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PubMed2005

Evaluating cultural competence among behavioral health professionals.

Persistent racial and ethnic disparities in access and utilization of behavioral health services have highlighted the need for cultural competence among providers. In response, many agencies are now implementing education and training programs to ensure that behavioral health professionals improve their skills when serving diverse ethnic, racial, and cultural populations. The evaluation of these trainings is vital to ensure that they both improve the cultural competence of providers and promote recovery among persons with severe mental illnesses. This paper discusses the philosophical and practical issues related to measuring cultural competence, based on the evaluation of statewide cultural competence trainings for behavioral health professionals. The evaluation process illustrates the challenges of operationalizing cultural competence, balancing the needs of program implementers and evaluators, and developing a robust and feasible evaluation design, which assesses outcomes both for persons in recovery and providers.

Behavioral Medicine↗

PubMedDate not supplied

Gender and ethnic differences in health behaviors and risk factors for coronary disease among urban teenagers: the PATH program.

OBJECTIVE: To assess gender and ethnic differences among teenagers in heart health behaviors, risk factors for coronary heart disease (CHD), and cardiovascular fitness. DESIGN: Observations consist of cross-sectional data collected prior to a school-based health promotion intervention program. PARTICIPANTS: Teenage girls (N = 865) and boys (N = 497) from three New York City high schools. The ethnic composition of this sample was 20% Asian-American, 40% African-American, 25% Hispanic, and 15% white. METHOD: Subjects were compared on the following: height, weight, body mass index, percentage body fat, total cholesterol, blood pressure, heart health knowledge, family history, socioeconomic status, dietary habits, smoking, physical activity, and estimated aerobic capacity. Differences were assessed with independent t tests, analysis of variance, and chi-square statistical techniques. RESULTS: Compared with girls, boys were more active and had higher estimated aerobic capacity, higher systolic blood pressure, and better self-perception of health. Compared with boys, girls had higher cholesterol, percentage body fat, and heart health knowledge scores and ate fewer foods high in saturated fat, cholesterol, salt, and simple sugars. Among girls, African-Americans had the highest blood pressure, cholesterol, body mass index, and intake of foods high in saturated fat, cholesterol, and sugar. Among boys, Hispanics had the highest body mass index and percentage body fat and the lowest heart health knowledge scores. White girls and white boys were the most frequent smokers. CONCLUSIONS: Poor health behaviors and risk factors for CHD occurred frequently among urban teenagers. In general, teenage girls had poorer health behaviors and a greater prevalence of risk factors than teenage boys, even though they scored better in heart health knowledge testing. Ethnic comparisons revealed poorer health behaviors and higher prevalence of risk factors in African-American and Hispanic teens compared with white and Asian-American teens. Results support the need for health promotion intervention among urban teenagers.

Adolescent↗

PubMedDate not supplied

Health behavior goals of cardiac patients after hospitalization.

OBJECTIVES: To examine the types and influences of health behavior goals self-selected by post hospitalized cardiac patients. METHODS: Subjects participated in a trial assessing the effectiveness of a health behavior change program. RESULTS: Nearly 95% of smokers and 89.7% of patients with elevated weights selected a smoking and/or dietary modification goal, respectively. Only 43.8% of physical activity goal patients started a rehabilitation program. Although no consistent relationships were found between patient characteristics and type of goal(s) selected, significant improvements in readiness to change levels occurred. CONCLUSIONS: Many patients can make health behavior progress consistent with behaviors needing improvements by clinical criteria.

Attitude to Health↗

PubMed2006

Health behaviors and breast cancer: experiences of urban African American women.

Breast-cancer survival rates are lower among African American women compared to White women. Obesity may contribute to this disparity. More than 77% of African American women are overweight or obese. Adopting health behaviors that promote a healthy weight status may be beneficial because obesity increases risk for recurrence. Studies among White breast-cancer survivors indicate that many make health behavior changes after diagnosis. This cross-sectional pilot study collected quantitative and qualitative data on the attitudes, beliefs, barriers, and facilitators related to health behavior changes in 27 overweight/obese African American breast-cancer survivors. Results indicated that most participants reported making dietary changes since their diagnosis, and some had increased their physical activity. Focus groups provided rich details on the barriers and facilitators for behavior change. These results begin to address the significant gap in our knowledge of African American breast-cancer survivors' health behaviors and underscore the need for culturally competent health behavior interventions.

Adult↗

PubMed2006

Social status, risky health behaviors, and diabetes in middle-aged and older adults.

OBJECTIVE: This article investigates: (a) how social status influences diabetes prevalence and incidence; (b) how risky health behaviors contribute to the prediction of incident diabetes; (c) if the effects of health behaviors mediate the effects of social status on incident diabetes; and (d) if these effects differ in midlife and older age. METHODS: We examined nationally representative data from the 1992/1993-1998 panels of the Health and Retirement Study for middle-aged and older adults using logistic regression analyses. RESULT: The odds of prevalent diabetes were higher for people of older age, men, Black adults, and Latino adults. Higher early-life social status (e.g., parental schooling) and achieved social status (e.g., respondent schooling, economic resources) reduced the odds in both age groups. We observed similar patterns for incident diabetes in midlife but not in older age. Risky health behaviors--particularly obesity--increased the odds of incident diabetes in both age groups independent of social status. The increased odds of incident diabetes in midlife persisted for Black and Latino adults net of other social status factors. DISCUSSION: Risky health behaviors are key predictors of incident diabetes in both age groups. Economic resources also play an important protective role in incident diabetes in midlife but not in older age.

Aged↗

PubMed2001

Illness representations according to age and effects on health behaviors following coronary artery bypass graft surgery.

OBJECTIVES: To determine if illness representations differ as a function of age and how these representations, in conjunction with age, predict postoperative health behaviors. DESIGN: Prospective study of patients undergoing coronary artery bypass graft (CABG) surgery. SETTING: A large metropolitan hospital providing regional cardiac care for patients in a tri-state area, located in Pittsburgh, Pennsylvania. PARTICIPANTS: All consenting patients (N = 309) from a consecutive series of patients scheduled for CABG surgery between January 1992 and January 1994. To be eligible for participation, patients could not be scheduled for any other coincidental surgery (e.g., valve replacement), and could not be in cardiac intensive care or experiencing angina at the time of the referral. Participants were predominantly male (70%) and married (80%), and averaged 62.8 years of age. MEASUREMENTS: Postoperative self-reported health behaviors. RESULTS: Older participants awaiting CABG surgery were significantly more likely to believe old age to be the cause of their coronary heart disease (CHD) and significantly less likely to believe genetics, health-damaging behaviors, health-protective behaviors, and emotions to be the cause of their CHD than were younger participants awaiting surgery. Furthermore, the older participants were significantly more likely to believe they had no control over the disease and that the disease would be gone after surgery, and reported fewer postoperative health behavior changes than did younger participants. CONCLUSION: These findings demonstrate significant differences in illness representations as a function of age. Furthermore, differences in postoperative health behaviors were consistent with differing illness representations.

Adult↗

PubMed2003

Changing multiple health behaviors: smoking and exercise.

BACKGROUND: Previous stage of change research examining health behaviors has tended to examine one behavior at a time. However, one recent study by King et al. (1996) examined the relationship between smoking and exercise across cognitive-behavioral mediators (i.e., decisional balance and self-efficacy) shown to be important in predicting readiness to change. In this study, we seek to replicate the study of King et al. (1996) in a low-income sample, the majority of whom are women, with at least one chronic illness who are attending primary care clinics. METHODS: Data were obtained from 270 adult outpatients attending four public primary care clinics in Louisiana. RESULTS: Smoking and exercise stage of change were not related. Significant relationships existed between the cognitive variables of smoking and exercise. No significant differences existed within exercise stage of change on the cognitive variables of smoking, and vice versa, no significant differences were noted within smoking stage of change on the cognitive variables of exercise. CONCLUSIONS: Smoking and exercise appear to be specific health behaviors that are independent constructs in this particular sample. However, caution should be taken when interpreting the findings since 75% of the sample had at least one chronic illness.

Adult↗

PubMed1994

Preventive oral health behaviors in a multi-cultural population: the North York Oral Health Promotion Survey.

To examine the preventive oral health behavior levels of randomly-selected dentate and edentulous adults, age 18 and over, a mail survey was conducted in North York, Ontario, a multicultural suburb of Metropolitan Toronto (n = 1,050). High optimal levels of at least daily tooth brushing were reported by the majority of the dentate (96 per cent). Lower rates were evident for yearly preventive visiting (69 per cent), daily flossing (22 per cent), daily use of an interdental device (25 per cent), not snacking between meals (12 per cent) and eating one or no cariogenic foods on the previous day (36 per cent). Logistic regression results indicated higher levels on an additive index of oral preventive behaviors for females, those having a higher education and non-Italian respondents. Edentulous respondents reported high daily denture cleaning rates (87 per cent), but less frequent night removal (51 per cent), checking for oral lesions (68 per cent) and preventive visiting (12 per cent). Oral disease is one of the most common and costly chronic disorders affecting modern populations. However, unlike most other chronic diseases, it is largely preventable. These data indicate a clear need for determined oral health promotion efforts to inform and encourage increased levels of preventive behaviors in addition to tooth and denture brushing, particularly among specific sociodemographic and ethnic groups.

Adolescent↗

PubMed1995

Conception, commitment, and health behavior practices in medically high-risk pregnant women.

Based on cognitive dissonance and related theories of commitment, this study tested hypotheses that planning pregnancy and number of months spent trying to conceive would be associated with better prenatal health behaviors and that commitment to pregnancy and motherhood would mediate these associations. Participants (N = 96) were pregnant women at high medical risk for an adverse birth outcome. As predicted, planning pregnancy predicted better prenatal health care practices, and this effect was mediated by commitment level. Among women who planned their pregnancy, longer time to conceive predicted higher commitment but did not influence prenatal health behaviors directly. Women who had given birth previously practiced fewer prenatal health behaviors. Commitment, however, remained the strongest predictor of prenatal health care practices. Results are consistent with theories of commitment and with prominent approaches to the study of health behavior.

Adult↗

PubMed1991

Determinants of dental health behaviors in Nordic schoolchildren.

As part of the comprehensive study "Health Behavior in Schoolchildren. A WHO Cross National Survey", this paper set out to identify determinants of four dental health behavioral dimensions in Finnish, Norwegian, and Swedish schoolchildren aged 11, 13, and 15. The data were collected by means of self-administered questionnaires, and the results are considered to be representative of each country. The total sample size approximated 3000 pupils in each country. The four dependent variables, fluoride, interdental cleaning, sugar, and brushing behavior, were all based upon sum-scores of several questions, and were subsequently regressed upon five predictors: school achievement, sex, time spent with friends, educational plans, and family meal pattern. This model provided a far better fit to the data on sugar and brushing behavior than to fluoride and interdental cleaning behavior. However, brushing seems to be different from sugar behavior, being influenced by different factors. While brushing is closely linked to the prevailing sex-role pattern, sugar behavior is stronger related to peer group norms. Thus, the symbolic function of sweet consumption of the youth culture should have implications for the design of intervention strategies. For example, the provision of alternative behaviors will only be successful if the behaviors serve the same function as sugar consumption.

Adolescent↗

PubMedDate not supplied

Practical and relevant self-report measures of patient health behaviors for primary care research.

PURPOSE: With increasing evidence for the value of behavior change counseling, there is a need for health behavior measurements that can be implemented in primary care research. This article discusses criteria for and reviews self-report measures to briefly assess cigarette smoking, eating patterns, physical activity, and risky drinking across the life course. It then proposes pragmatic measures for use in practice-based research. METHODS: Drawing from literature reviews, previous multisite studies, personal communications with experts in the field, and guidance from an expert panel, we identified self-report behavior change measures and gave priority to items that addressed Healthy People 2010 goals, as well as those that were practical (ie, shorter, and easier to score and use for intervention), were sensitive to change, and produced results that could directly inform primary care intervention. RESULTS: Separate recommendations are described for measures for adults and for children/adolescents. We recommend a set of 22 items for adults and 16 items for adolescents to track succinctly their status on the 4 health behaviors above. Perfected measures remain elusive: newly developed measures of physical activity and eating patterns are recommended, and in general, the brief measures for adults are currently better validated than are the child measures. CONCLUSIONS: A set of totally satisfactory practical instruments for measuring behavior change in primary care settings does not yet exist. There is sufficient progress to encourage use of and further research on the proposed items. Use of a common set of items across different interventions and projects will help to advance clinical and behavioral research in primary care settings.

Adolescent↗

PubMed1987

Health behavior of elderly Hispanic women: does cultural assimilation make a difference?

The role of cultural assimilation in Hispanic health behavior has received little empirical examination. Prior studies have operationalized assimilation primarily in terms of language preference and have obtained weak or no effects. We interviewed 603 elderly Hispanic women residing in Los Angeles to evaluate the usefulness of cultural factors as predictors of preventive health behavior (e.g., physical examination, screening for breast cancer) more rigorously. Factor analysis of responses yielded four dimensions of cultural assimilation: "language preference", "country of birth", "contact with homeland", and "attitudes about children's friends." After controlling for education and age, no dimension of assimilation associated strongly or consistently with health behavior. Of the four dimensions, use of English language associated most closely with increased screening, although most of the effects for language were small in magnitude. These findings, coupled with those of other studies, strongly suggest that cultural factors may have little impact on the health behavior of Hispanics. Access to and availability of services, affective reactions toward screening, and sociodemographic factors are stronger determinants of Hispanic health practices.

Aged↗

PubMed2006

Causal attributions and health behavior choices among stroke and transient ischemic attack survivors.

To reduce the risk of a recurring event in patients who have suffered an initial stroke or transient ischemic attack (TIA), nurses are challenged with implementing and promoting changes in lifestyle and adherence to treatment regimens. Assessing patients' beliefs about the cause of the stroke or TIA is important to understanding their subsequent health behaviors. This study describes the causal attributions and health behavior choices of 9 participants following a stroke or TIA. Attributions were categorized as internal or external and cross-tabulated by controllability. The attributions were compared with health behavior choices. All participants attempted to make causal attributions, both internal (e.g., anxiety, hypertension, lifestyle) and external (e.g., stress, fate). Those making external attributions demonstrated poorer health behavior choices than those making internal attributions; controllability had no influence on behavior. Patients diagnosed more than 6 months before the study tended to make more external attributions. The results can help nurses understand the beliefs that drive the health behavior choices made by stroke and TIA survivors and guide them in tailoring prevention strategies and engaging patients in preventive activities.

Adult↗

PubMed1985

Smoking, health behavior, and values: a replication, refinement, and extension.

Within a larger study, 181 female undergraduates completed the Rokeach instrumental value survey and a version of the terminal value survey which included the value 'health', as well as measures of general preventive health behavior and social desirability. Analyses showed that nonsmokers reported better health behavior, and particularly direct rather than indirect-risk behavior, than smokers. While there was no difference in the value of 'health', smokers gave more priority to being 'broadminded' than nonsmokers gave. Smokers were also more concerned with 'freedom', being 'independent' and not being 'obedient', suggesting that smokers were more concerned with being 'flexible' or 'unconstrained'. Further, the value of being 'broadminded' was inversely related to the general health behavior and direct-risk behavior of smokers. Together with other research, these findings suggest that decreasing the extent to which smokers value 'broadmindedness' might not only reduce their smoking behavior but also affect their general preventive health behavior.

Adult↗

PubMedDate not supplied

Behavioral health restraint: the experience and beliefs of seasoned psychiatric nurses.

Psychiatric nurses are faced with the challenge of using behavioral health restraints to ensure client safety while following changing policies and procedures regarding restraint use. This phenomenological study examined how eight seasoned psychiatric nurses experienced the therapeutic use of physical behavioral health restraint in their current practice settings. Data collected by audiotaped interviews were analyzed using qualitative methodology. Eight themes emerged from the analysis of the nurses' experiences that described the beliefs that use of behavioral health restraints should be resorted to only after less restrictive measures, safely implemented, failed to control potentially harmful behavior, avoided through early recognition and the subsequent implementation of less restrictive interventions. Furthermore, the participants believed that behavioral health restraint should never be employed in a punitive manner and being involved in a therapeutic restraint incident is a painful experience for clients and staff.

Adult↗

PubMed2005

Associations of self-reported anxiety symptoms with health-related quality of life and health behaviors.

BACKGROUND: Anxiety disorders affect approximately 19 million American adults annually and have been associated with impaired health-related quality of life (HRQOL), an increased rate of adverse health behaviors, and poor outcomes related to chronic illness in studies conducted in clinical populations. Our study was designed to examine the association of self-reported anxiety symptoms with HRQOL and health behaviors among a representative sample of US community-dwellers. METHODS: Data were obtained from the Behavioral Risk Factor Surveillance System,an ongoing, state-based, random-digit telephone survey of the noninstitutionalized US population aged > or = 18 years. In 2002, HRQOL measures were administered in 18 states and the District of Columbia. RESULTS: An estimated 15% of persons reported frequent (> or = 14 days in the past 30 days) anxiety symptoms. After adjusting for frequent depressive symptoms and sociodemographic characteristics, those with frequent anxiety symptoms were significantly more likely than those without to report fair or poor general health (vs. excellent, very good, or good general health), frequent physical distress, frequent activity limitations, frequent sleep insufficiency, infrequent vitality, frequent mental distress, and frequent pain. In addition, they were more likely to smoke, to be obese, to be physically inactive, and to drink heavily. CONCLUSION: Given their association with impaired HRQOL and adverse health behaviors, our results suggest that assessment of anxiety symptoms should be a facet of routine standard medical examinations.

Adolescent↗

PubMed1998

Health behaviors and pharmacotherapy.

OBJECTIVE: To review factors related to health beliefs and behavior that affect treatment adherence, and to suggest behavioral strategies for improving adherence. DATA SOURCES: We conducted MEDLINE and PSYHLIT (January 1966-October 1997) searches of English-language literature pertaining to behavioral medicine and health behavior as they relate to treatment adherence. Additional articles from these sources and reference texts were identified. DATA EXTRACTION: All articles and chapters identified were considered. The most pertinent information, as judged by the authors, was selected for discussion. DATA SYNTHESIS: Health care is moving into an era of disease management, and practitioners will be called upon to help patients change health-related behaviors and to improve adherence to treatment. Fundamental to this new paradigm of practice is an understanding of behavior, its relationship to health, and methods by which it can be altered. Current concepts of health behavior have been heavily influenced by social learning theory, self-efficacy theory, and a biopsychosocial view of health and disease. The intent of this review is to provide clinicians with an overview of factors that affect health-related behaviors, as well as suggestions for helping patients to improve them. As illustrations, behavioral interventions used in patients with asthma are presented. CONCLUSIONS: Adherence to treatment recommendations depends on a complex interplay of many psychological variables. An understanding of these factors, and how behavioral techniques may be used, will help healthcare providers to assist patients in improving adherence.

Attitude to Health↗

PubMedDate not supplied

Multimodal chronic pain rehabilitation program: its effect on immune function, depression, and health behaviors.

This pilot study examined the effects of a multimodal pain rehabilitation program on the immune function, self-reported pain, depression levels, and health behaviors of patients with chronic back pain. It also estimated the relationships between self-reported pain levels, immune function, depression, and health behaviors. Data were collected at week 1 (baseline) and at week 4 (last week of treatment program) on a convenience sample of 23 patients. In general, the patients' mean T lymphocyte proliferation levels showed a decline from baseline to week 4, while natural killer cell activity showed a slight increase in cell lysis. None of the findings were statistically significant. Failure to detect significant differences may be attributed to a small effect size due to the relatively small sample size. The depression levels dropped significantly during the treatment program (p = .001). Reported levels of pain and health behaviors did not significantly change. More research is needed to determine treatment effects on immune function as well as relationships between pain levels, immune function, depression, and health behaviors in this patient population.

Adolescent↗