Showing papers in "Health Education Research in 2001"

Consumer health information seeking on the Internet: the state of the art

Abstract: Increasingly, consumers engage in health information seeking via the Internet. Taking a communication perspective, this review argues why public health professionals should be concerned about the topic, considers potential benefits, synthesizes quality concerns, identifies criteria for evaluating online health information and critiques the literature. More than 70 000 websites disseminate health information; in excess of 50 million people seek health information online, with likely consequences for the health care system. The Internet offers widespread access to health information, and the advantages of interactivity, information tailoring and anonymity. However, access is inequitable and use is hindered further by navigational challenges due to numerous design features (e.g. disorganization, technical language and lack of permanence). Increasingly, critics question the quality of online health information; limited research indicates that much is inaccurate. Meager information-evaluation skills add to consumers' vulnerability, and reinforce the need for quality standards and widespread criteria for evaluating health information. Extant literature can be characterized as speculative, comprised of basic 'how to' presentations, with little empirical research. Future research needs to address the Internet as part of the larger health communication system and take advantage of incorporating extant communication concepts. Not only should research focus on the 'net-gap' and information quality, it also should address the inherently communicative and transactional quality of Internet use. Both interpersonal and mass communication concepts open avenues for investigation and understanding the influence of the Internet on health beliefs and behaviors, health care, medical outcomes, and the health care system.

Receiving social support online: implications for health education

Abstract: Online support groups are expanding as the general public becomes more comfortable using computer-mediated communication technology. These support groups have certain benefits for users who may not be able to or do not have the desire to attend face-to-face sessions. Online support groups also present challenges when compared to traditional face-to-face group communication. Communication difficulties may arise resulting from lack of visual and aural cues found in traditional face-to-face communication. Online support groups have emerged within health care as a result of the need individuals have to know more about health conditions they are confronting. The proliferation of these online communities may provide an opportunity for health educators to reach target populations with specific messages. This paper reviews the development of health-related online support groups, examines research conducted within these communities, compares their utility with traditional support groups and discusses the implications of these groups for health education.

Understanding reasons for drug use amongst young people: a functional perspective

Abstract: This study uses a functional perspective to examine the reasons young people cite for using psychoactive substances. The study sample comprised 364 young poly-drug users recruited using snowball-sampling methods. Data on life-time and recent frequency and intensity of use for alcohol, cannabis, amphetamines, ecstasy, LSD and cocaine are presented. A majority of the participants had used at least one of these six drugs to fulfil 11 of 18 measured substance use functions. The most popular functions for use were using to: relax (96.7%), become intoxicated (96.4%), keep awake at night while socializing (95.9%), enhance an activity (88.5%) and alleviate depressed mood (86.8%). Substance use functions were found to differ by age and gender. Recognition of the functions fulfilled by substance use should help health educators and prevention strategists to make health messages about drugs more relevant and appropriate to general and specific audiences. Targeting substances that are perceived to fulfil similar functions and addressing issues concerning the substitution of one substance for another may also strengthen education and prevention efforts.

Child-reported family and peer influences on fruit, juice and vegetable consumption: reliability and validity of measures

Abstract: Family, peers and other environmental factors are likely to influence children's dietary behavior but few measures of these phenomena exist. Questionnaires to measure family and peer influences on children's fruit, juice and vegetable (FJV) consumption were developed and pilot tested with an ethnically diverse group of Grade 4-6 children. Principal components analyses revealed subscales with acceptable internal consistencies that measured parent and peer FJV modeling, normative beliefs, normative expectations, perceived peer FJV norms, supportive and permissive parenting practices, food rules, permissive eating, and child food preparation. Internal consistencies were adequate to high, but test-re-test correlations often were low. Children also completed questionnaires on FJV availability and accessibility in the home, and food records for 2 days in the classroom. Parental modeling, peer normative beliefs and FV availability were significantly correlated with FJV consumption. Further research with these scales is warranted.

Using qualitative methods to elicit young people's perspectives on their environments: some ideas for community health initiatives

Abstract: This paper describes qualitative methods used in a research project for the former Health Education Authority, exploring Putnam's concept of 'social capital' in relation to children and young people's well-being and health. Putnam's conceptualization of social capital consists of the following features: trust, reciprocal support, civic engagement, community identity and social networks, and the premise is that levels of social capital in a community have an important effect on people's well-being. Research was carried out with 102 children aged between 12 and 15 in two relatively deprived parts of a town in southeast England. The paper describes the research setting, methods, consent process and ethical issues that arose. It explores how the methods generated different forms of interconnected data, giving rise to a number of health/well-being-related themes. The paper concludes that using a range of methods, including visual methods, has helped to explore quality of life issues for children that are usually neglected in studies of young people's health-related behaviours.

Web-based tailored nutrition education: results of a randomized controlled trial

Abstract: There is ample evidence that printed, computer-tailored nutrition education is a more effective tool for motivating people to change to healthier diets than general nutrition education. New technology is now providing more advanced ways of delivering tailored messages, e.g. via the World Wide Web (WWW). Before disseminating a tailored intervention via the web, it is important to investigate the potential of web-based tailored nutrition education. The present study investigated the immediate impact of web-based computer-tailored nutrition education on personal awareness and intentions related to intake of fat, fruit and vegetables. A randomized controlled trial, with a pre-test-post-test control group design was conducted. Significant differences in awareness and intention to change were found between the intervention and control group at post-test. The tailored intervention was appreciated better, was rated as more personally relevant, and had more subjective impact on opinion and intentions to change than the general nutrition information. Computer literacy had no effect on these ratings. The results indicate that interactive, web-based computer-tailored nutrition education can lead to changes in determinants of behavior. Future research should be aimed at longer-term (behavioral) effects and the practicability of distributing tailored interventions via the WWW.

Food likes and their relative importance in human eating behavior: review and preliminary suggestions for health promotion

Abstract: The present article reviews research about the psychological determinants of human eating behavior. A hypothetical model of food choice and intake is introduced, presenting various factors influencing eating behavior. Internal factors include sensory food aspects. Among the external factors are information, the social context and the physical environment. Processes such as mere exposure, Pavlovian conditioning and social learning shape the relationships between these factors, food liking and eating behavior. The relative contribution of the various determinants is discussed. In spite of a scarcity of studies, liking for the sensory aspects of food seems to be at the center of the development, maintenance and change of dietary patterns. Consequently, efforts for promoting healthy eating behavior might benefit from an increased attention towards learning principles and food likes in the development of interventions. Existing intervention strategies are criticized and preliminary suggestions are formulated to enhance their effectiveness.

Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19-year-old children and adolescents

Abstract: The aim of the study was to examine the effect of socioeconomic status (SES), age, weight and gender on the body image and weight control practices of children and adolescents, and to investigate whether health education about weight issues should target low socioeconomic groups. The study participants were a randomly selected group of school children who completed a questionnaire, and had their height and weight measured. Participants (n = 1131) were aged 6-19 years from 12 schools in New South Wales. SES, age, gender, body weight, body image, skipping breakfast, physical self-esteem, attempts to lose or gain weight, and dietary and weight control advice received from others were examined. Log-linear, chi 2 and MANOVA analyses were used to determine interactions between variables. Low SES children were more likely to be overweight, to skip breakfast, to perceive themselves as 'too thin', to be trying to gain weight and less likely to receive dietary or weight control advice. Physical self-esteem was lowest among overweight girls of middle/upper SES and greatest among boys of low SES, despite the latter being more likely to be overweight. Being overweight does not appear to adversely affect the physical self-esteem of children of low SES, particularly boys. Health educators should examine these issues with young people to help make health education and nutrition education most relevant and appropriate.

A comparative study of peer-led and adult-led school sex education

Abstract: There are, and have been, many school-based sex education projects in this country which have used peer leaders (students delivering an educational programme who are of similar, or slightly older, age than the students receiving the programme). Rigorous evaluation of the methodology remains scant. This paper describes a comparative investigation of peerled and adult-led sex education in National Curriculum Year 9 (aged 13/14 years). The results from this study suggest that peer leaders appear to be more effective in establishing conservative norms and attitudes related to sexual behaviour than the adults. Peer leaders were less effective than adults in imparting factual information and getting students involved in classroom activities. These findings suggest that both adult-led and peer-led methods may have a place in effective sex education— the challenge being to determine which areas are best dealt with by whom.

How did Project Northland reduce alcohol use among young adolescents? Analysis of mediating variables

Abstract: Project Northland is a randomized trial designed to create, implement and evaluate multilevel, community-wide strategies to prevent alcohol use among adolescents. This paper will focus on the mediating outcomes of the early adolescent phase of Project Northland when the students in the study cohort were in Grades 6-8. The project was conducted in 24 school districts and adjacent communities in northeastern Minnesota. The intervention consisted of social-behavioral curricula in schools, peer leadership activities, parental involvement and education, and community-wide activities. At the end of 3 years of intervention, significantly fewer students in the intervention school districts reported alcohol use than students in the reference districts. Mediation analyses were conducted to investigate if the intervention's effects on mediating variables could explain the reduction in alcohol use. Important mediators of Project Northland's effect on alcohol use were: (1) peer influence to use, including normative estimates, (2) functional meanings of alcohol use, (3) attitudes and behaviors associated with alcohol and drug problems like stimulus seeking, rule violations and bad judgement, and (4) parent-child alcohol-related communication around alcohol use. In addition, among those who did not use alcohol at baseline, self-efficacy to refuse offers of alcohol was a significant mediator.

Evaluation of a comprehensive school-based AIDS education programme in rural Masaka, Uganda

Abstract: A 19 activity extracurricular school-based AIDS education programme lasting 1 year was conducted in rural southwestern Uganda using specially trained teachers, and was evaluated using mutually supportive quantitative and qualitative methods. In total, 1274 students from 20 intervention schools and 803 students from 11 control schools completed questionnaires at baseline, and their classes were followed up. In addition, 93 students from five of the intervention schools participated in 12 focus group discussions. The programme had very little effect--seven of the nine key questionnaire variables showed no significant increase in score after the intervention. Data from the focus group discussions suggest that the programme was incompletely implemented, and that key activities such as condoms and the role-play exercises were covered only very superficially. The main reasons for this were a shortage of classroom time, as well as teachers' fear of controversy and the unfamiliar. We conclude that large-scale comprehensive school-based AIDS education programmes in sub-Saharan Africa may be more completely implemented if they are fully incorporated into national curricula and examined as part of life-skills education. This would require teachers to be trained in participatory teaching methods while still at training college.

Effect of culturally appropriate health education on glycaemic control and knowledge of diabetes in British Pakistani women with type 2 diabetes mellitus

Abstract: Type 2 diabetes is a growing problem in people of South Asian origin. It is associated with severe complications if it is not adequately controlled. This paper is a secondary assessment of 105 British Pakistani women within a larger randomized controlled trial of 200 Pakistani patients with diabetes. The trial used one-to-one structured diabetes health education, delivered by a linkworker with pictorial flashcards as a visual aid. Earlier published results from this study have shown that the women in the study knew less about diabetes and had poorer glycaemic control than men, which is why this assessment was performed to see what happened to them when they received appropriate health education. All patients were assessed before and 6 months after intervention by questionnaire and haemoglobin A1c blood tests to measure their overall blood sugar control. Nearly everyone improved their knowledge scores after 6 months in the intervention group, with women showing a catch-up improvement such that they equalled men. Multiple regression analysis found that glycaemic control improved in women receiving health education. Although this method of health education improved knowledge and glycaemic control in women in this sample, illiterate women did not do as well as their literate peers, continuing to score less on knowledge parameters. They also did not show an improvement in glycaemic control. Further work is needed to discover methods that will reach this sizeable subsection of the community.

Smoking cessation between teenage years and adulthood

Abstract: Most smokers begin smoking in adolescence. It is less well known how young people quit smoking and the factors that are associated with this process. A 15-year follow-up study on the North Karelia Youth Project has made it possible to assess these factors using a longitudinal study design. The project began in 1978 with students in Grade 7 of junior high school (age 13 years) and concluded in 1980 when the students reached Grade 9 (age 15 years). The follow-up study included four additional surveys. The present analyses are based on the data collected at ages 15, 21 and 28. The original sample comprised 903 students and the response rate of the last survey was 71%. A quarter (26%) of daily smokers and about half (46%) of occasional smokers at age of 15 had quit by the age of 28. The cessation rate was higher among females than males (P = 0.006). The cessation rate was higher among married (P = 0.015), employed (P = 0.01) and white-collar workers (P = 0.006). Cessation was less prevalent among those who had friends (P < 0.001) and family (P = 0.012) members who smoked. The cessation rate was lower among those who consumed fatty milk (P = 0.050), had less leisure-time physical activity (P = 0.032) and consumed more alcohol (P < 0.001). One-third of all teenage smokers stop smoking before the age of 28, averaging a 2.3% annual decline. Cessation is greater among occasional than daily smokers and greater overall among females.

Using the mass-media to target obesity: an analysis of the characteristics and reported behaviour change of participants in the BBC's 'Fighting Fat, Fighting Fit' campaign

Abstract: The study aimed to assess the characteristics and reported behaviour change of participants in the BBC's 'Fighting Fat, Fighting Fit' (FFFF) campaign. A postal questionnaire survey was sent to a random sample of 6000 adults registering with the FFFF campaign at the start of the campaign and 5 months later. Demographic characteristics, weight, eating behaviour and activity patterns were assessed. In total, 3661 respondents completed the baseline questionnaire and 2112 (58%) of these completed a follow-up evaluation questionnaire 5 months later. The majority of evaluation participants were women and classified as 'overweight' or 'obese'. Participants reported significant reductions in weight, and in fat and snack intake, and significant increases in exercise levels, and in fruit, vegetable and starch intake during the 6 months of the campaign. These effects remained significant if non-responders were assumed to have made no change. These results show that mass-media campaigns might make a contribution to weight control at the population level, but particular subgroups such as men and people under 25 may require specifically targeted campaigns. In addition, whilst such campaigns may initially attract obese people, they may be more likely to drop out of the campaign than overweight and normal weight individuals.

Rattling the plate—reasons and rationales for early weaning

Abstract: To identify a range of attitudes and beliefs which influence the timing of introduction to solid food, five focus group discussions were undertaken within a maternity hospital setting. These sessions explored early feeding behaviour, stimuli to changing feeding habits and subsequent responses in 22 primiparous and seven multiparous mothers (mean age 27.0+/-4.8 years) with babies aged 8-18 weeks (mean age 13.0+/-4.2 weeks). One-third of the participants had introduced solid food to their infants (mean age of introduction 11.6 weeks, range 2-16 weeks). Mothers believed that the introduction of solids was baby led and initiated by some physical characteristic or behavioural action of the infant. All mothers were aware of current recommendations to avoid the introduction of solid food until 4 months. Few knew why this should be and concepts of long-term ill health were difficult to conceptualize. The conflict between rigid feeding guidelines and flexible advice from supportive health professionals created confusion over the importance of good weaning practices. The current findings highlight issues relevant to the introduction of solid food, and provide a foundation for further research which can identify the relative importance of these factors and provide a rationale for the design of contemporary intervention strategies.

Gender and race differences in the predictors of daily health practices among older adults

Abstract: Preventive health behaviors are crucial for older adults' well-being. This study examined the factors that influence the practice of positive daily health behaviors over time in a sample of older adults (N = 1266) and investigated whether explanatory factors differ by health behavior, gender or race. Physical activity, weight maintenance, smoking, alcohol consumption and sleep patterns were examined as dependent variables. Independent variables included demographic characteristics, baseline health behavior, health status variables, psychological factors and social network characteristics. Results indicate that age and health status are important predictors of preventive health behaviors. However, the factors that predict preventive health behaviors vary by behavior, gender and race. The independent variables included in this study were most successful in explaining cigarette smoking and weight maintenance, and least successful in explaining amount of sleep. In addition, results suggest that social network variables are particularly influential for women's health behaviors, while health status is more influential among men. Greater education predicts better health behaviors among whites, while formal social integration seems particularly important for the health behaviors of older black women. These results indicate that examining older adults' health behaviors by race and gender leads to a fuller understanding of these behaviors.

Young people in `drinking' societies? Norwegian, Scottish and Swedish adolescents' perceptions of alcohol use

Abstract: The paper studies young people's reported drinking behaviors and their views on various social aspects of alcohol, utilizing a sample of over 4000 rural adolescents aged 11.8-16.5 years in Norway, Scotland and Sweden. The methodology employed includes a common questionnaire and a range of varying qualitative approaches (essays and focus group interviews). The various venues and drinking contexts used by young people, their motives for drinking, and their 'learning' experiences with alcohol are described. Beyond nationality, the most powerful predictors of 'high' drinking are 'involvement with friends' and 'participation in commercial leisure'. The predictors for 'low' drinking are 'involvement in activities with parents' and 'parental concerns about drinking'. Results show that Scottish teenagers drink most, Norwegians least and no differences in the predictor variables are found that can explain this. Results are discussed in relation to social and cultural differences, and illustrated by quotations from rural young people in Scotland and Sweden.

Barriers to STD/HIV prevention on the Internet

Abstract: Using the Internet as a mode for health promotion is appealing. There are important methodological considerations to the approach, but there are also important reasons why people will and will not participate in Internet interventions. This is a report on data from 4601 people who completed an online survey of sexual risk behavior in 2000. Most indicated they would visit a website for STD/HIV prevention information (61%), but fewer would open an E-mail (45%) or chat (30%) about the topic. Top reasons for rejecting website, E-mail and chat room education about STD/ HIV are given. Logistic regression results showed men who have sex with men (MSM) and persons with a history of testing for STD are consistently more likely to endorse STD/HIV prevention through chat rooms (MSM 1.8, STD testers 1.3), E-mail (MSM 1.6, STD testers 1.2) and websites (MSM 1.8, STD testers 1.2). The data demonstrate the Internet may facilitate health promotion among MSM who may not be reached in a publicly funded STD prevention setting. The Internet may also act as a good adjunct to STD information obtained in clinic settings among those who seek STD testing.

Enhancing learning through use of interactive tools on health-related websites

Abstract: The Internet offers a unique means of health promotion through the use of interactive tools like chat rooms, E-mail, hyperlinks and the like. This paper reports a study examining links between learning and interactivity of health-related websites. We address three research questions. First, are tools of interactivity present in health-related websites? Second, how prevalent is the occurrence of these interactive tools for three relevant top level domains (TLD) (e.g. .com, .gov and .org)? Finally, are there differences in how representative websites of diverse TLDs employ these interactive tools along nine dimensions of interactivity? A content analysis of 30 websites revealed that while the majority of sites in our sample do use interactive tools, overall the occurrence is quite low. An examination of the use of tools of interactivity across three different TLDs revealed that .com sites used a greater number of tools, followed by .gov sites and, lastly, .org sites. We also found support for our third research question, that different TLDs employ these tools of interactivity differently. How these differences may impact learning are discussed.

The benefits of anthropological approaches for health promotion research and practice

Abstract: In recent years health education practitioners have been looking for ways to extend the social psychological analysis of human behavior with approaches that focus on the cultural and social context of human behavior. In this article the value of the 'thick description' approach, borrowed from anthropology, is explored by examples from the Caribbean and South Africa. It demonstrates that an anthropological approach has much to offer as a basis for sound interventions for understanding human behavior. However, although an anthropological approach offers valuable starting points for interventions, its broad scope exceeds the traditional goals of health education (changing health beliefs, health counseling). Interventions will not aim at informing individuals, but at improving cultures. They may concern the change of basic cultural and social structures such as gender roles. To limit the risk of ethnocentrism, adequate ways need to be developed to make optimal use of the information thick description offers, while avoiding ethnocentrism. The article ends with a discussion concerning the assets of a dialogical approach towards health promotion. A dialogue between health promoters and their target population may help solve the problem of ethnocentrism in broadly scoped interventions.

Mass education for obesity prevention: the penetration of the BBC's `Fighting Fat, Fighting Fit' campaign

Abstract: The study aimed to evaluate the BBC's 'Fighting Fat, Fighting Fit' campaign's success in achieving public awareness of the need for obesity prevention, and putting over its message of healthy eating and increased physical activity. Demographic factors associated with awareness of the campaign were assessed. Data were collected from a national representative British sample as part of the ONS Omnibus survey in March 1999. Questions included weight and height, recognition of the campaign name, recall of the content of the campaign, and participation in the campaign registration scheme. More than half of the respondents had heard of the campaign and 30% recalled the healthy lifestyle messages, although fewer than 1% registered to participate in the scheme. Awareness of the campaign was high in all socio-economic groups, but memory for the healthy lifestyle message was significantly poorer in those with lower levels of education and from ethnic minority groups. Disappointingly, awareness was also no higher in overweight than normal weight respondents. The results strongly support the effectiveness of the campaign in publicizing the issue of increasing prevalence of obesity and the need for lifestyle change, but suggest that different approaches might be needed to maximize participation from groups most in need of lifestyle change.

Determinants of implementing heart health promotion activities in Ontario public health units: a social ecological perspective

Abstract: This paper reports the results of a study undertaken to explain levels of implementation of heart health promotion activities observed in Ontario public health agencies in 1997. Organizational-level data were collected by surveying all 42 health departments in 1994, 1996 and 1997 as part of the Canadian Heart Health Initiative Ontario Project. Guided by social ecological and organizational theories, the model examines relationships between implementation and four sets of possible determinants of activity: (1) the predisposition of agencies to undertake heart health promotion activities, (2) their capacity to undertake these activities, (3) internal organizational factors and (4) external system factors. A small set of five variables explains almost half of the variance in implementation (R2 = 0.46): organizational capacity (beta = 0.40), priority given to heart health (beta = 0.36), coordination of programs (beta = 0.19), use of resource centers (beta = 0.12) and participation in networks (beta = 0.09). The results suggest that models integrating organizational and socio-ecological theories can help us understand the implementation of community-based heart health promotion activities by public health agencies. Implications for future research, policy and practice are discussed.

Predictors of intention to adhere to physiotherapy among women with urinary incontinence

Abstract: During the last decade, pelvic floor muscle exercise (PFME) therapy has proved its short-term efficacy among women with urinary incontinence. Long-term success with PFME therapy is hampered by non-adherence. So far, specific knowledge on determinants of adherence behavior has been scarce. A cross-sectional study was conducted to elucidate the relative importance of determinants of the intention to adhere to PFME therapy in women with urinary incontinence. Based on behavioral theories, literature research and interviews, a questionnaire measuring determinants of the intention to adhere to PFME therapy was developed. In total, 129 women, aged 17 years or over, with symptoms of urinary incontinence, completed this questionnaire. Multiple regression analysis with backward elimination was carried out to identify determinants that predict intention. Significant predictors of the intention to adhere to PFME therapy were the amount to urinary loss per wet episode and women's perception of their ability to do the exercises as recommended under various circumstances. Building self-efficacy might be a good starting point for health education interventions aiming to promote adherence to PFME therapy, which can be used by physiotherapists and general practitioners.

Knowledge, attitudes and self-care practices related to sun protection among secondary students in Australia

Abstract: The aim of this research was to ascertain changes in sun-related knowledge, attitudes and self-care practices among Australian secondary school students between 1993 and 1996. Two cross-sectional surveys of sun-related attitudes, beliefs and behavior of young people aged 12-17 years of age, were conducted in 1993 and 1996. Over 80% of adolescents at both time periods knew about the issues related to skin cancer prevention, frequency of burning and burning on cloudy days. Adolescent attitudes had shifted positively in the areas of staying inside in 1996 [relative risk (RR): 1.13; 95% confidence interval (CI): 1.09-1.17] and staying under shade in 1996 (RR: 1.16; 95% CI: 1.13-1.18). Desire for a moderate or dark tan was lower in 1996 (45%) than in 1993 (50%). Respondents reported that they were less likely to wear brief clothing to get a suntan in 1996 (RR: 0.81; 95% CI: 0.78-0.84) and were significantly more likely to stay in the shade in 1996 (RR: 1.19; 95% CI: 1.16-1.23). We conclude that there has been a shift in attitudes towards use of shade and avoidance of unnecessary exposure, and away from use of sunscreens and sunglasses. The results suggest that adolescents may be more ready to accept structural changes that move desired activities out of the sun.

Community-based HIV/AIDS education in rural Uganda: which channel is most effective?

Abstract: A process evaluation was conducted to evaluate four channels (drama, video, community educators and leaflets) used in a community-based IEC (Information, Education and Communication) HIV/AIDS intervention in rural Uganda. Semi-structured interviews (n = 37) and focus groups (n = 3) were held with community members working as field staff. In addition, two questionnaire surveys (n = 105 and n = 69) and eight focus groups were conducted with the target community. Over 85% of the community had seen at least one drama or video show. They rated them as relevant and realistic. However, the messages 'taken home' were not always those intended by the plays. Access to community educators (CEs) was not equal. The CEs had a tendency to avoid the educated, rich and their older relatives. Those who had met with a CE rated them as knowledgeable and trustworthy, but felt they would rather be taught by a trained health worker. Around 80% of the community said they had seen the leaflets, but had not necessarily read them. Although appreciated by some as reference material, low literacy levels and a lack of reading culture meant that some leaflets may have gone astray. These findings suggest that a multi-channel approach may be required to overcome weaknesses inherent in individual channels.

Effects of persuasive message order on coping with breast cancer information

Abstract: The current study explored the impact of varying the order of message components on coping with breast cancer information. In a 2 x 2 x 2 factorial design, threat information, coping information and order of information were manipulated. College students read persuasive essays that varied in emphasis on threat of developing breast cancer and effectiveness of breast self-examination (BSE) in averting the threat of cancer. Participants who read the high-threat message reported higher intentions to perform BSE, more rational problem solving and more hopelessness than did those who read a low-threat message. The coping information messages produced a similar pattern of results. In addition, those who read the high-coping message reported less fatalism than did participants who read the low-coping message. When threat information was presented first, the high-threat message led to less hopelessness and reliance on religious faith than when the coping information was presented first. These results demonstrate the threatening health information energizes one to act in both adaptive and maladaptive ways, and that coping information decreases the tendency to respond maladaptively to the health threat. They also suggest that the order of presentation of the information may affect the extent to which people respond adaptively.

How individuals coping with HIV/AIDS use the Internet

Abstract: Although identified 20 years ago, HIV/AIDS remains among the most serious disease epidemics of modern times. Because of the stigmatization associated with infection, no health crisis has rivaled HIV/AIDS in underscoring the need for emotional, informational and instrumental support. The critical role that support plays in coping with HIV/AIDS is well documented. Adults with HIV/AIDS have utilized traditional means of support--family, friends and community-based service organizations--in coping with their illness. Recently, however, the Internet has been recognized as a potential avenue for support. Although the Internet may prove promising, little is known about how the wide array of resources available via the Internet is used. The purpose of this study was to investigate how individuals with HIV/AIDS use the Internet in coping with their illness. This research study employed a descriptive qualitative design that used in-depth, semi-structured, face-to-face interviews for data collection. The sample of 10 purposefully selected individuals living with HIV/AIDS reflected diversity in gender, age, race, education, employment, number of years living with HIV/AIDS and Internet use. Data analysis guided by the constant comparative method revealed four themes. Individuals with HIV/AIDS use the Internet for finding information, making social connections, advocating and escaping.

The Revised Health Hardiness Inventory (RHHI-24): psychometric properties and relationship with self-reported health and health behavior in two Dutch samples

Abstract: Our objective was to examine the psychometric properties of a Dutch translation of the Health Hardiness Inventory (HHI), and to determine relationships between health hardiness scales and self-reported health and preventive health behavior. Data from a cross-sectional study with two samples [a general population sample (n = 205) and a student sample (n = 286)] were analyzed. The Revised Health Hardiness Inventory (RHHI-24) was found to consist of four stable and reliable scales: (1) Health Value, (2) Internal Health Locus of Control, (3) External Health Locus of Control and (4) Perceived Health Competence. Women valued their health more than men, older individuals (> 45 years) valued their health more than younger individuals ( 65 years) were more externally orientated with respect to health locus of control. Preventive health behavior was related to a higher value placed on health, a lower external health locus of control and a higher perceived health competence. Better self-reported health was related to a higher perceived health competence and a more internally orientated health locus of control. We conclude that the RHHI-24 is a theoretically sound instrument for the measurement of health cognitions.

Empowering counseling—a case study: nurse–patient encounter in a hospital

Abstract: This study illustrates practices that a nurse uses in order to empower patients. The emphasis is on speech formulae that encourage patients to discuss their concerns and to solicit information about impending surgery. The study is a part of a larger research project and a single case was selected for presentation in this article because it differed from the rest of the data by manifesting empowering practice. A videotaped nurse-patient health counseling session was conducted in a hospital and transcribed verbatim. The investigator interviewed the nurse and the patient after the conversation, and these interviews were transcribed as well. The encounter that is presented here as a case study is a concrete example of a counseling session during which the patient is free to discuss with the nurse. The empowering practices that the nurse employed were as follows: encouraging the patient to speak out, tactfully sounding out the patient's concerns and knowledge of impending surgery, listening to feedback, and building a positive vision of the future for the patient. We suggest that nurses should pay attention to verbal expression and forms of language. This enables them to gain self-awareness and discover new tools to work with.