Health Education & Behavior current issue

Practice Notes: Strategies in Health Education

Thu, 12 Nov 2009 12:50:42 PST

Measuring Exposure to Health Messages in Community-Based Intervention Studies: A Systematic Review of Current Practices

Morris, D. S., Rooney, M. P., Wray, R. J., Kreuter, M. W. — Thu, 12 Nov 2009 12:50:42 PST

Accurately measuring exposure is critical to all intervention studies. The present review examines the extent to which best practices in exposure assessment are adhered to in community-based prevention and education studies. A systematic literature review was conducted examining community-based studies testing communication interventions, published in 2003-2007. Of 663 studies identified, 54 met all inclusion criteria and were reviewed for type of exposure assessment conducted (if any), use of exposure data in study analyses, and discussion of biases related to exposure assessment. Although a majority of studies (n = 38; 70%) assessed exposure, most of these used only a simple dichotomous measure (n = 31; 82%), less than half used exposure data to adjust intervention effects (n = 16; 42%), and only six (16%) addressed selective exposure as a possible source of bias. There is substantial room for improvement in measurement and analysis of exposure to communication in community-based disease prevention studies.

The Impact of Removing Snacks of Low Nutritional Value From Middle Schools

Schwartz, M. B., Novak, S. A., Fiore, S. S. — Thu, 12 Nov 2009 12:50:42 PST

Removing low nutrition snacks from schools is controversial. Although the objective is to decrease the consumption of these foods at school, some critics argue that children will compensate by eating more of these foods at home. Others worry that school-based obesity prevention programs will increase student preoccupation with weight. The present study examines these concerns. Three middle schools replaced snacks and beverages that did not meet nutrition guidelines, whereas three comparison schools made no systematic changes. Students were surveyed about dietary intake and weight concerns before and after implementation of the intervention. Findings indicate that removing low nutrition items from schools decreased students’ consumption with no compensatory increase at home. Furthermore, there were no differences in students’ reported weight concerns. These results support the value of strengthening school nutrition standards to improve student nutrition and provide evidence dispelling concerns that such efforts will have unintended negative consequences.

Cultural Views, Language Ability, and Mammography Use in Chinese American Women

Liang, W., Wang, J., Chen, M.-Y., Feng, S., Yi, B., Mandelblatt, J. S. — Thu, 12 Nov 2009 12:50:42 PST

Mammography screening rates among Chinese American women have been reported to be low. This study examines whether and how culture views and language ability influence mammography adherence in this mostly immigrant population. Asymptomatic Chinese American women (n = 466) aged 50 and older, recruited from the Washington, D.C. area, completed a telephone interview. Regular mammography was defined as having two mammograms at age-appropriate recommended intervals. Cultural views were assessed by 30 items, and language ability measured women’s ability in reading, writing, speaking, and listening to English. After controlling for risk perception, worry, physician recommendation, family encouragement, and access barriers, women holding a more Chinese/Eastern cultural view were significantly less likely to have had regular mammograms than those having a Western cultural view. English ability was positively associated with mammography adherence. The authors’ results imply that culturally sensitive and language-appropriate educational interventions are likely to improve mammography adherence in this population.

Disseminating Chronic Disease Prevention "to or With" Canadian Public Health Systems

Masuda, J. R., Robinson, K., Elliott, S., Eyles, J. — Thu, 12 Nov 2009 12:50:42 PST

This article follows a conceptual article published in this journal by Elliott et al. and provides an empirical evaluation of the Canadian Heart Health Initiative—Dissemination Phase. Between 1994 and 2005, seven provincial research teams of the Canadian Heart Health Initiative—Dissemination Phase undertook projects to disseminate and evaluate the uptake of evidence-based chronic disease prevention strategies in their respective health systems. In this study, the authors draw from document and stakeholder interview analyses to assess the influence of strategic decisions about dissemination objects, targets, activities, and relationships between knowledge producers and users on the outcomes of chronic disease prevention programming. The findings show that successful dissemination strategies are not necessarily contingent on a high level of fidelity across these dimensions but depend more on the extent to which they are responsive to contextual variables within highly dynamic health systems.

A Comparison of Face-to-Face or Internet-Delivered Physical Activity Intervention on Targeted Determinants

Steele, R. M., Mummery, W.K., Dwyer, T. — Thu, 12 Nov 2009 12:50:42 PST

This article describes the equivalency testing results of a 12-week behavior change program on targeted determinates of physical activity (PA) and self-reported health status. Participants (n = 192) were randomized to face-to-face, combined Internet and face-to-face, and Internet-only groups. Equivalency testing was used to examine differences and statistical equivalency across groups for all outcome measures (social support, self-efficacy, perceived health status, and motivational readiness for PA). Participants were assessed at baseline, postintervention, and 2 and 5 months postintervention. Motivational readiness for PA increased across all groups. The face-to-face and combined groups showed changes in social support; however, they were not statistically different and were equivalent. There were no changes in self-efficacy or physical health status. Overall face-to-face and the Internet delivery modes show similar results. If Internet-based programs can be shown to be as effective as face-to-face, they may in turn be a more efficient and cost-effective delivery method.

Understanding the Role of Numeracy in Health: Proposed Theoretical Framework and Practical Insights

Lipkus, I. M., Peters, E. — Thu, 12 Nov 2009 12:50:42 PST

Numeracy—that is, how facile people are with mathematical concepts and their applications—is gaining importance in medical decision making and risk communication. This article proposes six critical functions of health numeracy. These functions are integrated into a theoretical framework on health numeracy that has implications for risk communication and medical decision-making processes. The authors examine practical underpinnings for targeted interventions aimed at improving such processes as a function of health numeracy. They hope that the proposed functions and theoretical framework will spur more research to determine how an understanding of health numeracy can lead to more effective communication and decision outcomes.

Relationship Between Attitudes and Indicators of Obesity for Midlife Women

Sudo, N., Degeneffe, D., Vue, H., Merkle, E., Kinsey, J., Ghosh, K., Reicks, M. — Thu, 12 Nov 2009 12:50:42 PST

This study uses segmentation analyses to identify five distinct subgroups of U.S. midlife women (n = 200) based on their prevailing attitudes toward food and its preparation and consumption. Mean age of the women is 46 years and they are mostly White (86%), highly educated, and employed. Attitude segments (clusters of women sharing similar attitudes) are a significant predictor of obesity indicators. Mean body mass index and percentage of body fat are lower for the "concerned about nutrition" attitude segment compared with the "guiltridden dieter" and "impulsive eater" attitude segments. Mean waist circumference is highest in "impulsive eater" compared with the "concerned about nutrition" segment. Those in the "busy cooking avoider" segment have a significantly higher energy intake compared with women in other attitude segments. Tailoring a weight management intervention according to attitude segments of midlife women may enhance effectiveness.

The Role of Policy Advocacy in Assuring Comprehensive Family Life Education in California

Brindis, C. D., Geierstanger, S. P., Faxio, A. — Thu, 12 Nov 2009 12:50:42 PST

As part of their 10-year $60 million Teenage Pregnancy Prevention Initiative, The California Wellness Foundation funded 18 state and local organizations to conduct policy advocacy to strengthen teen pregnancy prevention policies. This article describes how some of these grantees accomplished noteworthy goals, including the passage of the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act (SB71), the prevention of the state’s pursuit of federal "abstinence-only-until-marriage" funding, and the passage of a local school district FLE policy. Grantee progress is presented through a five-stage policy change framework: Institutional Capacity and Leadership Building, Policy Issue Recognition, Policy Prioritization, Policy Adoption, and Policy Maintenance. Implications are shared for advocates, policy makers, and funders who are developing initiatives aimed at improving the health of adolescents.