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Item A National Survey of Obstetrician/Gynecologists' Knowledge, Attitudes, and Beliefs Regarding Adult Human Papillomavirus Vaccination(Mary Ann Liebert, 2021) Kasting, Monica L.; Head, Katharine J.; DeMaria, Andrea L.; Neuman, Monica K.; Russell, Allissa L.; Robertson, Sharon E.; Rouse, Caroline E.; Zimet, Gregory D.; Communication Studies, School of Liberal ArtsBackground: Many women see an obstetrician/gynecologist (OB/GYN) annually and receive their primary care from an OB/GYN. Understanding OB/GYNs' human papillomavirus (HPV) vaccination practices, including knowledge of and barriers to vaccination, is essential to design effective interventions to increase vaccination. This study evaluated OB/GYN knowledge, attitudes, and beliefs regarding vaccinating both younger (18-26 years) and mid-adult (27-45 years) women. Materials and Methods: Data were collected from OB/GYN providers in October 2019 through a nationwide web-based survey. Items included the following: HPV-related vaccination practices, recommendation strength, knowledge (seven items), benefits (four items), and barriers (eight items). Results: The sample (n = 224) was majority were White (69%), men (56%), and practice in suburban clinics (55%). Most (84%) reported they usually or always recommend HPV vaccine to eligible patients, but estimated only about half (51%) of other OB/GYNs did the same. Recommendation strength varied by patient age with 84% strongly recommending it to patients ≤18 years, compared with 79% and 25% strongly recommending to younger and mid-adult patients, respectively (p < 0.01). Participants reported lower benefits (p = 0.007) and higher barriers (p < 0.001) for 27- to 45-year-old patients compared with younger patients. Cost was the most frequently reported barrier, regardless of patient age. Overall knowledge was high (m = 5.2/7) but 33% of participants did not know the vaccine was safe while breastfeeding. Conclusions: Although providers reported strongly and consistently recommending the HPV vaccination to their adult patients, there were gaps in knowledge and attitudinal barriers that need to be addressed. Provider performance feedback may be important in improving HPV vaccination awareness among providers.Item Are Health Care Professionals Prepared to Implement Human Papillomavirus Testing? A Review of Psychosocial Determinants of Human Papillomavirus Test Acceptability in Primary Cervical Cancer Screening(Liebert, 2020-03) Tatar, Ovidiu; Wade, Kristina; McBride, Emily; Thompson, Erika; Head, Katharine J.; Perez, Samara; Shapiro, Gilla K.; Waller, Jo; Zimet, Gregory; Rosberger, Zeev; Communication Studies, School of Liberal ArtsBackground: Guidelines for cervical cancer screening have been updated to include human papillomavirus (HPV) testing, which is more sensitive compared to cytology in detecting cervical intraepithelial neoplasia. Because of its increased sensitivity, a negative HPV test is more reassuring for a woman that she is at low risk for precancerous cervical lesions than a negative Pap test. Prompted by the inadequate translation of HPV test-based screening guidelines into practice, we aimed to synthesize the literature regarding health care providers (HCPs) knowledge, attitudes, and practices related to HPV testing and the influence of psychosocial factors on HCPs acceptability of HPV testing in primary cervical cancer screening. Materials and Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL, Global Health, and Web of Science for journal articles from January 1, 1980 to July 25, 2018. A narrative synthesis of HCPs knowledge, attitudes, and practices related to HPV testing is provided. Informed by the Patient Pathway framework, we used deductive thematic analysis to synthesize the influence of psychosocial factors on HCPs acceptability of HPV testing. Results: The most important HCP knowledge gaps are related to the superior sensitivity of the HPV test and age-specific guideline recommendations for HPV testing. Thirty to fifty percent of HCPs are not compliant with guideline recommendations for HPV testing, for example, screening at shorter intervals than recommended. Barriers, facilitators, and contradictory evidence of HCPs' acceptability of the HPV test are grouped by category: (1) factors related to the HCP; (2) patient intrinsic factors; (3) factors corresponding to HCP's practice environment; and (4) health care system factors. Conclusions: HCP's adherence to guidelines for HPV testing in cervical cancer screening is suboptimal and could be improved by specialty organizations ensuring consistency across guidelines. Targeted educational interventions to address barriers of HPV test acceptability identified in this review may facilitate the translation of HPV testing recommendations into practice.Item Ask the parents: Testing the acceptability and usability of a hypospadias decision aid(Elsevier, 2022) Binion, Kelsey; Miller, Andrew; Misseri, Rosalia; Kaefer, Martin; Longtin, Krista; Carroll, Aaron; Wiehe, Sarah E.; Chan, Katherine H.; Communication Studies, School of Liberal ArtsIntroduction: In previous work, we engaged key stakeholders to create a web-based decision aid (DA) prototype to facilitate shared decision making about hypospadias. Objective: The study's objective was to use a human-centered design approach to assess the DA's acceptability and usability and revise it prior to pilot testing. Methods: We recruited English-speaking parents (≥18 years old) of sons with hypospadias (≤5 years) for a two-phase process of semi-structured phone/video interviews to obtain feedback about our DA prototype. DA webpages included: "Hypospadias," "Surgery Basics," "No Surgery," "Family Stories," "Help Me Decide," and "FAQs." In both phases, participants viewed the DA using the "think aloud" technique and completed several validated scales to evaluate its acceptability and usability. In phase 1, we collected feedback about the "Homepage" organization, values clarification methods (VCM), and webpage content. In phase 2, participants searched the DA for answers to hypospadias-related questions, provided feedback on testimonial videos and VCM, and shared their preferences about data visualizations. All interviews were audio recorded. After each phase, transcripts were qualitatively analyzed to identify key areas for revision. Revisions were made between phase 1 and 2 to improve the DA's acceptability and usability. Results: We interviewed 20 participants (10/phase): median age 33.7 years, 60% female, 80% White. Mean score on the Preparation for Decision Making Scale: 86.8 (out of 100). We revised: 1) VCM, focusing on pros/cons of surgery and question prompts, 2) "Homepage," adding webpage descriptions (Extended Summary Figure), 3) menu organization, 4) "Surgery Day" webpage, adding general anesthesia risk information, and 5) "Hypospadias" webpage, adding an icon bar graph to help participants visualize statistics. Participants thought the testimonial videos were relatable and the VCMs would prepare them for their visit with their child's urologist. Discussion: Ours is the first parent-centered DA developed and pre-tested for hypospadias. Using validated usability and acceptability scales, participants highly rated the DA in helping them arrive at a decision about surgery. Study limitations include the sample's lack of diversity (i.e., educated, health literate) and participants already decided about their son's hypospadias management before enrolling. To learn more about the DA's usability and acceptability, we plan to pilot test it in a clinical setting. Conclusions: Participants found our DA informative in understanding hypospadias. There was a high perceived level of preparation for hypospadias decision making. Participatory research methods, such as "think aloud," may be helpful when testing DAs as they privilege the patient's experience.Item Association between patient characteristics and HPV vaccination recommendation for postpartum patients: A national survey of Obstetrician/Gynecologists(Elsevier, 2022-04-20) Lake, Paige W.; Head, Katharine J.; Christy, Shannon M.; DeMaria, Andrea L.; Thompson, Erika L.; Vadaparampil, Susan T.; Zimet, Gregory D.; Kasting, Monica L.; Communication Studies, School of Liberal ArtsHuman papillomavirus (HPV) vaccination rates in the U.S. are relatively low. Provider recommendation rates for HPV vaccination often vary by patient age and relationship status. Obstetrician/gynecologists (OB/GYNs) represent a key provider group that can recommend the HPV vaccine. This study examined differences in OB/GYN recommendation of HPV vaccination for inpatient postpartum patients by age, parity, and marital status. Data were collected from OB/GYNs nationally via a cross-sectional survey. Participants were randomized to two vignette groups (23-year-old patient or 33-year-old patient). Within each group, participants received 4 vignettes that were identical except for patient marital status (married/not in a committed relationship) and number of children (first/third child), and were asked to indicate HPV vaccination recommendation likelihood on a scale of 0 (definitely would not) to 100 (definitely would). A 2 × 2 × 2 general linear model with repeated measures was used to examine main and interaction effects of patient age, relationship status, and parity. 207 OB/GYNs were included in the final analyses. Recommendation was high for 23-year-old patients (range: 64.5-84.6 out of 100). When marital status and parity were held constant, recommendation likelihood was higher for the younger vs. older patient and was also higher for patients not in a committed relationship, compared to married patients (all p-values < 0.001). Differences in recommendation exist when considering age and relationship status, which provides insight into OB/GYN clinical decision-making. Findings highlight the need to address barriers to HPV vaccination recommendation, including awareness of risk factors to consider when recommending the vaccine.Item Characterization of Actions Taken During the Delivery of Medication Therapy Management: A Time-and-Motion Approach(Elsevier, 2018-01) Chang, Alice C.; Lincoln, Jutieh; Lantaff, Wendy M.; Gernant, Stephanie A.; Jaynes, Heather A.; Doucette, William; Snyder, Margie E.; Communication Studies, School of Liberal ArtsOBJECTIVES: To characterize actions performed by pharmacists and support staff during provision of medication therapy management (MTM) and to compare actions performed according to practice characteristics. METHODS: A purposeful sample of 7 MTM practices (2 call centers and 5 community practices) was identified and visited by investigators. Pharmacists and support staff were observed during their routine provision of MTM. Investigators characterized "major" (e.g., preparation for a comprehensive medication review) and "minor" (i.e., specific steps in overarching major action) actions with the use of a time-and-motion approach. RESULTS: A total of 32 major and 469 minor actions were observed. Practices were characterized as Later Maturity Level or Early Maturity Level on the basis of their self-reported MTM appointment volume, self-assessment of the extent of integration of chronic care model principles, and payer mix. Later Maturity Level practices were more likely to deliver follow-up medication therapy reviews and comprehensive medication reviews (CMRs) as opposed to targeted medication reviews (TMRs) and to receive physician referrals for MTM. Later Maturity Level practices were also more likely to use paid interns than pharmacy rotation students. CMR activities observed at Later Maturity Level practices lasted a median of 30.8 minutes versus 20.3 minutes for CMR activities at Early Maturity Level practices. Similarly, TMR activities observed at Later Maturity Level practices were longer: a median of 31.0 minutes versus 12.3 minutes. At Later Maturity Level practices, pharmacists spent a greater proportion of time providing patient education, while support staff spent a greater proportion of time on tasks such as capturing demographics and introducing or explaining MTM. CONCLUSION: MTM activities were longer at Later Maturity Level practices, and these practices were more likely to use paid pharmacy interns and to receive physician referrals for MTM. This work provides a foundation for future research.Item Communicating to promote informed decisions in the context of early pregnancy loss(Elsevier, 2017) Brann, Maria; Bute, Jennifer J.; Communication Studies, School of Liberal ArtsObjective. To evaluate residents’ ability to engage standardized patients in informed decision making during a pregnancy loss scenario. Methods. Forty patient encounters between interns and standardized patients were coded to assess informed decision-making practices, exploration of unexpressed concerns, and support provision. Results. Interns engaged in minimum informed decision making but did not address all of the communicative elements necessary for informed decisions, and most elements were only partially addressed. Patients in this study did not receive information about all management options, their concerns were not addressed, and there was limited support communicated for their decision. Conclusion. This study offers an initial assessment of a communicative approach to evaluate and improve decision making during early pregnancy loss. A comprehensive approach to making informed decisions must include discussion of all management options, exploration of patient preferences and concerns, and support for the patient’s decision. Practice Implications. Healthcare providers could benefit from communication skills training to communicate more effectively with patients to help them make more informed decisions.Item Conceptualization and operationalization: utility of communication privacy management theory(Elsevier, 2020-02) Petronio, Sandra; Child, Jeffrey T.; Communication Studies, School of Liberal ArtsCommunication Privacy Management (CPM) theory explains one of the most important, yet challenging social processes in everyday life, that is, managing disclosing and protecting private information. The CPM privacy management system offers researchers, students, and the public a comprehensive approach to the complex and fluid character of privacy management in action. Following an overview of Communication Privacy Management framework, this review focuses on recent research utilizing CPM concepts that cross a growing number of contexts and illustrates the way people navigate privacy in action. Researchers operationalize the use of privacy rules and other core concepts that help describe and explain the ups and downs of privacy management people encounter.Item The Conscientious Use of Images Illustrating Diversity in Medical Education Marketing(Wolters Kluwer, 2020) Hernandez, Rachael; Hoffmann-Longtin, Krista; Patrick, Shawn; Tucker-Edmonds, Brownsyne; Livingston, Nikki; Communication Studies, School of Liberal ArtsAn institution's marketing materials are an important part of presenting its culture. In 2018, communication professionals in the Office of Faculty Affairs, Professional Development, and Diversity at the Indiana University School of Medicine recognized after reviewing the literature that using images illustrating diversity in marketing materials may have unintended negative consequences and could potentially reflect poorly on the institution. Representations of diversity that are discordant with the actual demographics of an institution can create distrust among faculty, students, and staff who discover an institution is not as diverse or supportive of diversity as their marketing materials suggest. If institutions adopt an aspirational approach to images and depict more diversity than actual demographics reflect, the authors of this Perspective recommend that they both develop marketing materials that present a widely diverse selection of images and demonstrate transparency in their communication strategies.To improve their promotional materials, the authors conducted an analysis of their institution's strategy for selecting images for these materials, identified institutional goals related to the strategic use of images, created training materials for staff, and drafted a public-facing statement about diversity in images. These measures are a significant step forward in cultivating the ethical use of images illustrating diversity. In the future, institutions should highlight their approaches to using images to portray diversity, as well as photograph and document a wide range of events that represent diverse topics and individuals. When these images are used for marketing purposes, it is also important to ensure that they are used in an appropriate context and not selected with the single goal of presenting diversity. Future research should focus on how underrepresented students and faculty interpret the use of diverse images in marketing, as well as their preferences for the use of their own images in marketing materials portraying diversity.Item COVID-19 vaccine behaviors and intentions among a national sample of United States adults ages 18–45(Elsevier, 2022) Brownstein, Naomi C.; Reddy, Harika; Whiting, Junmin; Kasting, Monica L.; Head, Katharine J.; Vadaparampil, Susan T.; Giuliano, Anna R.; Gwede, Clement K.; Meade, Cathy D.; Christy, Shannon M.; Communication Studies, School of Liberal ArtsBackground: Vaccination for SARS-CoV-2, the virus that causes COVID-19 illness, is an important public health tool to reduce hospitalizations and deaths. Purpose: This report focuses on intentions and behaviors related to COVID-19 vaccination among United States (U.S.) adults ages 18-45. Methods: From February 25-March 24, 2021, we conducted an online survey assessing COVID-19 vaccine intentions and behaviors, health beliefs, vaccine attitudes, and sociodemographic characteristics. Participants were adults aged 18-45, living throughout the U.S. with oversampling in Florida, panelists of a research panel company directly or via verified partners, and able to read, write, and understand English. Associations between COVID-19 vaccination uptake, intentions, and other study variables were examined through multivariable logistic and proportional odds regression analyses. Results: Among participants in the final analytic sample (n = 2722), 18% reported having received at least one dose of a COVID-19 vaccine. Approximately 31% of unvaccinated participants reported strong intentions to receive a COVID-19 vaccine in the next year, whereas 35% reported strong intentions to receive a COVID-19 vaccine if it were strongly recommended by a healthcare provider. All COVID-19 vaccination outcomes were associated with male gender, sexual minority status, higher levels of education, and previous influenza vaccination. All vaccination intention outcomes were associated with vaccine attitudes and geographic region. Vaccination status and intentions were differentially associated with multiple additional sociodemographic, attitudinal, and/or healthcare experience variables. Conclusions: Several demographic variables, vaccine attitudes, and healthcare experiences were found to contribute to COVID-19 vaccine receipt and intentions. Targeted efforts are necessary to increase uptake of the vaccine in the U.S.Item Creating Choice and Building Consensus: Invitational Rhetoric as a Strategy to Promote Vasectomies in the United States(University of Florida Press, 2022-03-03) Longtin, Krista; Binion, Kelsey; Communication Studies, School of Liberal ArtsAccording to a recent study by the Brookings Institution (Reeves & Krause, 2016), vasectomies are safer, more effective, and less expensive than most other voluntary sterilization methods. While the procedure has grown in popularity in recent years, particularly in the United Kingdom and Canada, it is much less common in the United States. This discrepancy can be attributed to both social (a perception that contraception is “women’s work”) and policy-based factors (lack of coverage under the Affordable Care Act). This paper examines the role and extent to which invitational rhetoric could be a useful communicative lens for both partners and providers considering vasectomies, thus increasing access to and utilization of the safe, effective, and affordable procedure. In this policy brief, we suggest strategies for incorporating invitational rhetoric into health professions education curricula, patient counseling literature, and policy language in order to address some of the social stigma around the procedure.