Recent Research Publications and Funding

  •  | January 1, 2007 6:00AM

    Pain assessment is of high priority in the clinical setting. Facial Pain Scales (FPSs) are pain assessment tools generally used with school-aged children. The implicit theoretical bases for the success of FPSs have seldom been explored. Explanations why and how FPSs work (or do not work) have not been addressed. We support the existence of a universal pain expression--the Primal Face of Pain (PFP), which is present at birth, evolved in nature, and modulated through sociocultural factors. We propose it to be key in understanding the applicability of FPSs. We present here the design of a computer-assisted descriptive study that will observe, quantify and model the PFP as present in newborns. Measurement of the PFP will lead to exploration of the theoretical consequences of its existence, particularly as related to pediatric pain assessment and the valid use of FPSs. Further, this work can lay a foundation for the development of a new generation of FPSs.

    Pain, Pain
  •  | January 1, 2007 6:00AM

     The concept of palliative care originally evolved from the hospice philosophy of meeting gaps in care for seriously ill and dying patients. The Latin word palliate means “conceal or alleviate symptoms without curing” (Romesburg, 2007). The earliest recording of the word palliate can be traced to the late 14th century, where it originated in Elizabethan and Indo-European traditions (Morris, 1998). In 1967, Dame Cicely Saunders founded the first modern hospice program in the United Kingdom, which emphasized the importance of compassion and medical science (Georges, Grypdonck, & Dierckx de Casterle, 2002). Florence Wald, Dean of Yale University, invited Saunders to the U.S. to learn about her experiences, and in 1974, she founded the first home hospice program based in New Haven, Connecticut. In 1975, St. Luke’s Hospice in New York was the first hospice in the U.S. incorporated into an existing medical center. In 1982, the first children’s hospice center opened in England (Foster, 2007). Despite growth in hospice initiatives, researchers have only just begun to explore the unique aspects of pediatric palliative care.

    Palliative care was first introduced in 1990 by the World Health Organization (WHO) (2004) and is currently defined as “an approach to care which improves quality of life of patients and their families facing life-threatening illness through prevention, assessment, and treatment of pain and other physical, psychological, and spiritual problems.” WHO (2004) further describes palliative care for children as the active total care of the child’s body, mind, and spirit, as well as a means of providing support to the family.

    To provide this type of palliative care today, hospitals throughout the U.S. have increased initiatives to meet the unique needs of both adults and children. Although there are some commonalities, pediatric palliative care differs from adult palliative care in several ways that preclude the extension of existing adult services into the pediatric world (Sumner, 2003).

  •  | January 1, 2007 6:00AM

     PURPOSE: To review the concepts of reliability and validity, provide examples of how the concepts have been used in nursing research, provide guidance for improving the psychometric soundness of instruments, and report suggestions from editors of nursing journals for incorporating psychometric data into manuscripts.

    METHODS: CINAHL, MEDLINE, and PsycINFO databases were searched using key words: validity, reliability, and psychometrics. Nursing research articles were eligible for inclusion if they were published in the last 5 years, quantitative methods were used, and statistical evidence of psychometric properties were reported. Reports of strong psychometric properties of instruments were identified as well as those with little supporting evidence of psychometric soundness.

    FINDINGS: Reports frequently indicated content validity but sometimes the studies had fewer than five experts for review. Criterion validity was rarely reported and errors in the measurement of the criterion were identified. Construct validity remains underreported. Most reports indicated internal consistency reliability (alpha) but few reports included reliability testing for stability. When retest reliability was asserted, time intervals and correlations were frequently not included.

    CONCLUSIONS: Planning for psychometric testing through design and reducing nonrandom error in measurement will add to the reliability and validity of instruments and increase the strength of study findings. Underreporting of validity might occur because of small sample size, poor design, or lack of resources. Lack of information on psychometric properties and misapplication of psychometric testing is common in the literature.

  •  | January 1, 2007 6:00AM

     Objective: To describe a process for developing low-literacy health education materials that increase knowledge and activate patients toward healthier behaviors.

    Methods: We developed a theoretically informed process for developing educational materials. This process included convening a multidisciplinary creative team, soliciting stakeholder input, identifying key concepts to be communicated, mapping concepts to a behavioral theory, creating a supporting behavioral intervention. One half of American adults lack the literacy and numeracy skills necessary to effectively obtain, process, and act on the information in most patient education materials, recognition, designing and refining materials, and assessing efficacy.

    Results: We describe the use of this process to develop a diabetes self-management guide.

    Conclusions: Developing low-literacy health education materials that will activate patients toward healthier behaviors requires attention to factors beyond reading level.  

  •  | December 31, 2006 6:00AM

    This project was an exploratory effort to screen and treat immigrant Yemeni children who were at high risk for lead poisoning. The Detroit metropolitan area is home to the largest number of Arabic immigrants in the United States. In addition, Detroit has the largest rate of childhood lead poisoning in the state of Michigan. No published studies were found that explored the prevalence of lead poisoning among Yemeni children in Michigan. Immigrant children from countries where knowledge of lead poisoning is limited may be particularly vulnerable because of difficulties in language and accessing health care. Children’s Hospital of Michigan CATCH School Mobile Health Center conducted this health-screening project. This article reports on the gender and health issues encountered during the community outreach lead testing effort within a Yemeni neighborhood in Detroit.  

  •  | December 1, 2006 6:00AM


    Evaluate satisfaction with visit preparation at three rural resource center sites.


    The resource centers sent eight employees and two volunteers for training at UCSF in Consultation Planning (CP). CP is a service to help patients make a list of questions before seeing their doctors. Researchers used multivariate ordered logistic regression analysis to investigate the variation in satisfaction among 99 CP Clients served by the resource centers in 2003.


    Sixty-seven CP Clients who completed surveys were highly satisfied (mean=8.67, standard deviation (S.D.)=1.85, range=5–10). Variation in satisfaction was associated only with whether or not the CP Provider was a breast cancer survivor serving a breast patient (p=0.005). Satisfaction was not associated with CP Client demographics; type of upcoming medical visit; or CP Provider age, remuneration status, nursing background, and volume of CP Clients.


    Community-based resource centers have implemented CP to the satisfaction of their clients. Further research should expand the delivery of CP to more underserved members of the community and evaluate its acceptability and impact. There may be a therapeutic alliance formed when survivors provide CP to newly diagnosed patients.

    Practice implications

    CP should be considered by patient support programs wishing to expand their client services to include visit preparation.

  •  | December 1, 2006 6:00AM

     OBJECTIVE: To compare the availability, selection, quality, and price of fresh fruit and vegetables at food stores in four Detroit-area communities: 1) predominately African-American, low socioeconomic position (SEP); 2) racially heterogeneous, low SEP; 3) predominately African-American, middle SEP; and 4) racially heterogeneous, middle SEP.

    DESIGN: Cross-sectional observational survey, conducted fall 2002.

    SETTING: Detroit, Michigan

    SAMPLE: Overall, 304 food stores located in the four communities were evaluated: chain grocery, large independent grocery, "mom-and-pop" grocery, specialty (meat, fruit and vegetable markets), convenience without gasoline, and liquor stores.

    MAIN OUTCOME MEASURES: Availability was indicated by whether a store carried fresh fruit or vegetables, selection was based on a count of 80 fruit and vegetables, quality was evaluated according to USDA guidelines for a subset of 20 fruit and vegetables, and price was assessed for 20 fruit and vegetables by using the lowest-cost method.

    RESULTS: Mean quality of fresh produce was significantly lower in the predominately African-American, low-SEP community than in the racially heterogeneous, middle-SEP community. Differences in the types of stores present only partially explained this quality differential. The predominately African-American, low-SEP community had more than four times more liquor stores and fewer grocery stores per 100,000 residents than the racially heterogeneous, middle-SEP community. Mean overall selection and price of fresh produce at stores did not differ among communities.

    CONCLUSIONS: Increasing access to high-quality fresh produce in low-income communities of color is a critical first step toward improving health through better dietary practices in this population.

  •  | November 1, 2006 6:00AM

    This article evaluates the use of handheld computers for systematic observation of the social and physical environments. Handheld computers, also known as personal digital assistants (PDAs), make the advantages of computer-assisted data collection (CADC) more accessible to field-based researchers. In particular, CADC with handheld computers may improve data quality, reduce turnaround time, and enhance research capacity for community-academic partnerships. Here, we describe our experiences using handheld computers for the Healthy Environments Partnership's Neighborhood Observational Checklist, an instrument for systematic observation of the social and physical environments. We discuss hardware and software considerations, observer training and implementation strategies, and observer attitudes toward using handhelds in the field. We conclude that handheld computers are a feasible alternative to pen-and-paper forms, and we identify ways that future researchers can maximize the advantages of CADC with handheld computers to advance our understanding of how neighborhood context relates to individual-level outcomes.


  •  | October 14, 2006 4:00AM

    There is an increased risk for future cardiovascular disease in women who have had preeclampsia. In infants born to mothers with preeclampsia, there is growing evidence of increased risk for both cardiovascular disease and preeclampsia. Epidemiologic and experimental data provide a strong link between intrauterine exposure to preeclampsia and subsequent risk for the development of cardiovascular disease in women.  

  •  | October 1, 2006 4:00AM

     In this column, the authors discuss ethical and scientific standards in research and publication in light of their worldviews; human science; human becoming; and Parse's conceptual, ethical, methodological, and interpretive dimensions of the research process.