Health Education Research - recent issues

Using radon risk to motivate smoking reduction II: randomized evaluation of brief telephone counseling and a targeted video

2008-03-19

Radon and cigarette smoking have synergistic effects on lung cancer risk. Electric utility company bill stuffers offered free radon test kits to households with at least one smoker. Participating households (n = 1364) were randomized within a 2 x 2 design to evaluate the main effects of brief telephone counseling and a targeted video on smoking cessation and the establishment of new household smoking bans. Phone counseling was associated with cessation at 3-month follow-up but neither intervention led to 12-month or sustained cessation. While neither intervention had a significant effect on new bans, there were trends in the predicted direction and the combination of the two significantly increased new bans compared with no intervention. The presence of children in the household was associated with new bans. While few households had high levels of radon, such levels were associated with radon mitigation behaviors. Together with a previous study, these results suggest radon risk is a useful and inexpensive way to engage smoking households in risk reduction behaviors, especially the institution of household smoking bans.

Changes in cognitive measures associated with a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT)

Burke, V., Mansour, J., Mori, T. A., Beilin, L. J., Cutt, H. E., Wilson, A. — 2008-03-19

Cognitive changes are reported infrequently in programs targeting cardiovascular risk. We examined self-efficacy, behavioral barriers and health beliefs in a lifestyle program for drug-treated hypertensives that aimed to reduce blood pressure, antihypertensive drug needs and cardiovascular risk. In a randomized controlled trial, we compared usual care (controls) and a 4-month program focusing on weight loss, diet and exercise. Outcomes were assessed at baseline, 4 months and 1-year follow-up. Of 241 individuals randomized, 102/123 in the program and 90/118 of controls completed follow-up. In the program group, dietary barriers fell by 14% at 4 months (controls 2%, P = 0.025) and by 8% at follow-up (controls 3%, P = 0.010). Exercise barriers fell by 11% at 4 months (controls 3%, P = 0.020) and 17% (controls 4%, P = 0.002) at follow-up. Dietary self-efficacy improved by 3% at 4 months (controls –1%, P = 0.003) and by 2% at follow-up (controls –1%, P = 0.051). Exercise self-efficacy increased by 8% at 4 months (controls 3%, P < 0.001) and by 5% at follow-up (controls 3%, P = 0.130). Changes in cognitive variables predicted changes in health-related behaviors at 4 months and follow-up. A cognitively based lifestyle program in treated hypertensives is associated with improvements in cognitive measures in the shorter and longer term.

Testing the transtheoretical model for fruit intake: comparing web-based tailored stage-matched and stage-mismatched feedback

de Vet, E., de Nooijer, J., de Vries, N. K., Brug, J. — 2008-03-19

A match–mismatch test was conducted to test the transtheoretical model applied to fruit intake. Precontemplators and contemplators were randomly assigned to receive a web-based individualized precontemplation feedback (PCF), contemplation feedback (CF) or action feedback (AF) letter promoting fruit intake. Immediately and 1 week after reading this letter, post-test measures were obtained. Fruit intake increased significantly between pre- and post-test in contemplators, but not in precontemplators. No differences between the feedback conditions were found in fruit intake, stage progression, use or credibility of the feedback in precontemplators and contemplators. In precontemplators, also no differences between the conditions were found in personal relevance of the feedback. Contemplators, however, rated AF as more personally relevant than PCF or CF. To conclude, the present study failed to show superiority of stage-matched information in the promotion of fruit intake.

Food, Fun and Fitness Internet program for girls: influencing log-on rate

2008-03-19

Internet-based interventions hold promise as an effective channel for reaching large numbers of youth. However, log-on rates, a measure of program dose, have been highly variable. Methods to enhance log-on rate are needed. Incentives may be an effective method. This paper reports the effect of reinforcement schedule and recruitment method on log-on rates to an 8-week Internet-based obesity prevention program. It also explores trends in log-on rate. Girls were randomized to receive immediate (weekly) or delayed (program end) incentives ($5). The study was powered to detect a moderate-to-large effect (0.65). Overall log-on rate was 74.5%. A higher but not statistically different log-on rate was observed in the immediate incentive group (79%) than in the delayed incentive group (70%) (P = 0.118), and among girls recruited via media (80%) as opposed to non-media methods (69%) (P = 0.058). Trend analysis indicated a significant drop in log-on rate between weeks 4 and 5 among all participants (P = 0.009). Although an acceptable log-on rate was achieved in this program, there was a substantial drop between weeks 4 and 5. Identifying the reason that this occurred may provide insight into how to further enhance log-on rate. Recruitment method may influence log-on rate.

Program characteristics and organizational factors affecting the implementation of a school-based indicated prevention program

Thaker, S., Steckler, A., Sanchez, V., Khatapoush, S., Rose, J., Hallfors, D. D. — 2008-03-19

Reconnecting Youth (RY) is a school-based drug prevention program designed to address academic, substance use and mood management goals among youth at risk of dropping out of high school. This paper presents the organizational factors and RY program characteristics that either promoted or hindered the implementation of the program during a randomized controlled effectiveness trial in 10 schools in two school districts in the United States. Data were collected using surveys and interviews from teachers and school and district staff who participated in the implementation of the RY program in these schools. Results suggest that certain RY program characteristics made it difficult to implement. Small class size, resource-intensive procedures for student selection and recruitment and special training, qualities and skills needed to be an effective RY teacher meant that schools had to significantly change their usual practices to implement the program. Organizational barriers included a lack of financial resources and leadership support for program implementation, and low priority for non-academic courses for high-risk students. Transient student populations, staff turnover and district-wide scheduling and curriculum changes all resulted in high levels of organizational turbulence at most schools, further hindering program implementation.

Health information seeking among Mbararan adolescents: results from the Uganda Media and You survey

Ybarra, M. L., Emenyonu, N., Nansera, D., Kiwanuka, J., Bangsberg, D. R. — 2008-03-19

To maximize scarce intervention dollars, pediatricians and other adolescent health professionals must position health promotion efforts in mediums that most effectively reach youth. This may be especially true in resource-limited settings where access to primary health care and medications is limited. To improve the efficiency and impact of disease prevention and health promotion efforts in resource-limited settings, we examine sources of health information cited by adolescents in Mbarara Uganda. Participants in the Uganda Media and You survey were students aged 12–18 (n = 500) randomly identified in five secondary schools in Mbarara municipality, Uganda. Ninety-three percent of eligible and invited youth completed the cross-sectional, pencil-and-paper survey. Four in five adolescents (81%) indicated they turned to parents, teachers, and other adults while around half read a book/went to the library (56%) or turned to siblings and friends (50%) for information about health and disease. More than one in three (38%) indicated that they used the computer and Internet to search for health information. Older versus younger respondents tended to rely upon siblings and friends for all types of health questions. On the other hand, younger versus older youth were significantly more likely to turn to parents, teachers, and other adults for their questions about sexual health. Adults may be an important component of effective disease prevention and health promotion campaigns. Multiple delivery methods may be especially effective for reaching older adolescents. Technology also may be an important health promotion tool in resource-limited settings.

School policies and binge drinking behaviours of school-aged children in Wales--a multilevel analysis

Desousa, C., Murphy, S., Roberts, C., Anderson, L. — 2008-03-19

Research has highlighted increased and earlier alcohol consumption among young people. This study aims to explore whether the type of school alcohol policy employed is associated with the frequent binge drinking behaviours of adolescents, after adjusting for known demographic and social factors. Integrated cross-sectional data were used from Welsh school surveys that assess the health behaviours of adolescents and school health policies. Frequent binge drinking was more likely to occur among older pupils, those living with one parent and pupils from more affluent backgrounds. Frequent binge drinking was also associated with pupils who bullied others, those with greater peer involvement and who felt pressured by schoolwork. The results suggested that strong parental and school bonds were protective factors against frequent binge drinking as were greater life satisfaction. Pupils who were bullied were less likely to have frequently binge drank. There was some evidence to suggest that written school policies are associated with lower likelihood of frequent binge drinking, in particular among boys and pupils with lower school attachment. However, there is a need for greater understanding of the differential population influence of school alcohol polices and an evaluation of their effectiveness.

Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations

2008-03-19

Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities.

Promotion of safe sex: evaluation of a community-level intervention programme in gay bars, saunas and sex shops

Godin, G., Naccache, H., Cote, F., Leclerc, R., Frechette, M., Alary, M. — 2008-03-19

This study was an evaluation of a safe sex promotion programme in gay bars, saunas and sex shops in Québec City. The impact of the intervention on safe sex was assessed by means of an interrupted sequential pre-interventions and post-interventions quasi-experimental design with independent samples. At each measurement time, ~320 individuals were recruited in gay bars and saunas and were invited to complete a self-administered questionnaire. The intervention had a significant impact on safe sex mainly among the 18–29 age group (relative risk = 0.71; 95% confidence interval [CI_95%] = 0.55–0.92), even after controlling for the effect of gay venue frequentation. Thus, the effect size of the intervention corresponds to a significant reduction of 29% in risky unprotected anal sex among this age group. Implementation of a theory-based community-level intervention has a positive impact on reducing unsafe sex practices, particularly among the 18–29 age group. However, if the preventive activities are not maintained on a regular basis, there is recrudescence in unsafe sex practices.

Starting young? Children's experiences of trying smoking during pre-adolescence

Milton, B., Woods, S. E., Dugdill, L., Porcellato, L., Springett, R. J. — 2008-03-19

Although the risks smoking poses to health are now well known, many young people continue to take up the habit. While numerous cross-sectional studies of adolescents have identified correlates of smoking initiation, much less prospective, longitudinal research has been conducted with young children to gather their accounts of early experiences of smoking, and this study fills that significant gap. Quantitative and qualitative data, collected using questionnaires, interviews and focus groups, are presented from the pre-adolescent phase of the Liverpool Longitudinal Study of Smoking. By age 11, 27% of the cohort had tried smoking, 13% had smoked repeatedly and 3% were smoking regularly. Rates of experimentation increased over time. Qualitative data revealed that curiosity and the role of peers were central to children's accounts of early smoking. By pre-adolescence, children are at different stages in their smoking careers, therefore interventions must be targeted to their varied experiences. Current prevention strategies often focus on restricting access to cigarettes, but a broad range of intervention measures is required which take account of the multifactorial nature of smoking onset. To be effective, policies that aim to prevent smoking must be grounded in children's lived experiences.

Cost-effectiveness analyses of health promotion programs: a case study of smoking prevention and cessation among Dutch students

2008-03-19

Little research has been done to connect health promotion programs to outcomes in terms of life expectancy, health care costs and cost-effectiveness. For a policy maker, economic evaluation may be an important tool to support decisions on how to allocate the health care budget. The aim of this paper was to determine the cost-effectiveness of a Dutch school-based smoking education program. The incremental cost-effectiveness ratio of the school program was estimated at 19 900 per quality adjusted life year gained. For a complete analysis, not only intervention costs but also savings for smoking-related diseases and differences in total health care costs should be taken into account. As several assumptions had to be made in order to estimate cost-effectiveness, the study outcomes should be interpreted with caution. Main problem in estimating the cost-effectiveness was the lack of proper effectiveness data on daily smokers among adolescents. Absence of specific effectiveness data often is an obstacle in the economic evaluation of public health interventions. While some problems may be the result of insufficient sample size or follow-up, another possible explanation might be the different basic principles of analysis of health promoters and economists.

The forgotten dimensions in health education research

Hawks, S. R., Smith, T., Thomas, H. G., Christley, H. S., Meinzer, N., Pyne, A. — 2008-03-19

This paper evaluates the content focus of health education research as presented in the professional literature over a 6-year period (2000–2005). The majority of research (1365 papers) addresses the physical dimension of health (79%), while other health dimensions receive less attention. It is argued that the current content focus of research in health education fails to harmonize with the multidimensional, dynamic and functional nature of health as generally defined. The goal of health education, positive behavior change, also seems less reachable without a better understanding of how nonphysical dimensions of health influence wellness behaviors. At present, there exists an opportunity for health educators to move toward research agendas that more fully appreciate the interconnectedness of various dimensions of health and that evaluate them evenhandedly. Practical application of this approach will require a partial break from the biological orientations of other health professions, new research agendas that clarify multidimensional health relationships and new programs that seek to influence outcomes in a variety of dimensions.

Factors associated with children being driven to school: implications for walk to school programs

Wen, L. M., Fry, D., Rissel, C., Dirkis, H., Balafas, A., Merom, D. — 2008-03-19

In this study, we examined factors associated with children being driven to school. Participants were 1603 students (aged 9–11 years) and their parents from 24 public primary schools in inner western Sydney, Australia. Students recorded their modes of travel to and from school for 5 days in a student survey. Parents recorded their demographic data, their attitudes to travel, and their modes of travel to work, using a self-administered survey. An analysis of the two linked data sets found that 41% of students travelled by car to or from school for more than 5 trips per week. Almost a third (32%) of students walked all the way. Only 1% of students rode a bike and 22% used more than one mode of travel. Of those who were driven, 29% lived less than 1 km and a further 18% lived between 1 and 1.5 km from school. Factors associated with car travel (after adjusting for other potential confounders) were mode of parents’ travel to work, parent attitudes, number of cars in the household, and distance from home to school. To be effective, walk to school programs need to address the link between parent journey to work and student journey to school.

Tailored behavioral support for smoking reduction: development and pilot results of an innovative intervention

2008-03-19

Reduction of smoking may increase the likelihood of eventual smoking cessation among those not ready to quit. We describe the development and acceptance of a smoking-reduction intervention that integrates telephone counseling sessions with newsletters. A computer-assisted telephone interviewing program generates real-time-tailored counseling delivered by lay interviewers. Pilot participants (n = 53) were adult smokers scheduled for outpatient procedures in a health maintenance organization, randomized to intervention or a control condition (quarterly mailings). Smoking levels were measured by self-report and biochemically. Among intervention participants continuing at 3 months, all but one rated their telephone support person positively on all dimensions. Counseling calls were ‘about right’ in number, and newsletters were perceived as quite personal. Intervention recipients reported smoking significantly fewer mean cigarettes per day at 3 months than at baseline, and significantly fewer than control participants. Comparisons were non-significant under intent-to-treat analyses and on biochemical measures. The program was well received by outpatients who were not ready to quit smoking, and was implemented successfully by telephone staff who had no previous smoking cessation counseling experience. An ongoing trial is evaluating effectiveness, cost and relationship to eventual cessation.

Weight stigmatization and bias reduction: perspectives of overweight and obese adults

Puhl, R. M., Moss-Racusin, C. A., Schwartz, M. B., Brownell, K. D. — 2008-03-19

This study employed qualitative methods with a sample of overweight and obese adults to identify and describe their subjective experiences of weight bias. Participants (274 females and 44 males) completed an online battery of self-report questionnaires, including several open-ended questions about weight stigmatization. These questions asked them to describe their worst experiences of weight stigmatization, their perceptions of common weight-based stereotypes, their feelings about being overweight and their suggestions for strategies to reduce weight stigma in our culture. Participants reported experiencing weight stigma across a range of contexts and involving a variety of interpersonal sources. Close relationship partners (such as friends, parents and spouses) were the most common source of their worst stigmatizing encounters. Participants challenged common weight-based stereotypes (notably, that obese individuals are ‘lazy’) and reported that they would like the public to gain a better understanding of the difficulties of weight loss, the causes of obesity and the emotional consequences of being stigmatized. Education was reported as the most promising avenue for future stigma-reduction efforts. The experiences and opinions expressed were not significantly different for men versus women or overweight versus obese individuals. A minority of participants expressed beliefs suggestive of self-blame and internalization of weight-based stereotypes. These results indicate that while obese individuals experience weight bias across many domains, more stigma-reduction efforts should target stigmatizing encounters in close relationships, including parents, spouses and friends of obese persons.

Factors associated with recruitment and retention of youth into smoking cessation intervention studies--a review of the literature

2008-03-19

This paper examines factors associated with high levels of recruitment and retention of youth into smoking cessation interventions. Fifty-five articles published from 1976 to June 2004 reported cessation outcomes were analyzed to examine the associations between selected variables and recruitment and retention rates. Studies with participants who smoked ≤5 cigarettes per day (cpd) were more likely to have recruitment rates ≥85%. Yet, studies with participants who smoked ≥6 cpd were more likely to have high retention rates. Studies that did not use incentives were more likely to have retention rates at end of intervention ≥85%. Findings indicate a lack of information reported about recruitment and retention procedures in adolescent tobacco cessation studies. Additional analyses and research need to be conducted to identify successful methods.

The challenge of embracing a smoke-free lifestyle: a neglected area in smoking cessation programs

Segan, C. J., Borland, R., Hannan, A., Stillman, S. — 2008-01-16

Relapse prevention theory and practice has focussed on teaching coping skills to deal with withdrawal and temptations to relapse with the result that treatments appear to be effective in reducing relapse over the short term, but not over the longer term. Once cravings subside ex-smokers face a further task of adjusting to a smoke-free lifestyle that involves learning to think and act like a non-smoker. To highlight this task, we operationalized a new conceptual framework that describes three tasks of quitting (the 3Ts): (i) making a quit attempt; (ii) learning to effectively deal with cravings and withdrawal; and (iii) adapting to a smoke-free lifestyle. This was introduced to the Quitline service in Victoria, Australia, in preparation for a randomized controlled trial aimed at testing whether a program of four to six extra callbacks could help ex-smokers with the third task and as a result reduce rates of relapse compared with Quitline's standard callback program. This paper describes the conceptual framework (focussing on the third task) and initial reactions to it from both Quitline advisors and callers. The conceptual framework is now integrated in the service and appears to have changed the way Quitline operates and the apparent expectations of its clients.

Women's participation in a cervical cancer screening program in northern Peru

Winkler, J., Bingham, A., Coffey, P., Penn Handwerker, W. — 2008-01-16

Cervical cancer is often the most common cancer among women in developing countries, yet current screening efforts have not been effective in reducing incidence and mortality rates in these settings. In an effort to increase knowledge about screening participation in low-resource settings, this study sought to identify key factors affecting women's participation in a cervical screening program in north central Peru. We studied women who were exposed to various health promotion educational activities and compared a total of 156 women who sought screening between July 2001 and October 2003 with 155 women who did not. Results from logistic regression identified four significant predictors of screening: higher relative wealth, knowing other screened women, seeking care from a health facility when sick and satisfaction with services at the health facility. When we restricted our analysis to women who had experienced screening in the past, two additional predictors emerged: having a husband who was supportive of screening participation and attending an awareness-raising session. These results have important programmatic value for tailoring outreach efforts for women and indicate that different strategies may be required to best reach women who have never been screened.

Iatrogenic stigma in outpatient treatment for Hansen's disease (leprosy) in Brazil

White, C. — 2008-01-16

This paper explores how iatrogenic stigma, or stigma that is produced through a patient's encounter with physicians or with biomedicine in general, might emerge in outpatient treatment for Hansen's disease, or leprosy. Based on in-depth interviews with people affected by Hansen's disease and observations conducted at several public health clinics in Rio de Janeiro, Brazil, this research identified several aspects of the biomedical encounter that generated or contributed to stigma, either felt or enacted. Also noted in the research were positive examples of techniques used by physicians and health care workers for minimizing or circumventing stigma. The paper touches upon several topics, such as culturally mediated responses to medication side effects and communication between health care workers and patients, that might be salient or useful for health educators and others who are attempting to reduce health-related stigma.

Beneath the surface: discovering the unvoiced concerns of older adults with Type 2 diabetes mellitus

Tjia, J., Givens, J. L., Karlawish, J. H., Okoli-Umeweni, A., Barg, F. K. — 2008-01-16

Emerging clinical guidelines recommend shared decision making to individualize drug regimens for older adults with Type 2 diabetes mellitus. While the current health education campaign for diabetes in the United States recommends physician-initiated medication-related discussions about adherence and side effects, little emphasis is placed on soliciting patient concerns. This study's aim was to explore the concerns of older adults with diabetes about the complexity of their drug regimens and to determine whether they discussed medication-related concerns with their physician. Twenty-two patients with Type 2 diabetes age 65 years and older who used five or more medications were selected from an urban academic geriatric medicine practice in the United States. In-depth semi-structured interviews were conducted to uncover participants' perceptions of multiple medication use and related discussions with providers. The predominant theme that emerged was the variability in medication-related topics that patients perceived they could discuss with their physician. While most participants described physician-initiated discussions about adherence and side effects, many did not bring up concerns about medication cost or their desire to reduce medication burden. In order to encourage greater patient involvement in medication decision making for diabetes treatment, educational messages promoting patient–physician dialogue need to take more account of patient concerns.

Beyond Good Intentions: the development and evaluation of a proactive self-management course for patients recently diagnosed with Type 2 diabetes

Thoolen, B., de Ridder, D., Bensing, J., Gorter, K., Rutten, G. — 2008-01-16

This paper describes the development and first results of a brief self-management course for patients recently diagnosed with Type 2 diabetes. The intervention incorporates elements from proactive coping and self-regulation theory in a five-step plan to help newly diagnosed patients formulate and carry out intentions with regard to their self-management. The theoretical framework and course program are described, patient evaluations are summarized and proximal outcomes of the course will be analyzed, investigating whether the course is able to increase patients' proactive skills, goal attainment and confidence in dealing with self-management issues. Participants included 180 patients, diagnosed 3–33 months previously during a population screening. Participants were randomized into an intervention (n = 78) or control group (n = 102). Course evaluations were very positive, regardless of patients' demographic or medical background and participants were particularly positive about the five-step plan and potential for peer interaction. Compared with the control group, course participants improved significantly in terms of proactive coping, goal achievement and self-efficacy. An intervention based on proactive coping appears to meet the needs of patients newly diagnosed with Type 2 diabetes, teaching them new proactive skills, improving their goal achievement and increasing their self-efficacy in dealing with their self-management tasks.

Use of social network analysis to map the social relationships of staff and teachers at school

Hawe, P., Ghali, L. — 2008-01-16

Understanding the pre-existing social relationships in a setting is vital in health promotion, not only for understanding important people to get ‘on side’ with an intervention but also for appreciating how the intervention itself might change social structures. Social network analysis is a method for capturing the complexity of social relationships that has not been used widely in health promotion research. We present the results of an application in a high school. We characterize the school in terms of the density of relationships and the centrality of particular staff and teachers. We illustrate how simply being well-known or being nominated by lots of others as a person to turn to (a concept reflected in a person's degree centrality score) is not always the best guide for whom to select as an intervention champion. Indeed, for many interventions, a person's strategic connection to the most marginal people in a community, school or workplace could be the most important criteria (a concept better reflected by a person's betweenness centrality score). Given the ease of survey administration and the high yield in terms of analytic insight, we recommend that social network analysis be used more routinely in health promotion intervention design and evaluation.

Social psychological determinants of the use of performance-enhancing drugs by gym users

Wiefferink, C. H., Detmar, S. B., Coumans, B., Vogels, T., Paulussen, T. G. W. — 2008-01-16

The aim of this study is to identify the social psychological determinants of the use of performance-enhancing drugs by gym users who practice bodybuilding, fitness, powerlifting or combat sports. In this questionnaire-based study, 144 respondents answered questions on their actual use and intention to use such drugs and also on their background characteristics and beliefs, such as their attitudes, social influences and self-efficacy. While all social psychological determinants correlated with intention to use these drugs, the most important predictors were personal norms, beliefs about performance outcomes and the perceived behavior of others. Non-users held more restrictive norms about using performance-enhancing drugs, were less optimistic about the performance-enhancing outcomes and believed that fewer significant others used performance-enhancing drugs than users and ex-users. The results of this study indicate that users attribute advantages to performance-enhancing drugs and are inclined to overlook the risks of using them. Preventive interventions should focus on influencing personal norms and social processes.

Factors related to adolescents' estimation of peer smoking prevalence

Reid, J. L., Manske, S. R., Leatherdale, S. T. — 2008-01-16

Although adolescents who overestimate peer smoking prevalence are more likely to smoke, little research has focused on the factors associated with why the majority of adolescents overestimate peer smoking rate. The purpose of this study was to examine demographic, social, environmental and behavioural characteristics related to overestimation of peer smoking prevalence among secondary school students. The current study analysed data collected in two Canadian studies that used the Tobacco Module of the School Health Action, Planning and Evaluation System, a school-based questionnaire. One study surveyed 23 458 students (Grades 9–13) in 29 schools during 2001–02, and the other surveyed 25 452 students in 39 schools in 2003. Results of multiple logistic regression indicate that grade, gender, close friends’ smoking, seeing smoking at school, family members’ smoking, smoking in the home and smoking status have a clear association with overestimation; school smoking rate and susceptibility to smoking show a tentative relationship and warrant further study. Other factors may also be important for prevalence estimation, and further research is needed to identify these factors. Since adolescents tend to overestimate peer smoking prevalence and perceived prevalence is in turn linked to smoking behaviour, interventions should focus on creating realistic perceptions of smoking prevalence.

The impact of health education in managing self-reported arthritis-related illness among elderly persons in rural Bangladesh

Rana, A. K. M. M., Lundborg, C. S., Wahlin, A., Ahmed, S. M., Kabir, Z. N. — 2008-01-16

This study examines the impact of health education on prevalence of and expenditure on treatment of self-reported arthritis-related illness among elderly persons in rural Bangladesh. An intervention study was conducted, including 1135 elderly persons (≥60 years) from eight randomly selected villages, four each of an intervention and a control area. The analyses include 839 elderly persons who participated in both pre- and post-intervention surveys (intervention area: n = 425, control area: n = 414). Participants of the intervention area were further categorized as compliant (n = 315) and non-compliant (n = 110) based on adherence to the intervention instructions. The intervention that lasted for 15 months comprised home-based physical exercise, dietary instructions and other aspects of management. Results show that although there was no significant difference in self-reported arthritis-related illness between the compliant and non-compliant groups at baseline, it was significantly lower in the compliant group (71%) at post-intervention compared with the non-compliant (81%). Related monthly expenditure on treatment was significantly reduced in the compliant group (from Taka 104 to Taka 52) but not in the other two groups. Logistic regressions further showed that the control group had a higher probability of increased treatment-related expenditure compared with the compliant group (OR 2.0, 95% CI 1.4–2.8).

A snapshot of community-based research in Canada: Who? What? Why? How?

Flicker, S., Savan, B., Kolenda, B., Mildenberger, M. — 2008-01-16

Community-Based Research (CBR) is rapidly gaining recognitions as an important tool in addressing complex environmental, health and social problems. However, little is known about the Canadian CBR context. A web-based survey including 25 questions was circulated on listservs and via targeted e-mails to investigate the status of CBR in Canada. Univariate and bivariate statistical analyses were performed to examine variables and relationships of interest. Our sample included a cross-section of CBR community and academic practitioners (n = 308). Respondents reported a wide range of project foci, experience, operating budgets and reasons for engaging in their last CBR endeavor. Academic partners were perceived to be most involved at all stages of the research process except dissemination. Service providers were also perceived as being very involved in most stages of research. Community members were substantially less engaged. High levels of satisfaction were reported for both CBR processes and outcomes. Respondents reported a number of positive outcomes as a result of their research endeavors, including changes in both agency and government policies and programs. Our study shows that CBR practitioners are engaged in research on a wide array of Canadian health and social issues that is making a difference. Finding appropriate levels of participation for community members in CBR remains an ongoing challenge.

A video-based lifestyle intervention and changes in coronary risk

2008-01-16

If population-wide improvements in nutrition and physical activity behavior are to be made, behavior change interventions must use a variety of media. This study examines whether participation in a facilitator-based video version of the Coronary Health Improvement Project could significantly reduce coronary risk. A total of 28 video classes conducted in worksite, medical and community settings were used to teach 763 middle-aged adults, ages 30–79 years, about healthy lifestyles. Four to 8 weeks after baseline, follow-up measures were taken. Demographic and biometric data [body weight, body mass index (BMI), blood lipids, blood pressure and fasting blood glucose] were gathered. The class participants were evaluated in aggregate and showed significant improvements in body weight, BMI, resting heart rate, total cholesterol, low-density lipoprotein, triglycerides and fasting blood glucose. Males demonstrated greater improvement than females, and individuals with higher baseline health risks experienced the greatest reductions in risk. This video lifestyle change program appears to help participants make important lifestyle changes. For individuals empowered to make better choices regarding diet and exercise, significant improvements occurred in most coronary risk factors in as little as 4–6 weeks.

Factors associated with young children's self-perceived physical competence and self-reported physical activity

Sollerhed, A.-C., Apitzsch, E., Rastam, L., Ejlertsson, G. — 2008-01-16

The aim of this study was to identify factors associated with self-reported physical activity (PA), self-perceived physical fitness and competence in physical education (PE) among young children. The study included physical tests, anthropometric measures and a questionnaire. The study group comprised 206 children (114 boys and 92 girls, aged 8–12 years). Positive Odds Ratio was used in the logistic regression analyses. High level of self-reported PA was associated with membership of sport clubs and high self-perceived physical fitness. Variables associated with high self-perceived competence in PE were low age, high physical performance, living with both parents, high self-perceived physical fitness, male gender and enjoying PE. Variables associated with high self-perceived physical fitness were low age, high performance in endurance running, high self-reported PA, positive self-perceived body function and high self-perceived competence in PE. Correlations between children's self-perceived competence in PE and actual measured physical performance, between the self-perceived fitness and endurance performance and between self-reported PA and physical performance could be seen as a form of concurrent validity. One implication of the study for practitioners might be that children's own perceptions of their physical competence and activity levels could be used to roughly identify groups of children who are at risk of remaining physically inactive and therefore more prone to be unhealthy.

Community development and HIV/STI-related vulnerability among female sex workers in Rio de Janeiro, Brazil

Kerrigan, D., Telles, P., Torres, H., Overs, C., Castle, C. — 2008-01-16

The Sonagachi Project of Kolkata, India has been recognized as a model community development and human immunodeficiency virus/sexually transmitted infection (HIV/STI) prevention intervention among female sex workers. Limited research has been conducted regarding its applicability outside the South Asian context. This study sought to document the process and effectiveness of integrating community development activities based on the Sonagachi model into an ongoing HIV/STI peer education program with female sex workers in Rio de Janeiro, Brazil. Structured cross-sectional surveys examining HIV/STI-related behaviors and community development measures were conducted among ~500 sex workers at pre- and post-intervention. We found that several community development components including social cohesion and mutual aid were significantly associated with consistent condom use among sex workers and their paying clients at pre-intervention. However, only a minority of women actively engaged in community-building activities over the 18-month study period. In turn, limited changes in community development components and no significant increases in the HIV/STI-related protective behaviors assessed were documented. Findings indicate that internalized stigma and socioeconomic pressures may have constrained the scope and pace of community mobilization in this setting during the study observation period.

Reducing antibiotics for colds and flu: a student-taught program

Cebotarenco, N., Bush, P. J. — 2008-01-16

A student peer-taught program, to decrease antibiotic use for colds and flu, was developed and implemented in one school district (21 schools) in Chisinau, Moldova, in 2003–04. A second district (20 schools) served as the control (C). Students (12–13 years) and adults most responsible for the family's health care completed surveys in March pre–post intervention. The surveys determined the reported incidence of colds and flu during the past winter, treatment, beliefs about cause and usefulness of antibiotics. The intervention included peer-education sessions, parents' meetings, booklet, vignette video, newsletters, poster and poster contest. The intervention also provided basic information on appropriate use of medicines. Pre–post intervention survey results indicated that the intervention was successful. Adjusted for Cs, students who reported they did not treat colds or flu with antibiotics increased 33.7%; the comparable increase for adults was 38.0%. Adjusted for Cs, intervention students who did not know if they had used an antibiotic decreased 15.1% and for intervention adults the comparable decrease was 5.0%. All relative responses related to beliefs about the cause of colds and flu and the usefulness of antibiotics to treat them changed in a positive direction. In all groups, beliefs and behaviors relative to antibiotic use were related.

Factors associated with the duration of exclusive breast-feeding in asthmatic families

Gijsbers, B., Mesters, I., Knottnerus, J. A., van Schayck, C. P. — 2008-01-16

This study was part of a randomized controlled trial in which verbal and written advice about exclusive breast-feeding for 6 months was provided to Dutch women expecting a child with a high risk of developing asthmatic traits. Eighty-nine women completed a theory-based self-report questionnaire between the third and sixth months of pregnancy, which served as the baseline measurement. The aim of this study was to examine the factors that influence the duration of exclusive breast-feeding. Cox multiple regression analysis showed a positive significant association between the duration of exclusive breast-feeding and the mother's breast-feeding knowledge (P < 0.01), her intended hours of work per week after maternity leave (P < 0.01) and her age (P ≤ 0.05). Short-term, that is <5 weeks, or no previous breast-feeding experience of multiparous women appeared to be negatively associated with the duration of breast-feeding (P < 0.001). Furthermore, women who received the educational programme were more likely to succeed in breast-feeding exclusively for 6 months than the control group (48% versus 27%, P < 0.05). This study suggests that extra educational support is beneficial, and especially necessary for multiparous women with an earlier short-term, <5 weeks, or no breast-feeding experience, since they are at risk of discontinuing exclusive breast-feeding before completing the advisable 6-month period.

An Internet-based diabetes self-care intervention tailored to self-efficacy

Wangberg, S. C. — 2008-01-16

The main objective of this study was to assess whether self-efficacy (SE) could function as a moderator of the effect of a tailored Internet-based intervention aimed at increasing self-reported diabetes self-care behaviours. In a two-group, 1-month interval pre-test–post-test randomized controlled trial, participants (N = 64) were assigned at random to either a group that received an intervention on the area of self-care (blood glucose monitoring, diet management or physical activity) for which the reported SE was lowest (LSE group) or to a group that received an intervention on area of self-care for which the reported SE was highest (HSE group). Improvements in self-care were observed for both groups, but the HSE group improved more. Self-care also increased for those areas that the intervention did not target. Furthermore, SE levels decreased from baseline to follow-up. This study suggests that SE can function as a moderator in a behavioural intervention for diabetes self-care, and hence that initial level of SE provides relevant information for tailoring such interventions.

Comparing MSM in the Southeastern United States who participated in an HIV prevention chat room-based outreach intervention and those who did not: how different are the baseline HIV-risk profiles?

Rhodes, S. D., Hergenrather, K. C., Yee, L. J., Ramsey, B. — 2008-01-16

Chat room-based human immunodeficiency virus (HIV) prevention interventions are being implemented to reduce the risk of HIV exposure, infection and reinfection among men who have sex with men (MSM). However, little is known about how participants in chat room-based prevention interventions differ from their online non-participating peers. This analysis compared the baseline risk profiles of participants in an HIV prevention intervention (‘active recruitment’) to their chat room peers who did not participate in the intervention (‘passive recruitment’). Data were collected using an online brief risk assessment from MSM (N = 448) who were recruited within Internet chat rooms. Mean age was 30 years. Half self-identified as Black or African American, 29% as White and 64% as gay. Compared with participants, non-participants were more likely to report: spending higher mean number of hours in online chat rooms; using condoms inconsistently during anal intercourse with a man met online during the past 3 months; having had an sexually transmitted disease; being HIV seropositive; using methamphetamines during the past 30 days and using drugs to enhance sexual satisfaction during the past 30 days. Although risk among MSM who use chat rooms remains high, those at greater risk may be those who are less likely to engage in online HIV prevention interventions.

Asthma patient education opportunities in predominantly minority urban communities

Zayas, L. E., McLean, D. — 2007-11-17

Disenfranchised ethnic minority communities in the urban United States experience a high burden of asthma. Conventional office-based patient education often is insufficient to promote proper asthma management and coping practices responsive to minority patients' environments. This paper explores existing and alternative asthma information and education sources in three urban minority communities in western New York State to help design other practical educational interventions. Four focus groups (n = 59) and four town hall meetings (n = 109) were conducted in one Hispanic and two black communities. Focus groups included adult asthmatics or caretakers of asthmatics, and town meetings were open to all residents. A critical theory perspective informed the study. Asthma information and education sources, perceptions of asthma and ways of coping were elicited through semi-structured interviews. Data analysis followed a theory-driven immersion–crystallization approach. Several asthma education and information resources from the health care system, media, public institutions and communities were identified. Intervention recommendations highlighted asthma workshops that recognize participants as teachers and learners, offer social support, promote advocacy, are culturally appropriate and community-based and include health care professionals. Community-based, group health education couched on people's experiences and societal conditions offers unique opportunities for patient asthma care empowerment in minority urban communities.

Young people, smoking and gender a qualitative exploration

Amos, A., Bostock, Y. — 2007-11-17

Smoking among young people has become increasingly gendered. In several countries, smoking among adolescent girls is now higher than among adolescent boys. However, we have only a limited understanding of the reasons behind these gender patterns. This paper reports the findings from a qualitative study which used single-sex focus groups to explore the gendered nature of the meaning and function of smoking among Scottish 15- to 16-year old smokers. The study found that young people were ambivalent about their smoking but that this was somewhat different for boys and girls. These differences related to their social worlds, pattern of social relationships, interests, activities and concerns, the meanings they attached to smoking and the role smoking played in dealing with the everyday experience of being a boy or girl in their mid-teens. For example, boys were concerned about the impact of smoking on their fitness and sport, whereas girls were more concerned about the negative aesthetic effects such as their clothes and bodies smelling of smoke. Of particular importance was how smoking related in different ways to the gendered ‘identity work’ that adolescents had to undertake to achieve a socially and culturally acceptable image. The implications for programmes aimed at reducing smoking among young people, particularly the need for more gender-sensitive approaches, are discussed.

The impact of school smoking policies and student perceptions of enforcement on school smoking prevalence and location of smoking

Lovato, C. Y., Sabiston, C. M., Hadd, V., Nykiforuk, C. I. J., Campbell, H. S. — 2007-11-17

The purpose of this study was to comprehensively assess the impact of school tobacco policy intention, implementation and students' perceptions of policy enforcement on smoking rates and location of tobacco use during the school day. Data were obtained from all students in Grades 10–11 (n = 22 318) in 81 randomly selected schools from five Canadian provinces. Policy intention was assessed by coding written school tobacco policies. School administrators most familiar with the tobacco policy completed a survey to assess policy implementation. Results revealed policy intention and implementation subscales did not significantly predict school smoking prevalence but resulted in moderate prediction of tobacco use on school property (R² = 0.21–0.27). Students' perceptions of policy enforcement significantly predicted school smoking prevalence (R² = 0.36) and location of tobacco use (R² = 0.23–0.63). The research findings emphasize: (i) the need to consider both written policy intention and actual policy implementation and (ii) the existence of a policy is not effective in controlling tobacco use unless the policy is implemented and is perceived to be strongly enforced.

'If I don't smoke, I'm not a real man' Indonesian teenage boys' views about smoking

Ng, N., Weinehall, L., Ohman, A. — 2007-11-17

With a lack of tobacco control and regulation at the national level, Indonesia has been targeted by many national and transnational tobacco companies. The prevalence of youth smokers in Indonesia in 2005 was 38% among boys and 5.3% among girls. The aim of this study was to describe and analyse beliefs, norms and values about smoking among teenage boys in a rural setting in Java, Indonesia. Six focus group discussions with boys aged 13–17 years were conducted using a thematic discussion guide. Four themes were derived from the descriptive content analysis: (i) smoking as a culturally internalized habit, (ii) striving to become a man, (iii) the way we smoke is not dangerous and (iv) the struggle against dependency. Cultural resistance against women smoking in Indonesia remains strong. The use of tobacco in the construction of masculinity underlines the importance of gender-specific intervention. National tobacco control policy should emphasize a smoking-free society as the norm, especially among boys and men, and regulations regarding the banning of smoking should be enforced at all levels and areas of community. A comprehensive community intervention programme on smoking prevention and cessation should be a major focus of tobacco control policies in Indonesia.

Social construction and cultural meanings of STI/HIV-related terminology among Nguni-speaking inmates and warders in four South African correctional facilities

2007-11-17

Cultural sensitivity is increasingly recognized as a means to enhance the effectiveness of health promotion programmes all over the world. Sociocultural meanings and terminology of diseases are important in understanding how different groups perceive and interpret illness. This study was conducted as part of the process of developing and adapting a sexually transmitted infection (STI)/HIV peer led health education intervention for soon-to-be-released inmates who were predominantly Nguni speakers in South Africa. Two focus group discussions (FGDs) were conducted with prison inmates in each of four facilities. Additionally, one FGD was conducted in each prison with non-health trained (custodial) personnel who were Nguni speakers from the same community (n = 27). The data revealed unique terminology and meanings attached to several biomedically defined STIs. These sociocultural constructions were not limited to inmates as findings from warders' discussions showed a similar pattern. Moreover, we found the existence of a number of traditional ‘folk’ STIs and culture-specific prevention methods. These conceptualizations influence reported health-care-seeking behaviour, where dual consultation of traditional healers and biomedical remedies is widely practiced. The research has biopsychological as well as cultural implications for the development and adaptation of contextually relevant health promotion interventions.

Understanding physical activity participation in members of an African American church: a qualitative study

2007-11-17

Faith-based interventions hold promise for increasing physical activity (PA) and thereby reducing health disparities. This paper examines the perceived influences on PA participation, the link between spirituality and health behaviors and the role of the church in promoting PA in African Americans. Participants (n = 44) were adult members of African American churches in South Carolina. In preparation for a faith-based intervention, eight focus groups were conducted with sedentary or underactive participants. Groups were stratified by age (<55 years versus ≥55 years), geography and gender. Four general categories were determined from the focus groups: spirituality, barriers, enablers and desired PA programs. Personal, social, community and environmental barriers and enablers were described by both men and women, with no apparent differences by age. Additionally, both men and women mentioned aerobics, walking programs, sports and classes specifically for older adults as PA programs they would like available at church. This study provides useful information for understanding the attitudes and experiences with exercise among African Americans, and provides a foundation for promoting PA through interventions with this population by incorporating spirituality, culturally specific activities and social support within the church.

'I wouldn't have been interested in just sitting round a table talking about cancer'; exploring the experiences of women with breast cancer in a group exercise trial

2007-11-17

There is evidence that physical activity improves the psychological and physical health of patients with cancer. However, relatively little attention has been paid to understanding their experiences of exercise. This focus group study explored the experiences of women undergoing treatment for breast cancer who had taken part in a supervised group exercise trial. We found that setting up classes solely for women with breast cancer, led by an expert instructor, helped to reduce gender-related barriers to physical activity, such as difficulties in prioritizing exercise over caring roles and worries about changed appearance. For example, some women challenged traditional expectations of femininity by removing their wigs in the classes in order to exercise in comfort. Respondents valued exercising with women in the ‘same boat’ because of the empathy and acceptance they received and the opportunities to exchange information and form friendships. However, the action-orientated format of the group was preferred to a talk-based format such as a support group; some respondents felt that the ‘last thing’ they wished to do was to talk about cancer. Our findings therefore challenge stereotypes about women invariably preferring to cope with cancer through emotional disclosure.

Facilitators and barriers to adoption of evidence-based perinatal care in Latin American hospitals: a qualitative study

2007-11-17

Selective episiotomy and the active management of labor have been shown by numerous studies to benefit women's experience of labor as well as its outcomes. However, many Latin American public hospitals have not updated their clinical practices to reflect these findings. Limited access to new knowledge, limited time and physical resources and attitudes resistant to change are factors limiting the adoption of new practices in such hospitals. Interviews were conducted with three department heads, and focus groups were conducted with 31 physicians and midwives working in 10 public hospitals in Argentina and Uruguay. All were asked about facilitators and barriers to making changes in clinical practice. In addition, three focus groups were conducted with 16 pregnant women served by public hospitals. Responses were grouped according to stages of change in incorporating new evidence into practice. Numerous facilitators and barriers were identified by participants, as well as potential strategies for promoting change that could be incorporated into interventions. Barriers included limited access to information, negative attitudes toward changes in practice, lack of skills in performing new practices, lack of medical resources and explicit guidelines and a perceived need to practice defensive medicine. Changing long-standing clinical practice is difficult. Interventions must be adapted to translate evidence-based approaches to new cultures and contexts. Improving information access, use of role models, skill development and improved resources and support may be effective ways to overcome barriers to change in Latin American obstetric care.

Social capital: implications from an investigation of illegal anabolic steroid networks

Maycock, B. R., Howat, P. — 2007-11-17

Numerous studies have linked the constructs of social capital with behaviours that are health enhancing. The factors of social trust, social cohesion, sense of belonging, civic involvement, volunteer activity, social engagement and social reciprocity are all associated with social capital and their existence is often linked with communities or settings where health enhancement is high. Utilizing an interpretive perspective, this paper demonstrates how the existence of social capital may enhance the transition into drug use, the experience of using an illegal drug and decrease the risk of detection. It highlights how social capital may contribute to behaviours which are not health enhancing. Using a variety of data, including participant observation of 147 male anabolic steroid users and 98 semi-structured in-depth interviews with male anabolic steroid users, dealers and distributors it was found that social capital facilitated the operation of the illegal anabolic steroid distribution network. The subcultural norms and social trust that existed within the network allowed anabolic steroid dealers to sell the drug to others with reduced risk of detection. It is argued that social capital facilitates the distribution of illegal anabolic steroids and that social capital is a non-discriminatory concept, that may enhance both negative and positive health-related behaviours.

The changing meanings of participation in school-based health education and health promotion: the participants' voices

Simovska, V. — 2007-11-17

This paper addresses the issue of student participation and learning about health from the perspective of health-promoting schools. The combination of the democratic approach to health-promoting schools, characterized by the concepts of student participation and action competence, and the sociocultural theory of learning provides the conceptual framework for the discussion. The two sets of concepts help the building of a heuristic that views teaching and learning as mutually constitutive, establishing an integrated unit of analysis. Data are generated from a Web-based international project ‘Young Minds exploring links between youth, culture and health’. The project has its roots in the European Network of Health Promoting Schools (ENHPS). The methodological framework is constructed as theoretically based qualitative case study, using Web contents analysis and interviews with the participating teachers and students. A model distinguishing between two different qualities of student participation—token and genuine—is used as an analytical tool in analyzing the empirical data. The analysis of the case study illuminated the trajectories of participation in which students learned about health in intentional, relational and purposeful ways. These participation trajectories were viewed as situated in activity structures consisting of a variety of mutual interactions and different forms of participation.

'You think you know? ... You have no idea': youth participation in health policy development

Percy-Smith, B. — 2007-11-17

This paper draws on research in the United Kingdom which set out to explore young people's understandings and experiences of health as experienced in their everyday lives and according to their own terms of reference, rather than in response to policy priorities. The project involved a peer research process followed by a large community learning event in which practitioners, community leaders and decision makers were brought together in dialogue with young people to develop understanding and explore responses to young people's health needs as a collaborative process. The paper documents an ‘alternative’ ‘participative action research’ approach to involving young people in research and developing responses to issues and problems that affect them. The paper highlights the value of a dialogical and enquiry-based approach supported by the use of visuals for engaging professionals in collaboration with young people in a process of learning for change. It draws attention to the ‘policy gap’ between professional understandings of young people's health needs and young people's lived realities and how this is reflected in differences in what young people and professionals consider appropriate responses to stress.

'Binge drinking? It's good, it's harmless fun': a discourse analysis of accounts of female undergraduate drinking in Scotland

Guise, J. M. F., Gill, J. S. — 2007-11-17

Binge drinking in young people, particularly females and students, is a source of some concern to those engaged in health education. The concept is usually defined in terms of quantities of alcohol consumed within a relatively short space of time. Research suggests that reasons for drinking are varied, and are likely to be influenced by culture and context. This study aimed to explore issues important to female undergraduate students in Scotland. Semi-structured interviews were carried out with 19 participants who were asked to describe what they understand by the term ‘binge drinking’, why they drink and what might trigger excessive consumption. Discourse analysis was used to explore the possible ‘functions’ of what was said, as well as the content. Participants showed sensitivity to how others might interpret their responses. They described binge drinking in terms of its behavioural effects rather than quantities consumed. Crucially, they positioned themselves outside the categories of ‘serious’ or ‘anti-social’ drinkers. These findings have important implications for our understanding of factors influencing drinking behaviour in this group of people, which in turn impacts on the potential design of health-enhancing interventions. The study also demonstrates the usefulness of a discourse analytic approach to accounts of drinking behaviour.

Health education in rural settings in Ghana: a methodological approach

Gokah, T. K. — 2007-11-17

Although the search for appropriate methodology in educating and training rural community populations is on going, previous efforts have yielded few results, some of which have not been successful with consequences for scarce resources. This paper, based on field reports from the Population Communication Project in Ghana, demonstrates that community learning theory can offer understanding of appropriate methodology in rural learning, education and training. The report shows steps used in educating people in Wusuta (a rural community) on health and environmental issues in the community using a mix of traditional and modern approaches. The result shows that the community internalized learning activity and were able to relate their learning experiences to existing traditional values and the need for action. The paper thus offers the method as a solution to rural population training and learning methodology.

The development and evaluation of written medicines information for Type 2 diabetes

Lee, D. Y. L., Armour, C., Krass, I. — 2007-11-17

Written Medicines Information (WMI) is regarded as a key component in diabetes consumer education. In Australia, there is a paucity of WMI that specifically tailors to the extensive array of medicines used for the lifelong management of Type 2 diabetes. This research project aimed to employ a novel framework, the ‘Consumer Involvement Cycle’, to investigate consumer perspectives and needs of medicines information for Type 2 diabetes and develop appropriate WMI for the Type 2 diabetes population. The Consumer Involvement Cycle involved people with Type 2 diabetes and health professionals (HPs) working in partnership to design a series of WMI, incorporating a range of consumer-conceived ideas and concepts with professional evaluation from an expert panel of reviewing HPs. A total of 12 leaflets were developed. The Flesch-Kincaid Grade Level Score for the leaflets was approximately 8.0, which is considered to be ‘fairly easy’, in other words easily understood by a large proportion of the general public. The Consumer Involvement Cycle was validated as a useful framework in developing and evaluating appropriate consumer information. Consumer perspectives should be sought and well incorporated throughout the process of designing and assessing educational materials intended for consumer use.

IUHPE NEWS

2007-11-17