Dr. Gaye Raye and Dr. Karen Whitt, Nursing Department
Evaluation of Objectives
The purpose of this project was to mentor undergraduate nursing students as they worked on a project to identify the most effective tools for collecting family health history and to assess the impact of knowledge of family health history on preventive health behaviors. This project helped to identify tools that can be used to collect family health history and provided evidence that informs clinical practice. This project provided multiple mentoring and learning opportunities for undergraduate nursing students. Those mentored had opportunities to prepare manuscripts and present study findings at conferences and directly see how evidence is translated into practice. Mentored students learned about the best practices associated with collecting family health history and were able to analyze and interpret this information in order to effectively educate patients about risk and prevention of disease. Additionally, students were able to assess if knowledge of family health history influences patient behavior. Students not only learned research skills but learned how to effectively collect and interpret family health history which is a valuable skill for future professional practice that can be shared with other healthcare professionals and in turn have great influence on individualized patient care.
This study was important because it provided insight regarding the best tools to use to collect family health history. Although primary care providers agree on the importance of family history, studies indicate that the thoroughness of the information collected is lacking, and information about many chronic disorders is not recorded even though this information might provide important information that would be useful in identifying those individuals who need screening and specific interventions. There are many tools both electronic and paper that have been developed to collect family health history. However, very little research has been conducted that compares the effectiveness of various tools for collecting family health history. This project helped to identify tools that can be used to collect family health history efficiently in clinical practice and provided evidence about how knowledge of family health history influences patient behavior. Findings from this study are important for clinical practice and can be used to provide training for health care providers on the best method to collect family health history.
This project addressed four main research questions that are listed below along with the findings for each question.
Research Question 1: What are the best tools for collecting family health history in the clinical setting?
To address this research question, a systematic literature review was conducted to critically evaluate tools for collecting family health history in primary care practice with regard to validity, reliability, length, format, and inclusion of questions related to United States Preventive Service Task Force (USPSTF) Screening Guidelines. A search of CINAHL, Medline, PsychINFO, and Health and Psychosocial Instruments databases using the keywords family health history, medical history, tool, instrument, survey, or questionnaire yielded 272 articles. From these articles we identified and evaluated 36 different family health history tools. Over 70% of the tools collected information from three generations and included questions about breast cancer, ovarian cancer, and colon cancer. Less than 30% of the tools included questions about lipid disorders, chronic kidney disease, osteoporosis, sickle cell disease, and hemoglobinopathies. Less than half of the tools included questions about race and ethnicity and less than one-third had published information on reliability and validity. Most family health history tools do not include questions regarding chronic disorders even though this might provide important information that would be useful in identifying individuals who need screening and specific interventions. More research needs be conducted to identify and develop effective tools for collecting family health history in primary care practice.
Research Question 2: How do nursing students rate the usability of various family health history tools?
Research Question 3: How efficiently can information collected from various family history tools be interpreted and used to assess risk and design preventive measures based on evidenced based guidelines?
To address research questions 2 and 3 we conducted a study to identify the most effective tools for collecting FHH in primary care practice in terms of usability and time. A group of 10 nursing students used 6 different FHH tools of varying length and format to collect information from 101 college students. Nursing students rated usability according to a 10-item System Usability Scale and recorded the total number of minutes to complete each FHH tool. Data was entered in SPSS and ANOVA was conducted to compare mean usability ratings and amount of time to complete each FHH tool. The mean time to complete a FHH interview using each of the 6 tools ranged from 5 to 17 minutes. Number of items on the tools ranged from 6 to 92.There were significant differences in usability ratings and the mean amount of time to complete each FHH tool (p<.001). Tools with fewer items had higher usability ratings (p<.05). FHH tools with 12-15 items containing a combination of checklist and open ended questions and completed in an average of 5 minutes received the highest usability ratings. This study provided evidence regarding best methods for collecting FHH. We are still analyzing our data to evaluate the correlation between usability and quality of information collected from various FHH tools.
Research Question 4: Does knowledge of family health history change college student’s health behaviors?
To address this research question we conducted a study aimed to determine if FHH interviews conducted by nursing students effected perceived risk and intent to engage in preventive behaviors among college students. FHH interviews were conducted by 10 nursing student research assistants with a convenience sample of 101 college students utilizing 6 published FHH tools of varying length and format. The total number of minutes to complete each interview was recorded. Participants rated their perceived risk for developing 28 diseases on a five point scale before and after the interview. Participants were also asked an open ended question about intent to engage in preventive behaviors. Data was entered in SPSS and paired t-tests were used to compare mean pre and post interview ratings. Content analysis of responses to open ended questions was conducted by 3 researchers to identify common themes among responses. Participants had significantly higher overall post interview perceived risk of developing disease compared with pre interview ratings (p<.05). The majority of the participants indicated they planned to change health behaviors after the FHH interview. Findings from this study demonstrate that a FHH interview conducted by a nursing student was effective in increasing perceived risk for disease and intent to change health behavior among college students.
In addition to addressing the four research questions listed above, we also had the opportunity as a related project to analyze student reflection papers detailing what they learned about Family health history (FHH) gathering and utilization during transcultural clinical experiences in Czechia, formerly the Czech Republic. Student nurses worked alongside Czech nurses and nursing students in three separate medical facilities in Czechia. During this time, students observed FHH gathering methods and engaged in conversation about methods, utilization, barriers and skills for FHH gathering in Czechia. As part of their discussions, students learned how patients are identified and referred for necessary preventative screenings. Students prepared reflection papers about their observations regarding FHH gathering and utilization during this experience. This analysis identified the barriers and strengths related to Czech FHH gathering methods and utilization as observed by nursing students.
Evaluation of Mentoring Environment
Students had the opportunity to work one-on-one with faculty mentors which allowed for development of life-long professional and personal relationships. Participation in this project fit with the mission of BYU to assist individuals in their quest for perfection and eternal life. Participation in the project was spiritually strengthening, intellectually enlarging, character building, and lead to lifelong learning and service.
Students who participated in this study were mentored in aspects of the research process including systematic review of the literature, survey design, data collection, analysis and dissemination of research findings. The mentored students participated in the following opportunities while working on this project.
• Two students helped to conduct a systematic review of the literature to identify and evaluate published family health history tools. These students reviewed 272 abstracts and created a literature grid to identify 36 unique family health history tools in the published literature. The students then requested copies of the 36 tools.
• Two students reviewed the USPSTF guidelines for screening and prevention to identify any guidelines that pertained to collecting family health history. The students created a grid to compare the content in the family health history tools.
• Two students helped to critically appraise the family health history tools according to validity, reliability, length, format, and inclusion of questions related to United States Preventive Task Force Screening Guidelines offered on the tools.
• FHH interviews were conducted by 10 nursing student research assistants with a convenience sample of 101 college students utilizing 6 published FHH tools of varying length and format. These students had the opportunity to learn about how to conduct a family health history interview and also how to assess usability of the FHH tools. The students also learned about how to recruit and consent research participants.
• Two students had the opportunity to enter the data collected from the family health history interviews and surveys into an Excel spreadsheet for data analysis.
• Several students had the opportunity to prepare an abstract and present findings at the 2018 Transcultural Nursing Society Conference in New Orleans.
• One student was a co-author on an abstract that was selected as a podium presentation at the 2017 International Society of Nurses in Genetics annual conference in Reston, VA.
• One student was a co-author on an abstract that was selected for a podium presentation at the upcoming 2018 International Society of Nurses in Genetics annual conference in Orlando, Florida.
• One student was a co-author on an abstract that was submitted to the Council for Advancement of Nursing Science annual meeting that will be held in September 2018.
• Three students prepared an abstracts that was selected for poster presentations at the Western Institute of Nursing Research annual conference.
• Four students presented findings at the BYU College of Nursing annual Scholarly Works Conference in 2017.
• Several students are working with the PIs on preparing manuscripts for publication. This project continues to generate findings and we will continue to involve students in the publication of manuscripts.
List of students who participated and contributions
• Lauren Bretzing- systematic review of literature, critical appraisal of FHH tools, data entry and analysis, abstract preparation, presentation at three conferences
• Brittni Boyd- systematic review of literature, data gathering, analysis, abstract preparation, presentations at two conferences
• Ashlyn Pruitt- data gathering, analysis, abstract preparation, presentation at two conferences
• Camry Shawcroft- data gathering, analysis, abstract preparation, presentation at two conferences
• Madysn Tipton- data gathering, analysis, presentations at two conferences
• Sarah Rushton- data gathering, analysis, data entry, presentations at three conferences
• Emily Henstrom- data gathering
• Reily Mattson- data gathering, research team organization, follow-up on research team interviews
• Sage Hawkins- data gathering
• Amanda Landon- data gathering
• Mike McNeil- data gathering
• Valin Heward- data gathering
• Kaylee Hawkins- data gathering
• Emily Workman- data gathering
• Kaitlyn Bretzing- data gathering
• Madelyn Skillings- data gathering
• Makalee Owens-data gathering
• Ashlen Yost-data gathering
• Sydney Walsh-data gathering
We are grateful for the funding from this MEG award and feel that we fully accomplished the objectives of this study plus much more. The budget was exhausted with student wages, student and faculty travel to conferences to present findings, conference registration, supplementary support for study abroad travel to Czechia for 10 students, supplies, and poster printing.