Browsing by Author "Sandy, Robert"

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    Development of the CoMac Adherence Descriptor™: a linguistically-based survey for segmenting patients on their worldviews
    (Dove Medical Press, 2015) Connor, Ulla M.; Mac Neill, Robert S.; Mzumara, Howard R.; Sandy, Robert; Department of English, School of Liberal Arts
    Nonadherence to prescribed medication and healthy behaviors is a pressing health care issue. Much research has been conducted in this area under a variety of labels, such as compliance, disease management and, most recently, adherence. However, the complex factors related to predicting and, more importantly, understanding and explaining adherence, have nevertheless remained elusive. However, through an in-depth linguistic analysis of patient talk, the International Center for Intercultural Communication (ICIC) at Indiana University has produced a psycholinguistic coding system that uses patients' own language to cluster them into distinct groups based on their worldviews. ICIC's studies have shown, for example, that patients reveal their fundamental perceptions about themselves and their environment in their life narratives; clustering of individual patients based on these different perceptions is possible via the use of differential language in survey questions, and differential language can be used to tailor messages for individual patients in a manner that these individuals prefer over generically worded communication. In grant-funded research, an interdisciplinary team of researchers at the ICIC reviewed the literature and identified three basic psychosocial tenets related to adherence: control orientation, based on locus of control research; agency, based on self-efficacy; and affect or attitude and emotion. These three constructs were selected because, in the published literature, they have been consistently found to be connected to patient adherence. Based on this research, a survey, the CoMac Descriptor™ was developed. This report shows that The Descriptor™ questions and responses are valid and reliable in segmenting patients across psychosocial constructs, which will have positive implications for health care providers and patients.
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    Effects of the Built Environment on Childhood Obesity: the Case of Urban Recreational Trails and Crime
    (Elsevier, 2013) Sandy, Robert; Tchernis, Rusty; Wilson, Jeff; Liu, Gilbert; Zhou, Xilin; Economics, School of Liberal Arts
    We study the effects of urban environment on childhood obesity by concentrating on the effects of walking trails and crime close to children's homes on their BMI and obesity status. We use a unique dataset, which combines information on recreational trails in Indianapolis with data on violent crimes and anthropomorphic and diagnostic data from children's clinic visits between 1996 and 2005. We find that having a trail near a home reduces children's weight. However, the effect depends on the amount of nearby violent crimes. Significant reductions occur only in low crime areas and trails could have opposite effects on weight in high crime areas. These effects are primarily among boys, older children, and children who live in higher income neighborhoods. Evaluated at the mean length of trails this effect for older children in no crime areas would be a reduction of 2 lb of the body weight. Falsification tests using planned trails instead of existing trails, show that trails are more likely to be located in areas with heavier children, suggesting that our results on effects of trails represent a lower bound.
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    Implementing person-centered communication in diabetes care: a new tool for diabetes care professionals
    (Dovepress, 2019-08-26) Connor, Ulla; Kessler, Lucina; de Groot, Mary; Mac Neill, Robert; Sandy, Robert; English, School of Liberal Arts
    Purpose: This study tested the clinical implementation of the CoMac Communication System, an empirically validated tool for individualized Diabetes Self-Management Education and Support (DSMES). This system provides immediate feedback and guidance to health care providers (HCPs) to facilitate speaking with persons with type 2 diabetes mellitus in language reflecting patients' own worldviews and health beliefs. Patients and methods: This 6-month implementation science study at an accredited diabetes care clinic in a Midwestern US hospital was conducted in two phases. Phase I consisted of CoMac implementation, qualitative interviews with HCPs, and evaluation of clinic flow among the diabetes education team. Seventy-two participants received CoMac's linguistically tailored patient-centric communication; a control group of 48 did not receive this intervention. In Phase II, glycosylated hemoglobin A1c (HbA1c) levels from the first visit to the follow-up visit for each group were compared. Results: Interviews conducted during Phase I suggested that the system can be successfully implemented into DSMES practice. Knowing individual psychosocial profiles and participants' language use allowed for more effective patient counseling. In Phase II, multiple regression analysis with HbA1c change as the dependent variable showed that the key variable of interest, treated with the CoMac intervention, had a one-tailed t-value of -1.81, with a statistically significant probability value of 0.037. Conclusion: Findings suggest that use of the CoMac System by diabetes care professionals has the potential for improved patient health outcomes. Patients receiving the CoMac intervention showed significantly improved HbA1c levels, suggesting that this approach has great promise for effective DSMES management.