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Health promotion and health education: the emerging role of the private sector.

The climate is right for new ventures in health education, especially those in which corporate leaders join forces with other members of the communities where they do business. Working with the public sector and other members of the private sector--with schools, universities, health departments, churches, professional associations, voluntary agencies, and foundations--corporations can become a vital new force in supporting health education not only of their own employees but also of children and adults and the public at large.

Commerce↗

[A program of adult health promotion by health care workers].

The purpose of this work is to evaluate an alternative methodology of education in adult health care undertaken with health care workers. The evaluation was made by the directional question: what did the Adult Health Course mean to you? The analysis consisted of detecting in the responses, the affirmatives that were respective and grouping them in seven categories: 01. Learning new things. 02. Learning to orient people who goes to the basic Health Unit. 03. Interaction with colleagues. 04. Feeling professionally appraned. 05. Worrisome with sons. 06. Improving way of life. 07. Suggestions. The results refers to the presuppositions presented in the introduction of the article, as well as, with the Epidemiologic Model proposed by BLUM.

Adult↗

Promoting health for transgender women: Transgender Resources and Neighborhood Space (TRANS) program in San Francisco.

Transgender women are at high risk for HIV, substance abuse, and mental health problems. We describe a health promotion intervention program tailored to transgender women in San Francisco. The program creates a safe space for providing transgender-sensitive education about HIV risk reduction, substance abuse prevention, and general health promotion. Transgender health educators conduct workshops and make referrals to appropriate substance abuse treatment programs and other services in the community. Evaluation findings indicate that this community-tailored intervention may be an effective way to reach transgender women and reduce sexual risk behaviors, depression, and perceived barriers to substance abuse treatment.

Attitude to Health↗

The relationship of health-promoting behaviour to health locus of control: analysis of one baccalaureate nursing class.

This study established a health-promoting lifestyle profile in one first year baccalaureate nursing class using the Health-Promoting Lifestyle Profile (HPLP) scale (Walker, Sechrist, & Pender, 1987). Students also completed the Multidimensional Health Locus of Control Scale. Pearson correlation coefficients were run to determine the relationship between perceived health locus of control and each of the categories in the HPLP scale. The only significant, albeit low, correlations were between: stress management and internal health locus of control (r = .39, p = .01); and, interpersonal support and powerful others locus of control (r = .33, p = .03). Although low statistical power (n = 34) may have contributed to these findings, the value of health locus of control as an antecedent to health promoting behaviour is questioned. The students in the current study did engage in health-promoting behaviours as measured by the HPLP scale, with behaviours in the categories self-actualization and interpersonal support receiving the highest scores. As a group, the students displayed a high perceived internal locus of control. There was virtually no relationship between perceived health locus of control and the health-promoting lifestyle profile categories. However, the significant relationship between internal locus of control and the dimension, stress management, and the powerful others locus of control and the dimension, interpersonal support, may indicate that people with a differing locus of control have different coping strategies.

Education, Nursing, Baccalaureate↗

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions.

BACKGROUND: Provision of evidence on costs alongside evidence on the effects of interventions can enhance the relevance of systematic reviews to decision-making. However, patterns of use of economics methods alongside systematic review remain unclear. Reviews of evidence on the effects of interventions are published by both the Cochrane and Campbell Collaborations. Although it is not a requirement that Cochrane or Campbell Reviews should consider economic aspects of interventions, many do. This study aims to explore and describe approaches to incorporating economics methods in a selection of Cochrane systematic reviews in the area of health promotion and public health, to help inform development of methodological guidance on economics for reviewers. METHODS: The Cochrane Database of Systematic Reviews was searched using a search strategy for potential economic evaluation studies. We included current Cochrane reviews and review protocols retrieved using the search that are also identified as relevant to health promotion or public health topics. A reviewer extracted data which describe the economics components of included reviews. Extracted data were summarised in tables and analysed qualitatively. RESULTS: Twenty-one completed Cochrane reviews and seven review protocols met inclusion criteria. None incorporate formal economic evaluation methods. Ten completed reviews explicitly aim to incorporate economics studies and data. There is a lack of transparent reporting of methods underpinning the incorporation of economics studies and data. Some reviews are likely to exclude useful economics studies and data due to a failure to incorporate search strategies tailored to the retrieval of such data or use of key specialist databases, and application of inclusion criteria designed for effectiveness studies. CONCLUSION: There is a need for consistency and transparency in the reporting and conduct of the economics components of Cochrane reviews, as well as regular dialogue between Cochrane reviewers and economists to develop increased capacity for economic analyses alongside such reviews. Use of applicable economics methods in Cochrane reviews can help provide the international context within which economics data can be interpreted and assessed as a preliminary to full economic evaluation.

Clinical Protocols↗

A comprehensive review of the effects of worksite health promotion on health-related outcomes.

PURPOSE: This article provides the foundation for a series of literature reviews that critically examine the effectiveness of worksite health promotion programs. This issue reviews the exercise, health risk appraisal, nutrition and cholesterol, and weight control literatures; a future issue will review the alcohol, HIV/AIDS, multicomponent program, seat belt, smoking, and stress management literatures. METHODS: The literature search used a four-step process that included a computerized database search, a reference search, a manual search of relevant health promotion journals, and the writing of the review by a recognized expert in the area being searched. The databases were searched from 1968 through 1994 and included Medline, Aidsline, Psychological Abstracts, Combined Health Information Database, Employee Benefits Infosource, National Prevention Evaluation Research Collection, National Resource Center on Worksite Health Promotion, National Technical Information Service, and the Substance Abuse Information database. A total of 288 articles were identified by the search, not including the 37 articles in the hypertension literature. Authors of each review were requested to incorporate additional studies not identified by the search, provide a research rating for each individual article, and a rating for the overall literature for their respective area. The authors reviewed 316 studies. FINDINGS: The overall ratings for the reviews reported in this issue were suggestive for exercise, weak for health risk appraisals, suggestive/indicative for both nutrition and cholesterol, and indicative for weight control. The ratings for the other reviews will be reported in the subsequent issue. CONCLUSIONS: Research reported in these reviews suggests the effectiveness of worksite health promotion programs, however, additional research is required to provide conclusive evidence of their impact.

Health Knowledge, Attitudes, Practice↗

Implications of health promotion for integrated health systems.

Summarizes key conclusions and recommendations found in the Centre for Health Promotion's position paper on the role of health promotion within integrated health systems. The original position paper was based on advice received from a working group of organizations and practitioners interested in health promotion. This group was established to formulate recommendations for the government of the Province of Ontario, which was in the process of reforming its system of health care delivery.

Community Participation↗

The impact of screening on future health-promoting behaviours and health beliefs: a systematic review.

OBJECTIVES: To carry out a systematic review to examine the effects of cholesterol, breast and cervical cancer screening on actual or intended health-promoting behaviours and health-related beliefs. DATA SOURCES: Eleven electronic databases (between 1980 and 2000). REVIEW METHODS: All English language studies that investigated the impact of cholesterol, breast and cervical screening programmes on health-promoting behaviours and beliefs were assessed for inclusion. The data extraction form and quality assessment criteria were developed using the NHS Centre for Reviews and Dissemination guidelines. Data were extracted and a non-quantitative synthesis was conducted. Reviewers categorised the outcomes into those that could be considered beneficial or detrimental to health. This categorisation was based on a value judgement that considered both statistical and clinical significance. RESULTS: The cholesterol studies used prospective designs more frequently, possibly as many focused on observing changes in lifestyle following screening. Participants who went for breast or cervical screening were not offered advice on lifestyle changes and most of the research into cancer screening programmes investigated issues related to uptake of screening services, explanations of why people are or are not screened and interventions to improve uptake. All three screening programmes are associated with high levels of favourable health behaviours and beliefs that have been measured, although there is evidence that recommended follow-up after screening is often not adhered to. There was no literature on the cost-effectiveness regarding the wider implications of screening (only on reduction of disease-specific mortality/morbidity), possibly due to the outcomes being very broad and not easily categorised and classified. CONCLUSIONS: The studies reviewed suggest that cholesterol screening had a positive effect on health behaviours, although participation was voluntary and those screened were possibly more motivated to make changes. These results are therefore not generalisable to the entire population and other factors need to be taken into account. Reduction in blood cholesterol levels was reported in all but two of the studies that assessed this outcome, suggesting that successful lifestyle changes were made. However, as most of the studies only reported follow-up of those screened, some of the reduction can be attributable to regression to the mean. Whether breast and cervical screening affect future health behaviours and beliefs has not been directly measured in many studies and few studies have collected baseline measures. However, evidence suggests that women who attend breast and cervical screening once are likely to reattend and attendance is associated with several positive health behaviours, although it cannot be confirmed whether the associations observed were a result of screening or because these women have a certain set of health behaviours and beliefs irrespective of their experience of screening. Areas of further research include: measuring a much wider range of behaviours and beliefs before and after screening is accepted or declined, examining the subgroup of participants who receive 'desirable' results and the impact of this on health beliefs and health-promoting behaviour, and qualitative research into the experiences of screening and how this interacts with knowledge and beliefs about other aspects of health.

Breast Neoplasms↗

Promoting health by promoting comfort.

While comfort is a concept frequently addressed in the nursing literature, few have adequately addressed this concept as a central patient objective. At present, our literature focuses more on comfort as a nursing action than on comfort as an individualized patient goal. Comfort may be more likely to be the driving force for patients obtaining healthcare services than health itself. This patient need, coupled with nursing interventions to assist them in identifying and implementing constructive ways of promoting their own comfort needs, will help to achieve an optimal state of health.

Health↗

Demographic factors: interaction effects on health-promoting behavior and health related factors.

The purpose of this study was to examine the main and interaction effects of race, gender, and education on health-promoting behaviors, problem solving appraisal, health value, and health definition. Using a convenience sample of 331 employees, a series of three-way ANOVAs were performed. Only gender exerted main effects on health-promoting behaviors, including exercise, relaxation, and health promotion. No interaction effects were presented. Neither main nor interaction effects were found for approaching problems and having confidence in solving problems. However, interaction effects indicated that better educated women and better educated black employees perceived less personal control when solving problems. Women valued health more than men, even though there were no gender, race or education differences in the sample's definition of health. Community health nurses and workplace wellness planners are challenged to design programs sensitive to gender differences regarding health behaviors and the valuing of health. Developing training programs to enhance personal control over problem situations is also indicated.

Adult↗

Levelling the playing fields of England: promoting health in deprived communities.

Health promotion is about focusing on systems in which those 'waiting to be ill' are living their lives now. Unlike the old, the new public health agenda is about developing and implementing healthy public policies. This stance involves everyone working together to develop change in the conditions of living. This article presents a brief overview of the role of the health promotion specialist in a Primary Care Trust working with six Sure Start Programmes in a town that has high levels of poverty and deprivation. To demonstrate the principles of 'health for all', the article concludes with an overview of the development of a partnership to promote initiation and continued exclusive breastfeeding using collaborative working, community participation and equity.

Breast Feeding↗

International collaboration in health promotion and disease management: implications of U.S. health promotion efforts on Japan's health care system.

For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.

Cost-Benefit Analysis↗