Brief report on the effect of providing single versus assorted brand name condoms to hospital patients: a descriptive study.
OBJECTIVES: This study examined condom acquisition by persons in a hospital setting when single versus assorted brand name condoms were provided. METHODS: Condom receptacles were placed in exam rooms of two clinics. During Phase 1, a single brand name was provided; for Phase 2, assorted brand names were added. Number of condoms taken was recorded for each phase. RESULTS: For one clinic there was nearly a two-fold increase in number of condoms taken (Phase 1 to Phase 2); for the second clinic there was negligible difference in number of condoms taken. CONCLUSIONS: The provision of assorted brand name condoms, over a single brand name, can serve to increase condom acquisition. Locations of condoms and target population characteristics are related factors. (+info)
Physician perceptions of primary prevention: qualitative base for the conceptual shaping of a practice intervention tool.
BACKGROUND: A practice intervention must have its basis in an understanding of the physician and practice to secure its benefit and relevancy. We used a formative process to characterize primary care physician attitudes, needs, and practice obstacles regarding primary prevention. The characterization will provide the conceptual framework for the development of a practice tool to facilitate routine delivery of primary preventive care. METHODS: A focus group of primary care physician Opinion Leaders was audio-taped, transcribed, and qualitatively analyzed to identify emergent themes that described physicians' perceptions of prevention in daily practice. RESULTS: The conceptual worth of primary prevention, including behavioral counseling, was high, but its practice was significantly countered by the predominant clinical emphasis on and rewards for secondary care. In addition, lack of health behavior training, perceived low self-efficacy, and patient resistance to change were key deterrents to primary prevention delivery. Also, the preventive focus in primary care is not on cancer, but on predominant chronic nonmalignant conditions. CONCLUSIONS: The success of the future practice tool will be largely dependent on its ability to "fit" primary prevention into the clinical culture of diagnoses and treatment sustained by physicians, patients, and payers. The tool's message output must be formatted to facilitate physician delivery of patient-tailored behavioral counseling in an accurate, confident, and efficacious manner. Also, the tool's health behavior messages should be behavior-specific, not disease-specific, to draw on shared risk behaviors of numerous diseases and increase the likelihood of perceived salience and utility of the tool in primary care. (+info)
Young people's and professionals' views about ways to reduce teenage pregnancy rates: to agree or not agree.
CONTEXT: We know little about young people's views of the effectiveness of interventions to reduce the frequency of teenage pregnancy. OBJECTIVE: To compare the views of young people and professionals about ways to reduce the frequency of teenage pregnancy. DESIGN: Comparison of consensus emerging from adult and teenagers' workshop discussions and subsequent modified two-round Delphi questionnaires for each subject group. SETTING: North Staffordshire community. PARTICIPANTS: Fifty-six professionals from health, education, social care, youth and community and other sectors and 55 young people. MAIN OUTCOME MEASURES: Views with which at least 70% of participants agreed. RESULTS: Young people emphasised the importance of interventions being young person-centred, whereas professionals stressed that re-organisation of sexual health and education services was key. Young people suggested more creative ways of communicating health and education messages than did professionals. Both groups advocated peer education and recognised the need for developing help and services for young men. Both suggested that staff should be educated to be more sensitive in relating to young people. Professionals and young people advocated the locating of sexual health services for teenagers in youth settings. CONCLUSION: In the main, professionals favoured dedicated young people's services whilst young people emphasised the need for young person-centred services. Those working in the health and education sectors should seek and listen to young people's views and preferences when planning and providing sexual health education and services. (+info)
Responding to racial and ethnic disparities in use of HIV drugs: analysis of state policies.
OBJECTIVES: The objectives of this study were to assess racial/ethnic trends in surveillance data in four states--California, New York, Florida and Texas, identify structural barriers to and facilitators of access to HIV pharmaceuticals by individuals in Medicaid and the AIDS Drug Assistance Program (ADAP), and identify treatment education and outreach efforts responding to the needs of ethnic minority HIV patients. METHODS: State surveillance and claims data were used to assess trends by race/ethnicity in AIDS cases and mortality as well as participation rates in Medicaid and ADAP. Key informant interviews with state program administrators and local clinic-based benefit eligibility workers were used to identify social and policy barriers to and facilitators of access to HIV drugs and state strategies for overcoming racial/ethnic disparities. RESULTS: Racial/ethnic disparities in the reduction of AIDS-related mortality were identified in three of the four states studied. Policy barriers included Medicaid requirements for legal immigration status and residency, limits on Medicaid eligibility based on disability requirements, and state-imposed income and benefit limits on ADAP. Social barriers to accessing AIDS medications included lack of information, distrust of government, and HIV-related stigma. State strategies for overcoming disparities included contracting with community-based organizations for treatment education and outreach, the use of regional minority coordinators, and public information campaigns. CONCLUSIONS: State policies play a significant role in determining access to HIV drugs, and state policies can be used to reduce racial/ethnic disparities in pharmaceutical access. Overall, eliminating racial/ethnic disparities in access to HIV pharmaceuticals appears to be an achievable goal. (+info)
A program to increase seat belt use along the Texas-Mexico border.
A school-based, bilingual intervention was developed to increase seat belt use among families living along the Texas-Mexico border. The intervention sought to increase seat belt use by changing perceived norms within the community (i.e., making the nonuse of seat belts less socially acceptable). The intervention was implemented in more than 110 classrooms and involved more than 2100 children. Blind coding, validity checks, and reliability estimates contributed to a rigorous program evaluation. Seat belt use increased by 10% among children riding in the front seat of motor vehicles in the intervention community, as compared with a small but nonsignificant decline in use among control community children. Seat belt use among drivers did not increase. (+info)
Can we measure encoded exposure? Validation evidence from a national campaign.
Exposure is often cited as an explanation for campaign success or failure. A lack of validation evidence for typical exposure measures, however, suggests the possibility of either misdirected measurement or incomplete conceptualization of the idea. If whether people engage campaign content in a basic, rudimentary manner is what matters when we talk about exposure, a recognition-based task should provide a useful measure of exposure, or what we might call encoded exposure, that we can validate. Data from two independent sources, the National Survey of Parents and Youth (NSPY) and purchase data from a national antidrug campaign, offer such validation. Both youth and their parents were much more likely to recognize actual campaign advertisements than to claim recognition of bogus advertisements. Also, gross rating points (GRPs) for a campaign advertisement correlated strikingly with average encoded exposure for an advertisement among both youth (r = 0.82) and their parents (r = 0.53). (+info)
Holding fast: the experience of collaboration in a competitive environment.
Collaboration is one of the cornerstones of health promotion, with the literature indicating a range of circumstances under which it can either succeed or be undermined. In New Zealand in the 1990s, a market structure for health made collaboration of all kinds exceptionally difficult. This paper traces the efforts of a group of nutrition agencies (Agencies for Nutrition Action) to defy the popular wisdom and persist with collaborative efforts. The agencies were unsuccessful in their attempts to develop joint campaigns, but were very successful in advocacy and intersectoral action that did not threaten the position of individual agencies in the competitive environment. It is possible that the collaboration could have been more effective if agencies had been willing to surrender some autonomy and commit themselves to supporting a more independent new organization. However, this would have compromised not only their individual integrity but also their commitment to a relationship of equals. In 'holding fast' to a belief in health promotion, the ANA resisted being coopted by a now discredited market system, and emerged with its integrity and that of its participating agencies intact. ANA is now well positioned to work within an emerging policy environment that is more supportive of health promotion. (+info)
Cost and cost-effectiveness of HIV/AIDS prevention strategies in developing countries: is there an evidence base?
Many donors and countries are striving to respond to the HIV/AIDS epidemic by implementing prevention programmes. However, the resources available for providing these activities relative to needs are limited. Hence, decision-makers must choose among various types of interventions. Cost information, both measures of cost and cost-effectiveness, serves as a critical input into the processes of setting priorities and allocating resources efficiently. This paper reviews the cost and cost-effectiveness evidence base of HIV/AIDS prevention programmes in low- and middle-income countries (LMICs). None of the studies found have complete cost data for a full range of HIV/AIDS prevention programmes in any one country. However, the range of studies highlight the relative emphasis of different types of HIV/AIDS prevention strategies by region, reflecting the various modes of transmission and hence, to a certain extent, the stage of the epidemic. The costing methods applied and results obtained in this review give rise to questions of reliability, validity and transparency. First, not all of the studies report the methods used to calculate the costs, and/or do not provide all the necessary data inputs such that recalculation of the results is possible. Secondly, methods that are documented vary widely, rendering different studies, even within the same country and programme setting, largely incomparable. Finally, even with consistent and replicable measurement, the results as presented are generally not comparable because of the lack of a common outcome measure. Therefore, the extent to which the available cost and cost-effectiveness evidence base on HIV/AIDS prevention strategies can provide guidance to decision-makers is limited, and there is an urgent need for the generation of this knowledge for planning and decision-making. (+info)