Linkage leaders. Behavioral health providers form partnerships for success.
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Community Mental Health Services↗
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Results for “Health Behavior”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Health behavior correlates of hazardous drinking by Army personnel.
The current investigation determined that military personnel who drink heavily differ from those who drink moderately in the practice of nine behaviors often associated with unhealthy lifestyle. In particular, excessive drinkers were found to smoke more, drive dangerously more frequently, and consume saturated fats more often. The project further found that the relationship of excessive drinking to these activities is mediated by age, marital status, and race, although not by gender or rank. Implications of the findings for prevention and treatment are suggested.
Adult↗
Making the transition to critical pathways--a community behavioral health center's approach.
BACKGROUND: Shawnee Hills, Inc., formally began the transition to critical pathways in January 1996. The goal was to design and implement a service delivery model with clearly defined clinical paths and appropriate and functional technical support systems. No specific goal date for full implementation was designated; however, the intent was to move into the new system in a manner that allowed both consumer and employee participation in the planning process and to accommodate the organization's transition from a fee-for-service to a capitated model of contracting for services. The target date for completion of phase one, research and initial planning, was March 1, 1996. Although there were a number of benefits anticipated in adopting the critical paths method (CPM), the primary rationale was threefold: (1) standardizing the quality of care and treatment, (2) cost containment, and (3) better positioning of the organization for success within a capitated funding environment. A review of the publications indicated that the CPM had proved to be effective in other healthcare fields. In addition, the goals and approaches inherent within the CPM were consistent with the organization's total quality management (TQM) philosophy and operational practices. METHOD: By using the approach common to the organization since the adoption of the principles and practices of TQM in early 1992, a team was appointed with the mission of reengineering the clinical services delivery model. Unlike previous instances, however, this team was comprised largely of senior leadership, and two staff members were assigned on a full-time basis. A more detailed review of publications was conducted and, where possible, identification of critical pathways developed within the mental health field in other states were secured. Focus groups were used to address "best" or "preferred" practices for specific populations and age groups. Team members provided an orientation to the process, along with the opportunity to critique proposed pathways and models for service delivery as they were drafted to all employees through participation in ongoing staff development efforts. The center leadership was kept informed and was provided additional opportunities for input through regular presentations to the Quality Council that meets on a weekly basis. RESULTS: The first phase of the transition, research and initial planning, was completed on March 1, 1996. To date, the team has adopted or developed initial drafts of proposed clinical pathways for frequently occurring diagnoses within adult and child mental health, adult and child substance abuse, and specific to early childhood for the mental retarded or developmentally delayed. A model for clinical pathways was developed incorporating the JCAHO requirements to address assessment, care, and education at the major junctures of service delivery. In addition, the team formulated recommendations specific to priority areas for each major pathway and the approach to be taken in the transition from a fee-for-service to a capitated environment. A service delivery model built around acute care and continuing care was outlined, but remains a work-in-progress at this time. Finalizing the model and the completion of the clinical pathways for specific diagnostic groupings are two priorities for the second phase, product development-continued planning and transition, now underway. CONCLUSIONS: Although the effort is very much outcomes-oriented, data are not available at this early stage in the process. (ABSTRACT TRUNCATED)
Adult↗
Relative success of state-managed behavioral health care: does the financing structure play any role?
Federal Section 1915(b) and Section 1115 waivers, through the Health Care Financing Administration, are the primary modes for implementing Medicaid-managed mental health and chemical dependency services. This paper focuses on three distinct case studies of managed mental health programs in Tennessee, Massachusetts, and Hawaii. The purpose is to determine, among other design factors (such as carve-in, carve-out, and covered services) the specific roles that differences in the financing structure play in the relative success of these programs. Findings from the three distinct models should provide lessons for the impending mental health programs of other states, including those in the varying stages of implementation.
Financial Management↗
Managed behavioral health care: is there a basis for optimism?
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Economic Competition↗
Some early lessons from the rise of managed behavioral health care in the United States.
In the 1990s the United States has, because of an unacceptable surge in health care costs, made a revolutionary shift of the reimbursement process from fee-for-service to managed care's restricted, discounted and capitated payment approaches. Mental health care has for 150 years largely been subsidized by tax supported hospitals and clinics. Federal and state governments have recently instead begun to direct much of their monies to for-profit national managed mental health care companies. While efficiency has improved and the steep rise in costs has been eased, the major drawback of this change is a too enthusiastic focus on corporate profits. Since on the whole managed care organizations do not reinvest profits into medical education or research and may pull out of the health care business once the business is no longer so profitable, clinicians and academicians must become more successful in urging politicians and the citizenry to better manage managed care.
Cost-Benefit Analysis↗
Developing behavioral health clinical guidelines for depression: emerging standards for guiding care.
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Algorithms↗
[Preventive behavior in health: an exploration of the concept].
The purpose of this paper is: to show some aspects concerning preventive health behaviors, as well as determinants inducings and inbitings, component parts and phases; to contribute in the identification of influence of this behavior about the life and health personal's level; to subsidize with a theoretical fundamentation, the atuation of the nurse together patientes.
Community Health Nursing↗
Guidelines for designing a Web-delivered college health risk behavior survey: lessons learned from the University of Florida Health Behavior Survey.
Collecting health-risk behavior data from college students is a Web survey research application with extraordinary potential that has implications for individual schools and for the next National College Health Risk Behavior Survey. Recent evidence suggests that it is now feasible to collect health-risk behavior data from college students using the Web. This article describes the eight steps used in the 1999 University of Florida Health Behavior Survey that demonstrated the feasibility of the Web to collect health-risk behavior data from undergraduates. Practical issues researchers should consider when conducting Web-delivered survey research also are presented. Information in this article can be used by college and university health survey researchers and student health service administrators to plan and conduct their own health-risk behavior Web-delivered survey, and to develop an electronic college health-risk behavior surveillance system for their schools.
Behavioral Risk Factor Surveillance System↗
Health related attitudes and health promoting behaviors: differences between health fair attenders and a community group.
Demographic, attitudinal, and behavioral differences between health fair attenders and a community comparison group were examined along with predictions of health promoting behaviors from demographic and attitudinal variables. Differences between questionnaire responses of 155 health fair attenders and 71 grocery shoppers indicated attenders perceived themselves having better current health and greater internal control of their health, and reported more behaviors indicating health responsibility, exercise, and nutrition than the comparison group. Psychological variables--particularly perceptions of greater self-efficacy and better health status--were the best predictors of attenders' health promoting behaviors; demographic variables were less important. On the other hand, demographic variables were most predictive of comparison group health promoting behaviors with psychological variables playing a lesser role. Further studies of relationships between the variables examined here and experimental studies of the effects of health fair attendance on health knowledge and performance of health promoting behaviors are needed. Assuming health fairs are effective in educating attenders, it was concluded that health fair planners should: 1) encourage nonattenders to become attenders and attenders to be repeat attenders, 2) carefully promote and advertise health fairs, and 3) hold health fairs in locations easily accessible to large numbers of people.
Attitude to Health↗
A community-oriented primary care demonstration project: refining interventions for cardiovascular disease and diabetes.
BACKGROUND: We describe a community-oriented primary care project that implemented all 5 steps of the formal model. Data are presented on cardiac risk factors, protective behaviors, health locus of control, and stage of readiness for change in an African American community. We discuss the use of these data to refine our health promotion interventions. METHODS: We undertook a cross-sectional study of self-reported health behaviors from a door-to-door household survey of a geographically-defined community. Trained community members administered the survey questionnaire, which was completed in 386 of 557 randomly sampled households (response rate 69.4%). Qualitative discussions of survey results with 2 community groups were taped, transcribed, and analyzed for common themes. RESULTS: Compared with their counterparts, respondents who were older than 65 years (P = .0006), who had hypertension (P <.0001), and who had diabetes (P = .001) had higher mean scores for powerful others locus of control. Rates for physical activity and low-fat diet indicators were low compared with national statistics. Most respondents reported a maintenance stage of change for exercise (46.2%) and diet (57.5%). Group discussions found lack of local exercise resources and high-quality grocery stores to be major barriers to health behavior change. Ministers and physicians were identified as important powerful others. CONCLUSION: This study documents low rates of physical activity and healthy dietary patterns and describes recent interventions to address environmental barriers to behavior change. The association between powerful others locus of control and specific cardiac risk factors has prompted a greater emphasis on developing faith-based interventions and renewing physician-counseling efforts. Stage of readiness for change findings have prompted strategies to disseminate existing diet and physical activity recommendations more effectively.
Black or African American↗
Covariations of eating behaviors with other health-related behaviors among adolescents.
PURPOSE: The study objectives are: (1) to examine and compare patterns of covariation of a wide range of health behaviors among adolescent boys and girls; (2) to determine whether eating behaviors are part of a larger construct of health-related behaviors and to identify the behaviors with which they share underlying similarities; and (3) to determine whether youth engaging in other health-compromising behaviors are at risk for unhealthy eating. METHODS: Data were analyzed from the Minnesota Adolescent Health Survey, a classroom-administered questionnaire, completed by 36,284 adolescents, in grades 7-12 from 1986-87. RESULTS: Among boys, factor analysis revealed five factors: (1) risk-taking behaviors, (2) school-related behaviors, (3) "quietly" disturbed behaviors (e.g., frequent dieting, self-induced vomiting, suicide attempts), (4) health-promoting behaviors; and (5) exercise. Eating behaviors loaded on the construct of health-promoting behaviors with brushing teeth and seat belt use. Among girls, four similar factors emerged; however, exercise loaded on the construct of health-promoting behaviors. Therefore, eating behaviors loaded with brushing teeth, seat belt use, and exercise among girls. Logistic regression analyses, controlling for sociodemographic and personal variables, revealed that boys and girls engaging in health-promoting behaviors were less likely to have unhealthy eating behaviors, while those engaging in quietly disturbed behaviors, risk-taking behaviors, and problematic school behaviors were more likely to have unhealthy eating behaviors. CONCLUSIONS: Eating behaviors appear to be part of a health-promoting behavioral construct and should not be viewed in isolation from other behaviors. Although eating behaviors do not appear to be part of the "problem behavior syndrome," youth engaging in a wide range of health-compromising behaviors are at risk for unhealthy eating; emphasizing the need to target high-risk youth with health promotion programs.
Adolescent↗
Oral health, related behaviors and oral health impacts among homeless adults.
OBJECTIVE: To assess the oral health needs, related behavior and oral health impact among homeless persons in Newark, New Jersey. METHODS: Participants represented a convenience sample of adults (n=46) participating in Homeless Services Day, an annual event sponsored by the Homeless Services Division of the Newark, NJ Department of Health and Human Services. Their mean age was 40.4 yr (SD=10.0), and 51.1% were female. The majority (76%) reported African-American ethnicity; remaining participants self-identified as Hispanic, White or Asian. Participants reported being homeless for a median of 11 months, with a range of 1 to 108 months. RESULTS: The 46 participants had 745 teeth (averaged 16.2 per person) that were either missing, had fillings or had untreated decay. Diseased teeth averaged 3.8 per person; missing teeth averaged 8.6 per person; and filled teeth averaged 3.7 per person. Only 28.3% had a dental visit in the past year. Approximately 87% reported negative oral health impacts impact: over half (55.6%) had current oral facial pain and two-thirds of our participants reported having dental-related face pain during the past year. Additional oral health impacts included: eating (42%), smiling (33%), concentrating (18%) and talking (16%). CONCLUSIONS: Consistent with other studies, this homeless sample presented with considerable oral health needs. Newark's homeless, like other homeless cohorts, face access to care and negative oral health impacts. This study informs the need for future research that can provide substantive evidence for care providers and policy makers.
Adult↗
Urban seventh graders and smoking: a health risk behavior assessment.
Health risk behaviors undertaken in adolescence, such as smoking, can have a lasting impact on both short-term and long-term health developments. To better describe the health risk behaviors of an adolescent urban population, a study was conducted at two parochial middle schools in the southwest section of Philadelphia. The study purpose was to describe (1) the types of health risk behaviors being undertaken by a seventh grade student population, (2) the frequency of health risk behaviors, and (3) the age of initiation of the health risk behavior, e.g., age when they first began smoking. A descriptive, correlational study was undertaken with 106 urban seventh graders (ages of 11-13 years) from two seventh grade classes. Using the Youth Risk Behaviors Surveillance System Questionnaire, information was collected about health risk behaviors. Correlational statistics indicated significant correlations between students who smoke and alcohol use, dieting, and not feeling safe in their neighborhood. Interestingly, girls were more likely to use smoking as their primary method of weight control and dieting. Because the long-term impact of smoking is known to be negative, nurses should provide support to this at-risk population and also should be prepared to educate adolescents who come under their care.
Adolescent↗
Effects of father-daughter contact on use of pregnancy services by Mexican, Mexican-American, and Anglo adolescents.
This study describes whether frequency and quality of father-daughter contact during adolescent pregnancy differ by ethnicity, whether this contact affects health behavior, and how ethnicity conditions the relationship between contact and behavior. Health behavior is defined as timing of pregnancy test and first prenatal visit. Data were gathered from a sample of 105 Anglo, Mexican-American, and Mexican adolescents interviewed at mid-pregnancy. Almost twice as many Mexicans (64%) as Mexican-Americans never saw their fathers (p less than 0.03). Girls living with their fathers obtained pregnancy tests significantly later (p less than 0.01) than those living independently. This relationship was maintained when ethnicity was held constant (p less than 0.01). When quality of contact was included, the relationship between residency with father and timing of pregnancy test became even stronger (p less than 0.003).
Adolescent↗
Behavioral correlates of health and illness in youths with chronic illness.
Relationships between and among general health behavior, illness management behavior, indicators of health (functional, physical/mental, and perceived health status) and indicators of illness (duration, control, and perception of severity) were compared across five samples of youth with either insulin dependent diabetes mellitus (IDDM) or asthma. Descriptive data indicated that youths performed approximately 72% of the health and illness management behaviors recommended by health professionals. General health behavior and illness management behavior were significantly related (r = .39 to .62; p < .05). General health behavior was more consistently related to indicators of health (r = .37 to .62; p < .001) than to indicators of illness. Illness management behavior was not related to indicators of illness either. However, illness management behavior was significantly related to higher perception of health status (r = .35, .48; p < .001). Interestingly, there were no relationships between health and illness indicators. These findings challenge nurses to address general health behavior as well as illness management in practice and to raise questions as to whether illness management improves illness status or if illness status influences health status when health is viewed from a nursing perspective. Knowing the links between behavior and relevant health and illness outcomes will facilitate identification and movement toward goals of improved health and may account for intervention failure.
Adaptation, Psychological↗
Culture and gender diversity in commonsense beliefs about the causes of six illnesses.
One hundred seventy-eight subjects attributed a variety of causes to six illnesses/diseases: AIDS, the common cold, diabetes, hypertension, lung cancer, and headaches. Factor analysis of these causal attributions yielded four factors which were more complex than those in the existing literature. Each of the six illnesses was seen as caused by different factors. Ethnic and gender differences in causal attributions also were assessed. Although there were no differences between minorities and whites in the perceived causes of the six illnesses, a number of gender differences did emerge. Women were more likely than men to view illness as caused by Sin and Sex and as a form of punishment. Results are discussed in terms of their implications for ethnic and gender differences in health behavior, health service utilization, and somatic symptoms, and suggestions for future research are offered.
Adult↗
Health education needs of adolescents with congenital heart disease.
Self-concept, health beliefs, health behaviors, health information sources, and perceived health information needs were assessed in 90 patients with congenital heart disease and 54 peers without chronic illness, ages 13 to 22 years. Data revealed that patients with congenital heart disease did not differ from their healthy counterparts in overall self-concept, health beliefs, use of preventive health services, and sources of health information. Patients with congenital heart disease reported greater perceived stress in comparison to peers. Significantly more patients with heart disease needed information regarding pregnancy and contraception, and older cardiac subjects were less likely to be sexually active. For these patients who currently seem to rely largely on peers for some critical health information, sensitive and comprehensive counseling by health professionals is imperative.
Adolescent↗