Health Promotion Counseling Research Articles

Physicians' health practices strongly influence patient health practices.

Physicians' health practices strongly influence patient health practices.

Do Overweight Adolescents Perceive the Need to Reduce Weight and Take Healthy Actions?

Studies indicate that weight perception among adolescents is associated with weight control, certain risky behaviors, and mental health. The aims of this study were to explore the perception of body size among overweight adolescents and to determine whether they consider it necessary to adjust weight and adopt healthier life habits and associated health-promoting behaviors. A cross-sectional descriptive design was used to investigate a convenience sample of 217 overweight adolescents(mean body mass index = 27.01 kg/m2, SD = 3.44 kg/m2) in the Taoyuan County, Taiwan, between January 2005 and December 2006. Results showed that 93% (202/217) of participants perceived a need to adjust weight. However, only 59.9% (121/202) took weight-reducing action. Of those who took action, only 32.2% (39/121) employed "healthy" methods (including healthier eating and greater exercise), with 28.1% (34/121) focusing on exercise only and 20.7% concentrating on altering eating behavior only. The remaining 19% chose alternative strategies, such as restricting their diet, skipping breakfast, or taking herbs. Adolescents who perceived it necessary to adjust their weight and take appropriate action had higher scores on health promotion practices than those of adolescents who did not. This study provides valuable insight, showing that overweight adolescents, although eager to lose weight, are likely to choose unhealthy methods. School and family health promotion counseling may help encourage overweight adolescents to adopt more healthy habits.

Description of Clinical Risk Factor Changes During Naturopathic Care for Type 2 Diabetes

Survey findings report that 48% of people with type 2 diabetes use complementary and alternative medicine (CAM) practice. Publications suggest a high incidence of health promotion counseling in naturopathic practice, yet clinical data on risk factor changes are not available in the literature. The primary aim of this study was to describe clinical risk factor changes during the utilization of naturopathic CAM services in patients with type 2 diabetes. A retrospective, observational study design was used to describe naturopathic care. Abstracted medical charts were from patients of the Bastyr Center for Natural Health in Seattle, WA. The patients in this study had type 2 diabetes and received naturopathic care between 2001 and 2006. Abstracted data included patient demographics, duration of care, number of visits, laboratory values for hemoglobin A1c (HbA1c), low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol, triglycerides (TAG); and systolic/diastolic blood pressure (SPB, DBP). Thirty-seven (37) patient records met inclusion criteria and were abstracted in detail. Mean and median duration of care were 27 and 20 months, respectively. The mean number of visits was 11. Significant mean changes in clinical laboratory risk factors over the duration of care were: -0.65% for HbA1c (p = 0.046), -45 mg/dL for TAG (p = 0.037), -7 mm Hg in SBP (p = 0.02), and -5 mm Hg in DBP (p = 0.003). Mean changes for cholesterol did not reach statistical significance. The percentage of patients who reached new control, had clinically significant risk factor improvements, or had any improvement was: 26%, 42%, and 68% for HbA1c, 7%, 28%, and 62% for LDL, 0%, 25%, and 39% for HDL, 14%, 38%, and 52% for TAG, 16%, 51%, and 86% for SBP, and 27%, 54%, and 70% for DBP. COMMENTS/CONCLUSIONS: These preliminary outcomes suggest that risk factor improvements occur during naturopathic care for diabetes, although the contribution of naturopathic care to these changes cannot be determined. Effectiveness and generalizability of naturopathic approaches in treating type 2 diabetes should be evaluated in controlled prospective studies in representative populations or randomized trials.

Message framing: A communication strategy for the medical encounter

As the focus of medicine has changed from acute to chronic care, prevention and health promotion counselling has become increasingly important for healthcare providers and their patients. Research has shown that patients want and value such health education and counselling from their healthcare professionals, but still may not comply with such recommendations. Further, health professionals may not feel adequately trained in health behaviour counselling and/or may feel constrained in spending time on such issues within the brief context of the medical encounter. Health communication offers useful strategies, through persuasion theory, that may assist health professionals in addressing counselling within the medical encounter to optimal effect. This paper will present one typology for addressing both prevention and detection behaviours in the health context through message framing. The theoretical basis for framing, as well as practical applications and tips for implementation within the healthcare context, will be presented and explored.

Message framing: A communication strategy for the medical encounter

As the focus of medicine has changed from acute to chronic care, prevention and health promotion counselling has become increasingly important for healthcare providers and their patients. Research has shown that patients want and value such health education and counselling from their healthcare professionals, but still may not comply with such recommendations. Further, health professionals may not feel adequately trained in health behaviour counselling and/or may feel constrained in spending time on such issues within the brief context of the medical encounter. Health communication offers useful strategies, through persuasion theory, that may assist health professionals in addressing counselling within the medical encounter to optimal effect. This paper will present one typology for addressing both prevention and detection behaviours in the health context through message framing. The theoretical basis for framing, as well as practical applications and tips for implementation within the healthcare context, will be presented and explored.

Ensuring Quality Care for Cancer Survivors: Implementing the Survivorship Care Plan

To review emerging strategies to improve upon the coordination of care for cancer survivors through the adoption and promotion of cancer treatment summaries and survivorship care plans. Special attention is focused on the needs of childhood cancer survivors. Reports from the Institute of Medicine and the President's Cancer Panel, and work being performed by several professional societies. Cancer care is poorly coordinated during and after treatment. The growing number of cancer survivors demands innovative strategies to improve the quality and coordination of post-cancer patient care. Nurses play an important role in the implementation and delivery of treatment summaries and survivorship care plans. Incorporation of cancer prevention and health promotion counseling is a natural activity for nurses as the health care system focuses on improving care for cancer survivors.

Health-Promoting Behavior of Adolescents with Congenital Heart Disease

Purpose To evaluate and compare the health-promoting behavior of adolescents with congenital heart disease (CHD) to that of adolescents without CHD. Methods Cross-sectional data were collected from pediatric cardiology outpatient departments at two medical centers in Taiwan. A total of 1209 adolescents, including 316 with various forms of CHD and 893 without CHD, completed the Adolescent Health Promotion (AHP) scale. Of those with CHD, 162 were female, and 12–18 years old. The scores of adolescents with CHD were compared with published normative adolescent data. Results No significant differences were found between those adolescents with CHD and those without in terms of dimensions of the AHP, which consisted of nutrition, social support, health responsibility, life appreciation, exercise, stress management, and overall health-promoting behavior. The three highest and lowest mean scores of scale items between these two groups were identified. Factors among adolescents with CHD, such as age, gender, parental educational level, and cardiac function were significantly associated with at least one dimension of the AHP. Such significant associations were not indicated when comparing body mass index, medical diagnoses, and whether they had undergone heart surgery. Conclusions Adolescents with CHD practice health-promoting behavior similar to that of their counterparts without CHD. Health-promotion counseling for adolescents with CHD should be encouraged to improve lifestyle habits, especially to ensure that they engage in adequate and vigorous exercise and practice good dental hygiene.

Determinants of Physician Discussion Regarding Tobacco and Alcohol Abuse

The U.S. Preventive Services Task Force recommends that clinicians screen adults for tobacco and alcohol abuse and provide appropriate interventions. This study employed direct observation and interactional analysis of medical visits to investigate factors associated with physician discussion of tobacco and alcohol use with patients. New adult patients were randomly assigned to primary care at a university medical center. Videotapes of the visits were analyzed using the Davis observation code. Regression equations related discussions of substance use (alcohol and other substances), smoking, and health promotion to patient health status, depression, age, education, income, gender, alcohol abuse, and current smoking. Patients reporting better physical health were more likely to have their physicians employ a practice style emphasizing addiction behaviors (p = .0186). Substance use (p = .0117) and health promotion counseling (p = .0130) occurred more frequently with younger patients. Physicians discussed substance use (p = < .0001) and addiction (p < .0001) more often with male patients. Problem drinkers were more likely to have physicians address their substance use (p = .0069) and focus on addiction behaviors (p = .0017). Physicians adopted an addiction-oriented practice style (p < .0001), addressing substance use (p = .0009) and smoking (p < .0001), more often with patients who smoked. Physicians appear more apt to discuss these behavioral risk factors with healthier, younger, male patients who abuse tobacco and alcohol.

Health promoting attitudes and behaviors of emergency physicians

The purpose of this paper is to report on gender differences in emergency physicians with respect to their attitudes, knowledge, and practices concerning health promotion and disease prevention. A mail survey of 325 male and 97 female Canadian emergency physicians. Results suggest female emergency physicians report having greater knowledge of health promotion topics, spend more time with each of their patients in the emergency setting, and engage in more health promotion counseling in the emergency setting than do their male counterparts. The paper argues that in the future, educating and socializing emergency physicians, both male and female, in the practice of health promotion will enhance the potential of the emergency department to be a more effective resource for their community.

Proyecto de acción interdisciplinaria en salud (PAIS): un modelo de atención centrado en el hogar hace la diferencia

To propose an interdisciplinary approach in Community Health through a model based on Home Health Care. A prospective study programmed in two periods: a cross sectional study for data collection followed by home assistance for the health problems detected. 100 families (570 inhabitants) were randomly submitted to a clinical, nutritional and laboratory examination in order to detect major health problems. Afterwards the same professional team took care of 10 families in health promotion counseling and illness treatment. This study shows that 84% of the patients in whom a health abnormality was detected were not aware of their illness. The population was mainly affected by hypertension, hypercholesterolemia, hypertrigliceridemia, and anemia. None of these problems were listed as the main causes of consultation in a local center belonging to the traditional health services. Almost 70% of the inhabitants consumed a daily diet with less nutrients and calories than recommended. The project included health care for all family members and free drugs provision for all illnesses detected. Ninety-eight percent of patients had a proper and continuous follow up of their illness for a 3 year period, compared with a 31% follow up provided by the traditional health care organization. This work shows an integrated effort by the University, health centers, and all health care disciplines to propose an alternative program that personalizes attention and moves health care from Institutions to people's own homes. This model improved community health conditions, had a high impact on illness follow up and increased health care accessibility.

Disparities in primary care for vulnerable children: the influence of multiple risk factors.

To analyze vulnerability as a profile of multiple risk factors for poor pediatric care based on race/ethnicity, poverty status, parent education, insurance, and language. Profiles are used to examine disparities in child/adolescent health status and primary care experience. Cross-sectional data on 19,485 children/adolescents 0-19 years of age from the 2001 California Health Interview Survey. Multiple logistic regression models are used to examine risk profiles in relation to health status and three aspects of primary care: access (physician and dental visit; access surety), continuity (regular source of care), and comprehensiveness (i.e., health promotion counseling). About 43 percent of (or 4.4 million) children in California have two or more risk factors (RF). Controlling for age and gender, more RFs is associated with poorer health status (i.e. percent reporting "excellent/very good" health: no RFs=81 percent, 1=71 percent, 2=57 percent, 3=45 percent, 4=35 percent, 5=28 percent, all p<.001). Controlling for health status, higher risk profiles is associated with poorer primary care access and continuity, but greater comprehensiveness of care. For example, higher risk profile children are less likely to have a regular source of care: one RF (prevalence ratio [PR]=0.92, confidence interval [CI]: 0.86-0.98), two (PR=0.77, CI: 0.69-0.84), three (PR=0.55, CI: 0.46-0.65), and four or more (PR=0.31, CI: 0.22-0.44), all p<.001. This study demonstrates a dose-response relationship of higher risk profiles with poorer child health status, access to, and continuity of primary care. Having gained access, however, adolescents with higher risk profiles are more likely to receive health promotion counseling. Higher profiles appear to be associated with greater barriers to accessing primary care for children in "fair or poor" health, suggesting that vulnerable children who have the greatest health care needs also have the greatest difficulty obtaining primary care.

Comparison of health-promoting behavior between Taiwanese and American adolescents: A cross-sectional questionnaire survey

Objectives The main aim of this study was to compare the health promotion practices of Taiwanese ( n = 2 6 5 ) and American ( n = 2 8 5 ) adolescents, using the revised Adolescent Health Promoting scale. Methods A comparative and descriptive design was used. Categorical data analysis was applied to explore the association of culture differences and adolescent health-promoting behaviors. Results Findings indicated significant differences between Taiwanese and American adolescents in some demographic characteristics: American participants had higher self-perceived health status ( p < 0.0 0 1 ), parental educational level ( p < 0.0 0 1 ), overweight percentage ( p < 0.0 0 1 ), and rate of living only with the mother ( p < 0.0 0 1 ) than the Taiwanese participants. Taiwanese adolescents had a higher frequency of health-promoting behavior than Americans in terms of healthy diet behavior, stress management, health responsibility, and social support ( p < 0.0 1 ), but less frequently engaged in exercise and life appreciation ( p < 0.0 0 1 ). Because many of the demographic characteristics between the two countries, such as the parent's educational level, differ significantly, a comparison can be difficult. However, healthy behavior is an important measure of demand for preventive health services. Conclusions The findings should sound an alarm for all public health professionals to take heed of what is happening to our youth based on culture differences. School and family health promotion counseling should be encouraged for adolescents to improve their lifestyle habits. Based on the findings, school health promotion programs should focus on factors for which there may be significant local ethnic differences. For the locales in this study, Taiwanese adolescents need encouragement to improve their exercise and life appreciation behaviors. For American adolescents, healthy diet, stress management, health responsibility, and social support should be emphasized.

Tooth Loss and Heart Disease: Findings from the Behavioral Risk Factor Surveillance System

The purpose of this study was to examine the association between tooth loss and heart disease. Data were analyzed from the 1999 to 2002 Behavioral Risk Factor Surveillance System, an ongoing telephone survey operated by state health agencies with assistance from the Centers for Disease Control and Prevention. The study was conducted based on 41,891 adults aged 40 to 79 years old in 22 states and the District of Columbia. A significant association was observed between the extent of tooth loss and heart disease prevalence. After adjustment for age, gender, race/ethnicity, education, and marital status, respondents who had 1 to 5 missing teeth, 6 to 31 missing teeth, or were edentulous were significantly more likely than those without tooth loss to have heart disease (adjusted prevalence: 6.8%, 10.2%, and 11.5%, respectively, vs. 5.3%; p<0.001). These associations persisted after further adjustment for smoking status, diabetes, alcohol consumption, hypertension, hypercholesterolemia, and body mass index (5.7%, 7.5%, and 8.5%, respectively, vs. 4.7%; p<0.05); and after stratification by age group (40 to 59 years and 60 to 79 years) and smoking status (ever smoked and never smoked). Tooth loss is associated in a consistent and graded fashion with the self-reported prevalence of heart disease. Health promotion counseling should include the prevention and control of cardiovascular disease risk factors and the maintenance of good oral health.

Considering the Factors of Gender and Body Weight in the Promotion of Healthy Behavior Among Adolescents

Obesity among adolescents is increasing in both developed and developing countries. However, previous studies have paid little attention to the roles that gender and body weight variables play in health-related behavior. This article examines the effects of these two variables on health-related behavior in Taiwanese adolescents. A cross-sectional descriptive design was used with three body weight categories (underweight, average and overweight) and two gender categories (female and male). Data were analyzed using descriptive statistics, Student's t test, and one-way ANOVA with Scheffe's post hoc test. The results showed that average weight adolescents scored significantly higher than their overweight peers in the three dimensions of social support, health responsibility, and exercise behavior. Average weight adolescents also scored higher than the underweight group in the dimension of health responsibility. Girls scored significantly better than boys in five out of the total six health-related behavior - scoring lower only in the exercise dimension. These findings should sound an alarm for all public health professionals to take heed to what is happening to our youth. School and family health promotion counseling should be encouraged for overweight adolescents to improve their exercise and lifestyle habits. Based on the findings, school health promotion programs should focus on gender differences. Girls, in particular, need encouragement to improve their exercise habits.

The Experiences of Overweight Female Adolescents After Health Promotion Counseling

The experiences of female overweight adolescents undergoing weight reduction are rarely reported. There is a paucity of studies using qualitative methodology to evaluate weight-reduction experiences. The aim of this study was to understand the main themes of the experiences of overweight female adolescents undergoing weight reduction after receiving school based health promotion counseling. Qualitative design was adopted and seven focus group discussions were conducted. On the basis of the qualitative method, the data were subjected to content analysis by means of the constant comparison method. A total of 30 female participants studying in a junior college of nursing were recruited in this study. All of them had been overweight or obese throughout the past four years. The findings revealed four themes of weight reduction experiences: living with changes; aspire vs. retreat; sense of alienation; support is a motivator. The outcomes of this study support the value of health promotion counseling conducted at school-based settings. It also provides references for health professionals promoting healthy ways of life.

The Experiences of Overweight Female Adolescents After Health Promotion Counseling

The experiences of female overweight adolescents undergoing weight reduction are rarely reported. There is a paucity of studies using qualitative methodology to evaluate weight-reduction experiences. The aim of this study was to understand the main themes of the experiences of overweight female adolescents undergoing weight reduction after receiving school based health promotion counseling. Qualitative design was adopted and seven focus group discussions were conducted. On the basis of the qualitative method, the data were subjected to content analysis by means of the constant comparison method. A total of 30 female participants studying in a junior college of nursing were recruited in this study. All of them had been overweight or obese throughout the past four years. The findings revealed four themes of weight reduction experiences: living with changes; aspire vs. retreat; sense of alienation; support is a motivator. The outcomes of this study support the value of health promotion counseling conducted at school-based settings. It also provides references for health professionals promoting healthy ways of life.

More than heights and weights: what parents of urban adolescents want from health care providers

Abstract To examine health care providers' expected role in health promotion counseling to urban adolescents from the perspective of parents. Although participating parents wanted health care providers to counsel their adolescents on sensitive health issues, their desires and expectations were rarely met.

More than heights and weights: what parents of urban adolescents want from health care providers

Abstract To examine health care providers' expected role in health promotion counseling to urban adolescents from the perspective of parents. Although participating parents wanted health care providers to counsel their adolescents on sensitive health issues, their desires and expectations were rarely met.

Alcohol counseling as part of general wellness counseling.

Healthcare providers, and nurses in particular, are increasingly being called upon for health promotion counseling. Alcohol risk assessment is often included in general health screening questionnaires, but often little use is made of this information. Alcohol consumption is infrequently included as a focus of health promotion campaigns. Because alcohol intake influences many other health risks, it is logical and practical to include alcohol risk reduction in general wellness counseling. This article presents evidence that incorporating alcohol counseling lowers alcohol risk and lowers the risk of other chronic diseases. It also provides examples of ways nurses and other health professionals can discuss alcohol risk reduction in the context of general health, thus helping remove the stigma associated with alcohol risk and engage clients in efforts to lower their alcohol risk.

A vision for older adults and health promotion.

Our rapidly aging population is expected to place heavy demands on all segments of society, particularly the health care resources needed to attend to health concerns associated with aging. Is this a looming crisis, as some predict, or a challenge to use resources more wisely and to help older adults and their caregivers share in the responsibility for health promotion and chronic disease self-management activities? Community-based organizations serving older adults are uniquely positioned to augment health care providers' health promotion counseling activities and to bridge the gap between the research and practice of health promotion in older adults. They already play a crucial role by providing appropriate health promotion education, screening and referral, service planning, and reinforcement to facilitate self-care activities and behavior changes that promote healthy aging. By increasing teamwork across the network of services for the aging, the health sector, public and private organizations, and academe, there is a great opportunity to enhance the health and well-being of all older Americans.