Showing papers in "Health Education Research in 1993"

Community coalitions for prevention and health promotion

Abstract: In the last several years, health promotion specialists have stressed the importance of multiple interventions aimed both at individuals who are at health risk, and at risk-producing environments and policies (Milio, 1980; McLeroy et al., 1988; Pentz et al., 1989; Winett et al., 1989). The current emphasis on multiple interventions at multiple levels of the 'social ecology' is a response to the severity and complexity of chronic health conditions that are rooted in a larger social, cultural, political and economic fabric. The current wisdom in health promotion holds that targeting the behavior of individuals, without also intervening at these other social levels that shape behavior, will not have as great an impact on health status (McLeroy et al., 1988; Minkler, 1989; Hawkins and Catalano, 1992; Stokols, 1992). The development of coalitions of community agencies, institutions and concerned citizens to combat chronic health conditions is gaining popularity as an intervention aimed at strengthening the social fabric. Currently, hundreds of millions of dollars are being invested in coalition development as a health promotion intervention. For instance, both the COMMIT and ASSIST community tobacco control programs, funded by the National Institutes for Health, require coalitions of citizens in order to develop local strategies to decrease tobacco use (National Cancer Institute, 1988; Shopland, 1989).

Scales for assessing perceptions of health hazard susceptibility

Abstract: Two studies examined the effectiveness of a variety of commonly used likelihood scales (dichotomous scale, five-point verbally-labeled scale, odds scale, percentage scale, etc.) for assessing perceptions of personal susceptibility to health and safety risks. Two direct evaluation criteria (subjects' ratings of how easy it was to use a scale and of how well the scale reflected their feelings) and three additional measures of validity and reliability (the agreement of scale-derived ranks with a direct ranking, the magnitude of correlations between risk perceptions and appropriate risk factors, and the stability of scores over time) were used to compare the scales. Increasing the number of scale categories did not necessarily improve performance. In fact, a scale with seven verbally-labeled categories performed as well as or better than other scales on all evaluation criteria. These data may help health education researchers in selecting scales to measure perceptions of susceptibility to harm. Language: en

Determinants of consistent condom use by adolescents: the impact of experience of sexual intercourse

Abstract: The determinants of consistent condom use were investigated in a cross-sectional study of 1018 students 12-19 years of age from 18 Dutch secondary schools. The study was prompted by concern over the lack of acceptance of condoms on the part of young people in The Netherlands despite extensive acquired immunodeficiency syndrome (AIDS) prevention campaigns. Components of the variance in behavioral intention to use condoms included intuitive attitude regarding personal consequences 34%; self-efficacy (degree to which students considered themselves able to obtain and negotiate condom use) 12%; subjective social norms derived from parents peers and sexual partners 3%; perceived vulnerability to AIDS 2%; and perceived beliefs and behaviors of peer 2%. Adolescents with significant sexual experience (intercourse more than 5 times) were less likely than their inexperienced counterparts to respond positively to condom use as a means of avoiding transmission of AIDS. Students with extensive sexual experience were less likely to express discomfort with the idea of raising the subject of condom use with a new partner than their inexperienced peers but were likely to anticipate problems with consistent condom use with a well-known sexual partner. Those who reported consistent condom use also expressed confidence in their ability to use condoms even when drunk and to interrupt lovemaking to apply a condom. In addition consistent users were less likely to focus on the unpleasant aspects of condom use (decreased sexual stimulation messiness) and to perceive a positive social norm regarding this method of AIDS prevention. Given the finding that condoms decline in popularity as adolescents gain sexual experience behavioral skills programs that increase confidence in purchasing condoms and negotiating their use with sex partners should be implemented.

How young Europeans sleep

Abstract: This study investigated sleeping habits, difficulties in being able to fall asleep and their connections to self-reported health conditions, as well as other selected health behaviours and use of leisure time, among 11-16 year old Europeans from 11 countries. The study was part of a larger, comparative, WHO coordinated project on the health and life-style of school children (Health Behaviour of School Age Children--A WHO Cross-National Survey, The HBSC Study). In most of the countries, research data were collected from samples representative of the whole country. Using a standardized survey questionnaire, the data were collected anonymously in schools. Altogether 40,202 students responded to the survey. Sleeping habits and an inability to fall asleep varied significantly between countries as well as between age groups but only slightly between the sexes. Finnish school children experienced the most difficulty in being able to fall asleep. After the Israeli youth, the Finnish school children had the shortest night's sleep. At least a fifth of Finnish and Norwegian school children also reported that they felt tired almost every morning, the corresponding figure being smaller in other countries. A frequent use of psychoactive substances (alcohol and tobacco), lack of physical activity, excessive watching of TV/videos together with numerous evenings spent outside the home were all connected with going to bed late as well as with frequent difficulty in not being able to fall asleep. The results of the study offer an important challenge to health promotion and health education. Much more attention must be paid to this essential and exciting health habit!

A methodology for monitoring and evaluating community health coalitions

Abstract: Community coalitions are prominent mechanisms for building local capacities to address health and social concerns. Although there are case studies and descriptive reports on coalitions, there is little empirical information about coalition process and outcome. This paper describes a case study using a methodology for monitoring and evaluating community health coalitions. Data are fed back to coalition leaders and members, funding agents, and other relevant audiences as part of the development process. The monitoring system provides data on eight key measures of coalition process and outcome: the number of members, planning products, financial resources generated, dollars obtained, volunteers recruited, services provided, community actions and community changes. Illustrative data are presented for two different community health coalitions. Finally, challenges and opportunities in evaluating community coalitions are discussed.

A prevention program for disturbed eating and body dissatisfaction in adolescent girls: a 1 year follow-up

Abstract: This study evaluated an intervention program to reduce moderate and extreme weight loss behaviors, disordered eating and low body image. The Body Image and Eating Behavior Intervention Program consisted of five specialized classes addressing media images of women, determinants of body size, healthy and unhealthy weight control methods, and emotional eating. The program was conducted in year 9 in Schools 1 (n = 80) and 2 (n = 27), while students from the same year in School 3 (n = 29) were control subjects. Participants completed self-report questionnaires assessing eating behavior and body image attitudes prior to the program, 1 months after the program and at 12 months follow-up, while control subjects completed the questionnaires at the same time but did not receive the program. Data were analyzed using groups (Schools 1, 2 and 3) by testing occasion (pre, post and follow-up) analyses of variance with repeated measures on testing occasion. Measures of disordered eating and frequency of use of extreme weight loss behaviors were constant over testing occasion and showed no effect of the intervention program. Body dissatisfaction was consistently lower in School 1 but increased across all subjects over the year. The implications of these data for school-based intervention programs in this area are examined.

Background, conceptualization and design of a community-wide research program on adolescent alcohol use: Project Northland

Abstract: Project Northland is a community-wide research program funded by the National Institute on Alcoholism and Alcohol Abuse, for a 5-year period (1990-95). The aim of the study is to prevent or delay onset of alcohol use among young adolescents, as well as to reduce use among those who are already drinkers. Twenty communities were recruited in northeastern Minnesota, an area referred to as the Northland, Arrowhead or Iron Range region, and then were randomly assigned to either Education or Delayed Program conditions. The 10 Education school districts have agreed to participate in 3 years of intervention programs in schools, with parents and in the community-at-large. One group of young adolescents, the Class of 1998 (sixth grade students in the 1991-92 school year), form the study cohort. Surveys (1991-94) of the Class of 1998, their parents, community leaders and alcohol merchants are the primary components of the program's evaluation. Many conceptual and methodological questions emerged during the development of the research protocols for Project Northland over the past 2 years. These questions are the impetus for this article. Specifically, the focus on young adolescents and alcohol use was selected, as contrasted with older adolescents or with multiple problem behaviors. The project was designed using a community-wide model that addresses both supply and demand issues, rather than limited to a school-based model. Intervention strategies and evaluation methods were chosen that could address community-level as well as individual-level behavior change, which required the development and application of new technologies. The rationale for these decisions may be useful to others considering community-wide health promotion efforts. Language: en

Social science theory in health education: time for a new model? [editorial]

Abstract: Two of the leading journals on health education have published theme issues in the past 3 years on the relationship between theory and practice in health education. A major text on health education theory has also been published. This recent literature indicates the existence of a clear disparity between the ways in which theory is taught and advocated by academicians and the ways in which theory is used in practice. It is also unclear whether or not theory should be used in the manner advocated by many in academic training programs. The academic perspective on theory the use of theory in health education practice ecological planning for health education practice the theory of the problem theory of intervention understanding the context of practice and strengthening health education practice are discussed.

Correlates of coalition effectiveness: the Smoke Free Class of 2000 Program

Abstract: Fifty state and local coalitions that carry out the Smoke Free Class of 2000 program of the American Cancer Society, American Heart Association and American Lung Association were surveyed in 1990. Almost all (95%) rated themselves moderately or very active and a total of 88 900 second grade teachers were estimated to have received the materials. The availability of funds, competing priorities, lack of coordination, differences in agency service areas and personnel availability were most frequently cited as areas of concern to the coalitions. Personnel barriers and formality of coalition structure were independently related to perceived coalition effectiveness and, with the number of elementary schools, to perceived coalition activity. General recommendations, that were accepted upon completion of the assessment, included (1) formalization of agreements, mission statements, and goals and objectives, (2) attention to group formation and identification, and (3) clarification of national coalition expectations.

Project Towards No Tobacco Use: implementation, process and post-test knowledge evaluation

Abstract: This paper describes the curricula contents, and presents data to evaluate the implementation, process and immediate post-test knowledge of Project Towards No Tobacco Use (Project TNT). Four different school-based tobacco use prevention curricula were developed to counteract the effects of three types of tobacco use acquisition variables typically addressed within a comprehensive social influences program: (1) peer approval for using tobacco (normative social influence), (2) incorrect social informational provided about tobacco use (information social influence) and (3) lack of knowledge or misperceptions about physical consequences resulting from tobacco use. Three curricula were designed to counteract the effects of single acquisition variables, whereas a fourth curriculum was designed to counteract the effects of combined social and physical consequences-related influences. These curricula were delivered to seventh grade students by trained project health educators to maximize implementation. 'Program' schools, those schools that received one of these curricula, were compared to 'control' schools that provided asystematic health education delivered by school personnel. A total of five conditions were contrasted through use of a randomized experiment involving 48 southern California junior high schools. This paper documents high levels of implementation in all program conditions. Also, favorable process ratings were obtained across the four program conditions, using multiple measures and sources of ratings (students, health educators and classroom teachers who observed curricula delivery). Finally, knowledge item sets completed by the students demonstrated discriminant validity across all five conditions. Because the program conditions were discriminable, yet were quite similar in implementation and process ratings, planned future study of behavioral outcomes can be interpreted as relatively uncontaminated by delivery or credibility confounds.

Development of a health education program for parents of preschool children with asthma

Abstract: This paper presents the development and pilot testing of a self-management education program for parents of preschool children (0-4 years) with asthma, involving general practitioners, asthma nurses, community nurses and doctors of child health centers. The program intends to integrate education in the medical care provided to the child (and the parent). The program contains four manuals, one for each group of health care providers, and a booklet for parents. The manuals identify the educational tasks per discipline and regulate referral from one discipline to another. The booklet provides written information for parents. In the development of the program, representative from both the target population and the providers of the education were involved in needs assessment surveys. Findings of these surveys were integrated into the design of the program. Then, a pilot study was conducted to test the efficacy of the program during group sessions. Findings indicate that the variables measured (knowledge, attitude, self-efficacy and self-management behaviors) improved significantly from pre- to post-test. Finally, the program was revised for the next phase in which the program will be evaluated in primary health care with a controlled trial.

Perception of physical education classes among young adolescents: do physical education classes provide equal opportunities to all students?

Abstract: From a public health perspective, physical activity in children and adolescents is seen as important for disease prevention and health promotion. Physical activity patterns are learned through socialization processes where one of the influential sources is the school through physical education classes. The purpose of the present study was (1) to examine young adolescents' general perception of physical education classes, and (2) to explore the relationship between these perceptions and students' social resources, gender and level of leisure time physical activity and self-evaluated competence in physical education. A total of 895 seventh graders (13 year olds) were surveyed in Norway concerning their perception of physical education classes. Indicators of social resources were chosen from the arenas of family, friends and school. The main finding was that a majority of students liked physical education classes. Physical education classes seemed, however, not to offer the less socially resourceful minority the same opportunities for positive experience with physical activity as the resourceful majority. Boys' general perception of physical education classes seemed to be more positive than girls' and physically active students perceived physical education classes more favorably than less physically active students.

In search of a psychology of safer-sex promotion; beyond beliefs and texts

Abstract: Promoting the use of condoms is the most promising approach to controlling the spread of HIV infections. Health psychologists therefore have been challenged to construct a psychology of condom use promotion. Whereas models which specify how behavior is shaped by socially-shared health-related beliefs (social-cognitive models) are an improvement over simple information provision campaigns they still have limitations. They are useful in changing HIV-related knowledge and attitudes but have led to little or no change in sex behavior. These models depend on the assumption that perceived susceptibility is a prevention determinant but studies of 22 measures of safer sex behavior have revealed a correlation in only 7 (5 positive and 2 negative). Further studies have led to conflicting and contradictory results. The alternative discourse analysis approach which questions the assumptions inherent in measurements of beliefs and intentions deserves consideration. Expression of beliefs for example can be strongly influenced by conversational shifts. This variation in response has made discourse analysts reject the assumption that beliefs can be identified. Instead these researchers focus on ways respondents use language to construct versions of reality which achieve the desired conversational goals. Health psychologists however are reluctant to abandon attempts to infer beliefs attitudes and intentions because without a methodology of individual characterization they are unable to demonstrate the effectiveness of health interventions or alter a campaign to target a particular at-risk group. Through contraceptive research psychological predictors of condom use which are categorized as personality relationship characteristics and situation constraint measures have been identified. In fact one characteristic erotophilia-erotophobia which is a measure of learned emotional responses to sexuality predicts condom use more than does intention. Other positive and significantly associated characteristics are perceived duration of the relationship quality of communication and exclusivity of the relationship. Nonuse is related to substance use before intercourse and unplanned sexual encounters. Since sexual interaction is the result of negotiation between people negotiation processes must be changed by empowering individuals. Condom negotiation skills may require practice and accurate feedback and previous practice may be a more accurate determinant of sex behavior than appropriate beliefs. The gender differences in sexual situational scripts must be addressed to empower young women to dismantle gender role constraints. To develop the sophisticated interactive skills these social psychological models call for will require a change in health education methods from persuasion to practice with interactive competence the goal rather than related cognitions.

Women defining health: food, diet and body image

Abstract: This article explores the relationship between gender and food through analysing data obtained from a series of women-only discussion groups, the participants of which explored self definitions of the term 'health' What is distinct about this data, collected in the North East of England, is the clear link respondents perceive between food, diet and health However, due to a number of factors such a knowledge may not result in dietary and ultimately bodily change The many implications of such findings for health education are outlined in the discussion section of the paper

Back to complacency: AIDS in the Australian press, March—September 1990

Abstract: This paper reports the results of a quantitative and qualitative content analysis of all articles about AIDS published in the Australian metropolitan press during the 7 month period of March-September 1990. During the study period, almost 2800 articles mentioning AIDS were published, representing a drop in number of articles published compared with earlier years. Those issues receiving most press attention included people living with AIDS, AIDS and the law, AIDS policy and politics, the general spread of HIV/AIDS, AIDS education campaigns, drugs and medical treatment, and the HIV/AIDS threat posed to prison officers and health practitioners. The analysis demonstrates that the reporting of AIDS has changed over the course of the epidemic: topics which in the past commanded enormous press attention, such as AIDS as a 'gay plague' and the threat posed by the disease to heterosexuals, are no longer considered as newsworthy. Implications for AIDS health promotion activities are discussed.

Resistance to peer group pressure: an inadequate basis for alcohol education

Abstract: This paper explores the notion of ‘peer group pressure’ as it has been deployed in educational interventions on alcohol for adolescents. It is argued that ‘peer group pressure’ is an inadequate explanation for youthful alcohol use and that interventions formulated around the inculcation of resistance to peer group norms must inevitably be at variance with the everyday experience of those at whom such interventions are aimed. The paper argues that a reformulation of the concept of ‘peer group pressure’ opens up its positive features and that these offer a strong base for a new range of educational initiatives.

The determinants of four cancer-related risk behaviours

Abstract: This paper reports research into the determinants of four cancer-related risk behaviours: smoking, excessive alcohol consumption, high fat consumption and exposure to artificial sunlight. The results indicate that the four types of risk behaviour are determined by several factors: the perceived behaviour of the social environment, individual's attitudes towards the risk behaviour and self-efficacy perceptions on changing the risk behaviour. High fat consumption differs from the other risk behaviours in that people tend not to be aware of their high fat consumption. No significant relationships were found among the risk behaviours apart from small correlations between smoking and heavy alcohol consumption, and between high fat consumption and heavy alcohol consumption. The implications of these results for the development of behaviour change programs are discussed.

Investigating Hispanic adolescent involvement with alcohol: a focus group interview approach

Abstract: Focus group interviews were conducted with Hispanic teenagers to explore their patterns of alcohol consumption, influences on drinking and possible intervention strategies. The findings revealed that drinking and alcohol-impaired driving are common. Conviviality and social facilitation are the predominant contexts for alcohol consumption in this population. The strong influence of peers was detected where drinking to 'fit in' and be part of the crowd was observed. Parents were also noted to have influence. Some parents actively promoted drinking among their sons as it is often seen as a sign of masculinity or 'machismo'. Suggestions for effective prevention strategies included a preference for messages which vividly portray the harmful consequences of alcohol consumption and the use of testimonials from people who have suffered some form of impairment due to alcohol abuse. Teens, especially those who speak Spanish and understand the Hispanic culture, were seen as the most credible spokespersons for prevention campaigns. Language: en

A community education monitoring system: methods from the Stanford Five-City Project, the Minnesota Heart Health Program and the Pawtucket Heart Health Program

Abstract: Understanding the process of behavior change interventions is critical to achieving campaign effectiveness and successful program replication. The present article presents a community education monitoring system (CEMS) using data from the Stanford Five-City Project (FCP), the Minnesota Heart Health Program (MHHP) and the Pawtucket Heart Health Program (PHHP). CEMS records the number and type of intervention activities, outcome objectives, targets of change (individual, organizational or environmental), channel(s) of dissemination and proportion of programs funded by the community. These data illustrate (1) the application of theory for each project, (2) data-based program administration, (3) feedback for revising programs and (4) type of reach or 'dose' information obtained from intervention monitoring. Process evaluations such as CEMS provide critical links between field realities and evaluation outcomes. This type of evaluation develops standards for measuring program reach and allows comparisons with other programs. CEMS also illustrates how programs enact theory. Validation studies are critical to the continued successful use of CEMS. The first step, however, is to develop a uniform way of describing complex multichannel behavior change programs. CEMS in a refined form should prove invaluable to health promotion program planners whether in research or service settings.

Crutches, confetti or useful tools? Professionals, views on and use of health education leaflets

Abstract: This paper examines the views on and use of health education leaflets by a number of professional groups: health visitors, midwives, occupational health workers, pharmacists and school health education co-ordinators. Eighty nine percent currently obtain leaflets from health promotion units, with the exception of health visitors, professionals are largely satisfied with the units' service. Seventy six percent use commercial or sponsored leaflets primarily because of the large numbers and topics that are available. The numbers and type of leaflets used were found to vary across the professions. All professionals see an increasingly important role for leaflets in their work. A number of them, pharmacists and occupational health workers in particular, saw the numbers they use rising. These views were accompanied by lower levels of belief in a leaflets ability to increase knowledge and behaviour as well as lower levels of satisfaction with current leaflet use and a concern over the public's reception of leaflets. Methods of leaflet distribution to the public largely reflect the professionals' work contexts. Most popular were handing out leaflets with advice, leaving them in a public place and using them as a back-up to a meeting. A number of contradictions emerge between distribution practices and perceived effectiveness. Few professionals thought leaving leaflets in a public place was effective, and few health visitors and midwives believed giving leaflets to the family of a client was effective despite large numbers doing so. The implications of these findings for health promotion policy and practice are discussed.

Prevention of home related injuries of pre-school children: safety measures taken by mothers

Abstract: Home related injuries are a major threat to the health of pre-school children in the Netherlands. Many risk situations can only be avoided through parental safety behaviour, especially with measures taken to structure the child's environment. This study was meant to contribute to the information needed to develop a safety education programme directed at parents. Therefore, we assessed mothers' safety measures related to poisoning, burns and falls, the consistency between these measures within one type of accident, and their relation to the mothers' education. A written questionnaire was completed by 1129 mothers of pre-school children (response rate 84%). Results suggest that many of the safety measures taken by mothers have to be judged moderately safe or unsafe and therefore correction or development of these measures is needed. Furthermore, this study suggests that safety measures belonging to one type of accident are not consistent with one another. This implies that each measure has to be advocated separately. Moreover, there was no substantial evidence for a relation between the mothers' safety measures and their education. Safety educators, therefore, do not need to differentiate between mothers with different educational levels when designing programmes. Language: en

The worksite component of variance: design effects and the Healthy Worker Project

Abstract: Variance estimates in worksite health promotion studies depend partly on the intraclass correlation coefficient (ICC). ICC quantifies homogeneity of a variable within worksites. ICC would be zero for randomly formed worksites, but is generally positive because employees tend to share personal characteristics. The ratio comparing the variance estimated from worksite means with that estimated from individuals under simple random sampling is the design effect (DEFF). A DEFF of 1.0 indicates no excess variance due to worksite. The Healthy Worker Project (HWP) was a 32 worksite cross-sectional and longitudinal study of a weight and smoking intervention program. ICCs in cross-sectional surveys for health-related outcome variables ranged from 0.006 to 0.009, DEFFs from 2.0 to 2.6 ICCs/DEFF's in longitudinal analysis were smaller; ICCs ranged from -0.002 to 0.003, DEFFs from 0.7 to 1.5. Positive ICCs substantially increased variance estimates at a single measurement, yet variance of longitudinal analysis was less subject to worksite dependence. It is concluded the worksite component of variance is real and should not be ignored, although the worksite component of variance is small in these longitudinal analyses. This observation should be replicated before it is used in other worksite health promotion research.

The role of outcome and efficacy expectations in an intervention designed to reduce infants' exposure to environmental tobacco smoke

Abstract: The purpose of this paper is to examine the role of a theoretical framework in an intervention program designed to reduce infants' exposure to environmental tobacco smoke (ETS). The content of a nurse-based intervention focused on two psychosocial constructs: expectations of outcomes which may result from behaviors associated with ETS exposure and expectations of self-efficacy associated with the mother's ability to engage in these behaviors. This study found both constructs predictive of change in, and maintenance of, ETS exposure control. In particular, mothers reporting both low outcome and low efficacy expectations tended to have infants with the highest levels of ETS exposure. We also found that our intervention was effective in changing outcome and efficacy expectations in the desired direction. These findings suggest that outcome and efficacy expectations are changeable, and, therefore, represent important targets in future programs aimed at controlling ETS exposure.

The evolution, operation and future of Minnesota SAFPLAN: a coalition for family planning

Abstract: Minnesotas Statewide Association for Family Planning (SAFPLAN) a coalition formed in 1990 to address the inadequacy of state-subsidized family planning funds provides a valuable case study of the formation and maintenance of a health coalition. In this case coalition formation was prompted by the Minnesota Department of Healths replacement of a pro-rated funding policy with a competitive grant application process. Information on SAFPLANs recruitment of members and division of labor was collected through 31 interviews with coalition representatives and lobbyists document review and participant observation in coalition activities. Organizations that had applied for state family planning funds were invited to an initial meeting at which the goal of educating the community and legislators about the advantages of preventing unwanted pregnancies was established. At present community clinics (operated by city health departments or Planned Parenthood) comprise the largest membership sector. Notably underrepresented are rural agencies natural family planners and minorities. An organizations level of influence in formulating the coalitions goals emerged as the key predictor of level of involvement in SAFPLAN. 77% of those interviewed cited time and scheduling conflicts as the major barrier to more active involvement. Less involved representatives were able to keep informed about funding developments through monthly organizational meetings while more activist-oriented members participated in weekly lobbying meetings and brainstorming sessions. 90% of SAFPLAN members have indicated that the coalition has succeeded in meeting its goal of increasing available subsidized family planning dollars through a lobbying presence. Now that the funding crisis has improved somewhat SAFPLAN members are discussing broadening the goals of the coalition and recruiting a broader membership. SAFPLANs challenge will be to achieve this expansion without diminishing the coalitions cohesion and effectiveness.