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Community health behavior change through computer network health promotion: preliminary findings from Stanford Health-Net.

Computer-based health education has been employed in many settings. However, data on resultant behavior change are lacking. A randomized, controlled, prospective study was performed to test the efficacy of Stanford Health-Net (Stanford, CA, U.S.A.) in changing community health behaviors. Graduate and undergraduate students (N = 1003) were randomly assigned to treatment and control conditions. The treatment group received access to Health-Net, a health promotion computer network emphasizing specific self-care and preventive strategies. Over a 4-month intervention period, 26% of the treatment group used Health-Net an average of 6.4 times each (range 1-97). The most commonly cited reasons for use were curiosity, general health education, evaluation of current symptoms and anonymity of information. Users rated Health-Net favorably. The most commonly reported reasons for non-use were related to lack of health problems, limited time and lack of access to computer facilities. The mean number of ambulatory medical visits decreased 22.5% more in the treatment group than in the control group (P less than 0.05), while hospitalizations did not differ significantly between groups. In addition, perceived self-efficacy for preventing the acquisition of a sexually transmitted disease (STD) and herpes increased 577% (P less than 0.05) and 261% (P less than 0.01) more, respectively, in the treatment group than in the control group. These findings suggest that access to Stanford Health-Net can result in significant health behavior change. The advantages of the network approach make it a potential model for other communities.

Adult↗
PubMed2002

An exploratory analysis of behavioral health care use within families.

OBJECTIVES: The authors studied enrollees in employer-sponsored managed health plans to determine the extent of multiple behavioral health consumers within families, use of behavioral health services by employees who have another family member using such services, congruence of diagnoses between two family members using behavioral health services, and the effect on covered charge per behavioral health consumer when other family members use behavioral health services. METHODS: Claims data from 911 plans sold or managed by a single managed behavioral health care company were examined. The plans provided coverage for 724,789 employees and covered about 1.7 million lives. Family members of employees were identified by the relationship codes on the claims. Service utilization rates were calculated for employees overall and for employees who had spouses or children who used behavioral health services. Mean and median covered charges were determined and were examined by number and type of consumers in the family. RESULTS: The use of behavioral health services was greater among employees whose children or spouses used behavioral health services. Utilization rates varied by the child's or spouse's diagnoses. More than 50 percent of male employees whose children received treatment for a depressive disorder also received such treatment. Congruence of diagnoses within families was noted. Covered charges per person generally increased with the number of family members who used behavioral health services. CONCLUSION: Greater knowledge about patterns of use of behavioral health services within families may help in improving access to care and developing more effective family interventions.

Adult↗
PubMed2003

Sleeping problems and health behaviors as mediators between organizational justice and health.

The aim of this longitudinal cohort study was to investigate whether sleeping problems and health behaviors (smoking, alcohol consumption, and sedentary lifestyle) mediate the association between organizational justice and employee health. Health indicators were minor psychiatric morbidity, as assessed by the General Health Questionnaire (U. Werneke, D. P. Goldberg, I. Yalcin, & B. T. Ustun, 2000), and poor self-rated health status. The results of logistic regression analysis of data for 416 male and 3,357 female hospital employees working during the 1998-2000 period in 10 Finnish hospitals suggest that sleeping problems are one of the underlying factors causing the adverse health effects of low organizational justice at work. No support for a mediating role of health behaviors between low organizational justice and health problems was obtained.

Adolescent↗
PubMed1994

African American college students' health behaviors and perceptions of related health issues.

The authors identify specific health-related behaviors of African American college students and compare them with the students' perceptions of corresponding health issues. Among students surveyed, the rate of cigarette smoking (4%) was very low compared with smoking rates found in a national survey (14%); but alcohol consumption was relatively high (63%), although lower than the national average of 91%. More men than women smoked, but more women than men reported they drank alcoholic beverages. Most students (90.2%) said they did not usually eat breakfast, 73.6% reported that their diets were not nutritionally balanced, and the majority (55.4%) were not involved in daily physical activity. More than half (63%) of the students reported satisfactorily handling stress, and 74.1% indicated that they were sexually active. Respondents perceived the most important health issues facing college students as HIV/AIDS and sexually transmitted diseases (STDs), birth control, date rape, stress management, suicide, and alcohol and other drugs.

Adolescent↗
PubMed2001

The impact of concept of health on health behavior.

Although previous studies have examined selected factors influencing health behavior, the complex interplay of the concept of health and health behavior in persons with chronic illness has not been investigated. The purpose of this study was to investigate the individual effects of six factors in the concept of health on the health behavior of Taiwanese people with chronic illness. A sample of 372 persons with chronic illness completed instruments measuring their concept of health and health behavior. Six proposed models were assessed using the maximum likelihood estimation, which is implemented by LISREL 8.3. The overall fit of the models tested in this study lends support to the assertion that the factors of the concept of health affect health behavior. Zest for life, serenity and meaning were the strongly affecting factors. These factors each accounted for 34-43% of the variance in health behavior. The results of this study support the notion that the health behavior of people with chronic illness can be predicted by their concept of health. Further research using a longitudinal design is needed to clarify the causal relationship between the concept of health and health behavior in Taiwanese people with chronic illness.

Adult↗
PubMed1999

Perceived health competence and personality factors differentially predict health behaviors in older adults.

OBJECTIVES: Previous studies have shown relationships among personality, perceived efficacy, and proactive health behaviors. Although health behaviors are particularly important among seniors, little is known regarding predictors of health behaviors in older adults. The current study examined the extent to which facets of personality, perceived health competence (PHC), and health status predicted health behaviors among older adults. METHODS: Ninety-seven older adults responded to questionnaires assessing health status, personality, PHC, and level of engagement in certain health behaviors. RESULTS: Whereas higher levels of Conscientiousness and lower levels of Neuroticism predicted a greater likelihood of engaging in social support/relaxation behaviors, after controlling for health status and education, higher levels of PHC predicted greater exercise and dietary/health information-seeking behaviors. DISCUSSION: These findings suggest the importance of considering facets of personality and PHC when evaluating health care strategies for the elderly.

Aged↗
PubMed2003

Health education and multimedia learning: educational psychology and health behavior theory (Part 1).

When health education researchers began to investigate how individuals make decisions related to health and the factors that influence health behaviors, they referred to frameworks shared by educational and learning research. Health education adopted the basic principles of the cognitive revolution, which were instrumental in advancing the field. There is currently a new challenge to confront: the widespread use of new technologies for health education. To better overcome this challenge, educational psychology and instructional technology theory should be considered. Unfortunately, the passion to incorporate new technologies too often overshadows how people learn or, in particular, how people learn through computer technologies. This two-part article explains how educational theory contributed to the early development of health behavior theory, describes the most relevant multimedia learning theories and constructs, and provides recommendations for developing multimedia health education programs and connecting theory and practice.

Computers↗
PubMed2003

Financing results and value in behavioral health services.

Current changes require that behavioral health care leaders understand how public and private financing mechanisms interact and how, now more than ever, behavioral health care leadership must span multiple systems and financing streams. Understanding how financing mechanisms work, what they create, and what they cause is essential if we are to make the most of increasingly limited and increasingly complex resource streams in today's health care market. This article explores a different paradigm of what adds value to publicly funded behavioral health care systems, and provides the framework for the American College of Mental Health Administration's call to behavioral health care administrators to take a new approach to the considerations behind funding decisions and payment mechanisms.

Behavioral Medicine↗
PubMed1994

Associations between major domains of personality and health behavior.

Broad personality traits may be important predictors of health behavior patterns. Two studies are reported which examined the associations between five major personality dimensions and four major health behavior dimensions. Prior associations between health behaviors and neurotic and extraverted personality tendencies generally were replicated. However, Conscientiousness and Agreeableness, two domains of personality that have received little research attention, emerged as important personality predictors of health behaviors. The results indicate that personality is a reliable predictor of health behavior patterns. It is suggested that the importance of personality has been underestimated in past research by the failure to consider appropriate health behavior criteria and the omission of important personality dimensions, such as Conscientiousness and Agreeableness, when studying health behavior patterns.

Adolescent↗
PubMed1999

Health behaviors among American Indians with spinal cord injury: comparison with data from the 1996 Behavioral Risk Factor Surveillance System.

OBJECTIVE: To identify patterns of health behaviors and health outcomes among a sample of American Indian men with spinal cord injury. DESIGN: Telephone interviews with all participants, except those who did not have telephones (they returned materials by mail). SETTING: Large rehabilitation hospital in the Western mountain region of the United States. PARTICIPANTS: Seventy-six American Indian men with traumatic SCI of at least 1 year in duration. MAIN OUTCOME MEASURE: Selected health-related behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) were used to assess health behaviors and general health outcomes among the American Indian SCI sample and to compare findings with those from American Indian men without SCI based on nationwide BRFSS data. RESULTS: The study participants reported lower overall health and satisfaction with health care than the non-SCI BRFSS group. They also reported a different pattern of health behaviors, including a greater frequency of inoculations for flu and pneumonia but a lower rate of HIV testing and cholesterol screening. A smaller percentage of American Indians used alcohol, but those who did reported more heavy drinking. CONCLUSIONS: American Indians with SCI are more likely to receive health care consistent with the prevention of secondary conditions of SCI (eg, pneumonia), but less likely to receive basic health screens intended to prevent chronic health diseases.

Adult↗
PubMed2005

Models of research-operational collaboration for behavioral health in space.

Addressing the behavioral health needs of astronauts clearly requires collaborations involving researchers, clinicians and operational support personnel, program administrators, and the astronauts themselves. However, such collaborations are often compromised by a failure to understand the needs, priorities, constraints, and preferences of potential collaborators. This failure, in turn, can lead to research of poor quality, implementation of programs and procedures that are not evidence-based, and an increased risk of morbidity and mission failure. The experiences of social marketing strategies in health promotion and disease prevention, cultural exchange between developers of evidence-based treatments and consumers, and dissemination and implementation of evidence-based practices in mental health services offer three different models of research-operational collaboration with relevance to behavioral health in space. Central to each of these models are the patterns of interpersonal relations and the individual, social, and organizational characteristics that influence these patterns. Any program or countermeasure for behavioral health in space must be both needs-based and evidence-based. The successful development, dissemination, implementation, and sustainability of such a program require communication, collaboration, and consensus among all key stakeholders. To accomplish this, all stakeholders must participate in creating a culture of operational research.

Aerospace Medicine↗
PubMed1999

More providers taking risk for Medicaid behavioral health.

Providers making inroads into managed Medicaid behavioral health. A new study shows that traditional public agencies and providers, not commercial managed care organizations, are running behavioral health programs in managed Medicaid. Even Medicaid HMOs with behavioral health benefits integrated in their program are turning behavioral health over to providers, putting them at full risk. See how one plan's behavioral health contractor is rising to the challenge.

Alabama↗
PubMed1995

Self-esteem and value of health as determinants of adolescent health behavior.

PURPOSE: To study the relationship between personality attributes and health behaviors and practices during adolescence. DESIGN: We have studied a total of 100 subjects aged 12-13 and 16-17 years of both sexes. To examine self-esteem and the value of health in a series of habitual practices of health, a stepwise multiple regression analysis was undertaken. The instruments used were the Gordon Personal Profile (GPP) (1978) to evaluate self-esteem, the Costa et al.'s (1989) Value of Health Scale to estimate the value of health and, the Rivas Torres (1991) Health Behavior Questionnaire to measure health behavior. RESULTS: Self-esteem explains 39% of the mental health behavior and 5% of the social health behaviors. Meanwhile, the value of health, in the case of security behaviors, explains 13%, and in relation to personal health behaviors, 9%. CONCLUSIONS: The importance assigned to certain personality attributes in relation to adolescent health behavior shows the need for additional investigations that incorporate other variables and subject groups with different ages.

Adolescent↗
PubMed2002

Training and education needs of consumers, families, and front-line staff in behavioral health practice.

Much of the behavioral health care delivered to people with serious mental illnesses and chronic addictive disorders is provided by front-line or direct service mental health workers. Issues related to the qualifications, training, and ongoing evaluation of the competencies of this important provider group have received scant attention in the behavioral health field. This paper explores the educational needs and best practices of the consumers and families who carry much of the burden of caring for disabled populations, as well as the front-line staff, many of whom are employed in state psychiatric hospitals and community mental health or addiction treatment systems. Within the overall context of culturally competent behavioral health care, specific recommendations are proposed in an attempt to move the field forward.

Adult↗
PubMed1992

Multi-level analysis in epidemiologic research on health behaviors and outcomes.

Individual-level health behaviors and outcomes have multi-level determinants (individual and environmental). Multi-level analysis seeks to explain individual outcomes in terms of both individual and environmental or aggregate variables. Ecologic fallacy (improper inference about individual-level associations based on associations measured only at the aggregate level) can result from confusion about the level of inference that is of ultimate interest. The perspective of multi-level analysis acknowledges the importance of both individual and environmental variables in determining health behaviors and outcomes at the level of the indivisible unit--the individual. The authors review concepts and methods of multi-level analysis and their application to epidemiologic research on health behavior and health outcomes.

Chronic Disease↗
PubMed1993

Do communities differ in health behaviors?

Communities differ in the prevalence of various health behaviors, but it is not known to what extent these differences are due to "different types" of people living in them. We used data from the evaluation of the Henry J Kaiser Family Foundation Community Health Promotion Grant Program to study individual-level and community-level variation in health behaviors for 15 communities. Our results show (1) there was significant variation among these communities in prevalences of smoking, consumption of alcohol and dietary fat, and use of seatbelts; (2) these differences persisted after control for demographic, health status, and other health behavioral characteristics of the people in the communities; (3) the community effect on a particular person's behavior, as represented by R2, was very small (less than 1%); and (4) the adjusted differences in prevalences among communities were potentially large (for example, a 7 percentage point difference in the probability of smoking). Unique features of communities may influence health behaviors. These findings affirm the potential importance of contextual effects on individual health behavior and thus support the theory that changing the community environment may offer effective ways to change individual health behavior.

Adolescent↗
PubMed2002

Utilization and cost of behavioral health services: employee characteristics and workplace health promotion.

The study sought to (1) model demographic and employment-related influences on behavioral health care utilization and cost; (2) model behavioral health care utilization and cost influences on general health care cost, job performance, and earnings; and (3) assess workplace-based health promotion's impact on these factors. Behavioral health care utilization was more common in employees who were female, over age 30, with below-median earnings, or with above-median general (non-behavioral) health care costs. Among employees utilizing behavioral health care, related costs were higher for employees with below-median earnings. Employees utilizing behavioral health care had higher general health care costs and received lower performance ratings than other employees. Health promotion participants were compared with a nonparticipant random sample matched on gender, age, and pre-intervention behavioral health care utilization. Among employees without pre-intervention behavioral health care, participants and nonparticipants did not differ in post-intervention utilization. Among employees utilizing behavioral health care adjusting for pre-intervention costs, participants had higher short-term post-intervention behavioral health care costs than nonparticipants.

Adolescent↗