Health Communication Interventions Research Articles

A comparison of selected evidence reviews and recommendations on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries

Medical Subject Headings (MeSH): cariostatic agents, community dentistry, community health planning, community health services, decision making, dental caries, evidencebased medicine, facial injuries, fluoridation, intervention studies, meta-analysis, mouth protectors, oral health, pharyngeal neoplasms, pit and fissure sealants, practice guidelines, preventive dentistry, preventive health services, public health dentistry, public health practice, review literature, tooth injuries

Assessing Health in Our Rural Communities

Recent years have seen rising interest in the health of defined populations. This interest has been fueled, in part, by the growth of managed care organizations, which require health care professionals to provide high quality, comprehensive care to a specified population of individuals. Operating on the assumption that it is less costly in the long run to prevent disease or to treat it at an early stage rather than as an established condition, these organizations have encouraged proactive health assessment and implementation of preventive care. And the public health system, of course, has for many years been charged with identifying and improving the health and well-being of people in defined geographical areas. But because public health agencies operate under a variety of mandates—to collect vital statistics, monitor the environment, track transmittable diseases, encourage immunizations, etc.—it is difficult for them, with their limited resources, to mount comprehensive community health assessment and intervention programs. Furthermore, communities themselves want to have a voice and a leading role in developing local health initiatives. Community citizens often have different health priorities, even a different definition of “health,” from health professionals or institutions who may not share their cultural context. Organized segments of the community—senior citizen groups, civic clubs, religious organizations, businesses—have opinions to offer about the health of their communities. We 1 and others 2-4 have described the bringing together of disparate people and organizations into functioning part

Promoting gun trigger-lock use: insights and implications from a radio-based health communication intervention

A radio public service announcement (PSA) focusing on the danger to children from an unlocked and loaded gun was designed and aired 340 times on three radio stations in one Michigan county. At the end of the message, individuals were given a toll-free number to call to receive a free gun trigger-lock. Three surveys were used to assess the effectiveness of this intervention: a general population telephone survey, an automated telephone survey, and a follow-up mail survey. Approximately 20 percent of individuals in the general population heard the PSA. There was a significant increase in uncued knowledge of the locking-related gun-safety practices in the treatment county between time one and time two. Further, individuals in both counties had very high levels of self-efficacy and response efficacy, moderate levels of perceived severity, and very low levels of perceived susceptibility at both points in time. Seven-hundred and ninety-nine individuals called the toll-free number to receive a free gun trigger-lock; or approximately 17 percent of gun-owning households exposed to the message. The majority of callers were males who owned guns primarily for hunting purposes and who planned to use the lock themselves. Follow-up survey results indicated that individuals were using the gun trigger-locks, and that they believed using gun trigger-locks was an easy and effective way to prevent gun injuries. Insights and practical implications of these findings are discussed.

Report from a symposium on health communication to promote healthy lifestyles for the prevention of cancer (United States).

On 25 January 2002, the Harvard Center for Cancer Prevention and the Health Communication Core and Risk Reduction Program of the Dana-Farber/Harvard Cancer Center co-sponsored a symposium in Boston, MA, on the use of health communication to more effectively promote healthy lifestyles for the prevention of cancer. The purpose of the symposium was to discuss past research developments in this area, and to identify practical steps for improving health communication strategies. Speakers presented some of the successes and considerations in implementating health communication interventions, and were followed by a set of panelists from the media, clinical, research, and public health communities who provided their perspectives. During the latter part of the symposium, symposium participants conceived of potential methods for integrating the areas of health communication research, policy, and practice to promote sustained healthy lifestyles.

A nursing model of community organization for change.

Community health nursing has the potential to reach beyond the individual and create interventions that affect the community as a whole. The Nursing Model of Community Organization for Change presented in this article describes the relationships among the concepts of empowerment, partnership, participation, cultural responsiveness, and community competence within a community organizing context. These concepts are implemented through the use of the Nursing Model of Community Organization for Change, which consists of four phases: assessment/reassessment, planning/design, implementation, and evaluation/dissemination. This nursing model provides a theoretical framework for community health professionals when creating community health interventions in partnership with community members.

A Multicomponent Program for Nutrition and Physical Activity Change in Primary Care

Most adolescents do not meet national recommendations for nutrition and physical activity. However, no studies of physical activity and nutrition interventions for adolescents conducted in health care settings have been published. The present study was an initial evaluation of the PACE+ (Patient-centered Assessment and Counseling for Exercise plus Nutrition) program, delivered in primary care settings. Adolescents aged 11 to 18 years (N = 117) were recruited from 4 pediatric and adolescent medicine outpatient clinics. Participants' mean (SD) age was 14.1 (2.0) years, 37% were girls, and 43% were ethnic minorities. Behavioral targets were moderate physical activity, vigorous physical activity, fat intake, and fruit and vegetable intake. All patients completed a computerized assessment, created tailored action plans to change behavior, and discussed the plans with their health care provider. Patients were then randomly assigned to receive no further contact or 1 of 3 extended interventions: mail only, infrequent telephone and mail, or frequent telephone and mail. Brief, validated, self-report measures of target behaviors were collected at baseline and 4 months later. All outcomes except vigorous physical activity improved over time, but adolescents who received the extended interventions did not have better 4-month outcomes than those who received only the computer and provider counseling components. Adolescents who targeted a behavior tended to improve more than those who did not target the behavior, except for those who targeted vigorous physical activity. A primary care-based interactive health communication intervention to improve physical activity and dietary behaviors among adolescents is feasible. Controlled experimental research is needed to determine whether this intervention is efficacious in changing behaviors in the short- and long-term.

Offender and Offense Characteristics of a Nonrandom Sample of Adolescent Mass Murderers

The authors conducted a descriptive, archival study of adolescent (< or =19 years of age) mass murderers-subjects who intentionally killed three or more victims in one event-to identify demographic, clinical, and forensic characteristics. A nonrandom sample of convenience of adolescent mass murderers was utilized. Thirty-four subjects, acting alone or in pairs, committed 27 mass murders between 1958 and 1999. The sample consisted of males with a median age of 17. A majority were described as "loners" and abused alcohol or drugs; almost half were bullied by others, preoccupied with violent fantasy, and violent by history. Although 23% had a documented psychiatric history, only 6% were judged to have been psychotic at the time of the mass murder. Depressive symptoms and historical antisocial behaviors were predominant. There was a precipitating event in most cases--usually a perceived failure in love or school--and most subjects made threatening statements regarding the mass murder to third parties. The majority of the sample clustered into three types: the family annihilator, the classroom avenger, and the criminal opportunist. The adolescent mass murderer is often predatorily rather than affectively violent and typically does not show any sudden or highly emotional warning signs. Although the act of mass murder is virtually impossible to predict because of its extremely low frequency, certain clinical and forensic findings can alert the clinician to the need for further, intensified primary care, including family, school, community, law enforcement, and mental health intervention.

Population-Based Prevention of Eating Disorders: An Application of the Rose Prevention Model

Background. Several decades of concerted research on eating disorders have generated a broad range of proposed causal influences, but much of this etiologic research does not elucidate practical avenues for preventive interventions. Translating etiologic theory into community health interventions depends on the identification of key leverage points, factors that are amenable to public health intervention and provide an opportunity to maximize impact on the outcome of interest. Population-based preventive strategies, elaborated by epidemiologist Geoffrey Rose, can maximize the impact of public health interventions. In the case of eating disorders, Rose's model is instructive: Dieting stands out as risk behavior that may both fit Rose's model well and be a key leverage point for preventive intervention.Methods. Grounded in Rose's work, this article lodges a theoretical argument for the population-based prevention of eating disorders. In the introductory section, existing research on the epidemiology of dieting is reviewed, showing that it is extremely common among adolescent girls and women and that the behavior has been implicated as a causal factor for disordered eating. Next, new evidence is offered to build a case for how a population-wide reduction in dieting may be an effective strategy for prevention of eating pathology. Finally Rose's prevention framework is used to introduce a unique and provocative perspective on the prevention of eating disorders.Results. Dieting is a normative behavior in our culture with psychological and physiological effects in the causal chain leading to eating pathology. This behavior may represent an ideal target for population-based prevention.Conclusions. Theoretical and empirical evidence suggests that a population-wide reduction in dieting may be a justifiable and effective strategy for prevention of eating pathology.

Public health communication interventions: values and ethical dilemmas

Introduction Values in Public Health Communication Interventions Beyond a Strategic Approach Justifications 'They Are Always There' Values in Intervention Facets Even When They Apply the Same Justifications, Interventions Are Not the Same The Personal Responsibility Typology Analyses of Intervention Types Community Involvement Ethical Dilemmas and Practice-Oriented Questions Toward a Normative Approach

Audience construction and AIDS education efforts: Exploring communication assumptions of public health interventions

Anderson's (1996) notion of an analytic audience offers a fruitful organizing concept for discourse analysis regarding health communication interventions. An analytic audience in this context might be conceived as an entity produced by health practitioners as they describe intervention development. In order to illustrate this idea, the present paper briefly explores examples of discourse on educational efforts related to AIDS. Analysis in this vein might suggest implications regarding the relationships between health organizations and the individuals they ostensibly serve through interventions that may not be obvious from other perspectives. In so far as such realizations are worthwhile, such analysis is not idle perusal of arcane documents but rather is vital work for public health researchers. Moreover, focusing on discourse concerning constructed audiences is one way to approach the current lack of reflexive inquiry among public health researchers.

Distance education for health centre staff in rural Japan.

We have evaluated a course delivered by videoconferencing to rural health centre staff in Hokkaido. The course focused on the planning and evaluation of community health interventions. It included four 90 min sessions and two follow-up sessions. Fourteen professional staff members (public health nurses, nutritionists and dental assistants) attended each class. Knowledge of community health-care planning and evaluation was higher at post-education testing than pre-education testing. Ratings for 'using a computer', 'using some computer software', 'using the Internet' and 'interest in telehealth' increased significantly in post-education testing compared with pre-education testing. The course had an additional benefit in increasing the collaboration between community health workers and university staff.

The Ability of the AIDS Quilt to Motivate Information Seeking, Personal Discussion, and Preventative Behavior as a Health Communication Intervention

A Solomon 4-group-design-style field experiment examined the ability of the NAMES Project Foundation's AIDS Memorial Quilt (AIDS Quilt) to motivate information seeking, personal discussion, and behavioral outcomes among those who viewed it. Results indicate that the AIDS Quilt intervention explained significant differences in information-seeking motivations and information-seeking behavior. Information-seeking motivation positively predicted actual information-seeking behavior, which in turn predicted increased discussion and decreased risky behavior. Information-seeking motivation in itself did not predict discussion or behavior. The results suggest that campaigns designed primarily to increase information-seeking motivation can result in desired behavioral outcomes.

Nontraditional Services Provided by Nonprofit and For-profit Hospitals: Implications for Community Health

In part because of reimbursement changes in the 1980s, hospitals became involved in health promotion and disease prevention activities often to attract patients. Today, these services may have an effect on the burden of disease and on illness prevention in some communities. Given the changes anticipated in healthcare delivery, assessing the scope of these services and integrating them with other private-public efforts is of utmost importance. Here we use a 1993 survey of all 4,977 private medical and surgical hospitals in the United States to determine the scope of disease prevention, health enhancement, and palliative services provided by facility type, geographic location, and institutional ownership. We found that church-operated and other nonprofit hospitals appear to provide a spectrum of palliative and preventive health services both for their patients and those in the local community. Given their apparent scope, these services could have an effect on the burden of disease and on illness prevention in many communities. With major changes anticipated in future healthcare delivery and the recent failures reported for many community health intervention programs, healthcare administrators need to focus on ways to integrate their services with other private and public health efforts. If this could be achieved, then private hospitals could be more successful in serving their local communities and in enhancing the public's health in the new century. This article outlines several basic steps to assist administrators in achieving these goals.

Augmenting cognitive learning of community nutrition by tutorials.

Community health interventions are increasingly being considered a priority area in medical curriculum. In the topic of nutrition, a situation analysis of final MBBS students in our institution revealed significantly lower levels of knowledge in community applications as compared to basics and clinical aspects, indicating the need for some educational intervention. An improvised tutorial was conducted to address this deficiency at cognitive level. The intervention was a special scheme of flow of discussion with a positive bias in favour of nutritional applications at community level. Half of the learners were given routine tutorial, as part of existing teaching schedule in nutrition and the remaining were subjected to educational intervention, to provide control and study groups respectively. Before and after assessment of the recall of learners on community applications demonstrated a positive impact of improvised tutorial. The learners' level of knowledge in two groups was comparable before the tutorial but it was significantly higher ('P' < 0.001) in study group as compared to control, after the tutorial (mean scores: 134.38/150 and 91.20/150 respectively). No extra resources, tutor time or student's learning hours were needed for the improvised tutorial. Tutor's positive bias in favour of applied aspects can bring about a desired change even in conventional teaching-learning process, without asking for extra resources. It can be a supplement to community-based learning.

Conducting a participatory community-based survey for a community health intervention on Detroit's east side.

This article describes a participatory action research process that brought together community members, representatives from community-based organizations and service providers, and academic researchers to collect, interpret, and apply community information to address issues related to the health of women and children in a geographically defined urban area. It describes the development and administration of a community-based survey designed to inform an intervention research project; discusses the establishment of a community/research partnership and issues that the partnership confronted in the process of developing and administering the survey; and examines the contributions of participants, and implications for research and collective action.

Social support as conversation: Analysing breast cancer patients' interactions with their partners

This paper demonstrates an alternative approach to studying the process of social support in close relationships by examining three tape-recorded conversations between breast cancer patients and their partners. We argue that existing research fails to take account of the “social” aspects of social support, and that new methods, sensitive to the complexities of human interaction, are needed. One promising method, tape-assisted recall (in which an audiotape of an interaction is played back to participants), allows researchers to examine the help-intended communication within a dyad as well as each participant's view of that communication. The conversations of the three couples and the participants' moment-by-moment perceptions of these conversations illustrate the complexities of help-intended communication. The commentaries in the tape-assisted recall sessions yielded insights into the interactions that were not always apparent on the surface: the personal meanings of the interactions, in the context of the couple's relationship, were necessary for understanding how support attempts are delivered effectively and why they sometimes fail. The strengths and limitations of the method for the study of social support are discussed. Implications for community health interventions to optimize support for couples coping with illness are also addressed.

Beyond Strategic Research: A Value-Centered Approach to Health Communication Interventions

Research on health communication interventions tends to focus on achieving the intervention sponsor's goals. Thus, it can be characterized as strategic. Client and sponsor values, though recognized as important by researchers who adopt this approach, tend to be treated as independent variables that might serve as barriers to behavior change goals, or as dependent variables that can be manipulated to achieve those goals. This paper adopts the proposition that values have a pivotal role in the analysis and design of health communication interventions and that analyses that focus on values embedded in the intervention process can contribute to theory development. Instead of focusing exclusively on health-related objectives, the paper proposes that analyses can also examine the extent to which certain values might have contributed to both problem definition and intervention strategies. The rationale for focusing on values, distinctions between a strategic and a value-centered approach, and the importance of ethical issues in the analysis of health communication interventions are presented through a series of eight propositions. The propositions address six main areas: (a) the locus of analysis, (b) definition of the problem, (c) values, (d) intervention strategies and behavior change models, (e) program evaluation, and (f) ethical concerns.

Ethical Dilemmas in Health Campaigns

The design, implementation and evaluation of health campaigns involve inherent ethical concerns and dilemmas. Many of these concerns, however, are often invisible. This article presents 13 dilemmas related to 4 specific areas: (a) strategies and content of health communication campaign messages, (b) inadvertent adverse outcomes from campaign activities, (c) power and control, and (d) social values. Examples to illustrate these ethical dilemmas draw from the literature and from a study of 2 national and 3 community-based health communication interventions. The 13 ethical dilem- mas are summarized as a series of practice-oriented questions to help scholars, practitioners and the those who are targeted by the campaign to identify and articulate ethical concerns embedded in health campaigns.

Values and justifications in health communication interventions: an analytic framework.

A conceptual framework for analyzing health communication interventions is presented as a systematic approach to identify values and justifications embedded in major facets of the communication intervention: the definition of the problem, the strategies adopted, the intervention stakeholders or its targeted populations, and the evaluation of the program. Although values and ethical concerns are embedded in all facets of health communication interventions, they are often left unexamined, or are taken for granted by practitioners and intervention populations (policy makers and the researchers who analyze, evaluate, or help design and implement them). The development, adaptation, and application of this framework can serve three inter-related purposes: (1) to provide constructs and a systematic approach to examine the design and implementation of interventions from a normative perspective, (2) to contribute to a theoretical perspective on health interventions as a social change phenomenon, and (3) to provide additional criteria for program evaluation and policy-making.

Early Identification and Intervention: Primary Health Care in the Nineties

Sunbury Community Health Centre's Early Identification and Intervention Program is comprehensive. The Centre has a broad range of identification initiatives which assess for early physical changes in an individual's health, as well as recognising the social and emotional causes of ill health. The Centre has undertaken early identification activities for groups in the community at risk of health problems, has identified environmental hazards and, where possible, taken appropriate action. The Centre has made links with other community agencies which participate in and support the comprehensive Early Identification and Intervention Program.