Papers by Lorraine O Walker
Women s Health Nursing, May 24, 2024
A systematic method for reviewing and analysing health information on consumer-oriented websites
Journal of Advanced Nursing, Jul 8, 2018
AimA discussion of a proposed method for analysing the quality of consumer‐oriented websites that... more AimA discussion of a proposed method for analysing the quality of consumer‐oriented websites that provide health‐related information.BackgroundThe quality of health information available to consumers online varies widely in quality. In an effort to improve the quality of online information, experts have undertaken systematic reviews on selected health topics; however, no standardized comprehensive methodology currently exists for such review.DesignAn eight‐step method is recommended embracing the following steps: (a) select topic; (b) determine the purpose of the analysis; (c) select search terms and engines; (d) develop and apply website inclusion and exclusion criteria; (e) develop processes and tools to manage search results; (f) specify measures of quality; (g) compute readability; (h) evaluate websites. Each of these steps is illustrated in relation to the health topic of gynaecomastia, a physical and mental health challenge for many adolescent males and young men.Implications for nursingAlthough most extant analyses of consumer‐oriented websites have focused on disease conditions and their treatment, website analysis methodology would encourage analyses that fall into the nursing care domain.ConclusionThe method outlined in this paper is intended to provide nurses and others who work with specific patient populations with the tools needed for website analytic studies. Such studies provide a foundation for making recommendations about quality websites, and identifying gaps in online information for health consumers.
UNSTRUCTURED Health communication campaigns often suffer from the shortcomings of a limited budge... more UNSTRUCTURED Health communication campaigns often suffer from the shortcomings of a limited budget and limited reach, resulting in a limited impact. This paper suggests a shift to audience-centered communication platforms – particularly apps on mobile phones. By using a common platform, multiple interventions and campaigns can combine resources and increase user engagement, resulting in a larger impact on health behavior. Given the widespread use of mobile phones, mobile apps can be an effective and efficient tool to provide health interventions. One such platform is Father’s Playbook, a mobile app designed for men to be more involved during their partner’s pregnancy. Health campaigns and interventions looking to reach expectant fathers can use Father’s Playbook as a vehicle for their messages.
Women & Health, 2010
Despite a lack of studies on Hispanic midlife women's physical activity, the existing studies hav... more Despite a lack of studies on Hispanic midlife women's physical activity, the existing studies have indicated that Hispanics' ethnic-specific attitudes toward physical activity contributed to their lack of physical activity. However, little is still clearly known about Hispanic midlife women's attitudes toward physical activity. The purpose of this study was to explore Hispanic midlife women's attitudes toward physical activity using a feminist perspective. The study was a 6-month qualitative online forum among 23 Hispanic women who were recruited through Internet communities/groups. The data were collected using 17 online forum topics on attitudes toward physical activity and ethnicspecific contexts. The data were analyzed using thematic analysis. Three major themes emerged from the data analysis process: (a) "family first, no time for myself," (b) "little exercise, but naturally healthy," and (c) "dad died of heart attack." Although some of the women perceived the importance of physical activity due to their family history of chronic diseases, the study participants thought that physical activity would be a waste of time in their busy daily schedules. These findings provided directions for future health care practice and research to increase physical activity among Hispanic midlife women.
Relationships Between Body Image and Depressive Symptoms During Postpartum in Ethnically Diverse, Low Income Women
Women & Health, 2002
The aim of this study was to examine body image, depressive symptoms, and their interrelationship... more The aim of this study was to examine body image, depressive symptoms, and their interrelationship at post-delivery and at 6 weeks postpartum in a triethnic sample of low income new mothers. Data for this study were drawn from the Austin New Mothers Study. Participants were 76 Anglo/White, 72 African American, and 135 Hispanic new mothers who were participating in Medicaid, at least 18 years old, free of medical risk factors, and delivered at term. Body image was measured by the Body Cathexis Scale (BCS) and depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D). The leading areas of body dissatisfaction in postpartum were similar across ethnic groups. At 6 weeks postpartum Anglo women had the highest number of body image components perceived negatively, whereas African-American women had the least. In the overall sample, body image attitudes were significantly related to depressive symptoms in correlational (r's .19 to .34) and regression analyses. In addition, African American ethnicity was associated in regression analyses with higher depressive symptoms. Neither African American nor Hispanic ethnicity significantly moderated the relationship between body image attitudes and depressive symptoms in tests of interactions. Marital/partnered status and income level were related to depressive symptoms at both time points. In addition, being a woman with a parity of II was associated with higher depressive symptoms at 6 weeks postpartum. Although addition of these personal variables increased the percent of variance accounted for, body image attitudes continued to be significant predictors of depressive symptoms.
Journal of Pediatric Health Care, 2013
Introduction: Our aims were to assess postpartum health care barriers; health status (including d... more Introduction: Our aims were to assess postpartum health care barriers; health status (including depression and health behaviors); missed opportunities to discuss maternal health at health visits; acceptability of maternal screening in pediatric settings; and association of these variables with income level and race/ethnicity. Method: A mail survey was used with names randomly drawn from birth files and balanced for race/ethnicity and income level. Results: The adjusted response rate was 27.6%, with 41% reporting one or more health care barrier(s), 22% screening positive for depression, and 30% screening positive for alcohol abuse. Women of lower income were eight times more likely than those of higher income to have health care barriers (adjusted odds ratio = 8.15; 95% confidence interval: 3.60, 18.44). Missed discussions of postpartum depression or behavioral health during pediatric or other health care visits ranged from 26% to 79%. Acceptability of discussing topics, including depression, smoking, and alcohol use at pediatric care visits generally exceeded 85%. Discussion: Postpartum women experienced incomeassociated barriers to health care and generally had favorable views about maternal screening in pediatric settings.
Journal of Obstetric, Gynecologic & Neonatal Nursing, 2006
Objective : To determine the trajectory of postpartum weight changes and to examine associations ... more Objective : To determine the trajectory of postpartum weight changes and to examine associations between weight change in the fi rst 6 weeks postpartum and demographic, clinical, psychosocial, and behavioral variables. Design : Prospective, longitudinal design. Setting : Community hospital and university research setting. Participants : 26 low-income women (9 White, 8 Black, and 9 Hispanic) with uncomplicated term pregnancies. Main Outcome Measure : Body mass index measured weekly. Results : Among White women, body mass index decreased significantly for the first 3 weeks of the postpartum period. Black women experienced a significant reduction in body mass index for only the first 2 postpartum weeks. Similarly, the postpartum body mass index decreased for the first 2 weeks for Hispanic women. Prepregnancy body mass index and gestational weight gain each had a significant positive effect on postpartum body mass index. Perception of social support at 4 weeks had a significant positive effect on postpartum body mass index in Black women. Conclusions : The trajectory of weight change was nonlinear with large initial weight losses during the fi rst 2 to 3 weeks postpartum followed by weight plateaus for the remainder of the fi rst 6 weeks postpartum.
Factors Related To African American Women's Withdrawal From Postpartum Weight Research
PsycEXTRA Dataset
Postpartum Women
Promoting weight loss among overweight low-income postpartum women has proven difficult. The stud... more Promoting weight loss among overweight low-income postpartum women has proven difficult. The study’s aims were to pilot-test ethnic-specific weight-loss interventions using randomized control-group designs for White/Anglo (n = 23), African American (n = 25), and Hispanic low-income postpartum women (n = 23) and draw lessons from psychosocial data and follow-up interviews. Interventions lasting 13 weeks were offered in group settings in the community. Similar to other randomized trials with low-income mothers, weight changes between intervention and control groups were nonsignificant in each ethnic group; however, changes correlated sig-nificantly with self-efficacy (Spearman r =.50) for White/Anglo women and self-efficacy (Spearman r = −.48) and perceived stress (Spearman r =.48) for African American women. In follow-up interviews, women felt inter-ventions gave a good foundation for weight loss, but program and situational factors affected participation and weight loss. Control gro...
Maternal and Child Health Journal
Introduction Excessive and inadequate gestational weight gain (GWG) are associated with a number ... more Introduction Excessive and inadequate gestational weight gain (GWG) are associated with a number of negative health outcomes for mother and infant. Approximately two-thirds or more of Latinas gain outside of GWG guidelines. Acculturation plays a role in GWG-related factors, however the views of Latinas are often aggregated in overall study samples, thus trivializing the specific needs of this demographic group. The purpose of the present meta-ethnography was to better understand GWG beliefs, attitudes, and practice among Latinas by synthesizing extant qualitative findings on this topic. Methods Qualitative studies offer an important window into Latinas' views and practices related to GWG. A qualitative meta-ethnography (a form of meta-synthesis) was implemented to synthesize qualitative studies about Latinas' views of GWG-related factors. An initial sample of articles was distilled based on meta-ethnography guidelines from Noblit and Hare (1988) to a final sample of six qualitative articles that included perspectives from Latinas. Results Six concepts emerged across the studies, they included: shifts in feeling control, inconsistent/lacking information, self vs. other, applied wisdom, isolation vs. support, and everyday practicality. Studies met most quality assessment criteria (Atkins et al., BMC Medical Research Methodology 8:21, 2008). Discussion The views of Latinas about GWG-related factors are often buried in with perspectives of other women, which hides important details that are valuable for health program interventions designed to support these women. Future research should further explore the cultural differences in experience among Latinas to produce information and resources that are culturally relevant and relatable.
for Low-Income Postpartum Women: Findings and Lessons
Promoting weight loss among overweight low-income postpartum women has proven difficult. The stud... more Promoting weight loss among overweight low-income postpartum women has proven difficult. The study’s aims were to pilot-test ethnic-specific weight-loss interventions using randomized control-group designs for White/Anglo (n = 23), African American (n = 25), and Hispanic low-income postpartum women (n = 23) and draw lessons from psychosocial data and follow-up interviews. Interventions lasting 13 weeks were offered in group settings in the community. Similar to other randomized trials with low-income mothers, weight changes between intervention and control groups were nonsignificant in each ethnic group; however, changes correlated sig-nificantly with self-efficacy (Spearman r =.50) for White/Anglo women and self-efficacy (Spearman r = −.48) and perceived stress (Spearman r =.48) for African American women. In follow-up interviews, women felt inter-ventions gave a good foundation for weight loss, but program and situational factors affected participation and weight loss. Control gro...
Helping Individuals Achieve a Healthful Weight Gain During Pregnancy: A Multipronged Approach
Nursing for women's health, 2021
Approximately half of pregnant individuals in the United States exceed recommendations for gestat... more Approximately half of pregnant individuals in the United States exceed recommendations for gestational weight gain (GWG). Excessive GWG is associated with negative outcomes for maternal and infant health. In this article, we provide guidance to nurses who counsel patients about GWG. Because of negative bias toward persons with obesity, nurses need to understand their own attitudes toward obesity to provide supportive GWG counseling. The use of words such as weight is preferred to obese, and recommended GWG goals should be consistent with established guidelines. The setting of specific, measurable, attainable, realistic, and trackable behavioral goals can help translate a goal for GWG into practical actions in daily living. Mobile phone apps, if carefully chosen, may help individuals learn about and track GWG.
Weight Loss, Gain, or Stability from 6 Weeks to 6 Months Postpartum: Associations with Depressive Symptoms and Behavioral Habits
Journal of Women's Health, 2019
Background: Studies examining postpartum retained weight referenced to prepregnant body mass inde... more Background: Studies examining postpartum retained weight referenced to prepregnant body mass index (BMI) may mask weight gained after 6 weeks postpartum, a potential unrecognized factor contributing to weight increases after pregnancy. Materials and Methods: Using data from a longitudinal study, we examined three weight patterns from 6 weeks to 6 months postpartum (>2.3 kg gain; >2.3 kg loss; and ±2.3 kg as stable weight) in 302 low-income women. Predictor variables included perinatal variables, health habits, and depression risk at 3 and 6 months postpartum. Results: Mean weight changes were weight-gain group: 5.77 kg, standard deviation (SD) = 2.57; weight loss group: -4.79 kg, SD = 2.10; and stable group: 0.05 kg, SD = 1.24. The odds of gaining weight compared with stable weight increased with prepregnant overweight/obesity (adjusted odds ratio [aOR] = 3.22, 95% confidence interval [CI] = 1.74-6.00), and decreased with a first birth (aOR = 0.47, 95% CI = 0.24-0.93). The odds of losing weight increased with excessive gestational weight gain (aOR = 2.40, 95% CI = 1.10-5.21) and depression risk at 6 months (aOR = 2.57, 95% CI = 1.40-4.72), and decreased with prepregnant overweight/obesity (aOR = 0.49, 95% CI = 0.25-0.94). Health habits were not associated with weight gain or loss. Conclusions: Women with high BMIs may need added postpartum care to avoid gaining weight. Weight loss, although welcomed, may be secondary to depression risk. In both cases, low-cost, effective, and targeted care during the extended postpartum period could benefit women's health.
Journal of Behavioral Medicine, 2018
The well-being of mothers and infants is influenced by mothers' behavioral and psychosocial healt... more The well-being of mothers and infants is influenced by mothers' behavioral and psychosocial health (B&PH), yet it is often neglected during healthcare visits. To address this gap, this study aimed to develop and evaluate acceptability of a postpartum toolkit (screening questionnaire, feedback template, and decision aid) to promote B&PH. Using a decision-making model and participatory design (N = 24), a B&PH screening questionnaire was refined, and prototypes of feedback templates and decision aids for selecting health goals were developed. Most mothers in this multi-ethnic sample rated the resulting toolkit as easy to understand/use and useful, and reported they were likely to act on their health goals. Toolkit ease of use and usefulness ratings were largely unrelated to education, ethnicity, and acculturation. In conclusion, findings support the toolkit's acceptability and applicability to women of diverse backgrounds. The toolkit is a promising strategy to engage mothers in setting goals to promote B&PH.
Western Journal of Nursing Research, 2019
Using a weight resilience framework, health habits of diet and physical activity, social support,... more Using a weight resilience framework, health habits of diet and physical activity, social support, and perceived stress were compared in women who lost weight (resilient) and those who did not lose or gained weight (nonresilient) during a weight-loss intervention. Participants were low-income postpartum women participating in a 13-week randomized treatment-control group intervention, with 20 of 50 classified as resilient in losing weight. Measures included the Postpartum Support Scale, the Perceived Stress Scale, and health habit items from the Self Care Inventory. Weight-loss resilient women showed significantly more frequent healthful dietary habits, such as eating a nutritious breakfast, and less frequent unhealthy habits, such as substituting junk food for meals, and less perceived stress than their nonresilient counterparts at both the midpoint and end of the study. Weight-loss resilient women also showed significantly more frequent physical activity habits at the end of the stu...
The Journal of Perinatal Education, 2016
ABSTRACTFew women gain the recommended amount of weight during pregnancy, which has health implic... more ABSTRACTFew women gain the recommended amount of weight during pregnancy, which has health implications for mothers and their newborns. Work in this area focuses on factors that are difficult to change. The purpose of this project was to review literature on a more patient-centered concept—health literacy. A scoping review was conducted to determine whether aspects of health literacy are included in gestational weight gain (GWG) research. Thirty articles were selected for review. Although these studies included health literacy aspects indirectly, only 2 directly measured health literacy using existing measures. Work that incorporates health literacy in a GWG context is needed. Health literacy may be a critical, yet understudied, factor in understanding why GWG falls outside of the recommendations.
Public Health Nursing, 2007
The concept of positive deviance (PD), which highlights uncommon practices that reduce risk in lo... more The concept of positive deviance (PD), which highlights uncommon practices that reduce risk in low-resource communities, has been effective in community mobilization and programming to improve health outcomes. We present a protocol for extending the concept to analysis of existing public health data. The protocol includes assessing whether PD fits the situation, identifying positive deviants, and identifying behaviors associated with positive deviants' healthy outcomes. Analyzing existing datasets from a PD perspective may aid public health nurses in efforts to reduce health disparities. The effectiveness of our protocol will be clarified in future research.
Public Health Nursing, 2010
Developing focused and relevant health promotion interventions is critical for behavioral change ... more Developing focused and relevant health promotion interventions is critical for behavioral change in a low-resource or special population. Evidence-based interventions, however, may not match the specific population or health concern of interest. This article describes the Multi-Source Method (MSM) which, in combination with a workshop format, may be used by health professionals and researchers in health promotion program development. The MSM draws on positive deviance practices and processes, focus groups, community advisors, behavioral change theory, and evidence-based strategies. Use of the MSM is illustrated in development of ethnicspecific weight loss interventions for low-income postpartum women. The MSM may be useful in designing future health programs designed for other special populations for whom existing interventions are unavailable or lack relevance.
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Papers by Lorraine O Walker