Dirt and diarrhoea: formative research in hygiene promotion programmes.
(17/7064)
Investment in the promotion of better hygiene for the prevention of diarrhoeal diseases and as a component of water and sanitation programmes is increasing. Before designing programmes capable of sustainably modifying hygiene behaviour in large populations, valid answers to a number of basic questions concerning the site and the intended beneficiaries have to be obtained. Such questions include 'what practices favour the transmission of enteric pathogens?', 'what advantages will be perceived by those who adopt safe practices?' and 'what channels of communication are currently employed by the target population?' A study of hygiene and diarrhoea in Bobo-Dioulasso, Burkina Faso, used a mixture of methods to address such questions. This paper draws on that experience to propose a plan of preliminary research using a variety of techniques which could be implemented over a period of a few months by planners of hygiene promotion programmes. The techniques discussed include structured observation, focus group discussions and behavioural trials. Modest investment in such systematic formative research with clear and limited goals is likely to be repaid many times over in the increased effectiveness of hygiene promotion programmes. (+info)
Provocative appeals in anti-smoking mass media campaigns targeting adolescents--the accumulated effect of multiple exposures.
(18/7064)
This paper reports findings from a longitudinal study that evaluated the accumulated effect of three consecutive mass media campaigns using provocative and dissonance arousing appeals to prevent cigarette smoking by adolescents. In the spring of 1992, all eligible adolescents aged 14 and 15 in one intervention county (N = 4898) and one control county (N = 5439) in Norway were included in the study, and were followed until they were 17 and 18 years of age in 1995. Only students who completed questionnaires both in 1992 and 1995 were included in the analyses. Among the non-smokers at baseline, a significantly lower proportion of adolescents of both genders had started to smoke in the intervention county compared to the proportion in the control county. Among those who were smokers at baseline, significantly more girls in the intervention county had stopped smoking than in the control county, while no significant difference between the counties was detected among boys. Our findings suggest that provocative and dissonance arousing appeals that create affective reactions and lead to interpersonal communication should be given more attention in campaigns designed to influence adolescent smoking. However, such appeals may easily produce negative reactions and the normative context should be thoroughly considered when using such appeals in future interventions. (+info)
A successful tobacco cessation program led by primary care nurses in a managed care setting.
(19/7064)
We conducted a descriptive study of a tobacco cessation program sponsored by a health maintenance organization (HMO) and led by primary care nurses. The tobacco cessation program was conducted at 20 primary care clinics in northeastern and central Pennsylvania. We gauged the successfulness of the program by the patients' self-reported quit rates at 1 year. We also examined the association between quit rates and compliance with scheduled counseling visits, the impact of the availability of an HMO pharmacy benefit that supported the costs of nicotine replacement therapy, and the quit rates among patients with HMO insurance versus those with insurance other than managed care. Of 1,695 patients enrolled in the program from July 1993 to March 1996, 1,140 completed 1 year of follow-up. Of these, 348 (30.5%) reported they had quit using tobacco. Among the 810 HMO enrollees who participated in the program, the quit rate was 280 (34.6%); among the 330 non-HMO participants, the quit rate was 69 (20.9%), a statistically significant difference (P < 0.001). For all patients, keeping more than four visits with the program nurse was associated with a significantly higher likelihood of quitting (317/751 [42.2%] versus 32/389 [8.2%]; P < 0.001). Non-HMO patients were less likely than HMO enrollees to keep four or more visits (165 [50%] versus 586 [72.3%]; P < 0.001). We were unable to detect a difference in quit rates among those with and those without a pharmacy benefit (196/577 [34%] versus 84/233 [36.1%]). These data are limited by their descriptive nature and the lack of information about other factors important in determining the quit rate among program participants. Nevertheless, they suggest that HMOs can successfully sponsor nurse-led tobacco cessation programs in multiple primary care settings and achieve 1-year quit rates significantly higher than the 15% quit rate reported in the medical literature. In addition, successfully quitting tobacco use appeared to be associated with use of counseling visits but not with use of a pharmacy benefit to pay for nicotine replacement therapy. Even though tobacco cessation programs have the best chance of benefitting HMO enrollees, patients not enrolled in managed care plans also appear to benefit significantly. This finding has important implications for developing future strategies--including the role of managed care organizations, the need to defray the costs of nicotine replacement therapy, and the best approach to provide counseling to patients--to meet the Healthy People 2000 goal of reducing tobacco smoking. (+info)
Exploring self-care and wellness: a model for pharmacist compensation by managed care organizations.
(20/7064)
Self-care and wellness are rapidly becoming mainstays of practice for many pharmacists. Consumer confidence and trust in pharmacists provides continuing opportunities for pharmacists to create products and services to satisfy consumer demands related to disease prevention and healthcare delivery. We outline two pharmacy wellness programs designed to meet consumer needs, and offer them as models for pharmacists. Issues related to the program and extent of involvement by pharmacists are raised, including the role of the pharmacists in behavior modification efforts; selecting areas of focus (e.g., smoking cessation); working with physicians for referrals; enlightening community business leaders and managed care organizations to the economic benefits of the program; and developing strategies for fair purchase of services to achieve program goals and provide adequate compensation in return. (+info)
AIDS information needs: conceptual and content analyses of questions asked of AIDS information hotlines.
(21/7064)
Dissemination of accurate information about HIV is an essential element of national AIDS prevention strategies and AIDS telephone hotlines serve a vital function in providing such information. In this study, questions asked of two AIDS information hotlines were collected and examined to determine the AIDS information needs of the general public. Questions asked of local AIDS lines in Houston and Milwaukee (N = 1611) were independently classified into 30 content areas, with two independent raters achieving 94% agreement. The content areas were organized for analysis into 11 broader information domains. Questions about HIV antibody testing were the most frequently asked (27%), followed by questions about sexual transmission of HIV (16%), HIV-related symptoms (16%) and situations that do not confer risk for HIV infection (14%). Content analyses suggested that individuals were motivated to call hotlines by fears of contracting HIV from actual risk behaviors or to dismiss concerns about contracting HIV through casual modes. Many individuals had information needs related to their own personal experiences that could not be addressed through media campaigns or other means of mass public health education. Results suggest that HIV information dissemination to the public through hotlines and other means of direct health education serves both preventive and destigmatizing functions. (+info)
Do local inhabitants want to participate in community injury prevention?: a focus on the significance of local identities for community participation.
(22/7064)
During the 1980s the community became the object of new interest and enthusiasm among many health promotion practitioners and researchers, and the principle of community participation was put on the research agenda. However, recent evaluations of major community health promotion programs have questioned the value of community interventions. This paper argues that the community level need not be of less importance in future health promotion initiatives. It is discussed whether the cultural dimension and the significance of local identities, neglected in most community health promotion programs, should receive more attention when local inhabitants are invited to participate in health promotion or disease prevention activities. Results from a study of injury prevention projects in small Norwegian municipalities indicate that the inhabitants' identification with local spatial subarenas might play an important role when they decide to become involved in injury prevention. Contemporary sociological approaches to the community, focusing on developments of local identities in processes of globalization, have formed a theoretical frame of reference in this study. (+info)
Environment, development and health: ideological metaphors of post-traditional societies?
(23/7064)
Environment and health have become nearly interchangeable concepts in post-traditional societies. We are able to observe almost an obsession with them, as if individual changes in ways of life--important for the individual and significant for the culture though they may be--possessed the power to overthrow a system of economic relations that aims at growth in numerical terms rather than at development, enabling society to sustain its specific modes of private and public interaction. (+info)
Global health promotion models: enlightenment or entrapment?
(24/7064)
This paper suggests that there is a tendency for health promotion to be located within models that consider health to be a product of a range of forces, with practice itself assumed to comprise a similarly wide range of activities. This paper develops a critique of this tendency that is essentially accommodating, all embracing and 'neutral'. It is argued that this leads to the masking of tensions between the conflicting values contained within the different elements of the models. We suggest that for health promoters, this is neither conceptually appropriate nor practically sensible. These notions are developed in five main stages. We start by defining some of the key concepts in the piece, e.g. the nature of a 'model' and examples of 'global' models. We then examine some of the general reasons why global models are favoured, with respect to the emergence of the UK's strategy for health, The Health of the Nation. The third stage of the discussion identifies and considers, within the British context, professional and governmental factors perceived to have driven this choice. The fourth aspect of the paper will introduce a critique of the use of global modelling. The paper concludes by critically questioning this evolving relationship, and suggests that it will be essentially conservative and unproductive. We end by reviewing the implications for practice and suggesting a useful way forward. (+info)