[Sociology of health behavior. Hypotheses--thoughts--results].
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This column describes a creative effort on the part of a national behavioral managed care plan to identify cases of domestic violence in its covered population. Although the screening efforts by intake counselors and clinicians yielded a lower rate of domestic violence than would have been expected, the effort established a baseline or benchmark from which the organization can now work. Clinical benchmarks are critical to developing an understanding of best practices. In this case, the benchmark finding initiated a best practices process through which this organization--and, hopefully, others--will continue to create better methods for identifying and helping people who experience domestic violence.
Depression, anxiety, and somatoform disorders are 2 to 3 times more prevalent in women than in men. Since the advent of managed care and other pressures on the healthcare delivery system in the United States, there has been a notable diminishment of services and service funding for treatment of mental health conditions, whether they are temporary, transitional, or chronic. As a result of this trend, we have seen an increase in the number of patients seeking help for emotional and mental health concerns from their family doctors or, in the case of women, from their obstetrician-gynecologists. We have also found that emotional and mental health problems are often converted into physical symptomatology that carries fewer stigmas and is often viewed as easier to treat. Many women use their obstetrician-gynecologists for primary care, particularly during their reproductive years. Provision of behavioral healthcare is critical to health maintenance for many of these women. Barriers to the integration of behavioral healthcare into obstetrics and gynecology practice need to be understood and systemically addressed.
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Although humanism has emerged as an important issue in medical education and practice, there is no standardized definition of humanism or an instrument that measures patients' perceptions of their physician's level of humanism. This study addressed these three issues: 1) A definition of physician humanism was developed based on the current literature; 2) an instrument was designed that measured patients' perceptions of humanism in their family physicians; and 3) health outcome variables were measured relative to these perceptions. The design was a cross-sectional survey of 185 randomly selected patients from two family practice sites. The questionnaire consisted of a humanism scale, in addition to items to assess patient satisfaction and patients' adherence to medical advice regarding exercise, diet, and smoking cessation. A positive association was found between perceived physician humanism and patient satisfaction. Greater success in patients' attempts to quit smoking was associated with higher physician humanism. The implications of these findings for evaluation and training of health care providers and patients' use of health care services are discussed.
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A model has been proposed to improve program development and management of behavior change programs with large-scale community impact. It can be applied to epidemiologic problems of which lifestyle is an important component, such as heart disease, adolescent pregnancy, hypertension, weight control, and cancer control and prevention programs. The model combines two previously existing models: one indicating that program development is an ongoing cyclical process which starts with uncertainty yet can progress to institutionalization with suitable testing; and the second model indicating that program management within each developmental cycle progresses through specific phases which can be hampered by plateaus and setbacks. Nine systems are essential for program development and operations: education (philosophy, objectives, and content), communications, reward, intervention, program process, program development, and program evaluation. These systems can be used as a guide to facilitate selection from the many guidelines recommended in the literature, and to ensure coordination of innovative program elements.
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Some women receiving abnormal cervical screening tests do not complete recommended treatment. A prospective study (N = 660) investigated the value of conceptualizing attendance at colposcopy for treatment as either (a) an active problem-solving response to a health threat, motivated by attitudes toward an abnormal result, as implied by self-regulation theory (H. Leventhal, D. Meyer, & D. Nerenz, 1980); or (b) as a behavior motivated by attitudes toward clinic attendance, as implied by the theory of planned behavior (TPB; I. Ajzen, 1985). Responses to questionnaires containing variables specified by these models were used to predict women's subsequent attendance or nonattendance for treatment over the following 15 months. Although the TPB offered superior prediction of intentions and completion of treatment, discriminant function analyses showed that consideration of both models was important in distinguishing between those who attended all their appointments as scheduled, attended after being prompted, or ceased attending. Implications for measurement and theory in health protection are discussed.
The burgeoning of consumer health informatics and virtual health care can help people improve their health. However, little is known about individuals' reactions to such systems. We conducted an evaluation of the telephone-linked care (TLC) system, a computer-based telecommunications system, that functions as an at home monitor, educator, and counselor for patients with chronic health conditions. Our multimethod assessment of individuals' reactions to using TLC included both quantitative and qualitative methods. Ethnographic in-depth open-ended interviews indicated more subtle and surprising reactions to TLC than the overall positive responses from surveys: individuals formed personal relationships with this technology. This relationship formation suggests that TLC designers may have been successful in their attempts to emulate a conversation with a human being. Our study adds to evidence that technology can serve as a projective device for peoples' values and psychological issues. Both designers and users project values and goals onto computer-based technologies and take on different identities through it. Different groups of users, therefore, may see the same technology differently. People also form relationships with technologies, as they did with TLC. These findings, as well as implications for system design and health outcomes, need to be explored in additional studies.
The purpose of this study was to explore the impact of education about urinary incontinence on the subsequent help-seeking behaviors of older adults. Forty-five community-dwelling seniors were randomized to two groups. One group received individualized instruction supported by written information, the other received written information alone. All participants received a list of local health care professionals specializing in the assessment and treatment of urinary incontinence. Seventeen participants sought professional help following the intervention; however, there was no significant difference in help-seeking behaviors between intervention groups, chi2 = 1.42, alpha = 0.05. The most common reasonfor lack of help-seeking postintervention was a preference for self-care. Eighty-eight percent of those who initiated self-help behaviors reported a subjective improvement in the frequency or volume of their incontinence. Results emphasize the important role registered nurses should play in the dissemination of complete and accurate information about urinary incontinence.
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