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Biomedical subjects

R C Lefebvre

Publications and source records attributed to R C Lefebvre.

At least 19 recordsLinked to original sources
PubMed1993

A community education monitoring system: methods from the Stanford Five-City Project, the Minnesota Heart Health Program and the Pawtucket Heart Health Program.

Understanding the process of behavior change interventions is critical to achieving campaign effectiveness and successful program replication. The present article presents a community education monitoring system (CEMS) using data from the Stanford Five-City Project (FCP), the Minnesota Heart Health Program (MHHP) and the Pawtucket Heart Health Program (PHHP). CEMS records the number and type of intervention activities, outcome objectives, targets of change (individual, organizational or environmental), channel(s) of dissemination and proportion of programs funded by the community. These data illustrate (1) the application of theory for each project, (2) data-based program administration, (3) feedback for revising programs and (4) type of reach or 'dose' information obtained from intervention monitoring. Process evaluations such as CEMS provide critical links between field realities and evaluation outcomes. This type of evaluation develops standards for measuring program reach and allows comparisons with other programs. CEMS also illustrates how programs enact theory. Validation studies are critical to the continued successful use of CEMS. The first step, however, is to develop a uniform way of describing complex multichannel behavior change programs. CEMS in a refined form should prove invaluable to health promotion program planners whether in research or service settings.

Behavior Therapy↗
PubMed1991

Community-based approach to weight loss: the Pawtucket "weigh-in".

The Pawtucket Heart Health Program (PHHP), in its attempt to treat obesity in the community, has delivered many traditional group and self-help weight loss programs. However, in order to reach a sufficient number of people to produce a public health impact in Pawtucket, PHHP devised a monthly city-wide "weigh-in." This program, designed to be delivered by volunteers, allowed individuals to set a weight loss goal and pledge a monetary incentive toward this goal. Self-help materials and the opportunity to join weight loss groups were provided. In the pilot study, 129 (61%) of 213 enrollees completed the 10-week program with a mean weight loss of 8.2 lb (p less than .001). A large decrease in total serum cholesterol was also observed. Nonpersonnel costs, including the total costs of the cholesterol measurement, were $1.30 per pound lost. Moreover, success is also evident by continued availability of the program and the increasing number of new participants "referred" to the weigh-in by members.

Adult↗
PubMed1991

Enhancing adherence to referral advice given at blood cholesterol screenings: impact on participant follow-up and physician behavior.

Adherence to referral recommendations given to participants at blood cholesterol screening programs is a critical aspect of these efforts to help detect and control high blood cholesterol in the US adult population. In this study, 386 participants who had received two consecutive blood cholesterol measurements above 240 mg/dl (6.21 mmol/l) were interviewed by telephone 3 months after their second measurement (May 1987 - May 1988). Approximately 40% of respondents had seen a physician by the time of the interview; another 30% reported having scheduled an appointment. There was no significant difference in adherence behavior between participants who received a letter reiterating the referral and those who did not. However, participants who received the letter reported greater physician attention to the evaluation and treatment of their high blood cholesterol, primarily because these participants stated that they visited their physician for their high blood cholesterol. Significantly higher rates of further blood tests, cholesterol education material distribution, cholesterol-lowering medication prescription and patient-physician discussions about cholesterol were the result. These findings suggest that consumers can be effective in stimulating and reinforcing physician practice behaviors related to cholesterol control. However, strategies must be crafted so that consumers are aware of, and appreciate, the necessity of seeking physician care when they become aware of a high blood cholesterol level.

Adult↗
PubMed1991

Are people more health conscious? A longitudinal study of one community.

Secular changes in cardiovascular health awareness, knowledge and behavior were observed in four biennial cross-sectional surveys and a cohort survey in a New England community. These changes are not related to more health promotion activities in the social milieu of respondents, but are more likely due to national mass media health campaigns, the effects of which may influence outcomes of community-based cardiovascular disease prevention studies.

Adolescent↗
PubMed1990

Efficacy of an incentive-based community smoking cessation program.

Although the number of smokers has declined in recent years, many people remain resistant to traditional smoking cessation programs. Therefore, new and innovative approaches have been attempted. This study describes the application and effects of a community-wide smoking cessation program over three successive years. Smoking cessation rates ranged from 10.6% (CO verified) to 30.1% (self-report) at 1 month, and 17.3% to 24.5% at 1 year follow-up. Analyses revealed that successful quitters were more likely to have heart about the program at work and to have used materials contained in the self-help kit; and were more likely to be married and have a higher average income than either people who attempted to quit or made no attempt. Twelve-month follow-up data were used to classify participants into four new, distinct groups: maintainers, new quitters, relapsers, and nonquitters. Maintainers were more likely to have heard about the program at work and less likely to have become involved at Octoberfest. These programs do reach representative samples of the community. Their results compare favorably to other minimal contact intervention and physician-mediated efforts.

Adolescent↗
PubMed1990

Counseling strategies for blood cholesterol screening programs: recommendations for practice.

Blood cholesterol screening programs offer an important venue for nutrition counseling aimed at lowering blood cholesterol levels. This paper presents a screening, counseling and referral protocol that has been developed by the Pawtucket Heart Health Program (PHHP). A review of general considerations for counseling strategies in the screening context highlights the necessity for brief, focused, behaviorially oriented tactics. The PHHP Summary and Referral protocol includes a review of multiple risk factors for heart disease, a discussion of blood cholesterol levels, recommendations for eating pattern changes based on response to a food frequency questionnaire, and a final summary and referral as needed. The training of lay volunteers and health professionals in delivery of the program is also reviewed.

Adult↗
PubMed1990

Information-seeking about health in a community sample of adults: correlates and associations with other health-related practices.

Action by individuals to acquire information about their health has been an element incorporated throughout theory, research, and programs related to health promotion. This report describes an attempt to determine if an information-seeking dimension could be empirically identified in a general community-resident sample, and if so, to examine some of its characteristics. A total of 281 adults aged 18-75 were contacted by telephone using random digit dialing and were interviewed about a variety of personal health practices. Factor analysis identified a five-item cluster representing a tendency to seek out information about health. Women were more likely than men to report seeking information. In addition, more frequent information-seeking was associated with favorable responses to several other health-related practices. Formal health service use was the only type of health practice not associated with information-seeking, perhaps because regularity of contact is influenced strongly by health professionals (e.g., reminder cards and having staff call to schedule annual exams). Overall, results of the investigation support the importance of information-seeking as a component of a personal health practice repertoire. Additional attention might be directed toward elaborating its role as a "process" variable in health education programs and social marketing efforts, particularly in areas such as response to recruitment messages, dropout vs. maintenance, and differential gains on outcome measures of program effectiveness.

Adolescent↗
PubMed1990

Pawtucket Heart Health Program point-of-purchase nutrition education program in supermarkets.

Point-of-purchase nutrition education in supermarkets is one intervention strategy of the Pawtucket Heart Health Program, a community cardiovascular disease prevention program in Pawtucket, Rhode Island. Using consumer intercept interviews, awareness of shelf labels and their effect on purchase behavior have been continuously evaluated. Between 1984 and 1988, the percent of shoppers who could identify correct labels increased from 11 percent to 24 percent (95% confidence intervals of difference: 7.17). The percent who reported they were encouraged to purchase the identified foods increased from 36 percent to 54 percent (95% CI of difference: 5.41).

Adult↗
PubMed1989

Dispositional optimism and recovery from coronary artery bypass surgery: the beneficial effects on physical and psychological well-being.

The effect of dispositional optimism on recovery from coronary artery bypass surgery was examined in a group of 51 middle-aged men. Patients provided information at three points in time--(a) on the day before surgery, (b) 6-8 days postoperatively, and (c) 6 months postoperatively. Information was obtained relating to the patient's rate of physical recovery, mood, and postsurgical quality of life. Information was also gathered regarding the manner in which the patients attempted to cope with the stress of the surgery and its aftermath. As expected, dispositional optimism proved to be an important predictor of coping efforts and of surgical outcomes. More specifically, dispositional optimism (as assessed prior to surgery) correlated positively with manifestations of problem-focused coping and negatively with the use of denial. Dispositional optimism was also associated with a faster rate of physical recovery during the period of hospitalization and with a faster rate of return to normal life activities subsequent to discharge. Finally, there was a strong positive association between level of optimism and postsurgical quality of life at 6 months.

Adaptation, Psychological↗
PubMed1988

Social marketing and public health intervention.

The rapid proliferation of community-based health education programs has out-paced the knowledge base of behavior change strategies that are appropriate and effective for public health interventions. However, experiences from a variety of large-scale studies suggest that principles and techniques of social marketing may help bridge this gap. This article discusses eight essential aspects of the social marketing process: the use of a consumer orientation to develop and market intervention techniques, exchange theory as a model from which to conceptualize service delivery and program participation, audience analysis and segmentation strategies, the use of formative research in program design and pretesting of intervention materials, channel analysis for devising distribution systems and promotional campaigns, employment of the "marketing mix" concept in intervention planning and implementation, development of a process tracking system, and a management process of problem analysis, planning, implementation, feedback and control functions. Attention to such variables could result in more cost-effective programs that reach larger numbers of the target audience.

Health Promotion↗
PubMed1988

Labeling of participants in high blood pressure screening programs. Implications for blood cholesterol screenings.

Screening programs have expanded to identify the many persons who are unaware of their high blood cholesterol level and thus are at an increased risk for coronary heart disease. These programs bring both potential benefits and potential risks to the participant. One potential risk is that of iatrogenic effects of learning one's risk status, often referred to as the "labeling phenomenon." Research that has addressed the labeling phenomenon in blood pressure screening programs has important implications for blood cholesterol screenings. Detrimental effects on screening participants are possible, but they can be attenuated by careful attention to characteristics of the debriefing and counseling that should be included in screening protocols.

Absenteeism↗
PubMed1988

Pawtucket Heart Health Program: the process of stimulating community change.

The Pawtucket Heart Health Program (PHHP) is a community-based research and demonstration project in cardiovascular disease (CVD) prevention located in the United States. Targeted risk factors include high blood pressure, elevated blood cholesterol, cigarette smoking, obesity and sedentary living. Evaluation methods included biennial household risk factor surveys in the education and comparison communities, morbidity and mortality surveillance in hospitals serving each community, and both formative evaluation and process tracking. Intervention methods are theoretically derived from social learning theory and seek to motivate, enable and maintain individual behavior change; modify social networks; and introduce environmental change in organizations and normative shifts in the community in ways that reduce the prevalence of CVD risk factors. The intervention strategy began as an organization-based model, and has evolved into a community-wide effort in which marketing research tools and techniques are employed. In the past 4 years, over 40,000 individual contacts have been made with PHHP programs, including 1,260 persons who have volunteered their time to deliver risk factor programs.

Cardiovascular Diseases↗