National Science Education Standards

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Health Behavior And Health Education Theory Research And Practice

Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services.

Purpose: To develop an instrument to measure how hospital nurses perceive the ethical climate of their work setting and to evaluate its psychometric properties. A way to measure ethical climate can help nurses understand the work setting influences on their practice and can be used to diagnose areas for organizational change as well as to evaluate effectiveness of organizational interventions.

Design: Descriptive. Instrument developed was the Hospital Ethical Climate Survey (HECS). Sampled were 360 RNs (48% response rate) employed in clinical practice at two acute-care hospitals in one U.S. midwestern city. The nurses completed a questionnaire in 1993–1994 consisting of items developed to assess their perceptions of ethical climate, along with the 43-item Integrity Audit, a social desirability scale, and a demographic inventory.

Methods: Construct validity was assessed by confirmatory factor analysis (CFA) using the LISREL®7 statisticaI program.

Results: The final CFA model consisted of 26 variables in five factors, which were organized according to the relationships of nurses with peers, patients, managers, hospital, and physicians. Internal consistency reliability, using Cronbach's alpha, for the final 26-item instrument was 0.91 (range 0.68 to 0.92) for the subscales.

Conclusions: The Hospital Ethical Climate Survey has acceptable initial reliability and validity.

Hospital Nurses' Perceptions of the Ethical Climate of Their Work Setting

Over the past decade, there has been a substantial increase in the use of financial incentives by private employers and public programs to encourage healthy behaviors, wellness activities, and use of preventive services. The research evidence regarding the effectiveness of this approach is reviewed, summarizing relevant findings from literature reviews and from recent evaluations. The article concludes that financial incentives, even relatively small incentives, can influence individuals' health-related behaviors. However, the findings regarding health promotion and wellness are based primarily on analyses of a limited number of private sector initiatives, whereas the evidence regarding preventive services is based on evaluations of initiatives sponsored predominantly by public programs and directed at low-income populations. In either case, there are several important limitations in the ability of the published findings to provide clear guidance for public program administrators or private purchasers seeking to design and implement effective incentive programs.

Impact of Targeted Financial Incentives on Personal Health Behavior; A review of the literature

Women with inadequate health insurance have lower mammography rates than the general population. Finding successful strategies to enroll eligible women is an ongoing challenge for the National Breast and Cervical Cancer Early Detection Program. To test the effectiveness of a population-based strategy to increase mammography utilization among low-income underinsured women ages 40 to 64 years, a randomized trial was conducted to assess the effect of two mailed interventions on mammography utilization through Sage, the National Breast and Cervical Cancer Early Detection Program in Minnesota. Women ( N = 145,467) ages 40 to 63 years [mean (SD), 49.7 (6.8)] with estimated household incomes below $50,000 (47.9% were <$35,000) from a commercial database were randomized to three groups: Mail, Mail Plus Incentive, or Control. Both the Mail and the Mail Plus Incentive groups received two simple mailings prompting them to call a toll-free number to access free mammography services. The Mail Plus Incentive intervention offered a small monetary incentive for a completed mammogram. After 1 year, both intervention groups had significantly higher Sage mammography rates than the Controls, and the Mail Plus Incentive group had a significantly higher rate than the Mail group. The Mail and Mail Plus Incentive interventions were estimated to produce increases in Sage screening rates of 0.23% and 0.75%, respectively, beyond the composite Control rate of 0.83%. Direct mail is an effective strategy for increasing mammography use through Sage. Coupling direct mail with an incentive significantly enhances the intervention's effectiveness. Direct mail should be considered as a strategy to increase mammography use among low-income, medically underserved women.

https://cebp.aacrjournals.org/content/cebp/14/10/2346.full.pdf

Effect of Direct Mail as a Population-Based Strategy to Increase Mammography Use among Low-Income Underinsured Women Ages 40 to 64 Years

The concept of organizational climate is important for the study and understanding of work organizations. Researchers have not yet studied the organizational climate of hospital intensive care units, so it is not clear that the dimensions useful in description of other work settings will be appropriate for conceptualizing neonatal intensive care units (NICU's). This study investigated nurse perceptions of the organizational climate of NICU's in a sample of 18 hospitals. The Organizational Climate Description Questionnaire was modified for use in the NICU setting. A set of homogeneous climate scales was developed from the revised instrument. The six scales of the resulting instrument, the Nursing Organizational Climate Description Questionnaire, Form B (NOCDQ-B), demonstrated median internal-consistency reliability of .69 on cross-validation. Analysis of variance indicated that each of the six NOCDQ-B dimensions served to differentiate the NICU's in the study. Further, significant relationships were found at the unit mean level between three of the six NOCDQ-B scales and nurse satisfaction, as measured by the Minnesota Satisfaction Questionnaire.

Measurement of the nurse organizational climate of neonatal intensive care units.

Many innovative item formats have been proposed over the past decade, but little empirical research has been conducted on their measurement properties. This study examines the reliability, efficiency, and construct validity of two innovative item formats—the figural response (FR) and constructed response (CR) formats used in a K–12 computerized science test. The item response theory (IRT) information function and confirmatory factor analysis (CFA) were employed to address the research questions. It was found that the FR items were similar to the multiple-choice (MC) items in providing information and efficiency, whereas the CR items provided noticeably more information than the MC items but tended to provide less information per minute. The CFA suggested that the innovative formats and the MC format measure similar constructs. Innovations in computerized item formats are reviewed, and the merits as well as challenges of implementing the innovative formats are discussed.

Measurement Properties of Two Innovative Item Formats in a Computer-Based Test

Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy. However, little is known about how to translate incentive-based strategies to public health practice geared toward improving population-level health, and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail. This study reports results of a population-based randomized controlled trial testing a direct mail, incentive-based intervention for promoting mammography uptake. The study population was composed of a random sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening. Participants ( N = 18,939) were randomized into three groups: (1) Direct Mail only, (2) Direct Mail plus Incentive, and (3) Control. Both direct mail groups received two mailers with a message about the importance of mammography; however, Mail plus Incentive mailers also offered a $25 incentive for getting a mammogram. Logistic regression analyses measured intervention effects. Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups. The use of incentives also proved to be cost-effective. Additionally, the Direct Mail only group was more likely to receive mammography than the Control group. Findings offer experimental evidence on how the population-based strategy of direct mail coupled with a financial incentive can encourage healthy behavior, as well as how incentive-based programs can be translated into health promotion practice aimed at achieving population-level impact.

Coupling Financial Incentives with Direct Mail in Population-Based Practice: A Randomized Trial of Mammography Promotion.

Background Ischemia-induced pain associated with walking (claudication) in peripheral artery disease limits mobility and diminishes quality of life. Self-reports of pain during standardized treadmill testing are used in clinical trials to assess the efficacy of interventions. Objectives The aim of this study was to model pain trajectories during a peak walking test after 12 weeks of treatment in participants in four randomly assigned treatment groups (treadmill, arm ergometry, combination, and usual care) compared with baseline pain trajectories. Methods Self-reports of pain obtained at baseline and after 12 weeks of supervised exercise training for 41 participants (71% male; age, M = 64 years, SD = 8.6 years) were used. Pain was measured every 30 seconds with a numeric rating scale that had ordinal response options ranging from 0 (no pain) to 5 (severe pain). The test was continued until the maximum level of pain was reached and the participant could no longer walk. Observed responses from individual cases were plotted and patterns of pain were identified. A hierarchical generalized linear model for ordinal data was fit to compare baseline and postintervention trajectories. Results : Patterns in observed data reflected variations in time to onset of mild pain, acceleration to severe pain, and total walking time. All groups improved at 12 weeks; arm ergometry trajectories showed slower onset of pain, whereas treadmill training produced slower rates of increase to the maximum toward the end of the test. Effects for individuals appear as offsets from personal models at baseline. Discussion Change in the experienced claudication trajectory varied by type of exercise. Findings can inform design of future trials and aid decision making about exercise interventions for claudication.

George A. Henly

Papers

Effect of Direct Mail as a Population-Based Strategy to Increase Mammography Use among Low-Income Underinsured Women Ages 40 to 64 Years

Measurement of the nurse organizational climate of neonatal intensive care units.

Measurement Properties of Two Innovative Item Formats in a Computer-Based Test

Coupling Financial Incentives with Direct Mail in Population-Based Practice: A Randomized Trial of Mammography Promotion.

The pain trajectory during treadmill testing in peripheral artery disease.