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PubMed2000

[Health promotion indicators - selected model approaches].

The aim of the paper is to present the problem, how to find the optimal set of indicators necessary in the different phases of planning, programming and evaluation of health promotion programmes. In health promotion the application of classic health measurements is limited, because they are not related to "positive health". Moreover, time perspective when effects of promotion could appear is difficult to define. Some model approaches are presented. The PRECEDE-PROCEED model is recognised as a robust framework in health promotion. This model provides a continuous series of steps and phases in planning, implementation and evaluation process. Some authors recommend already in the early phase of programming to draw a diagram showing a relationship between the objectives, activities, indicators and resources. In the process of evaluation it seems very important for health promotion initiatives to focus on the changes in human knowledge, attitudes and behaviours. For that reason models like KAP analysis (knowledge, attitudes, practice), HBM (Health Belief Model) and TTM (Transtheoretical Prochaska's model) are commonly applied. However, the- re is still a need to develop and choose indicators, which would consider environmental aspects of health promotion and link local actions with national health promotion policy.

Health Knowledge, Attitudes, Practice↗
PubMed1996

Qualitative methods in general practice research: experience from the Oceanpoint Study.

BACKGROUND: The Oceanpoint Study is a collaborative study between general practice and medical anthropology. METHODS: The study involved a qualitative ethnographic approach including long-term participant observation, in-depth interviews, health diaries and focus group discussions. Qualitative methods are suited to describing the phenomenological perspectives of people through the generation of rich detailed accounts which leave participants' perspectives intact. RESULTS: The use of these methods in this study has enabled the researchers to explore a range of community beliefs and practices concerning health and illness. The underlying concerns and approach of general practice medicine are similar to those of the qualitative research tradition. CONCLUSIONS: The experience of being a general practitioner parallels the experience of an ethnographer conducting qualitative research and the paper explores the similarities and differences between them and discusses the usefulness of such collaborative research.

Adult↗
PubMed1999

Towards evidence-based health promotion and service provision for new migrants to Australia.

OBJECTIVES: To examine patterns of health utilization and health information dissemination among immigrants to Australia in the first 6 months of immigration using data from the Longitudinal Study of Immigrants to Australia (LSIA). METHODS: The population for the LSIA consists of 5178 principal applicants making their first arrival to Australia on a migrant visa between 1 September 1993 and 31 August 1995, inclusive, and who are aged 15 years or over at the time (96% of all principal applicants). The influence of immigration category, country of birth, health status and age on the likelihood of receiving information about health, sources of health information and use of general practitioners were explored using separate logistic regressions for men and women. RESULTS: Women who received health information were older and less likely to have a chronic illness than women who did not. Men who received health information were older and more likely to be in the Business visa category. Younger women, those in Preferential Family visa categories and bilingual women were more likely than other women to have received health information from an NGO. For men, the only significant predictor of source of health information was being in the Independent visa category. Women who used health services were younger, more likely to have a chronic illness, be proficient in English and less likely to be in the Independent visa category than women who did not. Men who used health services were older, more likely to have a chronic condition and have limited English than men who did not. Men who used health services were more likely to be in the Humanitarian visa class and less likely to be in the Concessional Family or Business visa categories than men who did not use health services. They were also more likely to have been born in Oceania, Middle East and North Africa and Africa. CONCLUSIONS: The results of this study indicate that there are important differentials in knowledge of and use of the health system and these differences are unlikely to be captured by using measures based on ethnicity or country of origin alone. Predictors of health service utilization were different for men and women. In particular, age and lack of English proficiency appeared to be barriers to health service use for women. Visa category and country of birth were more important determinants of health service use for men.

Adult↗
PubMed1997

Primary care--opportunities and threats. Developing professional knowledge: making primary care education and research more relevant.

The trio of recent government white papers heralds a new world for primary care. Many changes in the education of future primary health care professionals and in the research ethos of the discipline will be needed to realise this vision. New skills and attitudes, not least in multidisciplinary working; lifelong learning; and greater understanding of and participation in primary care research will have to emerge from educational efforts in the next few years.

Education, Medical, Continuing↗
PubMed1991

Evaluation of existing status of knowledge, practice and attitude towards oral health of rural communities of Haryana--India.

The KAP survey on oral health practices of 3247 individuals, 6-60 years of age, of Sidhaura block of Haryana revealed that use of dattan was more prevalent (56% in adult community & 49% students) than tooth brush (35% adult community & 34% students). 37% of the total community had the knowledge of brush being the best oral hygiene measure. 25% of the community using brush were brushing only once/day. The knowledge of the community regarding the role of fluorides in prevention of dental caries was completely lacking: 1.8% of the community was using fluoride dentifrice. 35-45 percent of the community were practising sweet foods/drinks etc. four times a day. The snyder test showed a positive relation with frequency of sugar intake.

Adolescent↗
PubMed1996

The referral practice of general medical practitioners to the surgical specialties: implications for the future.

With increasing numbers of general medical practitioners (GMPs) becoming purchasers of health care, providers of surgical services need to understand factors influencing GMP referrals. Using an anonymous postal questionnaire, criteria used by 400 randomly selected general medical practitioners to make referral decisions were assessed. Issues regarding the importance of waiting lists, cost, distance and communication were assessed, along with previous training and fundholding status. The findings of this study reveal that waiting list times for consultation and treatment, along with communication, are the most important criteria influencing referral. Cost, travel and literature from each specialty were the least important factors. General medical practitioners are shown, in the majority, to remain unaware of the range of conditions managed by oral and maxillofacial surgeons. A series of strategies are outlined, which might be used to broaden the referral base for maxillofacial surgery. The need for active education of practitioners is emphasised and the possible effects of regionalisation of the service is discussed.

Attitude of Health Personnel↗
PubMed2004

Awareness of family health history as a risk factor for disease--United States, 2004.

Persons who have close relatives with certain diseases (e.g., heart disease, diabetes, and osteoporosis) are more likely to develop those diseases themselves. Family health history is an important risk factor that reflects inherited genetic susceptibility, shared environment, and common behaviors. Although clinicians are trained to collect family histories, substantial barriers exist to obtaining this information in primary care practice (e.g., lack of time or lack of reimbursement). To promote the use of family history as a screening tool for disease prevention and health promotion, several initiatives have called for new self-administered family history collection tools and educational programs to help clinicians interpret and apply family history information to patient care. To assess attitudes, knowledge, and practices of U.S. residents regarding their family health histories, CDC analyzed data from the 2004 HealthStyles Survey. This report summarizes the results of that analysis, which indicated that although 96.3% of survey respondents believe their family history is important for their own health, few have actively collected health information from their relatives to develop a family history. Targeted public health efforts are needed to 1) help persons collect family history information to share with their health-care providers and 2) educate and assist providers to interpret and apply this information effectively.

Adult↗
PubMed2002

[General practitioners' practices and attitudes in regard to suicidal behavior].

As demonstrated at the recent Consensus Conference on the "suicidal crisis" held by the French Psychiatry Union and the National Agency for the Accreditation and the Evaluation of Care, suicide is recognised as a current public health problem. The general practitioner's role is situated on two levels: in a preliminary stage, the early identification of risk, and in a secondary stage, the provision of care at the time of a suicide attempt and then the provision of on-going follow-up care in partnership with other special services. The study aimed at evaluating general practitioners' practices when encountered with suicidal patients and assessing their management of suicidal behaviour, as well as difficulties met and their expectations. Responses to a questionnaire were received from 290 general practitioners in one regional department in France. The results revealed that two-thirds of the respondents considered the identification of suicidal tendencies as being difficult, in particular with regard to the detection of young people at risk. General hospitals are the most common structures where patients are referred to in the event of a suicide attempt, as a facility that is permanently open and capable of delivering ambulatory care. A majority of the general practitioners expressed the need for training which was focused on methods for the early identification of risk as well as the development of listening skills.

Aftercare↗
PubMed1997

Health promotion and early detection of cancer in older adults: a practical approach.

Little is known about the cancer-related knowledge, attitudes and health behaviours of older adults (> 55 years), or about designing health promotion and early detection interventions responsive to their learning needs. A collaborative project was established with the intent of designing an appropriate program for older adults. The initial work included a community needs assessment using focus groups, one-on-one interviews and self-report surveys. The use of key community contacts was effective in locating older adult subjects (> 55 years) through pre-established linkages with agencies. Various ethnocultural groups, low income communities and isolated individuals, as well as other pre-established groups, were included in this study. The needs assessment found that: age is not perceived as a cancer risk factor; transportation is a barrier to screening; fear inhibits people from being screened; physicians are viewed as both the main source of expert cancer knowledge and as the gatekeepers to screening; family and peers are the main source of support, ethnospecific groups have different information needs; and finally, that lifestyle suggestions can reduce the risk of cancer. The findings indicated that community health promotion programs for older adults will require multiple approaches with a combination of strategies in order to meet their learning needs.

Aged↗
PubMed2004

Hepatitis C knowledge among primary care residents: is our teaching adequate for the times?

BACKGROUND: Increasingly, primary care (PC) physicians will be the first to encounter patients with hepatitis C virus (HCV) infection. AIM: To determine opinions and practices of PC residents regarding HCV. METHODS: We administered a one-page questionnaire to 180 PC residents at five U.S. training programs. RESULTS: Respondents were distributed equally across postgraduate year, 83% were U.S. graduates, and 44% had seen >11 (HCV) patients in the past year. Residents tested for HCV in persons with: increased transaminases (83%), history of blood transfusion (46%), multiple tattoos (57%), +ANCA (16%), and alcohol abuse (31%). Sixteen percent of respondents tested all patients. Forty-one percent would vaccinate HCV patients for hepatitis A and 65% for hepatitis B while only 19% and 78% knew the respective vaccination schedules. Although no vaccine is available, 66% recommended vaccination for HCV. Only 37% and 29%, respectively, reported HCV genotype 1 as most common and most resistant to treatment. Fifty-three percent recommend liver biopsy before treating HCV. Only 52% reported alpha-interferon (IFN) with ribavirin as initial treatment for HCV while 28% recommend ribavirin or lamivudine alone or combinations of IFN and lamivudine or amantadine. As contraindications to treatment, 33% reported AIDS with PCP infection, 19% coronary artery disease, and 19% suicidal ideation. Sixty-nine percent felt that there was insufficient information on HCV. CONCLUSIONS: Many PC residents lack adequate knowledge of recommended guidelines for the management of HCV. Many test for HCV in inappropriate situations, are unclear regarding available vaccines and their administration, and are uncertain about current treatment. Education of PC residents on guidelines for detection and management of HCV must be improved.

Adult↗
PubMed2006

Promoting physical activity among South Asian women with coronary heart disease and diabetes: what might help?

BACKGROUND: People of South Asian origin have higher mortality and morbidity from coronary heart disease (CHD) and diabetes than those of European origin. However, physical activity, of established value in primary and secondary prevention, appears lower among South Asians. OBJECTIVE: To explore influences on, and attitudes towards, physical activity among South Asian women with CHD and diabetes to inform secondary prevention strategies. METHODS: Exploratory qualitative study with women aged 26-70 years of varying South Asian ethnicity, religion and socio-economic background with CHD and/or non-insulin-dependent diabetes were recruited from primary care practices in the UK. RESULTS: The beneficial use of physical activity to improve and limit progression of their disease was largely unrecognized by the women interviewed. They were uncertain what type and level of physical activity was appropriate and safe for them. They operated their own threshold for physical activity in relation to their condition, which they were afraid to exceed. Specific guidance from health professionals was lacking. Respondents emphasized the cultural importance of being active day to day, rather than the 'Western' concepts of organized exercise. However, women's principal motivations and attitudes towards physical activity, to loose weight, socialize and maintain independence, were culturally similar to 'majority' populations. CONCLUSIONS: Better health professional guidance on appropriate physical activity, its health benefits and its safety is needed for this highly at-risk group. Promoting informal moderate-intensity physical activity may help. Strategies should avoid any tendency to overemphasize cultural barriers noting greater similarities than differences between cultural groups.

Adult↗
PubMed2001

Traditional mental health practitioners in Kwara State, Nigeria.

OBJECTIVES: To assess the knowledge, practice and attitude of traditional mental health practitioners (TMHPs) in four Local Government Areas (LGAs) in Kwara State, Nigeria, on mental health care; to organise training sessions aimed at improving their knowledge base, practice and; to evaluate such training after allowing for a period of practice. STUDY DESIGN/INTERVENTION: Pre-training evaluation phase: TMHPs were assessed in the area of knowledge, attitude and practice of mental health, with the use of a questionnaire. They were then trained in the concepts of normality and abnormality, types of mental illness, treatment of mental illness including follow up, after-care, relapse prevention, other primary preventive measures, and some introductory talks on some sub-specialties of psychiatry, for example, child psychiatry, old age psychiatry, forensic psychiatry, drug and alcohol abuse and; after a free-practice period of two months, the TMHPs were again reassessed for the impact of the training. RESULTS: Pre-intervention phase: TMHPs could easily recognise most symptoms of mental illness except undue sadness. The TMHPs also expressed strong belief in the supernatural factor as a cause of mental illness. Some of them beat their patients for therapeutic reasons and; Post-intervention phase: there was a widening of the sense of recognition of TMHPs of important mental symptoms such as undue sadness, social withdrawal and elation. There was a better understanding of the aetiological concepts of mental illness. There was also a reduction in the habit of beating their patients as a form of treatment. CONCLUSIONS: The use of information, education and communication intervention techniques could lead to more positive and less hazardous forms of practice among TMHPs and; The high level of cooperation achieved in this study would indicate a bright chance for future collaborative activities between orthodox and traditional healthcare providers.

Adult↗
PubMedDate not supplied

Activating patients to practice skin cancer prevention: response to mailed materials from physicians versus HMOs.

OBJECTIVES: We investigated whether the source and emphasis of mailed messages about skin cancer would differentially activate patients to initiate skin cancer prevention by calling a toll-free number. METHODS: We mailed a questionnaire to 981 randomly selected patients of a large medical group to assess their concern about and risk for skin cancer: 48 were returned undeliverable (n = 933). The booklet was accompanied by a letter inviting patients to call a toll-free number. Patients received the letter from one of three sources: (1) their physician, (2) their HMO, or (3) a fictitious junk mail organization. Patients received one of three different messages emphasizing the effects of ultraviolet (UV) rays on (1) the risk of skin cancer, (2) aging and wrinkling of the skin, or (3) aging and wrinkling accompanied by a book further emphasizing these harmful effects of the sun. RESULTS: The overall activation rate was low (7%); nevertheless, the source of the preventive message significantly affected whether patients called in. Messages from physicians and HMOs were more activating than messages from the junk mail organization (odds ratio [OR] = 3.40, confidence intervals [CI] = 1.66, 6.97), but messages from physicians were not more activating than messages from HMOs (OR = 1.56, CI = .90, 2.72). The emphasis of the message did not significantly affect call-in rates. Risk for skin cancer was positively associated with patient activation, but attitudes and beliefs about skin cancer prevention were unrelated to activation. CONCLUSIONS: These results should encourage HMOs and physicians to continue their preventive health outreach as one aspect of multicomponent prevention efforts. The results also suggest that HMOs and physicians can activate patients most at risk for skin cancer by emphasizing both risks of cancer and aging and wrinkling when they deliver a skin cancer preventive message.

Adult↗