Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: randomised trial.
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OBJECTIVE: To measure the effect of behaviourally oriented counselling in general practice on healthy behaviour and biological risk factors in patients at increased risk of coronary heart disease. DESIGN: Cluster randomised controlled trial. PARTICIPANTS: 883 men and women selected for the presence of one or more modifiable risk factors: regular cigarette smoking, high serum cholesterol concentration (6.5-9.0 mmol/l), and high body mass index (25-35) combined with low physical activity. INTERVENTION: Brief behavioural counselling, on the basis of the stage of change model, carried out by practice nurses to reduce smoking and dietary fat intake and to increase regular physical activity. MAIN OUTCOME MEASURES: Questionnaire measures of diet, exercise, and smoking habits, and blood pressure, serum total cholesterol concentration, weight, body mass index, and smoking cessation (with biochemical validation) at 4 and 12 months. RESULTS: Favourable differences were recorded in the intervention group for dietary fat intake, regular exercise, and cigarettes smoked per day at 4 and 12 months. Systolic blood pressure was reduced to a greater extent in the intervention group at 4 but not at 12 months. No differences were found between groups in changes in total serum cholesterol concentration, weight, body mass index, diastolic pressure, or smoking cessation. CONCLUSIONS: Brief behavioural counselling by practice nurses led to improvements in healthy behaviour. More extended counselling to help patients sustain and build on behaviour changes may be required before differences in biological risk factors emerge. (+info)
Health-related lifestyle in adolescence--origin of social class differences in health?
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Survey data collected by mail, representing Finnish 16 year olds (N = 2977; response rate 83%), were used to identify which particular aspects of lifestyle are typical of adolescents who select various educational tracks and, thus, have different probabilities of ending up in low or high social positions. The dependent variable, educational track, was formed by classifying the respondents into five successive categories predicting their social position in adulthood. Lifestyle is measured by health behaviours, leisure-time activities and social relations. The probability of belonging to educational tracks with good social prospects in adulthood was high among adolescents who placed much emphasis on health-enhancing behaviours (not smoking, physical exercise, low milk-fat diet, dental hygiene, use of seatbelts, etc.), who did not spend much time watching TV or listening to music and who attended church or other religious meetings weekly. Health-related lifestyle, at the age of 16, is oriented towards the social group the individual is likely to belong to as an adult. The study provides evidence for a strong association between health-related lifestyle and educational track in adolescence. (+info)
A brief motivational intervention to improve dietary adherence in adolescents. The Dietary Intervention Study in Children (DISC) Research Group.
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Motivational interviewing offers health care professionals a potentially effective strategy for increasing a patient's readiness to change health behaviors. Recently, elements of motivational interviewing and the stages of change model have been simplified and adapted for use with patients in brief clinical encounters. This paper describes in detail a brief motivational intervention model to improve and renew dietary adherence with adolescents in the Dietary Intervention Study in Children (DISC). DISC is a randomized, multi-center clinical trial assessing the efficacy and safety of lowering dietary fat to decrease low-density lipoprotein cholesterol in high-risk children. In the first 3 years of follow-up covering ages 8-13, intervention participants (n = 334) were exposed to a family-based group intervention approach to change dietary choices. To address adherence and retention obstacles as participants moved into adolescence (age 13-17), an individual-level motivational intervention was implemented. The DISC motivational intervention integrates several intervention models: stages of change, motivational interviewing, brief negotiation and behavioral self-management. A preliminary test of the intervention model suggests that it was acceptable to the participants, popular with interventionists and appeared to be an age-appropriate shift from a family-based intervention model. (+info)
Increased sexual abstinence among in-school adolescents as a result of school health education in Soroti district, Uganda.
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A school health education programme in primary schools aimed at AIDS prevention in Soroti district of Uganda emphasized improved access to information, improved peer interaction and improved quality of performance of the existing school health education system. A cross-sectional sample of students, average age 14 years, in their final year of primary school was surveyed before and after 2 years of interventions. The percentage of students who stated they had been sexually active fell from 42.9% (123 of 287) to 11.1% (31 of 280) in the intervention group, while no significant change was recorded in a control group. The changes remained significant when segregated by gender or rural and urban location. Students in the intervention group tended to speak to peers and teachers more often about sexual matters. Increases in reasons given by students for abstaining from sex over the study period occurred in those reasons associated with a rational decision-making model rather than a punishment model. A primary school health education programme which emphasizes social interaction methods can be effective in increasing sexual abstinence among school-going adolescents in Uganda. The programme does not have to be expensive and can be implemented with staff present in most districts in the region. (+info)
Evidence for decline in disability and improved health among persons aged 55 to 70 years: the Framingham Heart Study.
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OBJECTIVES: This study detected secular change in disability and health among persons aged 55 to 70 years, the life period when increases in disability and morbidity begin and retirement occurs. METHODS: Cross-sectional comparisons were completed with data from similarly aged members of the original (n = 1760) and offspring (n = 1688) cohorts of the Framingham Heart Study, which represent 2 generations. Analyses were conducted by gender and on chronic disease subgroups by logistic regression. RESULTS: There was substantially less disability in the offspring cohort than in the original cohort. Thirty-six percent of offspring men were disabled vs 52% of original cohort men (P = .001); among women, these proportions were 54% vs 72% (P = .001). Fewer offspring perceived their health as fair or poor and fewer had chronic diseases. Offspring were more physically active and less likely to smoke or consume high amounts of alcohol, but their average weight was greater. The secular decline in disability was strongly evident among individuals with chronic diseases. CONCLUSIONS: Our findings depict a secular change toward a less disabled and globally healthier population in the period of life when retirement occurs. (+info)
Closing the ecological gap: the public/private dilemma.
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Numerous health behavior theories and models address human and environmental factors that affect health status. Although ecological models have called for multilevel intervention strategies, all too often health professionals remain unsure which levels of intervention to target: individual, institutional/organizational, community, public-policy or some combination of these. The decision is often influenced by general societal perceptions of how much control individuals have over health risks. These perceptions, in turn, influence health professionals' own perceptions. The question raised here is how do these perceptions of how public or private a health issue is affect the intervention levels we target? Frequently intervention levels are discussed as if they exist on a continuum, with private individual interventions at one end, and societal policies and laws at the other. This article offers a 'public/private health matrix' based on two axes, one representing individual rejectability of health risks, the other showing how publicly or privately supplied or regulated these risks are. The 10 leading causes of death and two childhood illnesses in the US are used to demonstrate how the matrix might help analyze the public/private nature of different health risks and risk-reducing strategies, and to demonstrate how such distinctions may influence the levels of intervention health professionals target. (+info)
Measuring the impact of a behaviour change intervention for commercial sex workers and their potential clients in Malawi.
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A peer-education HIV/AIDS prevention programme for bar-based sex workers and their potential clients (long-distance truck drivers) in Malawi was evaluated for impact. A mixed method approach was used, the tools being structured questionnaires and focus group discussions. The results showed that in the active districts, the presence of sex worker peer educators led to a increase in condom use with paying partners (90.3 compared to 66.7 and 76.3% in the two other groups--non-active and average) and increased condom distribution. Condom use with regular non-paying partners of sex workers had, however, not increased since the baseline data. The truck driver peer educators were found to be generally inactive but companies where training had occurred were more likely to encourage and distribute condoms. The qualitative data gave a more in-depth view of several areas for concern: the reasons for the non-use of condoms with non-paying partners; acceptance of educators by their peers; and the sex workers' and truck drivers' criteria for condom use based neither on knowledge nor on their own risk awareness. These issues need to be explored further. (+info)
A flexible approach to guideline modeling.
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We describe a task-oriented approach to guideline modeling that we have been developing in the EON project. We argue that guidelines seek to change behaviors by making statements involving some or all of the following tasks: (1) setting of goals or constraints, (2) making decisions among alternatives, (3) sequencing and synchronization of actions, and (4) interpreting data. Statements about these tasks make assumptions about models of time and of data abstractions, and about degree of uncertainty, points of view, and exception handling. Because of this variability in guideline tasks and assumptions, monolithic models cannot be custom tailored to the requirements of different classes of guidelines. Instead, we have created a core model that defines a set of basic concepts and relations and that uses different submodels to account for differing knowledge requirements. We describe the conceptualization of the guideline domain that underlies our approach, discuss components of the core model and possible submodels, and give three examples of specialized guideline models to illustrate how task-specific guideline models can be specialized and assembled to better match modeling requirements of different guidelines. (+info)