Around It: A Qualitative Study Exploring Dyadic Congruence in Managing the Uncertainty of Living With a Ventricular Assist Device.
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2022)
              Stress is a significant part of daily life, and systemic social inequities, such as racism and discrimination, are well-established contributors of chronic stress for African Americans. Added exposure to the stress of caregiving may exacerbate adverse health outcomes. This secondary analysis describes subjective and objective stress in African American family caregivers, and relationships of subjective and objective stress to health outcomes. Baseline data from 142 African American dementia family caregivers from the "Great Village" study were described using means and frequencies; regression models and Pearson's correlation were used to examine associations between demographics, social determinants of health, and health outcomes. Mixed models were used to examine change and change variation in cortisol. Most caregivers had moderate degrees of stress. Stress was associated with sleep disruption and depressive symptoms, and discrimination appeared to be an independent contributor to depressive symptoms. This work provides a foundation for interpreting subjective and objective indicators of stress to tailor existing multicomponent interventions.
                Cover page: A Landscape of Subjective and Objective Stress in African-American Dementia Family Caregivers
                • Article
                • Peer Reviewed
                UC Davis Previously Published Works (2020)
                BACKGROUND: In a study of Italian heart failure patient-caregiver dyads, greater caregiver strain significantly predicted lower patient clinical event risk. OBJECTIVE: The purpose of this secondary analysis was to examine this relationship in a sample from the United States. METHODS: Data came from 92 dyads who participated in a self-care intervention. Logistic regression was used to test the relationship between baseline strain (Bakas Caregiving Outcomes Scale, divided into tertiles) and patient likelihood of events (heart failure hospitalization/emergency visit or all-cause mortality) over 8 months. RESULTS: Nearly half of patients (n = 40, 43.5%) had an event. High (vs low) caregiver strain was associated with a 92.7% event-risk reduction, but with substantial variability around the effect (odds ratio, 0.07; 95% confidence interval, 0.01-0.63; P = .02). CONCLUSIONS: Although findings were similar to the Italian study, the high degree of variability and contrasting findings to other studies signal a level of complexity that warrants further investigation.
                  Cover page: Caregiver Strain and Heart Failure Patient Clinical Event Risk: An Extension of Previous Work.
                  • Article
                  • Peer Reviewed
                  UC Davis Previously Published Works (2020)
                  The number of older adults living with functional decline and serious illness is growing exponentially at a time when availability of both family and professional caregivers is strained. Achieving optimal outcomes for this vulnerable population involves advancing the knowledge needed to improve the quality of care delivered by families, health professionals, and community programs. Recent reports from National Institute of Health and the National Academy of Science, Engineering and Medicine have called for the identification of gaps in key areas of family caregiving intervention research. In March 2018, the Family Caregiving Institute at UC Davis convened an invitational meeting of over 50 thought leaders in family caregiving-representing service agencies, funding organizations, and academia-to participate in the Research Priorities in Caregiving Summit: Advancing Family-Centered Care across the Trajectory of Serious Illness. Using an iterative process, attendees identified the top 10 research priorities and created research priority statements that incorporated a definition of the priority topic, rationale for the priority; problem(s) to address; priority population(s); and example research topics. The research priority statements serve as a roadmap for research development that will address the most significant gaps in the caregiving field.
                    Cover page: Research Priorities in Family Caregiving: Process and Outcomes of a Conference on Family-Centered Care Across the Trajectory of Serious Illness.Creative Commons 'BY-NC' version 4.0 license
                    • Article
                    • Peer Reviewed
                    UC Davis Previously Published Works (2022)
                    Despite a national vaccination effort prioritizing frontline healthcare workers, COVID-19 vaccination rates among nurses have been lower than necessary to protect workforce and patient health. Historically, nurses have been more vaccine hesitant than other healthcare workers. To assess the vaccine attitudes and COVID-19 vaccine intent of California's registered nurses, we conducted a statewide cross-sectional survey among 603 licensed RNs working in direct patient care. Of 167 respondents (27.7%), 111 met inclusion criteria. Their mean score of 3.01 on a 6-point rating scale on the Vaccine Attitudes Examination scale measuring general vaccine hesitancy was comparable to previous findings among U.S. West Coast adults. Greater vaccine hesitancy was significantly associated with lower COVID-19 vaccine intent, after controlling for relevant confounders. Since nurses make up the largest portion of the healthcare workforce, it is crucial to specifically address this group's vaccine hesitancy.
                      Cover page: COVID-19 vaccine hesitancy and intent in California registered nursesCreative Commons 'BY-NC-ND' version 4.0 license
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