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At least 793 records · Page 44Linked to original sources
PubMed1999

Regulating managed care: interest group competition for control and behavioral health care.

In this essay I identify how historic patterns of competition among health care interest groups have simultaneously retained their past contours and also changed significantly as a result of the jolt created by the rise of managed care. I explain why it is that I and other executives of for-profit managed behavioral health care organizations, traditionally advocates of market-based approaches to accountability, have begun to support some versions of regulation by the national government in order to restore consumer confidence in the credibility of managed health plans. Key concepts that are addressed include notions of public accountability, control of the purse strings, consumer protections, and provider privileges.

Behavioral Medicine↗
PubMed2005

Reversal of fortune. After years of scaling back beds because of low occupancy rates, behavioral health facilities are beginning to make a comeback.

For decades states have been cutting behavioral health beds because of low occupancy. But a recent survey showed occupancy rates at these hospitals at record highs, and analysts expect more consolidation as larger providers expand. A change in federal payment methods favors free-standing facilities. "The free-standing units will do better as a group," says the National Association of Psychiatric Health Systems' Mark Covall.

Aged↗
PubMed2006

An analysis of health behavior theories applied to breast-screening behavior for relevance with American Indian women.

This article reviews studies of the efficacy of breast-screening interventions and their related theories that have had a positive effect in influencing women to use mammography and assesses the potential of various behavioral models for use with American Indian women. The study involved a search of literature in nursing and other health fields. Both community and practice-based interventions have incorporated elements of various theoretical models. Because of its adaptability, the modified health behavior model appears most relevant for designing interventions to encourage mammography use among American Indian women.

Breast Neoplasms↗
PubMed1990

Community health workers in a Peruvian slum area: an evaluation of their impact on health behavior.

In 1986 the authors conducted a survey examining the performance of health promoters in Pucallpa, Peru, three years after an initial Danish project for training and supervising those promoters ended. The survey found that some two-fifths of the promoters were still active, that increased stress had been placed on curative tasks, and that the promoters appeared to have had their greatest impact in the areas of vaccination coverage and increased use of the available public health care service. No significant changes were found in the affected population's treatment of diarrhea or improvement of drinking water quality.

Adult↗
PubMed1984

Modifying and developing health behavior.

The literatures on both behavior modification and behavioral development have engendered innovations in public health programs, addressing problems of patient adherance to preventive and therapeutic regimens, delay in seeking diagnosis of illness symptoms, risk-taking behavior, and other aspects of lifestyle associated with health. Because most of this literature derives from psychology, there has been a distinct bias in the construction of interventions, pointing them directly at individuals, usually in a counseling or small group mode of delivery. These developments served public health well enough during a decade or so when the preoccupation was with utilization of health services and medical management of chronic diseases. With the publication of the Lalonde Report in Canada in 1974, the passage of Public Law 94-317 in 1976 in the United States, and similar initiatives in other English-speaking and European countries, the recognition of the greater complexities of lifestyle development and modification in the absence of symptoms has taken hold. Policy makers and public health workers seek a more efficient and equitable set of strategies to meet the behavioral health challenges of modern society without placing the entire weight of responsibility for behavior on the individual or on therapeutic practitioners. Concurrently, on a more global scale and in the developing countries, a concern has emerged for strategies that give individuals, families, and communities a greater role in deciding their own health priorities. The convergence of these two trends--one seeking to distribute responsibility for lifestyle more equitably and the other seeking to distribute responsibility for planning health programs more equitably --calls for policies, strategies, and interventions that will place similar emphasis on health education and organizational, economic, and environmental supports for health behavior. The combination of these elements of support for behavior calls, in turn, for research and more inventive applications of theory from sociology, political science, economics, and anthropology. Public health workers will need to become more conversant and facile in these social sciences, as they have in psychology and its applications in the recent past.

Adolescent↗
PubMed2004

Personal health behaviors in women who have undergone risk-reducing mastectomy.

BACKGROUND: Risk-reducing mastectomy (RRM) remains an effective yet controversial modality for the primary prevention of breast cancer. Is the choice of RRM consistent with a generally proactive healthy lifestyle? METHODS: The National Prophylactic Mastectomy Registry is a volunteer database comprised of 460 women who have undergone bilateral RRM. Each patient received a questionnaire drawn from the Centers for Disease Control Behavioral Risk Factor Surveillance System. Their responses were compared with gender-specific national data from the Centers for Disease Control. RESULTS: Women in the RRM group were statistically more likely to engage in risk-reducing personal health behavior including not smoking, exercising, maintaining their health, and taking advantage of screening programs. CONCLUSIONS: Women in the registry who underwent RRM practiced a more "healthy" lifestyle than gender-matched controls. Therefore, the decision to have prophylactic surgery may have been part of a proactive approach toward their overall physical well-being.

Adult↗
PubMed2004

Differential association of modifiable health behaviors with hot flashes in perimenopausal and postmenopausal women.

OBJECTIVE: To determine the association of modifiable factors, such as smoking, body mass index, and alcohol use, with hot flashes, and to ascertain whether the association with hot flashes varies by menopausal stage. DESIGN: A written survey completed by perimenopausal and postmenopausal women enrolling in a randomized, controlled trial of a menopause risk management program in 1999. Survey items included questions on demographics, health status, and health behaviors. SETTING: A Massachusetts-based health maintenance organization. PATIENTS/PARTICIPANTS: Female members, age 40 to 65, excluding women with chronic conditions precluding study participation, were randomly selected from an automated medical record system. MEASUREMENTS AND MAIN RESULTS: The majority of the 287 postmenopausal and 468 perimenopausal women participating in the study were white, college educated, and nonsmoking. Approximately 30% of both groups reported experiencing hot flashes. Separate multivariable logistic regression models were developed for perimenopausal and postmenopausal women to identify correlates of reporting any versus no hot flashes. After controlling for age, race, oral contraceptive use, hormone replacement therapy use, and depression, correlates of hot flashes in perimenopausal women were body mass index >/=25 kg/m(2) (odds ration [OR], 2.00; 95% confidence interval [CI], 1.28 to 3.12) and alcohol use of 1 to 5 drinks per week (OR, 0.52; 95% CI, 0.31 to 0.86). The only significant correlate of hot flashes in the postmenopausal population was high dietary fat intake (OR, 0.35; 95% CI, 0.15 to 0.81). CONCLUSION: Although study respondents were from similiar sociodemographic groups and received their health care in the same health maintenance organization, modifiable factors associated with hot flashes were different for perimenopausal and postmenopausal women.

Adult↗
PubMed2002

Evaluation of the Massachusetts Behavioral Health Program: Year 8.

The eight-year provider evaluation of the Massachusetts Behavioral Health Program showed positive assessments of care provision, continuing problems in integration of care, high assessments of the clinical review process, high evaluations for administration, and positive ratings compared with other managed care organizations. Changes in provider organizations continue. Substance abuse and mental health providers gave similar ratings, while inpatient providers were more critical than outpatient providers. Ratings in Year 8 were higher generally than in Year 7. The program continues to be a success; however, improvement in several areas continues to be difficult.

Behavioral Medicine↗
PubMed1982

Health behaviors of women.

This article has reviewed both historical and current perspectives on women's health and illness behaviors. It has considered the existing risks to optimal health as well as the potential changes which may occur as women's roles and lifestyles continue to change. Jenkins' model was used to provide a framework for examining the sequence of events which frequently comprise a health behavior, and interventions were offered for the various categories of need--information, motivation, and specific skills to enhance action. Health care providers need to be facilitators of positive health in women but must encourage the female client to determine her own goals and behaviors. The nursing role can include assessing health and illness behaviors, assisting the client with development of manageable health goals, offering specific intervention strategies, and providing ongoing monitoring and support as the woman moves toward her desired goal. As nurses become more knowledgeable about preventive care for women of today, especially in regard to their unique needs and behaviors, perhaps positive health action may be encouraged not only for the prevention of disease but also for the joy of being healthy.

Attitude to Health↗
PubMed2004

Health behaviors in a representative sample of older Canadians: prevalences, reported change, motivation to change, and perceived barriers.

PURPOSE: Prevalence estimates of healthy behaviors and preventive care among older adults have not received sufficient attention, despite important health benefits such as longevity and better quality of life. Moreover, little is known about general population prevalences of older adults' efforts to change behavior, motivations to improve health behaviors, and perceived barriers to change. DESIGN AND METHODS: This study estimates the prevalence of a wide range of health behaviors and preventive-care activities, self-reported behavior change, and perceived barriers to change in a 1996-1997 population-based survey of 17,354 Canadian adults aged 60 and older. RESULTS: The findings indicate that a substantial proportion of older adults lead relatively inactive lives and often fall short of recommended standards for preventive health-care visits and screening tests. Moreover, nearly two thirds (63.2%) of older adults reported no efforts in the prior year to make changes to improve their health, and similar numbers (66.7%) indicated they thought no changes were needed. Differences in prevalences were found by gender, age, and education. IMPLICATIONS: Results from this study are useful for policy makers who need to prioritize public health efforts, researchers studying interventions, and health professionals developing preventive-care guidelines.

Age Distribution↗
PubMed1999

The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review.

OBJECTIVE: To critically review the literature concerning the accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease among the general population. METHOD: A literature search was conducted on three major health research databases: MEDLINE, HealthPLAN, and PsychLit. The bibliographies of located articles were also checked for additional relevant references. Studies meeting the following five inclusion criteria were included in the review: They were investigating the accuracy of self-report among the general population, as opposed to among clinical populations. They employed an adequate and appropriate gold standard. At least 70% of respondents consented to validation, where validation imposed minimal demands on the respondent; and 60% consent to validation was considered acceptable where validation imposed a greater burden. They had a sample size capable of estimating sensitivity and specificity rates with 95% confidence intervals of width +/-10%. The time lag between collection of the self-report and validation data for physical measures did not exceed one month. RESULTS: Twenty-four of 66 identified studies met all the inclusion criteria described above. In the vast majority, self-report data consistently underestimated the proportion of individuals considered "at-risk." Similarly, community prevalences of risk factors were considerably higher according to gold standard data sources than they were according to self-report data. CONCLUSIONS: This review casts serious doubts on the wisdom of relying exclusively on self-reported health information. It suggests that caution should be exercised both when trying to identify at-risk individuals and when estimating the prevalence of risk factors among the general population. The review also suggests a number of ways in which the accuracy of individuals' self-reported health information can be maximized.

Cardiovascular Diseases↗
PubMed1997

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↗
PubMed2001

Searching for evidence about health education and health behavior interventions.

Evidence is fundamental to science, but finding the right evidence in health education and health behavior (HEHB) is often a challenge. The authors discuss some of the controversies about the types of evidence that should be considered acceptable in HEHB, the tension between the use of qualitative versus quantitative data, the need for measures of important but neglected constructs, and interpretation of data from experimental and nonexperimental research. This article discusses some of the challenges to the use of evidence and describes a number of strategies and some forces encouraging the use of evidence-based interventions. Finally, the authors suggest ways to improve the practice and dissemination of evidence-based HEHB. Ultimately, if evidence-based interventions are not disseminated, the interventions will not achieve their potential. The goal should be to develop more effective interventions and disseminate them to improve the public's health.

Community Health Planning↗
PubMed2000

Trends in social class inequalities in health status, health-related behaviors, and health services utilization in a Southern European urban area (1983-1994).

BACKGROUND: The objective of this study was to describe the evolution of social class inequalities in Barcelona (Spain) residents in perceived health status, health-related behaviors, and utilization of health services between 1983 and 1994. METHODS: The information was obtained from the Health Interview Surveys conducted in 1983, 1986, 1992, and 1994 in Barcelona. In this study we included noninstitutionalized people ages >14 years. Social class was obtained from the Spanish adaptation of the British Registrar General classification. We studied health status, health-related behaviors, and health services utilization variables. Age-adjusted percentages and the relative index of inequality were obtained. RESULTS: Of the health status variables, having been confined to bed and acute restriction of activity in the 2 weeks prior to the interview showed an increase in inequalities by social class in 1994. The pattern of chronic conditions by social class in men did not change between 1983 and 1994. Women had a higher prevalence of chronic conditions and the inequalities among social classes had increased. In men there were no social class inequalities in smoking in 1983. In 1992 and 1994 smoking was more prevalent in men of social classes IV and V. In women, smoking was more prevalent in social classes I and II in 1983 than in social classes IV and V, something that had changed by 1994. Lack of usual physical activity in men was always more prevalent in social classes I and II, and this difference increased since more people of advantaged classes moved into inactivity. Health services utilization showed no inequalities in the years studied. CONCLUSION: The changing pattern according to social class of smoking and physical activity practice needs to be taken into account by policy-makers and public health workers.

Adolescent↗