Showing papers in "Health Education & Behavior in 1994"
TL;DR: The fundamental conditions and resources for health are peace, shelter, edu cation, food, income, a stable ecosystem, sustainable resources, social justice, and equity.
Abstract: The prevailing emphasis in health education is on understanding and changing life-style choices and individual health behaviors related to health status. Although such approaches are appropriate for some health problems, they often ignore the association between increased morbidity and mortality and social, structural, and physical factors in the environment, such as inadequate housing, poor sanitation, unemployment, exposure to toxic chemicals, occupational stress, minority status, powerlessness or alienation, and the lack of supportive interpersonal relationships. A conceptual model of the stress process incorporates the relationships among these environmental factors, powerlessness (or conversely empowerment), social support, and health status. The concept of empowerment has been examined in diverse academic disciplines and professional fields. However, there is still a lack of clarity on the conceptualization of empowerment at different levels of practice, including its measurement, relationship to health, and application to health education. The purpose of this article is to address these issues as they relate to the concept of community empowerment. It provides a definition of community empowerment that includes individual, organizational, and community levels of analysis; describes how empowerment fits within a broader conceptual model of stress and its relationship to health status; and examines a series of scales that measure perceptions of individual, organizational, community, and multiple levels of control. The article concludes with broad guidelines for and barriers to a community empowerment approach for health education practice.
763 citations
TL;DR: It is argued that health promotion is not a social movement but a professional and bureaucratic response to the new knowledge challenges of social movements, and has both empowering and disempowering aspects.
Abstract: Recent reformulations of health promotion focus on empowerment as both a means and an end in health promotion practice. Both concepts, however, are rarely examined for their assumptions about social change processes or the potential of community groups, professionals, and institutions to create healthier living situations. This article attends to some of these assumptions, expressing ideas generated during 6 years of professional training workshops with over 2,500 community health practitioners in Canada, New Zealand, and Australia. The article first argues that health promotion is not a social movement but a professional and bureaucratic response to the new knowledge challenges of social movements. As such, it has both empowering and disempowering aspects. The article analyzes empowerment as a dialectical relation in which power is simultaneously given and taken, and illustrates this in the context of health promotion programs. A model of an empowering professional (institutional) health promotion practice is presented, in which linkages among personal services, small group supports, community organizing, coalition advocacy, and political action are made explicit. Practice examples are provided to illustrate each level of the empowering relation, and the article concludes with a brief discussion of the model's educational and organizational utility.
348 citations
TL;DR: In the last decade, a revolution has been occurring in the field of health promotion, which has introduced new ideas, new language, and new concepts about what constitutes health and how health promotion efforts should be configured to achieve health.
Abstract: In the last decade, a revolution has been occurring in the field of health promotion. Guided to a large extent by position papers disseminated by the World Health Organization (WHO) Europe Health Promotion Office, and furthered by the Ottawa Charter, the Epp Report in Canada, the Healthy Cities project, as well as by other efforts, this new health promotion movement has introduced new ideas, new language, and new concepts about what constitutes health and how health promotion efforts should be configured to achieve health. Punctuated by the terms like empowerment and community participation, this movement has generated a whole new discourse about the theory and practice of health promotion. This paper explores the multiple meanings that surround these terms, and the implications for practice, by addressing questions like: What does health mean in this new context? What is empowerment? What does participation look like? Has the tyranny of the professional been replaced by the tyranny of the community? Has anything changed about the practice of health promotion other than the language? Finally, it is argued that an acknowledgment of the multidimensionality of these concepts may facilitate their translation from rhetoric into health promotion practice.
327 citations
TL;DR: This research presents a novel approach to community medicine called “informed consent” that aims to provide real-time information about the risks and benefits of vaccination and its applications in the context of community health.
Abstract: Nina Wallerstein is Assistant Professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico. Edward Bernstein is Associate Professor, Boston University School of Public Health, Boston City Hospital, Boston, Massachusetts. Address reprint requests to Nina Wallerstein, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 8713
314 citations
TL;DR: Findings indicated that a greater proportion of the population has actively tried to reduce fat intake than to consume more fiber, which has implications for the design of nutrition interventions and for the evaluation of intermediate outcomes.
Abstract: The stages of change construct, which addresses the readiness to change, has only recently been applied to dietary behavior, such as fat consumption. This article describes the application of the stages of change construct to dietary fat and fiber consumption and examines the association of dietary stages to eating practices and related demographic and psychosocial factors in a large, geographically diverse population of workers. We present results from the baseline survey of 17,121 employees in the Working Well Trial. We assessed stage from an algorithm based on seven items and measured dietary intake with an 88-item food frequency questionnaire. Findings indicated that a greater proportion of the population has actively tried to reduce fat intake than to consume more fiber. Stage of change was associated with fat, fiber, and fruit and vegetable intake in a stepwise manner, as predicted. In multivariate analyses that controlled for demographic characteristics, stage of change predicted between 8 and 13% of the variance in dietary intake, and more than demographic variables. These findings have implications for the design of nutrition interventions and for the evaluation of intermediate outcomes.
294 citations
TL;DR: The evaluation methods employed for a health promotion program in a rural poor county of the Mississippi Delta that chose to define community in this way revealed that after 1 year of implementation, community competence moved from social interactions internal to communities to those more externally focused on mediating with outside institutions and officials.
Abstract: If political dynamics are included in the definition of community, health promotion programs have a greater potential to recognize that assisting people to empower their communities is as important as assisting them to improve their health. This paper reports on the evaluation methods employed for a health promotion program in a rural poor county of the Mississippi Delta that chose to define community in this way. The evaluation took an action research approach so that the methods would not contradict or interfere with the program's empowerment agenda. The methods required a close and collaborative working relationship among evaluators and local service providers, community leaders, and program staff who defined and operationalized eight dimensions of community competence, determined the units of analysis, and developed the data collection protocol. Emphasis was placed on using the data to engage the program and three communities in a dialogue on how to confront a system with the difficult issues they faced. The findings revealed that after 1 year of implementation, community competence moved from social interactions internal to communities to those more externally focused on mediating with outside institutions and officials. At the same time, measures of self-other awareness and conflict containment showed a decrease or virtual nonexistence.
270 citations
TL;DR: It appears that dental health education can result in improvements in objective measures of dental health behaviors and actual oral health measures, but has only limited success in changing attitudes towards dental issues and achieves only short-term gains in knowledge.
Abstract: This article presents a review of research in dental health education and health promotion In the period 1982 to 1992, a total of 57 studies evaluating the effectiveness of interventions to alter individuals' behavior related to dental health were identified Combining the results of these 57 studies with descriptive articles published over the same period, it appears that dental health education can result in improvements in objective measures of dental health behaviors and actual oral health measures, but has only limited success in changing attitudes towards dental issues and achieves only short-term gains in knowledge The limited use of theoretical frameworks, poor statistical analyses, the use of convenient samples and the short post-intervention follow-up periods diminish the contribution of this research to the development of dental health policy and the formation of strategies to improve the health of communities
134 citations
TL;DR: The conceptual model underlying the CATCH process evaluation system is described, and process measures and data collection protocols are reviewed, highlighting the importance of incorporating process evaluation into final outcome analyses and assessments of program impact.
Abstract: Process evaluation complements outcome evaluation by providing data to describe how a program was implemented, how well the activities delivered fit the original design, to whom services were delivered, the extent to which the target population was reached, and factors external to the program that may compete with the program effects. The process evaluation system used in the Child and Adolescent Trial for Cardiovascular Health (CATCH) is presented in this paper. The conceptual model underlying the CATCH process evaluation system is described, and process measures and data collection protocols are reviewed. Functions of process evaluation data in the trial include: (1) describing the implementation of the program, (2) quality control and monitoring, and (3) explaining program effects. The importance of incorporating process evaluation into final outcome analyses and assessments of program impact is emphasized.
131 citations
TL;DR: This article focuses on an extension of Freire's problem-posing educational methods to include participant involvement in the development and production of their own learning materials.
Abstract: Freire used very specific materials in culture circles to support an empowering process that allowed learners to define the content and outcome of their own learning. However, the materials themselves were carefully crafted and developed by Freire and his co-workers. This article focuses on an extension of Freire's problem-posing educational methods to include participant involvement in the development and production of their own learning materials.
116 citations
TL;DR: The purpose of holding a forum was to expand on some of the issues that emerged through the review process related to power and power dynamics within health professional and community relationships.
Abstract: This forum involves several members of the guest editorial board for the Health Education Quarterly (HEQ) two-issue set on &dquo;Community Empowerment, Participatory Education, and Health.&dquo; The purpose of holding a forum was to expand on some of the issues that emerged through the review process related to power and power dynamics within health professional and community relationships. Although many of the articles touched on these issues, we wanted to take advantage of the collective wisdom within the guest editorial board to deepen our understanding of the potential implications for incorporating community empowerment into our practice. As a result of reviewing the articles, a common set of theoretical and practical questions were circulated to and agreed upon by the entire guest editorial board. The questions concerned definitions of community empowerment (CE) and power, the underlying values in these terms, the parameters of empowerment processes and outcomes, and the contradictions and paradoxes that confront us as we try to
89 citations
TL;DR: The objective of the paper is to explore the ways different initiatives have defined and operationalized their commitment to community empowerment and to examine the implications of these data for health educators.
Abstract: There is a developing consensus among health educators and other public health specialists that successful programs--especially among low-income people--emerge from empowered communities that participate proactively in all phases of program planning, implementation, and evaluation. Yet, there is no consensus on the definition of empowerment or on the guidelines that successful community empowerment initiatives have followed. The author surveys 17 community empowerment initiatives based in neighborhoods representing the diversity of low-income communities--both rural and urban--throughout the country. The objective of the paper is to explore the ways different initiatives have defined and operationalized their commitment to community empowerment and to examine the implications of these data for health educators. In order to understand the varying effectiveness of the initiatives surveyed, the author compares them considering several variables:their history and neighborhood context, their planning process and structure, their goals and objectives, their strategies, their relationships to their funders, and their accomplishments.
TL;DR: To invoke the primacy of culture in health education activities is not only to challenge approaches to health education that overlook or downplay this domain, but to also deepen and extend the possibilities of progressive approaches that focus on culture.
Abstract: To invoke the primacy of culture in health education activities is not only to challenge approaches to health education that overlook or downplay this domain, but to also deepen and extend the possibilities of progressive approaches that focus on culture. Border pedagogy, which seeks to establish a countervoice to Eurocentrism and patriarchy, enhances and magnifies the possibilities that were opened up when critical pedagogy invoked the engagement of students in the production of knowledge. This process of engaging the teacher/interventionists and the students/audiences in the production of meaning, value, pleasure, and knowledge should be central to the mission of health education. It is only through such dialogue where varied cultural expressions are affirmed and centralized that the production of cultural identity can be legitimating and empowering relative to health promotion.
TL;DR: The article describes the federal Healthy Start Initiative and its community participation mandate, the background on infant mortality in Boston, a case study of the development of the Healthy Start program from the perspective of community empowerment, and the lessons learned in the first 2 years of the program.
Abstract: This article examines the efforts on the part of a city health department, in partnership with a broad-based coalition of community-based, government, and social service agen cies, to plan and implement, using principles of empowerment and community partici pation, a federally funded infant mortality reduction program. It examines the social and institutional dynamics of sharing power in an environment highly charged politically. Infant mortality in Boston is much more than a public health problem. It is the focal point of complex racial, political, and institutional factors. This case study illustrates how empowerment moves from rhetoric to reality and the challenge to both traditional public health practice and traditional community mobilization. The article describes the federal Healthy Start Initiative and its community participation mandate, the background on infant mortality in Boston, a case study of the development of the Healthy Start program from the perspective of community empowerment, and fin...
TL;DR: A selective review of health education interventions among Native Americans that address the prevention and management of chronic illnesses/conditions as well as preventive health behaviors.
Abstract: Relatively few health education interventions directed at preventive health behaviors and management of chronic illness among Native Americans have been reported in the literature. This article provides a selective review of health education interventions among Native Americans that address the prevention and management of chronic illnesses/conditions as well as preventive health behaviors. For each intervention included in the review, a description of its cultural relevance, sample, design, and evaluation is provided. Limitations are noted, as well as implications for research and practice.
TL;DR: It is argued that the human development perspective supplies a framework for understanding the critical interaction between elements of social environment and health: Analyzing the social epidemiological research from this perspective can help to explain why and how the most potent factor affects health outcomes.
Abstract: Social epidemiology research has provided persuasive evidence of the link between the social environment--especially socioeconomic status--and health outcomes, but has failed to identify underlying mechanisms that might account for the association. The research may have been limited to date by its reliance on traditional epidemiological methods that emphasize a search for specific causal factor-disease relationships. It is time to take the research evidence and recast it to find practical solutions. We argue that the human development perspective supplies a framework for understanding the critical interaction between elements of social environment and health: Analyzing the social epidemiological research from this perspective can help to explain why and how the most potent factor, socioeconomic status, affects health outcomes. Equally important, this alternative perspective also presents health education practice implications.
TL;DR: Results indicate that children have a high level of awareness about AIDS and correct knowledge about the modes of human immunodeficiency virus (HIV) transmission and understand that AIDS is a serious illness that cannot be cured and know the main ways of preventing HIV infection.
Abstract: Focus groups were used as a qualitative technique to elicit knowledge and attitudes of children in Grades 3 to 6 about acquired immune deficiency syndrome (AIDS). Twenty-seven small groups of children responded to open-ended questions about general AIDS knowledge; transmission, causation, consequences, and prevention of AIDS; emotional response to AIDS; and susceptibility. Results indicate that children have a high level of awareness about AIDS and correct knowledge about the modes of human immunodeficiency virus (HIV) transmission. They understand that AIDS is a serious illness that cannot be cured and know the main ways of preventing HIV infection. Participants had more difficulty explaining causation and greatly overestimated the number of people their age and in high school that might be infected. They also had difficulty applying accurate knowledge to the hypothetical situation of encountering a child with AIDS in school. Misconceptions about AIDS exist at all grade levels, but appear more prevalent ...
TL;DR: The findings indicate that neither doctors nor patients provide a consistently accurate reflection of health promotion discussions, nor do they appear to agree with one another very much as to what was discussed, and suggest that underreport may pose an even greater threat to accurate estimates of physician practice than overreports.
Abstract: Patient education objectives are included as a strategy in every health promotion area addressed in Healthy People 2000. The likelihood of accomplishing these objectives is linked to the accuracy of the baseline estimates of practice. These estimates have most usually relied upon patient and physician reports. However, the accuracy of these reports has been infrequently studied. We analyzed audiotapes of interactions among 377 adult chronic disease patients and 38 physicians in a variety of practice settings to estimate the accuracy of their reports. Our findings indicate that neither doctors nor patients provide a consistently accurate reflection of health promotion discussions, nor do they appear to agree with one another very much as to what was discussed. Smoking and diet were reported quite accurately by both doctors and patients, whereas discussions regarding physical activity, alcohol, and stress were less so. Further, our findings suggest that underreport may pose an even greater threat to accurate estimates of physician practice than overreports.
TL;DR: Significant differences in participation, predictors of participation, and content of telephone counseling calls with nonvolunteer smokers who were identified through health surveys administered to a random sample of enrollees in a health maintenance organization are reported.
Abstract: Brief supportive telephone counseling is a promising adjunct to self-help smoking cessation programs. This article reports rates of participation, predictors of participation, and content of telephone counseling calls with nonvolunteer smokers who were identified through health surveys administered to a random sample of enrollees in a health maintenance organization. Eighty-six percent of smokers accepted at least one of three counselor calls; 66% accepted all three calls. Baseline characteristics associated with acceptance of calls included being female and greater average length of time to the first cigarette of the day. Acceptance did not differ significantly by stage of cessation. First calls with smokers who accepted all three calls were longer and were more likely to be with smokers who were willing to take a specific next action step. Overall, 12% of the sample reported having quit smoking by the third counseling call, with the highest quit rate (23%) among smokers who, at baseline, were planning t...
TL;DR: Investigation of condom beliefs of low income, urban African American and Hispanic youth living in the Midwest indicated that women, African American respondents, and Hispanic respondents high in acculturation tended to have more neutral or more positive views about condoms than other types of respondents.
Abstract: This article focuses on the condom beliefs of low income, urban African American and Hispanic youth living in the Midwest. The condom beliefs under investigation were derived from prior research with members of this population and through consultation with African American and Hispanic youth and service providers. Significant gender, ethnic, and acculturation differences were found among beliefs related to frequency of condom use in the past year (p < .05). These differences indicated that women, African American respondents, and Hispanic respondents high in acculturation tended to have more neutral or more positive views about condoms than other types of respondents.
TL;DR: Results of the quali tative evaluation are presented, including HPP's service model and approach to empowerment, including the "mother-child connection," and the principle of "giving back."
Abstract: The Homeless Prenatal Program (HPP) is one of the first programs in the country to provide comprehensive prenatal services to homeless pregnant women. A formative evaluation was conducted in 1992, indicating that HPP is achieving its program goals of improving birth outcomes and transforming the lives of its clients. Results of the quali tative evaluation are presented, including HPP's service model and approach to empow erment. In this model, empowerment has two central tenets, derived from the special needs of women who are pregnant and homeless: the "mother-child connection," and the principle of "giving back."
TL;DR: Program Notes and all correspondence concerning abstract review should be sent to Drew DiGiovanni, MPH, CHES, Manager, Education Department, Daniel Freeman Hospitals, 333 North Prairie Avenue, Inglewood, CA 90301.
Abstract: s for &dquo;Program Notes &dquo; and all correspondence concerning abstract review should be sent to Drew DiGiovanni, MPH, CHES, Manager, Education Department, Daniel Freeman Hospitals, 333 North Prairie Avenue, Inglewood, CA 90301. Published abstract length is 200 words. Submitted abstracts may be up to 400 words in length and will be edited. Submit a typed original and two copies.
TL;DR: A graduate program for community health nurses in a large Midwestern city formed a partnership with a diverse, integrated neighborhood for the dual purposes of enhancing the community's capacity to improve its own health and teaching CHNs community organizing as a means to improve health.
Abstract: This article presents two case studies highlighting the role of community conflict in the process of community empowerment. A graduate program for community health nurses (CHNs) in a large Midwestern city formed a partnership with a diverse, integrated neighborhood for the dual purposes of enhancing the community's capacity to improve its own health and teaching CHNs community organizing as a means to improve health. Central to the partnership are a broad definition of health, trust developed through long-term involvement, a commitment to reciprocity, social justice, and Freire's model of adult learning.
TL;DR: The author examines the Casa en Casa model for its contributions to furthering health education practitioners' understanding of critical pedagogy and community organizing and their relationship to health education.
Abstract: Casa en Casa is a popular education project of the community health education section of La Clinica de la Raza, a community-based health clinic in Oakland, California. The author examines the Casa en Casa model for its contributions to furthering health education practitioners' understanding of critical pedagogy and community organizing and their relationship to health education. A description of the project's achievements and the obstacles faced in reaching its goals of community empowerment is followed by an analysis of the weaknesses in the project that may undermine its effectiveness. Recommendations are made as to the importance of linking theory to practice and practice to a long-term vision of social change.
TL;DR: This 1993 SOPHE Presidential Address examines the role of health education under the plans for and principles of health care reform and suggests that health reform provides new opportunities to invest in prevention, public health and health education.
Abstract: In the fall of 1993 the plans for the Health Security Act were unveiled: health education was referenced no fewer than 18 times. This 1993 SOPHE Presidential Address examines the role of health education under the plans for and principles of health care reform. As Bill Clinton stated, "an intensified health education system must be designed to educate and encourage the American people to change behavior that results in ill health and high costs." It is argued that health education has been demonstrated to be effective at reducing risk behaviors associated with each of the leading causes of death. Likewise health education should, can, and does play a role in each of the health goals and objectives for the year 2000. Health reform provides new opportunities to invest in prevention, public health and health education—not only in medical care settings—but in schools, at worksites, and in the community. Health education in these settings can help create supportive environments that make healthy choices the ea...
TL;DR: In completing the two-issue set on Community Empowerment, Participatory Education and Health, the Guest Editors became aware that the concept of empowerment may have different meanings for different cultures and languages.
Abstract: In completing the two-issue set on Community Empowerment, Participatory Education and Health, the Guest Editors became aware that the concept of empowerment may have different meanings for different cultures and languages. We were privileged to receive a short piece on how the concept translates into Spanish and Latin American culture. We hope this piece in combination with several articles in these volumes stimulates greater thinking on the cultural and language context of empowerment-oriented practice.
TL;DR: The authors of the Perspectives article provide a useful and insightful review of the dilemmas inherent in attempts to apply traditional epidemiologic methods to the analysis of the link between social variables and health.
Abstract: The authors of the Perspectives article provide a useful and insightful review of the dilemmas inherent in attempts to apply traditional epidemiologic methods to the analysis of the link between social variables and health. They aptly point out that despite the well-documented link between social class and health, a link that persists over time, within a variety of cultures and across class gradients, the components of social class that affect health outcomes have never been satisfactorily identified. Factors such as gender, ethnicity, occupation, and social support have been found to contribute to the socioeconomic status (SES)-health relationship, but only explain a relatively small amount of the variance. Bloomberg et all argue for a model in which the health effects of objective inputs from the social environ-
TL;DR: In the 1980s, health educators discovered the value of social marketing approaches to health education and learned that it is not enough to explain the health benefits of certain lifestyle choices, it must also emphasize benefits that are not related to health per se, but to universal human desires such as social acceptance, security, status, and beauty.
Abstract: In the 1980s, health educators discovered the value of social marketing approaches to health education. We learned that it is not enough to explain the health benefits of certain lifestyle choices. To have real impact, we must also emphasize benefits that are not related to health per se, but to universal human desires such as social acceptance, security, status, and beauty. As we move through the 1990s, I believe that more and more health educators